Long term consequences of the 1944-1945 Dutch famine on the insulin-like growth factor axis

Exposure to Holocaust is associated with chronic morbidity in older adults-Results from national health and nutrition surveys

BACKGROUND

Although studies have suggested that Holocaust survivors are more likely than their non-Holocaust-exposed counterparts to suffer from mental and chronic morbidity, methodology differences and potential confounders often compromise result replicability and external validity. We examined associations between Holocaust exposure and chronic morbidity, as well as overall risk of mortality.

METHODS

Sociodemographic, health-related behavior and nutritional-intake data from two representative National Health and Nutrition Survey Ages 65 and Over-the 2005-2006 MABAT ZAHAV 1 (MZ1) and the 2014-2015 MZ2, including face-to-face interviews and anthropometric measurements-were analyzed. Demographic, health, nutritional and lifestyle characteristics, and exposure to the Holocaust were self-reported. Longitudinal data on overall mortality were obtained by linking the MZ1 population to the population registry dataset. Associations between Holocaust exposure and prevalence of chronic morbidity and risk factors were estimated by multivariable logistic regression analyses, and to risk of overall mortality by Cox regression analysis, both adjusted to significant covariates.

RESULTS

Among 2096 study participants aged 75.7 ± 6.1 years, 47.0% male, 518 were Holocaust survivors. In the fully adjusted model, Holocaust exposure was associated with increased prevalence of heart disease (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.07-1.83), metabolic syndrome (OR 2.28, CI 1.23-4.21), and stroke (OR 1.77, CI 1.17-2.69), but not cancer or osteoporosis. Holocaust exposure did not substantially affect the overall risk of mortality (hazard ratio 1.10, CI 0.92-1.32).

CONCLUSIONS

Further research is needed to understand the mechanisms governing long-term outcomes of exposure to acute physical or mental trauma.

Evidence that highly canalized fetal traits are sensitive to intergenerational effects of maternal developmental nutrition

OBJECTIVES

Maternal experiences before pregnancy predict birth outcomes, a key indicator of health trajectories, but the timing and pathways for these effects are poorly understood. Here we test the hypothesis that maternal pre-adult growth patterns predict pregnancy glucose and offspring fetal growth in Cebu, Philippines.

METHODS

Using multiple regression and path analysis, gestational age-adjusted birthweight and variables reflecting infancy, childhood, and post-childhood/adolescent weight gain (conditional weights) were used to predict pregnancy HbA1c and offspring birth outcomes among participants in the Cebu Longitudinal Health and Nutrition Survey.

RESULTS

Maternal early/mid-childhood weight gain predicted birth weight, length, and head circumference in female offspring. Late-childhood/adolescent weight gain predicted birth length, birth weight, skinfold thickness, and head circumference in female offspring, and head circumference in male offspring. Pregnancy HbA1c did not mediate relationships between maternal growth and birth size parameters.

DISCUSSION

In Cebu, maternal growth patterns throughout infancy, childhood, and adolescence predict fetal growth via a pathway independent of circulating glucose, with stronger impacts on female than male offspring, consistent with a role of developmental nutrition on offspring fetal growth. Notably, the strength of relationships followed a pattern opposite to what occurs in response to acute pregnancy stress, with strongest effects on head circumference and birth length and weakest on skinfolds. We speculate that developmental sensitivities are reversed for stable, long-term nutritional cues that reflect average local environments. These findings are relevant to public health and life-history theory as further evidence of developmental influences on health and resource allocation across the life course.

Association of early-life famine exposure with low bone mass in adulthood

Famine exposure in early life has been found to have a long-term effect on metabolic diseases, but its effect on bone health was not clear. In this study, we found women, who suffered from famine exposure during their childhood or adolescence period, had significantly decreased BMD at several skeletal sites compared to the age-matched non-exposed groups. The risk of clinical fracture was also elevated in adolescence-exposed women.

PURPOSE

To investigate the correlation between famine exposure at certain stages and bone mass in adulthood.

METHODS

We enrolled participants born in 1943-1962 from the China Osteoporosis Prevalence Study (COPS), which were classified into three famine exposure groups according to their birth year: fetal-famine exposure (1959-1962, n = 1693), childhood-famine exposure (1949-1958, n = 5557), and adolescence-famine exposure (1943-1948, n = 1530). We also selected age-balanced non-exposed participants as the control groups for men and women separately. Bone mineral density (BMD) and vertebral fractures (VFs) were measured by dual X-ray absorptiometry (DXA) and X-ray, respectively. The associations of famine exposure in early life with BMD were assessed via multiple linear regression. Logistic regression was performed to examine the association of famine exposure in early life with fracture risk with adjustments for covariates.

RESULTS

In women, the childhood-exposed and adolescence-exposed groups had significantly decreased BMD at several skeletal sites compared to the age-matched non-exposed groups. No significant decreased BMD was found in the fetal-exposed groups compared to the non-exposed groups in both sexes. Multiple linear regression analysis showed that famine exposure during childhood and adolescence was negatively associated with BMD at the femoral neck after adjusting for covariates in women. The risk of clinical fracture was also elevated in adolescence-exposed women.

CONCLUSION

Famine exposure during early life especially childhood and adolescence is associated with decreased bone mass in adulthood in women but did not affect bone mass in men.

Famine Exposure during Early Life and Risk of Cancer in Adulthood: A Systematic Review and Meta-Analysis

OBJECTIVES

Emerging evidences have explored the association between famine exposure during early life and cancer risk in adulthood, but the results remain controversial and inconsistent. This study aimed to provide a comprehensive evidence on the relation of famine exposure to later cancer risk.

DESIGN

Systematic review and meta-analysis.

METHODS

Relevant reports published up to March, 2022 were identified by searching PubMed, Embase, Web of sciences and Medline databases. Pooled relative ratios (RRs) with 95% confidence intervals (CIs) were used to evaluate the effect famine exposure on cancer risk.

RESULTS

Totally, 18 published articles with 6,061,147 subjects were included in this study. Compared with unexposed group, early life famine exposure dramatically increased the risk of cancer in adulthood (RR=1.13, 95% CI: 1.04-1.22). The pooled RRs were different in terms of sex, exposure severity, exposure period, famine type, study design type and cancer location. A remarkably elevated risk for cancer was discerned in women exposed to famine (RR=1.09, 95% CI: 1.00-1.18), severe exposure (RR=1.12, 95% CI: 1.02-1.22) and adolescence exposure (RR=1.76, 95% CI: 1.02-2.50), Chinese famine exposure (RR=1.55, 95% CI: 1.29-1.82) and cohort studies (RR=1.28, 95% CI: 1.13-1.42). Moreover, a significant association of early-life famine exposure with increased risk of breast (RR=1.16, 95% CI: 1.05-1.27) and stomach cancers (RR=1.89, 95% CI: 1.24-2.54) was observed.

CONCLUSION

This meta-analysis suggests that exposure to famine during early life may increase the risk of cancer in adulthood. The above-mentioned association is pronounced in women exposed to famine, severe exposure, adolescence exposure, Chinese famine, cohort studies, breast and stomach cancers. It is essential for decision-makers to take targeted measures for improving population awareness regarding the long-term effect of early life nutritional status.

Growth Rate in Childhood and Adolescence and the Risk of Breast and Prostate Cancer: A Population-Based Study

Growth rate is regulated by hormonal pathways that might affect early cancer development. We explored the association between rate of growth in height from ages 8 to 13 years (childhood) and from age 13 to attainment of adult height (adolescence), as measured at study entry, and the risk of breast or prostate cancer. Participants were 2,037 Icelanders born during 1915-1935, who took part in the Reykjavik Study, established in 1967. Height measurements were obtained from school records and at study entry. We used multivariable Cox regression models to calculate hazard ratios with 95% confidence intervals of breast and prostate cancer by rates of growth in tertiles. During a mean follow-up of 66 years (women) and 64 years (men), 117 women were diagnosed with breast cancer and 118 men with prostate cancer (45 with advanced disease). Women in the highest growth-rate tertile in adolescence had a higher risk of breast cancer (hazard ratio = 2.4, 95% confidence interval: 1.3, 4.3) compared with women in the lowest tertile. A suggestive inverse association was observed for highest adolescent growth rate in men and advanced prostate cancer: hazard ratio = 0.4, 95% confidence interval: 0.2, 1.0. Rapid growth, particularly in adolescence may affect cancer risk later in life.

