Magnetic resonance imaging of abdominal adiposity in a large cohort of British children

OBJECTIVE

To describe abdominal adipose tissue distribution in a large sample of contemporary British children; to determine the influence of gender, stage of maturation and body mass index (BMI) on abdominal adipose tissue distribution; and to compare the ability of BMI and waist circumference to predict abdominal adipose tissue.

SUBJECTS AND METHODS

A total of 74 boys (mean age 13.4+/-0.4 years) and 96 girls (mean age 13.5+/-0.5 years) were selected from volunteer children enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Height, weight and waist circumference were measured and BMI calculated. Stage of sexual maturation was available for 113 children using a self-report questionnaire based on Tanner's criteria. Magnetic resonance imaging was used to assess subcutaneous abdominal adipose tissue (SAAT) and intra-abdominal adipose tissue (IAAT) volumes and patterning.

RESULTS

Boys had lower levels of IAAT (P=0.036) and SAAT (P=0.003) than girls. IAAT and SAAT were higher in overweight and obese boys and girls when compared with normal weight children (P<0.0001). This pattern was also reflected in waist circumference groups. Boys had higher IAAT/SAAT ratios than girls, indicating proportionately more adipose tissue deposited intra-abdominally (P=0.002). However, both boys and girls deposited less than 10% of their abdominal fat as internal adipose tissue. WC predicted 67.4% of the variance in IAAT (P<0.001), and BMI predicted 84.8% of the variance in SAAT (P<0.001). However, BMI as the best single predictor explained only 8.4% of the variance in the IAAT/SAAT ratio (P<0.001).

CONCLUSIONS

At this age and stage of sexual maturation, the amount of IAAT remains relatively small. WC and BMI offer a feasible alternative to the MRI estimation of IAAT and SAAT, respectively, in a population-based sample of boys and girls. International Journal of Obesity (2008) 32, 91-99; doi:10.1038/sj.ijo.0803780; published online 27 November 2007.

Is there an intrauterine influence on obesity? Evidence from parent child associations in the Avon Longitudinal Study of Parents and Children (ALSPAC)

BACKGROUND

It has been suggested that increasing obesity levels in young women lead to intrauterine environments that, in turn, stimulate increased obesity among their offspring, generating an intergenerational acceleration of obesity levels. If this mechanism is important, the association of maternal body mass index (BMI) with offspring BMI should be stronger than the association of paternal with offspring BMI.

OBJECTIVE

To compare the relative strengths of association of maternal and paternal BMI with offspring BMI at age 7.5, taking into account the possible effect of non-paternity.

METHODS

We compared strength of association for maternal-offspring and paternal-offspring BMI for 4654 complete parent-offspring trios in the Avon Longitudinal Study of Parents and Children (ALSPAC), using unstandardised and standardised regression analysis. We carried out a sensitivity analysis to investigate the influence of non-paternity on these associations.

RESULTS

The strength of association between parental BMI and offspring BMI at age 7.5 was similar for both parents. Taking into account correlations between maternal and paternal BMI, performing standardised rather than unstandardised regression and carrying out a sensitivity analysis for non-paternity emphasised the robustness of the general similarity of the associations. The associations between high parental BMI (top decile) and offspring BMI are also similar for both parents.

CONCLUSION

Comparison of mother-offspring and father-offspring associations for BMI suggests that intergenerational acceleration mechanisms do not make an important contribution to levels of childhood BMI within the population. Associations at later ages and for different components of body composition now require study.

Phase I trial of daily lenalidomide and docetaxel given every three weeks in patients with advanced solid tumors

