Early growth and abdominal fatness in adult life

STUDY OBJECTIVE

The aim was to determine whether abdominal fatness in adult men is associated with retarded growth in fetal life and infancy.

DESIGN

This was a follow up study of (1) men born during 1920-30 whose birthweights and weights at one year were recorded at the time by health visitors; and (2) men born during 1935-43 whose size at birth was measured in detail. The main outcome measure was the ratio of waist circumference to hip girth.

SETTING

Hertfordshire and Preston, England.

SUBJECTS

Subjects were 845 men born in east Hertfordshire who still live there; and 239 men born in Preston who still live in or close to the city.

MAIN RESULTS

After allowing for body mass index, mean waist to hip ratio fell with increasing birthweight and rose as the ratio of placental weight to birthweight increased. These trends were independent of duration of gestation and therefore reflected retarded fetal growth. Waist to hip ratio also fell with increasing weight at one year. All these trends were independent of adult height, alcohol consumption, smoking, social class, and age.

CONCLUSIONS

The tendency to store fat abdominally, which is known to increase the risk of cardiovascular disease and diabetes independently of obesity, may be a persisting response to adverse conditions and growth failure in fetal life and infancy.

The relation of fetal growth to plasma glucose in young men

In a study of men aged 59 to 70 years plasma glucose levels 30 min and 2 h after a 75-g glucose load were inversely related to birthweight. To determine whether there are similar relations at a younger age the 30-min plasma glucose levels of 40 men aged 21 years, who were born in one hospital in the United Kingdom, were measured. Lower birthweight was associated with higher 30-min plasma glucose levels. This trend was independent of gestational age, and current body mass, height and social class.

Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease

OBJECTIVE

To examine whether method of infant feeding is associated with adult serum lipid concentrations and mortality from ischaemic heart disease.

DESIGN

Follow up study of men born during 1911-30.

SETTING

Hertfordshire, England.

SUBJECTS

5718 men, for 5471 of whom information on infant feeding had been recorded by health visitors and 1314 of whom had died. 485 of the men born during 1920-30 and still living in Hertfordshire who had blood lipid measurements.

MAIN OUTCOME MEASURES

Death from ischaemic heart disease; serum cholesterol and apolipoprotein concentrations.

RESULTS

474 men had died from ischaemic heart disease. Standardised mortality ratios were 97 (95% confidence interval 81 to 115) in men who had been breast fed and had not been weaned at 1 year, 79 (69 to 90) in breast fed men who had been weaned at 1 year, and 73 (59 to 89) in men who had been breast and bottle fed. Compared with men weaned before one year men not weaned had higher mean serum concentrations of total cholesterol (6.9 (not weaned) v 6.6 (weaned) mmol/l), low density lipoprotein cholesterol (5.0 v 4.6 mmol/l) and apolipoprotein B (1.14 v 1.08 g/l). Men who had been bottle fed also had a high standardised mortality ratio for ischaemic heart disease (95; 68 to 130) and high mean serum concentrations of total cholesterol (7.0 mmol/l), low density lipoprotein cholesterol (5.1 mmol/l), and apolipoprotein B (1.14 g/l). In all feeding groups serum apolipoprotein B concentrations were lower in men with higher birth weight and weight at 1 year.

CONCLUSIONS

Age of weaning and method of infant feeding may influence adult serum low density lipoprotein cholesterol concentrations and mortality from ischaemic heart disease. Adult serum apolipoprotein B concentrations are related to growth in fetal life and infancy.

Relation of fetal and infant growth to plasma fibrinogen and factor VII concentrations in adult life

OBJECTIVE

To determine whether reduced fetal and infant growth are associated with higher plasma fibrinogen and factor VII concentrations in adult life.

DESIGN

Follow up study of men born during 1920-30 whose weights at birth and at 1 year had been recorded by health visitors, and men born during 1935-43 whose size at birth had been measured in detail.

SETTING

Hertfordshire and Preston, England.

SUBJECTS

591 men born in east Hertfordshire who still lived there and 148 men born in Preston who still lived in or close to the city.

MAIN OUTCOME MEASURES

Plasma fibrinogen and factor VII concentrations.

