1
|
Jakobsen ME, Stentebjerg LL, Tanvig MH, Jørgensen JS, Ovesen PG, Christesen HT, Jensen DM, Vinter CA. Body mass index z-scores in the first 2 years of life were associated with adverse metabolic and anthropometric outcomes at 3 years of age. Acta Paediatr 2024; 113:1068-1075. [PMID: 38259098 DOI: 10.1111/apa.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
AIM We investigated associations between body mass index (BMI) z-scores for children aged 0-2 years and the BMI z-scores, body fat percentage and metabolic risk factors at 3 years of age. METHODS This was a secondary analysis of the Lifestyle in Pregnancy and Offspring randomised controlled trial, carried out at two university hospitals in Denmark. It comprised 149 mothers with BMI ≥30 kg/m2 who did or did not receive a lifestyle intervention during pregnancy and a reference group of 97 mothers with normal-weight, with follow-up of their 3-year-old offspring. The children in these three groups were pooled for the data analyses, due to similar characteristics between groups. The BMI z-scores were calculated at 5 weeks, 5 months and 1, 2 and 3 years, using Danish reference groups. Their anthropometrics and metabolic outcomes were examined at 3 years of age. RESULTS BMI z-scores at 5 months to 2 years were associated with BMI z-scores and body fat percentage at 3 years of age and BMI z-scores were not associated with metabolic risk factors at 3 years. CONCLUSION BMI z-scores from 5 weeks of age were associated with adverse anthropometric outcomes but not with metabolic risk factors at 3 years of age.
Collapse
Affiliation(s)
- Mikala E Jakobsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- The National Research Center for the Working Environment, Copenhagen, Denmark
| | - Louise L Stentebjerg
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette H Tanvig
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jan S Jørgensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Per G Ovesen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Christesen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Christina A Vinter
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| |
Collapse
|
2
|
Guo T, Zheng S, Chen T, Chu C, Ren J, Sun Y, Wang Y, He M, Yan Y, Jia H, Liao Y, Cao Y, Du M, Wang D, Yuan Z, Wang D, Mu J. The association of long-term trajectories of BMI, its variability, and metabolic syndrome: a 30-year prospective cohort study. EClinicalMedicine 2024; 69:102486. [PMID: 38370536 PMCID: PMC10874716 DOI: 10.1016/j.eclinm.2024.102486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Background Limited data exists on how early-life weight changes relate to metabolic syndrome (MetS) risk in midlife. This study examines the association between long-term trajectories of body mass index (BMI), its variability, and MetS risk in Chinese individuals. Methods In the Hanzhong Adolescent Hypertension study (March 10, 1987-June 3, 2017), 1824 participants with at least five BMI measurements from 1987 to 2017 were included. Using group-based trajectory modeling, different BMI trajectories were identified. BMI variability was assessed through standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Logistic regression analyzed the relationship between BMI trajectory, BMI variability, and MetS occurrence in midlife (URL: https://www.clinicaltrials.gov; Unique identifier: NCT02734472). Findings BMI trajectories were categorized as low-increasing (34.4%), moderate-increasing (51.8%), and high-increasing (13.8%). Compared to the low-increasing group, the odds ratios (ORs) [95% CIs] for MetS were significantly higher in moderate (4.27 [2.63-6.91]) and high-increasing groups (13.11 [6.30-27.31]) in fully adjusted models. Additionally, higher BMI variabilities were associated with increased MetS odds (ORs for SDBMI, VIMBMI, and ARVBMI: 2.30 [2.02-2.62], 1.22 [1.19-1.26], and 4.29 [3.38-5.45]). Furthermore, BMI trajectories from childhood to adolescence were predictive of midlife MetS, with ORs in moderate (1.49 [1.00-2.23]) and high-increasing groups (2.45 [1.22-4.91]). Lastly, elevated BMI variability in this period was also linked to higher MetS odds (ORs for SDBMI, VIMBMI, and ARVBMI: 1.24 [1.08-1.42], 1.00 [1.00-1.01], and 1.21 [1.05-1.38]). Interpretation Our study suggests that both early-life BMI trajectories and BMI variability could be predictive of incident MetS in midlife. Funding This work was supported by the National Natural Science Foundation of China No. 82070437 (J.-J.M.), the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University of China (No. XJTU1AF-CRF-2022-002, XJTU1AF2021CRF-021, and XJTU1AF-CRF-2023-004), the Key R&D Projects in Shaanxi Province (Grant No. 2023-ZDLSF-50), the Chinese Academy of Medical Sciences & Peking Union Medical College (2017-CXGC03-2), and the International Joint Research Centre for Cardiovascular Precision Medicine of Shaanxi Province (2020GHJD-14).
Collapse
Affiliation(s)
- Tongshuai Guo
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Sirui Zheng
- Biostatistics Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Tao Chen
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jie Ren
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yue Sun
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mingjun He
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hao Jia
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yueyuan Liao
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yumeng Cao
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mingfei Du
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dan Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zuyi Yuan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Duolao Wang
- Biostatistics Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jianjun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| |
Collapse
|
3
|
Rocha AS, Ribeiro-Silva RDC, Silva JFM, Pinto EJ, Silva NJ, Paixao ES, Fiaccone RL, Kac G, Rodrigues LC, Anderson C, Barreto ML. Postnatal growth in small vulnerable newborns: a longitudinal study of 2 million Brazilians using routine register-based linked data. Am J Clin Nutr 2024; 119:444-455. [PMID: 38128734 PMCID: PMC10884605 DOI: 10.1016/j.ajcnut.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/21/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Preterm, low-birth weight (LBW) and small-for-gestational age (SGA) newborns have a higher frequency of adverse health outcomes, including linear and ponderal growth impairment. OBJECTIVE To describe the growth trajectories and to estimate catch-up growth during the first 5 y of life of small newborns according to 3 vulnerability phenotypes (preterm, LBW, SGA). METHODS Longitudinal study using linked data from the 100 Million Brazilian Cohort baseline, the Brazilian National Live Birth System (SINASC), and the Food and Nutrition Surveillance System (SISVAN) from 2011 to 2017. We estimated the length/height-for-age (L/HAZ) and weight-for-age z-score (WAZ) trajectories from children of 6-59 mo using the linear mixed model for each vulnerable newborn phenotype. Growth velocity for both L/HAZ and WAZ was calculated considering the change (Δ) in the mean z-score between 2 time points. Catch-up growth was defined as a change in z-score > 0.67 at any time during follow-up. RESULTS We analyzed 2,021,998 live born children and 8,726,599 observations. The prevalence of at least one of the vulnerable phenotypes was 16.7% and 0.6% were simultaneously preterm, LBW, and SGA. For those born at term, all phenotypes had a period of growth recovery from 12 mo. For preterm infants, the onset of L/HAZ growth recovery started later at 24 mo and the growth trajectories appear to be lower than those born at term, a condition aggravated among children with the 3 phenotypes. Preterm and female infants seem to experience slower growth recovery than those born at term and males. The catch-up growth occurs at 24-59 mo for males preterm: preterm + AGA + NBW (Δ = 0.80), preterm + AGA + LBW (Δ = 0.88), and preterm + SGA + LBW (Δ = 1.08); and among females: term + SGA + NBW (Δ = 0.69), term + AGA + LBW (Δ = 0.72), term + SGA + LBW (Δ = 0.77), preterm + AGA + LBW (Δ = 0.68), and preterm + SGA + LBW (Δ = 0.83). CONCLUSIONS Children born preterm seem to reach L/HAZ and WAZ growth trajectories lower than those attained by children born at term, a condition aggravated among the most vulnerable.
