Early growth and coronary heart disease and type 2 diabetes: findings from the Helsinki Birth Cohort Study (HBCS)

Maternal weight in pregnancy and offspring body composition in late adulthood: findings from the Helsinki Birth Cohort Study (HBCS)

INTRODUCTION

Maternal obesity has long-term consequences for the offspring's later health, including an increased risk of type 2 diabetes and cardiovascular disease. The underlying mechanisms explaining these associations are, however, not fully understood.

METHODS

A total of 2003 individuals from the Helsinki Birth Cohort Study born 1934-44, underwent measurements of body size, body composition, and clinical characteristics at a mean age of 62 years. Data on maternal anthropometry were available from hospital records.

RESULTS

Maternal BMI was positively associated with BMI in the offspring. Higher maternal BMI was associated with less favorable body composition in the offspring. There was a significant interaction between birth weight and maternal BMI on offspring body fat percentage (P for interaction 0.003). In mothers with low BMI, a higher offspring birth weight was associated with lower fat percentage, while among those with maternal BMI in the highest fourth, higher offspring birth weight predicted higher body fat percentage.

DISCUSSION

Our findings suggest that a disadvantageous body composition is programmed in early life. This may in part underlie the association between maternal obesity and later cardio-metabolic health of the offspring. These findings support the importance of prevention of overweight in women of child-bearing age.

Early life body mass trajectories and mortality in older age: findings from the Helsinki Birth Cohort Study

BACKGROUND

Overweight and obesity in childhood have been linked to an increased risk of adult mortality, but evidence is still scarce.

METHODS

We identified trajectories of body mass index (BMI) development in early life and investigated their mortality risk. Data come from the Helsinki Birth Cohort Study, in which 4943 individuals, born 1934-1944, had serial measures of weight and height from birth to 11 years extracted from health care records, weight and height data in adulthood, and register-based mortality data for 2000-2010.

RESULTS

Three early BMI trajectories (increasing, average, and average-to-low for men and increasing, average, and low-to-high BMI for women) were identified. Women with an increasing or low-to-high BMI (BMI lower in early childhood, later exceeded average) trajectory had an increased risk of all-cause mortality compared to those with an average BMI trajectory (HR 1.55, 95% CI 1.07-2.23; and HR 1.57, 95% CI 1.04-2.37, respectively). Similar associations were observed for cancer mortality. Among men, BMI trajectories were not associated with all-cause mortality, but those with average-to-low BMI (BMI first similar then dropped below average) had an increased risk of cancer mortality.

CONCLUSIONS

An increasing BMI in early life may shorten the lifespan of maturing cohorts as they age, particularly among women.

Adipose tissue dysregulation and metabolic consequences in childhood and adolescent obesity: potential impact of dietary fat quality

Evidence suggests that at a population level, childhood and adolescent obesity increase the long-term risk of chronic diseases such as type 2 diabetes and CVD. At an individual level, however, the metabolic consequences of obesity in youth vary immensely. Despite comparable BMI, some adolescents develop impaired glucose tolerance while others maintain normal glucose homeostasis. It has been proposed that the variation in the capacity to store lipid in the subcutaneous adipose tissue (SAT) may partially discriminate metabolically healthy from unhealthy obesity. In positive energy balance, a decreased capacity to expand SAT may drive lipid accumulation to visceral adipose tissue, liver and skeletal muscle. This state of lipotoxicity is associated with chronic low-grade inflammation, insulin resistance and dyslipidaemia. The present review examines the differential adipose tissue development and function in children and adolescents who exhibit metabolic dysregulation compared with those who are protected. Additionally, the role of manipulating dietary fat quality to potentially prevent and treat metabolic dysfunction in obesity will be discussed. The findings of the present review highlight the need for further randomised controlled trials to establish the effect of dietary n-3 PUFA on the metabolic phenotype of obese children and adolescents. Furthermore, using a personalised nutrition approach to target interventions to those at risk of, or those with established metabolic dysregulation may optimise the efficacy of modifying dietary fat quality.

