1
|
Lyons-Reid J, Derraik JGB, Kenealy T, Albert BB, Ramos Nieves JM, Monnard CR, Titcombe P, Nield H, Barton SJ, El-Heis S, Tham E, Godfrey KM, Chan SY, Cutfield WS. Impact of preconception and antenatal supplementation with myo-inositol, probiotics, and micronutrients on offspring BMI and weight gain over the first 2 years. BMC Med 2024; 22:39. [PMID: 38287349 PMCID: PMC10826220 DOI: 10.1186/s12916-024-03246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Nutritional intervention preconception and throughout pregnancy has been proposed as an approach to promoting healthy postnatal weight gain in the offspring but few randomised trials have examined this. METHODS Measurements of weight and length were obtained at multiple time points from birth to 2 years among 576 offspring of women randomised to receive preconception and antenatally either a supplement containing myo-inositol, probiotics, and additional micronutrients (intervention) or a standard micronutrient supplement (control). We examined the influence on age- and sex-standardised BMI at 2 years (WHO standards, adjusting for study site, sex, maternal parity, smoking and pre-pregnancy BMI, and gestational age), together with the change in weight, length, BMI from birth, and weight gain trajectories using latent class growth analysis. RESULTS At 2 years, there was a trend towards lower mean BMI among intervention offspring (adjusted mean difference [aMD] - 0.14 SD [95% CI 0.30, 0.02], p = 0.09), and fewer had a BMI > 95th percentile (i.e. > 1.65 SD, 9.2% vs 18.0%, adjusted risk ratio [aRR] 0.51 [95% CI 0.31, 0.82], p = 0.006). Longitudinal data revealed that intervention offspring had a 24% reduced risk of experiencing rapid weight gain > 0.67 SD in the first year of life (21.9% vs 31.1%, aRR 0.76 [95% CI 0.58, 1.00], p = 0.047). The risk was likewise decreased for sustained weight gain > 1.34 SD in the first 2 years of life (7.7% vs 17.1%, aRR 0.55 [95% CI 0.34, 0.88], p = 0.014). From five weight gain trajectories identified, there were more intervention offspring in the "normal" weight gain trajectory characterised by stable weight SDS around 0 SD from birth to 2 years (38.8% vs 30.1%, RR 1.29 [95% CI 1.03, 1.62], p = 0.029). CONCLUSIONS Supplementation with myo-inositol, probiotics, and additional micronutrients preconception and in pregnancy reduced the incidence of rapid weight gain and obesity at 2 years among offspring. Previous reports suggest these effects will likely translate to health benefits, but longer-term follow-up is needed to evaluate this. TRIAL REGISTRATION ClinicalTrials.gov, NCT02509988 (Universal Trial Number U1111-1171-8056). Registered on 16 July 2015.
Collapse
Affiliation(s)
- Jaz Lyons-Reid
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Timothy Kenealy
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Medicine and Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | - Benjamin B Albert
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - J Manuel Ramos Nieves
- Nestlé Institute of Health Sciences, Nestlé Research, Société Des Produits Nestlé S.A, Lausanne, Switzerland
| | - Cathriona R Monnard
- Nestlé Institute of Health Sciences, Nestlé Research, Société Des Produits Nestlé S.A, Lausanne, Switzerland
| | - Phil Titcombe
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Heidi Nield
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sheila J Barton
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah El-Heis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Tham
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University of Singapore, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University of Singapore, Singapore, Singapore
| | - Wayne S Cutfield
- Liggins Institute, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
- A Better Start - National Science Challenge, The University of Auckland, Auckland, New Zealand.
