Effects of body size and change in body size from infancy through childhood on body mass index in adulthood

BACKGROUND

Weight and weight gain throughout infancy are related to later obesity, but whether the strength of the associations varies during the infancy period is uncertain.

AIMS

Our aims were to identify the period of infancy when change in body weight has the strongest association with adult body mass index (BMI) and also the extent to which these associations during infancy are mediated through childhood BMI.

METHODS

The Copenhagen Perinatal Cohort, in which participants were followed from birth through 42 years of age, provided information on weight at 12 months and BMI at 42 years for 1633 individuals. Information on weight at birth, 2 weeks, 1, 2, 3, 4 and 6 months was retrieved from health visitors' records and information on BMI at ages 7 and 13 years from school health records. The associations of infant weight and weight gain standard deviation scores (SDS) with adult BMI-SDS were analyzed using multiple linear regression and path analysis.

RESULTS

Higher-weight-SDS at all ages from birth to an age 12 months were associated with higher-BMI-SDS at 42 years (regression coefficients 0.08-0.12). Infant weight gain-SDS was associated with greater BMI-SDS at 42 years only between birth and 3 months (0.09, 95% confidence intervals (CI) 0.04, 0.15) driven by an association between 2 and 3 months (0.12, 95% CI: 0.04, 0.20). The latter was partly mediated through later BMI in the path analysis. Infant weight gain-SDS between 3 and 12 months was not associated with greater BMI-SDS at 42 years.

CONCLUSIONS

Faster weight gain during only the first 3 months of infancy was associated with increased adult BMI, although not in a consistent monthly pattern. Adult BMI is more sensitive to high weight gain during early infancy than late infancy, but not specifically to the first month of life.

Dietary long-chain n-3 PUFA, gut microbiota and fat mass in early postnatal piglet development--exploring a potential interplay

Dietary n-3PUFA and gut bacteria, particularly Bacteroidetes, have been suggested to be related to adiposity. We investigated if n-3PUFA affected fat storage and cecal bacteria in piglets. Twenty-four 4-day-old piglets were allocated to formula rich in n-3PUFA (∼3E%) from fish oil (FO) or n-6PUFA from sunflower oil (SO) for 14 days. We assessed body weight, fat accumulation by dual-energy X-ray absorptiometry and microbial molecular fingerprints. Dietary PUFA-composition was reflected in higher erythrocyte n-3PUFA in the FO- than the SO-group (P<0.001). Principal component analysis revealed group differences in the overall microbiotic composition, which involved a larger Bacteroides community in the SO-group (P=0.02). There was no significant difference in body fat percentage and no relationship between fat accumulation and gut Bacteroides. Hence, this study does not support an impact of n-3PUFA or microbiota on fat accumulation during the postnatal maturation period. The impact of dietary PUFA on the gut Bacteroides warrants further investigation.

Degree of fatness after treatment for acute lymphoblastic leukemia in childhood

Excessive fatness is considered a frequent late complication of treatment for childhood acute lymphoblastic leukemia. Most previous studies, however, were based on body mass index (BMI) rather than more direct fat mass measurements. We studied 95 survivors of childhood acute lymphoblastic leukemia a median of 11 yr (range, 3-23 yr) after diagnosis. BMI values at diagnosis, at cessation of therapy, yearly thereafter for up to 10 yr, and at follow-up were compared with French reference values. Whole body percent fat was measured at follow-up by dual energy x-ray absorptiometry and compared with data from 463 local controls. Adjusted for sex and age, the mean BMI increased significantly during therapy and remained largely unchanged thereafter. At follow-up, BMI did not differ significantly between patients and local controls. On the other hand, the whole body percent fat was significantly increased (mean observed/predicted value, 21.8/19.0%; P < 0.0002). Twenty-five patients (26%) had a percent fat above the 90th percentile of the reference values, which indicates excessive fatness. Adjusted for sex and age, a higher percent fat was related to cranial irradiation or GH insufficiency, but not to sex, the cumulative doses of anthracyclines or corticosteroids, or the type of corticosteroid used. BMI was a poor measure of body fatness.