Energy balance‐related factors in childhood and adolescence and risk of colorectal cancer expressing different levels of proteins involved in the Warburg‐effect

Early‐life (childhood to adolescence) energy balance‐related factors (height, energy restriction, BMI) have been associated with adult colorectal cancer (CRC) risk. Warburg‐effect activation via PI3K/Akt‐signaling might explain this link. We investigated whether early‐life energy balance‐related factors were associated with risk of Warburg‐subtypes in CRC. We used immunohistochemistry for six proteins involved in the Warburg‐effect (LDHA, GLUT1, MCT4, PKM2, P53, and PTEN) on tissue microarrays of 2399 incident CRC cases from the prospective Netherlands Cohort Study (NLCS). Expression levels of all proteins were combined into a pathway‐based sum score and categorized into three Warburg‐subtypes (Warburg‐low/‐moderate/‐high). Multivariable Cox‐regression analyses were used to estimate associations of height, energy restriction proxies (exposure to Dutch Hunger Winter; Second World War [WWII]; Economic Depression) and adolescent BMI with Warburg‐subtypes in CRC. Height was positively associated with colon cancer in men, regardless of Warburg‐subtypes, and with Warburg‐low colon and Warburg‐moderate rectal cancer in women. Energy restriction during the Dutch Hunger Winter was inversely associated with colon cancer in men, regardless of Warburg‐subtypes. In women, energy restriction during the Hunger Winter and WWII was inversely associated with Warburg‐low colon cancer, whereas energy restriction during the Economic Depression was positively associated with Warburg‐high colon cancer. Adolescent BMI was positively associated with Warburg‐high colon cancer in men, and Warburg‐moderate rectal cancer in women. In conclusion, the Warburg‐effect seems to be involved in associations of adolescent BMI with colon cancer in men, and of energy restriction during the Economic Depression with colon cancer in women. Further research is needed to validate these results.

Associations between Early-Life Food Deprivation and Risk of Frailty of Middle-Age and Elderly People: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

The association between childhood food deprivation (FD) and health in later life has been extensively studied; however, studies on the association between childhood food deprivation and frailty are scarce. This study assessed the associations between childhood FD and the risk of frailty at middle-age and old age.

METHODS

Three waves of the China Health and Retirement Longitudinal Study (CHARLS), including 11,615 individuals aged over 45 years, were used for this research. Frailty was operationalized according to the FRAIL scale as a sum of fatigue, resistance, ambulation, illness, and the loss of weight. Childhood FD experiences and levels were measured by self-reported FD and historical content. Logistic mixed-effects models and proportional odds ordered logistic regression models were used to analyse the association between childhood FD and frailty.

FINDINGS

Childhood FD increased the odds of frailty at old age (1.30, 95% CI: 1.26-1.36). Compared with subjects with mild FD, those with extreme FD experiences had increased risks of frailty (1.34, 95% CI: 1.26-1.43). Subjects exposed to hunger at different ages all had an increased risk of frailty, and subjects who had FD during ages 6-12 (1.15, 95% CI: 1.09-1.22) were more likely to have an increased risk of frailty than those who had experienced FD in younger ages. The interaction of experience of FD at ages 0-6 and the experience of FD at ages 6-12 is not statistically significant after adjusting all covariates.

CONCLUSIONS

Our findings suggest that childhood FD exerts long-lasting effects on frailty among older adults in China. The prevention of childhood FD may delay or even avert the emergence of frailty in people of middle-age and old age.

Environmental epigenetics of sex differences in the brain

Experiences throughout the life course lead to unique phenotypes even among those with the same genotype. Genotype sets the substrate on which physiologic processes, which communicate with the brain, mediate the effects of life experiences via epigenetics. Epigenetics modify the expression of genes in the brain and body in response to circulating hormones and other mediators, which are activated to facilitate survival responses through a process called allostasis. Epigenetic signatures can even be inherited, resulting in transgenerational effects. This chapter addresses epigenetics in the context of sex differences, discussing the intersection between genetics and gonadal hormones and their effect in the brain at discrete developmental periods.

The relationship between IGF-I and -II concentrations and body composition at birth and over the first 2 months

BACKGROUND

Insulin-like growth factor (IGF)-I and -II play an important role in prenatal growth. During the first 2 months from birth, body fat doubles, and rapid weight gain during this time increases future risk of cardiometabolic disease. The aim of this study was to determine whether IGF measurements at birth associate with body composition and the trajectory of its changes in the first 2 months.

METHODS

Umbilical cord IGF-I and -II concentrations were measured in term infants. Air displacement plethysmography was performed at birth and 2 months. Fat mass (FM) and fat-free mass (FFM) were corrected for infant length (L) to FM/L³ and FFM/L², respectively.

RESULTS

In 601 (317 male) infants, IGF-I concentrations at birth were associated with FM/L³ and FFM/L² Z-scores at birth (R² = 0.05 and 0.04, respectively, P < 0.001), and IGF-II concentrations were associated with FFM/L² Z-scores at birth (R² = 0.01, P = 0.02). Lower IGF-I concentrations were weakly associated with increases in FM/L³ Z-scores over the first 2 months (R² = 0.01, P = 0.003).

CONCLUSION

IGF-I concentrations at birth are associated with adiposity and lean mass at birth and inversely with the trajectory of FM accumulation over the first 2 months. IGF-I measurements only account for a small amount of the variance in these measures.

Association of Maternal Prepregnancy Body Mass Index With Placental Histopathological Characteristics in Uncomplicated Term Pregnancies

INTRODUCTION

Prepregnancy obesity is a growing global health problem and has several risks for mother and child. The aim of this study was to systematically examine the effect of increased maternal body mass index (BMI) on placental pathology in otherwise uneventful term pregnancies.

METHODS

In this analysis, we studied data of the Netherlands Amniotic Fluid study, a prospective study of women delivering in Utrecht, the Netherlands, between 2006 and 2007. We included women with uncomplicated pregnancies, vaginal delivery, and data on prepregnancy weight and height (n = 382). Placental histopathology was compared between women of normal BMI (≤24.9 kg/m²), overweight (25-29.9 kg/m²), and obese (≥30 kg/m²).

RESULTS

Increasing prepregnancy BMI was associated with heavier placentas and higher mean infant's birth weight. In addition, obesity was positively associated with high-grade chronic villitis (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 1.6-205.2), accelerated villous maturation (OR: 1.1, 95% CI: 1.0-1.2), and lower incidence of placental weight below the 10th percentile for gestational age (OR: 0.5, 95% CI: 0.3-1.0). There was a substantial effect of parity on maternal, placental, and neonatal weights.

CONCLUSIONS

Even in uncomplicated pregnancies, maternal obesity is associated with characteristic changes in placental pathology. Further research is needed to evaluate these changes in view of later-life health of infants born to obese mothers.

Associations of adult-attained height and early life energy restriction with postmenopausal breast cancer risk according to estrogen and progesterone receptor status

Adult-attained height is a marker for underlying mechanisms, such as cell growth, that may also influence postmenopausal breast cancer (BC) risk, perhaps specifically hormone-sensitive BC subtypes. Early life energy restriction may inhibit these mechanisms, resulting in shorter height and a reduced postmenopausal BC risk. Women (62,573) from the Netherlands Cohort Study completed a self-administered questionnaire in 1986 when 55-69 years old, and were followed-up for 20.3 years (case-cohort: N_subcohort = 2,438; N_cases = 3,354). Cox multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated for BC risk overall and by estrogen and progesterone receptor subtypes in relation to height and early life energy restriction during the Hunger Winter, War Years, and Economic Depression. Although energy restriction can only influence longitudinal growth in women exposed before and/or during the growth spurt, it may also influence BC risk when occurring after the growth spurt, possibly through different growth processes. Therefore, Cox analyses were additionally conducted according to timing of energy restriction in relation to the growth spurt. Height was associated with an increased BC risk (HR_{per 5cm} = 1.07, 95%CI:1.01-1.13), particularly hormone receptor-positive BC. Energy restriction before and/or during the growth spurt was associated with a decreased hormone receptor-positive BC risk. Energy restriction during the Hunger Winter increased the estrogen receptor-negative BC risk regardless of the timing of energy restriction. In conclusion, height and energy restriction before and/or during the growth spurt were both associated with hormone receptor-positive BC risk, in the direction as expected, indicating critical exposure windows for hormonal growth-related mechanisms.