| |
Collapse
|
2
|
van Biljon N, Lake MT, Goddard L, Botha M, Zar HJ, Little F. Latent Classes of Anthropometric Growth in Early Childhood Using Uni- and Multivariate approaches in a South African Birth Cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.01.23294932. [PMID: 37693390 PMCID: PMC10491380 DOI: 10.1101/2023.09.01.23294932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Conventional methods for modelling longitudinal growth data focus on the analysis of mean longitudinal trends or the identification of abnormal growth based on cross-sectional standardized z-scores. Latent Class Mixed Modelling (LCMM) considers the underlying heterogeneity in growth profiles and allows for the identification of groups of subjects that follow similar longitudinal trends. Methods LCMM was used to identify underlying latent profiles of growth for univariate responses of standardized height, standardized weight, standardized body mass index and standardized weight-for-length/height measurements and multivariate response of joint standardized height and standardized weight measurements from birth to five years for a sample of 1143 children from a South African birth cohort, the Drakenstein Child Health Study (DCHS). Allocations across latent growth classes were compared to better understand the differences and similarities across the classes identified given different composite measures of height and weight as input. Results Four classes of growth within standardized height (n1=516, n2=112, n3=187, n4=321) and standardized weight (n1=263, n2=150, n3=584, n4=142), three latent growth classes within Body Mass Index (BMI) (n1=481, n2=485, n3=149) and Weight for length/height (WFH) (n1=321, n2=710, n3=84) and five latent growth classes within the multivariate response of standardized height and standardized weight (n1=318, n2=205, n3=75, n4=296, n5=242) were identified, each with distinct trajectories over childhood. A strong association was found between various growth classes and abnormal growth features such as rapid weight gain, stunting, underweight and overweight. Conclusions With the identification of these classes, a better understanding of distinct childhood growth trajectories and their predictors may be gained, informing interventions to promote optimal childhood growth.
Collapse
Affiliation(s)
| | - Marilyn T Lake
- Department of Paediatrics and Child Health, and SA-MRC unit on Child & Adolescent Health, University of Cape Town, SA
| | - Liz Goddard
- Department of Paediatrics and Child Health, and SA-MRC unit on Child & Adolescent Health, University of Cape Town, SA
| | - Maresa Botha
- Department of Paediatrics and Child Health, and SA-MRC unit on Child & Adolescent Health, University of Cape Town, SA
| | - Heather J Zar
- Department of Paediatrics and Child Health, and SA-MRC unit on Child & Adolescent Health, University of Cape Town, SA
| | | |
Collapse
|
3
|
Stevens DR, Starling AP, Bommarito PA, Keil AP, Nakiwala D, Calafat AM, Adgate JL, Dabelea D, Ferguson KK. Midpregnancy Phthalate and Phenol Biomarkers in Relation to Infant Body Composition: The Healthy Start Prospective Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:87017. [PMID: 37616158 PMCID: PMC10449008 DOI: 10.1289/ehp12500] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Gestational phthalate and phenol exposure disrupts adipogenesis, contributing to obesity in mice. Whether gestational phthalate or phenol exposure is associated with infant body composition has not been investigated in humans. OBJECTIVE We examined associations between biomarkers of phthalate and phenol exposure in midpregnancy and infant size and body composition at birth and at 5 months of age. METHODS Analyses were conducted among 438 infants from the Healthy Start prospective pregnancy cohort. Sixteen phthalate and phenol biomarkers were quantified in spot urine samples collected at 24-28 wk of gestation. Infant outcomes measured at birth and at 5 months of age included size [weight (in grams)] and body composition [fat and lean masses (in grams); percentage fat mass]. Single- (linear) and multipollutant (quantile g-computation) models were used to estimate associations of phthalate and phenol biomarkers with infant outcomes at birth and at 5 months of age. Models were adjusted for sociodemographics, sample collection timing, and lifestyle factors and used to examine for effect modification by infant sex. RESULTS In single-pollutant models, mono-benzyl phthalate and di-n -butyl phthalate were inversely associated with percentage fat mass [β : - 0.49 (95% CI: - 0.91 , - 0.08 ) and - 0.51 (95% CI: - 1.02 , 0.01), respectively] in male but not female infants at birth. Similar, but less precise, associations were observed at 5 months of age. In multipollutant models, a 1-quartile increase in the phthalate and phenol biomarker mixture was inversely associated with percentage fat mass at birth [- 1.06 (95% CI: - 2.21 , 0.1)] and at 5 months of age [- 2.14 (95% CI: - 3.88 , - 0.39 )] among males, but associations were null among females [0.48 (95% CI: - 0.78 , 1.75) and - 0.64 (95% CI: - 2.68 , 1.41), respectively]. Similar associations were observed with infant weight. CONCLUSION In this U.S.-based prospective cohort, gestational phthalate and phenol biomarkers were inversely associated with infant weight and fat mass, particularly in males. https://doi.org/10.1289/EHP12500.