Hookworm infection in Kweneng District, Botswana, A prevalence survey and a controlled treatment trial

Stool specimens from a sample of schoolchildren at six schools in Kweneng District were examined for hookworm infection, using the brine flotation method. Necator americanus was the only hookworm identified. The western part of the District forms part of the Kalahari Desert, and in four villages here 90%, 88%, 88% and 86% of the children were infected. In two villages in the eastern non-desert part, only 13% and 9% were infected. Most infections were light. There was no significant correlation between severity of infection and anaemia. In one school (228 pupils; 86% infected with hookworm), half the children were treated with tetrachloroethylene (0.1 ml/kg, maximum 5 ml) and the other half with placebo. Two weeks after treatment the prevalence of infection were 28% and 75% respectively (p less than 0.001), and five months after treatment 51% and 69% (p less than 0.05). Measured over the five-month period there were no significant changes in haemoglobin and nutritional status (weight/height). Based on the results of the survey, a hookworm mass treatment programme was not recommended.

Vitamin D status in infants: relation to nutrition and season

In a cross-sectional study, the primary objective was to assess the plasma concentration of 25-hydroxyvitamin D (25(OH)D) in healthy 9-month-old infants (n=255). The secondary objective was to evaluate nutritional variables and season in relation to 25(OH)D. The concentration of 25(OH)D was 77.2 ± 22.7 nmol/l (mean ± s.d.), ranging from 12 to 151 nmol/l. During the first 9 months, 97% received vitamin D supplementation (10 μg/day) and 89% had sufficient levels of 25(OH)D (50-250 nmol/l). In multiple regression analysis, controlled for body mass index (BMI) and intake of infant formula, a longer period of exclusive breastfeeding (P=0.026) and breastfeeding at 9 months (P=0.001) were both associated with lower levels. Dietary vitamin D intake was 4.4 ± 3.1 μg/day and in multiple regression analysis, controlled for BMI, intake of infant formula and mean energy intake, it was positively associated with 25(OH)D (P=0.001). There was a significant seasonal difference in 25(OH)D, with higher levels during summer-autumn compared with winter-spring (P=0.021) after control for BMI.

Growth during treatment of familial hypercholesterolemia

Treatment of hypercholesterolemic children with restriction of dietary saturated fat may result in an inadequate supply of energy for normal somatic growth. We examined the growth of 30 children with familial hypercholesterolemia, some of whom were also treated with colestipol, a bile acid-binding resin. The median duration of treatment was 8.5 years in 13 patients on diet only, and 5.5 years + 3.5 years in 17 patients treated with diet followed by diet and colestipol. Statistically significant reductions in serum total cholesterol were obtained in both groups. The SD scores for both height/age and weight/age decreased by approximately 0.4 during dietary treatment (p < 0.05), but were not affected by treatment with colestipol. These results document the risk of growth retardation during dietary treatment of children with familial hypercholesterolemia.

Associations between vitamin D status in infants and blood lipids, body mass index and waist circumference

AIM

To study the relationships between 25-hydroxyvitamin D status and blood lipids, insulin, glucose, body mass index and waist circumference in infants.

METHODS

In a cross-sectional study, 255 infants aged 9 months with a blood sample for 25-hydroxyvitamin D were examined. Plasma 25-hydroxyvitamin D concentrations were analysed by chemiluminescent immunoassay. Associations between plasma 25-hydroxyvitamin D and high-density lipoprotein (HDL), low-density lipoprotein, total cholesterol, triglycerides, insulin, glucose, body mass index and waist circumference were analysed.

RESULTS

Mean plasma 25-hydroxyvitamin D was 77.2 ± 22.7 nM. At the time of examination, 97% received vitamin D supplementation. 25-Hydroxyvitamin D was negatively associated with HDL (p = 0.003), cholesterol (p = 0.002) and triglycerides (p = 0.010) in multivariate analysis controlled for gender, season, body mass index, length, birth weight and breastfeeding. There were no associations between 25-hydroxyvitamin D and glucose or insulin (all p > 0.05). 25-hydroxyvitamin D was negatively associated with body mass index (p = 0.005) and waist circumference (p = 0.002) controlled for gender, season, breastfeeding, birth weight and length.

