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Rached V, Diogenes MEL, Donangelo CM, Bezerra FF. Calcium plus vitamin D supplementation during pregnancy reduces postpartum fat mass in adolescents: A randomized trial. Am J Hum Biol 2023; 35:e23911. [PMID: 37166151 DOI: 10.1002/ajhb.23911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Pregnancy during adolescence may increase the risk of overweight/obesity. There is evidence that increasing calcium intake, alone or vitamin D-combined, may favor loss of weight and/or fat mass. OBJECTIVES We hypothesized that calcium supplementation during pregnancy reduces excessive fat accumulation during postpartum period. We aimed to investigate the effect of calcium plus vitamin D supplementation during pregnancy on body composition measurements throughout 1 year postpartum in Brazilian adolescents with habitually low calcium intake (~600 mg/day). METHODS Adolescents (14-19 years) were randomly assigned to receive a daily supplement (600 mg of calcium plus 200 UI of cholecalciferol, n = 30) or a placebo (n = 26) from 26 weeks of gestation until parturition. Body composition was determined at 5, 20, and 56 weeks postpartum by dual-energy x-ray absorptiometry. The effects of intervention group, time point, as well as their interaction were assessed using repeated measures mixed-effects models. RESULTS In the adjusted analysis, those supplemented showed lower total body mass [mean difference = -3.32 kg; confidence interval (CI) 95% -6.12 to -0.52 kg], trunk (-1.25 kg; CI 95% -2.34 to -0.15 kg), android (-0.29 kg; CI 95% -0.53 to -0.04 kg) and subcutaneous (-0.23 kg; CI 95% -0.43 to -0.03 kg) fat masses. In the supplemented group, BMI and postpartum weight retention significantly decreased from 5 to 20 weeks (-0.90 kg/m2 and -1.76 kg, respectively; p < .05). At 56 weeks, BMI was still lower (-1.22 kg/m2 ; p < .05) than 5 weeks. CONCLUSIONS Our findings suggest that increasing calcium intake through supplementation in combination with vitamin D contributes to a more pronounced reduction in total body mass overtime, mostly as a consequence of fat mass reductions in central body regions. This trial was registered at clinicaltrials.gov as NCT01732328.
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Affiliation(s)
- Verônica Rached
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria Eduarda Leão Diogenes
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Brazilian National Cancer Institute José Alencar Gomes da Silva, Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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Sámano R, Martínez-Rojano H, Ortiz-Hernández L, Nájera-Medina O, Chico-Barba G, Gamboa R, Mendoza-Flores ME. Individual, Family, and Social Factors Associated with Gestational Weight Gain in Adolescents: A Scoping Review. Nutrients 2023; 15:nu15061530. [PMID: 36986260 PMCID: PMC10058126 DOI: 10.3390/nu15061530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
About 56% to 84% of pregnant adolescents have inappropriate (insufficient or excessive) gestational weight gain (GWG); however, the factors associated with GWG in this age group have not been systematically identified. This scoping review aimed to synthesize the available scientific evidence on the association of individual, family, and social factors with inappropriate gestational weight gain in pregnant adolescents. To carry out this review, the MEDLINE, Scopus, Web of Science, and Google Scholar databases were searched for articles from recent years. The evidence was organized according to individual, family, and social factors. The analyzed studies included 1571 adolescents from six retrospective cohorts, 568 from three prospective cohorts, 165 from a case-control study, 395 from a cross-sectional study, and 78,001 from two national representative samples in the USA. At the individual level, in approximately half of the studies, the pre-pregnancy body mass index (pBMI) was positively associated with the GWG recommended by the Institute of Medicine of the USA (IOM). The evidence was insufficient for the other factors (maternal age, number of deliveries, and family support) to determine an association. According to the review, we concluded that pBMI was positively associated with the GWG. More quality studies are needed to assess the association between GWG and individual, family, and social factors.
