Translating the Developmental Origins of Health and Disease concept to improve the nutritional environment for our next generations: a call for a reflexive, positive, multi-level approach

Evidence supporting the Developmental Origins of Health and Disease (DOHaD) hypothesis indicates that improving early life environments can reduce non-communicable disease risks and improve health over the lifecourse. A widespread understanding of this evidence may help to reshape structures, guidelines and individual behaviors to better the developmental conditions for the next generations. Yet, few efforts have yet been made to translate the DOHaD concept beyond the research community. To understand why, and to identify priorities for DOHaD Knowledge Translation (KT) programs, we review here a portion of published descriptions of DOHaD KT efforts and critiques thereof. We focus on KT targeting people equipped to apply DOHaD knowledge to their everyday home or work lives. We identified 17 reports of direct-to-public DOHaD KT that met our inclusion criteria. Relevant KT programs have been or are being initiated in nine countries, most focusing on secondary school students or care-workers-in-training; few target parents-to-be. Early indicators suggest that such programs can empower participants. Main critiques of DOHaD KT suggest it may overburden mothers with responsibility for children's health and health environments, minimizing the roles of other people and institutions. Simultaneously, though, many mothers-to-be seek reliable guidance on prenatal health and nutrition, and would likely benefit from engagement with DOHaD KT. We thus recommend emphasizing solidarity, and bringing together people likely to one day become parents (youth), people planning pregnancies, expecting couples, care workers and policymakers into empowering conversation about DOHaD and about the importance and complexity of early life environments.

Stature and adiposity among children in contrasting neighborhoods in the city of Hamilton, Ontario, Canada

It is hypothesized in this study that body size and shape vary by local area within the North American urban environment. This study tests that hypothesis by comparing stature and adiposity among children (of age 6-10 years) attending elementary schools in three neighborhoods that contrast by socioeconomic status and recent immigrant status. While the whole sample of children (n = 266) has 27.4% of children that can be classified as overweight/obese (> or =85th percentile for body mass index), analysis by socioeconomic status (SES) reveals that there are approximately twice as many children in the overweight/obese category in the two low-SES schools compared to the high-SES school. Further analysis by individual school indicates that the school in the poorest neighborhood has a statistically significantly lower mean height-for-age Z score relative to the most affluent school. It is concluded that the influence of socioeconomic, demographic, and environmental factors on stature and adiposity can be investigated through studies such as this one that consider local area variation.

A biocultural investigation of the weanling's dilemma in Kathmandu, Nepal: do universal recommendations for weaning practices make sense?

The primary objective of this report is to use data from a study of infant growth and weaning practices in Kathmandu, Nepal, to investigate universal recommendations about exclusive breast-feeding up to 6 months postpartum. A secondary objective is to demonstrate the complexity of the biocultural nature of infant feeding practices. A sample of 283 children under 5 years of age and their 228 mothers living in a peri-urban district of Kathmandu participated in this study. The children's height/length and weight were measured three times over 9 months. At each session, a demographic, child health and infant feeding survey was administered; between sessions, in-depth interviews were conducted with mothers regarding infant feeding practices. While a few of the infants under 2 months were receiving non-breast milk foods, at 3 months of age half of the sample had been introduced to non-breast milk foods and by 7 months all infants were eating non-breast milk foods. A comparison of growth indices and velocities between exclusively and partially breast-fed infants from birth to 7 months of age shows no evidence for a difference in nutritional status between the two groups. Although there are cultural rules about breast-feeding that vary by ethnic group, all mothers followed a feeding method that depended on their assessment of whether the child was getting enough breast milk. The conclusion is that exclusive breast-feeding up to 6 months may not be appropriate for all infants. In this sample, breast-feeding duration is not shortened by the early introduction of non-breast milk foods, as the median age of breast-feeding cessation is 36 months. One of the main reasons for severance was the onset of another pregnancy. Investigation of infant feeding practices must be contextualized in the local ecology of the population. While cultural beliefs about breast-feeding are relevant, mothers' individual assessments of their children's nutritional needs and demographic events in parents' lives must also be considered.

The historical roots of high rates of infant death in Aboriginal communities in Canada in the early twentieth century: the case of Fisher River, Manitoba

Infant mortality is investigated for a period of thirty years at the beginning of the 20th century in the Aboriginal Nations community of Fisher River, Manitoba. Infant mortality rates were generated from parish records of infant burials from the Methodist mission at Fisher River and later archived at the United Church Archives in Winnipeg, Man. The average infant mortality rate (IMR) for the total period (1910-1939) was 249 per 1000 live births, an exceedingly high rate compared to modern IMRs and even higher than those in developing countries today. Acute respiratory infections were found to be the cause of death in the majority of cases. These infectious diseases and high rates of postneonatal infant mortality point to conditions of poverty associated with malnutrition as the major precipitating factor in infant death. Fisher River, like other early 20th century First Nations communities in Canada, experienced socio-economic deprivation because of the decline of the fur trade and the underdevelopment of a reserve economy competing for resources with the Canadian government and Euro-Canadian settlers. These conditions of economic and political marginalization are concluded to be the ultimate causes of high rates of infant mortality and are incorporated in a disease ecology model.