CONCLUSION

Vitamin D status is negatively associated with blood lipids, body mass index and waist circumference in infants where nearly all received vitamin D supplements. Whether this has long-term health effects remains to be elucidated.

Effect of iron deficiency on Trichuris suis and Ascaris suum infections in pigs

The objective of this experiment was to detect a possible interaction between iron deficiency and intestinal nematode infections. We report on a 2 x 2 study where thirty-one 10-week-old pigs fed a low or a normal iron diet were infected with both Trichuris suis (4500 eggs) and Ascaris suum (1200 eggs). No significant difference was detected between diet groups with respect to parasitological parameters for A. suum or the total number of adult T. suis recovered at necropsy 10 weeks p.i. However, in the low iron group T. suis were located more proximally and the worms were increased in length. A higher proportion of pigs with initial faecal egg excretion at 6 weeks p.i. was observed in the low iron group, indicating a shortened pre-patency period. Worm fecundity and total faecal egg excretion were also highest in the low iron group. A significant correlation was found between female worm length and fecundity. The peripheral eosinophil counts were diminished in the low iron host groups. The infected low iron group experienced more severe pathophysiological changes in terms of hypoalbuminaemia and decreases in erythrocyte volumes. A significant inverse correlation existed between iron content in the bone-marrow and liver (body) store. In conclusion, iron deficiency increased the severity of T. suis infection in pigs.

Influence of weight, age and puberty on bone size and bone mineral content in healthy children and adolescents

The biology of bone mineralization during growth is important for peak bone mass. The aim of the study was to examine how body size, age and puberty influence bone size and bone mineral density. Whole body bone area (BA) and bone mineral content (BMC) were examined by dual-energy X-ray absorptiometry (Hologic 1000/W) in healthy girls (n = 201) and boys (n = 142) aged 5-19 y. The influence of height, weight, age and puberty on bone mineralization was examined by multiple regression. Main determinants of BA were height and weight. Bone width, approximated by BA corrected for height, increased highly significantly with weight and depended weakly significantly on pubertal stage. Main determinants of BMC were BA, height, age and pubertal stages. Bone mineral density, approximated by BMC corrected for BA and height, depended on age and pubertal stage, but not on weight. Thus skeletal size is mainly determined by body size, while bone density is determined by age and pubertal stage.

IGF-I at 9 and 36 months of age — relations with body composition and diet at 3 years — the SKOT cohort

OBJECTIVE

High infancy levels of insulin-like growth factor-I (IGF-I) have been associated with increased linear growth and fat-free mass (FFM) but also with risk of obesity. This paper examines how IGF-I at 9 and 36 months relates to diet and body composition.

DESIGN

Healthy term infants from the prospective cohort study, SKOT, were examined at 9 and 36 months with anthropometry, bioelectrical impedance (36 months), 7-day food records and blood analysis of IGF-I and IGFBP-3 by chemiluminescent immunometric assay.

RESULTS

IGF-I at 36 months (n = 229) was positively correlated with 9 months values and values were considerably higher in girls (43%). Children breastfed at 9 months had lower IGF-I concentrations at 9 months but reached the same IGF-I concentrations at 36 months as infants not breastfed at 9 months. IGF-I at 36 months was positively associated with height, weight, BMI, predicted FFM and FFM index (FFM/height (kg/m2)). Although there also was a positive association with predicted fat mass (FM) there was no association with FM index (FM/height (kg/m2)). Further, a negative association with skin fold thickness was observed. A change in IGF-I from 9–36 months was positively related to FFM and FFM index but not BMI, FM and FM index. No associations were seen between IGF-I and current intake of milk, meat or protein energy percentage, but both fat and saturated fat energy percentage were negatively associated with IGF-I.

CONCLUSION

IGF-I concentrations were positively associated with growth but not with adiposity at this age. However, the higher tempo of growth may influence age at adiposity rebound and thereby later risk of obesity. Milk and protein intake at 36 months did not influence IGF-I but there was a negative association with intake of fat and saturated fat. The implications of this finding for development of obesity need further exploration.

