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Mamidi RS, Banjara SK, Manchala S, Babu CK, Geddam JJB, Boiroju NK, Varanasi B, Neeraja G, Reddy GVR, Ramalakshmi BA, Hemalatha R, Meur G. Maternal Nutrition, Body Composition and Gestational Weight Gain on Low Birth Weight and Small for Gestational Age-A Cohort Study in an Indian Urban Slum. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101460. [PMID: 36291396 PMCID: PMC9600910 DOI: 10.3390/children9101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 01/16/2023]
Abstract
Maternal nutritional status and care during pregnancy are essential for adequate birth weight. In this prospective cohort study (N = 1061) in an urban slum, we investigated the association of maternal anthropometry, body composition, gestational weight gain and dietary intakes with low birthweight (LBW, <2.5 kg). About one-third of the women were short (<150 cm), 35% were underweight (<45 kg), 23% suffered from chronic energy deficiency (CED, BMI < 18.5 kg/m2) and another 30% were overweight/obese. The mean age and BMI were 23 years and 21.7 kg/m2, respectively, and haemoglobin was 10.73 g/dL. The mean birthweight (N = 605) was 2.81 ± 0.5 kg, and the average gestational age was 38 ± 2 weeks. About 15% of infants had LBW, and 48% were small for gestational age (SGA). Maternal body composition was assessed by skinfold thickness (SFT) in all trimesters. In the first trimester (N = 762), we found that mean fat-free mass (FFM), fat mass (FM) and body fat percentage (% BF) were 38.86 kg, 11.43 kg and 21.55%, respectively. Low birthweight was significantly associated with preterm deliveries (p < 0.001) and less fat free mass (p = 0.02) in the third trimester. Among other factors were age (p = 0.017), maternal anthropometry (height: p = 0.031; weight: p = 0.059) and fewer antenatal check-ups (p = 0.037). Small size (SGA) was consistently associated with maternal bodyweight at all trimesters (term I, p = 0.013, term II, p = 0.003 and term III, p < 0.001), fat mass in the third trimester (p < 0.001) and maternal height (p = 0.003).
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Affiliation(s)
- Raja Sriswan Mamidi
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | | | - Sridevi Manchala
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - Ch Khadar Babu
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - J. J. Babu Geddam
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - Naveen Kumar Boiroju
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - Bhaskar Varanasi
- Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - G. Neeraja
- Public Health Nutrition, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - G. Venkat Raji Reddy
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - B. A. Ramalakshmi
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
| | - R. Hemalatha
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
- Correspondence: (R.H.); (G.M.); Tel.: +91-4027197200 (R.H.); +91-4027197472 (G.M.)
| | - Gargi Meur
- Clinical Epidemiology Division, ICMR-National Institute of Nutrition, Hyderabad 500 007, India
- Correspondence: (R.H.); (G.M.); Tel.: +91-4027197200 (R.H.); +91-4027197472 (G.M.)
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Mishra PS, Sinha D, Kumar P, Srivastava S, Bawankule R. Newborn low birth weight: do socio-economic inequality still persist in India? BMC Pediatr 2021; 21:518. [PMID: 34798861 PMCID: PMC8603541 DOI: 10.1186/s12887-021-02988-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of preterm birth and subsequent low birth weight (LBW) are vital global public health issues. It contributes to high infant and child mortality in the early stages of life and later on in adult life; it increases the risk for non-communicable diseases. The study aims to understand the socio-economic status-related inequality for LBW among children in India. It hypothesises that there is no association between the socio-economic status of the household and the newborn's LBW in India. METHODS The study utilised data from the fourth round of the National Family Health Survey, a national representative cross-sectional survey conducted in 2015-16 (N = 127,141). The concentration index (CCI) and the concentration curve (CC) measured socio-economic inequality in low birth status among newborns. Wagstaff decomposition further analysed key contributors in CCI by segregating significant covariates. RESULTS About 18.2% of children had low birth weight status. The value of concentration was - 0.05 representing that low birth weight status is concentrated among children from lower socio-economic status. Further, the wealth quintile explained 76.6% of the SES related inequality followed by regions of India (- 44%) and the educational status of mothers (43.4%) for LBW among children in India. Additionally, the body mass index of the women (28.4%), ante-natal care (20.8%) and residential status (- 15.7%) explained SES related inequality for LBW among children in India. CONCLUSION Adequate attention should be given to the mother's nutritional status. Awareness of education and usage of health services during pregnancy should be promoted. Further, there is a need to improve the coverage and awareness of the ante-natal care (ANC) program. In such cases, the role of the health workers is of utmost importance. Programs on maternal health services can be merged with maternal nutrition to bring about an overall decline in the LBW of children in India.