Sex differences in the developmental origins of cardiovascular disease

The Developmental Origins of Health and Disease (DOHaD) proposes that adverse events during early life program an increased risk for cardiovascular disease. Experimental models provide proof of concept but also indicate that insults during early life program sex differences in adult blood pressure and cardiovascular risk. This review will highlight the potential mechanisms that contribute to the etiology of sex differences in the developmental programming of cardiovascular disease.

Social Disadvantage and Social Isolation Are Associated With a Higher Resting Heart Rate: Evidence From The Irish Longitudinal Study on Ageing

OBJECTIVES

A high resting heart rate (RHR) represents a major risk factor for cardiovascular disease and individuals from poorer backgrounds have a higher RHR compared with their more advantaged peers. This study investigates the pathways through which low socioeconomic status (SES) contributes to a higher RHR.

METHOD

The sample involved data for 4,888 respondents who were participating in the first wave of The Irish Longitudinal Study on Ageing. Respondents completed a detailed interview at home and underwent a 5-min baseline electrocardiograph recording as part of a clinic-based health assessment. SES was indexed using household income.

RESULTS

The mean difference in RHR between those at polarized ends of the income distribution was 2.80 beats per minute (bpm) (95% CI = 1.54, 4.06; p < .001), with the magnitude of the socioeconomic differential being greater for men (4.15 bpm; 95% CI = 2.18, 6.12; p < .001) compared with women (1.57 bpm; 95% CI = 0.04, 3.10; p < .05). Psychosocial factors including social network size and loneliness accounted for a sizeable proportion of the socioeconomic differential in RHR, particularly among men.

DISCUSSION

The finding that poorer people have a higher RHR reinforces the need for additional research exploring the pathways through which social inequalities are translated into biological inequalities.

Comparative study of four growth models applied to weight and height growth data in a cohort of US children from birth to 9 years

BACKGROUND/AIMS

The objective of our study was to compare the fit of four growth models for weight and height in contemporary US children between birth and 9 years.

METHODS

In Project Viva, we collected weight and height growth data between birth and 9 years. We compared the Jenss model, the adapted Jenss model that adds a quadratic term, and the Reed 1st and 2nd order models. We used the log likelihood ratio test to compare nested models and the Akaike (AIC)/Bayesian information criterion (BIC) to compare nonnested models.

RESULTS

For weight and height, the adapted Jenss model had a better fit than the Jenss model (for weight: p < 0.0001), and the Reed 2nd order model had a better fit than the Reed 1st order model (for weight: p < 0.0001). Compared with the Reed 2nd order model, the adapted Jenss model had a better fit for both weight (adapted Jenss vs. Reed 2nd order, AIC: 66,974 vs. 82,791, BIC: 67,066 vs. 82,883) and height (adapted Jenss vs. Reed 2nd order, AIC: 87,108 vs. 87,612, BIC: 87,196 vs. 87,700).

CONCLUSIONS

In this pre-birth study of children aged 0-9 years, for both weight and height the adapted Jenss model presented the best fit of all four tested models.

A lifecourse approach to health development: implications for the maternal and child health research agenda

Lifecourse-informed models of health fundamentally challenge simple biomedical models, introducing new ways of thinking about how diseases develop. This paper considers the broad implications of lifecourse theory for the maternal and child health (MCH) research agenda. The Lifecourse Health Development model provides an organizing framework for a synthesis of the existing literature on lifecourse health and identification of gaps in knowledge. Priority areas identified for MCH research in order to close these knowledge gaps include: epigenetic mechanisms and their potential mutability; peri-conception as a critical and sensitive period for environmental exposures; maternal health prior to pregnancy; the role of the placenta as an important regulator of the intra-uterine environment; and ways to strengthen early mother-child interactions. Addressing knowledge gaps will require an emphasis on longitudinal rather than cross-sectional studies, long-term (lifetime) rather than short-term perspectives, datasets that include socio-demographic, biologic and genetic data on the same subjects rather than discipline-specific studies, measurement and study of positive health as well as disease states, and study of multi-rather than single generational cohorts. Adoption of a lifecourse-informed MCH research agenda requires a shift in focus from single cause-single disease epidemiologic inquiry to one that addresses multiple causes and outcomes. Investigators need additional training in effective interdisciplinary collaboration, advanced research methodology and higher-level statistical modeling. Advancing a life course health development research agenda in MCH will be foundational to the nation's long-term health.