RESULTS

Among men in Hertfordshire mean plasma fibrinogen and factor VII concentrations fell with increasing weight at 1 year (from 3.21 g/l in men of less than or equal to 18 lb to 2.93 g/l in men greater than or equal to 27 lb and from 122% of standard to 103%; p less than 0.001, p less than 0.005 respectively). The trends were independent of cigarette smoking, alcohol consumption, body mass index, and social class. Neither plasma fibrinogen nor factor VII concentration was related to birth weight. In men in Preston, however, fibrinogen concentration fell progressively as the ratio of placental weight to birth weight decreased (p = 0.01).

CONCLUSIONS

Reduced growth in fetal life and infancy is strongly related to high plasma concentrations of the haemostatic factors fibrinogen and factor VII. This may be a persisting response to impaired liver development during a critical early period.

The relation of fetal length, ponderal index and head circumference to blood pressure and the risk of hypertension in adult life

The blood pressure of 327 men and women aged 46 to 54 years was related to birthweight, placental weight, length, ponderal index and head circumference at birth. All the subjects were born after 38 completed weeks of gestation. There were strong trends of higher blood pressure in adult life with lower birthweight (P = 0.04) and greater placental weight (P = 0.002). In subjects with placental weights of 1.25 lb or less, mean blood pressure, and the risk of hypertension, rose as ponderal index at birth fell (P = 0.0001). Mean systolic pressure rose by 13 mm Hg as ponderal index fell from greater than 14.75 to 12 or less. In those with placental weights above 1.25 lb, mean blood pressure, and the risk of hypertension, rose as length decreased and as the ratio of head circumference to length increased (P = 0.02). Mean systolic pressure rose by 14mm Hg as the head circumference to length ratio increased from less than 0.65 to greater than or equal to 0.7. These findings characterise the birth measurements of two groups of babies who are at increased risk of hypertension in adult life.

Fetal heart rate and intrauterine growth

OBJECTIVE

To assess whether fetal heart rate in early and late pregnancy relates to size at birth.

DESIGN

Prospective study of fetal heart rates in early and late pregnancy.

SETTING

Princess Anne Hospital, Southampton.

SUBJECTS

63 primigravid women.

MAIN OUTCOME MEASURES

Anthropometric measurements made on the newborn infant.

RESULTS

There were no differences in heart rate between the sexes at 18 weeks gestation but by 36 weeks the boys had rates which were 4.4 beats lower than those of the girls. Higher fetal heart rate at 18 weeks was associated with lower ponderal index, smaller head circumference and smaller mid-arm circumference. There were no trends in fetal heart rate at 36 weeks with any birth measurements.

CONCLUSION

Babies born at term who have a pattern of neonatal measurements which reflect growth retardation have raised heart rates in early pregnancy. Influences which impair fetal growth appear to take effect early in gestation.

The relation of maternal weight to the blood pressures of Gambian children

The objective of the study was to relate blood pressure levels in children to their mother's weight in pregnancy. The blood pressures of 675 children aged from one to nine years in three villages in rural Gambia were measured. They were matched to antenatal clinic data which had been collected from all pregnant women in the three villages since 1980. Among children under eight years of age those born in the dry season had the highest blood pressures and were heavier. Their blood pressures were positively related to body weight and to mothers' weight at six months of pregnancy. These relationships were independent of mothers' age and parity, birthweight, gestational age, and placental weight. Among older children, aged eight and nine years, those born in the rainy season had the highest blood pressures. Their blood pressures were not related to their mothers' weight at six months of pregnancy. Rather they were inversely related to mothers' weight gain in the last trimester. An interpretation of these findings is that among young children differences in blood pressure are largely determined by rates of maturation. However, the long-term effects of adverse intra-uterine influences which elevate blood pressure become apparent in older children.

Maternal and fetal influences on blood pressure

To study maternal and fetal influences on blood pressure in childhood 405 children aged 4 years who were born and still resident in the Salisbury health district were visited at home for blood pressure and growth measurements. Information on the pregnancy, delivery, and baby was abstracted from the routine obstetric notes. Similar to recent findings in adults, the child's systolic pressure was inversely related to birth weight and positively related to placental weight. Systolic pressure at 4 years increased by 1.2 mm Hg for every SD decrease in the ratio of head circumference to length at birth, and by 1.1 mm Hg for every SD decrease in ponderal index at birth. Mothers whose haemoglobin concentrations fell below 100g/l during pregnancy had children whose systolic pressures were on average 2.9 mm Hg higher than the children of mothers with higher haemoglobin concentrations. Patterns of placental weight, birth weight, head circumference, and length that are associated with high blood pressure in adults are also associated with higher blood pressure in 4 year old children. Identification of the intrauterine influences that lead to these patterns of fetal growth could lead to the primary prevention of hypertension.