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Affiliation(s)
- Reyna Sámano
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico
| | - Hugo Martínez-Rojano
- Sección de Posgrado e Investigación de la Escuela Superior de Medicina del Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Luis Ortiz-Hernández
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
- Departamento de Atención a la Salud, Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 04960, Mexico
| | - Oralia Nájera-Medina
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
- Departamento de Atención a la Salud, Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 04960, Mexico
| | - Gabriela Chico-Barba
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Ricardo Gamboa
- Departamento de Fisiología, Instituto Nacional de Cardiología, Mexico City 14080, Mexico
| | - María Eugenia Mendoza-Flores
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico
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Gooding HC, Ning H, Perak AM, Allen N, Lloyd-Jones D, Moore LL, Singer MR, de Ferranti SD. Cardiovascular health decline in adolescent girls in the NGHS cohort, 1987-1997. Prev Med Rep 2020; 20:101276. [PMID: 33344149 PMCID: PMC7736975 DOI: 10.1016/j.pmedr.2020.101276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 01/31/2023] Open
Abstract
Adolescence is a critical time for the preservation or loss of cardiovascular health. We aimed to describe trajectories of cardiovascular health in adolescent girls and identify early adolescent factors associated with cardiovascular health in young adulthood. We used data from the National Growth and Health Study, a longitudinal cohort of 2,379 girls followed annually from ages 9-19 years. We classified participants as having ideal, intermediate, or poor levels of the seven cardiovascular health metrics at four developmental stages: early (ages 9-11), middle (ages 12-14), and late (ages 15-17) adolescence, and early young adulthood (ages ≥ 18). We calculated total cardiovascular health scores (range 0-14) at each stage and empirically identified patterns of cardiovascular health trajectories. We examined associations between trajectory group membership and various demographic, behavioral, and physiological factors. Mean cardiovascular health scores declined with age from 10.8 to 9.4 in white girls and 10.3 to 8.9 in black girls; 17% of white girls and 23% of black girls had low cardiovascular health (score < 8) by early young adulthood. We identified five cardiovascular health trajectories: high-stable (14% of participants), high-to-moderate (48%), high-to-low (20%), moderate-stable (10%), and moderate-to-low (8%). Exceeding 14 h per week of television in early adolescence and teen pregnancy were associated with higher odds of being in several less healthy trajectory groups. In conclusion, cardiovascular health declines during adolescence and black-white disparities begin before early adolescence. Key targets for improving cardiovascular health in adolescent girls may include reductions in sedentary behavior and prevention of teen pregnancy.
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Affiliation(s)
- Holly C. Gooding
- Department of Pediatrics, Emory University School of Medicine, USA
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA
- Department of Medicine, Northwesten University Feinberg School of Medicine, USA
| | - Lynn L. Moore
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, USA
| | - Martha R. Singer
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, USA
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Wallace JM. Competition for nutrients in pregnant adolescents: consequences for maternal, conceptus and offspring endocrine systems. J Endocrinol 2019; 242:T1-T19. [PMID: 30615597 DOI: 10.1530/joe-18-0670] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/08/2022]
Abstract
The competition for nutrients that arises when pregnancy coincides with continuing or incomplete growth in young adolescent girls increases the risk of preterm delivery and low birthweight with negative after-effects for mother and child extending beyond the perinatal period. Sheep paradigms involving nutritional management of weight and adiposity in young, biologically immature adolescents have allowed the consequences of differential maternal growth status to be explored. Although nutrient reserves at conception play a modest role, it is the dietary manipulation of the maternal growth trajectory thereafter which has the most negative impact on pregnancy outcome. Overnourishing adolescents to promote rapid maternal growth is particularly detrimental as placental growth, uteroplacental blood flows and fetal nutrient delivery are perturbed leading to a high incidence of fetal growth restriction and premature delivery of low birthweight lambs, whereas in undernourished adolescents further maternal growth is prevented, and depletion of the maternal body results in a small reduction in birthweight independent of placental size. Maternal and placental endocrine systems are differentially altered in both paradigms with downstream effects on fetal endocrine systems, organ development and body composition. Approaches to reverse these effects have been explored, predominantly targeting placental growth or function. After birth, growth-restricted offspring born to overnourished adolescents and fed to appetite have an altered metabolic phenotype which persists into adulthood, whereas offspring of undernourished adolescents are largely unaffected. This body of work using ovine paradigms has public health implications for nutritional advice offered to young adolescents before and during pregnancy, and their offspring thereafter.