Long-term consequences of maternal overweight in pregnancy on offspring later health: findings from the Helsinki Birth Cohort Study

INTRODUCTION

Obesity has reached epidemic proportions worldwide. Maternal obesity has consequences for the offspring's later health. Only few studies have focused upon the long-term consequences of maternal obesity on the offspring's later health.

METHODS

A total of 13,345 men and women born in Helsinki during 1934-44 belonging to the Helsinki Birth Cohort Study were included in the study. Data on maternal weight and height in late pregnancy were available from hospital records. Using validated national registers we report on the following outcomes in relation to maternal BMI: death, cancer, coronary heart disease, stroke, and diabetes among the offspring.

RESULTS

Maternal BMI was positively associated with each of the later health outcomes of the offspring. The associations were strongest for cardiovascular disease and type 2 diabetes. The association with type 2 diabetes was stronger in women.

DISCUSSION

Our findings stress the importance of early prevention of overweight and obesity in women of child-bearing age.

Low birthweight and elevated levels of lipoprotein(a) in prepubertal children

AIM

To evaluate whether healthy prepubertal children with low birthweight (LBW) exhibited higher serum levels of lipoprotein(a) (Lp(a)) than did those with normal birthweight (NBW).

METHODS

A total of 350 healthy children aged 6 to 9 years and in Tanner stage 1 were enrolled in a community-based cross-sectional study. Family history of hypertension, diabetes or cardiovascular disease (CVD) in parents and grandparents; active smoking; a diagnosis of acute or chronic illness; and intake of vitamins or nutritional supplements were exclusion criteria. The cut-off point for Lp(a) was 0.79 μmol/L.

RESULTS

LBW was identified in 51 (14.6%) children. In total, 42 (12.0%) children had elevated Lp(a) levels, with 25 (49.0%) and 17 (5.7%) in the LBW and NBW groups, respectively (P < 0.0005). None of the children had adverse cardiovascular outcomes. Average body mass index (BMI) (17.1 ± 3.3 and 18.8 ± 3.9, P = 0.001), glucose levels (4.5 ± 0.5 and 4.8 ± 0.4 mmol/L, P = 0.007), insulin levels (67.4 ± 45.1 and 86.1 ± 54.9 pmol/L, P = 0.02), and Lp(a) levels (0.52 ± 0.21 and 1.40 ± 0.49 μmol/L, P < 0.0005) were higher in the children with LBW than in the children with NBW. A multivariate analysis adjusted by age, sex, raw BMI, BMI standard deviation score and insulin level showed a significant association between LBW and elevated levels of Lp(a) (odds ratio 8.02, 95% confidence interval 7.3-21.3; P < 0.0005).

CONCLUSIONS

LBW was shown to be strongly associated with elevated serum levels of Lp(a).

Periconceptional undernutrition in sheep leads to decreased locomotor activity in a natural environment

Maternal undernutrition during pregnancy increases offspring obesity and metabolic disease risk. We hypothesized that periconceptional undernutrition in sheep from 60 days before conception through to day 30 of gestation (UN) would decrease voluntary locomotor activity in adult offspring. Distance travelled was measured at 18 months of age for ∼48 h in the paddock. Data were analysed using multiple regression analysis, with explanatory variables including sex, nutrition group, birth weight, average time between GPS measurements and percentage of time during the measurement period spent in daylight. Mean (±s.e.) distance walked (m/h) was greater for control (CON) than UN animals, and greater for females than males [110.2 (6.5), CON females; 110.7 (6.3), CON males; 105.1 (5.3), UN females and 95.5 (5.8), UN males; P = 0.02 for nutrition group effect and for sex effect]. Periconceptional undernutrition may lead to a significant decrease in voluntary physical activity in adult offspring.

Faster increase in body mass index between ages 8 and 13 is associated with risk factors for cardiovascular morbidity and mortality

BACKGROUND AND AIMS

Excess childhood weight is associated with cardiovascular disease (CVD) in adulthood. Whether this is mediated through adult body mass index (BMI) and associated risk factors such as metabolic derangements remains unclear. The aim was to examine whether childhood BMI velocity (Δkg m(-2) per year) was associated with adult CVD mortality and to examine how adult BMI and cardiometabolic risk factors contribute to the association.

