A life course approach to diet, nutrition and the prevention of chronic diseases

Abstract

Objective: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the lifelong influences on the development of disease. Design: A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments. Setting: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. Results of review:There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under-and over-nutrition. Conclusions: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

A life course approach: research orientations and future challenges

“…A few long-term studies have shown the relationships between high blood pressure in adolescence or young adulthood and later risk of stroke or CDH in midlife [4]. This trend seems to be visible, particularly in developing countries [18].…”

“…The aim is to explore how biological, psychological, and social risk factor trajectories, acting across the whole life course, influence age-related diseases, functional decline, and disability. There is growing evidence from life course studies that adult function and age-related chronic diseases have their origins in early life experiences and share common risk actors [1,4]. The interest in this approach is not, however, new.…”

“…There is evidence suggesting, for example, that intrauterine growth retardation (as evidenced by small size at birth) may lead to a variety of chronic disorders in adult life, such as hypertension, cardiovascular disease, and non-insulin-dependent diabetes [4,9]. This model is also known as biological programming [8,9].…”

“…1 The accumulation model suggests that factors that elevate disease risk or enhance good health may accumulate gradually over the life course. Adapted from Darnton-Hill et al [4] and Aboderin et al [23] problems. Some diseases such as lung cancer may derive mostly from adult circumstances, coronary heart disease, and lung disease from both childhood and adult circumstances, while stroke and stomach cancer appear to be associated with adverse social circumstances during childhood [29].…”

Homeless street children in Nepal: Use of allostatic load to assess the burden of childhood adversity

“…A lifespan perspective and emphasis on cumulative burden increasingly inform views of stress and health among adults (Darnton-Hill, Nishida, & James, 2004). McEwen (2000a) has advanced the concept of allostatic load to maintain a necessary distinction between stressors and stress: the former is a property of circumstances to which individuals are exposed, the latter is the extent to which the individual is challenged to maintain function.…”