Collapse
Affiliation(s)
- Danielle R. Stevens
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Anne P. Starling
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paige A. Bommarito
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Alexander P. Keil
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dorothy Nakiwala
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John L. Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Public Health Campus, Aurora, Colorado, USA
| | - Dana Dabelea
- Center for Lifecourse Epidemiology of Adiposity and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelly K. Ferguson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| |
Collapse
|
4
|
Dalmartello M, Vermunt J, Negri E, Levi F, La Vecchia C. Adult lifetime body mass index trajectories and endometrial cancer risk. BJOG 2021; 129:1521-1529. [PMID: 34962692 DOI: 10.1111/1471-0528.17087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify body mass index (BMI) trajectories in adult life and to examine their association with endometrial cancer (EC) risk, also exploring whether relations differ by HRT use. DESIGN Pooled analysis of two case control studies. SETTING Italy and Switzerland. POPULATION A total of 458 EC cases and 782 controls. METHODS We performed a latent class growth model in order to identify homogenous BMI trajectories over 6 decades of age, with a polynomial function of age. Odds Ratios (ORs) and the corresponding 95% confidence intervals (CI) for EC risk were derived through a multiple logistic regression model, correcting for classification error. MAIN OUTCOME MEASURES The relation of BMI trajectories with endometrial cancer. RESULTS We identified 5 BMI trajectories. Compared with women in the 'Normal weight-stable' trajectory, a reduction by about 50% in the risk of EC emerged for those in the 'Underweight increasing to normal weight' (95% CI=0.28-0.99). The 'Normal weight increasing to overweight' and the 'Overweight-stable' trajectories were associated to, respectively, an excess of 3% (95% CI=0.66-1.60) and of 71% (95% CI= 1.12-2.59) in cancer risk. The OR associated to the trajectory 'Overweight increasing to obese' was 2.03 (95% CI= 1.31-3.13). Stronger effects emerged among HRT never users (OR= 2.19 for the 'Overweight-stable' trajectory and OR=2.49 for the 'Overweight increasing to obese' trajectory). CONCLUSIONS Our study suggests that longer exposure to overweight and obesity across lifetime is associated with an increased risk of endometrial cancer. Weight during adulthood also appears to play an important role.
Collapse
Affiliation(s)
- Michela Dalmartello
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jeroen Vermunt
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Eva Negri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Humanities, Università Telematica Pegaso, Naples, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Fabio Levi
- Department of Epidemiology and Health Services research, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
5
|
Lyons-Reid J, Albert BB, Kenealy T, Cutfield WS. Birth Size and Rapid Infant Weight Gain-Where Does the Obesity Risk Lie? J Pediatr 2021; 230:238-243. [PMID: 33157072 DOI: 10.1016/j.jpeds.2020.10.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Jaz Lyons-Reid
- Liggins Institute, The University of Aucklan, Auckland, New Zealand
| | | | - Timothy Kenealy
- Liggins Institute, The University of Aucklan, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, The University of Aucklan, Auckland, New Zealand; A Better Start - National Science Challenge, Auckland, New Zealand.
