Wednesday, December 11, 2013

Support mothers to curb the global rise in chronic diseases

By Carol Clark

After decades of studies showing that the chances of a person having a chronic disease in later life can be determined when they are in the womb, it is time to take stronger action, say researchers from Emory University and the University of Southampton in the current issue of Nature.

Rather than primarily focusing on people’s genes, or on their diets and lifestyles in adulthood, “we need a developmental approach to public health” that better supports girls and young women, they write.

The lead author of the commentary article is the late David Barker. He was a visiting professor at Emory’s Center for the Study of Human Health, a clinical epidemiologist at the University of Southampton in the UK, and a professor of cardiovascular medicine at the Oregon Health and Science University.

Barker, who co-taught undergraduate courses at Emory, including one on predicting lifespan health, and served as an adviser to graduate students, was widely considered to be one of the most important clinical epidemiologists of our time. He died of a cerebral hemorrhage last August at 75, after finishing the first draft of the Nature commentary. The article summarizes his life’s work, while also calling for action.

Barker essentially “invented” a new field of medicine, now known as Development Origins of Health and Disease, says Michelle Lampl, a co-author of the Nature article and director of Emory’s Center for the Study of Human Health.

“He’s responsible for a paradigm shift in medicine through his focus on the science of health in the womb and the early ages,” says Lampl, an anthropologist who focuses on human growth. “The idea that your first cell has a big influence on your later life sounds unbelievable, and he was criticized horribly when he came up with ‘the Barker hypothesis.’ But he opened the door and profoundly changed the way that we think about health and disease.”

The Nature article cites some staggering statistics: Globally, the prevalence of adult-onset diabetes is expected to double by 2030 and cardiovascular disease is expected to rise by about 35 percent.

“More than 30 years of epidemiological studies using data from several hundred thousand people around the world point to factors during prenatal and early childhood development that contribute to these statistics,” the researchers write.

The biology underlying the developmental origins of health and disease has begun to be better understood, and evidence suggests that women need to start eating healthily well before they become pregnant. Women who are obese, and those whose stores of nutrients mean the supply to their growing fetus is less than optimal, risk having babies with a greater likelihood of suffering diabetes, hypertension, cardiovascular disease or cancer in later life.

Watch a video of David Barker speaking to an Emory human health class last spring:

“People working in public health must support girls and young women with low incomes to feel more in control of their lives and so better able to prioritize healthy eating,” the researchers write. “At the same time, better access to quality food is necessary so that it is easier for people to make better choices. This would improve others’ nutrition and thereby the health of future generations.”

The researchers call for personal empowerment activities accompanied by environmental changes that make it easier for women to make better food choices.

They write: “So far, public health advocates have called for regulation and legislation as a means to improve diets — an increased tax on fatty and sugary foods, for instance. Yet this is unlikely to happen because raising the tax on soft drinks, say, is not in the interests of industry, or of politicians, who are sensitive to industry pressures and to a public who want cheap soft drinks.

“Instead of wagging fingers, we need to generate consensus. Empowering consumers to call for better access to better food will put pressure on both politicians to respond to voters, and on the food industry to please their customers.”

Additional co-authors on the paper are psychologist Mary Barker and developmental biologist Tom Fleming, both from the University of Southhampton.

Emory’s Center for the Study of Human Health was founded on Barker’s philosophy of predicting and supporting health, instead of just treating disease, Lampl says. “We will continue to build on this legacy, with our focus on empowering young people to make better personal health choices and preparing them to make the next generation of real breakthroughs in human health.”

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