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Tojjar J, Norström F, Myléus A, Carlsson A. The Impact of Parental Diabetes on the Prevalence of Childhood Obesity. Child Obes 2020; 16:258-264. [PMID: 32271617 DOI: 10.1089/chi.2019.0278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Obesity among children and adolescents is a worldwide public health concern. Type 1 diabetes (T1D) and type 2 diabetes (T2D) incidence are increasing, with heredity and socioeconomic status as possible risk factors. How these factors affect the risk of childhood obesity remains unclear. The aim of this study was to investigate the association between obesity and parental diabetes among 12-year-olds in Sweden, and how it relates to parental education level. Methods: We used data collected within the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a cross-sectional multicenter national screening study for celiac disease in 12-year-old children. Relative risk (RR) and confidence interval (CI) were calculated for the association between parental diabetes and obesity, also stratifying for gender and highest parental education. Results: Among 11,050 children, for both children with parental T1D and T2D, 31% of the children were overweight or obese, compared with 21% among other children. Comparing those with parental T1D with those without parental T1D within gender, boys had a statistically significant higher risk [RR 1.6 (95% CI 1.3-2.0)], and girls had a nonsignificant increased risk [RR 1.3 (95% CI 0.95-1.8)], of being overweight. For children with parental T2D, both boys and girls had a statistically significant increased risk of 1.5. Parental education showed no sign of influencing the RRs. Conclusions: Parental diabetes is associated with an increased risk of overweight among children, independent of parental education. Concomitant parental diabetes and overweight should be particularly alarming criteria when prioritizing preventive interventions at an early age.
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Affiliation(s)
- Jasaman Tojjar
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health and Family Medicine, Umeå University, Umeå, Sweden
| | - Anna Myléus
- Department of Epidemiology and Global Health and Family Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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Hermans MP, Ahn SA, Rousseau MF. Crossing family histories of diabetes and cardiovascular disease leads to unexpected outcomes in diabetic offspring. J Diabetes 2019; 11:301-308. [PMID: 30105804 DOI: 10.1111/1753-0407.12840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 08/05/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study investigated the isolated and crossed effects of familial histories (FH) of early onset coronary heart disease (EOCHD) and type 2 diabetes mellitus (T2DM) on diabetic offspring. METHODS The cardiometabolic phenotype of 1098 T2DM patients was analyzed according to an FH of T2DM and/or EOCHD, including body composition, fasting insulinemia, insulin sensitivity, β-cell function (BCF), lipids, lipoprotein(a), high-density lipoprotein (HDL) number and functionality, and micro- and macrovascular complications. RESULTS Mean age and T2DM duration were 69 and 18 years, respectively; 64% of patients were male, 50% (n = 550) had an FH of T2DM (DM[+]), and 13% (n = 145) had an FH of EOCHD (EOCHD[+]). Four subgroups were generated by crossing FHs: DM[-]EOCHD[-] (44%; n = 487); DM[+]EOCHD[-] (42%; n = 466); DM[-]EOCHD[+] (6%; n = 61); and DM[+]EOCHD[+] (8%; n = 84). Microangiopathies were highest among DM[+] patients, whose BCF was deteriorating the fastest. More numerous/dysfunctional HDLs characterized EOCHD[+] patients. The greatest frequency of cardiovascular disease (CVD; 69%) was observed in DM[-]EOCHD[+] patients, whose lipoprotein(a) and insulinemia were also highest (81 nmol/L and 140 pmol/L, respectively). The lowest frequency of CVD (30%) was observed in DM[+]EOCHD[-] patients. CONCLUSIONS Familial histories of DM and EOCHD predispose to increased microvascular and macrovascular risk, respectively, with hyperinsulinemia, lipoprotein(a), and dysfunctional HDLs standing out as mediators of the inherited macrovascular risk. Yet, crossing these FHs did not randomly redistribute vascular risk, because patients with parental T2DM had fewer macrovascular diseases regardless of familial EOCHD. The odds of being left-handed were unexpectedly greater in patients with crossed parental histories.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology & Nutrition, St-Luc University Clinics and Institute for Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Sylvie A Ahn