METHODS AND RESULTS

Subjects were 1924 Icelanders born between 1921 and 1935 and living in Reykjavik when recruited into a longitudinal study from 1967 to 1991. From ages 8-13 years, BMI velocity was calculated to quantify the association between childhood growth and adult CVD mortality. Deaths from recruitment to 31 December 2009 were extracted from the national register. There were 202 CVD deaths among men and 90 CVD deaths among women (mean follow-up: 25.9 years). Faster BMI velocity from ages 8-13 years was associated with CVD mortality when comparing those in the highest versus lowest tertile with corresponding hazard ratio (HR) (95% confidence interval (CI)): 1.49 (1.03, 2.15) among men and 2.32 (1.32, 4.08) among women after adjustment for mid-life BMI and CVD risk factors. Faster childhood BMI velocity was associated with elevated CVD risk factors among men at mid-life but these associations were less pronounced among women.

CONCLUSION

Faster increase in BMI from ages 8-13 years was associated with an increased CVD mortality risk. Children with early growth spurts coupled with excess weight gain during this transition period from childhood into adolescence should be closely monitored to ensure better health in adulthood.

Maternal protein restriction induces alterations in hepatic tumor necrosis factor-α/CYP7A1 signaling and disorders regulation of cholesterol metabolism in the adult rat offspring

It is well recognized that adverse events in utero impair fetal development and lead to the development of obesity and metabolic syndrome in adulthood. To investigate the mechanisms linking impaired fetal growth to increased cholesterol, an important clinical risk factor characterizing the metabolic syndrome and cardiovascular disease, we examined the impact of maternal undernutrition on tumor necrosis factor-α (TNF-α)/c-jun N-terminal kinase (JNK) signaling pathway and the cholesterol 7α-hydroxylase (CYP7A1) expression in the livers of the offspring with a protein restriction model. The male offspring with intrauterine growth restriction (IUGR) caused by the isocaloric low-protein diet showed decreased liver weight at birth and augmented circulation and hepatic cholesterol levels at 40 weeks of age. Maternal undernutrition significantly upregulated cytokine TNF-α expression and JNK phospholytion levels in the livers from fetal age to adulthood. Elevated JNK phospholytion could be linked to downregulated hepatocyte nuclear factor-4α and CYP7A1 expression, subsequently led to higher hepatic cholesterol. This work demonstrated that intrauterine malnutrition-induced IUGR might result in intrinsic disorder in hepatic TNF-α/CYP7A1 signaling, and contribute to the development of hypercholesterolemia in later life.

A study of early complementary feeding determinants in the Republic of Ireland based on a cross-sectional analysis of the Growing Up in Ireland infant cohort

OBJECTIVE

Early complementary feeding has been shown to increase the risk of overweight, obesity and chronic diseases later in life. Poor compliance with current guidelines on complementary feeding has been reported by Irish studies. The aim of the present paper is to identify predictors of early complementary feeding in order to help health professionals target population groups in greater need of dietary intervention as well as to provide effective advice.

DESIGN

Cross-sectional analysis of the national, longitudinal Growing Up in Ireland study.

SETTING

Data were derived from the first wave (2007-2008) of the Growing Up in Ireland infant cohort.

SUBJECTS

A cohort of mothers (n 11 134) from the Republic of Ireland, interviewed when their infants were 9 months of age.

RESULTS

Of the infants, 1469 (13·5 %) had been regularly taking solids in the period between 12 and 16 weeks; this percentage increased to 47·0 % of the sample in the period between 16 and 20 weeks. Timing of formula feeding commencement, high maternal BMI and choosing a relative as the infant's minder were strongly associated with early introduction of solids both in bivariate and multivariate analysis. Those infants who started formula feeding at >4 months were 88·4% less likely to be introduced to solids early compared with those who started at <2 months (OR = 0·116; 95% CI 0·072, 0·186; P < 0·001).