Collapse
Affiliation(s)
- Aline S Rocha
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil; Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Juliana F M Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabete J Pinto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
| | - Natanael J Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; ISGlobal, Hospital Clínic. Universitat de Barcelona, Barcelona, Spain
| | - Enny S Paixao
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Rosemeire L Fiaccone
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura C Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Craig Anderson
- School of Mathematics and Statistics, University of Glasgow, Scotland, United Kingdom
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| |
Collapse
|
4
|
Zhao S, Tang J, Zhao Y, Xu C, Xu Y, Yu S, Zhang Y. The impact of body composition and fat distribution on blood pressure in young and middle-aged adults. Front Nutr 2022; 9:979042. [PMID: 36118739 PMCID: PMC9478411 DOI: 10.3389/fnut.2022.979042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background The relative contributions of each component of body composition to blood pressure (BP) remain unclear. Objective We aimed to comprehensively investigate the impact of body composition and fat distribution on BP and quantify their relative contributions to BP in a large cohort with young and middle-aged adults. Methods 14,412 participants with available data on whole-body DXA measurement from the National Health and Nutrition Examination Survey were included. Multiple stepwise linear regressions of BP on components of body composition and fat distribution were built. Then, relative importance analysis was performed to quantify the contributions of each component to BP. Results The median age of participants was 36 years and there were 50.7% women. Linear regression with mutual adjustment showed that total fat mass, total muscle mass, and trunk fat mass significantly and positively associated with BP; however, arm and leg fat mass significantly and negatively associated with BP. In men, after further adjusted for potential covariates, SBP were significantly determined by trunk fat mass (β = 0.33, P < 0.001), leg fat mass (β = − 0.12, P < 0.001), and total muscle mass (β = 0.10, P < 0.001); and DBP were significantly determined by trunk fat mass (β = 0.52, P < 0.001), leg fat mass (β = −0.15, P < 0.001), arm fat mass (β = −0.23, P < 0.001), and total muscle mass (β = 0.06, P < 0.001). Similar results were observed in women. Relative importance analysis showed that trunk fat mass was the major contributor (38–61%) to both SBP and DBP; meanwhile, total muscle mass also made relatively great contribution (35–43%) to SBP. Conclusion Both fat mass and muscle mass independently associated with and substantially contributed to SBP in both men and women. After full adjustment, trunk fat mass positively associated with both SBP and DBP, and was the most dominant contributor to BP; however, leg fat mass negatively associated with both SBP and DBP.
Collapse
|
5
|
Frithioff-Bøjsøe C, Lund MAV, Lausten-Thomsen U, Fonvig CE, Lankjær IOJ, Hansen T, Hansen T, Baker JL, Holm JC. Early detection of childhood overweight and related complications in a Danish population-based cohort aged 2-8 years. Obes Res Clin Pract 2022; 16:228-234. [PMID: 35514021 DOI: 10.1016/j.orcp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Overweight in early childhood often tracks into adolescence and adulthood and early childhood is a critical period for developing sustained overweight. This study aims to investigate the early detection of childhood overweight (including obesity) and related cardiometabolic complications in a Danish population-based cohort of children aged 2.5-8 years in collaboration with primary care municipal dental clinics and public health nurses. METHODS In this prospective population-based cohort study, 335 pre-school children (age 2.5 and 5 years) were recruited from municipal dental clinics, and 657 school children (age 6-8 years) by public health nurses. A subgroup of 392 children (40%) participated in additional hospital-based examinations including blood pressure measurement and a blood sample. Children were re-examined approximately one year later. RESULTS The prevalence of overweight was 13.73% in pre-school children and 13.69% in school children at baseline. In the pre-school children, differences in cardiometabolic risk markers between children with and without overweight were minor, whereas in school children with overweight, cardiometabolic derangements were manifest including significantly higher levels of fasting glucose, insulin, homoeostasis model of assessment for insulin resistance, triglycerides, and alanine aminotransferase and lower levels of high-density lipoprotein cholesterol. During follow-up the prevalence of overweight did not change in pre-school children but increased to 17.0% in school children. CONCLUSIONS Existing contacts with the primary health care sector, including dental care, can successfully be used for detection of overweight. This study suggests that early detection should be initiated at pre-school ages since overweight-related complications are already established by school ages.
Collapse
Affiliation(s)
- Christine Frithioff-Bøjsøe
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.
| | - Morten Asp Vonsild Lund
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Lausten-Thomsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Cilius Esmann Fonvig
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics, Kolding Hospital a Part of Lillebælt Hospital, Kolding, Denmark
| | - Ida Olivia Juhl Lankjær
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Tina Hansen
- Department of Dental Care, Holbæk Municipality, Holbæk, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jennifer Lyn Baker
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, accredited European Centre for Obesity Management, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark; The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Lee HJ, Lim YH, Hong YC, Shin CH, Lee YA. Body Mass Index Changes and Insulin Resistance at Age 4: A Prospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:872591. [PMID: 35677718 PMCID: PMC9169890 DOI: 10.3389/fendo.2022.872591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study is to investigate whether body mass index (BMI) changes are associated with fasting glucose and insulin resistance (IR) in early childhood. METHODS From the Environment and Development of Children (EDC) cohort, 334 children who visited at ages 2 and 4 were included in this study. Height and weight were measured at ages 2 and 4, and fasting glucose and insulin were assessed at age 4. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated as insulin (μIU/ml) × glucose (mg/dl)/405. The BMI Z-score [BMI (Z)] quartiles for each age group were defined as Q4, ≥75th percentile; Q2-3, 25th to 75th percentile; and Q1, <25th percentile. Glucose, insulin, and the HOMA-IR were compared between groups according to the change in BMI (Z) from age 2 to 4. RESULTS Children who stayed in Q4 at both ages had higher fasting glucose (92.2 vs. 88.0 and 87.1 mg/dl), insulin (3.2 vs. 2.5 and 2.3 μIU/ml), and HOMA-IR (0.68 vs. 0.54 and 0.52) than children who stayed in Q1 or Q2-3 (all P<0.01). Children in Q4 at both ages had higher fasting glucose than children whose BMI (Z) increased from Q1 or Q2-3 to Q4 (92.2 vs. 87.3, P<0.001). The BMI (Z) category at age 2 of children who were in Q2-3 at age 4 did not affect glucose or IR at 4 years. CONCLUSION The group of children within the highest BMI (Z) quartile at both 2 and 4 years of age had higher fasting glucose and IR at age 4 than any other BMI (Z) change group.
Collapse
Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Yun-Chul Hong
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, South Korea
- Environmental Health Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, South Korea
- *Correspondence: Young Ah Lee,
| |
Collapse
|
7
|
Investigating Relationships between Preschool Children's Perceived Competence, Motor Skills, and Physical Activity: A Cross-Lagged Panel Model. J Clin Med 2021; 10:jcm10235620. [PMID: 34884322 PMCID: PMC8658723 DOI: 10.3390/jcm10235620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Motor skill competence (MSC) and perceived competence (PC) are primary correlates that are linked with physical activity (PA) participation, yet there is limited evidence of the mutual longitudinal or temporal associations between these variables in preschoolers. Therefore, this study’s purpose was to examine the bidirectional relationships between MSC and PA, MSC and PC, and PC and PA in preschoolers over time. Methods: The final sample were 61 preschoolers (Mage = 4.45 years, ranging from 4 to 5) from two underserved schools. MSC was assessed using the Test of Gross Motor Development, Second Edition (TGMD-2). PC was assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children. PA was assessed using ActiGraph GT9X Link accelerometers during three consecutive school days. All assessments of MSC, PC, and PA were measured in identical conditions at schools at the baseline (T1) and the end of the eighth week (T2). We employed a cross-lagged model approach to understand the bidirectional relationships between MSC, PC, and PA. Results: The results showed that T1 MSC significantly predicted T2 MSC (p < 0.01) and T1 MSC significantly predicted T2 PA only in girls (p = 0.03). Additionally, a cross-lagged effect of T1 MSC and T2 PC was only observed in boys (p = 0.03). Lastly, a significant association for T1 moderate-to-vigorous physical activity (MVPA) and T2 PC was only observed in girls (p = 0.04). Conclusions: Bidirectional relationships between the variables were not observed in preschoolers. However, significant gender differences were observed in each cross-lagged model.
Collapse
|
8
|
Ji Y, Zhao X, Feng Y, Qu Y, Liu Y, Wu S, Wu Y, Xue F, Liu Y. Body mass index trajectory from childhood to puberty and high blood pressure: the China Health and Nutrition Survey. BMJ Open 2021; 11:e055099. [PMID: 34824123 PMCID: PMC8627396 DOI: 10.1136/bmjopen-2021-055099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The prevalence of childhood hypertension is rising in parallel with the increasing prevalence of overweight and obesity in children. How growth trajectories from childhood to puberty relate to high blood pressure (HBP) is not well defined. We aimed to characterise potential body mass index (BMI) dynamic changing trajectories from childhood to puberty and investigate their association with HBP. DESIGN A dynamic prospective cohort. SETTING China Health and Nutrition Survey 1991-2015. PARTICIPANTS There were 1907 participants (1027 men and 880 women) in this study. OUTCOMES The primary outcome was HBP defined as systolic blood pressure (SBP)/diastolic blood pressure (DBP) exceeding the standards or diagnosis by medical records or taking antihypertensive medication. RESULTS A model of cubic parameters with three groups was chosen, labelled as normal increasing group (85.16%, n=1624), high increasing group (9.81%, n=187) and resolving group (5.03%, n=96). Compared with the normal increasing group, the unadjusted HRs (95% CIs) for the resolving and high increasing groups were 0.91 (0.45 to 1.86) and 1.88 (1.26 to 2.81), respectively. After adjusting for baseline age, region, sex, baseline BMI z-score, baseline SBP and baseline DBP in model 3, the HRs (95% CIs) for the resolving and high increasing groups were 0.66 (0.30 to 1.45) and 1.56 (1.02 to 2.38). CONCLUSIONS These results indicate that the BMI trajectories from childhood to puberty have significant impact on HBP risk. Puberty is a crucial period for the development of HBP.