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Skeith AE, Stephens CQ, Nielson CM, Caughey AB. History of adolescent birth and diabetes in adulthood: a cross-sectional study of a nationally representative sample of American women. J Matern Fetal Neonatal Med 2019; 34:714-719. [PMID: 31039650 DOI: 10.1080/14767058.2019.1614159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In the USA, 12-14% have type 2 diabetes mellitus and the incidence is rising. Adolescent birth has been shown to be associated with significant gestational weight gain and obesity in adulthood.Objective: We sought to evaluate the association between the history of adolescent birth and diabetes in adulthood.Study design: We conducted a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) data, examining 2-year cycles from 2005 to 2014. In a population of adult women who had experienced at least one live birth and who were not currently pregnant, we examined the prevalence of type 2 diabetes mellitus by the history of adolescent birth (live birth prior to 20 years of age). Sample characteristics were compared using survey-weighted chi-square tests. Multivariate logistic regression was used to examine the association between diabetes mellitus and adolescent birth history, with progressive adjustments for birth cohort, race/ethnicity, education level, and body mass index (BMI).Results: In a survey sample of 6507 individuals, we found that 38% of the women had experienced adolescent birth. Significant differences were found between those who had experienced adolescent birth and those who had not by birth cohort, race/ethnicity, federal poverty level, education attainment, parity, and BMI (p < .001 for all). The prevalence of type 2 diabetes was higher in women with a history of adolescent birth in adulthood than in women without a history of adolescent birth (17.2 versus 12.1%, p < .001; BMI-adjusted odds ratio = 1.27; 95% confidence interval, 1.03-1.58, p = .03).Conclusion: American women with a history of adolescent birth are at a significantly higher risk of type 2 diabetes mellitus in adulthood. Greater attention must be paid to preventing metabolic disease in women who experience early parity.
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Affiliation(s)
- Ashley E Skeith
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Caroline Q Stephens
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Carrie M Nielson
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
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Huayanay-Espinoza CA, Quispe R, Poterico JA, Carrillo-Larco RM, Bazo-Alvarez JC, Miranda JJ. Parity and Overweight/Obesity in Peruvian Women. Prev Chronic Dis 2017; 14:E102. [PMID: 29072986 PMCID: PMC5662294 DOI: 10.5888/pcd14.160282] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction The rise in noncommunicable diseases and their risk factors in developing countries may have changed or intensified the effect of parity on obesity. We aimed to assess this association in Peruvian women using data from a nationally representative survey. Methods We used data from Peru’s Demographic and Health Survey, 2012. Parity was defined as the number of children ever born to a woman. We defined overweight as having a body mass index (BMI, kg/m2) of 25.0 to 29.9 and obesity as a BMI ≥30.0. Generalized linear models were used to evaluate the association between parity and BMI and BMI categories, by area of residence and age, adjusting for confounders. Results Data from 16,082 women were analyzed. Mean parity was 2.25 (95% confidence interval [CI], 2.17–2.33) among rural women and 1.40 (95% CI, 1.36–1.43) among urban women. Mean BMI was 26.0 (standard deviation, 4.6). We found evidence of an association between parity and BMI, particularly in younger women; BMI was up to 4 units higher in rural areas and 2 units higher in urban areas. An association between parity and BMI categories was observed in rural areas as a gradient, being highest in younger women. Conclusion We found a positive association between parity and overweight/obesity. This relationship was stronger in rural areas and among younger mothers.
