Early nutritional determinants in cardio-metabolic programming – A prospective randomized controlled dietary intervention study

Western societies have been faced with the fact that overweight, impaired glucose regulation and elevated blood pressure are already prevalent in pediatric populations. This will inevitably mean an increase in later manifestations of cardio-metabolic diseases. The dilemma has been suggested to stem from fetal life and it is surmised that the early nutritional environment plays an important role in the process called programming. The aim of the present study was to characterize early nutritional determinants associating with cardio-metabolic risk factors in fetuses, infants and children. Further, the study was designated to establish whether dietary counseling initiated in early pregnancy can modify this cascade. Healthy mother-child pairs (n=256) participating in a dietary intervention study were followed from early pregnancy to childhood. The intervention included detailed dietary counseling by a nutritionist targeting saturated fat intake in excess of recommendations and fiber consumption below recommendations. Cardio-metabolic programming was studied by characterizing the offspring’s cardio-metabolic risk factors such as over-activation of the autonomic nervous system, elevated blood pressure and adverse metabolic status (e.g. serum high split proinsulin concentration). Fetal cardiac sympathovagal activation was measured during labor. Postnatally, children’s blood pressure was measured at six-month and four-year follow-up visits. Further, infants’ metabolic status was assessed by means of growth and serum biomarkers (32-33 split proinsulin, leptin and adiponectin) at the age of six months. This study proved that fetal cardiac sympathovagal activity was positively associated with maternal pre-pregnancy body mass index indicating adverse cardio-metabolic programming in the offspring. Further, a reduced risk of high split proinsulin in infancy and lower blood pressure in childhood were found in those offspring whose mothers’ weight gain and amount and type of fats in the diet during pregnancy were as recommended. Of note, maternal dietary counseling from early pregnancy onwards could ameliorate the offspring’s metabolic status by reducing the risk of high split proinsulin concentration, although it had no effect on the other cardio-metabolic markers in the offspring. At postnatal period breastfeeding proved to entail benefits in cardio-metabolic programming. Finally, the recommended dietary protein and total fat content in the child’s diet were important nutritional determinants reducing blood pressure at the age of four years. The intrauterine and immediate postnatal period comprise a window of opportunity for interventions aiming to reduce the risk of cardio-metabolic disorders and brings the prospect of achieving health benefits over one generation.

Determinants of Polylepis (Rosaceae) Forest Distribution and Treeline Formation in the High Andes

High elevation treelines are formed under common temperature conditions worldwide, but the functional mechanisms that ultimately constrain tree growth are poorly known. In addition to environmental constraints, the distribution of high elevation forests is largely affected by human influence. Andean Polylepis (Rosaceae) forests are an example of such a case, forests commonly growing in isolated stands disconnected from the lower elevation montane forests. There has been ample discussion as to the role of environmental versus anthropogenic causes of this fragmented distribution of Polylepis forests, but the importance of different factors is still unclear. In this thesis, I studied functional, environmental and anthropogenic aspects determining Polylepis forest distribution. Specifically, I assessed the degree of genetic determinism in the functional traits that enable Polylepis species to grow in cold and dry conditions. I also studied the role of environment and human influence constraining Polylepis forest distribution. I found evidence of genetically determined climatic adaptations in the functional traits of Polylepis. High elevation species had reduced leaf size and increased root tip abundance compared to low elevation species. Thus these traits have potentially played an important role in species evolution and adaptation to high elevation habitats, especially to low temperatures. I also found reduced photosynthesis rate among high elevation tree species compared to low elevation species, supporting carbon source limitation at treelines. At low elevations, Polylepis forest distribution appeared to be largely defined by human influence. This suggests that the absence of Polylepis forests in large areas in the Andes is the result of several environmental and anthropogenic constraints, the role of environment becoming stronger towards high elevations. I also show that Polylepis trees grow at remarkably low air and soil temperatures near treelines, and present new evidence of the role of air temperatures in constraining tree growth at high elevations. I further show that easily measurable indices of accessibility are related to the degree of degradation of Polylepis forest, and can therefore be used in the rapid identification of potentially degraded Polylepis forests. This is of great importance for the conservation and restoration planning of Polylepis forests in the Andes. In a global context, the results of this thesis add to our scientific knowledge concerning high elevation adaptations in trees, and increase our understanding of the factors constraining tree growth and forest distribution at high-­elevation treelines worldwide.

Genetic, prenatal and postnatal determinants of weight gain and obesity in young children – The STEPS Study