PALTEM: What Parameters Should Be Collected in Disaster Settings to Assess the Long-Term Outcomes of Famine?

Evidence suggests that nutritional status during fetal development and early life leaves an imprint on the genome, which leads to health outcomes not only on a person as an adult but also on his offspring. The purpose of this study is to bring forth an overview of the relevant parameters that need to be collected to assess the long-term and transgenerational health outcomes of famine. A literature search was conducted for the most pertinent articles on the epigenetic effects of famine. The results were compiled, synthesized and discussed with an expert in genetics for critical input and validation. Prenatal and early life exposure to famine was associated with metabolic, cardiovascular, respiratory, reproductive, neuropsychiatric and oncologic diseases. We propose a set of parameters to be collected in disaster settings to assess the long-term outcomes of famine: PALTEM (parameters to assess long-term effects of malnutrition).

Pre-adult famine exposure and subsequent colorectal cancer risk in women

Background

Nutritional deprivation during growth and development may contribute to colorectal cancer (CRC) risk in later life.

Methods

We studied 7906 women who were aged 0-21 years during the 1944-45 Dutch famine, who enrolled in the Prospect-EPIC study between 1993 and 1997. We used Cox proportional hazard analyses to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal (proximal, distal and rectal) cancer risk across self-reported famine exposure and exposure-age categories, while adjusting for potential confounders.

Results

During a median of 17.3 years of follow-up, 245 CRC cases occurred. Moderately and severely famine-exposed women showed a respective 24% and 44% higher CRC risk compared with women who reported no exposure [HR moderate 1.24 (95% CI: 0.93-1.64); HR severe 1.44 (1.03-2.03); P trend 0.027]. This relation attenuated when adjusted for potential confounders [adjusted HR moderate 1.15 (0.87-1.53); HR severe 1.35 (0.96-1.90); P trend 0.091]. Stratified results suggested that severe famine exposure between 10 and 17 years of age was particularly related to CRC risk[adjusted HR moderate 1.39 (0.91-2.11); HR severe 1.76 (1.10-2.83); P trend 0.019; P interaction(famine*10-17yrs) 0.096]. Overall, we found no differences in famine effects across CRC subsites, but age-at-exposure stratified results suggested an increased risk for proximal CRC in those aged 10-17 years during exposure to the famine [adjusted HR moderate 2.14 (1.06-4.32), HR severe 2.96 (1.35-6.46); P trend 0.005]. Overall and within age-at-exposure categories, tests for subsite specific heterogeneity in famine effects were not significant.

Conclusions

Our findings suggest that severe exposure to a short period of caloric restriction in pre-adult women may relate to CRC risk decades later.

Manipulation of the Growth Hormone-Insulin-Like Growth Factor (GH-IGF) Axis: A Treatment Strategy to Reverse the Effects of Early Life Developmental Programming

Evidence from human clinical, epidemiological, and experimental animal models has clearly highlighted a link between the early life environment and an increased risk for a range of cardiometabolic disorders in later life. In particular, altered maternal nutrition, including both undernutrition and overnutrition, spanning exposure windows that cover the period from preconception through to early infancy, clearly highlight an increased risk for a range of disorders in offspring in later life. This process, preferentially termed “developmental programming” as part of the developmental origins of health and disease (DOHaD) framework, leads to phenotypic outcomes in offspring that closely resemble those of individuals with untreated growth hormone (GH) deficiency, including increased adiposity and cardiovascular disorders. As such, the use of GH as a potential intervention strategy to mitigate the effects of developmental malprogramming has received some attention in the DOHaD field. In particular, experimental animal models have shown that early GH treatment in the setting of poor maternal nutrition can partially rescue the programmed phenotype, albeit in a sex-specific manner. Although the mechanisms remain poorly defined, they include changes to endothelial function, an altered inflammasome, changes in adipogenesis and cardiovascular function, neuroendocrine effects, and changes in the epigenetic regulation of gene expression. Similarly, GH treatment to adult offspring, where an adverse metabolic phenotype is already manifest, has shown efficacy in reversing some of the metabolic disorders arising from a poor early life environment. Components of the GH-insulin-like growth factor (IGF)-IGF binding protein (GH-IGF-IGFBP) system, including insulin-like growth factor 1 (IGF-1), have also shown promise in ameliorating programmed metabolic disorders, potentially acting via epigenetic processes including changes in miRNA profiles and altered DNA methylation. However, as with the use of GH in the clinical setting of short stature and GH-deficiency, the benefits of treatment are also, in some cases, associated with potential unwanted side effects that need to be taken into account before effective translation as an intervention modality in the DOHaD context can be undertaken.

A Systematic Literature Review and Meta-Regression Analysis on Early-Life Energy Restriction and Cancer Risk in Humans

Background

In animal models, long-term moderate energy restriction (ER) is reported to decelerate carcinogenesis, whereas the effect of severe ER is inconsistent. The impact of early-life ER on cancer risk has never been reviewed systematically and quantitatively based on observational studies in humans.

Objective

We conducted a systematic review of observational studies and a meta-(regression) analysis on cohort studies to clarify the association between early-life ER and organ site-specific cancer risk.

Methods

PubMed and EMBASE (1982 –August 2015) were searched for observational studies. Summary relative risks (RRs) were estimated using a random effects model when available ≥3 studies.

Results

Twenty-four studies were included. Eleven publications, emanating from seven prospective cohort studies and some reporting on multiple cancer endpoints, met the inclusion criteria for quantitative analysis. Women exposed to early-life ER (ranging from 220–1660 kcal/day) had a higher breast cancer risk than those not exposed (RR_{RE all ages} = 1.28, 95% CI: 1.05–1.56; RR_{RE for 10–20 years of age} = 1.21, 95% CI: 1.09–1.34). Men exposed to early-life ER (ranging from 220–800kcal/day) had a higher prostate cancer risk than those not exposed (RR_RE = 1.16, 95% CI: 1.03–1.30). Summary relative risks were not computed for colorectal cancer, because of heterogeneity, and for stomach-, pancreas-, ovarian-, and respiratory cancer because there were <3 available studies. Longer duration of exposure to ER, after adjustment for severity, was positively associated with overall cancer risk in women (p = 0.02). Ecological studies suggest that less severe ER is generally associated with a reduced risk of cancer.

Conclusions

Early-life transient severe ER seems to be associated with increased cancer risk in the breast (particularly ER exposure at adolescent age) and prostate. The duration, rather than severity of exposure to ER, seems to positively influence relative risk estimates. This result should be interpreted with caution due to the limited number of studies and difficulty in disentangling duration, severity, and geographical setting of exposure.

Exposure to Famine at a Young Age and Unhealthy Lifestyle Behavior Later in Life

Background

A healthy diet is important for normal growth and development. Exposure to undernutrition during important developmental periods such as childhood and adolescence can have effects later in life. Inhabitants of the west of the Netherlands were exposed to severe undernutrition during the famine in the last winter of the second World War (1944–1945).

Objective

We investigated if exposure of women to the Dutch famine during childhood and adolescence was associated with an unhealthy lifestyle later in life.

Design

We studied 7,525 women from the Prospect-EPIC cohort, recruited in 1993–97 and aged 0–18 years during the Dutch famine. An individual famine score was calculated based on self-reported information about experience of hunger and weight loss. We investigated the association between famine exposure in early life and four lifestyle factors in adulthood: smoking, alcohol consumption, physical activity level and a Mediterranean-style diet.