CONCLUSIONS

The results demonstrate that biological, social and behavioural aspects exert an important role in infant feeding practices. These findings are relevant to the design of policies and intervention programmes aimed at educating parents.

FTO genotype, vitamin D status, and weight gain during childhood

Previous evidence suggests that variants in the fat mass and obesity-associated gene (FTO) affect adiposity in an age-dependent fashion in children, and nutritional factors may modify genotype effects. We assessed the effect of FTO rs9939609 on BMI and BMI-for-age Z score changes during childhood in a population-based longitudinal study in the Brazilian Amazon and investigated whether these effects were modified by vitamin D status, an important nutritional factor related to adiposity. At baseline, 1,088 children aged <10 years had complete genotypic and anthropometric data; 796 were followed up over a median 4.6 years. Baseline vitamin D insufficiency was defined as <75 nmol/L. We observed a 0.07 kg/m(2)/year increase in BMI and a 0.03 Z/year increase in BMI-for-age Z score per rs9939609 risk allele over follow-up (P = 0.01). Vitamin D status significantly modified FTO effects (P for interaction = 0.02). The rs9939609 risk allele was associated with a 0.05 Z/year increase in BMI-for-age Z score among vitamin D-insufficient children (P = 0.003), while no significant genetic effects were observed among vitamin D-sufficient children. Our data suggest that FTO rs9939609 affects child weight gain, and genotype effects are more pronounced among children with insufficient vitamin D levels.

How the kidney is impacted by the perinatal maternal environment to develop hypertension

Environmental conditions during perinatal development such as maternal undernutrition, maternal glucocorticoids, placental insufficiency, and maternal sodium overload can program changes in renal Na(+) excretion leading to hypertension. Experimental studies indicate that fetal exposure to an adverse maternal environment may reduce glomerular filtration rate by decreasing the surface area of the glomerular capillaries. Moreover, fetal responses to environmental insults during early life that contribute to the development of hypertension may include increased expression of tubular apical or basolateral membrane Na(+) transporters and increased production of renal superoxide leading to enhanced Na(+) reabsorption. This review will address the role of these potential renal mechanisms in the fetal programming of hypertension in experimental models induced by maternal undernutrition, fetal exposure to glucocorticoids, placental insufficiency, and maternal sodium overload in the rat.

Breast-fed infants and their later cardiovascular health: a prospective study from birth to age 32 years

The aim of the present study was to evaluate the impact of infant breast-feeding on cardiovascular risk in young adults. This unique study group involved 158 subjects (eighty-two females) originally collected prospectively at birth in 1975 and followed up to the age of 32 years. Frequent visits during the first year guaranteed the knowledge of the precise duration of breast-feeding. All infants received at least some breast milk. Participants were assessed for both individual cardiovascular risk factors (blood pressure, plasma lipids, homeostatic model assessment of insulin resistance and waist circumference) and the general clinical risk of cardiovascular events by calculating the Framingham risk score (FRS) and the metabolic syndrome criteria score (NCEP-ATPIII; National Cholesterol Education Program's Adult Treatment Panel III). Data on lifestyle factors were carefully collected. Linear regression analyses revealed that the effect of the duration of breast-feeding was not relevant (0·02 decrease in the FRS per one additional breast-feeding month; 95 % CI - 0·19, 0·09). Similarly, the effect of breast-feeding was minor on all of the individual cardiovascular risk factors. We used sex, physical activity, dietary fat and vitamin C, smoking and alcohol consumption as covariates. Again, logistic regression analyses detected no significant impact of the duration of breast-feeding on the risk of the metabolic syndrome according to the NCEP-ATPIII (OR 0·95, 95 % CI 0·8, 1·1). The strongest independent predictor for later CVD risk was male sex. In conclusion, in this prospectively followed cohort of young adults born at term and at weight appropriate for gestational age, the duration of breast-feeding did not have an impact on the accumulation of cardiovascular risk factors.

Seasonality and ambient temperature at time of conception in term-born individuals - influences on cardiovascular disease and obesity in adult life

Background

The influence of environmental conditions early in life – including temperature and season – on health later in life has so far not attracted much attention.