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Affiliation(s)
- Carlos A Huayanay-Espinoza
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Renato Quispe
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julio A Poterico
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Carlos Bazo-Alvarez
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Ave Armendáriz 497, 2do piso, Miraflores, Lima 18, Peru. .,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Parikh NI, Norberg M, Ingelsson E, Cnattingius S, Vasan RS, Domellöf M, Jansson JH, Edstedt Bonamy AK. Association of Pregnancy Complications and Characteristics With Future Risk of Elevated Blood Pressure: The Västerbotten Intervention Program. Hypertension 2017; 69:475-483. [PMID: 28137991 DOI: 10.1161/hypertensionaha.116.08121] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/10/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022]
Abstract
Pregnancy characteristics are associated with risk of cardiovascular diseases, but their independent associations with hypertension or blood pressure (BP) levels remain uncertain. We linked the Swedish Medical Birth Register with Västerbotten Intervention Program data (Northern Sweden). Using linear and logistic regression, we related pregnancy factors in any prior pregnancy with BP and hypertension at 40 years of age in 15 896 parous women free of prepregnancy hypertension. Pregnancy factors included parity, age at first delivery, preeclampsia, gestational diabetes mellitus, placental abruption, shortest gestational age small for gestational age baby (<third percentile for birth weight) or stillbirth. We defined hypertension as systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg or antihypertensive use. Multivariable models were adjusted for all pregnancy factors and potential lifestyle and sociodemographic confounders. At 40 years of age, 1535 women (9.6%) had hypertension. In multivariable models, lower parity, younger age at first birth, preeclampsia, small for gestational age, and placental abruption were independently associated with higher systolic and diastolic BP levels at 40 years of age. Younger age at first birth, preeclampsia, gestational age <32 versus ≥37 weeks, and small for gestational age were independently associated with hypertension. Our findings raise the possibility that earlier and more frequent BP screening may be desirable in women with these pregnancy characteristics.
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Affiliation(s)
- Nisha I Parikh
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.).
| | - Margareta Norberg
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Erik Ingelsson
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Sven Cnattingius
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Ramachandran S Vasan
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Magnus Domellöf
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Jan Håkan Jansson
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Anna-Karin Edstedt Bonamy
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
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Abstract
OBJECTIVES Excessive gestational weight gain (GWG) is associated with higher body mass index (BMI) later in life. Increased BMI is associated with health problems, but there is limited evidence linking GWG directly to later health in black women. We examined the association between GWG and health conditions 18 years after a first birth. METHODS This study was a secondary data analysis of 467 urban black women, enrolled during pregnancy (1990-1991). GWG was the difference between self-reported pre-pregnancy weight and measured weight at delivery. Hypertension, diabetes, obesity, and self-reported health were assessed with self-report and measurements of blood pressure, height, and weight, approximately 18 years after first childbirth. RESULTS Higher pre-pregnancy BMI was associated with increased probability of each health condition. Higher GWG was associated with hypertension for women with a pre-pregnancy BMI under 21.3 kg/m(2) (P < .05) and obesity for women with a pre-pregnancy BMI under 25.9 kg/m(2) (P < .05). Diabetes and poor health were not associated with GWG. CONCLUSIONS GWG may impact a mother's hypertension and obesity status 18 years after childbirth for underweight and normal weight women.
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Lundeen EA, Norris SA, Martorell R, Suchdev PS, Mehta NK, Richter LM, Stein AD. Adolescent Pregnancy and Attained Height among Black South African Girls: Matched-Pair Prospective Study. PLoS One 2016; 11:e0147861. [PMID: 26808552 PMCID: PMC4726513 DOI: 10.1371/journal.pone.0147861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE The impact of adolescent pregnancy on offspring birth outcomes has been widely studied, but less is known about its impact on the growth of the young mother herself. OBJECTIVE To determine the association between adolescent pregnancy and attained height. DESIGN Prospective birth cohort study. SETTING Cohort members followed from birth to age 20 y in Soweto, South Africa. PARTICIPANT From among 840 Black females with sufficient data, we identified 54 matched pairs, in which a girl who became pregnant before the age of 17 years was matched with a girl who did not have a pregnancy by age 20 y. Pairs were matched on age at menarche and height-for-age z scores in the year before the case became pregnant (mean 15.0 y). MAIN OUTCOME MEASURES The two groups were compared with respect to attained height, measured at mean age 18.5 y. RESULTS Mean age at conception was 15.9 years (range: 13.7 to 16.9 y). Mean height at matching was 159.4 cm in the adolescent pregnancy group and 159.3 cm in the comparison group (p = 0.3). Mean attained height was 160.4 cm in the adolescent pregnancy group and 160.3 cm in the comparison group (p = 0.7). CONCLUSIONS Among Black females in Soweto, South Africa, adolescent pregnancy was not associated with attained height.