Results

Of the 7,525 included women, 46% were unexposed, 38% moderately exposed and 16% severely exposed to the Dutch famine. Moderately and severely exposed women were more often former or current smokers compared to women that did not suffer from the famine: adjusted prevalence ratio 1.10 (95% CI: 1.05; 1.14) and 1.18 (1.12; 1.25), respectively. They also smoked more pack years than unexposed women. Severely exposed women were more often physically inactive than unexposed women, adjusted prevalence ratio 1.32 (1.06; 1.64). Results did not differ between exposure age categories (0–9 and 10–17 years). We found no associations of famine exposure with alcohol consumption and no dose-dependent relations with diet.

Conclusions

Exposure to famine early in female life may be associated with higher prevalence of smoking and physical inactivity later in life, but not with unhealthy diet and alcohol consumption.

Preweaning GH Treatment Normalizes Body Growth Trajectory and Reverses Metabolic Dysregulation in Adult Offspring After Maternal Undernutrition

Maternal undernutrition (UN) results in growth disorders and metabolic dysfunction in offspring. Although dysregulation of the GH-IGF axis in offspring is a known consequence of maternal UN, little is known about the efficacy of GH treatment during the period of developmental plasticity on later growth and metabolic outcomes. The present study investigated the effect of preweaning GH treatment on growth, glucose metabolism, and the GH-IGF axis in adult male and female offspring after maternal UN. Female Sprague Dawley rats were fed either a chow diet ad libitum (control [CON]) or 50% of ad libitum (UN) throughout pregnancy. From postnatal day 3, CON and UN pups received either saline (CON-S and UN-S) or GH (2.5 μg/g·d CON-GH and UN-GH) daily throughout lactation. At weaning, male and female offspring were randomly selected from each litter and fed a standard chow diet for the remainder of the study. Preweaning GH treatment normalized maternal UN-induced alterations in postweaning growth trajectory and concomitant adiposity in offspring. Plasma leptin concentrations were increased in UN-S offspring and normalized in the UN-GH group. Hepatic GH receptor expression was significantly elevated in UN-S offspring and normalized with GH treatment. Hepatic IGF binding protein-2 gene expression and plasma IGF-1 to IGF binding protein-3 ratio was reduced in UN-S offspring and elevated with GH treatment. GH treatment during a critical developmental window prevented maternal UN-induced changes in postnatal growth patterns and related adiposity, suggesting that manipulation of the GH-IGF-1 axis in early development may represent a promising avenue to prevent adverse developmental programming effects in adulthood.

Study of primary IGF-1 deficiency in Egyptian children with idiopathic short stature

BACKGROUND/AIMS

Primary insulin-like growth factor-1 (IGF-1) deficiency (IGFD) is defined by low levels of IGF-1 without growth hormone (GH) deficiency and absence of secondary causes. The aim of this study was to evaluate IGF-1 in Egyptian children with idiopathic short stature (ISS) and describe patients with IGFD.

METHODS

This cross-sectional study included 50 children with ISS following up at the Diabetes Endocrine and Metabolism Pediatric Unit at Cairo University Pediatric Hospital. Children were included based on the following criteria: (1) short stature with current height standard deviation score (SDS) ≤-2.5; (2) age between 2 and 9 years in boys and 2 and 8 years in girls, and (3) prepubertal status. Exclusion criteria were: (1) identified cause of short stature and (2) pubertal children. IGF-1-deficient children were defined as children without GH deficiency and with IGF-1 levels below the 2.5th percentile.

RESULTS

Among 50 children with ISS, 14 (28%) patients had low IGF-1 levels, consistent with the diagnosis of primary IGFD. When compared with non-IGFD children, IGFD children had lower birth weight SDS (-1.8 vs. -0.7 SDS, p < 0.0001) and lower height SDS (-4.2 vs. -3.1 SDS, p < 0.05) and more delayed bone age (2.6 vs. 1.6 years, p = 0.001).

CONCLUSION

Primary IGF-1 deficiency is found in 28% of children with ISS.

Epithelial cancers in the post-genomic era: should we reconsider our lifestyle?

The age-related epithelial cancers of the breast, colorectum and prostate are the most prevalent and are increasing in our aging populations. Epithelial cells turnover rapidly and mutations naturally accumulate throughout life. Most epithelial cancers arise from this normal mutation rate. All elderly individuals will harbour many cells with the requisite mutations and most will develop occult neoplastic lesions. Although essential for initiation, these mutations are not sufficient for the progression of cancer to a life-threatening disease. This progression appears to be dependent on context: the tissue ecosystem within individuals and lifestyle exposures across populations of individuals. Together, this implies that the seeds may be plentiful but they only germinate in the right soil. The incidence of these cancers is much lower in Eastern countries but is increasing with Westernisation and increases more acutely in migrants to the West. A Western lifestyle is strongly associated with perturbed metabolism, as evidenced by the epidemics of obesity and diabetes: this may also provide the setting enabling the progression of epithelial cancers. Epidemiology has indicated that metabolic biomarkers are prospectively associated with cancer incidence and prognosis. Furthermore, within cancer research, there has been a rediscovery that a switch in cell metabolism is critical for cancer progression but this is set within the metabolic status of the host. The seed may only germinate if the soil is fertile. This perspective brings together the different avenues of investigation implicating the role that metabolism may play within the context of post-genomic concepts of cancer.

Severe caloric restriction in young women during World War II and subsequent breast cancer risk

AIM

The objective of the study was to examine the impact of WWII-related caloric restriction (CR) on subsequent breast cancer (BC) risk based on individual exposure experiences and whether this effect was modified by age at exposure.

METHODOLOGY

We compared 65 breast cancer patients diagnosed between 2005-2010 to 200 controls without breast cancer who were all members of various organizations for Jewish WWII survivors in Israel. All participants were Jewish women born in Europe prior to 1945 who lived at least 6 months under Nazi rule during WWII and immigrated to Israel after the war. We estimated CR using a combined index for hunger and used logistic regression models to estimate the association between CR and BC, adjusting for potential confounders.

RESULTS

Women who were severely exposed to hunger had an increased risk of BC (OR=5.0, 95% CI= 2.3-10.8) compared to women who were mildly exposed. The association between CR and BC risk was stronger for women who were exposed at a younger age (0-7 years) compared to the risk of BC in women exposed at ≥ 14 years (OR= 2.8, 95% CI=1.3-6.3).

CONCLUSIONS

Severe exposure to CR is associated with a higher risk for BC decades later, and may be generalized to other cases of severe starvation during childhood that may have long-term effects on cancer in adulthood.

High incidence of skin cancer in the Channel Islands

BACKGROUND

Previous studies looking at rates of malignant melanoma (MM) and nonmelanoma skin cancer (NMSC) in the UK have documented one of the highest rates in the southwest of England; however, the incidence of these tumours in Guernsey and Jersey, two of the Channel Islands, has not previously been reported.

AIMS

To determine the incidence of cutaneous MM and NMSC in the Channel Islands.

METHODS

Data for the period 2005-2009 were obtained from clinical and histopathological records for all MMs excised in the Channel Islands, and from the South-west Cancer Registry for MMs excised in the southwest of England and for NMSCs in both areas. The age-standardized incidence rate (ASRs) per 100,000 of the population in the Channel Islands were compared with those with the southwest of England, the UK and the rest of Europe where available. The MM characteristics of the Channel Islands were then compared with the southwest of England using standardized incidence ratios (SIRs).

RESULTS

The ASR/100,000 for cutaneous MM for 2005-2009 was 30 for the Channel Islands (31.3 for Jersey, 28.2 for Guernsey), 20.3 for the southwest of England, and 15.6 for the UK. Comparison with the rest of Europe indicated that the incidence of MM in the Channel Islands is one of the highest in Europe. The highest incidence of MM was in the over 65 years age group on both Guernsey and Jersey, and when divided into 5-year age bands, the 70-74 years age group had the highest rate. This suggests that this particular age group may have previously received greater exposure to some environmental factor that promotes MM development. The ASR/100,000 for NMSC was also higher for the Channel Islands (263.3) than for the southwest of England (174.6) for 2005-2009, and for the UK in 2009 (104.9).

