Epidemiology of “Hunger in the World” the “Hunger-Obesity Paradox”, the "Fetal Origins Hypothesis" and its Physiological and Endocrinological Mechanisms pp. 187-224
Authors: (V.J.T. van Ginneken, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands)
Abstract: Hunger occurs in sub-Saharan Africa and in South Asia. Every year almost 16,000 children die from hunger-related causes in combination with an impaired immune-system, nearly one child every 5 seconds. Strange enough in the richest economy of the World, the USA, there is a Hunger-Obesity Paradox. This can be ascribed to coping strategies to food insecurity and food insufficiency in low income households to buy high-fat foods to prevent hunger. Unraveling the mechanism of starvation, which rely on stores/substrates earlier provided by food components will not be simple but is likely to provide insights into the individual response to starvation and its deteriorating health as a consequence to starvation/ malnutrition. Several epidemiological studies support the "Fetal origins Hypothesis" followed by the "thrifty phenotype" hypothesis. These state that fetal under-nutrition in middle or late gestation is programmed to exhibit a "thrifty phenotype" resulting in offspring with Metabolic Syndrome (obesity, hypertension, diabetes-2) as a result of in utero environ-mental alterations and implicate enhanced appetite and adipogenesis as contributory factors. It is suggested via epigenetic inheritance systems starvation of the parents and obesity (=> diabetes 2) of the offspring are related. Undeniably, to understand the interaction of fuels in the homeostasis of metabolism, there is besides a reductionistic approach for “one-gene” defect mutations, a need for additional research in the –omics of starvation and/or malnourishment and this should be integrated into epidemiological studies. Systems Biology and its rapid development is based on progress in nutrition, bioinformatics and molecular biology and can give us biomarkers for starvation and ultimately a personalized medical treatment.