The big picture

Question 1

What is the overall trend of obesity prevalence by deprivation decline?

Answer 1

There is a positive correlation seen between the data of those most deprived and least deprived

Question 2

National child measurement programme change in gap

Answer 2

Question 3

Can the epidemic of childhood obesity be tackled by just placing substantial taxes on high sugar products?

Research indicates that a 20% price increase for confectionary (including chocolate), biscuits and cakes would result in falls in obesity around what value…

A. 15%

B. 10%

C. 5%

D. 2.5%

Answer 3

D. 2.5%

Question 4

Why are we losing the war against obesity?

Answer 4

Because we intervene too late

Question 5

For coronary heart disease

What is the trend in the standardised mortality ratios (SMR) between men and women?

Answer 5

Lower birth weight individuals have higher death rate from heart disease

Question 6

Tell me the relationship that has been observed between boys birth rate and their ability to cope in stressful situations

Answer 6

Boys of high birth weight cope well during a stress challenge, but those of lower birth weight have high stress hormone levels and are more anxious

Resilience to environment is set during our early development. This is well established in animal biology. Link to birthweight

Question 7

A poor start in life has lasting effects on multiple organs and control systems in the offspring. What areas does it affect?

Answer 7

• Fat, muscle, and bone
• Heart, lungs, and kidneys
• Metabolic and stress responses
• Mood and behaviour
• Ability to learn and cognitive function
• Timing of puberty, reproductive function
• Immune responses

The effects can be subtly, so they don’t immediately signal danger

But they have lifelong consequences, altering how a person responds to their later environment and lifestyle

Question 8

Impaired early development increases the risk of what?

Answer 8

Obesity and sarcopenia

Osteoporotic bone fractures

Coronary heart disease and type 2 diabetes

Atopic and respiratory disorders including eczema and COPD

Mental ill-health and behavioural disorders

Hormonally related cancers

Question 9

What have experimental studies indicated about effects on early development?

Answer 9

• Maternal undernutrition, obesity and stress and major drivers

Maternal and paternal effects

• Developmental effects act over several generations

Effects past through male gametes from grandfather if they had something

• Epigenetic changes in non-imprinting genes are a key mechanism

Question 10

Developmental epigenetic plasticity

Answer 10

Question 11

During early life, “developmental epigenetic plasticity” enables what?

Answer 11

Predictive adaptive responses, which evolved to tune the phenotype to the anticipated future environment

Question 12

Individuals whose developmentally induced phenotype is “mismatched” to their subsequent environment are at an increased risk of what?

Answer 12

Adult cardiovascular disease, type 2 diabetes and obesity

Question 13

Early nutrition and stress alter development. What does this act through in order to do this?

Answer 13

Act through epigenetic and other processes, and may underlie parental and transgenerational influences on NCD risk

Question 14

How does epigenetics play a role in development?

Answer 14

The development and maintenance of plants and animals is orchestrated by reactions that twitch parts of their DNA on and off at strategic times and locations

Epigenetics is a study of these reactions and the factors that influence them

Plants and animals use epigenetic processes to adapt their development to the environmental experiences in early life

Example is shown below

Question 15

How does epigenetics effect the Meadow vole (Microtus pennsylvanicus)

Answer 15

Maternal photoperiod before conception determines coat thickness in offspring

Question 16

How does epigenetics plat a role in the human genome?

Answer 16

Epigenetics underlies differences between cells

Changes in gene function that do not depend on DNA sequence

Gene expression changed: methylation of CpG sites and chemical changes in the histone proteins alter “packaging” of DNA; non-coding RNAs have a variety of roles that alter gene transcription

CpG sites: The CpG sites or CG sites are regions of DNA where a cytosine nucleotide is followed by a guanine nucleotide in the linear sequence of bases along its 5’ → 3’ direction

Question 17

Effect of genotype and in utero environment on neonatal methylomes (237 singapore infants)

Answer 17

Question 18

Prenatal environment plays a dominant role in birthweight (and later adiposy) Vs. genetic influences (polygenic risk score, PRS)

Answer 18

Question 19

How does a higher birthweight affect the odds for an individual having type 2 diabetes?

Answer 19

Question 20

Men and women born after a famine period contribute an excess of diabetic patients…

Answer 20

Question 21

Not just gestational diabetes, but even normal higher fasting glucose levels increases what?