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Background: Lenalidomide is a potent anti-angiogenic and immune modulating agent. This phase I trial of docetaxel and lenalidomide was undertaken to evaluate the maximal tolerated dose (MTD), dose-limiting toxicity (DLT), and secondarily, any tumor response for this novel combination. Methods: Patients with advanced solid tumors with adequate organ function were eligible. Lenalidomide was given orally days 1–14, and docetaxel was administered intravenously on day 1 of each 21-day cycle. DLT was defined as grade 3 or higher non-hematologic toxicity, grade 4 neutropenia with fever, and grade 4 anemia or thrombocytopenia. Results: Nineteen patients, 14 male and 5 female, with tumor types including prostate (7), sarcoma (3), head and neck (2), pancreatic, colon, melanoma, adenocarcinoma of unknown primary, gastric, bladder, and GIST have been enrolled. ECOG performance status was zero (10 patients) or one (9 patients). The median age was 59 years (range 35 to 86). Fourteen patients had zero or one prior treatment regimens (range 0 to 6). A total of 64 cycles have been administered (range 1 to 12). In the first nine evaluable patients, eight (89%) had grade 3 or 4 neutropenia. Docetaxel 75 mg/m2 given every 3 weeks with lenalidomide 5 mg on days 1–14 exceeded the MTD due to one grade 3 nausea/vomiting and one grade 4 neutropenia with fever. After the addition of pegfilgrastim on day 2, there has not been any neutropenia in the subsequent seven evaluable patients. Other grade 3 and 4 toxicities included leukopenia (31%), lymphopenia (19%), as well as nausea, vomiting, fatigue, anemia, infection, hyponatremia, and hypokalemia (6% each). Seven patients (44%) have had stable disease (range 3 to 12 cycles). One prostate cancer patient experienced a >95% reduction of PSA. Enrollment is ongoing and the current dose level is docetaxel 75 mg/m2, lenalidomide 10 mg days 1–14, and pegfilgrastim on day 2. Conclusions: The toxicity evaluation is ongoing. This trial will provide the MTD of docetaxel 75 mg/m2 given every 3 weeks with lenalidomide on days 1–14 in combination with pegfilgrastim support to avoid neutropenia.

No significant financial relationships to disclose.

Intraindividual Variation of Objectively Measured Physical Activity in Children

PURPOSE

This study examined the seasonal and intraindividual variation in objectively measured physical activity in 11- to 12-yr-olds.

METHODS

Children were asked to wear a uniaxial accelerometer for 7 d four times throughout the course of about a year. A random-intercepts model was used to separate the inter- and intraindividual components of physical activity. Gender, age, body mass index (BMI), height, and month of measurement were fitted to the model as potential confounders.

RESULTS

A total of 315 children had valid data for at least two measurement occasions, and 244 had data for all four measurement occasions. The unadjusted intraclass correlation coefficient (ICC) for total activity (counts per minute) was 0.54; 0.49 after adjusting for gender, age, and BMI; and 0.53 after adjusting for gender, age, BMI, and month. Further adjustment for pubertal status at baseline had no effect on the ICC. Restricting the analysis to only those with data for all four measurement occasions (N=244), or to measurements taken on school days only, had no effect on the ICC. The fully adjusted ICC was 0.51 for weekdays only and 0.39 for weekend days only. For minutes of moderate to vigorous physical activity, minutes of vigorous activity, minutes of sedentary behavior, and number of 30-min blocks of sedentary behavior, the fully adjusted ICC were 0.45, 0.37, 0.59, and 0.39, respectively. The analysis was repeated for boys and girls separately, but the differences in ICC were small.

CONCLUSION

There was substantial intraindividual variation in the objectively measured physical activity of these children. Studies using single a measurement occasion where physical activity is the exposure should take this into account to adjust for regression dilution.

Dose-modified oral chemotherapy for AIDS-related non-Hodgkin’s lymphoma (AR-NHL) in East Africa