| |
Collapse
|
6
|
Fewtrell MS, Mohd Shukri NH, Wells JCK. 'Optimising' breastfeeding: what can we learn from evolutionary, comparative and anthropological aspects of lactation? BMC Med 2020; 18:4. [PMID: 31915002 PMCID: PMC6950880 DOI: 10.1186/s12916-019-1473-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Promoting breastfeeding is an important public health intervention, with benefits for infants and mothers. Even modest increases in prevalence and duration may yield considerable economic savings. However, despite many initiatives, compliance with recommendations is poor in most settings - particularly for exclusive breastfeeding. Mothers commonly consult health professionals for infant feeding and behavioural problems. MAIN BODY We argue that broader consideration of lactation, incorporating evolutionary, comparative and anthropological aspects, could provide new insights into breastfeeding practices and problems, enhance research and ultimately help to develop novel approaches to improve initiation and maintenance. Our current focus on breastfeeding as a strategy to improve health outcomes must engage with the evolution of lactation as a flexible trait under selective pressure to maximise reproductive fitness. Poor understanding of the dynamic nature of breastfeeding may partly explain why some women are unwilling or unable to follow recommendations. CONCLUSIONS We identify three key implications for health professionals, researchers and policymakers. Firstly, breastfeeding is an adaptive process during which, as in other mammals, variability allows adaptation to ecological circumstances and reflects mothers' phenotypic variability. Since these factors vary within and between humans, the likelihood that a 'one size fits all' approach will be appropriate for all mother-infant dyads is counterintuitive; flexibility is expected. From an anthropological perspective, lactation is a period of tension between mother and offspring due to genetic 'conflicts of interest'. This may underlie common breastfeeding 'problems' including perceived milk insufficiency and problematic infant crying. Understanding this - and adopting a more flexible, individualised approach - may allow a more creative approach to solving these problems. Incorporating evolutionary concepts may enhance research investigating mother-infant signalling during breastfeeding; where possible, studies should be experimental to allow identification of causal effects and mechanisms. Finally, the importance of learned behaviour, social and cultural aspects of primate (especially human) lactation may partly explain why, in cultures where breastfeeding has lost cultural primacy, promotion starting in pregnancy may be ineffective. In such settings, educating children and young adults may be important to raise awareness and provide learning opportunities that may be essential in our species, as in other primates.
Collapse
Affiliation(s)
- Mary S Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Nurul H Mohd Shukri
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.,Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| |
Collapse
|
7
|
Zhu Z, Chang S, Cheng Y, Qi Q, Li S, Elhoumed M, Yan H, Dibley MJ, Fawzi WW, Zeng L, Sudfeld CR. Early life cognitive development trajectories and intelligence quotient in middle childhood and early adolescence in rural western China. Sci Rep 2019; 9:18315. [PMID: 31797987 PMCID: PMC6892923 DOI: 10.1038/s41598-019-54755-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/19/2019] [Indexed: 12/24/2022] Open
Abstract
The relationship of cognitive developmental trajectories during the dynamic first years with later life development outcomes remains unclear in low- and middle-income countries. 1388 Children born to women who participated in a randomized trial of antenatal micronutrient supplementation in rural China were prospectively followed. Cognitive development was assessed six times between 3 and 30 months of age using Bayley Scales of Infant Development, and then in mid-childhood (7-9 years) and early adolescence (10-12 years) using Wechsler Intelligence Scale for Children. We identified four distinct infant cognitive development trajectory subgroups using group-based trajectory modeling: (i) consistently above average, (ii) consistently average, (iii) started below average and then improved, and (iv) started below average and then declined. LBW infants (<2500 g) were 10.60 times (95% CI 3.57, 31.49) more likely to be in the trajectory group that started below average and then declined, while each grade increase in maternal education decreased the risk of being in this group by 73% (95% CI 54%, 84%). Infants who performed consistently above average had 8.02 (95% CI 1.46, 14.59) points higher IQ in adolescence versus the declining trajectory group. These findings suggest that interventions to improve early child development trajectories may produce long-term human capital benefits.
Collapse
Affiliation(s)
- Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Suying Chang
- United Nations Children's Fund, China Office, Beijing, 100600, P.R. China
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Shaoru Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China
- Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, 710061, Shaanxi, China
| | - Michael J Dibley
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, P.R. China.
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, 710061, Shaanxi, China.