No strong long-term effect of vitamin A supplementation in infancy on CD4 and CD8 T-cell subsets. A community study from Guinea-Bissau, West Africa

The World Health Organization recommends that 100,000 IU of vitamin A be given to infants between 6 and 12 months of age at the same time as measles vaccination in order to prevent vitamin A deficiency. In the present study, our aim was to assess the effect of vitamin A supplementation on T-cell subsets in a randomized factorial design, seeking a possible modifying effect of measles vaccination. Three hundred children were allocated either to two doses of measles vaccine at 6 and 9 months of age or to poliomyelitis vaccine at age 6 months and measles vaccine at age 9 months. Within each group, infants were to receive two doses of vitamin A or two doses of placebo at 6 and 9 months of age. We found no significant effect of vitamin A supplementation on CD4 and CD8 T-cell subsets at 3 and 9 months after supplementation. We found no effect of measles vaccine and no interaction between vitamin A supplementation and measles vaccine. Based on these observations, vitamin A supplementation does not seem to have a strong long-term effect on CD4 and CD8 T-cell subsets in infants without clinical vitamin A deficiency.

Influence of breastfeeding and complementary food on growth between 5 and 10 months

The aim of this study was to examine the nature of the association between breastfeeding, complementary feeding and growth in a random sample of infants from Denmark, where the prevalence of breastfeeding is high. A semiquantitative food frequency questionnaire and a questionnaire on breastfeeding duration and on weight and length measurements taken at the infant welfare visit at 5 and 10 months were sent to 590 families with 10-month-old infants. A total of 339 infants with complete growth data were included in the analyses. When controlling for mid-parental height and birth weight infants breastfed for > or =7 months gained 198 g less in weight (p < 0.01) and 7 mm less in length (p < 0.01) during the period from 5 to 10 months than infants breastfed for < 7 months. Controlling for these effects, the 10% of the sample with the highest protein intake (i.e. > or =16 energy percentage) gained 262 g more than those with a lower protein intake (p = 0.03). Infants breastfed for > or =7 months received significantly less cow's milk (p < 0.01), and fewer meat-containing dishes (p < 0.05) and sweets or cakes (p < 0.01), which may partly explain the effect of breastfeeding. The long-term consequences of this moderate difference in growth velocity are unknown and the findings should not be used to advocate against breastfeeding during late infancy.

Bone mineral density in the lumbar spine as determined by dual-energy X-ray absorptiometry. Comparison of whole-body scans and dedicated regional scans

PURPOSE

To compare bone mineral in the lumbar spine as measured by either consecutive regional or whole-body dual-energy X-ray absorptiometry (DXA), and to develop models that predict regional results from whole-body results.

MATERIAL AND METHODS

In 180 children and young adults, bone mineral in the lumbar spine was measured by a Hologic QDR-1000/W DXA scanner, using either whole-body software (which can give data for the lumbar spine subregion) or dedicated lumbar spine software. Data on 139 persons were used to compare the two methods and to develop models that predict the result of a regional scan from the result of a whole-body scan. Data on the remaining 41 persons were used to control these models.

RESULTS

Bone mineral content, bone area, and bone mineral areal density (BMDA) of the lumbar spine were measured significantly lower by whole-body scans than by regional scans (p < 0.0001). The difference was larger for the lower values of bone area and BMDA. We developed models that predicted lumbar spine BMDA from whole-body results. When these models were controlled in another group, the mean error between the methods was non-significant and the error was unrelated to the BMDA value. However, the variance of the error was only minimally reduced.

CONCLUSIONS

Lumbar spine bone mineral was measured significantly lower by whole-body DXA than by regional DXA. Based on local data, models were developed that removed the significant difference between the methods.

Inadequate supplies of potassium and magnesium in relief food--implications and countermeasures

Analyses of relief food used in Ethiopia showed that, because of food refinement, 6 out of 10 samples of cereals contained too little potassium and magnesium to cover daily needs. Malnutrition is often associated with gastrointestinal infections, which lead to further deficiency of these electrolytes. Potassium and magnesium are required for protein synthesis, growth, and tissue repair. Since protein supplies are often marginal, relief food should contain sufficient potassium and magnesium to allow optimum utilisation of dietary nitrogen sources. This may be achieved by using coarse qualities of cereals, by supplementing cereals with legumes, and by avoiding cooking procedures that extract these salts from the cereals.

