1
|
Oh JH, Hong YM. Blood Pressure Trajectories from Childhood to Adolescence in Pediatric Hypertension. Korean Circ J 2019; 49:223-237. [PMID: 30808073 PMCID: PMC6393321 DOI: 10.4070/kcj.2018.0448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022] Open
Abstract
It has been known for a long time that elevated blood pressure (BP) in the young may persist and progress into adult hypertension (HTN). Multiple studies have revealed the predicted BP trajectory lines starting from childhood and related them to later cardiovascular (CV) risks in adulthood. As a small baby grows into a tall adult, BP will also naturally increase. Among early-life predictors of adult HTN, birth history, such as prematurity, and low birth weight have been popular subjects in research on pediatric HTN, because body size at birth has been reported to be inversely related to the risk of adulthood HTN. The hypothesis of HTN in prematurely born adolescents has been postulated as a physiological predisposition to postnatal excessive weight gain. Current body weight is a well-known independent predictor of HTN in children, and some studies showed that children demonstrating upward crossing of their weight percentiles while growing into adolescents have significantly increased risk for elevated BP later in life. Recently, reports focused on the adverse effect of excessive catch-up growth in this population are gradually drawing attention. Accordingly, children born prematurely or with intrauterine growth restriction who show rapid changes in their weight percentile should be under surveillance with BP monitoring. Prevention of childhood obesity, along with special care for premature infants or infants small for their gestational age, by providing healthy nutritional guidelines should be cardinal strategies for the prevention of adult HTN and CV risks later in life.
Collapse
Affiliation(s)
- Jin Hee Oh
- Department of Pediatrics, St.Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University Hospital College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
de Beer M, Vrijkotte TGM, Fall CHD, van Eijsden M, Osmond C, Gemke RJBJ. Associations of Infant Feeding and Timing of Weight Gain and Linear Growth during Early Life with Childhood Blood Pressure: Findings from a Prospective Population Based Cohort Study. PLoS One 2016; 11:e0166281. [PMID: 27832113 PMCID: PMC5104398 DOI: 10.1371/journal.pone.0166281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 10/26/2016] [Indexed: 11/28/2022] Open
Abstract
Objective Small birth size and rapid postnatal growth have been associated with higher future blood pressure. The timing of these effects, the relative importance of weight gain and linear growth and the role of infant feeding need to be clarified. Methods We assessed how blood pressure relates to birth weight, infant and childhood growth and infant feeding (duration of exclusive breastfeeding and timing of introduction of complementary feeding) in 2227 children aged 5 years from a prospective cohort study (Amsterdam Born Children and their Development). Postnatal growth was represented by statistically independent measures of relative weight gain (weight gain independent of height) and linear growth in four age periods during infancy (0–1 month; 1–3 months; 3–6 months; 6–12 months) and from 12 months to 5 years. Results Lower birth weight was associated with higher childhood diastolic blood pressure (-0.38 mm Hg.SD-1; P = 0.007). Faster relative weight gain and linear growth after 1 month were positively associated with systolic and diastolic blood pressure. Associations of linear growth with systolic blood pressure ranged from 0.47 to 1.49 mm Hg.SD-1; P<0.01 for all. Coefficients were similar for different periods of infancy and also for relative weight gain and linear growth. Compared to breastfeeding <1 month, breastfeeding >1 month was associated with lower blood pressure (e.g. >6 months -1.56 mm Hg systolic blood pressure; P<0.001). Compared to >6 months, introduction of complementary feeding <6 months was associated with higher blood pressure (e.g. 4–6 months 0.91 mm Hg systolic blood pressure; P = 0.004). Conclusions After the age of one month faster growth in either weight or height is associated with higher childhood blood pressure. It is unknown whether faster weight gain and linear growth carry the same risk for adult hypertension and cardiovascular morbidity. Longer breastfeeding and delayed introduction of complementary feeding may be associated with lower adult blood pressure.