- Division of Cardiology, St-Luc University Clinics and Cardiovascular Research Center, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Michel F Rousseau
- Division of Cardiology, St-Luc University Clinics and Cardiovascular Research Center, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
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Berenson GS, Srinivasan SR, Xu JH, Chen W. Adiposity and Cardiovascular Risk Factor Variables in Childhood Are Associated With Premature Death From Coronary Heart Disease in Adults: The Bogalusa Heart Study. Am J Med Sci 2016; 352:448-454. [DOI: 10.1016/j.amjms.2016.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 01/13/2023]
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Agirbasli M, Tanrikulu AM, Berenson GS. Metabolic Syndrome: Bridging the Gap from Childhood to Adulthood. Cardiovasc Ther 2016; 34:30-6. [PMID: 26588351 DOI: 10.1111/1755-5922.12165] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Childhood and adolescence are particularly vulnerable periods of life to the effects of cardiometabolic risk and later development of atherosclerosis, hypertension, and diabetes mellitus. Developing countries with limited resources suffer most heavily from the consequences of cardiometabolic risk in children and its future implications to the global health burden. A better understanding of mechanisms leading to cardiometabolic risk in early life may lead to more effective prevention and intervention strategies to reduce metabolic stress in children and later disease. Longitudinal "tracking" studies of cardiometabolic risk in children provide a tremendous global resource to direct prevention strategies for cardiovascular disease. In this review, we will summarize the pathophysiology, existing definitions for cardiometabolic risk components in children. Screening and identifying children and adolescents of high cardiometabolic risk and encouraging them and their families through healthy lifestyle changes should be implemented to as a global public health strategy.
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Affiliation(s)
- Mehmet Agirbasli
- Department of Cardiology, Medeniyet University Medical School, Istanbul, Turkey
| | - Azra M Tanrikulu
- Department of Cardiology, Maltepe State Hospital, Istanbul, Turkey
| | - Gerald S Berenson
- Bogalusa Heart Study, Tulane Center of Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, LA, USA
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Hannon TS, Arslanian SA. The changing face of diabetes in youth: lessons learned from studies of type 2 diabetes. Ann N Y Acad Sci 2015; 1353:113-37. [PMID: 26448515 DOI: 10.1111/nyas.12939] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 12/18/2022]
Abstract
The incidence of youth type 2 diabetes (T2D), linked with obesity and declining physical activity in high-risk populations, is increasing. Recent multicenter studies have led to a number of advances in our understanding of the epidemiology, pathophysiology, diagnosis, treatment, and complications of this disease. As in adult T2D, youth T2D is associated with insulin resistance, together with progressive deterioration in β cell function and relative insulin deficiency in the absence of diabetes-related immune markers. In contrast to adult T2D, the decline in β cell function in youth T2D is three- to fourfold faster, and therapeutic failure rates are significantly higher in youth than in adults. Whether the more aggressive nature of youth T2D is driven by genetic heterogeneity or physiology/metabolic maladaptation is yet unknown. Besides metformin, the lack of approved pharmacotherapeutic agents for youth T2D that target the pathophysiological mechanisms is a major barrier to optimal diabetes management. There is a significant need for effective therapeutic options, in addition to increased prevention, to halt the projected fourfold increase in youth T2D by 2050 and the consequences of heightened diabetes-related morbidity and mortality at younger ages.