CONCLUSIONS

This study indicates that the Channel Islands have a high incidence of skin cancer (both MM and NMSC). In addition, the data show that the ASRs in older people in this population group differ from those in mainland UK, showing higher rates in the over 65 years age group.

Insulin-like growth factor physiology: what we have learned from human studies

Although very similar to insulin and its receptor; the modus operandi of the insulin-like growth factors (IGFs) within the body is very different from that of the traditional peptide hormone. The IGF-binding proteins bind the IGFs with greater affinity than the cell surface receptors, enabling them to tightly control tissue activity. In addition to their role in fetal and childhood growth, IGFs play an important role in metabolic regulation. This article describes the basic underlying human physiology of IGFs, how this differs from that of experimental models, and why some information can only be learned from human clinical studies.

Milk protein intake, the metabolic-endocrine response, and growth in infancy: data from a randomized clinical trial

BACKGROUND

Protein intake in early infancy has been suggested to be an important risk factor for later obesity, but information on potential mechanisms is very limited.

OBJECTIVE

This study examined the influence of protein intake in infancy on serum amino acids, insulin, and the insulin-like growth factor I (IGF-I) axis and its possible relation to growth in the first 2 y of life.

DESIGN

In a multicenter European study, 1138 healthy, formula-fed infants were randomly assigned to receive cow-milk-based infant and follow-on formulas with lower protein (LP; 1.77 and 2.2 g protein/100 kcal) or higher protein (HP; 2.9 and 4.4 g protein/100 kcal) contents for the first year. Biochemical variables were measured at age 6 mo in 339 infants receiving LP formula and 333 infants receiving HP formula and in 237 breastfed infants.

RESULTS

Essential amino acids, especially branched-chain amino acids, IGF-I, and urinary C-peptide:creatinine ratio, were significantly (P < 0.001) higher in the HP group than in the LP group, whereas IGF-binding protein (IGF-BP) 2 was lower and IGF-BP3 did not differ significantly. The median IGF-I total serum concentration was 48.4 ng/mL (25th, 75th percentile: 27.2, 81.8 ng/mL) in the HP group and 34.7 ng/mL (17.7, 57.5 ng/mL) in the LP group; the urine C-peptide:creatinine ratios were 140.6 ng/mg (80.0, 203.8 ng/mg) and 107.3 ng/mg (65.2, 194.7 ng/mg), respectively. Most essential amino acids, IGF-I, C-peptide, and urea increased significantly in both the LP and HP groups compared with the breastfed group. Total IGF-I was significantly associated with growth until 6 mo but not thereafter.

CONCLUSIONS

HP intake stimulates the IGF-I axis and insulin release in infancy. IGF-I enhances growth during the first 6 mo of life. This trial was registered at clinicaltrials.gov as NCT00338689.

Sex-specificity in transgenerational epigenetic programming

Prenatal programming of the epigenome is a critical determinant in offspring outcome and stands at the interface between environment and genetics. Maternal experiences such as stress and obesity are associated with a host of neurodevelopmental and metabolic diseases, some of which have been characterized into the second and third generations. The mechanism through which determinants such as maternal diet or stress contribute to disease development likely involves a complex interaction between the maternal environment, placental changes, and epigenetic programming of the embryo. While we have begun to more fully appreciate and explore the epigenome in determination of disease risk, we know little as to the contribution embryo sex makes in epigenetic regulation. This review discusses the importance of sex differences in the transmission and inheritance of traits that are generated in the prenatal environment using models of maternal stress and diet.

Understanding bipolar disorder: the epigenetic perspective

Bipolar disease (BPD) is a complex major psychiatric disorder that affects between 1% and 2% of the population and exhibits ?85% heritability. This has made BPD an appealing target for genetic studies yet, despite numerous attempts, the genetic basis of this disease remains elusive. Recently, it has come to light that epigenetic factors may also influence the development of BPD. These factors act via stable but reversible modifications of DNA and chromatin structure. In this chapter, we revisit the epidemiological, clinical, and molecular findings in BPD and reanalyze them from the perspective of inherited and acquired epigenetic misregulation. Epigenetic research has great potential to enhance our understanding of the molecular basis of BPD.

Childhood and adolescent energy restriction and subsequent colorectal cancer risk: results from the Netherlands Cohort Study

BACKGROUND

Energy restriction during childhood and adolescence is suggested to lower colorectal cancer (CRC) risk. We investigated this in the Netherlands Cohort Study.

METHODS

Information on diet and other risk factors was collected by a baseline questionnaire in 1986 when cohort members were 55-69 years of age (n = 120 852). Three indicators of early life exposure to energy restriction were assessed: father's employment status during the Economic Depression (1932-40), place of residence during Second World War years (1940-44) and the 'Hunger Winter' (1944-45), a severe famine. Using the case-cohort approach, incidence rate ratios (RRs) and 95% confidence intervals (CIs) were calculated for total colorectal, proximal colon, distal colon, rectosigmoid and rectal cancers, according to the three time periods of energy restriction. After 16.3 years of follow-up, 2573 cases were available for multivariate analyses.

RESULTS

Men who lived in a western city during the Hunger Winter and therefore exposed to the highest degree of energy restriction, had a lower risk of developing CRC (RR: 0.81, 95% CI: 0.68-0.98), and tumours of the proximal colon (RR: 0.72, 95% CI: 0.54-0.96) and rectum (RR: 0.71, 95% CI: 0.53-0.96). In women, non-statistically significant inverse associations were observed for tumours of the distal colon, rectosigmoid and rectum. Inverse associations were also observed between the other two exposure times and studied endpoints, though not statistically significant.

CONCLUSIONS

This unique observational evidence suggests that severe energy restriction during childhood and adolescence may lower CRC risk, especially in men, thus providing insight regarding the role of energy intake during early life in CRC development.

The influence of a period of caloric restriction due to the Dutch famine on breast density

Recently, we showed that short, intense caloric restriction due to the Dutch famine increased breast cancer risk in women and influenced the hormonal- and IGF-system. These systems may also affect breast density, which is one of the strongest risk factors for breast cancer. We examined the influence of the Dutch famine on breast density, using mammograms of 1,035 women. Breast size, dense and non-dense tissue and the relative density were measured on a continuous scale. Mean density was compared between three groups of ascending levels of famine-exposure. Results were adjusted for known determinants of breast density and stratified by age at exposure. There were no overall, significant differences by exposure. In unexposed compared to severely exposed women, means varied from 124 cm(2) to 121 cm(2) (p(trend) = 0.50) for breast size, from 23.4 to 21.8 cm(2) (p(trend) = 0.48) for amount of dense tissue, from 87.7 to 85.4 cm(2) (p(trend) = 0.55) for non-dense tissue and from 22.8 to 22.3% (p(trend) = 0.78) for relative density. Only among women who were younger than 10 years during the famine was the amount of non-dense tissue significantly lower with higher exposure, with 53.1 cm(2) for severely exposed compared to 77.8 cm(2) (p(trend) = 0.03) for unexposed. This group also appeared to have smaller breasts with more absolute and relative density, but not statistically significant. We observed no overall effect on breast density in women severely exposed to a short, intense caloric restriction. However, in women exposed before puberty, the non-dense area was smaller and density tended to be higher.

Early life exposure to famine and colorectal cancer risk: a role for epigenetic mechanisms

BACKGROUND

Exposure to energy restriction during childhood and adolescence is associated with a lower risk of developing colorectal cancer (CRC). Epigenetic dysregulation during this critical period of growth and development may be a mechanism to explain such observations. Within the Netherlands Cohort Study on diet and cancer, we investigated the association between early life energy restriction and risk of subsequent CRC characterized by the (promoter) CpG island methylation phenotype (CIMP).

