Power of prevention in the
early years

June 15, 2012 1:31 pm Views: 137
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Prenatal life is a critical period for the development of obesity and evidence is mounting regarding the importance of maternal obesity and the intrauterine environment on the cycle of obesity. LGA=large for gestational age, OW/OB= overweight/obese

The battle against child obesity is a high priority in Canada not only from a population health perspective, but from the health care system’s economic perspective as well. Moreover, obesity tracks very closely from childhood to adolescence to adulthood meaning that if you have trouble maintaining a healthy weight as a child you are likely to struggle with these very same issues throughout life.

Commonly referred to as the ‘intergenerational cycle of obesity’ (see figure) the long-term burden on Canadian healthcare is even more significant if we include the obesity associated chronic co-morbid conditions including diabetes, cardiovascular disease and certain cancers. Having always been interested in the response of various metabolic systems to dietary and exercise intervention, Dr. Adamo’s background has uniquely positioned her to undertake lifestyle intervention trials that look at traditional physiological, anthropometric and metabolic outcomes but also incorporate biochemical or cellular aspects where appropriate.  Given the complexity of child obesity and the various contributing factors (genetic, physiological, societal, environmental, lifestyle-related, psychosocial), her research program uses a multi-disciplinary approach exploring aspects from basic science to advocacy.  Dr. Adamo’s research program includes lifestyle intervention projects targeting obesity prevention and management during critical developmental periods, namely pregnancy and the preschool years, as well as applied physiology studies and, where relevant, bench-science related to determinants of child obesity and its progression.

Her team recently discovered that both maternal obesity and gaining pregnancy weight in excess of the 2009 Institute of Medicine recommendations dramatically increase the likelihood that a child will be born large for gestational age; an effect that is stronger when a women is both obese and exceeds guidelines. This presents a clinically-relevant problem that needs to be addressed in order to attenuate the prevalence of overweight and obesity in both mom and child.

Data from Dr. Adamo’s team, and the overwhelming evidence illustrating that maternal pre-pregnancy BMI and gestational weight gain (GWG) are vital contributors to the intrauterine environment and thus downstream child health, has led them to develop a lifestyle intervention targeting pregnant women (i.e. the MOM trial).  The goal of this trial is to test the efficacy of a structured physical activity (PA) and nutrition program (i.e. the MOM trial) to prevent excessive gestational weight gain and reduce downstream child obesity.  Since her team is interested in intrauterine factors that contribute to excessive growth and potential downstream child obesity they are concurrently exploring potential mechanisms at the molecular-level; specifically the potential contribution of the insulin-like growth factor (IGF)-axis and placenta nutrient sensing and transport.

Below are some tips to help manage your pregnancy weight gain:

1.    Avoid prolonged periods of sitting still by getting up from your seat and walking around every 20 minutes, this helps regulate blood sugars and fats. If you’re watching TV get up and walk around every commercial
2.    Follow the CSEP-SOGC recommendations for physical activity (PA) in pregnancy and try to get 30 minutes of daily PA 4x/week, if this is a problem give the 5 minute rule a try (i.e., try your activity of choice for 5 minutes before you call it quits). Start off small and aim for 3x/wk with 15mins each time before you give up completely
3.    Try and get the recommended 6-8 hours of sleep nightly as adequate sleep helps manage hunger, appetite and physical activity
4.    Choose foods high in fibre; consume plenty of green leafy vegetables and avoid food rich in sugars and saturated fats
5.    Limit refined sugar intake (sugar sweetened beverages, candy etc); Water is an excellent no calorie substitute. Find water boring?  Add a squeeze of lemon or lime to a glass of water
6.    Reduce ‘all or nothing thinking’ when it comes to exercise and nutrition because every little bit helps
7.    Plan ahead and strategize ways to make small healthful changes in your lifestyle, such as getting an extra 30 mins of sleep, fitting in a 20 walk at lunch, etc
8.    It’s important to know when you’re pregnant that you are eating for two, NOT like two, so dietary quality is very important. Most women do not need to drastically increase intake more than 200-300 kcals a day until the 2nd and 3rd trimester. This is less than an extra bagel a day worth of calories
9.    Live the healthiest lifestyle you can happily maintain as it will lead to long-term adherence and success

Please feel free to contact momtrial@cheo.on.ca for information about the study or Dr. Adamo kadamo@cheo.on.ca for more information about the power of prevention in the early years research program.

Article By:

Dr. Zachary Ferraro

Dr. Zachary Ferraro, member of the Healthy Active Living & Obesity (HALO) Research Group at the Children’s Hospital of Eastern Ontario (CHEO) Research Institute.

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