Fetal and infant growth and impaired glucose tolerance at age 64

OBJECTIVE

To discover whether reduced fetal and infant growth is associated with non-insulin dependent diabetes and impaired glucose tolerance in adult life.

DESIGN

Follow up study of men born during 1920-30 whose birth weights and weights at 1 year were known.

SETTING

Hertfordshire, England.

SUBJECTS

468 men born in east Hertfordshire and still living there.

MAIN OUTCOME MEASURES

Fasting plasma glucose, insulin, proinsulin, and 32-33 split pro-insulin concentrations and plasma glucose and insulin concentrations 30 and 120 minutes after a 75 g glucose drink.

RESULTS

93 men had impaired glucose tolerance or hitherto undiagnosed diabetes. They had had a lower mean birth weight and a lower weight at 1 year. The proportion of men with impaired glucose tolerance fell progressively from 26% (6/23) among those who had weighted 18 lb (8.16 kg) or less at 1 year to 13% (3/24) among those who had weighed 27 lb (12.25 kg) or more. Corresponding figures for diabetes were 17% (4/23) and nil (0/24). Plasma glucose concentrations at 30 and 120 minutes fell with increasing birth weight and weight at 1 year. Plasma 32-33 split proinsulin concentration fell with increasing weight at 1 year. All these trends were significant and independent of current body mass. Blood pressure was inversely related to birth weight and strongly related to plasma glucose and 32-33 split proinsulin concentrations.

CONCLUSIONS

Reduced growth in early life is strongly linked with impaired glucose tolerance and non-insulin dependent diabetes. Reduced early growth is also related to a raised plasma concentration of 32-33 split proinsulin, which is interpreted as a sign of beta cell dysfunction. Reduced intrauterine growth is linked with high blood pressure, which may explain the association between hypertension and impaired glucose tolerance.

Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease

OBJECTIVE

To examine whether birth weight, infant weight, and childhood respiratory infection are associated with adult lung function and death from chronic obstructive airways disease.

DESIGN

Follow up study of men born during 1911-30 whose birth weights, weights at 1 year, and childhood illnesses were recorded at the time by health visitors.

SETTING

Hertfordshire, England.

SUBJECTS

5718 men born in the county during 1911-30 and a subgroup of 825 men born in the county during 1920-30 and still living there.

MAIN OUTCOME MEASURES

Death from chronic obstructive airways disease, mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), and respiratory symptoms.

RESULTS

55 men died of chronic obstructive airways disease. Death rates fell with increasing birth weight and weight at 1 year. Mean FEV1 at age 59 to 70 years, adjusted for height and age, rose by 0.06 litre (95% confidence interval 0.02 to 0.09) with each pound (450 g) increase in birth weight, independently of smoking habit and social class. Bronchitis or pneumonia in infancy was associated with a 0.17 litre (0.02 to 0.32) reduction in adult FEV1 and with an increased odds ratio of wheezing and persistent sputum production in adult life independently of birth weight, smoking habit, and social class. Whooping cough in infancy was associated with a 0.22 litre (0.02 to 0.42) reduction in adult FEV1.

CONCLUSIONS

Lower birth weight was associated with worse adult lung function. Intrauterine influences which retard fetal weight gain may irrecoverably constrain the growth of the airways. Bronchitis, pneumonia, or whooping cough in infancy further reduced adult lung function. They also retarded infant weight gain. Consistent with this, death from chronic obstructive airways disease in adult life was associated with lower birth weight and weight at 1 year. Promoting lung growth in fetuses and infants and reducing the incidence of lower respiratory tract infection in infancy may reduce the incidence of chronic obstructive airways disease in the next generation.

The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight

OBJECTIVE

To examine the maternal influences which determine large placental weight and a high ratio of placental weight to birthweight. These are known predictors of adult blood pressure.

DESIGN

Retrospective analysis of routine obstetric and haematology department records for a large cohort of pregnant women.

SETTING

John Radcliffe Hospital, Oxford.

SUBJECTS

8684 pregnant women who were delivered between January 1987 and January 1989 and whose records could be linked to the results of two or more pregnancy blood counts.

MAIN OUTCOME MEASURES

Placental weight and the ratio of placental weight to birthweight.