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Affiliation(s)
- Prem Shankar Mishra
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, Karnataka 560072 India
| | - Debashree Sinha
- Department of Development Studies, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Pradeep Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Rahul Bawankule
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
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Frémondière P, Thollon L, Marchal F. Pelvic and neonatal size correlations in light of evolutionary hypotheses. Am J Hum Biol 2021; 34:e23619. [PMID: 34028115 DOI: 10.1002/ajhb.23619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the correlations between maternal size, neonatal size, and gestational variables. METHODS Our sample comprises 131 mother-infant dyads. We investigated correlations between five neonatal traits (gestational age, birthweight, head, suboccipito-brematic, and abdominal girths), three maternal traits (height, BMI, and uterus height), and three pelvic variables (conjugate, inter-spinous diameters, and sub-pubic angle) using computed tomography pelvimetry. RESULTS We found that the five neonatal traits were significantly intercorrelated. BMI was not correlated with neonatal traits while maternal height was correlated with birthweight, suboccipito-brematic, and abdominal girth. In the multiple regression models, gestational age was correlated with birthweight, head, and abdominal girth. Among the neonatal and pelvimetry correlations, conjugate diameter was slightly correlated with suboccipito-bregmatic girth, but inter-spinous and sub-pubic angle were not correlated with neonatal traits. Uterus height predicted all neonatal variables, but it was not correlated with gestational age. DISCUSSION Our results suggest that fetal growth is shaped by maternal phenotype rather than external ecological factors. The association of the inlet size with suboccipito-bregmatic girth reflects the tight fit between the neonatal brain and the maternal pelvis dimensions, an adaptation that would reduce the risk of cephalo-pelvic disproportion, while the absence of tight fit at the midplane and outlet could be due to the effect of the pelvic relaxation. Uterus distention is not the only mechanism involved in the initiation of parturition. Birth and pregnancy are complex processes and we suggest that maternal-neonatal associations are the result of a combination of multiple obstetric tradeoffs.
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Affiliation(s)
- Pierre Frémondière
- Aix Marseille Univ, School of Midwifery, Faculty of Medical and Paramedical Sciences, Marseille, France.,Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Lionel Thollon
- Applied Biomechanics Laboratory (UMR-T24), Marseille, France
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Abdollahi S, Soltani S, de Souza RJ, Forbes SC, Toupchian O, Salehi-Abargouei A. Associations between Maternal Dietary Patterns and Perinatal Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr 2021; 12:1332-1352. [PMID: 33508080 PMCID: PMC8321866 DOI: 10.1093/advances/nmaa156] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.
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Affiliation(s)
- Shima Abdollahi
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Scott C Forbes
- Department of Physical Education, Faculty of Education, Brandon University, Brandon, Manitoba, Canada
| | - Omid Toupchian
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Pomeroy E, Mushrif-Tripathy V, Cole TJ, Wells JCK, Stock JT. Ancient origins of low lean mass among South Asians and implications for modern type 2 diabetes susceptibility. Sci Rep 2019; 9:10515. [PMID: 31324875 PMCID: PMC6642207 DOI: 10.1038/s41598-019-46960-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 07/05/2019] [Indexed: 12/21/2022] Open
Abstract
Living South Asians have low lean tissue mass relative to height, which contributes to their elevated type 2 diabetes susceptibility, particularly when accompanied by obesity. While ongoing lifestyle transitions account for rising obesity, the origins of low lean mass remain unclear. We analysed proxies for lean mass and stature among South Asian skeletons spanning the last 11,000 years (n = 197) to investigate the origins of South Asian low lean mass. Compared with a worldwide sample (n = 2,003), South Asian skeletons indicate low lean mass. Stature-adjusted lean mass increased significantly over time in South Asia, but to a very minor extent (0.04 z-score units per 1,000 years, adjusted R2 = 0.01). In contrast stature decreased sharply when agriculture was adopted. Our results indicate that low lean mass has characterised South Asians since at least the early Holocene and may represent long-term climatic adaptation or neutral variation. This phenotype is therefore unlikely to change extensively in the short term, so other strategies to address increasing non-communicable disease rates must be pursued.
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Affiliation(s)
- Emma Pomeroy
- Department of Archaeology, University of Cambridge, Downing Street, Cambridge, CB2 3DZ, UK.
