Early risk factors Interpretation of growth charts When to

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Early risk factors Interpretation of growth charts When to

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Early risk factors Interpretation of growth charts When to suspect a specific etiology?
Marie-Laure Frelut (France), Artur Mazur (Poland) Elpis Vlachopapadopoulou (Greece),

Marie-Laure Frelut, MD, MSc, is paediatrician, specialized into nutrition and childhood obesity. She spent most of her career in Paris Children University Hospitals. She is a founding member of Scope, past president of the European Childhood Obesity Group (ECOG), the editor of the ECOG’s first free eBook on child and adolescent obesity and deserved the Nutrition award of the French Academy of Medicine. She is deputy chair of the clinical committee of the World Obesity Federation.

Elpis Vlachopapadopoulou, MD, Msc, is pediatrician and endocrinologist. She is director of the Dept. of Endocrinology-Growth and Development in Children’s Hosp. “ P. A. Kyriakou” in Athens, Greece. She completed her residency and fellowship at Columbia and Cornell University Hospitals, USA. She is the author and co/author over for 50 articles on national and international scientific journals She is member of the Board of ECOG.

Prof. Artur Mazur is pediatrician and endocrinologist. He is current Dean of the Medical Faculty University of Rzeszow, Poland, Head of the Department Paediatric, Paediatric Endocrinology and Diabetology University of Rzeszow. He was Past President of ECOG for the term 2014-2018.. He is the author and co/author over 150 articles/abstracts on national and international scientific journals, editor of 3 books on obesity, nutrition, and public health.

Description of the course
The first part of this module focuses on some early risk factors of childhood obesity including: • The discovery of the links between phenomena that take place during
pregnancy and the outcome during the child’s first two years of life, called “the 1000 days hypothesis”. • Evidence that the first two years are strong determinants of later health and obesity risks
The second part shows how to use anthropometry including: • Which anthropometric criteria are useful to assess childhood obesity,
taking into account height and weight for Public Health or for individual assessment. • How a cautious clinical examination and reading of the growth charts allow detection of several distinct causes of early obesity and how it helps to choose optimal therapeutic strategies

Learning objectives
At the end of this module you should be able to:
1. Detect early risk factors of obesity during pregnancy and the first 2 years of life
2. Know which growth charts apply to children and adolescents 3. Choose the appropriate anthropometric parameters to assess
obesity for a clinical setting or for a Public Health survey 4. Assess growth charts in order to suspect various aetiologies of
child and adolescent obesity and settle corresponding optimal therapeutic strategies


The 1000 days hypothesis
The biological background of early development
• Genetics :
– Single gene polymorphisms are said to explain less than 5 % of obesity according to most populations studies
But: There are huge differences in weight gain in adults submitted to similar food excess intake in experimental conditions
• Twin and Adoption studies :
– Adopted individuals resemble their biological parents and not their adoptive parents (Stunkard 1986)
– Similar weight gain in monozygotic twins raised separately (Stunkard 1990)
– Similar weight gain in overfed twins (Bouchard 1990)

The 1000 days hypothesis
The biological background of early development
EPIGENETICS The gene environment interaction
– Modulation of the expression of the genome by its environment within cells • Methylation of the genes leading to silencing or over expression • Environment of the histones influencing gene expression • Transmission of epigenetic modification of the sperm to somatic cells of the child • Many unknown factors: endocrine disruptors, pesticides....
– Transmission from generation to generation from mother and father • Evidence started from world war 2 cohorts of pregnant women in the NL • Transmission from food deprived grandmothers to children and grand children
-> Increased risk of cardiovascular disease, type 2 diabetes, obesity

The 1000 days hypothesis
The biological background of early development
Gene mutations
• Genes linked to – Appetite regulation – Energy expenditure
• Careful Clinical examination in search of a genetic syndrome – Dysmorphic features ?
• Microcephaly, almond shaped eyes, macroglossia, small hands and feet
– Abnormal neonatal features ?
• LGA, SGA, hypotonia, hypoglycemia, failure to thrive
– Impaired psychomotor development ? – Tall or short stature ?
Growth curves are often suggestive
ObesityGrowth ChartsChildhood ObesityRisk FactorsHealth