The Developmental Origins of Health and Disease: Adolescence as a Critical Lifecourse Period to Break the Transgenerational Cycle of NCDs-A Narrative Review

Abstract

Noncommunicable diseases (NCDs), including type 2 diabetes and cardiovascular disease, represent a significant and growing global health burden. To date, a primary focus has been on treatment approaches to NCDs once manifested rather than strategies aimed at prevention. In this context, there is clear evidence that a range of adverse early life exposures can predispose individuals towards a greater risk of developing NCDs across the lifecourse. These risk factors can be passed to future generations, thus perpetuating a cycle of disease. This concept, preferentially termed "developmental programming", forms the basis of the Developmental Origins of Health and Disease (DOHaD) framework. To date, DOHaD has focused on preconception, pregnancy, lactation and, more recently, paternal health at the time of conception. However, it is becoming increasingly clear that investment in the window of adolescence is perhaps the most critical developmental window. Adolescence is a period where lifestyle behaviours become entrained. Therefore, a focus on adolescent behaviours, health literacy and emotional development may afford the best opportunity to break the cycle of NCDs. As the next generation of parents, adolescents should therefore be considered a priority group in advancing appropriate and informed actions aimed at reducing NCD risk factors across the lifecourse. This advancement requires a more comprehensive community understanding and uptake of DOHaD knowledge and concepts. NCD prevention strategies have typically entailed siloed (and often disease-specific) approaches with limited efficacy in curbing NCD prevalence and breaking the transgenerational transmission of disease traits. Recent findings across various disciplines have highlighted that a lifecourse systems approach is required to establish a comprehensive and sustainable framework for NCD intervention. A whole community approach with a particular focus on adolescents as potential agents of change is necessary to break the disease cycle.

Keywords: DOHaD; adolescence; adolescents; developmental origins of health and disease; developmental programming; lifecourse; noncommunicable diseases.

Figure 1

The power of early intervention. Developmental origins of metabolic disease: lifecourse and intergenerational perspectives. The lifecourse approach emphasizes the complex interactions between environmental exposures from pre-conception onwards that influence chronic disease risk. NCD risk increases throughout the lifecourse and as such NCDs do not fit the typical disease model in which an individual is healthy until they contract a disease. The greatest period of developmental plasticity and therefore responsiveness to interventions is in early life. As ageing occurs, responses to new challenges become increasingly inadequate. As such interventions are best timed in early life—although these require a long-term commitment, they are likely to return greater impacts on NCD prevalence than treatment of disease once already manifest. Such an approach also helps mitigate the potential for transgenerational transmission of disease traits. Although an initial focus was on mothers and infants, and more recently on paternal health, there is an increasing recognition of adolescents, as the next generation of parents, as a key lifecourse window of opportunity to break the DOHaD cycle. Adapted with permission from Godfrey et al. [21].

Figure 2

Use of narrative-based pedagogies to support evidence-based actions. Information adapted from Bay et al. [83].

Figure 3

The different levels of Health Literacy. Figure developed using information adapted from Nutbeam [120].