| | - Veena Mushrif-Tripathy
- Department of Archaeology, Deccan College Postgraduate and Research Institute, Yerwada, Pune, 411 006, India
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jonathan C K Wells
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jay T Stock
- ADaPt Project, PAVE Research Group, Department of Archaeology, University of Cambridge, Pembroke Street, Cambridge, CB2 3DZ, UK
- Department of Anthropology, University of Western Ontario, London, Ontario, N6A 5C2, Canada
- Department of Archaeology, Max Planck Institute for the Science of Human History, Kahlaische Strasse 10, Jena, Germany, Jena, Germany
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Kulkarni B. Addressing the Double Burden of Malnutrition in Developing Countries: Need for Strategies to Improve the Lean Body Mass. Food Nutr Bull 2019; 39:S69-S76. [PMID: 30238797 DOI: 10.1177/0379572118768572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The double burden of childhood undernutrition and adult-onset adiposity-related chronic diseases is a key concern in many developing countries that are currently undergoing epidemiological and nutrition transition. Impaired linear growth with suboptimal lean body mass development seems to be the link between these 2 seemingly contrasting forms of malnutrition. Studies assessing the role of early nutrition in the later lean body mass development have shown consistent positive association. In addition, the nutrition during life course, especially the dietary intake of protein, zinc, calcium, and vitamin D status, impacts the lean body mass. Promoting increased intake of these important nutrients throughout life course would, therefore, be important for optimal development and maintenance of lean body mass. Diversified diets with increased consumption of nutrient-rich foods, especially milk and other animal source foods, are crucial for the development of optimal body composition and alleviation of the double burden of malnutrition.
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Wells JCK. Life history trade-offs and the partitioning of maternal investment: Implications for health of mothers and offspring. Evol Med Public Health 2018; 2018:153-166. [PMID: 30152817 PMCID: PMC6101534 DOI: 10.1093/emph/eoy014] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 06/08/2018] [Indexed: 12/30/2022] Open
Abstract
Lay Summary: This review sets out the hypothesis that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk. Growth patterns in early life predict the risk of non-communicable diseases (NCDs), but adaptive explanations remain controversial. It is widely assumed that NCDs occur either because of physiological adjustments to early constraints, or because early ecological cues fail to predict adult environmental conditions (mismatch). I present an inter-generational perspective on developmental plasticity, based on the over-arching hypothesis that a key axis of variability in maternal metabolism derives from life history trade-offs, which influence how individual mothers partition nutritional investment in their offspring between pregnancy and lactation. I review evidence for three resulting predictions: (i) Allocating relatively more energy to growth during development promotes the capacity to invest in offspring during pregnancy. Relevant mechanisms include greater fat-free mass and metabolic turnover, and a larger physical space for fetal growth. (ii) Allocating less energy to growth during development constrains fetal growth of the offspring, but mothers may compensate by a tendency to attain higher adiposity around puberty, ecological conditions permitting, which promotes nutritional investment during lactation. (iii) Since the partitioning of maternal investment between pregnancy and lactation impacts the allocation of energy to 'maintenance' as well as growth, it is expected to shape offspring NCD risk as well as adult size and body composition. Overall, this framework predicts that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC, UK
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Geng TT, Huang T. Maternal central obesity and birth size: a Mendelian randomization analysis. Lipids Health Dis 2018; 17:181. [PMID: 30064420 PMCID: PMC6069873 DOI: 10.1186/s12944-018-0831-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/18/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Observational studies have illustrated that maternal central obesity is associated with birth size, including of birth weight, birth length and head circumference, but the causal nature of these associations remains unclear. Our study aimed to test the causal effect of maternal central obesity on birth size and puberty height growth using a Mendelian randomization (MR) analysis. METHODS We performed two-sample MR using summary-level genome-wide public data. Thirty-five single nucleotide polymorphisms (SNPs), 25 SNPs and 41 SNPs were selected as instrumental variables for waist-to-hip ratio adjusted for BMI, waist circumference adjusted for BMI and hip circumference adjusted for BMI, respectively to test the causal effects of maternal central obesity on birth size and puberty height using an inverse-variance-weighted approach. RESULTS In this MR analysis, we found no evidence of a causal association between waist circumference or waist-to-hip ratio and the outcomes. However, we observed that one standard deviation (SD) increase in hip circumference (HIP) was associated with a 0.392 SD increase in birth length (p = 1.1 × 10- 6) and a 0.168 SD increase in birth weight (p = 7.1 × 10- 5), respectively at the Bonferroni-adjusted level of significance. In addition, higher genetically predicted maternal HIP was strongly associated with the puberty heights (0.835 SD, p = 8.4 × 10- 10). However, HIP was not associated with head circumference (p = 0.172). CONCLUSIONS A genetic predisposition to higher maternal HIP was causally associated with larger offspring birth size independent of maternal BMI. However, we found no evidence of a causal association between maternal waist circumference, waist-to-hip ratio and birth size.