Predicting and monitoring of growth in children with short stature during the first year of growth hormone treatment

Fifteen prepubertal short stature children (10 girls, 5 boys), mean age 9.6 years (range 5.2-12.7 years), with normal response to growth hormone stimulation tests (group A) or partial growth hormone deficiency (GHD) of idiopathic nature (group B) were included in a controlled longitudinal study for evaluation of predictive parameters for the long-term growth response after administration of biosynthetic human growth hormone (B-hGH). The average knee-heel length velocity for the first 3 months was significantly correlated to total body height velocity during the following 9 months (p less than 0.0008). By contrast, this association could not be found for height velocity during the same period. The increase in serum values of alkaline phosphatase and insulin-like growth factor I (IGF-1) during the first month of treatment was not significantly correlated to height velocity during the first year. During one year of treatment with B-hGH the mean height velocity for groups A and B increased from 4.4 cm/year (range 2.5-6.5) to 7.6 cm/year (range 4.7-10.6). Bone age advanced by 1.08 +/- 0.60 per chronological year. The ratio between total height and knee-heel length prior to treatment was 3.34 +/- 0.10 and after one year 3.33 +/- 0.10, suggesting a proportional linear growth. An inverse relationship was observed between the ratio and chronological age. In conclusion, early knee-heel measurement may be a useful non-invasive predictor of long-term linear growth in children during treatment with growth hormone, and the ratio of total height to lower leg length may be of importance in detecting dysproportional growth.

Parental concerns about complementary feeding: differences according to interviews with mothers with children of 7 and 13 months of age

BACKGROUND/OBJECTIVES

To investigate and analyze differences in parental concerns during earlier and later phases of complementary feeding.

SUBJECT/METHODS

Eight focus group interviews were conducted with 45 mothers of children aged 7 or 13 months. Deductive and inductive coding procedures were applied in the analysis.

RESULTS

There were marked differences in mothers' health concerns in early and in later phases of complementary feeding. In the early phase, feeding a child healthy food was an unquestioned and self-evident practice. The child's food was a specific category, separated from the rest of the family's food, and the mother's focus was on the immediate well-being and safety of the child. In the later phase, health concerns shifted towards a longer-term perspective, and the aim of integrating the child into the family's social world became as important as concerns about well-being and safety. Contested and partly contradictory practices resulted, including conscious acceptance of some intake of sugar and unhealthy fats. Perceived relevance of nutritional guidelines on complementary feeding was high in the early phase but declined later.

CONCLUSION

Mothers' concerns and practices in the feeding of a young child vary considerably across the early and later phases of complementary feeding. This should be explored further and taken into consideration in the targeting and timing of dietary guideline communications.

Tracking of size-adjusted bone mineral content and bone area in boys and girls from 10 to 17 years of age

Positive correlations for bone mineral content (BMC) between 10 and 17 years of age were found for boys and girls after adjusting for body size, puberty, and diet. This tracking of BMC indicated that osteoporosis prevention should begin already in prepuberty.

INTRODUCTION

Previous studies indicate that BMC is tracking during growth, but it remains unclear whether this would remain significant after adjusting for important confounders. We tested the hypothesis that BMC and bone area (BA) track from 10 to 17 years of age, independently of body size, pubertal stage, and dietary intake of energy, calcium and protein.

METHODS

A longitudinal study where whole body (T) and lumbar spine (LS) BMC and BA (dual-energy X-ray absorptiometry) and dietary intake (7-day food records) were assessed at 10 and 17 years of age in boys and girls (n = 91). Tracking of bone variables from 10 to 17 years was estimated by Pearson's correlations adjusted for the selected confounders.

RESULTS

The unadjusted correlations for T-BMC between 10 and 17 years, likewise for LS-BMC and T-BA, were positive for both sexes (0.51-0.81; P < 0.0001) and remained significant after correcting for the selected confounders. The unadjusted correlations for LS-BA between 10 and 17 years were significant only for girls (0.29; P < 0.05), but not after further corrections.

