Effect of birth weight and postnatal weight gain on body composition in early infancy: The Generation R Study

Growth pattern during early infancy, body mass index during childhood and childhood asthma

BACKGROUND

There is a lack of longitudinal studies of associations between growth from infancy to childhood and asthma development.

OBJECTIVE

The objective of the study was to investigate the effects of weight change during infancy, body mass index (BMI) and the interaction of these factors on the risk of childhood asthma.

METHODS

We enrolled children born in 2008 and 2009 at full-term and with normal birth weight. The weight change in infancy was grouped into slow, on-track and rapid. BMI status in childhood was stratified into low, normal and high groups and used as a time-varying variable. The outcome was asthma, defined as two or more diagnoses of asthma separated by at least 1 year after 2 years of age. The risk of asthma was assessed using Cox proportional hazard regression, with adjustment for sex, residence area at birth, economic status and feeding types in infancy.

RESULTS

Of 917,707 children born in Korea in 2008 and 2009, 271,871 were eligible for analysis. The risk of asthma was greater in groups with low birth weight (aHR 1.06, 95% CI 1.04 to 1.08), rapid body weight change during early infancy (aHR 1.08, 95% CI 1.07 to 1.10) and high BMI during childhood (aHR 1.06, 95% CI 1.04-1.08). The interaction of weight change during early infancy with BMI during childhood was significant for asthma (p < .01). Rapid weight gain in infancy was associated with lower risk of asthma in those with low BMI during childhood; had no association with asthma in those with normal BMI during childhood; and was associated increased asthma risk in those with high BMI during childhood-aHR 1.26 (95% CI 1.19 to 1.33) and aHR 1.33 (95% CI 1.12 to 1.56) compared with on-track and slow infant weight gain, respectively.

CONCLUSION

Low birth weight, high BMI during childhood and, in those with high childhood BMI, rapid weight gain during early infancy are associated with increased risk of childhood asthma.

Relationship between prenatal and postnatal conditions and accelerated postnatal growth. Impact on the rigidity of the arterial wall and obesity in childhood

Restricted growth in utero and accelerated postnatal growth (APG) in the postnatal period have been associated with the development of overweight, obesity and an increased cardiovascular risk in childhood. The objectives of this study were to evaluate the influence of prenatal and perinatal conditions on APG and to evaluate the influence of this APG on different cardiovascular risk factors such as body mass index (BMI), body fat mass index (FMI), blood pressure (BP) and arterial wall stiffness [carotid to femoral pulse wave velocity (cf-PWV)]. All measurements were performed in 355 children (185 boys and 170 girls; 8-11 years). Data on mother weight before and during pregnancy, gestational age (weeks), birth weight (g) and breastfeeding of children were obtained through interviews with families. Children who presented APG were born of mothers with lower BMIs before pregnancy and who gained less weight during the second trimester of pregnancy. They also have a lower gestational age and birth weight, a shorter duration of breastfeeding and a longer duration of artificial feeding (AF). Later in childhood, they had higher values of cf-PWV, BMI, FMI and higher prevalence of hypertension. Low maternal gestational weight gain, inadequate fetal development (low birth weight, shorter gestational age) and reduced breastfeeding duration favor APG. Infants with such APG had higher values of cf-PWV, BP, BMI and FMI later in childhood, along with a higher risk of hypertension and obesity. The interaction between APG and a longer duration of AF had a negative effect on cf-PWV (arterial stiffness) and FMI.

Effect of birth weight, exclusive breastfeeding and growth in infancy on fat mass and fat free mass indices in early adolescence: an analysis of the Entebbe Mother and Baby Study (EMaBs) cohort

Background: There is limited data from Africa on the effect of pre- and post-natal growth and infant feeding on later body composition. This study's aim was to investigate the effect of birth weight, exclusive breastfeeding and infant growth on adolescent body composition, using data from a Ugandan birth cohort.

Methods: Data was collected prenatally from pregnant women and prospectively from their resulting live offspring. Data on body composition (fat mass index [FMI] and fat free mass index [FFMI]) was collected from 10- and 11-year olds. Linear regression was used to assess the effect of birth weight, exclusive breastfeeding and infant growth on FMI and FFMI, adjusting for confounders.

