Where is the A in MCH A LifeCourse Perspective on Adolescent Health

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Where is the A in MCH?A Life-Course Perspective
on Adolescent Health

• Michael C. Lu, MD, MPH
• Associate Professor
• Department of Obstetrics Gynecology
• David Geffen School of Medicine at UCLA
• Department of Community Health Sciences
• UCLA School of Public Health
• AMCHP Web Conference
• November 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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(No Transcript)
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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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Prenatal Programming of Childhood Obesity
Dysregulation of the Adipoinsular Feedback System
Maternal Diabetes Intrauterine Hyperglycemia
Maternal Diabetes Intrauterine Hyperglycemia
Maternal Diabetes Intrauterine Hyperglycemia
Intrauterine Hyperinsulinemia (Fetal Pancreatic ß
Cells)
Intrauterine Hyperinsulinemia (Fetal Pancreatic ß
Cells)
Intrauterine Hyperinsulinemia (Fetal Pancreatic ß
Cells)
Prenatal Postnatal Hyperleptinemia
Prenatal Postnatal Hyperleptinemia
Preadipocyte Differentiation
Programmed Insulin Resistance
Programmed Insulin Resistance
Prenatal Postnatal Hyperleptinemia
Preadipocyte Differentiation
Programmed Insulin Resistance
Adipocyte Hyperplasia
Adipocyte Hyperplasia
Adipocyte Hyperplasia
Postnatal Hyperinsulinemia
Postnatal Hyperinsulinemia
Postnatal Hyperinsulinemia
Hypothalamic Leptin Resistance
Hypothalamic Leptin Resistance
Pancreatic ß- Cell Leptin Resistance
Pancreatic ß- Cell Leptin Resistance
Hypothalamic Leptin Resistance
Pancreatic ß- Cell Leptin Resistance
Hyperphagia
Hyperphagia
Hyperphagia
Hyperinsulinism
Hyperinsulinism
Hyperinsulinism
Adipogenesis
Adipogenesis
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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,
235293-300, 2003. Reprinted in the New Scientist
2004
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• Adolescent Health
• MCH

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Allostasis

• Maintain stability through change

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Stress
Photo http//www.lam.mus.ca.us/cats/encyclo/smilo
don/
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Allostasis
McEwen BS. Protective and damaging effects of
stress mediators. N Eng J Med. 1998338171-9.
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Allostatic Load
McEwen BS. Protective and damaging effects of
stress mediators. N Eng J Med. 1998338171-9.
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Allostatic Load

• Wear and tear on the body from chronic stress

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Allostasis
Insulin Response
Plasma Glucose
Time
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Allostatic Load
Plasma Glucose
Insulin Resistance
Time
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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