Collapse
Affiliation(s)
- Yiman Ji
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Xiangjuan Zhao
- Department of gynaecology, Maternal and Child Health Care of Shandong Province, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yiping Feng
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yanlin Qu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Ying Liu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Sijia Wu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yutong Wu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| |
Collapse
|
9
|
Correa-Burrows P, Rogan J, Blanco E, East P, Lozoff B, Gahagan S, Burrows R. Resolving early obesity leads to a cardiometabolic profile within normal ranges at 23 years old in a two-decade prospective follow-up study. Sci Rep 2021; 11:18927. [PMID: 34556688 PMCID: PMC8460734 DOI: 10.1038/s41598-021-97683-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
Obesity is the most important predisposing factor for cardiovascular disease and type-2 diabetes. We explored the relationship between the age at onset of obesity and selected cardiometabolic parameters in young adults. Longitudinal study of n = 1,039 participants (48% males) in their early twenties. BMI was measured at birth, 1–5–10–12–14–16–23 years. BMI trajectories were interpolated. Five groups were identified: never obese (never-OB); early childhood obesity transitioning to non-obesity before adolescence (former-OB); obesity starting in preadolescence transitioning to non-obesity as adolescents (transient-OB); obesity from adolescence into early adulthood (recent-onset-OB); participants who were obese in early childhood and remained obese into adulthood (persistent-OB). Waist circumference (WC), blood pressure, lipids, glucose, and insulin were measured at 23 years. HOMA-IR and the Metabolic Syndrome Risk Z-Score were estimated. In the sample, 47% were obese during at least one time-point. Mean obesity duration was 20.7 years, 8.5 years, 6.2 years, and 3.3 years in persistent-OBs, recent-onset-OBs, former-OBs, and transient-OBs, respectively. The cardiometabolic profile was more adverse in recent-onset-OBs (12%) and persistent-OBs (15%) compared to never-OB participants (53%). Although former-OBs (15%) and transient-OBs (4%) had higher WC values than never-OBs, no differences were seen in other biomarkers. Both persistent and recent-onset obesity led to a cardiometabolic profile of risk in early adulthood, as suggested by values of WC, HOMA-IR, and hs-CRP above normal limits and HDL-chol values below normal limits. Participants who had obesity in early childhood or preadolescence but transitioned to a non-obesity status had a cardiometabolic profile similar to participants who were never obese and within normal limits. Obesity leads to risky values in a number of cardiometabolic biomarkers in young adulthood independent of age at obesity onset. Likewise, overcoming obesity during the pediatric age leads to a cardiometabolic profile within normal ranges at 23 years of age.
Collapse
Affiliation(s)
- Paulina Correa-Burrows
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Avda. El Líbano 5524, Macul, CP: 7830490, Santiago, Chile
| | - José Rogan
- Departamento de Física, Facultad de Ciencias, Universidad de Chile, Santiago, Chile.,Centro Para la Nanociencia y la Nanotecnología, CEDENNA, Santiago, Chile
| | - Estela Blanco
- Division of Child Development and Community Health, University of California San Diego, La Jolla, CA, USA
| | - Patricia East
- Division of Child Development and Community Health, University of California San Diego, La Jolla, CA, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Gahagan
- Division of Child Development and Community Health, University of California San Diego, La Jolla, CA, USA
| | - Raquel Burrows
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Avda. El Líbano 5524, Macul, CP: 7830490, Santiago, Chile.
| |
Collapse
|
10
|
Massara P, Keown-Stoneman CD, Erdman L, Ohuma EO, Bourdon C, Maguire JL, Comelli EM, Birken C, Bandsma RH. Identifying longitudinal-growth patterns from infancy to childhood: a study comparing multiple clustering techniques. Int J Epidemiol 2021; 50:1000-1010. [PMID: 33693803 DOI: 10.1093/ije/dyab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most studies on children evaluate longitudinal growth as an important health indicator. Different methods have been used to detect growth patterns across childhood, but with no comparison between them to evaluate result consistency. We explored the variation in growth patterns as detected by different clustering and latent class modelling techniques. Moreover, we investigated how the characteristics/features (e.g. slope, tempo, velocity) of longitudinal growth influence pattern detection. METHODS We studied 1134 children from The Applied Research Group for Kids cohort with longitudinal-growth measurements [height, weight, body mass index (BMI)] available from birth until 12 years of age. Growth patterns were identified by latent class mixed models (LCMM) and time-series clustering (TSC) using various algorithms and distance measures. Time-invariant features were extracted from all growth measures. A random forest classifier was used to predict the identified growth patterns for each growth measure using the extracted features. RESULTS Overall, 72 TSC configurations were tested. For BMI, we identified three growth patterns by both TSC and LCMM. The clustering agreement was 58% between LCMM and TS clusters, whereas it varied between 30.8% and 93.3% within the TSC configurations. The extracted features (n = 67) predicted the identified patterns for each growth measure with accuracy of 82%-89%. Specific feature categories were identified as the most important predictors for patterns of all tested growth measures. CONCLUSION Growth-pattern detection is affected by the method employed. This can impact on comparisons across different populations or associations between growth patterns and health outcomes. Growth features can be reliably used as predictors of growth patterns.
Collapse
Affiliation(s)
- Paraskevi Massara
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Charles Dg Keown-Stoneman
- Applied Health Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauren Erdman
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada.,Department of Computer Science, School of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Eric O Ohuma
- Center for Global Child Health & Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.,Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Joannah and Brian Lawson Center for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Catherine Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Hj Bandsma
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
11
|
Bleil ME, Spieker SJ, Booth-LaForce C. Targeting Parenting Quality to Reduce Early Life Adversity Impacts on Lifespan Cardiometabolic Risk. Front Psychol 2021; 12:678946. [PMID: 34149571 PMCID: PMC8211431 DOI: 10.3389/fpsyg.2021.678946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Mounting evidence that early life adversity (ELA) exposures confer risk for cardiometabolic disease over the lifespan motivated this narrative review to examine parenting quality as a potential intervention target to reduce ELA exposures or mitigate their impact as a way of reducing or preventing cardiometabolic disease. We describe findings from the limited number of family-based intervention studies in ELA-exposed children that have tested parenting impacts on cardiometabolic health outcomes. We then describe the implications of this work and make recommendations for future research that will move this field forward.
Collapse
Affiliation(s)
- Maria E Bleil
- Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
| | - Susan J Spieker
- Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
| | - Cathryn Booth-LaForce
- Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States
| |
Collapse
|
12
|
Sauder KA, Perng W, Palumbo MP, Bloemsma LD, Carey J, Glueck DH, Dabelea D. Fat Mass Accretion from Birth to 5 Years and Metabolic Homeostasis in Childhood: the Healthy Start Study. J Clin Endocrinol Metab 2021; 106:1684-1691. [PMID: 33616653 PMCID: PMC8118576 DOI: 10.1210/clinem/dgab115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT It is unclear how fat mass accretion in early life is related to glucose-insulin homeostasis. OBJECTIVE Examine associations of fat and fat-free mass accretion from birth to early childhood with glucose-insulin homeostasis in early childhood in a multi-ethnic cohort. METHODS Observational Healthy Start study with data collection from 2010 to 2020. Air displacement plethysmography at birth and 4.8 (SD 0.7) years estimated fat mass percent (FMP, %), fat mass index (FMI, kg/m2), and fat-free mass index (FFMI, kg/m2). General population recruited from academic obstetrics clinics in Denver, Colorado, consisting of 419 mother/offspring dyads. The main outcome measures were fasting glucose, insulin, homeostasis model assessment-2 insulin resistance (HOMA2-IR), and beta-cell function (HOMA2-B) at 4.8 years. RESULTS Greater fat mass accretion from birth to early childhood was associated with higher fasting glucose (ΔFMP β = 0.20 [95% CI 0.06-0.34], ΔFMI β = 0.90 [0.30-1.50]) in participants of Hispanic, Black, and Other races/ethnicities, while greater fat-free mass accretion was associated with higher fasting glucose in non-Hispanic White participants (ΔFFMI β = 0.76 [0.21-1.32]). Overall, greater fat, but not fat-free, mass accretion was also associated with higher insulin (ΔFMP β = 0.14 [0.09-0.18], ΔFMI 0.71 [0.51-0.92]), HOMA2-IR (FMP β = 0.02 [0.01-0.02], ΔFMI β = 0.09 [0.06-0.12]), and HOMA2-B (ΔFMP β = 0.92 [0.18-1.36], ΔFMI β = 4.76 [2.79-6.73]). CONCLUSION Greater fat mass accretion in infancy and childhood is associated with shifts in fasting glucose in children of Hispanic, Black, and Other races/ethnicities at 5 years of age. Body composition beginning in early life is relevant for metabolic health, and precise assessments of adiposity in pediatric research are needed.