Results: 177 adolescents with a median age of 10.1 years were included in analysis, with mean FMI 2.9 kg/m ² (standard deviation (SD) 1.2), mean FFMI 12.8 kg/m ² (SD 1.4) and mean birth weight 3.2 kg (SD 0.5). 90 (50.9%) were male and 110 (63.2%) were exclusively breastfeeding at six weeks of age. Birth weight was associated with FMI in adolescence (regression coefficient β= 0.66 per kg increase in birth weight, 95% confidence interval (CI) (0.04, 1.29), P=0.02), while exclusive breastfeeding (β= -0.43, 95% CI (-1.06, 0.19), P=0.12), growth 0-6 months (β= 0.24 95% CI (-0.43, 0.92), P=0.48) and growth 6-12 months (β= 0.61, 95% CI (-0.23, 1.46), P=0.11) were not associated with FMI among adolescents. Birth weight (β= 0.91, 95% CI (0.17, 1.65), P=0.01) was associated with FFMI in adolescence. Exclusive breastfeeding (β= 0.17, 95% CI (-0.60, 0.94), P=0.62), growth 0-6 months (β= 0.56, 95% CI (-0.20, 1.33), P= 0.10), and growth 6-12 months (β= -0.02, 95% CI (-1.02, 0.99), P=0.97) were not associated with FFMI.

Conclusions: Birth weight predicted body composition parameters in Ugandan early adolescents, however, exclusive breastfeeding at six weeks of age and growth in infancy did not.

Food Consumption, Nutrient Intake and Status during the First 1000 days of Life in the Netherlands: a Systematic Review

Adequate nutrition is essential for growth and development in early life. Nutritional data serves as a basis for national nutritional guidelines and policies. Currently, there is no insight into the availability of such data during the first 1000 days of life. Therefore, a systematic review was performed, following the PRISMA reporting guideline, to identify studies on food consumption, nutrient intake or status in the Netherlands. Potential gaps were identified, and the quality of the studies is discussed. The databases Embase and Medline were used, as well as databases from national institutes. Articles published in 2008-2018 were screened by two independent reviewers. In total 601 articles were identified, of which 173 were included. For pregnant women, 32 studies were available with nutritional data, for young children 40 studies were identified. No studies were available for breastfeeding women. A large variety of foods and nutrients were assessed, however certain nutrients were lacking (e.g., vitamin K). Overall, the studies had methodological limitations, making the data unsuitable to assess nutrient inadequacies. There is a need for recent, high quality nutritional research to strengthen the understanding of the nutritional needs and deficiencies during early life, and is fundamental for national guidelines and policies.

The Effect of Maternal Intact Protein- and Amino Acid-Based Diets on Development of Food Intake Regulatory Systems and Body Weight in Dams and Male Offspring of Wistar Rats

The objective of this study is to examine the effect of maternal and weaning intact protein- and amino acid-based diets on regulation of food intake, intake regulatory hormones, and body weight in dams and their male offspring. Pregnant Wistar rats were allocated to two groups (n = 12) and were fed either an intact protein diet (IPD) or mixed amino acid diet (AAD) from day 3 of gestation throughout gestation and lactation. Male offspring were weaned to either an IPD or AAD for 18 weeks. Food intake (FI) and body weight (BW) were measured weekly. Results: In dams, the AAD group had lower FI and BW in the post-partum period compared with the IPD group. In pups born to AAD dams, birth weight and BW were lower. However, the percentage of fat and lean mass were not affected. Food intake was influenced by maternal diet and was higher in pups born to IPD dams throughout post-weaning. Short-term FI in response to protein preloads was lower in pups born to AAD dams in 1 h. Fasting plasma concentrations of glucose, insulin, and ghrelin were not influenced by either maternal or weaning diet. However, peptide YY (PYY) was higher in pups born to IPD dams at weaning. Conclusions: The physicochemical properties of proteins fed during pregnancy and lactation had determining effects on the body weight and development of food intake regulatory systems in offspring. Maternal AAD resulted in lower BW in dams and lower birth weight and post-weaning BWs in pups compared with maternal IPD which was consistent with their lower FI.

Effect of birth weight, exclusive breastfeeding and growth in infancy on fat mass and fat free mass indices in early adolescence: an analysis of the Entebbe Mother and Baby Study (EMaBs) cohort