Collapse
Affiliation(s)
- Marieke de Beer
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Tanja G. M. Vrijkotte
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline H. D. Fall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Manon van Eijsden
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, The Netherlands
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
3
|
Figueroa H, Cifuentes J, Lozano M, Alvarado C, Cabezas C, Eixarch E, Fernández E, Contreras L, Illanes SE, Hernández-Andrade E, Gratacós E, Irarrazabal CE. Nitric oxide synthase and changes in oxidative stress levels in embryonic kidney observed in a rabbit model of intrauterine growth restriction. Prenat Diagn 2016; 36:628-35. [PMID: 27109011 DOI: 10.1002/pd.4829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/17/2016] [Accepted: 04/11/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This work aimed to study the effect of uteroplacental circulation restriction on endothelial kidney damage in a fetal rabbit model. METHODS New Zealand rabbits were subjected to 40% to 50% of uteroplacental artery ligation at day 25 of pregnancy. After 5 days, surviving fetuses were harvested by cesarean section. The gene and protein expressions of selected enzymes associated with nitric oxide production and oxidative stress were analyzed in fetal kidney homogenates. RESULTS The placenta weight (6.06 ± 0.27, p < 0.0319) and fetal body (19.90 ± 1.03, p < 0.0001) were significantly reduced in the uteroplacental circulation restriction group. The kidneys from restricted fetuses presented a mild vascular congestion and glomerular capillary congestion, without inflammation or hypertrophy. We found endothelial nitric oxide synthase phosphorylation inhibition (0.23 ± 0.13, p < 0.012) and arginase-2 (0.29 ± 0.14, p < 0.023) protein induction in fetal kidneys of the circulation restriction group. Finally, the kidneys from circulation-restricted fetuses showed increased inducible nitric oxide synthase messenger RNA (mRNA) (2.68 ± 0.24, p < 0.01) and reduced heme oxygenase-1 mRNA (23 ± 1.3, p < 0.003), with increased reactive oxygen species (1.69 ± 0.09, p < 0.001) and nitrotyrosine protein (1.74 ± 0.28, p < 0.003) levels, without changes in Nox mRNA. CONCLUSION We describe significant deregulation of vascular activity and oxidative damage in kidneys of fetal rabbits that have been exposed to restriction of the uterine circulation. © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Horacio Figueroa
- Department of Obstetrics and Gynecology and Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Jorge Cifuentes
- Laboratory of Molecular and Integrative Physiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Mauricio Lozano
- Laboratory of Molecular and Integrative Physiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Cristobal Alvarado
- Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
- Department of Biological and Chemical Sciences, Universidad San Sebastián, Concepción, Chile
| | - Claudia Cabezas
- Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Elisenda Eixarch
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, and Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Ellio Fernández
- Laboratory of Molecular and Integrative Physiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Luis Contreras
- Department of Pathological Anatomy, Clínica Universidad de los Andes, Santiago, Chile
| | - Sebastian E Illanes
- Department of Obstetrics and Gynecology and Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Edgar Hernández-Andrade
- Department of Biological and Chemical Sciences, Universidad San Sebastián, Concepción, Chile
| | - Eduard Gratacós
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, and Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Carlos E Irarrazabal
- Laboratory of Molecular and Integrative Physiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| |
Collapse
|
4
|
Alves PJS, Henriques ACPT, Silva KF, Leite AJM, Feitosa FEL, Alencar CHM, Carvalho FHC. The influence of fetal growth restriction on cardiovascular health among adolescents in Brazil: a retrospective cohort study. Indian Pediatr 2015; 52:109-14. [PMID: 25691176 DOI: 10.1007/s13312-015-0582-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether fetal growth restriction is associated with changes in cardiovascular risk factors later in life. DESIGN A retrospective cohort study. SETTING Tertiary-care hospital serving urban population from the Brazilian Northeast. PARTICIPANTS/PATIENTS 172 adolescents aged 10-20 years were evaluated for the effects of fetal growth restriction on anthropometric measurements, blood pressure, lipids and fasting glucose and flow-mediated brachial artery dilatation. INTERVENTION The adolescents' birth weight and their gestational age at birth were used to identify fetal growth restriction according to the 10th percentile and divided between exposed (<10th percentile) and not exposed (≥10th percentile). The Student-t test or the Mann-Whitney test and chi-square were used. The significance level was considered to be 0.05. MAIN OUTCOME MEASURE(S) Current Anthropometric, metabolic and endothelial measures of subjects. RESULTS The majority of the current anthropometric, metabolic and endothelial measures did not differ between groups. The unexposed group had a higher hip circumference (89.1 cm) and higher total cholesterol (196.4mg/dL) than those exposed (85.4 cm, 136.9mg/dL, respectively) (P=0.04). CONCLUSIONS In the sample studied, no association was found between fetal growth restriction and changes in cardiovascular risk factors in adolescents.