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Affiliation(s)
- Ting-Ting Geng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Wells JCK, Figueiroa JN, Alves JG. Maternal pelvic dimensions and neonatal size: Implications for growth plasticity in early life as adaptation. Evol Med Public Health 2018; 2017:191-200. [PMID: 29423225 PMCID: PMC5798154 DOI: 10.1093/emph/eox016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 10/02/2017] [Indexed: 01/05/2023] Open
Abstract
Patterns of fetal growth predict non-communicable disease risk in adult life, but fetal growth variability appears to have a relatively weak association with maternal nutritional dynamics during pregnancy. This challenges the interpretation of fetal growth variability as 'adaptation'. We hypothesized that associations of maternal size and nutritional status with neonatal size are mediated by the dimensions of the maternal pelvis. We analysed data on maternal height, body mass index (BMI) and pelvic dimensions (conjugate, inter-spinous and inter-cristal diameters) and neonatal gestational age, weight, length, thorax girth and head girth (n = 224). Multiple regression analysis was used to identify independent maternal predictors of neonatal size, and the mediating role of neonatal head girth in these associations. Pelvic dimensions displaced maternal BMI as a predictor of birth weight, explaining 11.6% of the variance. Maternal conjugate and inter-spinous diameters predicted neonatal length, thorax girth and head girth, whereas inter-cristal diameter only predicted neonatal length. Associations of pelvic dimensions with birth length, but not birth weight, were mediated by neonatal head girth. Pelvic dimensions predicted neonatal size better than maternal BMI, and these associations were mostly independent of maternal height. Sensitivity of fetal growth to pelvic dimensions reduces the risk of cephalo-pelvic disproportion, potentially a strong selective pressure during secular trends in height. Selection on fetal adaptation to relatively inflexible components of maternal phenotype, rather than directly to external ecological conditions, may help explain high levels of growth plasticity during late fetal life and early infancy.
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Affiliation(s)
- Jonathan C K Wells
- Population, Policy and Practice Programme, Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - José N Figueiroa
- Department of Pediatrics and Statistics Unit, Faculdade Pernambucana de Saúde (FPS), Medical School, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos 300, Boa Vista, Recife, PE Brazil CEP 52050-080, Brazil
| | - Joao G Alves
- Department of Pediatrics and Statistics Unit, Faculdade Pernambucana de Saúde (FPS), Medical School, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Rua dos Coelhos 300, Boa Vista, Recife, PE Brazil CEP 52050-080, Brazil
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Wells JCK. The New "Obstetrical Dilemma": Stunting, Obesity and the Risk of Obstructed Labour. Anat Rec (Hoboken) 2017; 300:716-731. [PMID: 28297186 DOI: 10.1002/ar.23540] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/27/2016] [Accepted: 08/30/2016] [Indexed: 01/24/2023]
Abstract
The "obstetrical dilemma" refers to the tight fit between maternal pelvic dimensions and neonatal size at delivery. Most interest traditionally focused on its generic significance for humans, for example our neonatal altriciality and our complex and lengthy birth process. Across contemporary populations, however, the obstetrical dilemma manifests substantial variability, illustrated by differences in the incidence of cephalo-pelvic disproportion, obstructed labour and cesarean section. Beyond accounting for 12% of maternal mortality worldwide, obstructed labour also imposes a huge burden of maternal morbidity, in particular through debilitating birth injuries. This article explores how the double burden of malnutrition and the global obesity epidemic may be reshaping the obstetrical dilemma. First, short maternal stature increases the risk of obstructed labour, while early age at marriage also risks pregnancy before pelvic growth is completed. Second, maternal obesity increases the risk of macrosomic offspring. In some populations, short maternal stature may also promote the risk of gestational diabetes, another risk factor for macrosomic offspring. These nutritional influences are furthermore sensitive to social values relating to issues such as maternal and child nutrition, gender inequality and age at marriage. Secular trends in maternal obesity are substantially greater than those in adult stature, especially in low- and middle-income countries. The association between the dual burden of malnutrition and the obstetrical dilemma is therefore expected to increase, because the obesity epidemic is emerging faster than stunting is being resolved. However, we currently lack objective population-specific data on the association between maternal obesity and birth injuries. Anat Rec, 300:716-731, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
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Wang Y, Mao J, Wang W, Qiou J, Yang L, Chen S. Maternal fat free mass during pregnancy is associated with birth weight. Reprod Health 2017; 14:47. [PMID: 28351407 PMCID: PMC5371275 DOI: 10.1186/s12978-017-0308-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background The relationship between maternal body compositions and birth weight was not definite. Fat Mass (FM) and Fat Free Mass (FFM) can accurately reflect the maternal body fat compositions and have been considered as better predictors of birth weight. Despite its potential role, no studies have been described the maternal compositions during pregnancy in East Asian women previously. We investigated the correlation between birth weight and Maternal body composition including fat mass (FM) and fat free mass (FFM). To determine whether birth weight is associated with maternal body fat FM and FFM during pregnancy and, if so, which trimester and parameter is more critical in determining birth weight. Methods A longitudinal prospective observational study performed, 348, 481 and 321 non-diabetics Han Chinese women with a singleton live birth attending a routine visit in their first, second and third trimesters were recruited. Maternal body composition was measured using segmental multi-frequency bioelectrical impedance analysis. Data of the pre-pregnancy body mass index (BMI), maternal BMI, the gestational weight gain (GWG), and placental and birth weight were collected. Results A significant correlation exists between maternal FFM in the process of pregnancy, placental weight, GWG at delivery, and birth weight (P < 0.05). On stepwise multiple linear regression analysis, material’s FFM was the most important factor associated with the birth weight. After adjustment, there was significantly associated with 2.47-fold increase in risk for birth weight more than 4 kg when FFM ≥ 40.76 kg (Upper quartile of participants). The increased maternal age became a protective factor (OR = 0.69) while the increased pre-pregnancy BMI (OR = 1.50) remained predictors to birth weight more than 4 kg. Conclusions The change of maternal FFM during pregnancy is independently affected the birth weight.