METHODOLOGY/PRINCIPAL FINDINGS

Information on diet and risk factors was collected by baseline questionnaire (n = 120,856). Three indicators of exposure were assessed: place of residence during the Hunger Winter (1944-45) and World War II years (1940-44), and father's employment status during the Economic Depression (1932-40). Methylation specific PCR (MSP) on DNA from paraffin embedded tumor tissue was performed to determine CIMP status according to the Weisenberger markers. After 7.3 years of follow-up, 603 cases and 4631 sub-cohort members were available for analysis. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals for CIMP+ (27.7%) and CIMP- (72.3%) tumors according to the three time periods of energy restriction, adjusted for age and gender. Individuals exposed to severe famine during the Hunger Winter had a decreased risk of developing a tumor characterized by CIMP compared to those not exposed (HR 0.65, 95%CI: 0.45-0.92). Further categorizing individuals by an index of '0-1' '2-3' or '4-7' genes methylated in the promoter region suggested that exposure to the Hunger Winter was associated with the degree of promoter hypermethylation ('0-1 genes methylated' HR = 1.01, 95%CI:0.74-1.37; '2-3 genes methylated' HR = 0.83, 95% CI:0.61-1.15; '4-7 genes methylated' HR = 0.72, 95% CI:0.49-1.04). No associations were observed with respect to the Economic Depression and WWII years.

CONCLUSIONS

This is the first study indicating that exposure to a severe, transient environmental condition during adolescence and young adulthood may result in persistent epigenetic changes that later influence CRC development.

Cancer incidence in Israeli Jewish survivors of World War II

BACKGROUND

Israeli Jews of European origin have high incidence rates of all cancers, and many of them were exposed to severe famine and stress during World War II. We assessed cancer incidence in Israeli Jewish survivors of World War II.

METHODS

Cancer rates were compared in a cohort of 315 544 Israeli Jews who were born in Europe and immigrated to Israel before or during World War II (nonexposed group, n = 57 496) or after World War II and up to 1989 (the exposed group, ie, those potentially exposed to the Holocaust, n = 258 048). Because no individual data were available on actual Holocaust exposure, we based exposure on the immigration date for European-born Israeli Jews and decided against use of the term "Holocaust survivors," implying a known, direct individual Holocaust exposure. Cancer incidences were obtained from the Israel National Cancer Registry. Relative risk (RR) estimates and 95% confidence intervals (95% CIs) were calculated for all cancer sites and for specific cancer sites, stratified by sex and birth cohort, and adjusted for time period.

RESULTS

The nonexposed group contributed 908 436 person-years of follow-up, with 13 237 cancer diagnoses (crude rate per 100 000 person-years = 1457.1). The exposed group contributed 4 011 264 person-years of follow-up, with 56 060 cancer diagnoses (crude rate per 100 000 person-years = 1397.6). Exposure, compared with nonexposure, was associated with a statistically significantly increased risk for all-site cancer for all birth cohorts and for both sexes. The strongest associations between exposure and all-site cancer risk were observed in the youngest birth cohort of 1940-1945 (for men, RR = 3.50, 95% CI = 2.17 to 5.65; for women, RR = 2.33, 95% CI = 1.69 to 3.21). Excess risk was pronounced for breast cancer in the 1940-1945 birth cohort (RR = 2.44, 95% CI = 1.46 to 4.06) and for colorectal cancer in the 1935-1939 cohort (for men, RR = 1.75, 95% CI = 1.19 to 2.59; for women, RR = 1.93, 95% CI = 1.25 to 3.00).

CONCLUSIONS

Incidence of all cancers, particularly breast and colorectal cancer, was higher among Israeli Jews who were potentially exposed to the Holocaust than among those who were not.

Early programming of the IGF-I axis: negative association between IGF-I in infancy and late adolescence in a 17-year longitudinal follow-up study of healthy subjects

BACKGROUND

IGF-I is a major regulator of growth, influenced primarily by diet in infancy and primarily by GH in childhood. Breastfed infants have lower IGF-I levels compared to formula fed and tend to be shorter. The higher protein content of infant formula has a stimulatory effect on IGF-I production. Conversely, studies suggest that later in childhood, those breastfed are taller and have higher IGF-I levels. Therefore, it has been suggested that the IGF-I axis may be programmed by diet during infancy. The association between IGF-I in infancy and later life is not known.

OBJECTIVE

To examine the association between IGF-I in infancy and adolescence.

DESIGN

Infants (109) from the observational Copenhagen cohort study.

METHODS

Serum-IGF-I was measured during infancy (2, 6, and 9 months) and at follow-up at 17 years. Associations were examined by correlation tests and linear regression controlling for gender, breastfeeding, and other covariates. Likelihood ratio test based on residual log likelihood was applied for analysis including all measurements during infancy.

RESULTS

There was an inverse association between IGF-I at 9 months and 17 years (r=-0.39, P=0.014, and n=40). A 1 ng/ml higher IGF-I concentration at 9 months corresponded to 0.95 ng/ml lower IGF-I concentration at 17 years. IGF-I levels at 2 and 6 months were not significantly associated with IGF-I at 17 years, but the estimated directions were negative. These associations were not changed when adjusted for breastfeeding and other covariates except IGF-I at 2 months which was significantly negatively associated with IGF-I at 17 years (P=0.030) corresponding to a 0.96 ng/ml lower IGF-I concentration at 17 years per ng/ml IGF-I at 2 months. Inclusion of all measurements during infancy showed a negative association with 17-year values (r=-0.26, P=0.043, and n=109).

CONCLUSION

The results support the hypothesis that the IGF-I axis can be programmed early in life.

Body size, weight change, fat distribution and breast cancer risk in Hispanic and non-Hispanic white women

INTRODUCTION

The incidence of breast cancer varies among women living in the Southwestern part of the US. We evaluate how body size influences breast cancer risk among these women.

METHODS

Cases (n = 2,325) diagnosed with breast cancer between October 1, 1999 and May 2004 residing in Arizona, Colorado, New Mexico, or Utah were matched to controls (n = 2,525). Participants were interviewed; height, weight, waist, and hip circumference were measured at the time of interview; blood was drawn.

RESULTS

A large body mass index (BMI) at age 15 was inversely associated with pre-menopausal breast cancer risk in both non-Hispanic white (NHW) and Hispanic women (Odds ratio, ORs 0.68 95% CI 0.44, 1.04, and 0.65 95% CI 0.39, 1.08, respectively); BMI at age 15 also had an impact on subsequent breast cancer associated with obesity after menopause. Among post-menopausal women, recent exposure to hormones was an important modifier of risk associated with body size. Among women not recently exposed to hormones risk associated with obesity was 1.61 (95% CI 1.05, 2.45) for NHW women; gaining > or = 25 kg between 15 and age 50 was inversely associated with breast cancer among Hispanic women (OR 0.51, 95% CI 0.23, 1.14). A large weight gain and a large waist-to-hip ratio (WHR) was associated with an increased odds of having an estrogen receptor negative tumor among NHW only (OR 1.81, 95% CI 1.07, 3.08, and 2.04 95% CI 1.20,3.50).

CONCLUSIONS

These findings suggest that the metabolic consequences of obesity on breast cancer risk differ between NHW and Hispanic women living in the Southwest.

BMI may overestimate the prevalence of obesity among women of lower socioeconomic status

OBJECTIVE

Our objective was to examine gender differences in height and weight associated with socioeconomic status (SES) and the consequent effect on body mass index in a multiethnic society.

RESEARCH METHODS AND PROCEDURES

A cross-sectional study, the First Israeli National Health and Nutrition Survey, was performed on a representative population sample of 3246 adults 25 to 64 years of age, between the years 1999 to 2001. Height and weight were measured, and BMI and other weight-height indices were calculated. SES was assessed by income and education.

RESULTS

Age-adjusted height was significantly lower at lower levels of SES among both women and men (p<0.001). As opposed to men, women of lower SES were heavier than those of higher SES, and the mean age-adjusted weight was 4.6 kg higher among those of lower SES (p<0.001). Thus, using the standard index of BMI, the prevalence of obesity was significantly higher among shorter women.