Collapse
Affiliation(s)
- P J S Alves
- Department of Community Health, *Faculty of Medicine, and #Department of Maternal and Child Health, Federal University of Ceara, Fortaleza, Brazil. Correspondence to: Priscilla de Jesus dos Santos Alves. Department of Community Health, Faculty of Medicine, Federal University of Ceara. R. Prof. Costa Mendes 1608/5º andar, Rodolfo Teófilo. CEP: 60430-140, Fortaleza-CE.
| | | | | | | | | | | | | |
Collapse
|
5
|
Pan HT, Guo MX, Xiong YM, Ren J, Zhang JY, Gao Q, Ke ZH, Xu GF, Tan YJ, Sheng JZ, Huang HF. Differential proteomic analysis of umbilical artery tissue from preeclampsia patients, using iTRAQ isobaric tags and 2D nano LC–MS/MS. J Proteomics 2015; 112:262-73. [DOI: 10.1016/j.jprot.2014.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/02/2014] [Accepted: 09/06/2014] [Indexed: 02/04/2023]
|
6
|
Hill DJ, Prapavessis H, Shoemaker JK, Jackman M, Mahmud FH, Clarson C. Relationship between Birth Weight and Metabolic Status in Obese Adolescents. ISRN OBESITY 2013; 2013:490923. [PMID: 24555145 PMCID: PMC3901987 DOI: 10.1155/2013/490923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/28/2013] [Indexed: 01/20/2023]
Abstract
Objective. To examine the relationships between birth weight and body mass index, percent body fat, blood lipids, glycemia, insulin resistance, adipokines, blood pressure, and endothelial function in a cohort of obese adolescents. Design and Methods. Ninety-five subjects aged 10-16 years (mean age 13.5 years) with a body mass index >95th centile (mean [±SEM] 33.0 ± 0.6) were utilized from two prospective studies for obesity prevention prior to any interventions. The mean term birth weight was 3527 ± 64 g (range 1899-4990 g;). Results. Body mass index z-score correlated positively with birth weight (r (2) = 0.05, P = 0.03), but not percent body fat. Insulin resistance negatively correlated with birth weight (r (2) = 0.05, P < 0.001), as did fasting plasma insulin (r (2) = 0.05, P < 0.001); both being significantly greater for subjects of small versus large birth weight (Δ Homeostasis Model Assessment = 2.5 and Δ insulin = 10 pmol/L for birth weight <2.5 kg versus >4.5 kg). Adiponectin, but not leptin, blood pressure z-scores or peripheral arterial tomography values positively correlated with birth weight (r (2) = 0.07, P = 0.008). Conclusions. Excess body mass index in obese adolescents was positively related to birth weight. Birth weight was not associated with cardiovascular risk factors but represented a significant determinant of insulin resistance.