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Background: Dose-modified chemotherapy for AR-NHL in the pre-HAART era has been shown to be equally efficacious and less myelotoxic [N Engl J Med 1997;336:1641 (mBACOD); J Clin Oncol 2001;19:2171 (mCHOP)]. In resource-constrained settings, intravenous chemotherapy and supportive care of the AIDS/cancer patient are challenging (J Natl Cancer Inst 2002;94:718). Methods: We embarked on a pilot feasibility trial of dose-modified oral chemotherapy [lomustine 50 mg/m2 D1 (C1 only); VP-16 100 mg/m2 D1–3; and cyclophosphamide/procarbazine 50 mg/m2 each D22–26 at 6-week intervals (1 cycle) for 2 cycles] in HIV-infected patients with biopsy-proven AR-NHL in East Africa. Results: A total of 52 pts (23 Uganda; 29 Kenya) were registered to study. The majority of pts were female (56%) with median age 39 yrs (range 18–64); poor PS (2 or 3) - 62%; high grade lymphoma (65%); advanced stage (III or IV) - 67%; and B symptoms (79%). At study entry median CD4 count was 207/μL and HIV-1 viral load 98,857 copies/ml. Nineteen pts (37%) had access to ARV. A total of 74.5 cycles of therapy were administered to 49 pts (median 2; range 0.5–2). The regimen was well tolerated. There were 4 episodes of febrile neutropenia and 3 treatment-related deaths (6% mortality rate). Overall objective response rate is 67% (CR/uCR 49%); median survival 8.2 months (range <1.0 to 52.5+ mos.); and 22 patients remain alive as of 10/7/05. Conclusions: Dose-modified oral chemotherapy is efficacious, has comparable outcome to that in the US in pre-HAART era, an acceptable safety profile, and is pragmatic in the resource-limited setting. Further investigation of the oral regimen vs. mCHOP is warranted. [Supported in part by NIH grants: CA83528, AI36219, CA70081, and TW00011. Bristol-Myers Squibb and Sigma Tau Pharmaceuticals provided the chemotherapy drugs for this trial.] (J. Black, PhD, formerly DCTD, NCI, Bethesda, MD, USA).

No significant financial relationships to disclose.

Oral combination chemotherapy in the treatment of AIDS-associated Hodgkin's disease

OBJECTIVES

To determine the effectiveness of an oral combination chemotherapy regimen administered to patients with AIDS-associated Hodgkin's disease.

DESIGN

Prospective, pilot phase II clinical trial.

SETTING

Consecutive patient recruitment occurred at two medical centers in the United States: Albany Medical Center, Albany, New York, where patients were recruited prior to December 31, 1996 (pre-HAART era); and University Hospitals of Cleveland, Cleveland, Ohio, where patients were recruited after January 1, 1997 (HAART era).

INTERVENTION

Oral chemotherapy consisted of lomustine (100 mg/m2 day I for cycle one and odd cycles thereafter); etoposide (200 mg/m2 days 1 through 3); and cyclophosphamide and procarbazine (each 100 mg/m2 days 22 through 31). Cycles were repeated every six weeks. Colony-stimulating factor support (G-CSF in all instances) was allowed.

MAIN OUTCOME MEASURES

Clinical demographic variables, peripheral blood counts, serum chemistries, CD4 lymphocyte count, histopathological subtype of Hodgkin's disease were identified for all patients, who were staged according to Ann Arbor criteria.

DATA ANALYSIS

Common Toxicity Criteria were utilized to assess safety; response was assessed using ECOG criteria; and survival was analyzed by Kaplan-Meier methods and difference of survival between pre-HAART and HARART era was compared using log-rank test.

RESULTS

Eleven patients (six in pre-HAART era), all but one male, with a median age of 36 years, excellent performance status and advanced International Prognostic Score were treated. Myelosuppression was the major side effect and there were minimal other grade 3 or greater toxicity all of which were promptly reversible. An overall objective response rate of 82% (with 18% complete responses) and median survival duration of 24 months (range 2.5 +/- 68) were observed. Survival was markedly improved in patients treated in the HAART era (median not reached versus 7.25 months, p = 0.034).

CONCLUSIONS

This feasibility study demonstrates acceptable tolerance and excellent clinical activity of oral combination chemotherapy in patients with AIDS-associated Hodgkin's disease. Improved survival is observed in combination with HAART therapy. Dose-modification of this regimen would be suitable to evaluate in the resource constrained setting and larger confirmatory studies are encouraged.

Sex-discordant associations with adiponectin levels and lipid profiles in children

In adults, lower circulating levels of the adipocyte-derived hormone adiponectin are associated with obesity, type 2 diabetes, and cardiovascular disease risks. Its use as a risk marker in children is less clear. In 839 children aged 8 years from a representative birth cohort, circulating adiponectin levels were associated with body weight, BMI, waist circumference, and fasting and 30-min insulin levels, but the associations were opposite in boys, with positive associations, and girls, with inverse associations (P = 0.008-0.00001 for interaction with sex). Girls had overall higher adiponectin, higher total cholesterol, lower HDL cholesterol, and higher triglyceride levels than boys, even after adjustment for BMI. With increasing BMI, girls showed steeper declines in HDL cholesterol (P = 0.01 for interaction) and adiponectin levels (P = 0.0005 for interaction) and a steeper increase in triglyceride levels (P = 0.009 for interaction) compared with boys. In conclusion, plasma adiponectin is not a simple marker of central fat and insulin sensitivity in children. With increasing BMI, decreasing adiponectin levels in girls could contribute to their faster deterioration in lipid profiles in comparison with boys. Our data suggest a complex age- and sex-related regulation of adiponectin secretion or clearance.