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Affiliation(s)
- Tamara S Hannon
- Indiana University School of Medicine, Department of Pediatrics, Sections of Pediatric Endocrinology & Diabetology and Pediatric Comparative Effectiveness Research, Indianapolis, Indiana
| | - Silva A Arslanian
- Children's Hospital of University of Pittsburgh Medical Center, Department of Pediatrics, Divisions of Weight Management and Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Pittsburgh, Pennsylvania
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Rationale and design of a comparative effectiveness trial to prevent type 2 diabetes in mothers and children: The ENCOURAGE healthy families study. Contemp Clin Trials 2015; 40:105-11. [DOI: 10.1016/j.cct.2014.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 01/22/2023]
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Nguyen QM, Xu JH, Chen W, Srinivasan SR, Berenson GS. Correlates of age onset of type 2 diabetes among relatively young black and white adults in a community: the Bogalusa Heart Study. Diabetes Care 2012; 35:1341-6. [PMID: 22399694 PMCID: PMC3357227 DOI: 10.2337/dc11-1818] [Citation(s) in RCA: 30] [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: 09/19/2011] [Accepted: 12/19/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The risk factors for middle-age onset of type 2 diabetes are well known. However, information is scant regarding the age onset of type 2 diabetes and its correlates in community-based black and white relatively young adults. RESEARCH DESIGN AND METHODS This prospective cohort study consisted of normoglycemic (n = 2,459) and type 2 diabetic (n = 144) adults aged 18-50 years who were followed for an average of 16 years. RESULTS The incidence rate of the onset of type 2 diabetes was 1.6, 4.3, 3.9, and 3.4 per 1,000 person-years for age-groups 18-29, 30-39, and 40-50 and total sample, respectively. Incidences of diabetes increased with age by race and sex groups (P for trend ≤ 0.01); higher in black females versus white females and blacks versus whites in total sample (P < 0.05). In a multivariable Cox model, baseline parental diabetes (hazard ratio [HR] 5.24) and plasma insulin were significantly associated with diabetes incidence at the youngest age (18-29 years); black race, BMI, and glucose at age 30-39 years; female sex, parental diabetes (HR 2.44), BMI, ratio of triglycerides and HDL cholesterol (TG/HDL-C ratio), and glucose at age 40-50 years; and black race, parental diabetes (HR 2.44), BMI, TG/HDL-C ratio, and glucose in whole cohort. Further, patients with diabetes, regardless of age onset, displayed a significantly higher prevalence of maternal history of diabetes at baseline (P < 0.01). CONCLUSIONS In relatively young adults, predictability of baseline cardiometabolic risk factors along with race, sex, and parental history of diabetes for the onset of type 2 diabetes varied by age-group. These findings have implications for early prevention and intervention in relatively young adults.
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Affiliation(s)
- Quoc Manh Nguyen
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Ji-Hua Xu
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Wei Chen
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Sathanur R. Srinivasan
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Gerald S. Berenson
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana
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Hermans MP, Ahn SA, Rousseau MF. The multi-faceted outcomes of conjunct diabetes and cardiovascular familial history in type 2 diabetes. J Diabetes Complications 2012; 26:187-94. [PMID: 22521319 DOI: 10.1016/j.jdiacomp.2012.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 02/21/2012] [Accepted: 03/13/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Familial history of early-onset CHD (EOCHD) is a major risk factor for CHD. Familial diabetes history (FDH) impacts β-cell function. Some transmissible, accretional gradient of CHD risk may exist when diabetes and EOCHD familial histories combine. We investigated whether the impact of such combination is neutral, additive, or potentiating in T2DM descendants, as regards cardiometabolic phenotype, glucose homeostasis and micro-/macroangiopathies. METHODS Cross-sectional retrospective cohort study of 796 T2DM divided according to presence (Diab[+]) or absence (Diab[-]) of 1st-degree diabetes familial history and/or EOCHD (CVD(+) and (-)). Four subgroups: (i) [Diab(-)CVD(-)] (n=355); (ii) [Diab(+)CVD(-)] (n=338); (iii) [Diab(-)CVD(+)] (n=47); and (iv) [Diab(+)CVD(+)] (n=56). RESULTS No interaction on subgroup distribution between presence of both familial histories, the combination of which translated into additive detrimental outcomes and higher rates of fat mass, sarcopenia, (hs)CRP and retinopathy. FDH(+) had lower insulinemia, insulin secretion, hyperbolic product, and accelerated hyperbolic product loss. An EOCHD family history affected neither insulin secretion nor sensitivity. There were significant differences regarding macroangiopathy/CAD, more prevalent in [Diab(-)CVD(+)] and [Diab(+)CVD(+)]. Among CVD(+), the highest macroangiopathy prevalence was observed in [Diab(-)CVD(+)], who had 66% macroangiopathy, and 57% CAD, rates higher (absolute-relative) by 23%-53% (overall) and 21%-58% (CAD) than [Diab(+)CVD(+)], who inherited the direst cardiometabolic familial history (p 0.0288 and 0.0310). CONCLUSIONS A parental history for diabetes markedly affects residual insulin secretion and secretory loss rate in T2DM offspring without worsening insulin resistance. It paradoxically translated into lower macroangiopathy with concurrent familial EOCHD. Conjunct diabetes and CV familial histories generate multi-faceted vascular outcomes in offspring, including lesser macroangiopathy/CAD.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium.