Collapse
Affiliation(s)
- David J. Hill
- London Health Sciences Centre, Lawson Health Research Institute, London, ON, Canada N6A 5W9
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor Street, London, ON, Canada N6A 4V2
- Department of Paediatrics, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5A5
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Harry Prapavessis
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - J. Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, ON, Canada N6A 5A5
| | - Michelle Jackman
- London Health Sciences Centre, Children's Hospital, London, ON, Canada N6A 5W9
- Department of Pediatrics , University of Calgary, Calgary, Alberta, Canada
| | - Farid H. Mahmud
- Department of Paediatrics, University of Toronto and Hospital for Sick Children, Toronto, ON, Canada M5G 1X8
| | - Cheril Clarson
- London Health Sciences Centre, Lawson Health Research Institute, London, ON, Canada N6A 5W9
- Department of Paediatrics, University of Western Ontario, London, ON, Canada N6A 5A5
- London Health Sciences Centre, Children's Hospital, London, ON, Canada N6A 5W9
| |
Collapse
|
7
|
Kelly TN, Gu D, Rao DC, Chen J, Chen J, Cao J, Li J, Lu F, Ma J, Mu J, Whelton PK, He J. Maternal history of hypertension and blood pressure response to potassium intake: the GenSalt Study. Am J Epidemiol 2012; 176 Suppl 7:S55-63. [PMID: 23035145 DOI: 10.1093/aje/kws272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The relation between parental history of hypertension and blood pressure response to potassium intake is unknown. A 7-day high-sodium followed by a 7-day high-sodium plus potassium dietary-feeding study was conducted from 2003 to 2005 among 1,871 Chinese participants. Those with a maternal history of hypertension had larger systolic blood pressure responses to potassium compared with those without: -4.31 (95% confidence interval (CI): -4.99, -3.62) mm Hg versus -3.35 (95% CI: -4.00, -2.70) mm Hg, respectively (P(difference) = 0.002). A consistent trend was observed for diastolic blood pressure responses: -1.80 (95% CI: -2.41, -1.20) mm Hg versus -1.35 (95% CI: -1.95, -0.74) mm Hg, respectively (P = 0.07). Stronger associations between early onset maternal hypertension and blood pressure responses were noted, with systolic blood pressure decreases of -4.80 (95% CI: -5.65, -3.95) mm Hg versus -3.55 (95% CI: -4.17, -2.93) mm Hg and diastolic blood pressure decreases of -2.25 (95% CI: -3.01, -1.50) mm Hg versus -1.42 (95% CI: -1.99, -0.85) mm Hg among those with early onset maternal hypertension versus those without, respectively (P = 0.001 and 0.009, respectively). Odds ratios for high potassium sensitivity were 1.36 (95% CI: 0.96, 1.92) and 1.60 (95% CI: 1.08, 2.36) for those with maternal hypertension and early onset maternal hypertension, respectively (P = 0.08 and 0.02, respectively). Potassium supplementation could help to reduce blood pressure among those with a maternal history of hypertension.
Collapse
Affiliation(s)
- Tanika N Kelly
- Department of Epidemiology, Tulane University, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Unilateral ureteropelvic junction obstruction (UPJO) is the most common prenatally detected disease leading to hydronephrosis. The obstructive anatomic lesion leads to varying degrees of hydronephrosis, ranging from no apparent effect on renal function to atrophy. Furthermore, the natural course of hydronephrosis varies from spontaneous resolution to progressive deterioration and may take upwards of 3 years for a kidney to declare itself. The objectives of this article are to update our knowledge regarding the evaluation and management of UPJO in depth and to discuss the emerging value of urinary proteome analysis to the clinical arena.
Collapse
Affiliation(s)
- Hrair-George O Mesrobian
- Division of Pediatric Urology, Department of Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
| | | |
Collapse
|
9
|
Abstract
OBJECTIVES We used magnetic resonance imaging (MRI) to perform volumetry of foetuses with and without growth restriction, and identify deviations in organ growth. STUDY DESIGN 20 growth restricted and 19 normal foetuses were scanned once during pregnancy at gestational age 20.53-36.57 weeks. MRI scans were performed on a 1.5T system using ssFSE sequences. Manual segmentation of whole body, brain, heart, lung, liver, thymus and kidney volume was performed. Data on the severity of foetal growth restriction and pregnancy outcome was collected. RESULTS There was a significant reduction in foetal whole body volume and volume of all internal organs except the brain in growth restricted foetuses. A brain:liver ratio above 3.0 was associated with a 3.3 fold increase in risk of perinatal mortality (95% CI=1.68-6.47). CONCLUSION MRI provides an accurate assessment of foetal organ growth. It may have a role to play in monitoring disease severity and the effect of future interventions.