Objective

Using data from the Helsinki Birth Cohort Study of 13,345 men and women, the influence of temperature and season at month of conception on birth weight, and on cardiovascular diseases and obesity-related traits in later life was studied.

Design

Linear regressions were fitted to examine the relationship between birth weight/obesity-related variables/hypertension and alternatively month of conception and average temperature of month of conception. The incidence of both coronary heart disease and cerebrovascular disease was assumed to follow a Weibull hazard model, and was modelled accordingly using survival analysis techniques.

Results

In women, unusually cold temperatures at month of conception predicted lower body mass index (BMI) and fat percentage, and protected from obesity. Warmer temperatures at month of conception were associated with higher risk for hypertension. In men, warmer temperatures around conception predicted lower BMI. No seasonal influences were detected on obesity-related variables, nor were there seasonal or temperature mediated influences on birth weight, coronary heart disease or cerebrovascular disease observed.

Conclusions

We suggest that ambient temperature has an influence on obesity-related outcomes and hypertension. This merits further study, also with regard to other health outcomes and from a global perspective.

Early growth and non-alcoholic fatty liver disease in adulthood-the NAFLD liver fat score and equation applied on the Helsinki Birth Cohort Study

INTRODUCTION

Prenatal and childhood growth influence the risk of developing the metabolic syndrome and type 2 diabetes. Both conditions are associated with non-alcoholic fatty liver disease (NAFLD). Our aim was to explore the associations between early growth and adult NAFLD.

METHODS

We studied 1587 individuals from the Helsinki Birth Cohort Study (HBCS) born 1934-44 for whom birth, childhood, and adult clinical data were available. NAFLD was defined using the NAFLD liver fat score and equation. The score was converted into a dichotomous variable, with outcomes defined as either a positive or negative score. The equation predicts liver fat percentage.

RESULTS

A positive score was found in 43% of men and 22.5% of women. Several measurements of birth and childhood body size were negatively associated with both NAFLD outcomes after adjustment for adult BMI. Those from the smallest BMI tertile at age 2 who were obese in adulthood had an OR of 18.5 for a positive score compared to those from the same group who were normal weight in adulthood.

CONCLUSIONS

A larger childhood body size was negatively associated with NAFLD outcomes. Individuals who are small during early childhood and obese as adults seem to be at the highest risk of developing NAFLD.

Interruption of scheduled, automatic feeding and reduction of excess energy intake in toddlers

BACKGROUND

Childhood obesity due to the consumption of excess calories is a severe problem in developed countries. In a previous investigation on toddlers, hospital laboratory measurements showed an association of food-demand behavior with constant lower blood glucose before meals than for scheduled meals. We hypothesize that maternal scheduling of meals for toddlers results in excess energy intake compared to feeding only on demand (previously "on request").

OBJECTIVE

We tested the cross-sectional null hypothesis of no difference in energy intake between scheduled (automatic) and demanded meals (administered after evaluation) in 24 mother-toddler (21 months old at entry) pairs with chronic, nonspecific diarrhea presenting at a clinic. We tested the same hypothesis in a subset of 14 toddlers by measuring the resting (sleeping) metabolic rate 4 hours after lunch, as well as the total daily energy expenditure (TEE) in 10 toddlers.

METHODS

We trained mothers to recognize meal demands (as in the previous investigation) and to provide food in response, but required no blood glucose measurements before meals. Energy intake was assessed by a 10-day food diary, resting metabolic rate (RMR) by respiratory analyses (indirect calorimetry) in 14 toddlers, and TEE by doubly labeled water in 10 toddlers. Their blood parameters, anthropometry, and number of days with diarrhea were assessed before training and 50 days after training.

RESULTS

RMR decreased from 58.6 ± 7.8 to 49.0 ± 9.1 kcal/kg/d (P < 0.001) and TEE decreased from 80.1 ± 6.9 to 67.8 ± 10.0 kcal/kg/d (P < 0.001). Energy intake decreased from 85.7 ± 15.3 to 70.3 ± 15.8 kcal/kg/d (P < 0.001). The height Z-score increased significantly, while weight growth was normal. Toddlers entering the study over the median RMR decreased their RMR significantly more than those below the median RMR (P < 0.01).