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Yoo EG, Park SS, Oh SW, Nam GB, Park MJ. Strong parent-offspring association of metabolic syndrome in Korean families. Diabetes Care 2012; 35:293-5. [PMID: 22210569 PMCID: PMC3263909 DOI: 10.2337/dc11-1283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the associations of metabolic syndrome (MetS) and its components between adolescents and their parents in Korea. RESEARCH DESIGN AND METHODS We analyzed data for 4,657 subjects (1,404 fathers, 1,404 mothers, 957 sons, and 892 daughters) from the Korean National Health and Nutrition Examination Surveys conducted between 1998 and 2008. RESULTS Compared with adolescents whose parents did not have MetS, the odds ratio (95% CI) for MetS in adolescents with MetS in one parent was 4.2 (2.1-8.5) and 8.7 (3.4-22.3) in those with MetS in both parents. Among obese adolescents, the prevalence of MetS was 18.2% without parental MetS, whereas 29.2% of obese adolescents with MetS in one parent and 53.9% with MetS in both parents also had MetS (P = 0.01 for trend). CONCLUSIONS The risk of MetS increased significantly in adolescents with parental MetS and was especially high in those with coexisting obesity and parental MetS.
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Affiliation(s)
- Eun-Gyong Yoo
- Department of Pediatrics, College of Medicine, CHA University, Sungnam, Korea
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10
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van Vliet M, van der Heyden JC, Diamant M, von Rosenstiel IA, Schindhelm RK, Heymans MW, Brandjes DPM, Beijnen JH, Aanstoot HJ, Veeze HJ. Overweight children with type 1 diabetes have a more favourable lipid profile than overweight non-diabetic children. Eur J Pediatr 2012; 171:493-8. [PMID: 21968905 PMCID: PMC3284654 DOI: 10.1007/s00431-011-1574-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 09/06/2011] [Indexed: 11/28/2022]
Abstract
In the present article, we aimed to compare the cardiometabolic risk between overweight children with and without type 1 diabetes (T1DM). Therefore, data with regard to cardiometabolic risk parameters of 44 overweight Caucasian children (3-18 years) with T1DM were matched with 44 overweight peers without T1DM for sex, ethnicity, age and standard deviation score of BMI (Z-BMI). Detailed history was taken, information regarding anthropometrics and family history were collected and blood pressure was measured. Blood samples were collected for evaluation of lipid profiles (fasting in controls, non-fasting in T1DM children), alanine aminotransferase and HbA1c (in children with T1DM). It was found that overweight children with T1DM had lower median standard deviation score of waist circumference (Z-WC) as compared to the overweight control group [median, 2.0 (interquartile range, IQR, 1.5-2.3) vs. 2.6 (IQR, 2.0-2.9), P < 0.001]. After adjustment for Z-WC, in children with T1DM, median high-density lipoprotein cholesterol levels were significantly higher and median low-density lipoprotein cholesterol lower in T1DM children, as compared to their peers without T1DM [1.40 (IQR, 1.2-1.5) vs. 1.2 (IQR, 1.0-1.3) and 2.7 (IQR, 2.5-3.2) vs. 3.0 (IQR, 2.5-3.4), respectively, all P < 0.01]. When dividing children according to glycaemic status, children with suboptimal glycaemic control had higher values of triglycerides as compared to well-controlled children [1.3 (IQR, 1.0-1.8) vs. 0.96 (IQR, 0.80-1.2), P = 0.036]. In conclusion, overweight children with T1DM have a more favourable lipid profile, as compared to non-diabetic overweight controls, in spite of a higher frequency of a positive family history of CVD, T2DM and hypertension. Still, paediatricians should give extra attention to cardiometabolic risk factors within this vulnerable group, taking into account the already high cardiometabolic risk.
