Paediatrics: DOHAD

Question 1

What are the 4 most common non-communicable diseases?

Answer 1

Type 2 Diabetes mellitus

Heart disease

Chronic Obstructive Pulmonary Diseases (COPD)

Cancer

Question 2

What are the big 4 risk factors for non-communicable diseases?

Answer 2

Poor nutrition

Smoking

Alcohol

Physical activity (lack of)

Question 3

What percentage of deaths in underprivileged developing communities are caused by NCDs?

Answer 3

80%

Question 4

What is the most common cause of anaphylaxis outside of the hospital?

Answer 4

Food allergy

Question 5

Why is maternal obesity implicated in the development of NCDs in children they are pregnant with?

Answer 5

Obesity is a chronic inflammatory state.

Early immune dysregulation affects development of many organ systems.

Question 6

How early is baseline CRP potentially programmed?

Answer 6

Before birth

Question 7

Can metabolism be changed by microbiome?

Answer 7

Yes, affects immune system and brain development

Question 8

What factors influence the microbiome?

Answer 8

How a baby is delivered

What we eat

Antibiotic use

Question 9

What factors in health are influenced by microbiome?

Answer 9

In animals changing gut bacteria changes:

Weight gain, brain and immune system development, heart disease, diabetes risk, and longevity.

Question 10

What are the beneficial effects of H. pylori? When are these results achieved?

Answer 10

Stimulates T reg tolerance

Appetite regulation (ghrelin)

When colonized early: Protects from GI pathology and other inflammatory diseases.

When colonized at maturity causes GI pathology and inflammatory diseases.

Timing is everything

Question 11

What were the effects of eradicating H. pylori from a population?

Answer 11

Obesity and insulin resistance

IBD

Autoimmunity

Asthma and atopic disorders

Question 12

What is the simplest and most effective way of changing ‘our’ genes?

Answer 12

By changing diet; this allows us to change our gut microbiome.

Question 13

How early do food taste preferences get influenced?

Answer 13

Before birth

Question 14

How many women drink during pregnancy?

Answer 14

15% excessive in first trimester

10% in 2nd trimester

These numbers are way higher in indigenous populations

Question 15

What are the features of FASD?

Answer 15

Behaviour problems

Speech and language delay

Anxiety delay

ADHD

Learning difficulties

Autistic features

Thin upper lip

Smooth gutter between nose and mouth

Short eye openings

Question 16

What is the most common condition related to alcohol exposure?

Answer 16

Lack of impulse control

Question 17

What are the effects of being born too early?

Answer 17

Links with rising rates of NCDs

Neurological deficits

Obesity risk

CVD risk

Osteoporosis

Question 18

Why is term birth so important?

Answer 18

During this period >1/3 of brain size is increased

5x increase in white matter volume >35 weeks

Question 19

What effect does preschool screentime have on children?

Answer 19

For every hour of DVD watched a preschool child has 8 less words

> 2hr/d 6x risk of language disorder

Reduced working memory / hour screen time

Question 20

What are the recommendations for kids that use electronic devices?

Answer 20

Avoid screen time under 2 years of age

Over 3 - 18 years limit entertainment screen time to 2 hours/day

Keep all electronics out of bedroom

Sit together at meal times

No snacks at computer or playing e games

Parents need to be good role models

Question 21

What is used as a good early predictor of cerebral palsy? What else do they predict?

Answer 21

Absent fidgety movements, they also predict cognitive delay.