Effects of lifestyle intervention in pregnancy and anthropometrics at birth on offspring metabolic profile at 2.8 years: results from the Lifestyle in Pregnancy and Offspring (LiPO) study

CONTEXT

Maternal obesity and gestational weight gain are linked to offspring adverse metabolic profiles, and lifestyle interventions during pregnancy in obese women may have long-term positive effects on their children. Furthermore, although the association between birth weight and later metabolic outcomes is well established, little is known about the predictive value of abdominal circumference at birth.

OBJECTIVES

The purpose of this study was to determine (1) the effects of lifestyle interventions during pregnancy in obese women on offspring metabolic risk factors and (2) predictive values of birth weight (BW) and birth abdominal circumference (BAC).

DESIGN

This was a follow-up of a randomized controlled trial, the Lifestyle in Pregnancy (LiP) study.

SETTING

The study was conducted in Odense and Aarhus University Hospitals, Denmark.

PARTICIPANTS

We studied the offspring of LiP study participants (n = 157) and offspring of normal-weight mothers (external reference group, n = 97).

INTERVENTION

INTERVENTIONs included dietary advice, coaching, and exercise during pregnancy.

MAIN OUTCOME MEASURES

The outcome measures were body mass index (BMI) Z-score, abdominal circumference, blood pressure, and fasting plasma glucose, insulin, high-density lipoprotein, and triglycerides at the age of 2.8 years.

RESULTS

No differences were detected in BMI Z-scores or metabolic risk factors between the LiP intervention and control groups or between the LiP and external reference groups. BAC and BW were associated (all P < .05) with BMI Z-score (0.19-0.23), abdominal circumference (0.57-0.70), plasma glucose (0.11-0.09), insulin (4.33-3.13), and triglycerides (0.07-0.07) but not with blood pressure or high-density lipoprotein (regression coefficients per increase in BAC and BW of 1 SD score).

CONCLUSIONS

Early childhood metabolic risk factors were unaffected by lifestyle interventions in obese pregnant women. Offspring of obese mothers who participated in the LiP study were comparable to offspring of normal-weight mothers, possibly indicating a general beneficial effect of trial participation. BAC and BW were both associated with later metabolic risk factors.

Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation

INTRODUCTION

Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1) whether, and if so, how, PD and HD prognosis had changed in recent years, (2) whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3) whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation.

PATIENTS AND METHODS

12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI), and mode of dialysis initiation.

RESULTS

Overall adjusted prognosis improved by 34% (HD 30%, PD 42%). PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation.

CONCLUSIONS

Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.

Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977-2010

OBJECTIVE

To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation.

DESIGN

A historical cohort study.

SETTING

Denmark.

PARTICIPANTS

170 000 randomly selected women born 1947-1963 (10 000/year) were followed from 1977 until the end of 2010.

MAIN OUTCOME MEASURES

Effect of hysterectomy with retained fallopian tubes or sterilisation on the risk of salpingectomy. Both were modelled in a Cox proportional hazards model as time-dependent covariates, analysing time to first salpingectomy. End of follow-up period was 31 December 2010.

RESULTS

Of 9591 hysterectomies, 6456 (67.3%) had both fallopian tubes retained. HRs for salpingectomy after hysterectomy with retained fallopian tubes and sterilisation were 2.13 (95% 1.88 to 2.42) and 2.42 (2.21 to 2.64), as compared with those for non-hysterectomised and non-sterilised women.

CONCLUSIONS

Women undergoing hysterectomy with retained fallopian tubes or sterilisation have at least a doubled risk of subsequent salpingectomy. Removal of the fallopian tubes at hysterectomy should therefore be recommended.

The use of the Internet in collecting CDI data--an example from Norway

This article presents the methodology used in a population-based study of early communicative development in Norwegian children using an adaptation of the MacArthur-Bates communicative development inventories (CDI), comprising approximately 6500 children aged between 0.8 and 3.0. To our knowledge, this is the first CDI study collecting data via the Internet. After a short description of the procedures used in adapting the CDI to Norwegian and the selection of participants, we discuss the advantages and potential pitfalls of using web-based forms as a method of data collection. We found that use of web-based forms was far less time-consuming, and therefore also far less expensive than the traditional paper-based forms. The risk of coding errors was virtually eliminated with this method. We conclude that in a society with high access to the Internet, this is a method well worth pursuing.

Pregestational body mass index is related to neonatal abdominal circumference at birth--a Danish population-based study

OBJECTIVES

To examine the impact of maternal pregestational body mass index (BMI) and smoking on neonatal abdominal circumference (AC) and weight at birth. To define reference curves for birth AC and weight in offspring of healthy, nonsmoking, normal weight women.

DESIGN

Population-based study.

SETTING

Data from the Danish Medical Birth Registry.

POPULATION

All live singletons without congenital malformations in Denmark 2004-10.

METHODS

Data on 366,886 singletons at 35(+0) to 41(+6) weeks(+days) of gestation were extracted and analysed using multivariate linear regressions.

MAIN OUTCOME MEASURES

Birth AC and weight in relation to pregestational maternal BMI, maternal smoking and medical conditions (any).