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Affiliation(s)
- Mariska van Vliet
- Department of Pediatrics, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
| | | | - Michaela Diamant
- Diabetes Center/Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Inès A. von Rosenstiel
- Department of Pediatrics, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - Roger K. Schindhelm
- Department of Clinical Chemistry, Isala Clinics, Dr C.A. van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Martijn W. Heymans
- Department of Methodology and Applied Biostatistics, Institute of Health Sciences, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Desiderius P. M. Brandjes
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | - Jos H. Beijnen
- Pharmacy & Pharmacology, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
| | | | - Henk J. Veeze
- Diabeter, Haringvliet 72, 3011 TG Rotterdam, The Netherlands
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Abstract
Epidemiologic studies have established that cardiovascular (CV) risk factors including obesity are identifiable in childhood. Childhood risk factors are predictive of adult cardiac risk and even premature death [Franks et al. (2010) N Engl J Med 362:485-493]. In the United States, CV diseases remains the leading causes of death. In fact, heart disease has become the major cause of death worldwide, surpassing undernutrition and infectious diseases, largely related to obesity in childhood [Wang and Lobstein (2006) Int J Pediatr Obes 1:11-25]. The concept that adult heart diseases begin in childhood is an outgrowth of extensive long-term epidemiologic studies in youth, that is, the Bogalusa Heart Study [Berenson et al. (1986) Causation of cardiovascular risk factors in children: Perspectives on cardiovascular risk in early life, Raven Press Books Ltd].
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Affiliation(s)
- Gerald S Berenson
- The Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
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12
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Abstract
Many epidemiological studies showed associations of low birth weight with cardiovascular disease, type 2 diabetes and obesity. The associations seem to be consistent and stronger among subjects with a postnatal catch up growth. It has been suggested that developmental changes in response to adverse fetal exposures might lead to changes in the fetal anatomy and physiology. These adaptations may be beneficial for short term, but may lead to common diseases in adulthood. Maternal smoking during pregnancy is one of the most important adverse fetal exposures in Western countries, and is known to be associated with a 150-200 g lower birth weight. An accumulating body of evidence suggests that maternal smoking during pregnancy might be involved in pathways leading to both low birth weight and common diseases, including cardiovascular disease, type 2 diabetes and obesity, in adulthood. In this review, we discuss epidemiological studies focused on the associations of maternal smoking with fetal growth and development and cardiovascular and metabolic disease in later life. We also discuss potential biological mechanisms, and challenges for future epidemiological studies.
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Bakker H, Jaddoe VWV. Cardiovascular and metabolic influences of fetal smoke exposure. Eur J Epidemiol 2011; 26:763-70. [PMID: 21994150 PMCID: PMC3218270 DOI: 10.1007/s10654-011-9621-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 09/30/2011] [Indexed: 01/09/2023]
Abstract
Many epidemiological studies showed associations of low birth weight with cardiovascular disease, type 2 diabetes and obesity. The associations seem to be consistent and stronger among subjects with a postnatal catch up growth. It has been suggested that developmental changes in response to adverse fetal exposures might lead to changes in the fetal anatomy and physiology. These adaptations may be beneficial for short term, but may lead to common diseases in adulthood. Maternal smoking during pregnancy is one of the most important adverse fetal exposures in Western countries, and is known to be associated with a 150–200 g lower birth weight. An accumulating body of evidence suggests that maternal smoking during pregnancy might be involved in pathways leading to both low birth weight and common diseases, including cardiovascular disease, type 2 diabetes and obesity, in adulthood. In this review, we discuss epidemiological studies focused on the associations of maternal smoking with fetal growth and development and cardiovascular and metabolic disease in later life. We also discuss potential biological mechanisms, and challenges for future epidemiological studies.