Collapse
Affiliation(s)
- Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Correspondence: Katherine Sauder, LEAD Center, University of Colorado Anschutz Medical Campus, 12474 E 19th Avenue – F426, Aurora CO, 80045, USA.
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Michaela P Palumbo
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Lizan D Bloemsma
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - John Carey
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah H Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
13
|
Associations between Prenatal Exposure to Phthalates and Timing of Menarche and Growth and Adiposity into Adulthood: A Twenty-Years Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094725. [PMID: 33946657 PMCID: PMC8125681 DOI: 10.3390/ijerph18094725] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Abstract
Phthalates are ubiquitous environmental chemicals with endocrine disrupting properties and potentially obesogenic effects. We hypothesised that antenatal phthalate exposure may influence growth and adiposity patterns in girls through childhood into adolescence. Among 1342 Raine Study singleton females, 462 had maternal serum and at least one outcome available up to 20 years of age. Individuals’ maternal serum collected at 18 and 34 weeks gestation was pooled and analyzed for concentrations of 32 metabolites of 15 phthalate diesters. Cox regression and linear models were used to determine associations between maternal phthalate levels and age at menarche, change in height and weight z-scores between birth and two years, height from birth to 20 years, BMI from two to 20 years, deviation from mid-parental height at age 20 and DEXA scan measures at age 20. Weak negative associations were detected with some phthalate metabolites and change in height and weight z-score during infancy. Weak positive associations between some of the high molecular weight phthalate metabolites and height z-score were detected during childhood. While still within the normal range, age at menarche was slightly delayed in girls with higher prenatal exposure to the higher molecular weight phthalate metabolites. We derived some associations between prenatal phthalate exposure with early growth patterns and age at menarche.
Collapse
|
14
|
Berman YE, Doherty DA, Main KM, Frederiksen H, Keelan JA, Newnham JP, Hart RJ. The influence of prenatal exposure to phthalates on subsequent male growth and body composition in adolescence. ENVIRONMENTAL RESEARCH 2021; 195:110313. [PMID: 33069699 DOI: 10.1016/j.envres.2020.110313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 05/13/2023]
Abstract
Phthalates are ubiquitous environmental chemicals with predominantly anti-androgenic, and potentially obesogenic effects. We hypothesised that antenatal phthalate exposure may influence subsequent boy's growth and body composition through childhood and adolescence. Among 1399 singleton males from the Raine Study, 410 had maternal serum and at least one height, BMI or DEXA outcome available after birth and up to 20 years of age. Maternal serum collected at 18 and 34 weeks' gestation was pooled, and analyzed for concentrations of 32 metabolites of 15 phthalate diesters. Their serum concentrations were categorized into undetectable/detectable levels or tertiles. Linear mixed models were used to determine associations between maternal serum phthalate levels and longitudinal height and body mass index (BMI) z-scores in boys from birth to 20 years of age (n = 250 and n = 295 respectively). Linear regression was used to determine associations between maternal phthalate levels and deviation from mid-parental height (n = 177) and DEXA scan outcomes (n = 191) at the 20 year follow-up. Weak positive associations of participants height z-score increase were detected with exposure to some phthalate metabolites in particular to the lower molecular weight phthalate metabolites. Less consistent findings, by mixed model analyses, were detected for BMI and body composition, by dual energy X-ray absorptiometry (DEXA), with some positive associations of phthalate metabolites with BMI and some negative associations with DEXA fat tissue measures, although no consistent findings were evident. In conclusion, we derived some associations of childhood growth with prenatal phthalate exposure, particularly with respect to the lower molecular weight phthalate metabolites.
Collapse
Affiliation(s)
- Ye'elah E Berman
- Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Australia
| | - Dorota A Doherty
- Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Australia; Division of Obstetrics and Gynaecology, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia, 6008
| | - Katharina M Main
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction and International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Jeffrey A Keelan
- Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Australia; Division of Obstetrics and Gynaecology, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia, 6008
| | - John P Newnham
- Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Australia; Division of Obstetrics and Gynaecology, University of Western Australia, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia, 6008
| | - Roger J Hart
- Women and Infants Research Foundation, Carson House, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, Australia.
| |
Collapse
|
15
|
Li X, Keown-Stoneman CDG, Lebovic G, Maguire JL, Omand JA, Sievenpiper JL, Birken CS. Body Mass Index Mediates the Association between Growth Trajectories and Cardiometabolic Risk in Children. Child Obes 2021; 17:36-42. [PMID: 33252262 DOI: 10.1089/chi.2020.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Few studies have published mediation analyses to quantify the role concurrent BMI plays in the relationship between growth and cardiometabolic risk (CMR) outcomes. Methods: We used data from a longitudinal cohort study conducted in children aged 0-60 months through The Applied Research Group for Kids (TARGet Kids!) in Canada. Four age and sex standardized BMI (zBMI) trajectories were identified using latent class mixed models. CMR were assessed using a CMR score. Concurrent zBMI was the zBMI measured on the same visit as CMR. Mediation analyses were performed comparing each trajectory with the reference trajectory. Results: One thousand one hundred sixty-five children were included. On average, compared with being in the stable low trajectory, being in the catch-up trajectory was associated with an increased CMR score of 0.42, 0.28 of which was mediated through concurrent zBMI [95% confidence interval (CI) 0.17 to 0.41, p = 0.001]; being in the stable high trajectory was associated with an increased CMR score of 0.23, 0.24 through concurrent zBMI (95% CI 0.18 to 0.31, p < 0.001). Similarly, being in the rapid accelerating trajectory was associated with an increased CMR score of 1.43, 1.18 of which was through concurrent zBMI (95% CI 0.89 to 1.50, p < 0.001). Conclusions: There was a strong evidence that the effect of BMI trajectories on CMR was indirect via concurrent BMI. It is important for researchers to choose the most appropriate analytic method based on the study hypothesis to understand the total or direct effect of growth patterns on cardiometabolic disease risk in children.
Collapse
Affiliation(s)
- Xuedi Li
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jessica A Omand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
16
|
Li X, Keown-Stoneman CDG, Lebovic G, Omand JA, Adeli K, Hamilton JK, Hanley AJ, Mamdani M, McCrindle BW, Sievenpiper JL, Tremblay MS, Maguire JL, Parkin PC, Birken CS. The association between body mass index trajectories and cardiometabolic risk in young children. Pediatr Obes 2020; 15:e12633. [PMID: 32181602 DOI: 10.1111/ijpo.12633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Rapid growth is associated with increased cardiometabolic risk (CMR) in adolescence and adulthood. Little is known about whether the association between rapid growth and increased CMR originates in early childhood. OBJECTIVES To identify age and sex standardized body mass index (zBMI) trajectories and to examine the association between zBMI trajectories and CMR outcomes in children 0 to 60 months. STUDY DESIGN A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) in Toronto, Canada. Participants had repeated measures of weight and length or height performed from birth to 60 months of age. Latent class mixed modelling was used to identify the zBMI trajectories. Linear regressions were performed to determine the association between zBMI trajectories and the primary outcome, a CMR score, quantified as the sum of age- and sex- standardized waist circumference, systolic blood pressure, glucose, log-triglycerides and negative high-density lipoprotein cholesterol (HDL-C), divided by √5. Secondary outcomes were the individual components of the CMR formula as well as diastolic blood pressure and non-HDL-C. RESULTS Four BMI trajectories were identified among the 1166 children. After adjusting for all covariates, children in the rapidly accelerating trajectory had increased total CMR score (β = 1.38, 95% CI 0.77; 1.99, P < .001) and increased waist circumference score (β = 2.39, 95% CI 1.92; 2.86, P < .001) compared to the stable low group. CONCLUSIONS Rapid growth during early childhood is associated with increased CMR in preschool children, largely driven by larger waist circumference.