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Affiliation(s)
- Elizabeth A. Lundeen
- Nutrition and Health Sciences Program, Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Parminder S. Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Neil K. Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Linda M. Richter
- MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence of Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D. Stein
- MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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10
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Malone SK, Zemel BS. Measurement and Interpretation of Body Mass Index During Childhood and Adolescence. J Sch Nurs 2014; 31:261-71. [PMID: 25199628 DOI: 10.1177/1059840514548801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The landscape of childhood health and disease has changed over the past century, and school nurses are now in a unique position to address the conditions that lead to chronic disease, such as obesity. Measuring body mass index (BMI) during childhood and adolescence is the recommended method for screening and/or monitoring obesity in school communities. Yet changes in the size, proportion, and distribution of fat mass and fat-free mass during growth and development introduce challenges to interpreting BMI measurements. Understanding these challenges and ensuring accurate measurement techniques are the foundation for implementing school-based BMI measurement programs. This article will provide an overview of body composition during childhood and adolescence, introduce strategies to improve the accuracy of BMI measurements, and explore the school nurse's role in BMI surveillance and/or screening activities.
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Affiliation(s)
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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11
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Mongraw-Chaffin ML, Anderson CAM, Clark JM, Bennett WL. Prepregnancy body mass index and cardiovascular disease mortality: the Child Health and Development Studies. Obesity (Silver Spring) 2014; 22:1149-56. [PMID: 24124023 PMCID: PMC3968178 DOI: 10.1002/oby.20633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/21/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Overweight early in life may contribute to cardiovascular disease mortality through progression to later life obesity or through a cumulative effect of excess weight. Few studies have investigated the relationship between body mass index (BMI) before middle age and cardiovascular disease mortality in women. Using the Child Health and Development Studies cohort of 11,006 pregnant women recruited between 1959 and 1967, the hypothesis that higher self-reported prepregnancy BMI is associated with increased stroke and coronary heart disease mortality was tested. METHODS Cause of death was assessed annually from enrollment through 2007 by linking with California Vital Status Records. Cox proportional hazards ratios for cause-specific mortality for each BMI category were calculated. RESULTS Median follow-up was 37 years with 1839 participant deaths at a mean age of 64.1 years. At higher levels of BMI, participants were older, had higher prevalence of co-morbid conditions, higher parity, and lower family income. In adjusted models, women with higher prepregnancy BMI had increased coronary heart disease mortality compared to those with normal BMI. Women who were underweight, overweight, or obese had higher all-cause mortality. Sensitivity analyses confirmed these results. CONCLUSIONS Prepregnancy BMI has a monotonic association with coronary heart disease mortality and a j-shaped association with noncardiovascular mortality.
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Affiliation(s)
- Morgana L Mongraw-Chaffin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Ruiz de Viñaspre Hernández R, Rubio Aranda E, Tomás Aznar C. Urinary incontinence and weight changes during pregnancy and post partum: A pending challenge. Midwifery 2013; 29:e123-9. [DOI: 10.1016/j.midw.2012.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 09/18/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
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13
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Chang T, Choi H, Richardson CR, Davis MM. Implications of teen birth for overweight and obesity in adulthood. Am J Obstet Gynecol 2013; 209:110.e1-7. [PMID: 23587742 DOI: 10.1016/j.ajog.2013.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/19/2013] [Accepted: 04/10/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to examine whether teen birth was independently associated with overweight and obesity in a US cohort. STUDY DESIGN We examined whether teen birth is independently associated with overweight and obesity in a multiyear US cohort using the 2001-2010 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey of the US civilian, noninstitutionalized population. We performed multinomial logistic regression adjusting for survey cohort, age at survey, race, education, and parity. We included women 20-59 years old at the time of survey, with at least 1 live birth, not currently or recently pregnant (unweighted, n = 5220; weighted, n = 48.4 million). Our outcome measure was the effect of teen birth on subsequent overweight and obesity. RESULTS In bivariate analyses, women with a teen birth were significantly more likely than women without a teen birth to be overweight (relative risk ratios [RRRs], 1.61; 95% confidence interval [CI], 1.37-1.90) or obese (RRR, 1.84; 95% CI, 1.56-2.16) at the time of the survey. In multivariate models, women with a teen birth remained significantly more likely to be overweight (adjusted RRR, 1.33; 95% CI, 1.10-1.62) or obese (adjusted RRR, 1.32; 95% CI, 1.09-1.61) than women without a teen birth. CONCLUSION For women in the United States, giving birth as a teen is associated with subsequent overweight/obese status later in life. To inform clinical and policy interventions with the goal to improve the long-term health of teenage mothers, future studies must examine modifiable physiological and sociomedical reasons for early child-bearing and later risk of obesity.