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Affiliation(s)
- Hanneke Bakker
- The Generation R Study Group (Room Ae-012), Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Hofman A, van Duijn CM, Franco OH, Ikram MA, Janssen HLA, Klaver CCW, Kuipers EJ, Nijsten TEC, Stricker BHC, Tiemeier H, Uitterlinden AG, Vernooij MW, Witteman JCM. The Rotterdam Study: 2012 objectives and design update. Eur J Epidemiol 2011; 26:657-86. [PMID: 21877163 PMCID: PMC3168750 DOI: 10.1007/s10654-011-9610-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 08/08/2011] [Indexed: 01/09/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Berenson GS, Agirbasli M, Nguyen QM, Chen W, Srinivasan SR. Glycemic status, metabolic syndrome, and cardiovascular risk in children. Med Clin North Am 2011; 95:409-17, ix. [PMID: 21281842 DOI: 10.1016/j.mcna.2010.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The metabolic syndrome and adult manifestation of prediabetes and diabetes are major public health problems that begin in childhood. Prevention must be considered as a serious public health issue. Health education and health promotion of school children needs incorporation as a community effort.
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Affiliation(s)
- Gerald S Berenson
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, 1440 Canal Street, Suite 1829, New Orleans, LA 70112, USA.
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Durmuş B, Ay L, Hokken-Koelega ACS, Raat H, Hofman A, Steegers EAP, Jaddoe VWV. Maternal smoking during pregnancy and subcutaneous fat mass in early childhood. The Generation R Study. Eur J Epidemiol 2011; 26:295-304. [PMID: 21229294 PMCID: PMC3088815 DOI: 10.1007/s10654-010-9544-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 12/27/2010] [Indexed: 01/09/2023]
Abstract
Maternal smoking during pregnancy increases the risk of obesity in the offspring. Not much is known about the associations with other measures of body composition. We assessed the associations of maternal smoking during pregnancy with the development of subcutaneous fat mass measured as peripheral and central skinfold thickness measurements in early childhood, in a population-based prospective cohort study from early fetal life onward in the city of Rotterdam, The Netherlands. The study was performed in 907 mothers and their children at the ages of 1.5, 6 and 24 months. As compared to non-smoking mothers, mothers who continued smoking during pregnancy were more likely to have a younger age and a lower educational level. Their children had a lower birth weight, higher risk of small size for gestational age and were breastfed for a shorter duration (P-values <0.01). We did not observe differences in peripheral, central and total subcutaneous fat mass between the offspring of non-smoking mothers, mothers who smoked in first trimester only and mothers who continued smoking during pregnancy (P > 0.05). Also, the reported number of cigarettes smoked by mothers in both first and third trimester of pregnancy were not associated with peripheral, central and total subcutaneous fat mass in the offspring at the ages of 1.5, 6 and 24 months. Our findings suggest that fetal exposure to cigarette smoke during pregnancy does not influence subcutaneous fat mass in early childhood. Follow-up studies are needed in children at older ages and to identify associations of maternal smoking during pregnancy with other measures of body composition.
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Affiliation(s)
- Büşra Durmuş
- The Generation R Study Group (AE-006), Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lamise Ay
- The Generation R Study Group (AE-006), Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anita C. S. Hokken-Koelega
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric A. P. Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group (AE-006), Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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The Shanghai Changfeng Study: a community-based prospective cohort study of chronic diseases among middle-aged and elderly: objectives and design. Eur J Epidemiol 2010; 25:885-93. [PMID: 21120588 DOI: 10.1007/s10654-010-9525-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 11/18/2010] [Indexed: 12/14/2022]
Abstract
The Shanghai Changfeng Study is a community-based prospective cohort study of chronic diseases ongoing since February 2009 in Shanghai, China. The study focuses on multiple chronic diseases, including obesity and metabolic syndrome, diabetes, osteoporosis, liver diseases, cardiovascular diseases and neurologic diseases. 15,000 subjects of 40 years or over are planned to be recruited. The rationale, objectives and design of this study are described in this paper.
