Paavo Nurmi Symposium 2006
Prevention of CVD, diabetes and obesity should begin very early on in life
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| Ricardo Uauy |
Experts from Finland and abroad meeting in Oulu in December 2006 for the 15th Paavo Nurmi Symposium drew attention to latest research findings that show a manifold interaction of factors that influence the development of cardiovascular disease in later life. The symposium focused on the foetal and childhood development of risk factors of atherosclerosis, and looked at a range of interventional efforts to forestall worrying trends in early life determinants of disease.
Speaking to journalists at the end of the symposium, Professor Pekka Puska the Director General of the National Public health Institute in Finland said that research data presented at it highlighted risk factors concerning the influence of conditions during pregnancy and draw attention to the relationship between low birth weight and a greater tendency towards later obesity, cardiovascular diseases, high cholesterol and diabetes.
"It is commonly known that cardiovascular diseases for the most part appear in adulthood, but in recent years there has been an abundance of research information on how the development of these begins very early on in life," said Puska.
He drew attention to the conclusions presented at the symposium by Professor Nils Stenby of the Department of Pathology, University Hospital MAS, University of Lund, Sweden, of a broad WHO study on young subjects who had died violent deaths. The study showed that atherosclerosis, in the form of fatty streak, develops in all individuals early in life, in their second decade, and which appears related to dietary and other lifestyle aspects. "This is a significant study showing that disease is traceable back to childhood," said Puska.
Multiple strategies needed to tackle childhood obesity
A particular focus of the symposium was on the problem of obesity among children, and both its precursors and later health impact. Research findings cut across a range of issues encompassing medical determinants and outcomes plus health promotion and policy. William Dietz, Director of the Division of Nutrition and Physical Activity at the US Centre for Disease Control, said that obesity is such a new problem that work has to proceed on the best available rather than the best possible evidence.
"Some of the strategies warranted in the US are the reduction in soft drink intake. Sugar sweetened beverages, which include sodas and the 10% juices, account for almost 15% of the average teenager’s caloric intake and is a reasonable target for reduction. This is a major problem. A second important concern in the US is television viewing and more generally screen time, including computer time. We know that there is a direct relationship between the amount of television children watch and the likelihood that they will be overweight."
Physical activity is also an important problem, and in the primary and secondary schools in both Finland and the US physical education programmes have been declining. Dietz said that restoring physical activity in schools is important. He also pointed to the growing body of data showing that the way communities are designed has an influence on physical activity and therefore on health. At the same time, he said that one of the most important early influences on nutritional development and obesity is breast feeding and the duration of it.
"We cannot expect that one single strategy is going to make a difference. Soft drink reduction in schools alone is unlikely to have an impact. Similarly, messages or instructions from paediatricians alone are unlikely to have an impact. As with the successes we have seen in tobacco control, multiple strategies in multiple settings are likely to be effective. There are now four community programmes worldwide that have shown a reduction in obesity, and all of them have employed multiple strategies, such as in school and community-based settings. Obesity is one of the rapidly growing risk factors in cardiovascular disease in the US and around the world. It is a very complicated risk factor, perhaps more so even than tobacco because of its relationship with both diet and physical activity."
Improving the quality of nutrition in pregnancy and early childhood is essential
Ricado Uauy of the Institute of Nutrition and Food Technology, Chile, said that the causes of cardiovascular disease are so interlinked that how much is due to obesity, physical inactivity, blood pressure or cholesterol cannot be isolated.
"One of the important things we are learning is that you cannot act late on; you have to act at every state of the life course. Before women are pregnant many of the risks associated later on cannot be addressed after pregnancy starts. If someone is overweight, the time to lose weight is before they get pregnant. Similarly, if they are underweight, like many teenage girls, they need to consider regaining weight before they get pregnant.
"Some of the nutrients critical for the development of the foetus may be tiny amounts, such as iodine, that needs to be present before the baby is conceived. During pregnancy itself, some of the factors that affect the birth weight of the baby concern things that cannot be altered, such as the height and health of the mother, and take more than one generation to influence."
Uauy said that some elements of diet are beyond individual control. People worldwide consume between six and ten times the amount of salt our bodies need, and only about 20% of this comes from the salt people add, the rest comes from manufactured products. "So there is a need for communities and government to be involved, either through regulation or by changing the food supply."
A coalition between the World Heart Federation, the International Association for the Study of Obesity, the International Paediatric Association, the International Union of Nutritional Sciences, the International Diabetes Federation and the WHO to work together to create a code of conduct on the marketing and advertising of food for children. "Ideally this could be done without regulation, but unfortunately the pressure of business is so great that the concept of a code of conduct is important," said Uauy.
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| The lecturers of 15th Paavo Nurmi Symposium in Oulu |
The Paavo Nurmi Foundation promotes research into cardiovascular disease treatment and prevention, a major forum of which is the biannual symposium it arranges that gathers leading experts in the field to consider the latest research findings.