RESULTS

Large placental weight was associated with a low maternal haemoglobin and a fall in maternal mean cell volume during pregnancy. The highest ratio of placental weight to birthweight occurred in the most anaemic women with the largest falls in mean cell volume. Large placental weight and a high ratio of placental weight to birthweight were also independently associated with a high maternal body mass index. Maternal smoking reduced placental weight, but increased the ratio of placental weight to birthweight.

CONCLUSIONS

Anaemia and iron deficiency during pregnancy are associated with large placental weight and a high ratio of placental weight to birthweight. This points to maternal nutritional deficiency as a cause for discordance between placental and fetal growth. This may have important implications for the prevention of adult hypertension, which appears to have its origin in fetal life.

Housing and appendicitis in Anglesey

STUDY OBJECTIVE

The aim was to test the hypothesis that provision of household amenities such as domestic hot water systems and bathrooms changed hygiene which thereby triggered the epidemic of appendicitis in Anglesey after the second world war.

DESIGN

The study was a cross sectional survey with histories of housing and appendicectomy obtained from Anglesey residents by postal questionnaire. The main outcome measure was reported appendicectomy.

SETTING

Four general practices in Anglesey.

SUBJECTS

2531 men and women born during 1923-62 and randomly selected from age-sex registers. Overall response rate was 73.7%.

MAIN RESULTS

Subjects born into households with amenities--piped water, hot water systems, and bathrooms had, if anything, a reduced risk of appendicectomy. However, those who subsequently moved to houses that lacked amenities were at significantly higher risk than people born into houses without amenities who later acquired them.

CONCLUSIONS

Provision of household amenities was not the important trigger to the epidemic of appendicitis which occurred in Anglesey after the second world war. Rather, the trigger may have been reduction in domestic crowding caused by the falling birth rate. Findings among those who moved house support other evidence that after infancy household amenities protect against appendicitis and contributed to the fall in appendicitis rates in Anglesey after 1965.

Ischaemic heart disease in England and Wales around the year 2000

STUDY OBJECTIVE

The aim was to predict death rates from ischaemic heart disease in England and Wales during the next 20 years.

STUDY DESIGN

Age and sex specific death rates for 1968-1987 were used to predict national and regional trends until 2007.

SETTING

The nine standard regions of England and Wales.

RESULTS

There will be a large fall in deaths from ischaemic heart disease. The fall will be greater in men and women below 65 years of age. There will, however, be a sharp worsening of the north/south divide. The largest fall in any region will be in Wales.

CONCLUSION

The campaign to change the national diet should give highest priority to the norther regions. Because infant growth is inversely related to adult risk of ischaemic heart disease, the poor growth of young children in some northern areas is a cause for concern.

Performance of young breeding cattle in commercial herds in the south-west of Western Australia. 2. Liveweight, body condition, timing of conception and fertility in first-calf heifers

A 5-year study was conducted using 3498 heifers on commercial properties in the south-west of Western Australia. Breed types represented were Angus, Angus x Friesian, Angus x Hereford, Devon crossbred, Hereford x Friesian, Hereford, Hereford x Simmental, Beef Shorthorn crossbred, Wokalup multibreed and Simmental. Heifers joined at 13-18 months of age were monitored throughout the growing season with emphasis on measurement of liveweight and condition score during joining (range 9-21 weeks) and subsequent reproductive performance. The timing and level of conception were examined for their relationship with liveweight, condition and their rates of change during the joining period. Mean liveweight at conception varied significantly among breeds and apparently corresponded to maturity type. Liveweights (kg) of heifers were: Angus, 255; Hereford, 281; Angus x Friesian, 290; Hereford x Friesian, 295; Simford, 326; Simmental, 416. There were large variations within breeds and between management groups in liveweight and rate of weight change at conception, the range within breed covering at least 160 kg (Angus x Hereford) and at most 240 kg (Simford). Most breeds of heifer conceived at a condition score of 2.0. Positive liveweight gains between 0.39 kglday in Angus heifers and 1.07 kgtday in Simmental heifers, and gains in condition, occurred in all breeds at conception. However, there was no significant relationship between rate of liveweight or condition score change early in the joining period, with calving rate in any breed.In 7 of 10 breeds higher calving rates were associated with heavier liveweight during the joining period. These trends were consistent throughout joining, with the strongest relationships determined by logistic regression analysis using liveweight at the beginning of joining. Statistically significant differences in calving rate were also found between light heifers, <220 kg for Herefords and Hereford x Friesian crossbreds, or <255 kg for larger or later maturing breeds including Angus x Friesian, Simford and Wokalup multibreed, and heifers in heavier liveweight categories. Similarly, the proportion of heifers pregnant was usually lower below a condition score of 1.5; highest fertility was commonly observed at condition scores of 1.5-2.5 during joining. The time from the beginning of joining to conception averaged less than 21 days for most breeds. Significant linear regressions between the interval from the beginning of joining to conception and either liveweight, condition or their rates of change in early joining showed that heifers which were heavier, in better condition, or gaining weight quickly, conceived earlier. These relationships were demonstrated in only half of the breeds in the study. The current data extend the range of cattle breeds for which there is some guide to target weights and condition scores for first conception under grazing management in southern Australia, and identify the relative importance of static and dynamic liveweight effects on heifer fertility.