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Affiliation(s)
- Yanxia Wang
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China.
| | - Jie Mao
- Department of Nutrition, Lanzhou University the Second hospital, Lanzhou, Gansu, China
| | - Wenling Wang
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China
| | - Jie Qiou
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China
| | - Lan Yang
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China
| | - Simin Chen
- Department of Nutrition, Lanzhou University the Second hospital, Lanzhou, Gansu, China
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Wells JC. Worldwide variability in growth and its association with health: Incorporating body composition, developmental plasticity, and intergenerational effects. Am J Hum Biol 2017; 29. [DOI: 10.1002/ajhb.22954] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/24/2016] [Accepted: 12/10/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jonathan C.K. Wells
- UCL Great Ormond Street Institute of Child Health; 30 Guilford Street London WC1N 1EH United Kingdom
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Wells JCK, Pomeroy E, Walimbe SR, Popkin BM, Yajnik CS. The Elevated Susceptibility to Diabetes in India: An Evolutionary Perspective. Front Public Health 2016; 4:145. [PMID: 27458578 PMCID: PMC4935697 DOI: 10.3389/fpubh.2016.00145] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/24/2016] [Indexed: 01/11/2023] Open
Abstract
India has rapidly become a "diabetes capital" of the world, despite maintaining high rates of under-nutrition. Indians develop diabetes at younger age and at lower body weights than other populations. Here, we interpret these characteristics in terms of a "capacity-load" model of glucose homeostasis. Specifically, we assume that glycemic control depends on whether the body's "metabolic capacity," referring to traits, such as pancreatic insulin production and muscle glucose clearance, is able to resolve the "metabolic load" generated by high levels of body fat, high dietary glycemic load, and sedentary behavior. We employ data from modern cohorts to support the model and the interpretation that elevated diabetic risk among Indian populations results from the high metabolic load imposed by westernized lifestyles acting on a baseline of low metabolic capacity. We attribute this low metabolic capacity to the low birth weight characteristic of Indian populations, which is associated with short stature and low lean mass in adult life. Using stature as a marker of metabolic capacity, we review archeological and historical evidence to highlight long-term declines in Indian stature associated with adaptation to several ecological stresses. Underlying causes may include increasing population density following the emergence of agriculture, the spread of vegetarian diets, regular famines induced by monsoon failure, and the undermining of agricultural security during the colonial period. The reduced growth and thin physique that characterize Indian populations elevate susceptibility to truncal obesity, and increase the metabolic penalties arising from sedentary behavior and high glycemic diets. Improving metabolic capacity may require multiple generations; in the meantime, efforts to reduce the metabolic load will help ameliorate the situation.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health , London , UK
| | - Emma Pomeroy
- McDonald Institute for Archaeological Research, University of Cambridge , Cambridge , UK
| | | | - Barry M Popkin
- Nutrition Department, Gillings Global School of Public Health, University of North Carolina School of Public Health , Chapel Hill, NC , USA
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The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam. Eur J Obstet Gynecol Reprod Biol 2015; 194:223-7. [PMID: 26454228 DOI: 10.1016/j.ejogrb.2015.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/01/2015] [Accepted: 09/17/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to: (1) examine the role of multiple measures of prepregnancy nutritional status (weight, height, body composition) on birth outcomes (low birth weight (LBW), small for gestational age (SGA), preterm, birth weight, birth length, infant head circumference and mid-upper arm circumference (MUAC)); (2) assess relative influence of maternal nutritional status before and during (gestational weight gain) pregnancy on birth outcomes. STUDY DESIGN We used prospective data on maternal body size and composition collected from women who participated in a randomized controlled trial evaluating the impact of preconceptional micronutrient supplements (PRECONCEPT) on birth outcomes in Thai Nguyen province, Vietnam (n=1436). Anthropometric measurements were obtained before conception through delivery by trained health workers. The relationship between prepregnancy nutritional status indicators, gestational weight gain (GWG) and birth outcomes were examined using generalized linear models, adjusting for potential confounding factors. RESULTS Maternal prepregnancy weight (PPW) was the strongest anthropometric indicator predicting infant birth size. A 1 standard deviation (SD) increase in PPW (5.4kg) was associated with a 283g (95%CI: 279-286) increase in birthweight. A similar and independent association was observed with birthweight for an increase of 1 SD in gestational weight gain (4kg) (250g; 95% CI: 245-255). Women with a PPW <43kg or who gained <8kg during their pregnancy were more likely to give birth to a SGA (OR 2.9: 95%CI 1.9-4.5, OR 3.3: 95%CI 2.2-5.1) or LBW infant (OR 3.1: 95%CI 1.5-6.2, OR 3.4: 95%CI 1.6-7.2), respectively. CONCLUSIONS These findings indicate that clinical care and programs aimed at improving birth outcomes will have the greatest impact if they address maternal nutrition both before and during pregnancy. Women with a PPW <43kg or a GWG <8kg are at greatest risk for poor birth outcomes in this setting. Preconception counseling and clinical care to obtain a healthy weight prior to pregnancy along with routine obstetric care on gestational weight gain is critical to improve birth outcomes. TRIAL REGISTRATION NCT01665378 (https://clinicaltrials.gov/show/NCT01665378).