Collapse
|
10
|
Alwasel SH, Ashton N. Segmental sodium reabsorption by the renal tubule in prenatally programmed hypertension in the rat. Pediatr Nephrol 2012; 27:285-93. [PMID: 21863227 DOI: 10.1007/s00467-011-1976-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/05/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
Abstract
Hypertension and renal dysfunction can be programmed in the rat by prenatal exposure to a low-protein (LP) diet. Expression of the renal thick ascending limb (TAL) sodium transporter NKCC2 is up-regulated, which has been predicted to result in greater sodium reabsorption. However, we have shown that LP rats excrete more not less sodium. The aim of this study was to determine whether the increased abundance of sodium:potassium:chloride (Na(+):K(+):2Cl(-)) co-transporter (NKCC2) leads to enhanced sodium uptake by the TAL. Pregnant Wistar rats were fed a control (18%) or LP (9%) diet. Amiloride (AM), bendroflumethiazide (BF), and furosemide (FUR) were administered acutely to male offspring at 4 weeks of age. Fractional excretion of sodium (FE(Na)) was significantly greater in vehicle-infused LP rats (3.0 ± 0.3%) compared with controls (1.7 ± 0.5, P < 0.01). FE(Na) by the LP proximal tubule did not differ from controls, whereas FE(Na) by the distal tubule was significantly greater (P < 0.01). These differences were abolished by the administration of AM + BF (equivalent to the outflow from the TAL) and AM + BF + FUR (equivalent to the outflow from the proximal tubule), suggesting that the increase in NKCC2 expression was not functional. However, during acute salt loading, the LP rat pressure natriuresis curve was shifted rightward, implying that raised systemic blood pressure is required to match urinary sodium excretion with dietary intake. These data suggest that renal sodium handling is impaired in the LP rat but that this is not due to increased NKCC2 expression.
Collapse
Affiliation(s)
- Saleh H Alwasel
- Fetal Programming of Diseases Research Chair, College of Science, King Saud University, PO Box 2455, Riyadh, 11451, Saudi Arabia.
| | | |
Collapse
|
11
|
Hernández MI, Mericq V. Metabolic syndrome in children born small-for-gestational age. ACTA ACUST UNITED AC 2011; 55:583-9. [DOI: 10.1590/s0004-27302011000800012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/16/2011] [Indexed: 02/08/2023]
Abstract
Being born small-for-gestational age and a rapid increase in weight during early childhood and infancy has been strongly linked with chronic diseases, including metabolic syndrome, which has been related to intrauterine life environment and linked to epigenetic fetal programming. Metabolic syndrome includes waist circumference > 90th percentile for age, sex and race, higher levels of blood pressure, triglycerides and fasting glucose, and low levels of HDL-cholesterol. Insulin resistance may be present as early as 1 year of age, and obesity and/or type 2 diabetes are more prevalent in those born SGA than those born AGA. The programming of adaptive responses in children born SGA includes an association with increased blood pressure, changes in endothelial function, arterial properties and coronary disease. Early interventions should be directed to appropriate maternal nutrition, before and during pregnancy, promotion of breast feeding, and prevention of rapid weight gain during infancy, and to promote a healthy lifestyle.
Collapse
|
12
|
Abstract
Epidemiologic studies now strongly support the hypothesis, proposed over two decades ago, that developmental programming of the kidney impacts an individual's risk for hypertension and renal disease in later life. Low birth weight is the strongest current clinical surrogate marker for an adverse intrauterine environment and, based on animal and human studies, is associated with a low nephron number. Other clinical correlates of low nephron number include female gender, short adult stature, small kidney size, and prematurity. Low nephron number in Caucasian and Australian Aboriginal subjects has been shown to be associated with higher blood pressures, and, conversely, hypertension is less prevalent in individuals with higher nephron numbers. In addition to nephron number, other programmed factors associated with the increased risk of hypertension include salt sensitivity, altered expression of renal sodium transporters, altered vascular reactivity, and sympathetic nervous system overactivity. Glomerular volume is universally found to vary inversely with nephron number, suggesting a degree of compensatory hypertrophy and hyperfunction in the setting of a low nephron number. This adaptation may become overwhelmed in the setting of superimposed renal insults, e.g. diabetes mellitus or rapid catch-up growth, leading to the vicious cycle of on-going hyperfiltration, proteinuria, nephron loss and progressive renal functional decline. Many millions of babies are born with low birth weight every year, and hypertension and renal disease prevalences are increasing around the globe. At present, little can be done clinically to augment nephron number; therefore adequate prenatal care and careful postnatal nutrition are crucial to optimize an individual's nephron number during development and potentially to stem the tide of the growing cardiovascular and renal disease epidemics worldwide.
