LEADing the way in a public health crisis
We are in the middle of a quiet crisis. 1 out of 10 Americans has diabetes. 1 out of 3 Americans has prediabetes – and 90% don’t even know. No other disease is as prevalent in our country or poses as severe an impact on quality of life for our communities. This is why we are dedicated to be at the forefront for changing how communities think about and, ultimately, reduce their risks of adiposity and diabetes.
To solve a problem as large and complex as diabetes, we knew we needed to think comprehensively about solutions. We’ve designed our approach to address the entire spectrum of the problem. Research at the LEAD Center integrates three critical approaches – the lifecourse, epidemiology, and team science.
Therefore, our mission focuses on three areas:
- To conduct research into the lifecourse health consequences of early and later life exposures that increase the risk and accelerate the onset of adiposity and diabetes
- To prevent the lifecourse health consequences of early and later life exposures
- To train the next generation of researchers and clinicians
What is the “Lifecourse”?
As we grow and develop, from the womb to old age, multiple exposures happen to us – and these exposures – nutritional, environmental, physical, infectious, and many others – cause us to respond in ways that are just beginning to be understood. It is crucial to integrate these multiple exposures, as well as the specific periods when they occur (called “critical periods”) to understand how to reduce or prevent their undesirable long-term outcomes such as adiposity (obesity), diabetes, heart disease, and cancer, among many diseases. This integration over time and critical periods is the “lifecourse” approach to health and disease.
Not only is a lifecourse approach important during childhood and adulthood, but it appears to be especially important during pregnancy for the baby’s development, when multiple control systems in the offspring may be ‘programmed’ about how to respond to exposures both during the pre-natal period as well as later in life.
This “Fetal Origins” hypothesis helps us understand (for example) how a mother’s pre-pregnancy weight, what she eats during pregnancy, how much weight she gains, and whether she smokes or not, will have lifelong effects on her child. In addition, there is evidence that these effects last into at least the next generation, so some of these exposures lead to effects that may be seen in grandchildren. Taking a “lifecourse” approach to the understanding of health and disease integrates the multiple forces that we experience daily into a more complete picture than can be developed by just looking at one or a few factors at one point in time. “Primordial” prevention over the lifecourse prevents risk factors before higher levels occur, which we believe is one of the strongest prevention approaches available, and it may help future generations. For example, preventing obesity development, harmful levels of blood pressure, elevated blood fats (lipids), blood sugar and inflammation factors will reduce the risk of future diabetes and heart disease among individuals who would otherwise be predisposed.
What does “Epidemiology” do?
Epidemiology is the study health and illness in populations. Thus, while individuals and their offspring are studied, relatively large numbers make up a population. Those who participate represent what happens, for example, to people living in Colorado and who have a set of exposures over time. The goal of epidemiology is to find factors that cause illness that can be changed to reduce or prevent illness, disability and early death.
Studies usually ‘observe’ populations through detailed studies that include asking about exposures, nutrition, physical activity, etc. as well as measuring many factors (for example height, weight, location of fatty tissues, blood samples, genes, markers of diet, levels of fitness). This information allows us to be able to assess the body’s responses to exposures throughout the lifecourse. Epidemiology integrates basic science, genetics, physiology, epigenetics, the microbiome (bacteria in our gut), family and social life, and population level factors such as economics, community safety, and even air pollution to produce as complete a picture as possible of the multiple stresses we encounter over our life. We are very interested in those factors that help make healthy children who are better able to develop into healthy adults over their own lifecourse.
Why “Adiposity” and “Diabetes”?
Two of the most important health events in modern society are adiposity (or the development of overweight and obesity) and diabetes mellitus, linked strongly to adiposity, which also increases the risk of heart disease, stroke, kidney failure, blindness, and excess mortality. Adiposity also increases the risk of several cancers, arthritis, depression, and a host of other undesirable outcomes. In addition, adiposity and diabetes are both increasing rapidly worldwide and are present at younger and younger ages. Thus, the Center’s focus on these two conditions, especially as they develop at an early age and throughout the lifecourse, is both important and timely.
What is “team science”?
Today’s complex issues in understanding the effects of the environment on growing up healthy require researchers with many different talents. To find, recruit, and study children and their mothers, for example, takes skills in epidemiology, recruiting, interviewing, and blood drawing, among others. Once such data are obtained, their understanding need computer specialists, biostatisticians, and an array of specialists, including laboratory scientists, pediatricians, behavioral scientists, environmental health scientists, radiologists, and more! As the figure above suggests, multiple overlapping areas comprise healthy growth and development. These teams meet regularly to discuss and review findings, develop new approaches to the next generation of studies, and publish the results (no individuals are ever identified, of course). This ‘team science’ is the best way to unravel the complex biology and social-environmental factors that help shape our future as healthy adults.