Life course health care and preemptive approach to non-communicable diseases

Abstract

Non-communicable diseases (NCDs), such as diabetes mellitus and coronary heart disease, are chronic, non-infectious diseases of long duration. NCDs are increasingly widespread worldwide and are becoming a serious health and economic burden. NCDs arise from complex interactions between the genetic make-up of an individual and environmental factors. Several epidemiological studies have revealed that the perinatal environment influences health later in life, and have proposed the concept of developmental programming or developmental origin of health and disease (DOHaD). These studies suggest the importance of life course health care from fetal life, early childhood, adulthood, and through to old age. Recent progress in genomics, proteomics and diagnostic modalities holds promise for identifying high risk groups, predicting latent diseases, and allowing early intervention. Preemptive medicine is the ultimate goal of medicine, but to achieve it, the full participation of the public and all sectors of society is imperative.

Figure 1.

Schematic representation of developmental programming. When insults such as undernutrition affect fetuses in utero, they are programmed to live in similar adverse environment after birth and body sizes are usually small. If intrauterine life is rich and problem-less, vice versa. If those who are programmed to adapt adverse environment actually live in affluent society in later life, they develop NCDs due to mismatch with programs.

Figure 2.

Models of growth and maintenance of islet beta cells throughout life and their response to increased insulin requirement in Caucasians and in Japanese. The Caucasian’s model is reproduced from the paper of Rhodes.²⁵⁾

Figure 3.

Human life history and life course health care. Life history in human is unique in some aspects. It has a long childhood and adolescence with delays of the first breeding. This might be evolved for maturing the brain, its cognitive ability and social behaviors. Another characteristic feature is menopause in females and long period as grandmothers that have helped probably the growth of grandchildren. “Programmed” means that a person is programmed to live in adverse environment after birth. Life course health care begins at periconceptual period, followed by care of pregnant mothers and fetuses. Early childhood care is as important as discussed in the text. Since human brain matures over a long period, physical and mental care of childhood and adolescence as well as health education are of great importance. In adulthood, regular check-ups are of importance and, if necessary, early intervention (preemptive approach) is effective for obviating serious diseases.

Figure 4.

Schematic representation of natural course of Alzheimer’s disease and importance of preemptive approach. Alzheimer’s disease develops through interactions of genetic and environmental factors. The role of perinatal environment is still not understood, but some cohort studies mentioned in the text showed that those who were exposed to adverse perinatal environment develop early decline of cognitive function, suggesting the possible involvement of fetal life. As environmental factors in adulthood, metabolic abnormalities such as type 2 diabetes become risk factors. It is possible to diagnose preclinical Alzheimer’s disease by some biomarkers or PET scanning, intervention before the onset of MCI will become the most important approach. In other words, preemptive medicine will become a standard approach for preventing Alzheimer’s disease.