Impact of the Environment on Long-Term Health

Question 1

What challenges could the fetus face in utero that might have lasting impact on its health?

Answer 1

Fetal infection in utero
Maternal nutrition
Maternal illness
Maternal stress
Maternal medication
Environmental factors/exposures

Question 2

What are the long-term influences on health and disease?

Answer 2

Biological = genetics and epigenetics

Social and Environmental 
Environment
Family, Neighbourhood, School
Nutrition (maternal and fetal/child)
Social behaviours 
Health provisions

Question 3

What is the Barker Hypothesis?

Answer 3

Involves programming adult health in early life (DOHaD hypothesis). Study found that undernutriton in utero and overnutrition as a child led to increased risk of metabolic syndrome which in turn led to increased risk of metabolic events.

Question 4

What is epigenetics?

Answer 4

Epigenetics: heritable changes in marks on the DNA that do not change the nucleotide sequence but influence how genes are expressed (where, when and how much a gene is switched on or off)

Question 5

How can mechanisms of DOHaD be linked to biology?

Answer 5

Foetal gene expression influenced by maternal health and environment plus foetal access to nutrients (demand vs supply), placental vascular supply and endocrine milieu. Leads to foetal developmental responses like: Altered endo/metabolism, changes in bone, lean and fat mass, altered blood flow/vascular loading, altered immune responses. Adult exposures and amplification in infancy lead to conditions.

Question 6

What are there associations between in terms of environmental exposures and in utero exposures?

Answer 6

Associations between early environmental exposures and:
Cardio-vascular disease
Type 2 diabetes
Lung disease
Cancer risk
Neurological, special sense and intellectual development
Allergic and auto-immune diseases

Question 7

What is the NHS Healthy Child Programme?

Answer 7

Aims to prevent disease and promote good health:

universal and reduces health inequalities.

Question 8

What does the NHS Healthy Child Programme involve?

Answer 8

Health Promotion (Obesity prevention is a key aspect)
Supporting care giving and care givers
Screening
Immunisation
Identification of high-risk families/ individuals for additional support
Signposting - accident prevention, dental hygiene

Question 9

What are the fundamentals of a good screening test?

Answer 9

1. Disease being screened for should be able to be: 
identified early/before critical point
treatable 
prevent/reduce morbidity/mortality 
2. Acceptable/easy to administer
3. Cost effective 
4. Reproducible and accurate results