Dietary energy intake at the age of 4 months predicts postnatal weight gain and childhood body mass index

OBJECTIVE

Rapid infant weight gain has been shown to predict later obesity risk; however, it is unclear which factors influence infant diet and weight gain. The objective of this study was to determine whether different feeding patterns and energy intakes that are provided to infants affect body weight and BMI later in childhood.

METHODS

This representative birth cohort study was conducted in the United Kingdom. Energy intake at age 4 months was estimated from 1-day unweighed dietary records in 881 infants and related to their childhood weight gain and BMI.

RESULTS

Among formula- or mixed-fed infants (N = 582), energy intake was higher in first-born infants (mean +/- SE: 2730 +/- 29.4 kJ/day; n = 263) than in subsequent-born infants (2620.8 +/- 25.2 kJ/day; n = 296). Energy intake at 4 months was also higher in infants who were given solid foods earlier (1-2 months: 2805.6 +/- 50.4 kJ/day, n = 89; 2-3 months: 2658.6 +/- 25.2 kJ/day, n = 339; 4+ months: 2587.2 +/- 46.2 kJ/day, n = 111). Higher energy intake at 4 months predicted greater weight gain between birth to age 1, 2, or 3 years and larger body weight and BMI at ages 1 to 5 years. No significant associations were seen in breastfed infants (N = 299).

CONCLUSIONS

Among formula- or mixed-fed infants, dietary energy intake at age 4 months predicted postnatal weight gain and childhood obesity risk. Both prenatal and postnatal factors may influence infant energy intake and postnatal weight gain.

Sun-safety behaviors of skiers and snowboarders on the South Island of New Zealand

AIMS

To study sun-protective behaviors among skiers and snowboarders on the South Island of New Zealand and to identify associations with personal characteristics or weather conditions.

METHODS

Two hundred twenty-six skiers and snowboarders completed an interviewer-administered questionnaire during September and October 2002. Reported behaviors were used to derive a composite sun-protection index, which was used to divide the sample into "protected" and "unprotected" groups. Odds ratios of being unprotected were calculated by logistic regression.

RESULTS

Forty-eight percent (95% CI 42-54%) of interviewees recalled being sunburned while skiing or snowboarding in the past. Sixty-eight percent (95% CI 62-74%) were unaware of any educational messages specific to sun protection while skiing or snowboarding. Women were more likely to be protected from the sun (OR 0.47; 95% CI 0.27-0.81). Having a skin type resistant to burning (OR 1.93; 95% CI 0.92-4.06) and reported awareness of education messages (OR 1.66; 95% CI 0.92-2.99) were associated with not using sun protection.

CONCLUSIONS

Sunburn is common and sun protection not used by all. Men are less likely to report use of sun-protection measures. There is no evidence from this study that current strategies are effective in promoting skin protection while skiing or snowboarding.

Smoking during pregnancy and components of stature in offspring

The objective of this study was to examine the association between maternal smoking during pregnancy and offspring height and its components. The analysis was based on 6,340 white singletons born in 1991-1992 and enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC), who had maternal smoking data recorded for at least one trimester in pregnancy, and who had their height recorded at age 7.5. Smoking at any time in pregnancy was associated with a reduction in offspring height, trunk, and leg length, and the leg-to-trunk ratio, after adjustment for age and sex. After additional adjustment for maternal factors, social factors, and breastfeeding, associations with leg length and leg-to-trunk ratio remained, with reductions of 0.25 cm (95% confidence interval, 0.05-0.46 cm) in leg length and 0.30% (95% confidence interval, 0.03-0.57%) in leg-to-trunk ratio if the mother smoked. Findings were similar when the smoking data were analyzed separately for each trimester. Furthermore, in each trimester, the more a mother smoked, the greater the reduction in offspring height, leg length, and leg-to-trunk ratio. These dose-response relationships remained after adjustment for all potential confounders for leg length and leg-to-trunk ratio. Smoking at any time in pregnancy reduces offspring height and its components, and in particular leg length and leg-to-trunk ratio at age 7.5.