Collapse
Affiliation(s)
- Valerie A. Luyckx
- Associate Professor, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
- To whom correspondence should be addressed. E-mail:
| | - Khuloud Shukha
- Internal Medicine Resident, Mount Auburn Hospital, Cambridge, MA, USA; and
| | - Barry M. Brenner
- Samuel A. Levine Distinguished Professor of Medicine Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Dötsch J. Low birth weight, bone metabolism and fracture risk. DERMATO-ENDOCRINOLOGY 2011; 3:240-2. [PMID: 22259651 DOI: 10.4161/derm.3.4.14636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 11/25/2010] [Indexed: 01/23/2023]
Abstract
As for other diseases of higher age, low birth weight was expected to be a risk factor for an altered bone metabolism and osteoporosis.ON THE FIRST GLANCE THIS EXPECTATION APPEARS TO BE CONFIRMED BY ANIMAL DATA: rats with intrauterine growth restriction following maternal protein malnutrition show a reduction of bone mineral density going in line with a decrease in serum vitamin D concentrations.HOWEVER, THE SITUATION IS LESS CLEAR IN NEWBORNS WITH LOW BIRTH WEIGHT: Some studies show a relation of birth weight and bone mineral density whereas others don't. The older the former low birth weight patients the fainter the effect seems to be. In fact young adults with idiopathic short stature have a low bone mineral density than the low birth weight group irrespective of whether they have experienced catch-up growth or not. As a consequence low birth weight is can not be identified as a relevant risk factor for hip fractures in menopausal women. Postmenopausal women with low birth weight even show higher vitamin D concentrations than normal birth weight individuals.In conclusion, there is no consistent long term effect of low birth weight on bone mineral density or hip fracture risk later in life. Whether methodological weaknesses in the studies performed so far are causal or whether postnatal factors such as physical activity and nutrition are of higher importance can only be speculated upon at present.
Collapse
Affiliation(s)
- Jörg Dötsch
- Klinik und Poliklinik für Kinder-und Jugendmedizin; Uniklinik Köln, Cologne, Germany
| |
Collapse
|
14
|
Vasylyeva TL, Chennasamudram SP, Okogbo ME. Can we predict hypertension among preterm children? Clin Pediatr (Phila) 2011; 50:936-42. [PMID: 21646252 DOI: 10.1177/0009922811409918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prematurity and low birth weight (LBW) cause hypertension (HTN), ischemic heart disease, and obesity in young adults. The objective of the study was to identify risk factors for the development of HTN in children born preterm or at a LBW and to assess pediatricians' awareness of the problem. A retrospective review of 160 cases was conducted. In total, 22% of babies born preterm/LBW developed HTN by age 15 years. The odds of developing HTN were 1.6 times greater for every one standard deviation increase in body mass index. Higher risk posses for those born small for gestational age and under 1000 g. Of the 35 cases of HTN identified, only 31% were recognized as abnormal by the primary care providers. The development of obesity and HTN appear related in preterm/LBW children. Awareness of prematurity or LBW as a risk factor for HTN should be raised among pediatric primary care providers.
Collapse
|
15
|
Mital S, Chung WK, Colan SD, Sleeper LA, Manlhiot C, Arrington CB, Cnota JF, Graham EM, Mitchell ME, Goldmuntz E, Li JS, Levine JC, Lee TM, Margossian R, Hsu DT. Renin-angiotensin-aldosterone genotype influences ventricular remodeling in infants with single ventricle. Circulation 2011; 123:2353-62. [PMID: 21576655 PMCID: PMC3137902 DOI: 10.1161/circulationaha.110.004341] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We investigated the effect of polymorphisms in the renin-angiotensin-aldosterone system (RAAS) genes on ventricular remodeling, growth, renal function, and response to enalapril in infants with single ventricle. METHODS AND RESULTS Single ventricle infants enrolled in a randomized trial of enalapril were genotyped for polymorphisms in 5 genes: angiotensinogen, angiotensin-converting enzyme, angiotensin II type 1 receptor, aldosterone synthase, and chymase. Alleles associated with renin-angiotensin-aldosterone system upregulation were classified as risk alleles. Ventricular mass, volume, somatic growth, renal function using estimated glomerular filtration rate, and response to enalapril were compared between patients with ≥2 homozygous risk genotypes (high risk), and those with <2 homozygous risk genotypes (low risk) at 2 time points: before the superior cavopulmonary connection (pre-SCPC) and at age 14 months. Of 230 trial subjects, 154 were genotyped: Thirty-eight were high risk, and 116 were low risk. Ventricular mass and volume were elevated in both groups pre-SCPC. Ventricular mass and volume decreased and estimated glomerular filtration rate increased after SCPC in the low-risk (P<0.05), but not the high-risk group. These responses were independent of enalapril treatment. Weight and height z-scores were lower at baseline, and height remained lower in the high-risk group at 14 months, especially in those receiving enalapril (P<0.05). CONCLUSIONS Renin-angiotensin-aldosterone system-upregulation genotypes were associated with failure of reverse remodeling after SCPC surgery, less improvement in renal function, and impaired somatic growth, the latter especially in patients receiving enalapril. Renin-angiotensin-aldosterone system genotype may identify a high-risk subgroup of single ventricle patients who fail to fully benefit from volume-unloading surgery. Follow-up is warranted to assess long-term impact. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT00113087.
