Early life opportunities for prevention of diabetes in low and middle income countries

Abstract

BackgroundThe global burden of diabetes and other non-communicable diseases is rising dramatically worldwide and is causing a double poor health burden in low- and middle-income countries. Early life influences play an important part in this scenario because maternal lifestyle and conditions such as gestational diabetes and obesity affect the risk of diabetes in the next generation. This indicates important periods during the lifecourse when interventions could have powerful affects in reducing incidence of non-communicable diseases. However, interventions to promote diet and lifestyle in prospective parents before conception have not received sufficient attention, especially in low- and middle-income countries undergoing socio-economic transition.DiscussionInterventions to produce weight loss in adults or to reduce weight gain in pregnancy have had limited success and might be too late to produce the largest effects on the health of the child and his/her later risk of non-communicable diseases. A very important factor in the prevention of the developmental component of diabetes risk is the physiological state in which the parents enter pregnancy. We argue that the most promising strategy to improve prospective parents’ body composition and lifestyle is the promotion of health literacy in adolescents. Multiple but integrated forms of community-based interventions that focus on nutrition, physical activity, family planning, breastfeeding and infant feeding practices are needed. They need to address the wider social economic context in which adolescents live and to be linked with existing public health programmes in sexual and reproductive health and maternal and child health initiatives.SummaryInterventions aimed at ensuring a healthy body composition, diet and lifestyle before pregnancy offer a most effective solution in many settings, especially in low- and middle-income countries undergoing socio-economic transition. Preparing a mother, her partner and her future child for “the 1000 days”, whether from planned or unplanned conception would break the cycle of risk and demonstrate benefit in the shortest possible time. Such interventions will be particularly important in adolescents and young women in disadvantaged groups and can improve the physiological status of the fetus as well as reduce the prevalence of pregnancy conditions such as gestational diabetes mellitus which both predispose to non-communicables diseases in both the mother and her child. Pre-conception interventions require equipping prospective parents with the necessary knowledge and skills to make healthy lifestyle choices for themselves and their children. Addressing the promotion of such health literacy in parents-to-be in low- and middle-income countries requires a wider social perspective. It requires a range of multisectoral agencies to work together and could be linked to the issues of women’s empowerment, to reproductive health, to communicable disease prevention and to the Millennium Development Goals 4 and 5.

Health Literacy Measurements with The Newest Vital Sign Instrument Among Adolescents from Dubai, United Arab Emirates

“…14 Especially among adolescents, health literacy interventions constitute an evidence-based approach for health promotion and reduction of non-communicable disease risks in adulthood. 15 In this study, we examined health literacy among high school students in Dubai, UAE.…”

Developmental Origins of Health and Disease (DOHaD): Implications for health and nutritional issues among rural children in China

“…So far, most community-based interventions such as promotion of diet and lifestyle have focused on adults and most investment has been injected into secondary prevention and treatment, whereas the major disease burden caused by non-communicable diseases such as cardiovascular disease and type II diabetes have their origins in transition from malnutrition in early childhood (9). The latest evidence shows overweight or obese children who were obese as adults had increased risk of type II diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis and the risk is not changed whether they became obese or not by adulthood (26), suggesting early intervention during childhood could be more effective (38). The scientific evidence on DOHaD indicates the probability and necessity of prevention of adult disease by promotion of maternal and childhood health (9).…”

Developmental origins of health and disease – Global public health implications

“…GDM now complicates as many as 20% of pregnancies in parts of Asia and the Middle East. It confers an increased risk of diabetes and cardiovascular disease on the mother but also passes the risk of diabetes and obesity to her offspring [14,15]. Maternal obesity, the prevalence of which is rising rapidly both in HICs and LMICs, and excessive weight gain during pregnancy also have intergenerational consequences.…”