Social position affects bone mass in childhood through opposing actions on height and weight

We studied relationships between social position of the mother in pregnancy and bone mass of the child at age 9.9 years. The tendency for social position to increase bone area and bone mass through a positive influence on height was opposed by a negative effect of social position on weight and fat mass.

INTRODUCTION

Evidence that social factors influence skeletal growth raises the possibility that bone mass acquisition in childhood is socially determined.

MATERIALS AND METHODS

To clarify the role of social factors in bone mass acquisition in childhood, we studied relationships between these variables in the Avon Longitudinal Study of Parents and Children (ALSPAC). Measures of the mother's social position during pregnancy were linked to DXA results obtained at age 9.9 years in 6,702 children. Linear regression analyses were carried out after adjusting for age and gender. Because social position may affect height and weight of the child, analyses were repeated after adjusting for these additional variables.

RESULTS

Measures of social position in pregnancy were unrelated to total body BMC in analyses adjusted for age and gender alone. However, after adjusting for height, which was positively related to social position, a strong negative association was observed between BMC and housing tenure (p < 0.001), maternal education (p < 0.001), paternal education (p < 0.001), and social class (p < 0.001). Similar results were obtained for bone area. After adjusting for weight as well as height, an association between social position and BMC and bone area was no longer observed. Hence, social position seems to exert opposing height- and weight-dependent effects on BMC and bone area in childhood. In further analyses, we found that adjusting for fat mass of the child led to similar results to those obtained with weight.

CONCLUSIONS

Social position in childhood seems to be positively related to bone mass acquisition in childhood as a consequence of enhanced gain in height (i.e., longitudinal growth). However, this influence is counteracted by the tendency for increased fat deposition in those from a lower social position to increase bone area, presumably reflecting the stimulation of appositional bone growth.

Milk consumption, stroke, and heart attack risk: evidence from the Caerphilly cohort of older men

OBJECTIVE

To examine associations between milk consumption and incident heart disease and stroke.

DESIGN

A representative population sample of men was asked to weigh and record their food intake for seven days. The total consumption of milk was obtained from these records. Details of all deaths and vascular events were collected during the following 20 years. Incident ischaemic strokes and heart disease events were diagnosed by standard criteria.

SETTING

The Caerphilly cohort, a representative population sample of men in South Wales, aged 45-59 when first seen in 1979-83.

PARTICIPANTS

A representative 3:10 subsample of the men in the cohort.

MAIN RESULTS

665 men (87% of those approached) returned satisfactory seven day diet diaries. After adjustment, the relative odds of an event in the men whose milk consumption was the median or higher, relative to those with lower intakes of milk, were 0.52 (0.27 to 0.99) for an ischaemic stroke and 0.88 (0.56 to 1.40) for an ischaemic heart disease event. Deaths from all causes were similar in the two milk consumption groups (relative odds 1.08; 0.74 to 1.58).

CONCLUSIONS

These results give no convincing evidence of an increased risk of vascular disease from milk drinking. Rather, the subjects who drank more than the median amount of milk had a reduced risk of an ischaemic stroke, and possibly a reduced risk of an ischaemic heart disease event. These conclusions are in agreement with the results of a previously reported overview of 10 large, long term cohort studies based on food frequency intake records.

Maternal diet in pregnancy and offspring height, sitting height, and leg length

STUDY OBJECTIVE

To examine the association between maternal diet in pregnancy and offspring height, sitting height, and leg length.

DESIGN

Cohort study.

SETTING

South west England.

PARTICIPANTS

6663 singletons (51% male) enrolled in the Avon longitudinal study of parents and children, with information on their mother's diet in late pregnancy (obtained by food frequency questionnaire) and their own height recorded at age 7.5 years.