Background: There is limited data from Africa on the effect of pre- and post-natal growth and infant feeding on later body composition. This study's aim was to investigate the effect of birth weight, exclusive breastfeeding and infant growth on adolescent body composition, using data from a Ugandan birth cohort. Methods: Data was collected prenatally from pregnant women and prospectively from their resulting live offspring. Data on body composition (fat mass index [FMI] and fat free mass index [FFMI]) was collected from 10- and 11-year olds. Linear regression was used to assess the effect of birth weight, exclusive breastfeeding and infant growth on FMI and FFMI, adjusting for confounders. Results: 177 adolescents with a median age of 10.1 years were included in analysis, with mean FMI 2.9 kg/m2 (standard deviation (SD) 1.2), mean FFMI 12.8 kg/m2 (SD 1.4) and mean birth weight 3.2 kg (SD 0.5). 90 (50.9%) were male and 110 (63.2%) were exclusively breastfeeding at six weeks of age. Birth weight was associated with FMI in adolescence (regression coefficient β= 0.66 per kg increase in birth weight, 95% confidence interval (CI) (0.04, 1.29), P=0.02), while exclusive breastfeeding (β= -0.43, 95% CI (-1.06, 0.19), P=0.12), growth 0-6 months (β= 0.24 95% CI (-0.43, 0.92), P=0.48) and growth 6-12 months (β= 0.61, 95% CI (-0.23, 1.46), P=0.11) were not associated with FMI among adolescents. Birth weight (β= 0.91, 95% CI (0.17, 1.65), P=0.01) was associated with FFMI in adolescence. Exclusive breastfeeding (β= 0.17, 95% CI (-0.60, 0.94), P=0.62), growth 0-6 months (β= 0.56, 95% CI (-0.20, 1.33), P= 0.10), and growth 6-12 months (β= -0.02, 95% CI (-1.02, 0.99), P=0.97) were not associated with FFMI. Conclusions: Birth weight predicted body composition parameters in Ugandan early adolescents, however, exclusive breastfeeding at six weeks of age and growth in infancy did not.

Associations between maternal lifestyle factors and neonatal body composition in the Screening for Pregnancy Endpoints (Cork) cohort study

Background

Neonatal body composition likely mediates fetal influences on life long chronic disease risk. A better understanding of how maternal lifestyle is related to newborn body composition could thus inform intervention efforts.

Methods

Using Cork participant data (n = 1754) from the Screening for Pregnancy Endpoints (SCOPE) cohort study [ECM5(10)05/02/08], we estimated how pre-pregnancy body size, gestational weight gain, exercise, alcohol, smoking and diet were related to neonatal fat and fat-free mass, as well as length and gestational age at birth, using quantile regression. Maternal factors were measured by a trained research midwife at 15 gestational weeks, in addition to a 3rd trimester weight measurement used to calculate weight gain. Infant body composition was measured using air-displacement plethysmography.

Results

Healthy (versus excess) gestational weight gain was associated with lower median fat-free mass [-112 g, 95% confidence interval (CI): -47 to -176) and fat mass (-33 g, 95% CI: -1 to -65) in the offspring; and a 103 g decrease in the 95th centile of fat mass (95% CI: -33 to -174). Maternal normal weight status (versus obesity) was associated with lower median fat mass (-48 g, 95% CI: -12 to -84). At the highest centiles, fat mass was lower among infants of women who engaged in frequent moderate-intensity exercise early in the pregnancy (-92 g at the 95th centile, 95% CI: -168 to -16). Lastly, women who never smoked tended to have longer babies with more fat mass and fat-free mass. No other lifestyle factors were strongly related to infant body composition.

Conclusions

These results suggest that supporting healthy maternal lifestyles could reduce the risk of excess fat accumulation in the offspring, without adversely affecting fat-free mass development, length or gestational age.

Longitudinal association of dietary protein intake in infancy and adiposity throughout childhood

BACKGROUND & AIMS

Protein intake in infancy promotes growth, but excessive intake may lead to adiposity in children. However, whether this increased adiposity persists throughout childhood and is independent of diet in later life remains unclear. Therefore, we studied the associations of total protein intake and protein from different sources at age 1 year with repeatedly measured growth and body composition up to age 10 years. Additionally, we examined whether these associations are independent of protein intake and overall diet quality at age 8 years.

METHODS

We included 3573 children from the Generation R study, a population-based prospective cohort in the Netherlands. Dietary intakes were assessed with food-frequency questionnaires at ages 1 and 8 years and macronutrient intakes were expressed as energy percentages (E%). Height and weight were measured at eight time points between ages 1 and 10 years. Fat and fat-free masses were measured at ages 6 and 10 years with dual-energy X-ray-absorptiometry. We calculated body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI). Outcomes were standardized for sex and age and expressed as standard deviation scores (SDS). Associations of protein intake with growth and body composition trajectories were examined with multivariable linear mixed models.

RESULTS

After adjustment for confounders, 5E% additional protein intake at age 1 year was associated with a 0.10 SDS higher weight (95% CI 0.04, 0.16), 0.10 SDS higher BMI (95% CI 0.04, 0.16), and 0.07 SDS higher FMI (95% CI 0.01, 0.13) up to age 10 years. These associations were explained by protein from animal sources and not plant sources. Associations were independent of protein intake and overall diet quality at age 8 years, and were independent of whether higher protein was consumed at the expense of carbohydrates or fat in the diet.

CONCLUSIONS

Our study suggests that high protein intake in infancy, particularly from animal food sources, is persistently associated with adiposity up to age 10 years. Restricting protein intake in this critical period of development may aid in the early prevention of adiposity in childhood.