Answer 21

Birthweight and adiposity

Question 22

Explain and give examples for the developmental overnutrition hypothesis

Answer 22

Question 23

Give some examples for different exposures from Preconception, pregnancy, infants and toddlers that act through specific mechanisms (state these) that can lead to different child obesity and adiposity risk (such as abnormal growth and fat deposition, insulin resistance and disease risk)

Answer 23

Question 24

Greater number of maternal/ early infancy adiposity risk factors- substantially increased risk of child overweight and obesity

Answer 24

Question 25

Epigenetic "marks" in perinatal tissue: strong associations with childhood fat mass and % fta in 2 independent cohorts

Answer 25

Question 26

Low maternal carbohydrate intake in early pregnancy is associated with what?

Answer 26

Higher umbilical cord RXRA gene promotor methylation in the Princess Anne hospital study

Question 27

Perinatal RXRA methylation, maternal 25(OH)D and offspring bone mass: observation to intervention

Answer 27

Question 28

What processes the phenotype from the genome are affected by

Answer 28

Question 29

Foresight "tackling obesities: future choices"

Answer 29

* Considered 17 different potential government policy responses across built, health, fiscal, research, educational, regulatory, social structure, and family domains * The only one with a significant impact on obesity in all three scenario contexts explored was… * **“… to promote/ implement a programme of early interventions at birth or in infancy”** * Since 2007, new evidence suggest that inventions before/during pregnancy may have even greater impact, but foresight still concluded” * **“Intervention in early life generated the highest average impact across all scenarios”** * “Greatest success was achieved in scenarios where a long-term approach prevailed, and where society was prepared to measure success over longer timeframes”

Question 30

Increased adjusted all cause premature mortality in adult offspring of obese mothers (BMI \>30)

Answer 30

Question 31

What results did the UPBEAT: UK better eating and activity trial come out with?

Answer 31

Question 32

What factors are affected with the following: * Preconception * Paternal obesity and undernutrition * Maternal obesity and Overnutrition * Maternal undernutrition * Assissted reproductive treatment (ART)

Answer 32

Question 33

Little evidence that women improve lifestyle pre-pregnancy

Answer 33

Question 34

What are some advices/ guidance that mothers should do preconception and pregnancy nutritional RCT

Answer 34

* Myo-inositol naturally produced in the kidney and by gut bacteria acting on dietary fibres- increased insulin sensitivity (Via phosphatidylinositol), previous RCTs in PCOS * Probiotic blend (L rhamnosis and B animalis sp. Lactis) linked with reduction in GDM * Micronutrients commonly insufficient and linked with offspring adiposity * Taken as a drink twice a day during pre-conception and pregnancy

Question 35

Life lab: science and health literacy for better health in teenagers

Answer 35

* Make health promotion concepts and behaviours culturally relevant and part of child’s environment * Capabilities develop earlier than often thought * Children themselves can become agents of change * Focus not so much on ability to read a health test but on science and health literacy * Can empower vulnerable and marginalised groups

Question 36

6 months after Life lab, students have persisting changes in beliefs about food and health, and have increased preferences for studying science and following healthcare careers

Answer 36

Question 37

Life lab Southampton- science and health literacy

Answer 37

Dedicated teaching programme at the heart of a major teaching hospital enables 4000 students per year to: * Experience for themselves exciting developments in science: focus on understanding how our early lives have effects on our later health * Learn how they can improve their own health and the health of their future children under a framework of ‘Me, my health and my children health’ * Become enthusiastic about science such that they consider further study and careers in science disciplines

Question 38

Why focus on adolescents?

Answer 38

* Known to have poor diet * Adopters of eating innovations * Foundations of adulthood are consolidated * Critical period of development * Begin to make independent choices * Purchasing power + social opportunities * Parents and leaders of tomorrow * Strong interest in planetary health **Multiple dividends if invest in adolescents:** * Them now * Them in the future * Their current families and peer * Their future families * Wider society * The environment

Question 39

**Summary**

Answer 39

**Developmental plasticity, programming, and adult health** * **Animal studies indicate the early life nutrition can alter epigenetic processes, inducing changes in development with major long-term consequences for later body composition and neural function** * **We need to define which exposures alter human growth and development, increased susceptibility to later obesity/ associated NCDs and impairing a child’s ability to learn** * **Epigenetic changes to provide a ‘memory’ of development- as predictors of later responses to environmental challenges they may aid definition of interventions to reduce NCD risk and improve neural development** * **We need further research trials to underpin a new vision of optimal early development, recognising that maternal lifestyle, diet and body composition have important effects on later health and ability to learn that they are of immense societal importance**