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14
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Meza C, Moral J. Modelos Recursivos de Índice de Masa Corporal con Variables Sociodemográficas, Funciones del Yo y Alteración Alimentaria en Mujeres Mexicanas. PSYKHE 2013. [DOI: 10.7764/psykhe.22.1.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Effect of adolescent pregnancy on final adult height in non-Hispanic white women. Arch Gynecol Obstet 2013; 288:679-82. [PMID: 23503935 DOI: 10.1007/s00404-013-2781-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study is to examine the effect of pregnancy on final adult height in women whose first live birth occurred in adolescence (<age 18) compared to women whose first live birth in adulthood (≥age 18). METHODS This retrospective cohort study used the National Health and Nutrition Examination Survey from 1999 to 2004. Regression analysis was used for comparisons of adult height between the two groups. Three ethnic groups were selected for the analysis: Mexican-American, non-Hispanic white and non-Hispanic black. RESULTS Non-Hispanic white women who gave birth in adolescence were approximately 2.97 cm shorter in final adult height than women who gave birth to their first child at ≥18 years [p = 0.03, 95 % confidence interval (-5.61, -0.33)]. There was no difference in final adult height in either the Mexican-American or non-Hispanic black groups. CONCLUSION Non-Hispanic white women who had their first live birth in adolescence have reduced height compared to women who had their first live birth as an adult.
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16
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Jenum AK, Sommer C, Sletner L, Mørkrid K, Bærug A, Mosdøl A. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review. Food Nutr Res 2013; 57:18889. [PMID: 23467680 PMCID: PMC3585772 DOI: 10.3402/fnr.v57i0.18889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 01/15/2013] [Accepted: 02/03/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM) and, in some groups, also cardiovascular disease (CVD). Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. OBJECTIVE TO REVIEW ETHNIC DIFFERENCES IN: 1) adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2) future risk in the mother of obesity, T2DM and CVD; and 3) prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring's future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. DESIGN Literature review. RESULTS Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI) is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM) is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. CONCLUSIONS Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention.
