 Kiitos paljon, että olen tämän seminaarin. Minun ulkoma on varmasti erittäin erittäin, että koko ajan on tämä konferenssi, koska en ole ulkomaan ulkomaan, mutta olen epidemiologiasta ja joten olen tullut tämän asioon aika erittäin yksinkertaisesti kuin nämä teille. Mutta tämä on minun taito, että omistaa, mutta se on hyvin pyrkyn, mutta olen V pursuing our focus because I will mainly talk about how human anthropometrics can be used as an indicator of childhood living conditions, especially childhood nutrition and how human anthropometrics is associated with adult health especially in chronic diseases. But just to bit motivate this presentation, this is probably very clear, childhood is very important part of human life, There is a lot of speculation and quite a lot of evidence as well that under nutrition in childhood it has a very long lasting effect on human metabolism. But also there may be more behavioural factors explaining the association between childhood and adult health because we learn also many health habits at home. So we can think that there is also this kind of behaviour factors explaining associations between childhood and adulthood. It's very difficult to measure human nutrition because of course we could use surveys but it is notoriously difficult to measure nutrition even in adulthood and not to speak in childhood. On the other hand we can use register based information collected by United Nations but it gives only information about food consumption in an area level but we don't know anything about how this food is distributed within populations. And so as Yuko will explain in her presentations height has been used quite a lot as indicator of childhood nutrition especially in history of economics. But also it can be used in modern-day epidemiology because human growth is very sensitive for nutrition and so we can think that if there is an unknown nutrition for this particular child it can be seen as a shorter body height. This is just to illustrate how important phase of life childhood is in the formation of the adult anthropometrics. It is of course very important for height because height doesn't change anymore in adulthood except slight shrinking, shrinking old age. But this is this trait correlation and we can see that already at five years of age the correlation with adult height is about point eight. And even for BMI it's quite height it's point six but then it's rapidly increasing and so there is strong tracking in BMI also between childhood and adulthood. There is of course some decrease here just because of the puberty. And because we had twin data used in this study we were able to decompose this correlation to genetic and environmental correlations and maybe not surprisingly most part of this correlation between childhood and adulthood in height was explained by genetic correlation. It's here it's even higher than this trait correlation and there's also a strong genetic correlation in explaining BMI between childhood and adult BMI. And this is because you already told that height can be used as an indicator of childhood living conditions. At the population level height is very much differences in height is very much explained by genetic factors. We have studied in this slide by using twin studies from different populations how much genetic and environmental factors contribute the differences in height within these populations. And we can see that around 80% of the variation of height is because of the genetic differences between individuals. But there's also about from 20 to 10% of the variation can be explained by some factors common for these coat fins. And they can be for example some factors related to childhood socioeconomic background or these type of factors served by coat fins. And then we have about same amount of the variation is explained by specific environmental factors for each twin individual and this also includes a measurement error. So they may be some real environmental factors affecting individually for both twins but also some part of this variation is just because of the measurement error. And we can use this at the population level even when major part of this variation is because of genetic differences. We can use height as indicator of like in economy or like general welfare. And this is an example about the two Nordic countries, my home country Finland and Sweden. And this is how the height, adult height vary according to birth cohort. And Finland before the second birth war Finland was a pretty poor country about the level of the current developing countries. And we can see it as a shorter adult mean height in these cohorts born before second birth war. And this is seen first in both men and women. But when we come these cohorts born after second birth war we see that this difference in mean height it has rapidly decreased. And this will demonstrate that how sensitive this mean body height of the population is to other indicators of the economy in this nation. And this is just some global indicators about stunting of preschool children. And this well corresponds the results that you could show us about childhood mortality. We see that this prevalence is very high in African countries. But that is for me is quite surprising or even shocking that it is very high also in India. Because India is not maybe it's a poor country or middle income country. But it's much more affluent country that many African countries. And this may be because of the pure hygiene level in many areas of India. So this is not necessary only because of the cross national product of this kind of economic indicators. But it can also be because of the level of childhood diseases. But what is the importance of height for diseases. In this study we look at the association between height in childhood and adult mortality from cardiovascular in coronary heart disease in this slide. And this shows that one increase in the