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Kao CC, Hsu JW, Dwarkanath P, Karnes JM, Baker TM, Bohren KM, Badaloo A, Thame MM, Kurpad AV, Jahoor F. Indian women of childbearing age do not metabolically conserve arginine as do American and Jamaican women. J Nutr 2015; 145:884-92. [PMID: 25833892 DOI: 10.3945/jn.114.208231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In a previous study in pregnant American women, we reported that arginine flux and nitric oxide synthesis increased in trimester 2. More recently, we reported that Indian women do not increase arginine flux during pregnancy as their American or Jamaican counterparts do. OBJECTIVE The purpose of this study was to determine whether Indian women of childbearing age are producing less arginine and/or catabolizing more arginine and therefore have less available for anabolic pathways than do Jamaican and American women. METHODS Thirty healthy women aged 28.3 ± 0.8 y from the United States, India, and Jamaica (n = 10/group) were given 6 h primed, constant intravenous infusions of guanidino-¹⁵N₂-arginine, 5,5-²H₂-citrulline, ¹⁵N₂-ornithine, and ring-²H₅-phenylalanine, in addition to primed, oral doses of U-¹³C₆-arginine in both the fasting and postprandial states. An oral dose of deuterium oxide was also given to determine fat-free mass (FFM). RESULTS Compared with American women, Indian and Jamaican women had greater ornithine fluxes (μmol · kg fat FFM⁻¹ · h⁻¹) in the fasting and postprandial states (27.3 ± 2.5 vs. 39.6 ± 3.7 and 37.2 ± 2.0, respectively, P = 0.01), indicating greater arginine catabolism. However, Jamaican women had a higher endogenous arginine flux than did Indian and American women in the fasting (66.1 ± 3.1 vs. 54.2 ± 3.1 and 56.1 ± 2.1, respectively, P = 0.01) and postprandial (53.8 ± 2.2 vs. 43.7 ± 4.9 and 42.8 ± 3.1, respectively, P = 0.06) states. As a consequence, Indian women had lower arginine bioavailability (μmol · kg FFM⁻¹ · h⁻¹) in the fasting state (42.0 ± 2.6) than did American (49.9 ± 1.3, P = 0.045) and Jamaican (55.5 ± 3.5, P = 0.004) women, as well as in the postprandial state (40.7 ± 3.5 vs. 51.8 ± 1.2 and 57.5 ± 3.2, respectively, P = 0.001). CONCLUSION Compared with American and Jamaican women, Indian women of childbearing age have a decreased arginine supply because of increased arginine catabolism without an increase in arginine flux.