Collapse
Affiliation(s)
- Xuedi Li
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jessica A Omand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Khosrow Adeli
- Clinical Biochemistry, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Biochemistry and Laboratory Medicine & Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jill K Hamilton
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anthony J Hanley
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Preventative Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark S Tremblay
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
17
|
East P, Delker E, Blanco E, Lozoff B, Correa P, Burrows R, Gahagan S. BMI Trajectories from Birth to 23 Years by Cardiometabolic Risks in Young Adulthood. Obesity (Silver Spring) 2020; 28:813-821. [PMID: 32108435 PMCID: PMC7093235 DOI: 10.1002/oby.22754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether the level, rate, and acceleration of BMI growth differ according to the presence or absence of adult cardiometabolic (CM) risks. METHODS BMI was measured in 1,000 Chileans at nine time points from birth to 23 years, and metabolic syndrome and its components were assessed at young adulthood. BMI growth was analyzed in the following three developmental periods: birth to 6 months, 6 months to 5 years, and 5 to 23 years. RESULTS Individuals with CM risks had a specific constellation of early-life growth (faster growth after infancy, lower BMI decline approaching age 5, absence of a definitive BMI nadir in early childhood, higher 5-year BMI) and distinct young adult growth (larger BMI increases from childhood to young adulthood and lower levels of expected growth deceleration approaching young adulthood). Those with CM risks also attained BMI ≥ 25 at significantly younger ages than those absent risks (metabolic syndrome: 12.3 years vs. 20.1 years; hyperglycemia: 13.1 years vs. 18.9 years; hypertension: 13.2 years vs. 19.4 years; hypertriglyceridemia: 14.3 years vs. 19.5 years; inflammation: 15.9 years vs. 20.6 years). CONCLUSIONS Larger and faster increases in BMI and a failure of BMI growth to decline or decelerate at specific developmental periods distinguished individuals who would and would not have adult CM risks.
Collapse
Affiliation(s)
- Patricia East
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Erin Delker
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Estela Blanco
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Paulina Correa
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, CA, USA
| |
Collapse
|
18
|
Lv J, Fan B, Wei M, Zhou G, Dayimu A, Wu Z, Su C, Zhang T. Trajectories of early to mid-life adulthood BMI and incident diabetes: the China Health and Nutrition Survey. BMJ Open Diabetes Res Care 2020; 8:8/1/e000972. [PMID: 32327441 PMCID: PMC7202728 DOI: 10.1136/bmjdrc-2019-000972] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION This longitudinal study aims to characterize distinct body mass index (BMI) trajectories during early to mid-life adulthood and to explore the association between BMI change from young adulthood to midlife and incident diabetes. RESEARCH DESIGN AND METHODS This study included 7289 adults who had repeatedly measured BMI 3-9 times during 1989-2011 and information on incident diabetes. Latent class growth mixed model (LCGMM) was used to identify different BMI trajectories. Cox proportional hazard models were used to investigate the association between the trajectory group membership and incident hyperglycemia, adjusting for covariates. The hyperglycemia group included individuals with prediabetes or diabetes. The model-estimated BMI levels and slopes were calculated at each age point in 1-year intervals according to the model parameters and their first derivatives, respectively. Logistic regression analyses were used to examine the association of model-estimated levels and slopes of BMI at each age point with incident hyperglycemia. The area under the curve (AUC) was computed from longitudinal growth curve models during the follow-up for each individual. Prior to the logistic regression analyses, quartiles of total, baseline, and incremental AUC values were calculated. RESULTS Three distinct trajectories were characterized by LCGMM, comprising of low-increasing group (n=5136), medium-increasing group (n=1914), and high-increasing group (n=239). Compared with the low-increasing group, adjusted HRs and 95% CIs were 1.21 (0.99 to 1.48) and 1.56 (1.06 to 2.30) for the medium-increasing and the high-increasing group, respectively. The adjusted standardized ORs of model-estimated BMI levels increased among 20-50 years, ranging from 0.98 (0.87 to 1.10) to 1.19 (1.08 to 1.32). The standardized ORs of level-adjusted linear slopes increased gradually from 1.30 (1.16 to 1.45) to 1.42 (1.21 to 1.67) during 20-29 years, then decreased from 1.41 (1.20 to 1.66) to 1.20 (1.08 to 1.33) during 30-43 years, and finally increased to 1.20 (1.04 to 1.38) until 50 years. The fourth quartile of incremental AUC (OR=1.31, 95% CI 1.03 to 1.66) was significant compared with the first quartile, after adjustment for covariates. CONCLUSIONS These findings indicate that the BMI trajectories during early adulthood were significantly associated with later-life diabetes. Young adulthood is a crucial period for the development of diabetes, which has implications for early prevention.
Collapse
Affiliation(s)
- Jiali Lv
- Biostatistics, Shandong University, Jinan, China
| | - Bingbing Fan
- Biostatistics, Shandong University, Jinan, China
| | - Mengke Wei
- Biostatistics, Shandong University, Jinan, China
| | | | - Alim Dayimu
- Biostatistics, Shandong University, Jinan, China
| | - Zhenyu Wu
- Biostatistics, Fudan University, Shanghai, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Zhang
- Biostatistics, Shandong University, Jinan, China
| |
Collapse
|
19
|
Cadenas-Sanchez C, Intemann T, Labayen I, Artero EG, Alvarez-Bueno C, Sanchis-Moysi J, Benito PJ, Beltran-Valls MR, Pérez-Bey A, Sanchez-Delgado G, Palou P, Vicente-Rodríguez G, Moreno LA, Ortega FB. Prevalence of severe/morbid obesity and other weight status and anthropometric reference standards in Spanish preschool children: The PREFIT project. Pediatr Res 2020; 87:501-510. [PMID: 30776792 DOI: 10.1038/s41390-019-0325-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/02/2019] [Accepted: 01/21/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children. METHODS A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined. RESULTS Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life). CONCLUSION Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.
Collapse
Affiliation(s)
- Cristina Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
| | - Timm Intemann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Idoia Labayen
- Institute for Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, Pamplona, Spain
| | - Enrique G Artero
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almeria, Almeria, Spain
| | - Celia Alvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Joaquin Sanchis-Moysi
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Island, Spain
| | - Pedro J Benito
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Alejandro Pérez-Bey
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Puerto Real, Spain
| | - Guillermo Sanchez-Delgado
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Pere Palou
- Department of Pedagogy and Specific Didactics, University of the Balearic Islands, Balearic Islands, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón -IA2- (CITA-Universidad de Zaragoza), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Faculty of Health and Sport Science (FCSD, Ronda Misericordia 5, 22001-Huesca, Spain), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Luis A Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Instituto Agroalimentario de Aragón -IA2- (CITA-Universidad de Zaragoza), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain and Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden
| | | |
Collapse
|
20
|
Long-term vs. recent-onset obesity: their contribution to cardiometabolic risk in adolescence. Pediatr Res 2019; 86:776-782. [PMID: 31426054 PMCID: PMC6891158 DOI: 10.1038/s41390-019-0543-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/20/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The contribution of long-term vs. recent-onset obesity to cardiometabolic risk in adolescence remains controversial. Here, we aimed to investigate the association of time of onset and length of obesity with the cardiometabolic profile of adolescence. METHODS Prospective study in 678 16-year-olds. BMI was measured at birth-1-5-10-16 years and BMI trajectories were interpolated using cubic splines. BMI > 2 SD at <6 years was defined as early obesity. Waist circumference (WC), blood pressure, lipid and glucose profiles were measured at 16 years. A cardiometabolic risk score was computed (MetS_score). According to the BMI trajectory, four groups were defined: participants who were never obese (NOB), participants with obesity during adolescence (recent-onset obese (ROB)), participants who were obese in early childhood but transitioned to normal/overweight as preadolescents (formerly obese (FOB)), and participants who were obese in early childhood and remained obese (persistently obese (POB)). RESULTS ROBs and POBs had significantly unhealthier cardiometabolic profile than NOBs. No differences were observed in the cardiometabolic profile of ROBs compared to POBs. Although FOBs had higher WC and MetS_score than NOBs, no differences were found in other biomarkers. FOBs were in healthier cardiometabolic condition than ROBs and POBs. CONCLUSIONS Both long-term and recent-onset obesity increase the cardiometabolic risk in adolescents.
