where is the a in mch? a life-course perspective on adolescent health michael c. lu, md, mph...

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

Life-Course Pespective

A way of looking at life not as disconnected stages, but as an integrated continuum

Life-Course Pespective

To improve adolescent health, we must promote MCH.

To improve MCH, we must promote adolescent health.

MCH

Adolescent Health

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

Fetal Origin of Obesity

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.

Prenatal Programming ofChildhood Overweight & Obesity

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

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

Adolescent Health

MCH

Maintain stability through change

Allostasis

Stress

Photo: http://www.lam.mus.ca.us/cats/encyclo/smilodon/

Allostasis

McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9.

Allostatic Load

McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9.

Allostatic Load

Wear and tear on the body from chronic stress

Allostasis

Pla

sma

Glu

cose

Time

Insulin Response

Allostatic Load

Pla

sma

Glu

cose

Time

Insulin Resistance

Allostasis vs. Allostatic Load

McEwen BS, Lasley EN. The end of stress: As we know it. Washington DC: John Henry Press. 2002

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