Collapse
Affiliation(s)
- Seema Mital
- Division of Pediatric Cardiology Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Filler G, Yasin A, Kesarwani P, Garg AX, Lindsay R, Sharma AP. Big mother or small baby: which predicts hypertension? J Clin Hypertens (Greenwich) 2011; 13:35-41. [PMID: 21214720 PMCID: PMC8673311 DOI: 10.1111/j.1751-7176.2010.00366.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 06/01/2010] [Indexed: 01/21/2023]
Abstract
According to the Barker hypothesis, intrauterine growth restriction and premature delivery adversely affect cardiovascular health in adult life. The association of childhood hypertension as a cardiovascular risk factor and birth weight has been understudied. In a prospective cohort study, the authors evaluated the effect of birth weight, gestational age, maternal prepregnancy body mass index (BMI), and child BMI z score at the time of enrollment on the systolic and diastolic blood pressure (BP) z score in 3024 (1373 women) consecutive outpatient clinic patients aged 2.05 to 18.58 years. The latest National Health and Nutrition Examination Survey (NHANES III) was used to calculate the age-dependent z scores. The median z scores of BMI (+0.48, range -6.96-6.64), systolic BP (+0.41, range -4.50-6.73), and diastolic BP (+0.34, range -3.15-+6.73) were all significantly greater than the NHANES III reference population. Systolic BP z score did not correlate with birth weight or gestational age, but did correlate with maternal prepregnancy BMI (r=.090, P<.0001) and BMI z score (r=.209, P<.0001). Diastolic BP z score positively correlated with birth weight (0.037, P=.044), gestational age (r=.052, P=.005), BMI z score(r=.106, P<.0001), and maternal prepregnancy BMI (r=.062, P=.0007). In contrast to what would be expected from the Barker hypothesis, the authors found no negative correlation between BP z score and birth weight or gestational age. This study suggests that a high BMI, a big mom, and a high birth weight are more important risk factors for hypertension during childhood than low birth weight or gestational age.
Collapse
Affiliation(s)
- Guido Filler
- Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital, London, Ontario, Canada.
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
Cardiovascular complications occurring in adults find their roots in risk factors operating early in life. Among the factors influencing cardiovascular risk, blood pressure values in children represent an important measurable marker of the level of potential cardiovascular risk later in life because the levels are both the cause and the consequence of early vascular alterations. Early vascular phenotypes represent a field of great interest, and they can be studied through indirect assessment using non-invasive techniques. Estimations of blood pressure components, pulse wave velocity, and reflecting waves provide valuable information that can be easily recorded and repeated overtime. A direct assessment, carried out by examining the umbilical vessels, can add further valuable information. In this review, we discuss the potential application of surrogate markers of early vascular alterations and describe the information provided by umbilical cord vessels.
Collapse
|
18
|
Abstract
Abundant evidence supports the association between low birth weight (LBW) and renal dysfunction in humans. Anatomic measurements of infants, children, and adults show significant inverse correlation between LBW and nephron number. Nephron numbers are also lower in individuals with hypertension compared with normotension among white and Australian Aboriginal populations. The relationship between nephron number and hypertension among black individuals is still unclear, although the high incidence of LBW predicts low nephron number in this population as well. LBW, a surrogate for low nephron number, also associates with increasing BP from childhood to adulthood and increasing risk for chronic kidney disease in later life. Because nephron numbers can be counted only postmortem, surrogate markers such as birth weight, prematurity, adult height, reduced renal size, and glomerulomegaly are potentially useful for risk stratification, for example, during living-donor assessment. Because early postnatal growth also affects subsequent risk for higher BP or reduced renal function, postnatal nutrition, a potentially modifiable factor, in addition to intrauterine effects, has significant influence on long-term cardiovascular and renal health.