CONCLUSIONS

Bone mass tracks from 10 to 17 years of age in boys and girls, especially after accounting for important confounders, indicating that osteoporosis prevention should begin in early stages of bone development.

Serum bone gamma-carboxyglutamic acid protein in a longitudinal study of infants: lower values in formula-fed infants

Bone gamma-carboxyglutamic acid protein [BGP (osteocalcin)] is a protein synthesized by osteoblasts and incorporated in the bone matrix. Serum BGP is a sensitive marker of bone formation, and it parallels the growth velocity curve during childhood and adolescence. Serum BGP was measured at the age of 2, 6, and 9 mo in a cohort study of nutrition and growth in 91 healthy infants. At 2 mo, the mean BGP value (+/- SD) was 275 +/- 87 ng/mL in infants exclusively breast-fed, and 80 +/- 44 ng/mL in formula-fed infants. At 6 mo, the values were 142 +/- 58 ng/mL and 55 +/- 30 ng/mL, and at 9 mo 75 +/- 39 ng/mL and 45 +/- 19 ng/mL in partially breast-fed and formula-fed infants, respectively. The differences were significant (p less than 0.001) at all three ages. At 2 and 9 mo, breast-milk intake was measured by test-weighing. Serum BGP was positively correlated to breast milk intake (mL/kg body wt) at 2 mo (r = 0.59, p less than 0.001) and 9 mo (r = 0.41, p = 0.06). When breast-feeding was stopped, the high BGP concentrations were not sustained. There were no significant differences in linear growth velocity between breast-fed and formula-fed infants and no correlation between BGP values and linear growth velocity. We speculate that either a factor in human milk or the level of minerals in human milk causes the high BGP values. Moreover, if the higher values are associated with increased osteoblast activity, then the remodeling or the mineralization of bone might be different in infants not being breast-fed.

Associations between adiposity, hormones, and gains in height, whole-body height-adjusted bone size, and size-adjusted bone mineral content in 8- to 11-year-old children

We examined fat-independent associations of hormones with height and whole-body bone size and mineral content in 633 school children. IGF-1 and osteocalcin predict growth in height, while fat, osteocalcin, and in girls also, IGF-1 predict growth in bone size. Leptin and ghrelin are inversely associated with bone size in girls.

INTRODUCTION

Obesity causes larger bone size and bone mass, but the role of hormones in this up-regulation of bone in obesity is not well elucidated. We examined longitudinal associations between baseline body fat mass (FM), and fat-independent fasting levels of ghrelin, adiponectin, leptin, insulin, insulin-like growth factor-I (IGF-1), osteocalcin, and intact parathyroid hormone, and subsequent changes in height and in whole-body height-adjusted bone area "BAheight" and size-adjusted bone mineral content "BMCsize" in 8- to 11-year-olds.

METHODS

Analyses were carried out separately for boys (n = 325) and girls (n = 308) including data from baseline, 3 and 6 months from OPUS School Meal Study.

RESULTS

In both sexes: gain in BAheight was positively associated with baseline FM (≥2.05 cm(2)/kg, both p ≤ 0.003). Furthermore, gain in height was positively associated with baseline IGF-1 (≥0.02 cm/ng/ml, p = 0.001) and osteocalcin (≥0.13 cm/ng/ml, p ≤ 0.009); and gain in BAheight was positively associated with baseline osteocalcin (≥0.35 cm(2)/ng/ml, p ≤ 0.019). In girls only, gain in BAheight was also positively associated with baseline IGF-1 (0.06 cm(2)/ng/ml, p = 0.017) and inversely associated with both baseline ghrelin (-0.01 cm(2)/pg/ml, p = 0.001) and leptin (-1.21 cm(2)/μg/ml, p = 0.005). In boys, gain in BMCsize was positively associated with osteocalcin (0.18 g/ng/ml, p = 0.030).

CONCLUSIONS

This large longitudinal study suggests that in 8- to 11-year-old children, IGF-1 and osteocalcin predict growth in height, while FM, osteocalcin, and in girls also, IGF-1 predict growth in BAheight. Fat-independent inverse associations of leptin and ghrelin with BAheight in girls' are contrary to proposed growth-stimulating effects of leptin. Osteocalcin in boys predicts gain in BMCsize.