MAIN RESULTS

Before adjustment, maternal magnesium, iron, and vitamin C were the nutrients most consistently associated with offspring height and its components. However, adjusting for potential confounders weakened all relations considerably. For example, a standard deviation (SD) increase in magnesium intake was associated with a 0.10 (-0.07, 0.14) SD unit increase in height before adjustment, which was reduced to 0.05 (0.01, 0.08) SD units after adjustment, and a SD unit increase in iron intake was associated with 0.08 (0.05, 0.12) and 0.04 (0.01, 0.08) SD unit increases in height before and after adjustment respectively. No other dietary variables were associated with height or its components after adjustment.

CONCLUSIONS

These findings do not provide evidence that maternal diet in pregnancy has an important influence on offspring height, sitting height, or leg length in well nourished populations, although effects may emerge as offspring become older.

The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study

BACKGROUND

Pre-school children are frequent users of health services, but little contemporary data are available describing their symptoms or why they consult.

OBJECTIVE

To describe symptom and consultation prevalence in pre-school children and to identify the socio-demographic factor or factors associated with consultations for those symptoms.

METHODS

Prospective cohort study of 13,617 pre-school children living in south-west England. Parents completed questionnaires asking about symptoms and consultations for those symptoms at six, 18, 30, 42 and 57 months.

RESULTS

During the pre-school years, all children experienced one or more symptoms, most commonly cold, cough, high temperature, vomiting or diarrhoea. Ninety seven percent consulted a doctor at least once, most commonly for cough, high fever and/or earache. Lower parity was most strongly and consistently associated with higher consultation rates.

CONCLUSIONS

Fever, respiratory and gastro-intestinal symptoms are a normal part of pre-school life. Research of acute conditions in young children could focus on the most common symptoms leading to consultation, namely cough, fever and earache. Efforts to support parents' help seeking decision making might usefully be targeted at first time parents.

Early life risk factors for obesity in childhood: cohort study

OBJECTIVE

To identify risk factors in early life (up to 3 years of age) for obesity in children in the United Kingdom.

DESIGN

Prospective cohort study.

SETTING

Avon longitudinal study of parents and children, United Kingdom.

PARTICIPANTS

8234 children in cohort aged 7 years and a subsample of 909 children (children in focus) with data on additional early growth related risk factors for obesity.

MAIN OUTCOME MEASURES

Obesity at age 7 years, defined as a body mass index (3) 95th centile relative to reference data for the UK population in 1990.

RESULTS

Eight of 25 putative risk factors were associated with a risk of obesity in the final models: parental obesity (both parents: adjusted odds ratio, 10.44, 95% confidence interval 5.11 to 21.32), very early (by 43 months) body mass index or adiposity rebound (15.00, 5.32 to 42.30), more than eight hours spent watching television per week at age 3 years (1.55, 1.13 to 2.12), catch-up growth (2.60, 1.09 to 6.16), standard deviation score for weight at age 8 months (3.13, 1.43 to 6.85) and 18 months (2.65, 1.25 to 5.59); weight gain in first year (1.06, 1.02 to 1.10 per 100 g increase); birth weight, per 100 g (1.05, 1.03 to 1.07); and short (< 10.5 hours) sleep duration at age 3 years (1.45, 1.10 to 1.89).

CONCLUSION

Eight factors in early life are associated with an increased risk of obesity in childhood.

Endothelial Dysfunction in Childhood Infection

Background— Atherosclerosis begins in early life, and endothelial dysfunction is recognized as a key initiating event in the development of atherosclerosis. Although infection has been implicated in endothelial dysfunction and atherogenesis, the impact of acute common childhood infections on the vascular endothelium is unknown.

Methods and Results— We studied 600 children aged 10 years drawn from the Avon Longitudinal Study of Parents and Children. The children were divided into 3 groups: those with current acute infection (AI; n=135; 73 boys and 62 girls); a convalescent group with infection in the past 2 weeks (n=166; 78 boys and 88 girls), and a healthy control group (n=299; 131 boys and 168 girls). Endothelial function was determined in all subjects by high-resolution ultrasound to measure brachial artery flow-mediated dilation (FMD) and was expressed as the percentage change in diameter from baseline after reactive hyperemia. FMD was repeated in 40 children in the AI group and 50 in the control group after a mean interval of 1 year. FMD was lower in both the AI group (6.3±2.7%, mean±SD) and the convalescent group (8.1±3.1%) than in the control group (9.7±2.5%; P <0.001 for both). The observed differences in FMD remained after adjustment for potential confounding variables. At the repeat visit, FMD was unchanged in controls ( P =0.85) but improved in the AI group ( P <0.001).