Collapse
Affiliation(s)
- Valerie A Luyckx
- Department of Medicine, HMRC 260, University of Alberta, Edmonton, Canada, T6G 2S2.
| | | |
Collapse
|
19
|
Meas T. Fetal origins of insulin resistance and the metabolic syndrome: a key role for adipose tissue? DIABETES & METABOLISM 2009; 36:11-20. [PMID: 19815442 DOI: 10.1016/j.diabet.2009.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 09/02/2009] [Accepted: 09/02/2009] [Indexed: 12/12/2022]
Abstract
For several years now, the epidemiological data have shown an inverse relationship between birth-weight and the development in later life of cardiovascular disease and metabolic disorders. The term "small for gestational age" (SGA) describes a neonate whose birth-weight is two standard deviations (SD) below the reference mean, corrected for gestational age and gender. SGA is associated with increased risks of developing hypertension, insulin resistance and type2 diabetes. However, the association with an atherogenic lipid profile is less clear. Nevertheless, all of the components of the metabolic syndrome are present. Yet, in spite of the large body of data in the literature, the biological mechanisms underlying this association are still unclear. To explain the association, various hypotheses have been proposed, pointing to the role of a detrimental fetal environment or genetic susceptibility, or interaction between the two, and to the particular dynamic changes in adiposity that occur during catch-up growth. However, not only quantitative, but also qualitative, abnormalities of adipose tissue have been observed, suggesting a critical role of this organ in the development of metabolic complications.
Collapse
Affiliation(s)
- T Meas
- U690 INSERM, hôpital Robert-Debré, 48, boulevard Sérurier, Paris, France.
| |
Collapse
|
20
|
Martín de Llano JJ, Fuertes G, Torró I, García Vicent C, Fayos JL, Lurbe E. Birth weight and characteristics of endothelial and smooth muscle cell cultures from human umbilical cord vessels. J Transl Med 2009; 7:30. [PMID: 19393064 PMCID: PMC2680391 DOI: 10.1186/1479-5876-7-30] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 04/24/2009] [Indexed: 11/13/2022] Open
Abstract
Background Low birth weight has been related to an increased risk for developing high blood pressure in adult life. The molecular and cellular analysis of umbilical cord artery and vein may provide information about the early vascular characteristics of an individual. We have assessed several phenotype characteristics of the four vascular cell types derived from human umbilical cords of newborns with different birth weight. Further follow-up studies could show the association of those vascular properties with infancy and adulthood blood pressure. Methods Endothelial and smooth muscle cell cultures were obtained from umbilical cords from two groups of newborns of birth weight less than 2.8 kg or higher than 3.5 kg. The expression of specific endothelial cell markers (von Willebrand factor, CD31, and the binding and internalization of acetylated low-density lipoprotein) and the smooth muscle cell specific α-actin have been evaluated. Cell culture viability, proliferation kinetic, growth fraction (expression of Ki67) and percentage of senescent cells (detection of β-galactosidase activity at pH 6.0) have been determined. Endothelial cell projection area was determined by morphometric analysis of cell cultures after CD31 immunodetection. Results The highest variation was found in cell density at the confluence of endothelial cell cultures derived from umbilical cord arteries (66,789 ± 5,093 cells/cm2 vs. 45,630 ± 11,927 cells/cm2, p < 0.05). Morphometric analysis indicated that the projection area of the artery endothelial cells (1,161 ± 198 and 1,544 ± 472 μm2, p < 0.05), but not those derived from the vein from individuals with a birth weight lower than 2.8 kg was lower than that of cells from individuals with a birth weight higher than 3.5 kg. Conclusion The analysis of umbilical cord artery endothelial cells, which demonstrated differences in cell size related to birth weight, can provide hints about the cellular and molecular links between lower birth weight and increased adult high blood pressure risk.
Collapse
Affiliation(s)
- José Javier Martín de Llano
- Pediatric Department, Consorcio Hospital General Universitario de Valencia, and CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Spain.
| | | | | | | | | | | |
Collapse
|