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Affiliation(s)
- Anne Karen Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Occupational Therapy and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Line Sletner
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Child and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway
- Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Kjersti Mørkrid
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Bærug
- Norwegian Resource Centre for Breastfeeding, Oslo University Hospital, Oslo, Norway
| | - Annhild Mosdøl
- Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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17
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Gunderson EP, Schreiber G, Striegel-Moore R, Hudes M, Daniels S, Biro FM, Crawford PB. Pregnancy during adolescence has lasting adverse effects on blood lipids: a 10-year longitudinal study of black and white females. J Clin Lipidol 2011; 6:139-49. [PMID: 22385547 DOI: 10.1016/j.jacl.2011.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 12/15/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Primiparity has been associated with 3 to 4 mg/dL lower high-density lipoprotein cholesterol concentrations in black and white adult women that persist several years after delivery. OBJECTIVE To examine the lasting effects of adolescent pregnancy on blood lipids, an early risk factor for future cardiometabolic diseases. DESIGN The National Heart Lung and Blood Institute's Growth and Health Study is a multicenter prospective cohort that measured fasting blood lipids for 1013 (513 black, 500 white) participants at baseline (1987-1988) ages 9-10, and again at follow-up (1996-1997) ages 18-19. METHODS Change in fasting plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, defined as the difference between baseline and follow-up measurements, was compared among 186 (145 black, 41 white) primi- or multiparas, 106 (55 black, 51 white) nulliparous, gravidas versus 721 (313 black, 408 white) nulligravidas. Fully adjusted multiple linear regression models estimated blood lipid changes among these pregnancy groups adjusted for race, age at menarche, baseline lipids, physical inactivity, body mass index, and family sociodemographics. RESULTS In the 10-year study period, adolescent paras compared with nulligravidas had greater decrements in high-density lipoprotein cholesterol (mg/dL; fully adjusted mean [95% confidence interval] group differences in black -4.3 [-6.7, -2.0]; P < .001 and white: -4.5 [-8.2, -0.7]; P = .016) and greater increments in fasting triglycerides (mg/dL; adjusted mean [95% confidence interval] group differences in black: 10.4 [3.9, 16.8]; P < .001, and white: 11.6 [-3.6, 26.8]; P = .167). CONCLUSION Adolescent pregnancy contributes to pro-atherogenic lipid profiles that persist after delivery. Further research is needed to assess whether adolescent pregnancy has implications for future cardiovascular disease risk in young women.
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Affiliation(s)
- Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
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18
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Skilton MR, Bonnet F, Begg LM, Juonala M, Kähönen M, Lehtimäki T, Viikari JSA, Raitakari OT. Childbearing, Child-Rearing, Cardiovascular Risk Factors, and Progression of Carotid Intima-Media Thickness. Stroke 2010; 41:1332-7. [DOI: 10.1161/strokeaha.110.579219] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Parity is associated with the risk of clinical cardiovascular events and the severity of preclinical atherosclerosis in older subjects. We sought to determine whether childbearing is associated with concurrent changes in cardiovascular risk factors and the progression of carotid intima-media thickness.
Methods—
We examined the association between the number of children born during a 6-year period and concurrent changes in cardiovascular risk factors and progression of carotid intima-media thickness in men and women of reproductive age from the Cardiovascular Risk in Young Finns study. Complete data for parity and carotid intima-media thickness were available for 1786 subjects (1005 females, 781 males).
Results—
For females, childbirth during the 6-year follow-up was associated with concurrent reductions in high-density lipoprotein cholesterol (
P
trend
<0.0001), apolipoprotein A-I (
P
trend
<0.0001), and apolipoprotein B (
P
trend
=0.01); a redistribution of adiposity to abdominal deposits; and increased progression of carotid intima-media thickness (7.5±3.2 μm/birth [mean±SEM],
P
=0.02). The association of childbirth with carotid intima-media thickness progression was not greatly modified by adjustment for concurrent changes in cardiovascular risk factors (fully adjusted:
P
=0.05). This association was significantly stronger in females than males (
P
heterogeneity
=0.001), who served as a control group exposed to the social and lifestyle influences of child-rearing but not the biological influences of childbearing.
Conclusions—
The progression of carotid atherosclerosis over a 6-year period is increased in females who gave birth during the same period, independent of traditional risk factors. Mechanisms that underlie this observation possibly include parity-induced changes in nontraditional risk factors or an acute influence of pregnancy itself.
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Affiliation(s)
- Michael R. Skilton
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Fabrice Bonnet
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Lisa M. Begg
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Markus Juonala
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Mika Kähönen
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Terho Lehtimäki
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Jorma S. A. Viikari
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
| | - Olli T. Raitakari
- From the Baker IDI Heart & Diabetes Institute (M.R.S.), Melbourne, Australia; the Department of Medicine (F.B.), Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France; the Department of Obstetrics & Gynecology (L.M.B.), Royal Women’s Hospital, Melbourne, Australia; the Department of Medicine (M.J., J.S.A.V.), University of Turku and Turku University Hospital, Turku, Finland; the Research Centre of Applied and Preventive Cardiovascular Medicine (M.J., O.T.R.), University of
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