Performance of young breeding cattle in commercial herds in the south-west of Western Australia. 3. Calf growth, dystocia, and their relationship with production and fertility measurements in first-calf heifers

The preweaning growth of the progeny from 2531 first-calf heifers calving on commercial properties in the south-west of Western Australia was studied over 5 years. Animals included the progeny of Angus sires mated to Angus, Angus x Friesian, Simford, Hereford and Beef Shorthorn crossbred heifers; the progeny of Hereford sires mated to Hereford, Hereford x Friesian, and Beef Shorthorn crossbred; and those of Devon crossbred, Simford or Wokalup multibreed heifers mated inter se. Calves were born between mid January and July of each year and date of birth, calving information and calf growth through to weaning at an average age of 230 days were recorded. Data recorded on the calves' dams included regular liveweight and condition score assessment and the date of second calving. Angus-sired calves were lighter at birth than Hereford-sired calves; breed means ranged from 25.1 kg for purebred Angus to 33.2 kg for Wokalup multibreeds, with male calves weighing 1.4 kg more than females at birth. Calf birth weight was positively and linearly related to weight of dam at the beginning of joining. Breed of calf, sex of calf, year of birth, day of the year born, liveweight and liveweight change of the dam at the beginning of rejoining all significantly influenced calf growth, with up to 64% of variation accounted for. At 50 days of age, Devon crossbreds, Simfords and Wokalup multibreeds were significantly heavier than crossbred Hereford or Angus calves, and this trend persisted until weaning. The average growth rate to 200 days of Angus calves was 0.113 kg/day slower, and Hereford calves 0.77 kg/day slower, than the average growth rate of their respective crossbred calves. Heaviest 200-day weights were found in Devon crossbred (235 kg), Simford (221 kg) and Wokalup multibreed (219 kg) calves. A strong seasonal influence on calf growth was detected. Each 1 day increase in calf age in calves born between mid January and June resulted in 0.29 kg extra liveweight at 100 days and 0.68 kg extra liveweight at 200 days of age. Overall, the liveweight of the dam at the beginning of re-joining was positively associated with calf growth, with 0.119 kg of calf liveweight/kg dam liveweight at 100 days and 0.123 kg at 200 days. There was less effect of dam liveweight in Herefords and Hereford x Friesians on calf growth to 200 days, but this relationship was closer in faster growing and later maturing breeds, including Angus x Friesian, Simford, and Wokalup multibreed. The dairy crossbreeds generally lost weight at the beginning of re-joining, resulting in a negative association between this weight change and calf growth to 100 days. No assistance was required in 93% of calvings and the highest incidence of dystocia corresponded with the highest birth weight calves in Wokalup multibreeds. The most common calving difficulty was an apparently slow birth where no assistance was given, resulting in a stillborn calf. Male calves experienced 3 times the level of dystocia recorded for female calves. There was no association detected between dystocia and dam liveweight subsequent to calving. The study highlighted the importance of dam breed, liveweight and condition of the dam and timing of calving as important influences on the growth of progeny reared by first-calf heifers.

Hip fracture in Hong Kong and Britain

Hip fractures in elderly people are an important public health problem in many Western populations. Little is known of their epidemiology in Oriental populations. A comparative study of hip fracture incidence in Hong Kong and Southampton showed similar incidence rates by age and sex. In the last two decades hip fracture incidence in Hong Kong has increased, particularly among men. This can be partly explained by reduction in the levels of activity among the elderly Chinese population.