Collapse
|
21
|
Steenbock B, Buck C, Zeeb H, Rach S, Pischke CR. Impact of the intervention program "JolinchenKids - fit and healthy in daycare" on energy balance related-behaviors: results of a cluster controlled trial. BMC Pediatr 2019; 19:432. [PMID: 31722702 PMCID: PMC6852984 DOI: 10.1186/s12887-019-1817-8] [Citation(s) in RCA: 5] [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: 03/28/2019] [Accepted: 10/31/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the multi-component health promotion program, JolinchenKids - fit and healthy in daycare, designed to promote physical activity (PA), healthy eating, and mental wellbeing among 3- to 6-year-old preschoolers. METHODS For this cluster controlled trial, 62 daycare facilities (DFs) from thirteen different federal states in Germany were recruited (31 intervention, 31 control DFs). Outcome measures were children's habitual PA, fruits and vegetable consumption, consumption of unsweetened beverages and snacks with parents as raters. Study nurses assessed children's body composition and motor skills. Data was collected at baseline and 12 months later. To track adherence to the implementation of intervention modules at individual DF groups, an implementation calendar was used from baseline to follow-up. Linear mixed models were used to investigate effects for survey, group and their interaction at the individual level while accounting for clustering. RESULTS Samples of 831 (baseline) and 641 (follow-up) children aged 4.3 ± 0.8 and 5.2 ± 0.8 years were analysed. More than half of the intervention DFs chose the nutrition or PA module for the first year of implementation while an implementation level of > 50% was only achieved in less than a third. A significant intervention effect (survey × group interaction) was found for the standing long jump favouring children at intervention DFs (β = 3.08; 95% Confidence interval [CI]: (0.09; 6.07)). No significant intervention effects were found for time spent on PA, total screen time, dietary habits, and body composition, i.e. body-mass-index and percentage of body fat. CONCLUSIONS Participation in JolinchenKids - fit and healthy in daycare led to improvements in some indicators for motor skills. However, other health outcomes and behaviours were not affected by program participation over the course of 1 year. TRIAL REGISTRATION German Clinical Trials Register DRKS00011065 (Date of registration 16-09-2016).
Collapse
Affiliation(s)
- Berit Steenbock
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany. .,Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany.
| | - Christoph Buck
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Stefan Rach
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - Claudia R Pischke
- Centre for Health and Society, Medical Faculty, Institute of Medical Sociology, Heinrich Heine University Duesseldorf, Moorenstrasse 5, 40225, Duesseldorf, Germany
| |
Collapse
|
22
|
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
|
23
|
Wibaek R, Girma T, Admassu B, Abera M, Abdissa A, Geto Z, Kæstel P, Vistisen D, Jørgensen ME, Wells JCK, Michaelsen KF, Friis H, Andersen GS. Higher Weight and Weight Gain after 4 Years of Age Rather than Weight at Birth Are Associated with Adiposity, Markers of Glucose Metabolism, and Blood Pressure in 5-Year-Old Ethiopian Children. J Nutr 2019; 149:1785-1796. [PMID: 31218356 DOI: 10.1093/jn/nxz121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fetal and early life growth is associated with adult risk of obesity and cardiometabolic disease. However, little is known about the relative importance of birth weight and successive periods of weight gain on markers of cardiometabolic risk in childhood in low-income populations. OBJECTIVES The objective was to study associations of birth weight and weight gain velocities in selected age intervals from birth to 60 mo with height, fat-free mass (FFM), and markers of adiposity and cardiometabolic risk at 60 mo. METHODS In a prospective cohort study of 375 Ethiopian children aged 60 mo, we estimated individual weight gain velocities in the periods between birth and 3, 6, 24, 48, and 60 mo using linear-spline mixed-effects modeling. Subsequently, we analyzed associations of birth weight, weight gain velocities, and current weight with height, FFM, and markers of adiposity and cardiometabolic risk. RESULTS Weight gain from 48 to 60 mo and weight at 60 mo rather than birth weight were the strongest correlates of insulin, C-peptide, HOMA-IR, blood pressure, height, FFM, waist circumference, and fat mass at 60 mo. For instance, 1 SD higher (1 SD = 50 g/mo) weight accretion from 48 to 60 mo was associated with a higher insulin of 23.3% (95% CI: 9.6%, 38.8%), C-peptide of 11.4% (2.7%, 20.8%), systolic blood pressure of 1.4 mm Hg (0.6, 2.3 mm Hg), fat mass of 0.72 kg (0.59, 0.85 kg), and FFM of 0.70 kg (0.56, 0.85 kg). Weight gain from 0 to 3 mo was positively associated with LDL cholesterol, systolic blood pressure, height, and the body composition indices, and weight gain from 24 to 48 mo was inversely associated with blood glucose. CONCLUSIONS In 60-mo-old Ethiopian urban children, weight gain and weight after 48 mo rather than weight at birth may represent a sensitive period for variations in markers of adiposity and glucose metabolism. The birth cohort is registered at https://www.isrctn.com/ as ISRCTN46718296.
Collapse
Affiliation(s)
- Rasmus Wibaek
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.,Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia.,JUCAN Research Center, Jimma University, Jimma, Ethiopia
| | - Bitiya Admassu
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.,JUCAN Research Center, 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.,JUCAN Research Center, Jimma University, Jimma, Ethiopia.,Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- JUCAN Research Center, Jimma University, Jimma, Ethiopia.,Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Zeleke Geto
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Pernille Kæstel
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, 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, Copenhagen, Denmark
| |
Collapse
|
24
|
Robinson HA, Dam R, Hassan L, Jenkins D, Buchan I, Sperrin M. Post-2000 growth trajectories in children aged 4-11 years: A review and quantitative analysis. Prev Med Rep 2019; 14:100834. [PMID: 30976485 PMCID: PMC6439270 DOI: 10.1016/j.pmedr.2019.100834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 02/08/2023] Open
Abstract
Children's body mass index (BMI) growth trajectories are associated with adult health outcomes, and vary by geography and epoch. Understanding these trajectories could help to identify high risk children and thus support improved health outcomes. In this review, we compare and quantitatively analyse BMI level and trajectory data published since 2010. We characterise recent growth in children aged 4-11 years, an age range most frequently targeted for BMI intervention, yet less studied than young childhood or infancy. Through searches in OVID, we identified 54 relevant texts which describe either post-2000 summary BMI values by age and gender in cohorts with sample sizes of over 1000 children, or the results of latent class analyses of BMI trajectories within the 4-11 year age range. Population level median growth curves were projected and visualised as weighted means. These BMI curves, based on data from 729,692 children, can be visually clustered into 'high' and 'low' charting groups with extreme outlying values. Within populations, latent class analyses converge on 3-4 individual child trajectories, two of which predispose adult overweight. These growth pathways diverge early in childhood, yet are not effectively distinguished via isolated BMI measurements taken between 4 and 11 years, meaning some high risk children may currently be poorly identified.
Collapse
|
25
|
Eny KM, Maguire JL, Dai DWH, Lebovic G, Adeli K, Hamilton JK, Hanley AJ, Mamdani M, McCrindle BW, Tremblay MS, Parkin PC, Birken CS. Association of accelerated body mass index gain with repeated measures of blood pressure in early childhood. Int J Obes (Lond) 2019; 43:1354-1362. [PMID: 30940913 PMCID: PMC6760600 DOI: 10.1038/s41366-019-0345-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 01/05/2023]
Abstract
Background/objectives We examined the association for rates of age- and sex-standardized body mass index (zBMI) gain between 0–3, 3–18, and 18–36 months with BP in children at 36–72 months of age. Methods We collected repeated measures of zBMI and BP in 2502 children. zBMI was calculated using the World Health Organization standards. Each child’s zBMI at birth and rates of zBMI gain in each period from birth to 36 months were estimated using linear spline multilevel models. Generalized estimating equations were used to determine whether zBMI at birth and zBMI gain between 0–3, 3–18, and 18–36 months were each associated with repeated measures of BP at 36–72 months of age. We sequentially conditioned on zBMI at birth and zBMI gain in each period prior to each period tested, as covariates, and adjusted for important socio-demographic, familial, and study design covariates. We examined whether these associations were modified by birthweight or maternal obesity, by including interaction terms. Results After adjusting for all covariates and conditioning on prior zBMI gains, a 1 standard deviation unit faster rate of zBMI gain during 0–3 months, (β = 0.59 mmHg; 95% CI 0.31, 0.86) and 3–18 months (β = 0.74 mmHg; 95% CI 0.46, 1.03) were each associated with higher systolic BP at 36–72 months. No significant associations were observed, however, for zBMI at birth or zBMI gain in the 18–36 month growth period. zBMI gains from 0–3 and 3–18 months were also associated with diastolic BP. Birthweight significantly modified the relationship during the 3–18 month period (p = 0.02), with the low birthweight group exhibiting the strongest association for faster rate of zBMI gain with higher systolic BP (β = 1.31 mmHg; 95% CI 0.14, 2.48). Conclusions Given that long-term exposure to small elevations in BP are associated with subclinical cardiovascular disease, promoting interventions targeting healthy growth in infancy may be important.