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Affiliation(s)
- Christina C Kao
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jean W Hsu
- USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Pratibha Dwarkanath
- St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India; and
| | - Jeffrey M Karnes
- USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Kurt M Bohren
- USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Asha Badaloo
- Tropical Metabolism Research Unit, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Anura V Kurpad
- St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India; and
| | - Farook Jahoor
- USDA Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX;
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Development of bioelectrical impedance analysis-based equations for estimation of body composition in postpartum rural Bangladeshi women. Br J Nutr 2012; 109:639-47. [PMID: 22716500 DOI: 10.1017/s0007114512001687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Equations for predicting body composition from bioelectrical impedance analysis (BIA) parameters are age-, sex- and population-specific. Currently there are no equations applicable to women of reproductive age in rural South Asia. Hence, we developed equations for estimating total body water (TBW), fat-free mass (FFM) and fat mass in rural Bangladeshi women using BIA, with ²H₂O dilution as the criterion method. Women of reproductive age, participating in a community-based placebo-controlled trial of vitamin A or β-carotene supplementation, were enrolled at 19·7 (SD 9·3) weeks postpartum in a study to measure body composition by ²H₂O dilution and impedance at 50 kHz using multi-frequency BIA (n 147), and resistance at 50 kHz using single-frequency BIA (n 82). TBW (kg) by ²H2O dilution was used to derive prediction equations for body composition from BIA measures. The prediction equation was applied to resistance measures obtained at 13 weeks postpartum in a larger population of postpartum women (n 1020). TBW, FFM and fat were 22·6 (SD 2·7), 30·9 (SD 3·7) and 10·2 (SD 3·8) kg by ²H₂O dilution. Height²/impedance or height²/resistance and weight provided the best estimate of TBW, with adjusted R² 0·78 and 0·76, and with paired absolute differences in TBW of 0·02 (SD 1·33) and 0·00 (SD 1·28) kg, respectively, between BIA and ²H₂O. In the larger sample, values for TBW, FFM and fat were 23·8, 32·5 and 10·3 kg, respectively. BIA can be an important tool for assessing body composition in women of reproductive age in rural South Asia where poor maternal nutrition is common.
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Kulkarni B, Shatrugna V, Nagalla B, Rani KU. Regional body composition changes during lactation in Indian women from the low-income group and their relationship to the growth of their infants. J Am Coll Nutr 2011; 30:57-62. [PMID: 21697539 DOI: 10.1080/07315724.2011.10719944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Increased energy requirement during lactation may lead to maternal tissue depletion in women from poor subsistence communities. OBJECTIVES To examine the regional body composition changes in undernourished lactating women and to assess the relationship of maternal body composition changes with weight gain of the infants. SUBJECTS AND METHODS Body composition was assessed using dual energy x-ray absorptiometry in 35 lactating women at 4 time points: within 1 month after delivery (baseline) and at 6, 12, and 18 months postpartum. RESULTS The mean age, height, and body mass index of the women were 23.5 years, 150.7 cm, and 20.0 kg/m(2), respectively. There were no significant differences in body weight or whole-body lean as well as fat mass at 4 time points, but the percentage fat decreased significantly during lactation. There was selective mobilization of fat mass from the leg region, whereas the appendicular skeletal mass (ASM) increased significantly. When the growth of the infants in the first 6 months (proxy for the lactation performance) was assessed in relation to the maternal body composition changes during that period, it was observed that the change in fat mass had a negative relationship to the weight gain of the infant. Change in the ASM during this period, however, had a significant positive relationship with the weight gain of the infants. CONCLUSION There were important differences in the lactation-related changes in the regional body composition parameters of these undernourished women. Regional body composition changes may be related to the weight gain of the breast-fed infants.
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Affiliation(s)
- Bharati Kulkarni
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.
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Subramanyam MA, Ackerson LK, Subramanian SV. Patterning in birthweight in India: analysis of maternal recall and health card data. PLoS One 2010; 5:e11424. [PMID: 20625399 PMCID: PMC2896401 DOI: 10.1371/journal.pone.0011424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 06/12/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND National data on birthweight from birth certificates or medical records are not available in India. The third Indian National Family Health Survey included data on birthweight of children obtained from health cards and maternal recall. This study aims to describe the population that these data represent and compares the birthweight obtained from health cards with maternal recall data in terms of its socioeconomic patterning and as a risk factor for childhood growth failure. METHODOLOGY/PRINCIPAL FINDINGS The analytic sample consisted of children aged 0 to 59 months with birthweight data obtained from health cards (n = 3227) and maternal recall (n = 16,787). The difference between the card sample and the maternal recall sample in the distribution across household wealth, parental education, caste, religion, gender, and urban residence was compared using multilevel models. We also assessed the ability of birthweight to predict growth failure in infancy and childhood in the two groups. The survey contains birthweight data from a majority of household wealth categories (>5% in every category for recall), both genders, all age groups, all caste groups, all religion groups, and urban and rural dwellers. However, children from the lowest quintile of household wealth were under-represented (4.73% in card and 8.62% in recall samples). Comparison of data across health cards and maternal recall revealed similar social patterning of low birthweight and ability of birthweight to predict growth failure later in life. Children were less likely to be born with low birthweight if they had mothers with over 12 years of education compared to 1-5 years of education with relative risk (RR) of 0.79 (95% confidence interval [CI]: 0.52, 1.2) in the card sample and 0.70 (95% CI: 0.59, 0.84) in the recall sample. A 100 gram difference in a child's birthweight was associated with a decreased likelihood of underweight in both the card (RR: 0.95; 95% CI: 0.94, 0.96) and recall (RR: 0.96; 95% CI: 0.96, 0.97) samples. CONCLUSIONS Our results suggest that in the absence of other sources, the data on birthweight in the third Indian National Family Health Survey is valuable for epidemiologic research.