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Wibaek R, Vistisen D, Girma T, Admassu B, Abera M, Abdissa A, Mudie K, Kæstel P, Jørgensen ME, Wells JCK, Michaelsen KF, Friis H, Andersen GS. Body mass index trajectories in early childhood in relation to cardiometabolic risk profile and body composition at 5 years of age. Am J Clin Nutr 2019; 110:1175-1185. [PMID: 31504088 DOI: 10.1093/ajcn/nqz170] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/03/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Both impaired and accelerated postnatal growth have been associated with adult risks of obesity and cardiometabolic diseases, like type 2 diabetes and cardiovascular disease. However, the timing of the onset of cardiometabolic changes and the specific growth trajectories linking early growth with later disease risks are not well understood. OBJECTIVES The aim of this study was to identify distinct trajectories of BMI growth from 0 to 5 y and examine their associations with body composition and markers of cardiometabolic risk at age 5 y. METHODS In a prospective birth cohort study of 453 healthy and term Ethiopian children with BMIs assessed a median of 9 times during follow-up, we identified subgroups of distinct BMI trajectories in early childhood using latent class trajectory modeling. Associations of the identified growth trajectories with cardiometabolic markers and body composition at 5 y were analyzed using multiple linear regression analyses in 4 adjustment models for each outcome. RESULTS We identified 4 heterogeneous BMI growth trajectories: stable low BMI (19.2%), normal BMI (48.8%), rapid catch-up to high BMI (17.9%), and slow catch-up to high BMI (14.1%). Compared with the normal BMI trajectory, children in the rapid catch-up to high BMI trajectory had higher triglycerides (TGs) (range of β-coefficients in Models 1-4: 19-21%), C-peptides (23-25%), fat masses (0.48-0.60 kg), and fat-free masses (0.50-0.77 kg) across the 4 adjustment models. Children in the stable low BMI trajectory had lower LDL cholesterol concentrations (0.14-0.17 mmol/L), HDL cholesterol concentrations (0.05-0.09 mmol/L), fat masses (0.60-0.64 kg), and fat-free masses (0.35-0.49 kg), but higher TGs (11-13%). CONCLUSIONS The development of obesity and cardiometabolic risks may be established already in early childhood; thus, our data provide a further basis for timely interventions targeted at young children from low-income countries with unfavorable growth patterns. The birth cohort was registered at ISRCTN as ISRCTN46718296.
Collapse
Affiliation(s)
- Rasmus Wibaek
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Dorte Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia.,Jimma University Clinical and Nutrition Research Partnership, Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Jimma University Clinical and Nutrition Research Partnership, Jimma University, Jimma, Ethiopia.,Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.,Jimma University Clinical and Nutrition Research Partnership, Jimma University, Jimma, Ethiopia.,Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Jimma University Clinical and Nutrition Research Partnership, Jimma University, Jimma, Ethiopia.,Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Kissi Mudie
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Gregers S Andersen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| |
Collapse
|
9
|
Wibaek R, Vistisen D, Girma T, Admassu B, Abera M, Abdissa A, Jørgensen ME, Kæstel P, Michaelsen KF, Friis H, Wells JCK, Andersen GS. Associations of fat mass and fat-free mass accretion in infancy with body composition and cardiometabolic risk markers at 5 years: The Ethiopian iABC birth cohort study. PLoS Med 2019; 16:e1002888. [PMID: 31430287 PMCID: PMC6701744 DOI: 10.1371/journal.pmed.1002888] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Accelerated growth in early childhood is an established risk factor for later obesity and cardiometabolic disease, but the relative importance of fat mass (FM) and fat-free mass (FFM) accretion is not well understood. We aimed to study how FM and FFM at birth and their accretion during infancy were associated with body composition and cardiometabolic risk markers at 5 years. METHODS AND FINDINGS Healthy children born at term were enrolled in the Infant Anthropometry and Body Composition (iABC) birth cohort between December 2008 and October 2012 at Jimma University Specialized Hospital in the city of Jimma, Ethiopia. FM and FFM were assessed using air displacement plethysmography a median of 6 times between birth and 6 months of age. In 507 children, we estimated individual FM and FFM at birth and their accretion over 0-3 and 3-6 months of age using linear-spline mixed-effects modelling. We analysed associations of FM and FFM at birth and their accretion in infancy with height, waist circumference, FM, FFM, and cardiometabolic risk markers at 5 years using multiple linear regression analysis. A total of 