Table of Contents
Page created on February 24, 2022. Not updated since.
Professors at the paediatric department at university of Pécs held a webinar on this exact topic in 2021, which you can view here. It appears that prof. Dénes Molnár and others at the department are very involved in this topic. Much of this topic is taken from that webinar. The topic ended up becoming much longer than intended, although I don’t think much of it is important to know.
Introduction and epidemiology
This topic is important because noncommunicable diseases (NCDs) like cardiovascular disease are the biggest cause of deaths worldwide, and the incidence is projected to grow in the future. 71% of deaths worldwide are due to NCDs. Although cardiovascular disease manifests in adulthood, the atherosclerotic process begins in childhood. In addition to the potential large number of cases to prevent, childhood prevention of adult disease is important because the earlier prevention starts, the better the outcome.
Childhood obesity is also on very prevalent and on the rise, and in 2019 almost 40 million children under the age of 5 were overweight or obese, while 340 million children aged 5 – 19 were.
Background
Up until the middle of the 20th century, it was believed that the foetus was immune to toxins ingested by the mother, like alcohol, medications, and cigarettes. The birth defects crises of thalidomide and diethylstilbesterol (DES) were important in overturning this belief, as it became obvious that intrauterine exposure could cause problems even into adulthood, as daughters of mother’s who were taking DES during pregnancy developed a rare form of vaginal cancer in their teens/early adult years.
An epidemiologist by the name of David Barker formed the “Barker’s hypothesis”, which proposes that adverse nutrition in prenatally or in early life increases susceptibility to metabolic syndrome (obesity, diabetes, insulin insensitivity, hypertension, and dyslipidaemia), which increases the risk for complications like CAD and stroke. Periods of rapid postnatal growth due to consumption of high-energy foods, as well as consumption of the high-energy Western diet, also appears to be risk factors.
The mechanism of action is likely to be multifactorial, with transgenerational epigenetic inheritance being one possible mechanism, where a history of starvation or deprivation in a grandparent causes effects seen in their grandchildren. Another possible mechanism is the inheritance of the baby’s microbiota from the mother; improvement of maternal health could improve her and therefore the child’s microbiota and health.
An increase in weight for gestational age (large for gestational age, LGA) is a risk factor for obesity and metabolic syndrome. A decrease in weight (small for gestational age, SGA) is a risk factor for obesity, metabolic syndrome, cardiovascular disease, and type 2 diabetes.
Prevention of cardiovascular disease
Primordial prevention includes preventing the development of risk factors for cardiovascular disease. This includes both individual promotion and population-based advocation for healthy measures for children, including:
- Tobacco and nicotine avoidance
- High-quality school lunch
- Smaller portion sizes
- Proper nutrition (low saturated fat, low sugar, high fibre)
- Regular exercise
During routine health check-ups, risk factors for cardiovascular disease should be identified and treated. The child’s diet, physical activity, family history, body parameters, blood pressure, etc. should be measured and assessed.
Unlike in adults, there are no clear guidelines as to which children should be screened for metabolic disorders like dyslipidaemia and insulin resistance. In general, risk-factor estimation of cardiovascular disease in children should be based on individual factors (body weight, BP, waist circumference, birth weight) and family history of cardiovascular diseases. Children at the age of 9 – 11 should be screened for dyslipidaemia and diabetes mellitus, unless they have cardiovascular risk factors, in which case screening should begin earlier.
A study conducted by researchers at the paediatric clinic at the university of Pécs concluded that having more than 4 pathological parameters meant an elevated risk for having pathological cardiometabolic laboratory values, like CRP, dyslipidaemia, or insulin resistance. The parameters in question were BMI, waist-to-height ratio, birth weight, presence of breastfeeding, and presence of cardiovascular disease in the family. As such, screening for cardiovascular risk could be recommended in those with 4 or more pathological parameters.
Hypertension, mostly primary hypertension, is on the rise in childhood and is now one of the most common disorders of the young. There’s a strong association with obesity. It’s known that treating and preventing hypertension in childhood prevents hypertension and its complications in adult life. As such, childhood hypertension should be treated, firstly by treating comorbid obesity.
Breastfeeding
Breastfeeding has both short-term and long-term protective effects against disease. It’s well-known that breastfeeding reduces the risk of:
- Type 1 and 2 diabetes
- Inflammatory bowel disease
- Dental problems
- Allergy
- Obesity
- Intellectual disability
- Visual defects
- ADHD
For these reasons, and because of the benefits for the mother, breastfeeding for all infants in whom it’s not contraindicated is strongly advocated for.
The effects of in vitro fertilisation on adult disease
Most IVF-conceived children are healthy, but IVF has also been associated with higher risk of poor long-term outcomes, like cardiovascular disease, male reproductive tract abnormalities, cryptorchidism, testicular cancer, and disrupted hormonal profile. As such, measures to prevent the need for artificial fertilisation would also prevent these disorders.