Association between breast-feeding and anthropometry and CVD risk factor status in adolescence and young adulthood: the Young Hearts Project, Northern Ireland

Gestational Age and Cardiorespiratory Fitness in Individuals Born At Term: A Life Course Study

BACKGROUND

In contrast to the effects of preterm birth, the extent to which shorter gestational age affects the cardiorespiratory fitness (CRF) levels of individuals who were born at term (ie, between 37 and 42 weeks) is largely unknown. The aim of this study was to examine whether life-course CRF levels varied across different gestational ages within the at-term range.

METHODS AND RESULTS

The association between gestational age (in weeks) obtained from Child Health Services records and CRF, estimated from field and laboratory tests and expressed by maximal oxygen uptake level through adolescence to young adulthood, was examined in 791 participants in the Northern Ireland Young Hearts Study, all singletons born at term. Longitudinal data were analyzed with generalized estimating equations, accounting for important potential confounders. Mean levels of CRF were 45.6, 43.7, and 33.0 mL/kg per minute when participants were aged 12, 15, and 22 years, respectively. After adjustment for confounders, each week increase in gestational age was associated with 0.46 mL/kg per minute (95% confidence interval, 0.14-0.79) in CRF. Compared with individuals born full term (39-40 weeks, n=533) or late term (41-42 weeks, n=148), those who were born early term (37-38 weeks, n=110) had a higher incidence of poor CRF (risk ratio, 1.57; 95% confidence interval, 1.14-2.16). The changes in CRF through adolescence to young adulthood were similar across groups, with those born early term consistently displaying the lowest CRF.

CONCLUSIONS

These findings suggest that early-term births within the at-term range are linked to poorer CRF through adolescence to young adulthood, and may have important clinical and public health implications for policies about (avoidable) early-term deliveries given their recent increasing trends.

Risk factors for cardiovascular diseases in adolescents

OBJECTIVE

Identify risk factors for cardiovascular disease in adolescents.

METHODOLOGY

Descriptive cross-sectional study, conducted from May to September 2012, in the public schools of the city of Picos (Piaui State, Brazil). The sample consisted of 320 adolescents 10-19 years.

RESULTS

As to gender, 60% were female. With regard to blood pressure values, 15.3% of participants had altered blood pressure values (6.9% with hypertension) and, in relation to nutritional status, 15.6% were overweight and 5.3% obese. None of the variables showed statistically significant differences according to sex. Correlation were found between the variables: family history of hypertension with arm circumference and triceps skinfold; maternal education with triceps skinfold thickness and diastolic blood pressure; uptime with body mass index, arm circumference, waist-hip ratio and heart rate; birth weight with body mass index and arm circumference.

CONCLUSION

A significant proportion of adolescent respondents had risk factors for cardiovascular disease. Nursing should lead the adoption of interventions that promote the improvement of healthy lifestyle in adolescence, thus avoiding not only cardiovascular disease, but also other chronic diseases that can develop.

Infant diet and metabolic outcomes in school-age children. The Generation R Study

BACKGROUND

Breastfeeding duration is associated with the risks of cardio-metabolic diseases in adulthood. We examined the associations of infant feeding patterns with metabolic outcomes in children and whether any association was explained by family-based socio-demographic, maternal lifestyle-related or childhood factors.

SUBJECTS/METHODS

We performed a population-based prospective cohort study in 3417 children to examine the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with blood levels of lipids, insulin and C-peptide and risk of clustering of cardio-metabolic risk factors at the median age of 6.0 years (90% range 5.7-6.8).

RESULTS

We observed that, in the models only adjusted for child's age and sex, ever breastfeeding was not associated with childhood blood levels of lipids but was associated with higher insulin and C-peptide concentrations (P-value<0.05). Breastfeeding duration and exclusivity were not consistently associated with metabolic outcomes. Early introduction of solid foods was associated with higher levels of total cholesterol (P-value<0.05) but not with high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides and insulin levels. Shorter breastfeeding duration and exclusive breastfeeding were associated with increased risks of clustering of cardio-metabolic risk factors. After additional adjustment for family, maternal and childhood factors, none of these associations remained significant.

CONCLUSIONS

In conclusion, we found no consistent associations of infant feeding patterns with metabolic outcomes at school age, after taking into account family-based socio-demographic, maternal lifestyle-related or childhood factors. Whether infant diet composition influences metabolic outcomes in later life should be further studied.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.

Breastfeeding shows a protective trend toward adolescents with higher abdominal adiposity

OBJECTIVE

The question of whether breastfeeding has a protective effect against the development of overweight or obesity later in life remains controversial, especially during adolescence. The objective was to assess the relationship between breastfeeding and adolescents' body composition.

METHODS

The HELENA study is a cross-sectional study involving 3,528 adolescents from 10 European cities. The outcome measures were body weight and height, subscapular skinfolds as well as waist circumferences. Breastfeeding, smoking status, and parental socioeconomic status were assessed by self-administered questionnaires. Dietary intake was recorded using two 24-hour recall surveys. Two adjustment approaches were used: i) covariance analysis adjusted for confounding factors (propensity score adjustment) and ii) multivariate quantile regression.