Infant Weight and Length Growth Trajectories Modeled Using Superimposition by Translation and Rotation Are Differentially Associated with Body Composition Components at 3 and 7 Years of Age

OBJECTIVE

To evaluate how infant weigh and length growth trajectories associate with body composition at 3 and 7 years because previous studies have noted that rapid infant weight gain increases risk for high body mass index (BMI) in children.

STUDY DESIGN

There were 322 children enrolled at 3 years of age with dual x-ray absorptiometry body composition data and pediatrician growth data for 0-2 years of age who were included in analysis. Superimposition by translation and rotation modeling was used to characterize infant weight and length trajectories in terms of size, tempo and velocity measures. Associations of these measures with fat mass, lean mass, percent body fat, bone mineral content, BMI z-score, and overweight prevalence at 3 and 7 years of age were determined.

RESULTS

Infant growth trajectories differed by sex, race, and breastfeeding status. Higher overall weight size and weight velocity from 0 to 2 years of age were associated positively with all age 3 body composition and anthropometry outcomes. However, longer length size from 0 to 2 years of age was associated independently with higher bone mineral content and lean mass, but lower percent body fat, BMI z-score, and a lower odds of overweight at 3 years of age. By 7 years of age, later than average infant weight tempo was also associated with lower fat mass, lean mass, and BMI z-score.

CONCLUSIONS

Greater average weight size and greater weight velocity in infancy are markers for greater overall body size at 3 and 7 years of age. However, longer average lengths and later weight gain tempo between 0 and 2 years of age may help to establish a leaner body composition by 3 and 7 years of age.

The effect of characteristics of proteins fed during gestation and lactation on development of metabolic syndrome in dams and male offspring of Wistar rats

Objective

The objective of the study is to examine the role of characteristics of proteins in maternal and weaning diets on risk of metabolic syndrome in male offspring.

Methods

Pregnant Wistar rats were allocated to two groups (n = 12) and were fed the AIN‐93G diets based on either intact protein‐based diet (IPD) or mixed amino acid‐based diet (AAD) from day 3 of gestation throughout gestation and lactation. Male offspring were weaned to either an IPD or AAD diet for 18 weeks.

Results

In dams, AAD group had lower body weight in post‐partum period and higher pulse rate compared with IPD group. In pups born to AAD dams, birth weight and body weight were significantly lower, and systolic blood pressure and fasting blood glucose were significantly higher compared with those born to IPD dams. Fat/weight ratio, insulin and homeostasis model assessment of insulin resistance were not influenced by either maternal or weaning diet.

Conclusions

These results indicate that the physico‐chemical structure of proteins fed to dams is important in altering risk factors of metabolic syndrome in the offspring, while weaning diets do not seem to play a role. IPD had more favourable effect than AAD. These results may also indicate that dietary recommendations during development must be updated based on physiological properties of dietary proteins that are beyond their nutritional role.

Neonatal fatty acid profiles are correlated with infant growth measures at 6 months

Rapid weight gain in infancy and low levels of n-3 long chain polyunsaturated fatty acids (LCPUFA) at birth are associated with increased adiposity later in life. The association between placental LCPUFA delivery and weight gain in infancy is poorly understood. We sought to determine the relationships between maternal phenotype, placental fatty acid transporter expression and offspring growth patterns over the first 6 months. Placental tissue and cord blood were collected at term delivery from women with uncomplicated pregnancies. Offspring body composition measurements were recorded 1 day and 6 months after birth. Body mass index (BMI) z-scores were determined using World Health Organization 2006 reference data. Body phenotype patterns were compared among offspring who had an increase in BMI z-score and those who had a decrease. High skinfold thickness at birth and positive change in BMI z-scores during infancy were associated with low neonatal n-3 LCPUFA plasma levels (r=-0.46, P=0.046) and high saturated fatty acids levels (r=0.49, P=0.034). Growth of skinfolds over 6 months of age was associated with placental fatty acid transporter gene expression. Change in BMI z-score in the first 6 months of life correlated with arm muscle area growth, a measure of lean mass (r=0.62, P=0.003), but not with growth in skinfold thickness. Early infancy weight gain was associated with poor plasma LCPUFA status at birth, and fat deposition in infancy was related to changes in placental lipid handling. Thus, neonatal fatty acid profiles may influence the trajectory of infant growth and fat and lean mass deposition.

Amino acid starvation-induced autophagy is involved in reduced subcutaneous fat deposition in weaning piglets derived from sows fed low-protein diet during gestation and lactation : Autophagy is involved in reduced fat deposition in maternal low-protein piglets

PURPOSE

The study aimed to determine the effects of maternal low-protein (LP) diet on subcutaneous fat deposition of weaning piglets and the potential mechanism.