Conclusions— Acute infection in childhood is associated with impaired endothelium-dependent vasodilation. These findings support a potential role for previously unsuspected extrinsic inflammatory stimuli in the pathogenesis of early atherosclerosis.

Maternal fish intake in late pregnancy and the frequency of low birth weight and intrauterine growth retardation in a cohort of British infants

OBJECTIVE

To investigate the relation between maternal fish intake in late pregnancy and the frequency of low birth weight and intrauterine growth retardation (IUGR).

PARTICIPANTS

11 585 pregnant women in south west England.

METHODS

Information on fish intake was obtained from a food frequency questionnaire sent to the women at 32 weeks' gestation, and used to calculate n-3 fatty acid (n-3FA) intake from fish. IUGR was defined as a birth weight for gestational age and sex below the 10th centile. Confounding variables considered included maternal age, height, weight, education, parity, smoking and drinking in pregnancy, and whether the mother was living with a partner. Only singleton, liveborn infants were included.

MAIN RESULTS

Mean daily intakes of fish and n-3FAs were 32.8 g and 0.147 g respectively. In unadjusted analyses there were positive associations between mean birth weight and fish intake or n-3FA intake, but these disappeared on adjustment for potential confounders. The frequency of IUGR decreased with increasing fish intake-the OR (95%CI) of IUGR in those eating no fish was 1.85 (1.44 to 2.38) compared with those in the highest fish intake group. On adjustment this relation was attenuated (adjusted OR 1.37 (1.02 to 1.84)), but the decline in the frequency of IUGR with increasing fish intake remained statistically significant. No relation was observed between mean gestation and fish or n-3FA intake.

CONCLUSIONS

These results lend some support to the hypothesis that raising fish or n3-FA intake during pregnancy may increase fetal growth rate. However, they provide no evidence that increasing fish consumption is associated with an increase in mean gestation.

Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC)

BACKGROUND

The epidemiological profile of infants failing to thrive is unclear. The aim of this study is to investigate the prenatal and socioeconomic factors associated with these infants using standardized weight gain conditional on previous weight.

METHODS

In a large UK population cohort study, 11 718 infants born at term in 1991-1992 with no major congenital abnormalities were identified. Using a weight gain criterion conditional on initial weight from birth to 6-8 weeks, 6-8 weeks to 9 months, and birth to 9 months, the slowest gaining 5% were identified.

RESULTS

None of the prenatal factors was associated with failure to thrive in the multivariable analysis nor were traditional markers of socioeconomic deprivation such as poor parental education or low occupational status. Parental height was significantly correlated with slow infant weight gain in both separate periods and from birth to 9 months (Pearson's r = +0.20, P < 0.001). Eight times as many infants born to shorter parents (8.7%, 95% CI: 6.6, 11.3) showed slow weight gain as infants born to taller parents (1.1%, 95% CI: 0.5, 2.5). Higher parity was also related to slow infant weight gain; infants born in the fourth or subsequent pregnancy were twice as likely to fail to thrive from birth to 9 months (8.3%, 95% CI: 6.4, 10.6) as first-born infants (3.4%, 95% CI: 2.9, 10.6).

CONCLUSIONS

Future studies need to take account of parental height when calculating growth standards and look at why failure to thrive is more common, not in poorer families but in larger families.

Lack of association between smoking behavior and the sex ratio of offspring in the avon longitudinal study of parents and children

In a population-based prospective cohort study, we found no evidence of an association between smoking behavior around the time of conception and the sex of the resulting offspring.

Fruit and vegetables and ischaemic heart disease: systematic review or misleading meta-analysis?

In a recent meta-analysis published in this journal Law and Morris (1998) sought to quantify the association between fruit and vegetable intake and ischaemic heart disease. They estimated that for six dietary markers of fruit and vegetables the risk of ischaemic heart disease was on average reduced by 15% at the 90th centile of consumption when compared to the 10th centile. In this commentary we will argue that this figure is misleading; and that a more cautious and considered approach should be adopted when reviewing the body of evidence that is available on this issue.