where is the a in mch? a life-course perspective on adolescent health michael c. lu, md, mph...
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Where is the A in MCH?A Life-Course Perspective on
Adolescent Health
Michael C. Lu, MD, MPHAssociate Professor
Department of Obstetrics & GynecologyDavid Geffen School of Medicine at UCLA
Department of Community Health SciencesUCLA School of Public Health
AMCHP Web ConferenceNovember 17, 2006
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Life-Course Pespective
A way of looking at life not as disconnected stages, but as an integrated continuum
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Life-Course Pespective
To improve adolescent health, we must promote MCH.
To improve MCH, we must promote adolescent health.
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MCH
Adolescent Health
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0
5
10
15
20
25
1976-1980 1988-1994 1999-2002
Perc
en
t
Black Hispanic White
Children 6-18 Overweight
Source: National Center for Health Statistics, National Health and Nutrition Examination Survey
Note: Estimate not available for 1976-1980 for Hispanic; overweight defined as BMI at or above the 95th percentile ofr the CDC BMI-for-age growth charts
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Fetal Origin of Obesity
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Fetal Programming
The process whereby a stimulus or insult, at a sensitive or ‘critical’ period, has lasting or lifelong impact on health or function.
Barker DJP. Mothers, babies and health in later life. Edinburgh: Churchill Livingstone. 1998.
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Prenatal Programming ofChildhood Overweight & Obesity
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Maternal Diabetes & Intrauterine Hyperglycemia
Intrauterine Hyperinsulinemia (Fetal Pancreatic β Cells)
Prenatal& Postnatal
Hyperleptinemia
Preadipocyte Differentiation
Adipocyte Hyperplasia
HypothalamicLeptin Resistance
Pancreatic β- Cell Leptin Resistance
HyperphagiaHyperinsulinism
Programmed Insulin
Resistance
Postnatal Hyperinsulinemia
Adipogenesis
Prenatal Programming of Childhood Obesity
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EpigeneticsVolume Control for Genes
R.A. Waterland, R.A. Jirtle, "Transposable elements: targets for early nutritional effects on epigenetic gene regulation," Mol Cell Biol, 23:5293-300, 2003. Reprinted in the New Scientist 2004
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Adolescent Health
MCH
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Maintain stability through change
Allostasis
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Stress
Photo: http://www.lam.mus.ca.us/cats/encyclo/smilodon/
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Allostasis
McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9.
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Allostatic Load
McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9.
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Allostatic Load
Wear and tear on the body from chronic stress
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Allostasis
Pla
sma
Glu
cose
Time
Insulin Response
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Allostatic Load
Pla
sma
Glu
cose
Time
Insulin Resistance
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Allostasis vs. Allostatic Load
McEwen BS, Lasley EN. The end of stress: As we know it. Washington DC: John Henry Press. 2002
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Summary
Life-Course Perspective A way of looking at life not as disconnected stages,
but as an integrated continuum
Fetal Programming The process whereby a stimulus or insult, at a
sensitive or ‘critical’ period, has lasting or lifelong impact on health or function.
Allostasis Maintain stability through change
Allostatic load Wear and tear on the body from chronic stress