DISCUSSION

In this group of Israeli adults, the unfavorable effect of low SES on BMI was evident among women, partly due to their decreased height combined with increased weight common in this socioeconomic sector. Since BMI is only partly independent of height, it may overestimate the prevalence of obesity among women of lower SES. Alternative measures for classifying obesity in the lower SES groups that put less emphasis on height may be considered and studied.

Transient caloric restriction and cancer risk (The Netherlands)

Over the past century, many animal experiments have shown that caloric restriction can reduce the risk of cancer, a finding that proved to be highly reproducible. Many papers have been published on its potential for human health, but until know little evidence is available on its actual effects in humans. In Utrecht, The Netherlands, we have been investigating the effects of the 1944–1945 Dutch famine on breast cancer risk factors and breast cancer risk, and paradoxically the relatively short-term famine seemed to be related to increased breast cancer risk in later life. One of the differences between the famine situation and the large body of evidence from animal experiments is the duration of caloric restriction. Almost all animal experiments investigated sustained caloric restriction and information on the effects of short-term transient caloric restriction is very scarce. A search in the literature identified some animal experiments on short-term transient caloric restriction and these seemed to be at least supportive to the famine findings. Because caloric restriction in humans for preventive health measures would be mostly short-term, it is important to extend animal research on short-term caloric restriction.

Childhood diet and insulin-like growth factors in adulthood: 65-year follow-up of the Boyd Orr Cohort

OBJECTIVE

High levels of insulin-like growth factor-I (IGF-I) are associated with an increased cancer risk and reduce risk of diabetes and coronary heart disease. We investigated associations of diet in childhood, in particular energy intake, with the IGF system in adulthood to determine if IGF-I - disease associations could be linked to early nutrition.

DESIGN

Retrospective cohort study.

SETTING

Sixteen survey centres in England and Scotland that originally participated in the Carnegie (Boyd Orr) Survey of Diet and Health in Pre-War Britain, 1937-1939.

SUBJECTS

Seven hundred and twenty-eight participants (679 with complete data) in the Boyd Orr cohort.

METHODS

Participants were originally surveyed between 1937 and 1939 (at median age 5.8 years; inter-quartile range: 2.9-9.6) and were followed up for 65 years. Dietary exposure in childhood was assessed from 7-day household food inventories. Outcomes are expressed as regression coefficients for the change in IGF per standard deviation increased childhood nutrient or food intake, as derived from levels of household consumption.

RESULTS

In fully-adjusted models, energy-rich family diets in childhood were not associated with IGF-I (regression coefficient: 0.9 ng/ml; 95% confidence interval (CI): -1.8, 3.7), IGF-II, IGF binding proteins (IGFBP)-2 or IGFBP-3 in adulthood. IGF-I was associated inversely with childhood family-diets high in milk (-2.5 ng/ml; -5.1, 0.1; P=0.05) and positively with vegetable-rich diets (3.5 ng/ml; 0.9, 6.1; P=0.009). IGF-I was not associated with family diets rich in protein, carbohydrates, fats, calcium, meat or fruit. IGF-II, IGFBP-2 and IGFBP-3 were not related to childhood family diet.

CONCLUSIONS

This study suggests that energy-rich family diets in childhood do not program the IGF system in adulthood. As childhood diet was based on household consumption, however, measurement error may obscure individual-level diet-IGF associations. The associations of milk- and vegetable-rich family diets in childhood with IGF-I could be chance findings, but nevertheless are consistent with recent publications and warrant further investigation.

Cow's milk and linear growth in industrialized and developing countries

The strongest evidence that cow's milk stimulates linear growth comes from observational and intervention studies in developing countries that show considerable effects. Additionally, many observational studies from well-nourished populations also show an association between milk intake and growth. These results suggest that milk has a growth-stimulating effect even in situations where the nutrient intake is adequate. This effect is supported by studies that show milk intake stimulates circulating insulin-like growth factor (IGF)-I, which suggests that at least part of the growth-stimulating effects of milk occur through the stimulation of IGFs. Given that the biological purpose of milk is to support the newborn during a period of high growth velocity, such an effect seems plausible. Adding cow's milk to the diet of stunted children is likely to improve linear growth and thereby reduce morbidity. In well-nourished children, the long-term consequences of an increased consumption of cow's milk, which may lead to higher levels of IGF-I in circulation or an increase in the velocity of linear growth, are likely to be both positive and negative. Based on emerging data that suggest both growth and diet during early life program the IGF axis, the association between milk intake and later health is likely to be complex.

Associations of adiposity from childhood into adulthood with insulin resistance and the insulin-like growth factor system: 65-year follow-up of the Boyd Orr Cohort

CONTEXT

One metabolic pathway through which adiposity influences disease risk may be via alterations in insulin and IGF metabolism.

OBJECTIVE

Our objective was to investigate associations of adiposity at different stages of life with insulin and the IGF system.

DESIGN, SETTING, AND PARTICIPANTS

The study was a 65-yr follow-up of 728 Boyd Orr cohort participants (mean age, 71 yr) originally surveyed between 1937 and 1939.

MAIN OUTCOMES

Outcomes included homeostasis model assessment of insulin resistance, total IGF-I and IGF-II, IGF binding protein (IGFBP)-2, and IGFBP-3 in adulthood.

RESULTS

Childhood body mass index (BMI) was weakly inversely related to adult IGF-I (coefficient per BMI sd, -3.4 ng/ml; 95% confidence interval, -7.3 to 0.5; P = 0.09). IGF-II (but not IGF-I) increased with higher current fat mass index (coefficient, 26.1 ng/ml; 95% confidence interval, 4.6 to 47.6; P = 0.02) and waist-hip ratio (30.0 ng/ml; 9.4 to 50.5; P = 0.004). IGFBP-2 decreased by 21.2% (17.2 to 24.9; P < 0.001), and homeostasis model assessment of insulin resistance increased by 38.8% (28.9 to 49.6; P < 0.001) per sd higher adult BMI. Among thin adults (BMI tertiles 1 and 2), IGFBP-2 was positively, and insulin resistance was inversely, associated with childhood BMI.

CONCLUSION

There was only weak evidence that associations of childhood BMI with chronic disease risk may be mediated by adult IGF-I levels. Circulating IGFBP-2 in adulthood, a marker for insulin sensitivity, was inversely associated with current adiposity, but overweight children who became relatively lean adults were more insulin sensitive than thinner children. The findings may indicate programming of later insulin sensitivity and consequently IGFBP-2 levels in response to childhood adiposity. The role of IGF-II in obesity-related chronic diseases warrants additional investigation.

Timing of puberty determines serum insulin-like growth factor-I in late adulthood

CONTEXT

IGFs may play an important role in disease etiology, especially cancer. Changes in diet can alter acute levels, but little is known about life course influences on IGF levels.

OBJECTIVE

The objective of the study was to examine the association between timing of puberty and adulthood serum IGFs (IGF-I and IGF binding protein-3).

DESIGN

This was a retrospective cohort study.

SETTING

Male pupils who attended a single school in Southern England were part of the study.

PARTICIPANTS

Participants in the study were a cohort of 1028 men born between 1927 and 1956 with anthropometric measures between 9 and 18 yr and adulthood serum IGF levels.

MAIN OUTCOME MEASURE

The study measured serum IGF-I and IGF binding protein-3 at mean age 63 yr.

RESULTS

Age at peak height velocity (APHV) was inversely associated with adult IGF-I levels. IGF-I decreased by 3.7 ng/ml (95% confidence interval 1.0-6.4, P = 0.007) for each sd increase in APHV. Prepubertal childhood height and body mass index were both inversely associated with APHV (P trend < 0.001). APHV was positively associated with adult height and inversely associated with adult body mass index. Adjustment for childhood, adult anthropometry, and other lifestyle factors did not substantially alter the association between APHV and adult IGF-I.

CONCLUSIONS

This is the first study to document an association between timing of puberty and adult IGF-I levels. A better understanding of life course determinants of the IGF system may provide new insights into disease etiology and primary prevention.

The Dutch Famine of 1944-1945: a pathophysiological model of long-term consequences of wasting disease

PURPOSE OF REVIEW

The tragic circumstances of the Dutch Hunger Winter of 1944-1945 created a unique opportunity to study the relation between exposure to prenatal famine and health in adult life. This review addresses the literature on the effects of maternal malnutrition during the different periods of gestation and childhood on health in adult life.