RESULTS

After adjustment, no significant associations were observed between breastfeeding and body composition parameters (BMI Z-score; sum of skinfolds; waist-to-height ratio). An adjusted quantile regression analysis showed a non-significant trend for a protective effect of breastfeeding toward the highest percentiles of adiposity in boys but not in girls. This is of particular interest with respect to the superiority of the waist-to-height ratio over waist circumference and BMI for detecting cardiometabolic risk factors.

CONCLUSION

This first European study, including a large set of factors influencing adolescents' body composition, showed a non-significant trend toward a protective effect of breastfeeding on highest percentiles of adolescent's abdominal adiposity.

Infant feeding patterns are associated with cardiovascular structures and function in childhood

Nutrition in infancy seems to be associated with cardiovascular disease and its risk factors in adulthood. These associations may be explained by cardiovascular developmental adaptations in childhood in response to specific infant feeding patterns. The aim of this study was to assess whether duration and exclusivity of breastfeeding and timing of introduction of solid foods affect cardiovascular development in childhood. In a population-based prospective cohort study from fetal life onward, information about duration and exclusivity of breastfeeding and timing of introduction of solid foods was obtained from delivery reports and questionnaires. Blood pressure, carotid-femoral pulse wave velocity (PWV), left atrial diameter (LAD), aortic root diameter (AOD), left ventricular (LV) mass, and fractional shortening (FS) were measured at a median age of 6.0 y (95% range: 5.6-7.4 y). Analyses were based on 5003 children. Age at introduction of solid foods was negatively associated with systolic and diastolic blood pressure at the age of 6 y. Compared with children who had ever been breast-fed, never-breast-fed children had a higher carotid-femoral PWV (β: 0.13 m/s; 95% CI: 0.03, 0.24 m/s), a smaller LAD (β: -0.29 mm; 95% CI: -0.55, -0.03 mm), and less LV mass (β:-1.46 g; 95% CI: -2.41, -0.52 g) at the age of 6 y. Among breast-fed children, duration and exclusivity were not associated with cardiovascular structures or function. Breastfeeding pattern and age at introduction of solid foods were not associated with AOD or FS. Feeding patterns in infancy may influence cardiovascular development in childhood. Further research is required to replicate these findings and to investigate whether these changes contribute to an increased risk of cardiovascular disease in later life.

Infant macronutrient composition is associated with differences in cardiovascular structures and function in childhood

Early-life nutrition may influence cardiovascular development. Not much is known about the associations between dietary composition and cardiovascular risk factors in childhood. We examined the associations of infant macronutrient intake with cardiovascular structures and function in 2882 children participating in a prospective, population-based cohort study. Information on macronutrient intake at the age of 14 mo was obtained from food-frequency questionnaires completed by a parent. Systolic and diastolic blood pressure, carotid-femoral pulse wave velocity (PWV), fractional shortening, and left cardiac structures (left atrial diameter, aortic root diameter, and left ventricular mass) were measured at the age of 6 y. Linear regression analyses were performed by using energy-adjusted macronutrient intakes, adjusted for maternal, child, and other dietary factors. Higher total fat intake was associated with higher carotid-femoral PWV (P-trend = 0.03), whereas higher intakes of total carbohydrate and mono- and disaccharides were associated with lower carotid-femoral PWV. No consistent associations were observed for macronutrient intake with systolic blood pressure, diastolic blood pressure, fractional shortening, and aortic root diameter. Higher intakes of total, saturated, monounsaturated, and polyunsaturated fat were associated with lower left atrial diameter (all P-trend ≤ 0.01), and higher total carbohydrate and mono- and disaccharide intakes were associated with higher left atrial diameter (P-trend < 0.01 and 0.02, respectively). Furthermore, the third tertile of mono- and disaccharide intake was associated with a higher left ventricular mass (difference: 1.01 g; 95% CI: 0.18, 1.85 g; P = 0.02). Dietary macronutrient composition in infancy may lead to developmental differences in cardiovascular structures and function in childhood. Further studies are needed to investigate whether these differences have consequences for the risk of future cardiovascular disease.

Determinants of metabolic syndrome in Chinese schoolchildren

The objective of this study was to identify the potential risk factors of metabolic syndrome (MetS) among Chinese schoolchildren. A cross-sectional study among 624 children (357 boys and 267 girls, aged 9.6 ± 0.7 years) was conducted in Wuhan, China, from May to June 2010. MetS was defined according to the criteria proposed by De Ferranti and the International Diabetes Federation (IDF) criteria. Data on cardiorespiratory fitness (CRF), household income, parental hypertension, and children's personal information, including birth weight, preterm birth, and breast-feeding, reported by their parents were obtained. Multiple logistic regression showed that CRF (odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.60-0.77), breast-feeding (OR = 0.32; 95% CI = 0.10-0.97), and paternal hypertension (OR = 5.06; 95% CI = 1.20-21.37) were all independently associated with MetS. In conclusion, low CRF and paternal hypertension significantly increase the risk, whereas breast-feeding may reduce the risk of MetS among Chinese schoolchildren.