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Jaddoe VWV, van Duijn CM, van der Heijden AJ, Mackenbach JP, Moll HA, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2010. Eur J Epidemiol 2010; 25:823-41. [PMID: 20967563 PMCID: PMC2991548 DOI: 10.1007/s10654-010-9516-7] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 09/27/2010] [Indexed: 01/09/2023]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. General follow-up rates until the age of 4 years exceed 75%. Data collection in mothers, fathers and preschool children included questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome wide association screen is available in the participating children. Regular detailed hands on assessment are performed from the age of 5 years onwards. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Vincent W V Jaddoe
- The Generation R Study Group (AE006), Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, Berenson GS. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 2010; 10:73. [PMID: 20937123 PMCID: PMC2964659 DOI: 10.1186/1471-2431-10-73] [Citation(s) in RCA: 213] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 10/11/2010] [Indexed: 12/28/2022] Open
Abstract
Background Body Mass Index (BMI) is widely used to assess the impact of obesity on cardiometabolic risk in children but it does not always relate to central obesity and varies with growth and maturation. Waist-to-Height Ratio (WHtR) is a relatively constant anthropometric index of abdominal obesity across different age, sex or racial groups. However, information is scant on the utility of WHtR in assessing the status of abdominal obesity and related cardiometabolic risk profile among normal weight and overweight/obese children, categorized according to the accepted BMI threshold values. Methods Cross-sectional cardiometabolic risk factor variables on 3091 black and white children (56% white, 50% male), 4-18 years of age were used. Based on the age-, race- and sex-specific percentiles of BMI, the children were classified as normal weight (5th - 85th percentiles) and overweight/obese (≥ 85th percentile). The risk profiles of each group based on the WHtR (<0.5, no central obesity versus ≥ 0.5, central obesity) were compared. Results 9.2% of the children in the normal weight group were centrally obese (WHtR ≥0.5) and 19.8% among the overweight/obese were not (WHtR < 0.5). On multivariate analysis the normal weight centrally obese children were 1.66, 2.01, 1.47 and 2.05 times more likely to have significant adverse levels of LDL cholesterol, HDL cholesterol, triglycerides and insulin, respectively. In addition to having a higher prevalence of parental history of type 2 diabetes mellitus, the normal weight central obesity group showed a significantly higher prevalence of metabolic syndrome (p < 0.0001). In the overweight/obese group, those without central obesity were 0.53 and 0.27 times less likely to have significant adverse levels of HDL cholesterol and HOMA-IR, respectively (p < 0.05), as compared to those with central obesity. These overweight/obese children without central obesity also showed significantly lower prevalence of parental history of hypertension (p = 0.002), type 2 diabetes mellitus (p = 0.03) and metabolic syndrome (p < 0.0001). Conclusion WHtR not only detects central obesity and related adverse cardiometabolic risk among normal weight children, but also identifies those without such conditions among the overweight/obese children, which has implications for pediatric primary care practice.
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Affiliation(s)
- Jasmeet S Mokha
- Center for Cardiovascular Health, Department of Epidemiology, Tulane University health Sciences Center, New Orleans, LA, USA
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Brambilla P, Pietrobelli A. Behind and beyond the pediatric metabolic syndrome. Ital J Pediatr 2009; 35:41. [PMID: 20028522 PMCID: PMC2803483 DOI: 10.1186/1824-7288-35-41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 12/22/2009] [Indexed: 12/21/2022] Open
Abstract
The growing use of the Metabolic Syndrome in pediatric age need a critical approach, on the basis of recent concerns on definition and usefulness for individual management in clinical practice. We reviewed these aspects from a pediatric point of view, providing a set of questions about what the Metabolic Syndrome means in a clinical setting. The new proposed pediatric definition by IDF was discussed, by outlying how it does not fully consider the peculiarities of children and adolescents. The comparison between two cases of obese children was used in order to show how this diagnosis could be confusing for a correct management. We stressed the need for health-related limits for each component of the Metabolic Syndrome instead of percentile-derived cut-points, as well as the opportunity to extend the estimation to other family or individual risk factors by means of a multiple-items screening form. In conclusion, Metabolic Syndrome use in pediatric age suffers at present from important limitations (i.e., adult derived definition, possibility to rule-in but not to rule-out the individual metabolic risk, instability of MetS during adolescence, poor usefulness of the diagnosis for specific treatment). Consequently, a prudent use of Metabolic Syndrome for children and adolescents seems to be the best and honest position for paediatricians, waiting for long term, longitudinal follow-up studies that could clarify the entire question.
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