METHODS

Sows were fed either a standard protein (SP, 15 and 18% crude protein) or a LP diet (50% protein levels of SP) throughout pregnancy and lactation. Subcutaneous fat and blood were sampled from male piglets at 28 days of age. Serum biochemical metabolites and hormone concentrations were detected with the enzymatic colorimetric methods. Serum-free amino acid (FAA) levels were measured by amino acid auto-analyzer. The mRNA and protein were measured by qRT-PCR and Western blot.

RESULTS

Body weight, back fat thickness, triglycerides concentrations in subcutaneous fat tissue, and serum, as well as FFA concentrations were significantly reduced in LP piglets when compared with SP piglets. Further studies showed that mRNA and protein expression of acetyl-CoA carboxylase and fatty acid synthetase, two key enzymes of de novo lipogenesis, were significantly reduced in LP piglets, while mRNA expression and the lipolytic enzymes activities of lipolysis genes, adipose triglyceride lipase and hormone-sensitive lipase, were significantly increased. Furthermore, expression of autophagy-related gene 7 and autophagy maker gene microtubule-associated protein 1A/1B-light chain 3 (LC 3) as well as the conversion of LC3I to LC3II were significantly elevated, along with the expression of activating transcription factor-4 and eukaryotic translation initiation factor-2a.

CONCLUSION

These results indicate that amino acid starvation-induced autophagy is involved in reduced subcutaneous fat deposition in maternal LP weaning piglets, demonstrating links between maternal protein restriction and offspring fat deposition.

The Role of Maternal Dietary Proteins in Development of Metabolic Syndrome in Offspring

The prevalence of metabolic syndrome and obesity has been increasing. Pre-natal environment has been suggested as a factor influencing the risk of metabolic syndrome in adulthood. Both observational and experimental studies showed that maternal diet is a major modifier of the development of regulatory systems in the offspring in utero and post-natally. Both protein content and source in maternal diet influence pre- and early post-natal development. High and low protein dams’ diets have detrimental effect on body weight, blood pressure191 and metabolic and intake regulatory systems in the offspring. Moreover, the role of the source of protein in a nutritionally adequate maternal diet in programming of food intake regulatory system, body weight, glucose metabolism and blood pressure in offspring is studied. However, underlying mechanisms are still elusive. The purpose of this review is to examine the current literature related to the role of proteins in maternal diets in development of characteristics of the metabolic syndrome in offspring.

Maternal obesity influences the relationship between location of neonate fat mass and total fat mass

BACKGROUND

It is suggested that maternal obesity perpetuates offspring obesity to future generations.

OBJECTIVE

To determine whether location of neonate fat mass (FM: central vs. peripheral) is related to total neonate FM and whether maternal obesity influences this relationship.

METHODS

Neonate body composition and skin-fold thicknesses were assessed in healthy neonates (n = 371; 1-3 days old). Linear regression models examined the relationship between total FM and location of FM (central vs. peripheral). Location of FM was calculated by skin-folds: peripheral was the sum of (biceps and triceps)/2 and central was represented by the subscapular skin-fold.

RESULTS

A significant interaction was found for location of FM and maternal obesity. Holding all predictors constant, in offspring born to non-obese mothers, a 0.5 mm increase in central FM predicted a 15 g greater total FM, whereas a 0.5 mm increase in peripheral FM predicted a 66 g greater total FM. However, in offspring born to obese mothers, a 0.5 mm increase in central FM predicted a 56 g total FM, whereas a 0.5 mm increase in peripheral FM predicted a 14 g greater total FM.

CONCLUSIONS

The relationship between total FM and location of FM is influenced by maternal obesity.

Relationship between maternal and newborn endothelial function and oxidative stress

OBJECTIVE

To evaluate the Relationship between maternal and newborn endothelial function and oxidative stress.

METHODS

Forty-three pregnant women and their offspring were evaluated. As markers of endothelial function, the flow-mediated dilation (FMD) was measured in pregnant women in the second and third trimesters, and nitric oxide (NO) was quantified in the endothelial cells of the umbilical cord vein. Malondialdehyde (MDA), as a marker of oxidative stress, was measured in the maternal plasma (second and third trimesters) and plasma from umbilical cord blood. Gestational age and birth weight were recorded. Correlations between variables were estimated, and adjustments were made for specific gestational week of measurement, gestational age at birth, and complications during pregnancy and/or at delivery.

RESULTS

Maternal FMD at second trimester correlated positively with newborn MDA, although with marginal significance (P = 0.090). The change in maternal FMD was positively correlated with newborn NO (P = 0.039), although adjustment for gestational age and specific week of gestation attenuated this relationship (P = 0.070). Maternal MDA at second trimester correlated positively with newborn MDA independently of gestational age at birth, specific week of gestation of the measurement, and having complications during pregnancy or at delivery (P = 0.032). After adjustments, the change in maternal MDA correlated with newborn MDA but marginally (P = 0.077).