CONCLUSION

Scheduled meal suspension induces meal demand frequency to increase. Demanded meals are associated with significantly lower energy intake, RMR, and TEE than scheduled meals. Feeding on demand may be an effective skill in a strategy for reducing excess energy intake in the long term and in regulating body weight in toddlers and children.

Life course health care and preemptive approach to non-communicable diseases

Non-communicable diseases (NCDs), such as diabetes mellitus and coronary heart disease, are chronic, non-infectious diseases of long duration. NCDs are increasingly widespread worldwide and are becoming a serious health and economic burden. NCDs arise from complex interactions between the genetic make-up of an individual and environmental factors. Several epidemiological studies have revealed that the perinatal environment influences health later in life, and have proposed the concept of developmental programming or developmental origin of health and disease (DOHaD). These studies suggest the importance of life course health care from fetal life, early childhood, adulthood, and through to old age. Recent progress in genomics, proteomics and diagnostic modalities holds promise for identifying high risk groups, predicting latent diseases, and allowing early intervention. Preemptive medicine is the ultimate goal of medicine, but to achieve it, the full participation of the public and all sectors of society is imperative.

Rate of neonatal weight gain and effects on adult metabolic health

The association of rapid weight gain in early life with increased adiposity and obesity in later life has been established, whereas whether rapid neonatal weight gain predisposes individuals to other risk factors for cardiovascular disease and type 2 diabetes mellitus remains controversial. Gain in weight of >0.5 SD scores in the first 3 months of life (described as rapid weight gain) is associated with an unfavourable health profile in adulthood, and keeping weight gain below this threshold could reduce the risk of cardiovascular and metabolic diseases later in life. Weight gain above this threshold is not necessarily unhealthy if the increase is in proportion with the increase in length. As such, regular measurement of both the weight and length of all infants is important. Preterm infants and those who are born small for gestational age are most likely to have rapid weight gain, and are high-risk populations for unfavourable health profiles in adulthood.

The dysfunctional placenta epigenome: causes and consequences

The placenta is a fetal–maternal endocrine organ responsible for ensuring proper fetal development throughout pregnancy. Adverse insults to the intrauterine environment often lead to expression level changes in placental genes, many of which are epigenetically regulated by DNA methylation, histone modifications and ncRNA interference. These epigenetic alterations may cause placental dysfunction, resulting in offspring of low birthweight owing to adverse pregnancy complications such as intrauterine growth restriction. Numerous epidemiological studies have shown a strong correlation between low birthweight and increased risk of developing metabolic diseases and neurological imbalances in adulthood, and in subsequent generations, indicating that epigenetic regulation of gene expression can be propagated stably with long-term effects on health. This article provides an overview of the various environmental factors capable of inducing detrimental changes to the placental epigenome, as well as the corresponding mechanisms that prime the offspring for onset of disease later in life.

Early determinants of type-2 diabetes

The global prevalence of type-2 diabetes (T2D) has more than doubled in the last 30 years and is predicted to continue to rise at an alarming rate. The associated health and financial burdens are considerable. The aetiology of common forms of T2D is multifactorial and involves a complex interplay between genetic, epigenetic and environmental factors. The influential role of the environment, in particular our diet and sedentary lifestyles, in diabetes risk is well established. Of major concern is the increasing prevalence of early onset T2D or pre-diabetic characteristics in children. In recent years, the role of the early life environment in programming diabetes risk has been the focus of numerous human and animal studies. Historical studies highlighted an association between low birthweight, a proxy for suboptimal in utero growth, and diabetes risk in adulthood. Over more recent years it has become apparent that a variety of expositions, including maternal obesity and/or maternal diabetes, can have a significant effect on offspring health outcomes. Further complicating matters, paternal and transgenerational transmission of T2D can occur thus mediating a perpetuating cycle of disease risk between generations. It is imperative for the underlying mechanisms to be elucidated so that interventions can be introduced. In doing so, it may be possible to prevent, delay or reverse a pre-programmed risk for T2D induced by pre- and/or postnatal environmental factors to improve health outcomes and curb premature metabolic decline. This review presents evidence for how the early life environment may programme T2D risk and suggests some mechanisms by which this may occur.

