PREVENTING
PRECURSORS OF ADULT DISEASES
Najjar S.S.
Faculty
of Medicine - American University of Beirut - Lebanon
Many
serious adult diseases have their pathologic roots in infancy and
childhood. Preventing or managing many of these precursors in the pediatric
age group will obviate their appearance or decrease their severity in
adulthood. Several of these precursors are related primarily to the life
style of these children and are more easily remedied than those pathologies
of undetermined etiology.
The
more common such precursors include Obesity Uterine Growth Retardation
(IUGR), Osteopenia, Premature Adrenarche, Tobacco Smoking and Abuse.
Obesity: Adiposity in infancy and childhood is a strong
predictor of young adult obesity along with its accompanying cardiovascular
risks including hypercholesterolemia in particular LDL cholesterol,
hypertension and the Insulin Resistance Syndrome. Moreover, claims have
been made that obese adults have an increased risk of cancer of the breast,
prostate and pancreas.
IUGR: Children born small for gestational age are more prone to develop
in later life obesity, hypertension, increased lipoproteins, coronary
artery disease, hyperinsulinism with all its ramifications and renal
failure. Premature adrenarche is also frequently associated with IUGR. The
exact mechanism of the fetal adaptations invoked when the maternoplacental
nutrient supply fails to match the fetal nutrient demand has yet to be
elucidated.
Osteopenia: There are two critical periods during which
bone density is maximized, namely in early infancy and during
midadolescence. Any factor that decreases bone density in these two periods
will predispose to osteoporosis in adults. Examples of such pathology
include delayed puberty, Turner syndrome, Klinefelter syndrome,
hypogonadism, growth hormone deficiency, Cushing syndrome, glucorticoid
therapy, celiac disease, anorexia nervosa, inflammatory bowel disease,
rheumatoid arthritis and other chronic diseases of childhood and
adolescence.
Premature Adrenarche: Premature adrenarche seems to
predispose to hyperinsulinism and syndrome X in adolescents and young
adults.
Smoking: Both passive and active exposure to tobacco
have adverse consequences for children and adolescents resulting in
decreased life expectancy. Exposure to tobacco may lead to endothelial
injury, particularly to atheroma of the aorta, increased levels of
lipoproteins, impaired exercise performance, altered oxygen delivery and
lung cancer.
Abuse: Children
subject to physical and, or, sexual abuse have an increased risk of
developing bipolar psychiatric disorders as adults. A high percentage of
adult perpetrators of violence had a history of being physically
abused.