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Affiliation(s)
- Malavika A. Subramanyam
- Center for Integrative Approaches to Health Disparities, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Leland K. Ackerson
- Department of Community Health and Sustainability, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - S. V. Subramanian
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Wells JCK. Maternal capital and the metabolic ghetto: An evolutionary perspective on the transgenerational basis of health inequalities. Am J Hum Biol 2010; 22:1-17. [PMID: 19844897 DOI: 10.1002/ajhb.20994] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There is particular interest in understanding socioeconomic and ethnic variability in health status. The developmental origins of disease hypothesis emphasize the importance of growth patterns across the life-course in relation to noncommunicable disease risk. The physiological components of cardiovascular risk, collectively termed the metabolic syndrome, derive in part from a disparity between the homeostatic "metabolic capacity" of vital organs and the "metabolic load" induced by large tissue masses, a rich diet and sedentary behavior. From an evolutionary perspective, the risk of such disparity is decreased by maternal physiology regulating offspring growth trajectory during gestation and lactation. Maternal capital, defined as phenotypic resources enabling investment in the offspring, allows effective buffering of the offspring from nutritional perturbations and represents the environmental niche initially occupied by the offspring. Offspring growth patterns are sensitive to the magnitude of maternal capital during early windows of plasticity. Offspring life-history strategy can then respond adaptively to further factors across the life-course, but only within the context of this initial maternal influence on growth. Maternal somatic capital is primarily gained or lost across generations, through variable rates of fetal and infant growth. I argue that the poor nutritional experience of populations subjected to colonialism resulted in a systematic loss of maternal capital, reflected in downward secular trends in stature. Accelerating the recovery of somatic capital within generations overloads metabolic capacity and exacerbates cardiovascular risk, reflected in increased disease rates in urbanizing and emigrant populations. Public health policies need to benefit metabolic capacity without exacerbating metabolic load.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom.
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Abstract
BACKGROUND The aim of the present study was to investigate the relationship between maternal and newborn anthropometry. METHODS In 1000 Sudanese mothers and newborns anthropometric measurements were taken within 24 h of birth. The relationship between maternal characteristics including age, years of education, social class and anthropometry, and newborn characteristics including gestational age, weight, body length, body circumference and skin-fold thickness, was investigated on multiple regression with backward selection, and multivariate anova (where appropriate) to identify the most important associations. RESULTS Maternal age and anthropometry were significantly associated with newborn anthropometry to a variable extent. The strongest associations (R2 > 5-6%) were found for mid-arm circumference, supine length and birthweight. The postpartum maternal lean body mass (LBM) was significantly associated with birthweight, body length and body circumference (P < 0.001), while skin-fold thickness was mainly associated with maternal age and maternal body mass index (BMI). Gestational age was only weakly associated with the maternal height (R2 > 1.3%) and the association between maternal anthropometry and the ponderal index (PI) of the newborn was negligible (R2 < 1%). Maternal education was significantly associated with birthweight and body circumference (except the abdominal), and the PI and the latter increased significantly with increasing number of years of education. No association between social class and newborn anthropometry was obtained. CONCLUSION There was a significant association between maternal LBM and newborn size and between maternal BMI and newborn fat stores. Maternal education and not social class was associated with newborn size.
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Affiliation(s)
- Eltahir M Elshibly
- Department of Paediatrics and Child Health, University of Khartoum, Khartoum, Sudan
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Nutritional status of mothers and low birth weight in India. Matern Child Health J 2009; 14:290-8. [PMID: 19199015 DOI: 10.1007/s10995-009-0451-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In this paper we examine the role of mothers' nutritional status and socio-biological aspects in determining the birth weight of their most recent child. METHODS We used data from the second Indian National Family Health Survey conducted in 1998-1999. Analysis is based on children born within 12 months prior to the survey date (N = 10,042). We used a subjective measure of the size of infant at birth as an indicator for birth weight and employed logistic regression to estimate the effect of BMI and other determinants on birth weight of children in India as a whole and for 17 states separately. RESULTS AND CONCLUSIONS Results show that mothers' nutritional status is the most important determinant of newborn children's birth weight. Safe drinking water, use of antenatal care and iron deficient anaemia were also significant contributors to low birth weight. Mothers' BMI impact is more pervasive across India than the impact of other factors on birth weight.
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Mohsen MA, . HAW. Influence of Maternal Anthropometric Measurements and Serum Biochemical Nutritional Indicators on Fetal Growth. JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.1330.1334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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