CONCLUSION

Study findings suggest that under physiological conditions, enhanced endothelial function and/or oxidative stress in the mother may impact on normal fetal development. Future studies are recommended, employing larger sample sizes, a more extensive set of markers of oxidative stress, and comparisons of complicated versus normal pregnancies.

Body composition assessment in infancy and early childhood: comparison of anthropometry with dual-energy X-ray absorptiometry in low-income group children from India

BACKGROUND/OBJECTIVE

Anthropometry is a simple, inexpensive method of body composition assessment, but its validity has not been examined adequately in young children. The study therefore compared the body composition estimates using anthropometry with those using dual-energy X-ray absorptiometry (DXA) in infants and young children.

METHODS

Body composition estimates using anthropometry and DXA were assessed and compared at 6, 12 and 18 months in a cohort of 137 infants enrolled at birth.

RESULTS

Fat mass (FM) and body fat percent (%BF) estimates by anthropometry were lower than those using DXA. Mean differences (DXA-skinfold thickness) in FM, fat free mass (FFM) and %BF were highest at 6 months (350 g, -226 g and 4%, respectively); the differences reduced with increase in age and were lowest at 18 months (46 g, 56 g and 0%, respectively). Bland-Altman analyses showed good agreement between the FM, FFM and %BF estimates by the two methods only at 18 months. Accretion of FM and FFM during follow-up, estimated by the two methods, was significantly different, with agreement between the methods seen only for increment in FFM from 6 to 12 months.

CONCLUSIONS

Substantial differences were found in the body composition estimates by anthropometry compared with DXA and also in the longitudinally assessed tissue accretion patterns by the two methods. As the body composition patterns may be influenced by the method used for body composition assessment, results of studies assessing body composition by anthropometry during infancy should be interpreted with caution.

Associated factors for accelerated growth in childhood: a systematic review

Several studies have shown that accelerated growth in the postnatal period is critical for the development of chronic diseases. The term catch-up has been used for the accelerated growth of children who have suffered some sort of restriction of nutrition or oxygen supply. However, accelerated growth has been observed among children who have an appropriate birth weight for their gestational age (AGA) and with no apparent morbidity. Therefore, this systematic review was carried out on the associated factors of accelerated growth, or catch-up, using the Medline/Pubmed database. Only cohort studies written in Portuguese, English or Spanish, with children between zero and 12 years old who presented accelerated growth or catch-up as the outcome were included. Out of the 2,155 articles found, 9 were selected. There is no uniformity in the operational definition of accelerated growth, or in the concept of catch-up. According to this review, accelerated growth is associated with primiparity, maternal smoking during pregnancy, lower birth weight, and early weaning. The main limitations in the available literature are the high number of follow-up losses and the lack of control for confounding factors. The determinants of accelerated growth still need to be studied further, especially among AGA children.

Change in weight-for-length status during the first three months: relationships to birth weight and implications for metabolic risk

Weight-for-length during the early postnatal period is a critical predictor of subsequent body composition and metabolic risk. This study was designed to analyze change in weight-for-length status according to birth weight in early infancy. Data were collected for 267 infants enrolled in the Jackson County Women, Infants, and Children (WIC) program. Postnatal measurements were collected at a clinic visit between birth and 12 weeks of age (mean = 5.7 weeks). Changes in WHO z-scores (weight, length, weight-for-length) between birth and the clinic visit were calculated. Infants were classified as exclusively breastfed or as formula-fed. Ethnicity was coded as Hispanic or non-Hispanic. Infants were classified based on birth weight z-score as lower (<-1 SD) or higher (> +1 SD). Multiple regression models tested birth weight, demographic factors, and feeding as predictors of z-score change measures. Demographic factors and feeding were also tested as moderators of the effects of birth weight. Lower birth weight infants displayed an increase in weight-for-length z-score between birth and the clinic visit. Change in weight-for-length was associated with significant increase in weight z-score but not in length z-score. Higher birth weight predicted decrease in weight and length z-scores but did not predict change in weight-for-length. Hispanic ethnicity predicted decrease in length z-score and increase in weight-for-length z-score but did not moderate effects of birth weight. Increase in weight-for-length among lower birth weight infants and persistence of high weight-for-length among higher birth weight infants may reflect phenotypic adjustments that are maladaptive in adverse dietary environments.

Child patterns of growth delay and cognitive development in a Bolivian mining city

OBJECTIVES

This study aims to (1) follow up and characterize infant growth patterns during the first year of life in Bolivia, and (2) determine whether there exists an association between weight gain and cognitive development in children living near contaminated mining industries.