Collapse
Affiliation(s)
- Karen M Eny
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Jonathon L Maguire
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - David W H Dai
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Khosrow Adeli
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jill K Hamilton
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada
| | - Anthony J Hanley
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Canada
| | - Brian W McCrindle
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Preventative Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Mark S Tremblay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Patricia C Parkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.
| | | |
Collapse
|
26
|
Dam R, Robinson HA, Vince-Cain S, Heaton G, Greenstein A, Sperrin M, Hassan L. Engaging parents using web-based feedback on child growth to reduce childhood obesity: a mixed methods study. BMC Public Health 2019; 19:300. [PMID: 30866878 PMCID: PMC6415344 DOI: 10.1186/s12889-019-6618-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 03/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To measure trends in child growth and combat rising levels of obesity, Manchester University NHS Foundation Trust and the University of Manchester have developed Children's Health and Monitoring Programme (CHAMP). CHAMP collects an annual measurement for primary school children (aged 4 to 11) in Manchester, England, and offers feedback of Body Mass Index (BMI) results to parents via a secure website. No similar digital tool exists that both provides high resolution data on the trajectory of child growth and acts as a feedback and monitoring system. This study investigates how effectively this intervention engaged with parents and supported the reduction of childhood obesity. METHODS Anonymised CHAMP registration and BMI data (UK1990) were collected between September 2013 and March 2017 from a total of 63,337 children. BMI change over time was compared in matched cohorts of 24,551 children, whose parents had and had not registered with the CHAMP website. Qualitative focus groups and interviews were used to explore perspectives among 29 key informants (parents, school and healthcare professionals) from six schools in Manchester. RESULTS Overweight children whose parents had not registered with the CHAMP website gained a median of 0.14 BMI centile between measurements, whilst children of CHAMP-registered parents reduced their BMI by a median of 0.4 centile per year (P = 0.02). Normal weight children of registered parents decreased their BMI by 0.3 centile each year, whilst those not registered increased their BMI by 0.8 centile per year (P = 0.001). There was no significant association between registration and BMI centile change in children already classified as obese (P = 0.34). A qualitative, thematic analysis revealed that the annual measurement programme was widely supported by parents and staff. A range of psychological and behavioural impacts on families were reported as a result of the monitoring and feedback processes, in some cases prompting reflection and monitoring of health and lifestyle choices. CONCLUSION These early findings indicate that CHAMP, as both a monitoring system and a digital intervention, could encourage positive lifestyle change and support healthier child growth trajectories.
Collapse
Affiliation(s)
- Rinita Dam
- Radcliffe Department of Medicine, Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU UK
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Heather Anne Robinson
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Gill Heaton
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Adam Greenstein
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lamiece Hassan
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
27
|
Grandemange M, Costet N, Doyen M, Monfort C, Michineau L, Saade MB, Multigner L, Cordier S, Pladys P, Rouget F. Blood Pressure, Heart Rate Variability, and Adiposity in Caribbean Pre-pubertal Children. Front Pediatr 2019; 7:269. [PMID: 31355164 PMCID: PMC6635797 DOI: 10.3389/fped.2019.00269] [Citation(s) in RCA: 5] [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: 03/29/2019] [Accepted: 06/14/2019] [Indexed: 11/30/2022] Open
Abstract
Childhood obesity prevalence has increased over the last 30 years. The Heart Rate Variability (HRV) studies performed in adults suggest a possible relation between abnormal autonomic regulation and hypertension in the situation of overweight or obesity. Objective: The aims of this study were to explore the early relationships between adiposity and blood pressure and HRV in pre-pubertal children. Methods: Data were collected during the medical examination of the follow-up at 7 years of the TIMOUN mother-child cohort in Guadeloupe. Body Mass Index z-score (zBMI), sum of tricipital and subscapular skinfold thickness, percentage of fat mass, and Waist-to-Height Ratio were measured. A global corpulence score was computed using a Principal Component Analysis (PCA). Systolic Blood Pressure (SBP) and HRV parameters (cardiac holter monitoring) were collected under 2 conditions (calm and tachycardial period). Relations between HRV, SBP, each adiposity indicator and the corpulence score were studied with restricted cubic splines models, and linear regression models. The age at adiposity rebound (AR) was estimated from the individual growth curves. Results: 575 children were included in the SBP study (mean age: 7.7 years, from 85 to 99 months). SBP was linearly correlated with the corpulence score and the zBMI. An increase of 1 in the zBMI was associated with an increase of 2.3 (±0.28) mmHg in SBP. The effect-size of zBMI on SBP was higher in children with early age at AR. Compared to children with normal BMI, children with a zBMI <™2SD had their RMSSD, SDNN, LF and HF indicators in tachycardial conditions significantly reduced by -30, -21, -37, and -48%, respectively. In boys with a zBMI >2SD, we observed a global increase in all HRV parameters (under tachycardial conditions), particularly the LF [β = 0.43 (±0.18)]. Conclusion: In pre-pubertal period a positive correlation between adiposity excess and SBP was observed with significant changes of HRV in boys, arguing for an early abnormal autonomic regulation and for early preventive intervention in the infancy period, particularly in case of overweight or obesity. Thinness was associated with a reduction in almost all the HRV parameters studied, when compared to normal corpulence, suggesting a decrease in autonomic influence.
Collapse
Affiliation(s)
| | - Nathalie Costet
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | | | - Christine Monfort
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Léah Michineau
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | | | - Luc Multigner
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Sylvaine Cordier
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Patrick Pladys
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Florence Rouget
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| |
Collapse
|
28
|
Geserick M, Vogel M, Gausche R, Lipek T, Spielau U, Keller E, Pfäffle R, Kiess W, Körner A. Acceleration of BMI in Early Childhood and Risk of Sustained Obesity. N Engl J Med 2018; 379:1303-1312. [PMID: 30281992 DOI: 10.1056/nejmoa1803527] [Citation(s) in RCA: 449] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The dynamics of body-mass index (BMI) in children from birth to adolescence are unclear, and whether susceptibility for the development of sustained obesity occurs at a specific age in children is important to determine. METHODS To assess the age at onset of obesity, we performed prospective and retrospective analyses of the course of BMI over time in a population-based sample of 51,505 children for whom sequential anthropometric data were available during childhood (0 to 14 years of age) and adolescence (15 to 18 years of age). In addition, we assessed the dynamics of annual BMI increments, defined as the change in BMI standard-deviation score per year, during childhood in 34,196 children. RESULTS In retrospective analyses, we found that most of the adolescents with normal weight had always had a normal weight throughout childhood. Approximately half (53%) of the obese adolescents had been overweight or obese from 5 years of age onward, and the BMI standard-deviation score further increased with age. In prospective analyses, we found that almost 90% of the children who were obese at 3 years of age were overweight or obese in adolescence. Among the adolescents who were obese, the greatest acceleration in annual BMI increments had occurred between 2 and 6 years of age, with a further rise in BMI percentile thereafter. High acceleration in annual BMI increments during the preschool years (but not during the school years) was associated with a risk of overweight or obesity in adolescence that was 1.4 times as high as the risk among children who had had stable BMI. The rate of overweight or obesity in adolescence was higher among children who had been large for gestational age at birth (43.7%) than among those who had been at an appropriate weight for gestational age (28.4%) or small for gestational age (27.2%), which corresponded to a risk of adolescent obesity that was 1.55 times as high among those who had been large for gestational age as among the other groups. CONCLUSIONS Among obese adolescents, the most rapid weight gain had occurred between 2 and 6 years of age; most children who were obese at that age were obese in adolescence. (Funded by the German Research Council for the Clinical Research Center "Obesity Mechanisms" and others; ClinicalTrials.gov number, NCT03072537 .).
