does heart disease begin in utero? -...
TRANSCRIPT
SYDNEY MEDICAL SCHOOL
Michael Skilton | Associate Professor
Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders
DOES HEART DISEASE
BEGIN IN UTERO?
ATHEROSCLEROSIS TIMELINE
Pepine, Am J Cardiol 1998
ATHEROSCLEROSIS TIMELINE
Pepine, Am J Cardiol 1998
CAROTID INTIMA-MEDIA THICKNESS
CAROTID INTIMA-MEDIA THICKNESS
O’Leary et al, NEJM 1999
ATHEROSCLEROSIS TIMELINE
Pepine, Am J Cardiol 1998
ALPHA LESIONS
Napoli et al, JCI 1997 & Lancet 1999
AORTIC INTIMA-MEDIA THICKNESS
Osmond et al, BMJ 1993
Women Men
FETAL GROWTH & CVD
Crispi et al, Circulation 2010 Skilton et al, Lancet 2005
“Low birth weight”
Napoli et al, Lancet 1999 Skilton et al, Pediatrics 2012 Adapted from Skilton et al, ATVB 2011
Osmond et al, BMJ 1993
Women Men
FETAL GROWTH & CVD
Osmond et al, BMJ 1993 ; Kuh & Ben-Shlomo, 2004
Women Men
POTENTIAL FOR PREVENTION
Adapted from Global Burden of Disease Study 2010, Lancet 2012
Cardiovascular diseases
% D
eath
s
PERHAPS A
DIFFERENT PERSPECTIVE
IS REQUIRED
Original source: http://basementgeographer.com/
Kotwal et al, Circulation: Cardiovascular Quality and Outcomes 2012
OMEGA-3
FATTY ACIDS
Skilton et al, Am J Clin Nutr 2013
PRECISION
NUTRITION
Skilton et al, J Pediatr 2015
Healthy birth weight
X Impaired fetal growth
Healthy birth weight
PRECISION
NUTRITION
People born SGA (~10% of the population), including children and
adolescents, should be actively encouraged to follow the American
Heart Association’s recommendations for omega-3 fatty acid intake.
• Eat a variety of (preferably oily, low mercury) fish at least twice a
week
• To include oils and foods rich in alpha-linolenic acid (flaxseed,
canola, and soybean oils; flaxseed and walnuts).
PRECISION
NUTRITION
© GE Healthcare 2003
Original source: National Ocean Service Image Gallery
FETAL GROWTH
IS JUST THE BEGINNING
Begg et al, ADC 2013 By MatthiasKabel
Original source: Cancer Council Victoria
By Eugene Ermolovich (CRMI) Scherrer et al, Circulation 2012
Napoli et al, JCI 1997
MATERNAL
HIGH
CHOLESTEROL
GDM +
LGA
LGA AGA
DIABETES IN
PREGNANCY
Koklu et al, Eur J Pediatr 2007
Skilton et al, Pediatrics 2013
EXCESSIVE
EARLY
CHILDHOOD
WEIGHT GAIN
THE JOURNEY
HAS JUST
BEGUN
By Néstor Galina
Acknowledgements
› Collaborators
- Guy Marks (Woolcock Institute of Medical Research)
- Julian Ayer, David Celermajer (University of Sydney)
- Katja Pahkala, Jorma Viikari, Olli Raitakari (Young Finns and STRIP, Finland)
- Nick Evans (RPA Hospital, Sydney)
- Lisa Begg, Ricardo Palma-Dias (RWH, Melbourne)
› Funding
- Supported by a National Heart Foundation of Australia Future Leader Fellowship