Genetic, Prenatal and Postnatal Determinants of Weight Gain and Obesity in Young Children – The STEPS Study University of Turku, Faculty of Medicine, Department of Paediatrics, University of Turku Doctoral Program of Clinical Investigation (CLIPD), Turku Institute for Child and Youth Research. Conditions of being overweight and obese in childhood are common health problems with longlasting effects into adulthood. Currently 22% of Finnish boys and 12% of Finnish girls are overweight and 4% of Finnish boys and 2% of Finnish girls are obese. The foundation for later health is formed early, even before birth, and the importance of prenatal growth on later health outcomes is widely acknowledged. When the mother is overweight, had high gestational weight gain and disturbances in glucose metabolism during pregnancy, an increased risk of obesity in children is present. On the other hand, breastfeeding and later introduction of complementary foods are associated with a decreased obesity risk. In addition to these, many genetic and environmental factors have an effect on obesity risk, but the clustering of these factors is not extensively studied. The main objective of this thesis was to provide comprehensive information on prenatal and early postnatal factors associated with weight gain and obesity in infancy up to two years of age. The study was part of the STEPS Study (Steps to Healthy Development), which is a follow-up study consisting of 1797 families. This thesis focused on children up to 24 months of age. Altogether 26% of boys and 17% of girls were overweight and 5% of boys and 4% of girls were obese at 24 months of age according to New Finnish Growth references for Children BMI-for-age criteria. Compared to children who remained normal weight, the children who became overweight or obese showed different growth trajectories already at 13 months of age. The mother being overweight had an impact on children’s birth weight and early growth from birth to 24 months of age. The mean duration of breastfeeding was almost 2 months shorter in overweight women in comparison to normal weight women. A longer duration of breastfeeding was protective against excessive weight gain, high BMI, high body weight and high weight-for-length SDS during the first 24 months of life. Breast milk fatty acid composition differed between overweight and normal weight mothers, and overweight women had more saturated fatty acids and less n-3 fatty acids in breast milk. Overweight women also introduced complementary foods to their infants earlier than normal weight mothers. Genetic risk score calculated from 83 obesogenic- and adiposity-related single nucleotide polymorphisms (SNPs) showed that infants with a high genetic risk for being overweight and obese were heavier at 13 months and 24 months of age than infants with a low genetic risk, thus possibly predisposing to later obesity in obesogenic environment. Obesity Risk Score showed that children with highest number of risk factors had almost 6-fold risk of being overweight and obese at 24 months compared to children with lowest number of risk factors. The accuracy of the Obesity Risk Score in predicting overweight and obesity at 24 months was 82%. This study showed that many of the obesogenic risk factors tend to cluster within children and families and that children who later became overweight or obese show different growth trajectories already at a young age. These results highlight the importance of early detection of children with higher obesity risk as well as the importance of prevention measures focused on parents. Keywords: Breastfeeding, Child, Complementary Feeding, Genes, Glucose metabolism, Growth, Infant Nutrition Physiology, Nutrition, Obesity, Overweight, Programming

The Impact of Foreign Direct Investment Inflows on the Economic Growth of Bangladesh. The Roles of Infrastructural Facilities

Foreign direct investment (FDI) inflow has been a key concern for Bangladesh to obtain additional support for the economic development. The Government of Bangladesh continuously competing with other South Asian countries and putting more effort to increase the number of FDI inflows in the country. From the country’s perspective, the constant increasing rate of economic growth shows a positive outcome of FDI inflow. However, the country still not performing up to the mark to pull enough FDI inflows to its potential. Thus, this study discusses about the major determinants and factors affecting FDI inflows in Bangladesh. Among those determinants and factors, infrastructural facility is considered as the most important to affect FDI inflows. FDI inflow is fundamentally depending upon infrastructural facilities to achieve its desire success. Foreign investors take this issue very seriously because based on this they can measure their ease of doing business in the host country. Despite of providing a large market size, due to having weak and lack of infrastructural facilities, Bangladesh is facing trouble in drawing attention of the foreign investors. In order to make the infrastructural facilities happen, it is highly required to organize each of the systems under of it. The body of this study discussed about the weak infrastructures in Bangladesh such as transport and communication, power and energy, education system, and governance services. Improvement in one of these systems cannot provide valuable positive changes on FDI inflows. It requires improvement in all the weak systems to grasp multinational companies and attract foreign investors. On the basis of this research problem, research questions are established. Both qualitative and quantitative methods are used to answer the research questions. Furthermore, several theories have been applied to justify possible scenarios from the research problem. In addition, the history in between Bangladesh, trade liberalization, and FDI inflows is presented briefly.

The Impact of Foreign Direct Investment Inflows on the Economic Growth of Bangladesh. The Roles of Infrastructural Facilities

Foreign direct investment (FDI) inflow has been a key concern for Bangladesh to obtain additional support for the economic development. The Government of Bangladesh continuously competing with other South Asian countries and putting more effort to increase the number of FDI inflows in the country. From the country’s perspective, the constant increasing rate of economic growth shows a positive outcome of FDI inflow. However, the country still not performing up to the mark to pull enough FDI inflows to its potential. Thus, this study discusses about the major determinants and factors affecting FDI inflows in Bangladesh. Among those determinants and factors, infrastructural facility is considered as the most important to affect FDI inflows. FDI inflow is fundamentally depending upon infrastructural facilities to achieve its desire success. Foreign investors take this issue very seriously because based on this they can measure their ease of doing business in the host country. Despite of providing a large market size, due to having weak and lack of infrastructural facilities, Bangladesh is facing trouble in drawing attention of the foreign investors. In order to make the infrastructural facilities happen, it is highly required to organize each of the systems under of it. The body of this study discussed about the weak infrastructures in Bangladesh such as transport and communication, power and energy, education system, and governance services. Improvement in one of these systems cannot provide valuable positive changes on FDI inflows. It requires improvement in all the weak systems to grasp multinational companies and attract foreign investors. On the basis of this research problem, research questions are established. Both qualitative and quantitative methods are used to answer the research questions. Furthermore, several theories have been applied to justify possible scenarios from the research problem. In addition, the history in between Bangladesh, trade liberalization, and FDI inflows is presented briefly