Requested meals versus scheduled meals

BACKGROUND

Scheduled meals are considered to be equivalent to those requested by the infant (null hypothesis). In adults, we have found high blood glucose before scheduled meals and low blood glucose after recognition of validated initial hunger. Low preprandial blood glucose is associated with a decrease in energy intake and body weight both in adults who are overtly overweight and in those who are of normal weight with insulin resistance (hidden overweight). In this study, we investigated the validity of the null hypothesis between scheduled and requested meals in 2-year-old infants with chronic nonspecific diarrhea.

METHODS

We trained a "recognizing request" meal pattern in 70 mother-infant pairs. The trained meal pattern consisted of administering food after a first request that we validated by blood glucose measurement in the hospital laboratory. Using a 7-day food diary, mothers reported preprandial blood glucose measurements for their infants three times a day. We assessed mean preprandial blood glucose, daily energy intake, days with diarrhea, blood parameters, and anthropometry before training and 4 months after training, and compared the results with measurements in 73 randomly selected untrained controls.

RESULTS

In the trained group, there was a decrease in mean blood glucose from 86.9 ± 9.4 mg/dL to 76.4 ± 6.7 mg/dL (P < 0.0001), as well as a decrease in energy intake and days with diarrhea in comparison with control infants who maintained scheduled meals. Only two of 21 infants who had a mean blood glucose lower than 81.2 mg/dL at recruitment showed a statistically significant decrease in mean blood glucose, whereas 36 of 49 infants above this cutoff level showed a statistically significant decrease after training (Chi-square test, P < 0.0001).

CONCLUSION

Requested meals are associated with low preprandial blood glucose, significantly lower energy intake, and recovery from diarrhea, whereas scheduled meals are associated with high blood glucose, higher energy intake, and persistence of diarrhea. The disparities in blood glucose levels and energy intake disprove the null hypothesis, suggesting the need for a change from scheduled to requested meals early on in food administration, ie, during the neonatal period.

Size at birth and adult fat mass in twin sheep are determined in early gestation

Size at birth is related to adult health outcomes. Twins are born smaller than singletons; this has been assumed to be secondary to limited nutrient supply in late gestation.We hypothesised that growth trajectory in twins, and the adult consequences of being conceived a twin, are determined in early gestation. Twin pregnancies in sheep were randomised to reduction of one twin on day 42 of a 148 day pregnancy by intra-thoracic KCl (Reductions, n =46) or a sham procedure (Twins, n =22). Singleton-bearing ewes also underwent a sham procedure (n =27). Ewes lambed spontaneously. Linear measures of size at birth were similar in Twins and Reductions, and significantly less than in Singletons. Birthweight was lower in Twins and Reductions than in Singletons, and less in Twins than in Reductions (means (SEM): Singletons, liveborn n =23: 6.59 (0.17) kg; Twins, liveborn n =36: 5.23 (0.16) kg; Reductions, liveborn n =27: 5.76 (0.15) kg; all comparisons P <0.05). Reductions grew most rapidly between birth and weaning (Singletons, 20.0 (0.4) g kg⁻¹ day⁻¹; Twins, 20.0 (0.3) g kg⁻¹ day⁻¹; Reductions, 21.0 (0.3) g kg⁻¹ day⁻¹, P <0.05) and were of similar weight as Singletons by weaning; Twins remained smaller by weaning but grew most rapidly thereafter (Singletons, 1.6 (0.1) g kg⁻¹ day⁻¹; Twins, 2.1 (0.1) g kg⁻¹ day⁻¹; Reductions, 1.6 (0.1) g kg⁻¹ day⁻¹, P <0.01), so that all groups had similar weight at 2 years. However, Twins and Reductions had greater percentage fat mass than Singletons at 2 years (Singletons, 11.1 (1.1)%; Twins, 14.8 (1.2)%; Reductions, 15.5 (1.1)%, P <0.05). Thus, in twins, fetal growth trajectory, linear size at birth and adult fat mass are largely determined in early gestation. If this is also true in humans, there are important implications for interventions aimed at optimising fetal growth and pregnancy outcome.