RECENT FINDINGS

Exposure to famine during gestation resulted in increases in impaired glucose tolerance, obesity, coronary heart disease, atherogenic lipid profile, hypertension, microalbuminuria, schizophrenia, antisocial personality and affective disorders. Exposure to famine during childhood resulted in changes in reproductive function, earlier menopause, changes in insulin-like growth factor-I and increases in breast cancer.

SUMMARY

Exposure to famine during gestation and childhood has life-long effects on health, and these effects vary depending on the timing of exposure as well as evolution of the recovery period.

Early life events and later risk of colorectal cancer: age-period-cohort modelling in the Nordic countries and Estonia

BACKGROUND

A lowering of colorectal cancer risk for the birth cohorts born around World War II (WWII) has previously been observed in Norway, a country which suffered some 20% caloric restriction during the war. The purpose of the study was to conduct a similar kind of analysis in the other Nordic countries and Estonia, which were also subjected to various degrees of energy restriction during WWII.

METHODS

All new cases of colorectal cancer in the Nordic countries and Estonia diagnosed between 40 and 84 years of age and born between 1874 and 1953, were collected from the national cancer registries. The incidence data were fitted to an age-period-cohort model.

RESULTS

A transient drop in the estimated colorectal cancer incidence rate was observed for the birth cohorts born around WWII in Estonia, together with a tendency of decreased risk in Sweden and Denmark.

CONCLUSION

The previously observed lowering of colorectal cancer risk for persons born during WWII in Norway also prevails in Estonia. Energy restriction is a possible explanation for these findings, since the countries suffered from varying nutritional conditions during the war. Exogenous factors acting during periods early in life may have an impact on later colorectal cancer risk.

Could associations between breastfeeding and insulin-like growth factors underlie associations of breastfeeding with adult chronic disease? The Avon Longitudinal Study of Parents and Children

OBJECTIVE

The influence of infant feeding method (breast/formula) on growth factor levels could underlie associations of breastfeeding with childhood growth and risk factors for cardiovascular disease. We investigated associations of having been breastfed with serum IGF-I and IGFBP-3 in childhood.

METHODS

Prospective birth cohort study (subsample of the Avon Longitudinal Study of Parents and Children, UK) based on 871 children born in 1991/1992 who underwent clinical follow-up and blood tests at age 7-8 years. A total of 488 (56%) children had complete data.

RESULTS

In children with complete data, the age- and sex-standardized IGF-I levels of those who were partially or exclusively breastfed were 6.1 and 13.8 ng/ml higher, respectively, than those who were never breastfed (increase in IGF-I levels per category of breastfeeding exclusivity: 7.1 ng/ml; 95% CI: 0.3-13.9; P = 0.04). In models also controlling for birthweight, gestational age, mother's age, and socioeconomic and dietary factors, the breastfeeding-IGF-I association was attenuated (regression coefficient: 3.3 ng/ml; -4.2-10.7; P = 0.4); further adjustment for IGFBP-3 made little difference (regression coefficient: 4.1 ng/ml; -2.8-10.9; P = 0.2). There was little evidence for an association between breastfeeding and IGFBP-3 or the molar ratio IGF-I/IGFBP-3.

CONCLUSIONS

The positive association between breastfeeding and IGF-I could be due to residual confounding or to chance. Nevertheless, the magnitude of the fully adjusted effect estimate and the novelty of the association suggest that larger studies should now be conducted to confirm or refute the hypothesis that variations in IGF-I by infant feeding mode explain associations of breastfeeding with health in later life.

Prenatal and Postnatal Milk Supplementation and Adult Insulin-like Growth Factor I: Long-term Follow-up of a Randomized Controlled Trial

OBJECTIVE

Insulin-like growth factors (IGF) are increasingly recognized as important determinants of adult health, in particular risk of certain cancers. However, little is known about the determinants of adult IGFs and to what degree they may be programmed by early life influences.

DESIGN

Randomized controlled trial of prenatal and postnatal milk supplementation among 951 subjects born in 1972 to 1974 in South Wales.

MAIN OUTCOME MEASURE

Measures of IGF-I, IGF binding protein 3, and the molar ratio.

RESULTS

Data on adult IGFs were available from 663 subjects at a mean age of 25 years. Subjects in the intervention arm had lower IGF-I (-8.5 ng/mL; 95% confidence interval, -15.1 to -1.8, P = 0.01) and ratio (-1.20; 95% confidence interval, -2.33 to -0.04, P = 0.04). These differences could not be explained by follow-up bias or confounding factors.

CONCLUSIONS

These results provide experimental data on the role of early life programming either in the intrauterine or postnatal period that may have long-term influences on the IGF axis, with potential implications for disease risk.

Breast cancer and the brain: a neurodevelopmental hypothesis to explain the opposing effects of caloric deprivation during the Dutch famine of 1944-1945 on breast cancer and its risk factors

Most studies on calorie deprivation and cancer risk in rodents show reductions in tumor occurrence. However, the few human studies on calorie restriction are conflicting. An overview is given of results in the DOM (diagnostic onderzoek mammacarcinoom) cohorts among women exposed to the Dutch Famine of 1944-1945. Opposing effects were found on risk factors (shortening of leg length, later menarche, and earlier menopause), whereas urinary estrogens and plasma insulin-like growth factor (IGF)-1 and IGF binding protein-3 were increased, as was breast cancer itself. Exposure between 2 and 10 y old was an unexpected window of susceptibility to the effects of calorie deprivation. The effects of famine exposure were most clearly seen in women who never gave birth. These opposing observations can be explained by a neurodevelopmental hypothesis on set-point shifts at the level of the diencephalons/hypothalamus, either directly or from rebound effects. Such a mechanism reflects old evolutionary adaptation systems in lower and higher organisms to cope with periods of stress and famine by adjusting, for example, reproductive functions. These effects in exposed women may later also affect their unexposed offspring. This hypothesis provides several testable, hormone-mediated corollaries on the relationships between the role of calories in a Westernized lifestyle and human cancer risk. The underlying developmental perspective, as opposed to a risk factor approach, can explain why certain ages, even before breast development, are especially sensitive to effects of large fluctuations in calories. The observations presented may have implications for preventive strategies such as promoting moderation of calorie intake to curb cancer risks.

Breast cancer risk after caloric restriction during the 1944-1945 Dutch famine

BACKGROUND

Data from animal models suggest that caloric restriction may reduce the risk of breast cancer, although not all dietary regimens produce similar effects. We examined whether caloric restriction imposed as a consequence of the 1944-1945 Dutch famine reduced the risk of breast cancer in women participating in a Dutch breast cancer screening program.

METHODS

Between 1983 and 1986, approximately 15 000 women, aged 2 to 33 years during the 1944-1945 Dutch famine, responded to a questionnaire about their famine experience. A famine exposure score, graded as absent, moderate, or severe exposure, was derived from answers regarding hunger, cold, and weight loss. During follow-up until January 2000, 585 women with incident breast cancer were identified by the regional cancer registry. The relationship between famine exposure and breast cancer risk was assessed by weighted Cox regression models, in which person-years lived for the entire cohort was extrapolated from data from a random sample of 15% of the cohort.

RESULTS

Women who were severely exposed to the famine had a statistically significantly higher risk of breast cancer (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.09 to 2.01) than women who were not exposed. Women who were moderately exposed to the famine had a 13% increased risk of breast cancer (HR = 1.13, 95% CI = 0.92 to 1.38; P(trend) = 0.016). The association between famine exposure and breast cancer risk was stronger for women who were exposed between the ages of 2 and 9 years (severely exposed versus unexposed: HR = 2.01, 95% CI = 0.92 to 4.41) than for women who were exposed at older ages.

CONCLUSIONS

The risk of breast cancer was increased in women who were severely exposed to a short but severe famine decades earlier. This result is compatible with data from the few animal studies investigating effects of short-term, transient caloric restriction.