RESULTS

Birth AC and weight increased with increasing pregestational BMI, and decreased with smoking (P < 0.0001). Reference curves were created for offspring of healthy, nonsmoking mothers with normal pregestational BMI. Mean AC ranged from 30.1 cm and 30.2 cm at 35 weeks of gestation to 33.9 cm and 34.1 cm at 41 weeks of gestation, for girls and boys, respectively. Mean birthweight ranged from 2581 and 2666 g at 35 weeks to 3705 and 3852 g at 41 weeks of gestation for girls and boys, respectively. Pregestational BMI correlated more to the Z score of birthweight than to the Z score of AC (P < 0.0001).

CONCLUSION

Birth AC and weight are affected by maternal smoking status and pregestational BMI. Pregestational BMI correlated more to birthweight than to AC. Using data from healthy, nonsmoking mothers with normal pregestational BMI we have provided new reference curves for birth AC and birthweight.

Reduced incidence of end stage renal disease among the elderly in Denmark: an observational study

BACKGROUND

A number of studies during the nineties have shown that antihypertensive therapy, particularly using RAS blockade, can reduce uremia progression, and ESRD incidence.

METHODS

National incidence rates were studied of end stage renal disease (ESRD) for Denmark between 1990 and 2011, and of national prescription of antihypertensive drugs between 1995 and 2010, in order to investigate whether prescription rates had changed, and whether the expected change in ESRD had materialized. The Danish Nephrology Registry (DNR) is incident and comprehensive. Incidence rates were classified according to renal diagnosis.

RESULTS

ESRD incidence was constant for age groups <60 years. Incidence rates rose during the nineties for all cohorts >60 years. Since 2001 rates for subjects 60-70 years have fallen from 400 ppm/yr to 234, and since 2002 for subjects 70-80 years from 592 to 398. The incidence of patients >80 years has increased to 341. The falling incidence for patients 60-80 years was distributed among a number of diagnoses. Since 1995 national antihypertensive drug therapy has increased from 24.5 defined daily doses (DDD)/citizen/yr to 101.3, and the proportion using renin-angiotensin system (RAS) blockade from 34 to 58%.

CONCLUSIONS

This national study has shown a reduction in actively treated ESRD incidence among patients aged 60-80 years. It is possible that this is the result of increased antihypertensive prescription rates, particularly with RAS blockade. If it is assumed that therapeutic intervention is the cause of the observed reduced incidence, ESRD incidence has been reduced by 33.8 ppm/yr, prevalence by 121 ppm, and ESRD expenditure by 6 €/citizen/yr.

Risk factors for recurrence and death after bacteraemia: a population-based study

Although most bacteraemic outcome studies have focused on mortality, a repeated episode(s) is another important outcome of bacteraemia. We sought to characterize patient factors and microbial species associated with recurrence and death from bacteraemia. Population-based surveillance for bacteraemia was conducted in a Canadian health region during 2000-2008. Episodes of bacteraemia were extracted and characterized. Transition intensities of both recurrence and death were estimated by separate multivariate Cox proportional hazards models. We identified 9713 patients with incident episodes of bacteraemia. Within 1 year: 892 (9.2%) had recurrent bacteraemia, 2401 (24.7%) had died without a recurrent episode and 330 (3.4%) had died after a recurrent episode. Independent risk factors for recurrence within 1 year (hazard ratio; 95% confidence interval) were: increasing Charlson comorbidity scores (score 1-2: 2.2; 1.8-2.7 and score 3+: 3.4; 2.8-4.2), origin of infection (nosocomial: 2.1; 1.8-2.6 and healthcare-associated: 2.4; 2.0-2.8), microorganism (polymicrobial: 1.5; 1.2-2.0 and fungal: 2.8; 1.9-4.2) and focus of infection (verified urogenital: 0.4; 0.3-0.6). Independent risk factors for death within 1 year included: a recurrent bacteraemic episode 3.6 (3.1-4.0), increasing age and different foci of infection. This study identifies patient groups at risk of having a recurrent episode and dying from these infections. It adds recurrent bacteraemia as an independent risk factor of death within 1 year and may help to target patients for prevention or changes in management.

Early vocabulary development in Danish and other languages: a CDI-based comparison

The main objective of this paper is to describe the trajectory of Danish children's early lexical development relative to other languages, by comparing a Danish study based on the Danish adaptation of The MacArthur-Bates Communicative Development Inventories (CDI) to 17 comparable CDI-studies. The second objective is to address the feasibility of cross-linguistic CDI-comparisons. The main finding is that the developmental trend of Danish children's early lexical development is similar to trends observed in other languages, yet the vocabulary comprehension score in the Danish children is the lowest across studies from age 1 ; 0 onwards. We hypothesize that the delay is related to the nature of Danish sound structure, which presents Danish children with a harder task of segmentation. We conclude that CDI-studies are an important resource for cross-language studies, but reporting of studies needs to be standardized and the availability of published data improved in order to make comparisons more straightforward.

The Danish Communicative Developmental Inventories: validity and main developmental trends

This paper presents a large-scale cross-sectional study of Danish children's early language acquisition based on the Danish adaptation of the MacArthur-Bates Communicative Development Inventories (CDI). Measures of validity and reliability imply that the Danish adaptation of the American CDI has been adjusted linguistically and culturally in appropriate ways which makes it suitable for tapping into Danish children's language acquisition. The study includes 6,112 randomly selected children in the age of 0 ; 8 to 3 ; 0, and results related to the development of early gestures, comprehension and production of words as well as grammatical skills, are presented.