Collapse
Affiliation(s)
- Mandy Geserick
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Mandy Vogel
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Ruth Gausche
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Tobias Lipek
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Ulrike Spielau
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Eberhard Keller
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Roland Pfäffle
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| | - Antje Körner
- From the Center for Pediatric Research, University Hospital for Children and Adolescents (M.G., T.L., U.S., R.P., W.K., A.K.), Leipzig Research Center for Civilization Diseases (LIFE Child) (M.G., M.V., W.K., A.K.), CrescNet, Medical Faculty (R.G., E.K., R.P.), and Integrated Research and Treatment Center (IFB), Adiposity Diseases, University Medical Center (T.L., U.S., A.K.), University of Leipzig, Leipzig, Germany
| |
Collapse
|
29
|
Michels N, Matthys D, Thumann B, Marild S, De Henauw S. Children's stress-related reports and stress biomarkers interact in their association with metabolic syndrome risk. Stress Health 2018; 34:523-533. [PMID: 29733496 DOI: 10.1002/smi.2813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/27/2023]
Abstract
The purpose was to examine the cross-sectional associations of stress-related reports and stress biomarkers with metabolic syndrome (MetS) risk in children while also testing the interaction between stress biomarkers and stress reports. In 353 children (5-10 years old, 7.9% overweight/obese), MetS risk was measured by blood pressure, waist circumference, glucose homeostasis, triglycerides, and high-density cholesterol. Stress was measured by stress-related reports (events, emotions, and internalizing/externalizing problems) and two biomarkers: salivary cortisol (total-day and morning output) and heart rate variability (percentage of consecutive normal RR intervals differing more than 50 ms and low-to-high-frequency ratio). Cross-sectional regression analyses with z scored total MetS risk as outcome were adjusted for age, sex, and socio-economic status. Only internalizing problems were directly related to a higher MetS risk score (β = 0.236). Cortisol and heart rate variability were significant moderators: High cortisol morning output resulted in a positive (unfavourable) report-MetS relationship (β = 0.259-0.552), whereas low percentage of consecutive normal RR intervals differing more than 50 ms resulted in a negative (favourable) report-MetS relationship (β = -0.298) and low low-to-high-frequency ratio in a positive (unfavourable) report-MetS relationship (β = 0.478). In conclusion, stress can sometimes be a disadvantageous factor in metabolic health of otherwise healthy children. The cortisol biomarker seems relevant because metabolic risk was highest when stress-related reports were accompanied by high morning cortisol output.
Collapse
Affiliation(s)
- Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dante Matthys
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Barbara Thumann
- Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
| | - Staffan Marild
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Stefaan De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
30
|
Ahrens W, Siani A, Adan R, De Henauw S, Eiben G, Gwozdz W, Hebestreit A, Hunsberger M, Kaprio J, Krogh V, Lissner L, Molnár D, Moreno LA, Page A, Picó C, Reisch L, Smith RM, Tornaritis M, Veidebaum T, Williams G, Pohlabeln H, Pigeot I. Cohort Profile: The transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort. Int J Epidemiol 2017; 46:1394-1395j. [PMID: 28040744 PMCID: PMC5837508 DOI: 10.1093/ije/dyw317] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
| | - A Siani
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - R Adan
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Eiben
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Kaprio
- Department of Public Health, University of Helsinki, Institute for Molecular Medicine (FIMM), Helsinki, Finland
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - A Page
- Centre for Exercise, Nutrition & Health Sciences, University of Bristol, Bristol, UK
| | - C Picó
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics), University of the Balearic Islands (UIB) and CIBER Fisiopatología de la Obesidad y Nutrición, Palma de Mallorca, Spain
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - R M Smith
- Minerva Communications UK, Andover, UK
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia and
| | - G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
| | | |
Collapse
|
31
|
Giudici KV, Rolland-Cachera MF, Gusto G, Goxe D, Lantieri O, Hercberg S, Péneau S. Body mass index growth trajectories associated with the different parameters of the metabolic syndrome at adulthood. Int J Obes (Lond) 2017; 41:1518-1525. [PMID: 28529329 DOI: 10.1038/ijo.2017.119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 04/14/2017] [Accepted: 05/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Growth trajectories have shown to be related to obesity and metabolic risks in later life, however body mass index (BMI) trajectories according to the presence or absence of metabolic syndrome (MS) and its parameters in adulthood are scarce in literature. OBJECTIVES To investigate BMI trajectories during childhood in relation to MS and its parameters in adult age. METHODS A total of 1919 subjects (43.4% male, 20-60 y) participated in this retrospective cohort study. Height, weight, waist circumference (WC), blood glucose, high-density lipoprotein cholesterol, triglycerides and blood pressure were measured at adulthood. Childhood weight and height were collected retrospectively from health booklets. Differences between BMI growth curves of subjects with and without MS were assessed using mixed models for correlated data. RESULTS BMI trajectories differed according to the presence or not of MS at adulthood, from the age of 4 years forward (all P<0.05), to the presence or not of hypertriglyceridemia from 1.5 years forward (all P<0.05), and to WC>94 cm (men) / 80 cm (women) compared to lower WC, at all ages (all P<0.05). CONCLUSIONS BMI growth curves differ according to the presence or not of MS at adulthood, but differences only appeared after the age of 4 years. Changes vary according to the MS parameters considered. Deviation of the MS-associated BMI curve from normal pattern could correspond to alteration in body composition. These differences in BMI trajectories during childhood support the theory of an early origin of the MS, justifying early prevention.
Collapse
Affiliation(s)
- K V Giudici
- Paris 13 University, Nutritional Epidemiology Research Team, French National Institute of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (Inra) U1125, French National Conservatory of Arts and Crafts (CNAM), Sorbonne Paris Cité University, Bobigny, France
| | - M-F Rolland-Cachera
- Paris 13 University, Nutritional Epidemiology Research Team, French National Institute of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (Inra) U1125, French National Conservatory of Arts and Crafts (CNAM), Sorbonne Paris Cité University, Bobigny, France
| | - G Gusto
- Institut inter-Régional pour la Santé (IRSA), La Riche, France
| | - D Goxe
- Institut inter-Régional pour la Santé (IRSA), La Riche, France
| | - O Lantieri
- Institut inter-Régional pour la Santé (IRSA), La Riche, France
| | - S Hercberg
- Paris 13 University, Nutritional Epidemiology Research Team, French National Institute of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (Inra) U1125, French National Conservatory of Arts and Crafts (CNAM), Sorbonne Paris Cité University, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, USEN (Unité de surveillance et d'épidémiologie nutritionnelle), Institut de Veille Sanitaire (InVS), Bobigny, France.,Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - S Péneau
- Paris 13 University, Nutritional Epidemiology Research Team, French National Institute of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (Inra) U1125, French National Conservatory of Arts and Crafts (CNAM), Sorbonne Paris Cité University, Bobigny, France
| |
Collapse
|
32
|
Voerman E, Jaddoe VWV, Franco OH, Steegers EAP, Gaillard R. Critical periods and growth patterns from fetal life onwards associated with childhood insulin levels. Diabetologia 2017; 60:81-88. [PMID: 27757489 PMCID: PMC5495163 DOI: 10.1007/s00125-016-4135-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/21/2016] [Indexed: 01/20/2023]
Abstract
AIMS/HYPOTHESIS We aimed to identify critical periods and specific longitudinal growth patterns from fetal life onwards associated with childhood insulin and C-peptide levels. METHODS In a prospective population-based cohort study of 4328 children, we repeatedly measured (femur) length and (estimated fetal) weight from the second trimester of fetal life until 6 years of age. BMI was calculated from 6 months onwards. Insulin and C-peptide levels were measured at 6 years of age. RESULTS Preterm birth and small or large size for gestational age at birth were not associated with childhood insulin levels. Conditional growth modelling showed that, independent of growth in other time intervals, weight growth in each time interval from birth onwards, length growth from 6 months onwards and BMI growth from 12 months onwards were positively associated with childhood insulin levels. The strongest associations were present for weight and BMI growth between 48 and 72 months of age. Repeated measurement analyses showed that, compared with children in the lowest quartile of childhood insulin, those in the highest quartile had a higher length from birth onwards and a higher weight and BMI from 24 months onwards. These differences increased with age. No associations were observed for fetal growth characteristics. Similar results were observed for C-peptide levels. CONCLUSIONS/INTERPRETATION Our results suggest that rapid length, weight and BMI growth from birth onwards, but not during fetal life, is associated with higher insulin levels in childhood.
Collapse
Affiliation(s)
- Ellis Voerman
- The Generation R Study Group (Room Na-2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (Room Na-2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Romy Gaillard
- The Generation R Study Group (Room Na-2915), Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
- Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|