METHODS

Data on 175 children participating to the ToxBol (Toxicity in Bolivia) birth cohort were analyzed. Rapid-growth during the first 6 months was defined as a change in weight z-score > 0.67 while slow-growth was defined as a weight z-score change of < -0.67. Neurodevelopment was evaluated using the Bayley Scales of Infant Development at 10.5-12.5 months of age. Mixed models were used to examine the association between cognitive development and weight gain.

RESULTS

Rapid growers weighed less at birth (P < 0.01). However, they revealed a higher body mass index at 12 months of age (0.70 ± 0.73, P < 0.01). After adjustment for confounding, rapid growth was not associated with cognitive development (coef = 0.49, 95% confidence interval = -4.10, 5.08).

CONCLUSIONS

In this Bolivian cohort, children born smaller were more likely to grow/develop faster and attain greater weight and length. Their cognitive development was not affected by their growth patterns.

Velocidade de ganho de peso e práticas alimentares no primeiro ano de vida em lactentes de baixo nível socioeconômico

OBJETIVO: Avaliar a velocidade do ganho de peso e sua associação com as práticas alimentares no primeiro ano de vida em crianças de baixo nível socioeconômico. MÉTODOS: Utilizaram-se dados de peso e comprimento ao nascer obtidos dos registros hospitalares e as medidas antropométricas aferidas aos 6 e 12 meses para o cálculo do ganho de peso no primeiro e no segundo semestres de vida. Dados das práticas alimentares das crianças foram obtidos por meio de entrevistas com as mães aos 6 e 12 meses de idade das crianças. RESULTADOS: Avaliaram-se 328 crianças: 184 meninos e 144 meninas. As meninas apresentaram maior ganho de peso em relação ao padrão da Organização Mundial de Saúde nos primeiros 6 meses de vida (4.452kg versus 4.079kg, p=0,000). Dos 6 aos 12 meses, o ganho de peso das crianças avaliadas foi significativamente maior em comparação ao padrão da Organização Mundial de Saúde para os dois sexos (1.929kg versus 1.688kg, p=0,000 para os meninos e 1.900kg versus 1.618kg, p=0,001 para as meninas). As crianças do sexo masculino que receberam aleitamento materno exclusivo por período menor que quatro meses apresentaram maior ganho de peso entre 6 e 12 meses de idade em relação àquelas que receberam somente leite materno por período igual ou superior a quatro meses (M=2,077, DP=0,777 versus M=1,814, DP=0,669 p=0,02). CONCLUSÃO: Este estudo evidenciou que as crianças avaliadas apresentaram ganho de peso excessivo no primeiro ano de vida, e que o aleitamento materno exclusivo apresentou papel protetor.

Is the macronutrient intake of formula-fed infants greater than breast-fed infants in early infancy?

Faster weight gain early in infancy may contribute to a greater risk of later obesity in formula-fed compared to breast-fed infants. One potential explanation for the difference in weight gain is higher macronutrient intake in formula-fed infants during the first weeks of life. A systematic review was conducted using Medline to assess the macronutrient and energy content plus volume of intake in breast-fed and formula-fed infants in early infancy. All studies from healthy, term, singleton infants reporting values for the composition of breast milk during the first month of life were included. The energy content of colostrum (mean, SEM: 53.6 ± 2.5 kcal/100 mL), transitional milk (57.7 ± 4.2 kcal/100 mL), and mature milk (65.2 ± 1.1 kcal/100 mL) was lower than conventional infant formula (67 kcal/100 mL) on all days analyzed. The protein concentration of colostrum (2.5 ± 0.2 g/100 mL) and transitional milk (1.7 ± 0.1 g/100 mL) was higher than formula (1.4 g/100 mL), while the protein content of mature milk (1.3 ± 0.1 g/100 mL) was slightly lower. Formula-fed infants consume a higher volume and more energy dense milk in early life leading to faster growth which could potentially program a greater risk of long-term obesity.

Obesity and pulmonary disease: unanswered questions

Obesity is associated with risk of pulmonary disease, and adversely affects lung function. The parallel increase in obesity and asthma suggests the two conditions are linked; indeed, they can worsen each other. Obesity and inadequate asthma control are associated with poor quality of life, and place a high economic burden on public health. Although the obesity-lung interaction is a major issue for basic research and clinical studies, various questions remain unanswered. Do intrauterine and early life factors impact on the development of obesity and lung disease? If so, can this be prevented? Asthma is generally more severe in obese subjects, but is adiposity a driver of a new asthma phenotype that features greater morbidity and mortality, worse control and decreased response to medications? Obese individuals have small lung volumes, hence their airway calibre is reduced and airway resistance is increased. What puzzles physicians is whether peripheral airways undergo remodelling, which would increase bronchoconstriction. Obese asthmatics respond suboptimally to anti-inflammatory treatment, which raises the question: 'what drug for what patient?' Life expectancy is decreased in obesity and in chronic pulmonary disorders, but does obesity protect against or trigger chronic obstructive pulmonary disease? The time has come to find answers to these questions.