340 children were studied at the 5-year follow-up (mean age: 60.0 months; girls: 50.3%; mean wealth index: 45.5 out of 100; breastfeeding status at 4.5 to 6 months post-partum: 12.5% exclusive, 21.4% almost exclusive, 60.6% predominant, 5.5% partial/none). Higher FM accretion in infancy was associated with higher FM and waist circumference at 5 years. For instance, 100-g/month higher FM accretion in the periods 0-3 and 3-6 months was associated with 339 g (95% CI: 243-435 g, p < 0.001) and 367 g (95% CI: 250-484 g, p < 0.001) greater FM at 5 years, respectively. Higher FM at birth and FM accretion from 0 to 3 months were associated with higher FFM and cholesterol concentrations at 5 years. Associations for cholesterol were strongest for low-density lipoprotein (LDL)-cholesterol, and remained significant after adjusting for current FM. A 100-g higher FM at birth and 100-g/month higher FM accretion from 0 to 3 months were associated with 0.16 mmol/l (95% CI: 0.05-0.26 mmol/l, p = 0.005) and 0.06 mmol/l (95% CI: 0.01-0.12 mmol/l, p = 0.016) higher LDL-cholesterol at 5 years, respectively. Higher FFM at birth and FFM accretion in infancy were associated with higher FM, FFM, waist circumference, and height at 5 years. For instance, 100-g/month higher FFM accretion in the periods 0-3 and 3-6 months was associated with 1,002 g (95% CI: 815-1,189 g, p < 0.001) and 624 g (95% CI: 419-829 g, p < 0.001) greater FFM at 5 years, respectively. We found no associations of FM and FFM growth with any of the other studied cardiometabolic markers including glucose, HbA1c, insulin, C-peptide, HOMA-IR, triglycerides, and blood pressure. Non-attendance at the 5-year follow-up visit was the main limitation of this study, which may have introduced selection bias and limited the power of the regression analyses. CONCLUSIONS FM accretion in early life was positively associated with markers of adiposity and lipid metabolism, but not with blood pressure and cardiometabolic markers related to glucose homeostasis. FFM accretion was primarily related to linear growth and FFM at 5 years.
Collapse
Affiliation(s)
- Rasmus Wibaek
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- * E-mail:
| | - Dorte Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Mubarek Abera
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma, Ethiopia
- Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Marit E. Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | |
Collapse
|
10
|
Admassu B, Wells JCK, Girma T, Belachew T, Ritz C, Owino V, Abera M, Wibaek R, Michaelsen KF, Kæstel P, Friis H, Andersen GS. Body composition during early infancy and its relation with body composition at 4 years of age in Jimma, an Ethiopian prospective cohort study. Nutr Diabetes 2018; 8:46. [PMID: 30190452 PMCID: PMC6127223 DOI: 10.1038/s41387-018-0056-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/26/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES Low and high birth weight and rapid weight gain during infancy are associated with childhood obesity. Associations of birth and infancy body composition (BC) growth with childhood BC remain unknown in low-income countries. We aimed to investigate the associations of fat mass (FM) and fat-free mass (FFM) at birth and its accretion during early infancy with FM and FFM at the age of 4 years. METHODS In the infant Anthropometry and Body Composition (iABC) cohort, BC was assessed at six consecutive time points from birth to 6 months and at 4 years of age by air displacement plethysmography. Multiple linear regression models were used to determine the association between FM and FFM at birth and their accretion rates during infancy and FM index (FMI) and FFM index (FFMI) at 4 years in 314 children. RESULTS One kilogram higher FFM at birth was associated with a 1.07 kg/m2 higher FFMI (95% CI 0.60, 1.55) at 4 years while a one SD increment in FFM accretion rate from 0 to 6 months was associated with a 0.24 kg/m2 increment in FFMI (95% CI 0.11, 0.36) and with a 0.20 kg/m2 higher FMI at 4 years (β = 0.20; 95% CI 0.04, 0.37). FFM at birth did not predict FMI at 4 years. FM at birth was associated with 1.17 kg/m2 higher FMI at 4 years (95% CI 0.13, 2.22) whereas FM accretion from 0 to 4 months was associated with an increase in FMI of 0.30 kg/m2 (95% CI 0.12, 0.47). FM at birth did not predict FFMI at 4 years, and neither did FM accretion from 0 to 4 months. CONCLUSIONS A higher FFM in early infancy predicted higher FFMI at 4 years while a higher FM accretion during early infancy predicted higher FMI at 4 years. Follow-up studies are merited to explore associations of childhood BC with cardio-metabolic risk later in life.
Collapse
Affiliation(s)
- Bitiya Admassu
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Victor Owino
- Technical University of Kenya, Haile Selassie Avenue, Nairobi, Kenya
| | - Mubarek Abera
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Rasmus Wibaek
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|