standard deviation of this adult this childhood height. It's associated with the lower risk of coronary heart disease. This is hazard ratios and so these hazard ratios lower than one indication lower risk to die from coronary heart disease. And we can see that this is especially high in adult in childhood. It's somewhat this association somewhat decrease coming closer to one in when looking this later later height. And so this indicates that especially childhood height would be the most informative indicator of the nutrition. And when look at adult height there's some catch up growth and so this association become somewhat weaker. But still even if you look at adult height we can still find an association between tall stature and lower risk of coronary heart disease or other cardiovascular diseases. But this association between height and health it's not limited only to physical diseases. In this study we analyzed the association between height and cognitive performance of elderly twins in Finland and Denmark. This may be a bit difficult to read this table but I have summarized the main message of this table here. And we can see that there is those elderly persons who are short. So they have lower cognitive performance in their old age than those who are tall ones. And we can see a very similar trend both in Finland and in Denmark. So please don't pay attention on these absolute numbers because this we use the same score here. But this Danish elderly persons were much older when the survey was conducted. And that's why this level of the cognitive performance is lower in this Danish survey. But still this height gradient is exactly the same. However at the moment under nutrition it's not so much problem anymore even in middle income societies. It's over nutrition it's become much more important problem. However it's surprising that these two opposites parts of nutrition they are not necessarily contradictory. Because we can find in societies we are actually suffering on double burden. That they suffer both from malnutrition and for excess nutrition. And this can also be clustered in the same families. For example we can well think that if the nutrition is poor quality people, the children may develop lack of different micronutrients. But still they have too much energy and so they develop obesity in childhood, in adulthood. And of course obesity is associated with a lot of chronic diseases. And this is a map of childhood overweight in different countries. And we see that it's especially difficult in Mexico and in United States even higher in Mexico. And then it's not so big problem in Asia and actually very low prevalence in Japan. And this results for girls. This actually is very big difference between Finland and Japan. Finland here and Japan here. We started to analyze socio-economic differences in BMI in Helsinki. And in Toyama, in civil servants. And we found that in Helsinki there is a very steep gradient socio-economic gradient in BMI. So that those who are in manual workers they have a higher BMI than those who are managers. But in Japan not only the level of BMI is much lower but in Japan we couldn't find any evidence about this. So socio-economic gradient. And the results are very similar for females as well. And this country occupation interaction effect is statistically highly significant for males and females. Just like in height also for BMI, the most part of the individual differences come from genetic factors. This is a meta-analysis of 19 studies. And we found that over the childhood and adolescence from 70 to 90% of the variation after meat childhood can be explained by genetic factors. However, this genetic component is not independent of environment. In this study we found that those who have high physical activity actually this genetic variation is lower than those who have sedentary lifestyle. And so you can by physical exercise you can suppress the genetic effect on obesity. And the very similar results were found in molecular genetic studies. This is genetic risk score of 16 known alleles of BMI. And we can see that in those who have a high genetic risk score of obesity they have a big difference between those who are physically active and those who are inactive. But we see only little difference in those who have at the low level of this genetic risk score. So couple of general conclusions. Childhood nutrition it has long lasting health effects. It has effects not only on physical health but also mental health. And like in these two previous presentation also this emphasises how important it is that we invest for belast nutrition in childhood. Because it has a very long lasting effects even decades. However, in western societies and increasingly also middle income societies, obesity is actually becoming more important problem than malnutrition. And hopefully we can get more information about this in the future. Because these genetic and environmental factors they are not operating independently but there is interaction effect also. And so hopefully in the future we can get more information that how this kind of macro environment how it modifies socio-economic differences and genetic differences affecting BMI. I'm just finishing soon. This is just to show that what information we will get in the future. This is new coded twins project time I'm heading and we have collected information on about 50 pink hearts from 22 countries. Information about height and BMI and also education and some baseline information and it's collected here in Helsinki. And hopefully based on this database we can get more information how macro environment modifies the genetic and environmental variation in height. Just thank you very much for all you and all twins. We have about half a million twins in this register and these two ones. Very young twins from Osaka Twin Festival. I was fortunate to participate last year and thank you for listening.