Objective: The overall strategic objective for this programme is to improve cardiometabolic health across the lifecourse by addressing the developmental determinants of disease that arise before conception and during pregnancy. The programme takes a behavioural systems approach to improving health across the lifecourse with an emphasis on preconception and pregnancy.
Non-communicable disease (NCDs) affect people of all ages and WHO has defined them as the world’s biggest killers. Cardiometabolic diseases, including cardiovascular disease and diabetes, account for a significant proportion of the NCD disease burden. Poor diet and physical inactivity, which cost the NHS £6 billion and £1 billion each year respectively, are fuelling increasing levels of overweight and obesity in children and adults, leading to increased risk of cardiometabolic disease at population level.
The risk of NCDs and cardiometabolic disease increases across the lifecourse due to declining plasticity and the accumulative effects of inadequate responses to new challenges (brown/grey triangles). The greatest increase in risk is seen in adult life, but the trajectory is set much earlier, influenced by factors arising before conception and during pregnancy, such as maternal health behaviours and body composition. Timely intervention in the early phases of the lifecourse can have a large effect on disease risk in adulthood and old age (blue arrow). We focus on the early phases of the lifecourse – ‘preconception’, pregnancy/infancy’ and ‘childhood/adolescence’, (shown in darker brown/grey) recognising that early intervention improves functional capacity and response to new challenges and that behaviour change influences gene expression through epigenetic processes. Our objectives in relation to understanding the determinants of cardiometabolic health, the mechanisms that link behaviour to health, and developing interventions to improve health behaviours and body composition, focus particularly on these phases of the lifecourse. Achieving these objectives in these early phases of the lifecourse not only improves health then but also at later stages of the lifecourse in adulthood and old age, shown in lighter grey. In this way, the programme has at its heart, the improvement of cardiometabolic health, and prevention of disease, across the entire lifecourse.
We are taking a behavioural systems approach to improving cardiometabolic health across the lifecourse focusing on the early phases of the lifecourse – preconception and pregnancy. This approach recognises that behaviour change occurs within a complex adaptive system that is the product of multiple interacting influences in several different domains as shown in figure 2. Some of the main studies being carried out within the programme are described in links that follow.
Programme 6 mission: The programme has four inter-related objectives:
- to characterise the determinants of cardiometabolic health across the lifecourse, that arise during preconception, pregnancy and in early life
- to elucidate the behavioural mechanisms that link preconception, pregnancy and early life determinants with later cardiometabolic health
- to use our observational and mechanistic findings to inform the development of complex behavioural interventions to optimise cardiometabolic health;
- to translate our findings into policy and practice