Session 8: Metabolic Syndrome and Developmental Origins of Adult Disease

Energy intake = expenditure

Body weight stable

Energy intake > expenditure

Energy stores (fat) will increase

Energy intake < expenditure

Energy stores deplete

Leptin resistance and obesity

-Promotes overeating and excessive weight gain (satiety signaling in hypothalamus is lost)

-Associated with insulin resistance

-Related to cardiovascular complications of obesity

Leptin

hormone that signals the hypothalamus and brain stem to reduce appetite and increase the amount of energy used

What is a syndrome

A group or recognisable pattern of symptoms or abnormalities that indicate a particular trait or disease

Metabolic syndrome features

- Insulin resistance = diabetes

- Fasting plasma glucose (>7.8mmol/L)

- Dyslipidemia (TG >1.7mmol/L; HDL-Cholesterol <1.0mmol/L)

- Hypertension (>140/90mmHg)

- Abdominal obesity (BMI >30kg/m2; waist-hip ratio >0.85)

- Increased fat around waist

System-wide approach to obesity

- Promotion of healthy diet

- Redesigning the environment to promote exercise

- Cultural change to shift societal values around food/activity

What types of studies can be used to study complex diseases such as obesity and T2DM?

Genome Wide Association Studies (GWAS)

Fetal programming

Fetal programming occurs during embryonic and fetal development, a critical period in which tissues and organs are created. Insufficient nutrition during this time results in permanent alterations to certain structural and physiological metabolic functions of the fetus

Developmental Origins of Adult Health and Disease (DOHaD)

The Developmental Origins of Health and Disease (DOHaD) theory hypothesized that environmental exposures during early life (particularly the in-utero period) can permanently influence health and vulnerability to disease in later life.

Importance on growth charts

- Growth = measure of health and wellbeing

- Body weight, length, height and head circumference

- Charts describe how big/heavy healthy children are expected to be

Determinants of birth weight

1) Environmental = nutrition/caloric intake, alcohol, tobacco, drugs, fetal hypoxia

2) Genetic = maternal pre-pregnancy weight, maternal birth weight, maternal weight gain between pregnancies

3) Health = intrauterine infections, anemia, gestational diabetes

4) Placental = impaired transport

Rapid postnatal growth is associated with risk of ___

obesity

Breast fed babies are ___ and have ___ postnatal weight gain and energy intake than formula-fed babies

Breast fed babies are leaner and have reduced postnatal weight gain and energy intake than formula-fed babies

Epigenetics

the study of environmental influences on gene expression that occur without a DNA change

Epigenetic modification

DNA methylation leading to histone modification

The Developmental Origins of Adult Health and Disease (DOHaD) hypothesis highlights the importance of...

Antenatal care in terms of adequate and appropriate nutrition

Socioeconomic issues with antenatal care in pregnant women

Women with greatest risk of poor nutrition during pregnancy are the least likely to present for antenatal care