Prenatal organochlorine compound exposure, rapid weight gain, and overweight in infancy

BACKGROUND

Although it has been hypothesized that fetal exposure to endocrine-disrupting chemicals may increase obesity risk, empirical data are limited, and it is uncertain how early in life any effects may begin.

OBJECTIVES

We explored whether prenatal exposure to several organochlorine compounds (OCs) is associated with rapid growth in the first 6 months of life and body mass index (BMI) later in infancy.

METHODS

Data come from the INMA (Infancia y Medio-Ambiente) Child and Environment birth cohort in Spain, which recruited 657 women in early pregnancy. Rapid growth during the first 6 months was defined as a change in weight-for-age z-scores > 0.67, and elevated BMI at 14 months, as a z-score ≥ the 85th percentile. Generalized linear models were used to estimate the risk of rapid growth or elevated BMI associated with 2,2-bis(p-chlorophenyl)-1,1-dichloroethylene (DDE), hexachlorobenzene, β-hexachlorohexane, and polychlorinated biphenyls in first-trimester maternal serum.

RESULTS

After multivariable adjustment including other OCs, DDE exposure above the first quartile was associated with doubling of the risk of rapid growth among children of normal-weight (BMI < 25 kg/m2), but not overweight, mothers. DDE was also associated with elevated BMI at 14 months (relative risk per unit increase in log DDE = 1.50; 95% confidence interval, 1.11-2.03). Other OCs were not associated with rapid growth or elevated BMI after adjustment.

CONCLUSIONS

In this study we found prenatal DDE exposure to be associated with rapid weight gain in the first 6 months and elevated BMI later in infancy, among infants of normal-weight mothers. More research exploring the potential role of chemical exposures in early-onset obesity is needed.

The Generation R Study: design and cohort update 2010

The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. General follow-up rates until the age of 4 years exceed 75%. Data collection in mothers, fathers and preschool children included questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome wide association screen is available in the participating children. Regular detailed hands on assessment are performed from the age of 5 years onwards. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.

Nutritional correlates and dynamics of diabetes in the Nile rat (Arvicanthis niloticus): a novel model for diet-induced type 2 diabetes and the metabolic syndrome

Background

The prevalence of Metabolic Syndrome and related chronic diseases, among them non-insulin-dependent (type 2) diabetes mellitus, are on the rise in the United States and throughout the world. Animal models that respond to environmental stressors, such as diet, are useful for investigating the outcome and development of these related diseases.

Objective

Within this context, growth and energy relationships were characterized in the Nile rat, an exotic African rodent, as a potential animal model for diet-induced type 2 diabetes mellitus and Metabolic Syndrome.

Methods

Compiled data from several studies established the relationship between age, body weight gain (including abdominal adiposity), food and water consumption, and blood glucose levels as determinants of diabetes in male and female Nile rats. Glucose Tolerance Testing, insulin, HbA1c, blood pressure measurements and plasma lipids further characterized the diabetes in relation to criteria of the Metabolic Syndrome, while diet modification with high-fat, low-fiber or food restriction attempted to modulate the disease.

Results

The Nile rat fed lab chow demonstrates signs of the Metabolic Syndrome that evolve into diet-induced non-insulin-dependent (type 2) diabetes mellitus characterized by hyperinsulinemia with rising blood glucose (insulin resistance), abdominal adiposity, and impaired glucose clearance that precedes increased food and water intake, as well as elevated HbA1c, marked elevation in plasma triglycerides and cholesterol, microalbuminuria, and hypertension. Males are more prone than females with rapid progression to diabetes depending on the challenge diet. In males diabetes segregated into early-onset and late-onset groups, the former related to more rapid growth and greater growth efficiency for the calories consumed. Interestingly, no correlation was found between blood glucose and body mass index (overall adiposity) in older male Nile rats in long term studies, whereas blood glucose and the perirenal fat pad, as well as liver and kidney weight, were positively related to early-onset diabetes. Rats weaned early (4-5 wks) and challenged with a high-fat Western-type diet developed diabetes faster, and body fat accumulation was more apparent, whereas food restriction curtailed it.

Conclusion

The Nile rat fed typical rodent diets develops hyperinsulinemia that precedes hyperglycemia (insulin resistance) leading to diet-induced type 2 diabetes associated with hypertriglyceridemia, hypercholesterolemia, and hypertension. Dietary modulation affected growth rate (weight gain and central adiposity) to impact disease progression. This rodent model represents a novel system of gene-diet interactions affecting energy utilization that can provide insight into the prevention and treatment of the type 2 diabetes and Metabolic Syndrome.