Duration of breast-feeding and cardiovascular risk factors among Iranian children and adolescents: the CASPIAN III study

OBJECTIVES

Studies examining the relationship between breast-feeding (BF) duration and cardiovascular disease (CVD) risk factors have reached contradictory results. This study aims to investigate the relationship between BF duration and CVD risk factors in adolescents.

METHODS

This national population-based study was conducted among 5258 Iranian students, ages 10 to 18 y living in central cities of 27 provinces of Iran. Association was examined between duration of BF and adolescent blood pressure, overweight, obesity, and fasting blood glucose and lipid profiles. Analyses were adjusted for potential confounders.

RESULTS

Low birth weight was less frequent in the longer than in the shorter BF duration categories (P < 0.0001). Number of children was lower in individuals with longer BF duration (P = 0.01). Individuals with longer BF duration used more homemade food than those with shorter BF duration (P < 0.0001). Means of total cholesterol and systolic blood pressure were lower in participants with the longest BF period compared with those with the shortest BF duration; this difference was marginally significant (P = 0.06). No significant association was found between BF duration and CVD risk factors in logistic regression after adjustment for potential confounders.

CONCLUSIONS

Although the long-term benefits of BF on preventing CVDs are well documented, controversies exist as to the association of BF duration with such beneficial effects. In this study, there was no substantial evidence that longer BF duration was protective against CVD risk factors among adolescents. More prospective studies are recommended to clarify this association.

Breastfeeding and adolescent blood pressure: evidence from Hong Kong's "Children of 1997" Birth Cohort

Observationally, breastfeeding is associated with lower blood pressure in Western developed settings, whereas little association exists in developing settings. However, postnatal characteristics (e.g., breast milk substitutes, infection rates, underweight, and pubertal timing) differ between these settings. We examined the association of breastfeeding with blood pressure at ∼13 years, using multivariable linear regression, in 5,247 term births in 1997 from a population-representative Hong Kong Chinese birth cohort where socioeconomic patterning of breastfeeding differs from that of Western and developing settings but standard of living, social infrastructure, and postnatal characteristics are similar to those of Western settings. Higher education is associated with short-term breastfeeding but recent migration with longer-term breastfeeding. Compared with never breastfeeding, exclusive breastfeeding for ≥3 months was not associated with blood pressure (systolic mean difference = 0.82 mm Hg, 95% confidence interval (CI): -0.46, 2.11 and diastolic mean difference = 0.49 mm Hg, 95% CI: -0.22, 1.21), nor was partial breastfeeding for any length of time or exclusive breastfeeding for <3 months (systolic mean difference = 0.01 mm Hg, 95% CI: -0.64, 0.66 and diastolic mean difference = 0.16 mm Hg, 95% CI: -0.20, 0.52), adjusted for socioeconomic position and infant characteristics. Lack of association in a non-Western developed setting further suggests that observations concerning breastfeeding and blood pressure vary with setting, thereby casting doubt on causality.

Early programming of adult blood pressure in the low birth weight Yucatan miniature pig is exacerbated by a post-weaning high-salt-fat-sugar diet

We previously demonstrated that intra-uterine growth-restricted (IUGR) Yucatan miniature pigs develop modestly elevated blood pressure (BP) as young adults. The present study evaluated the effects of a post-weaning Western-style, high-salt-fat-sugar (HSFS) diet on early programming of BP. IUGR piglets (3 d old, 0·77 (sem 0·04) kg, n 6) were paired with normal weight (NW) same-sex littermates (1·14 (sem 0·03) kg, n 6) and fed milk replacer for 4 weeks. A third littermate was left with the sow (SF; 1·01 (sem 0·05) kg, n 6). When 4 weeks old, all pigs were placed on a HSFS diet ad libitum for 5 h/d. When 11 months old, telemeters were implanted to measure BP in pigs before (4·5 % NaCl) and after (0·5 % NaCl) a 7 d reduced salt challenge. At necropsy, nephron numbers were determined. Before sexual maturity, IUGR pigs had greater relative feed intake (P < 0·05), and experienced catch-up growth with greater adiposity, with correlations between adiposity and BP (P < 0·05). Adult IUGR pigs had 26–34 % fewer nephrons and higher diastolic BP (107·7 (sem 4·9) mmHg, P = 0·044) than NW (97·2 (sem 1·8) mmHg) and SF (98·9 (sem 5·3) mmHg) pigs. Systolic BP was similar among the three groups, but was significantly elevated compared with levels previously reported for a control diet. Salt restriction reduced BP in all groups (P < 0·05), but with no differences (P>0·05) in the degree of salt sensitivity among groups. In conclusion, a post-weaning Western-style diet exacerbates early programming of diastolic BP in Yucatan miniature swine, whereas systolic BP is more sensitive to postnatal diet.