Aboriginal Health: early origins of adult disease
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Aboriginal Health: early origins of adult disease |
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Aboriginal Health: Early Origins of Adult Disease Chair John Walker-Smith Speaker: Professor Kerin O’Dea Early Origins of Adult Chronic Diseases Kerin O'Dea. Menzies School of Health Research, Darwin, N.T.Over the past decade there has been a resurgence of interest in the concept that many common chronic diseases have their origins in early life. The "Barker Hypothesis" (named after David Barker, the driving force for research on this question in humans) proposes that diseases such as coronary heart disease, type 2 diabetes, central obesity and hypertension originate through adaptations the fetus makes to under nutrition. These adaptations may be structural, metabolic or endocrine, and may result in permanent changes in structure and function ("fetal programming"). While it is an attractive hypothesis with considerable biological underpinning from studies in animal models, many unanswered questions remain. The focus of the Barker Hypothesis has been on low birth weight (as a surrogate for fetal under nutrition), however the role of maternal diet and the relative importance of nutritional status of the infant in early life are not well understood. International research has implicated maternal diabetes in pregnancy as increasing the risk of obesity and early onset type 2 diabetes in the offspring, suggesting that it is not just fetal under nutrition that can have long term sequelae. There are clearly major implications for Aboriginal health: very high rates and early age of onset of diabetes, renal disease and cardiovascular disease are well documented in adults, as are relatively high rates of low birth weight and "failure to thrive" in young infants. Local researchers are now actively working on these questions. Wendy Hoy and colleagues have documented links between low birth weight and risk of renal disease among the Tiwi people, however other factors such as central obesity and insulin resistance in adult life, and post streptococcal glomerular nephritis in early life were also associated with increased risk of renal disease. Sue Sayers and colleagues have been following an Aboriginal birth cohort now for 12 years and are producing very sound data from this powerful prospective study. The data available already provide a strong rationale for a focus on maternal and child health, but also highlight the importance of a life course approach to chronic disease prevention and management. |
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