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Yuan W, Jiang J, Song SS, Liu J, Chen M, Shi Q, Zhang Y, Chen L, Qin Y, Wang R, Guo T, Wang X, Ma Q, Dong Y, Ma J. The association of breastfeeding duration on metabolic syndrome among children and adolescents, stratified by birth weight for gestational age. Pediatr Obes 2024; 19:e13145. [PMID: 38890760 DOI: 10.1111/ijpo.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/19/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to examine the associations between breastfeeding duration and metabolic syndrome (MetS) in adolescents and to further investigate the role of birth weight for gestational age (GA) on these associations. METHODS A total of 10 275 participants aged 7 to 18 years were included applying multistage cluster random sampling from a Chinese national survey. Birth weight was classified into small for GA (SGA), appropriate for GA (AGA) and large for GA (LGA). Information was collected through a self-administered questionnaire, physical examination and blood biochemical examination. Multivariable linear regression, logistic regression models, restricted cubic spline models were applied to assess the relationships of breastfeeding duration and MetS with different birth weight for GA. RESULTS The prevalence of non-breastfeeding, 0-5, 6-12 and >12 months groups were 16.2%, 23.1%, 42.5% and 18.2%, and the prevalence of SGA and LGA was 11.9% and 12.7%, respectively. Prolonged breastfeeding duration was associated with higher odds of MetS (β: 0.08, 95% CI: 0.03, 0.13), WC (β: 3.49, 95% CI: 2.82, 4.16) and SBP (β: 2.34, 95% CI: 1.80, 2.89). SGA and prolonged breastfeeding synergistically increased MetS risks, but LGA appeared to offset the adverse effects of prolonged breastfeeding. CONCLUSION Prolonged breastfeeding may increase children's MetS risks. SGA synergies with prolonged breastfeeding increased MetS burden in children and adolescents, while LGA mitigated the risks. This reminds us that intensive attention should be paid to both early birth weight and subsequent living environment for children and adolescents' lifelong health.
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Affiliation(s)
- Wen Yuan
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Jianuo Jiang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Sha-Sha Song
- Pathology Department, Yantai Fushan People's Hospital, Yantai, PR China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Manman Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Qiaoxin Shi
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, PR China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Yang Qin
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Ruolin Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Tongjun Guo
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | | | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, PR China
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Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr 2024; 15:100220. [PMID: 38670164 DOI: 10.1016/j.advnut.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | | | - Seham Elmrayed
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Institute of Global Health and Human Ecology, American University in Cairo, Egypt
| | - Belal Alshaikh
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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3
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Madlala HP, Bengtson AM, Hannan L, Malaba TR, Kalk E, Nyemba D, Boulle A, Myer L. Maternal weight trajectories and associations with infant growth in South African women. BMC Public Health 2023; 23:2055. [PMID: 37858163 PMCID: PMC10588171 DOI: 10.1186/s12889-023-16963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Despite the close relationship between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and postpartum weight (PPW), these factors are often studied separately. There are no data characterising longitudinal weight trajectories among pregnant and postpartum women in urban African populations. We examined maternal weight trajectories from pregnancy through to 12 months postpartum, factors associated with higher weight trajectory class membership and associations of weight trajectories with infant growth at 12 months. METHODS Data from 989 women were examined for weight trajectories from first antenatal care visit in pregnancy to 12 months postpartum using latent-class growth models. Baseline factors associated with class membership were assessed using multinomial logistic regression. Of the enrolled women, 613 of their infants were assessed for growth at 12 months. Anthropometry measurements for mothers and infants were conducted by a trained study nurse. Associations between maternal weight trajectory class and infant weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ) at 12 months of age were analysed using linear regression. RESULTS Four distinct classes of maternal weight trajectories were identified. The classes included consistent low (29%), consistent medium (37%), medium-high (24%) and consistent high (10%) trajectories. Similar to trends observed with medium-high trajectory, baseline factors positively associated with consistent high class membership included age (OR 1.05, 95% CI 1.01-1.09), pre-pregnancy BMI (OR 2.24, 95% CI 1.97-2.56), stage 1 hypertension (OR 3.28, 95% CI 1.68-6.41), haemoglobin levels (OR 1.39, 95% CI 1.11-1.74) and parity (OR 1.39, 95% CI 1.15-1.67); living with HIV (OR 0.47, 95% CI 0.30-0.74) was inversely associated. In adjusted analyses, compared to consistent medium weight trajectory, consistent low weight trajectory (mean difference -0.41, 95% CI -0.71;-0.12) was associated with decreased, and consistent high weight trajectory (mean difference 1.21, 95% CI 0.59-1.83) with increased infant WAZ at 12 months of age. CONCLUSION Identification of unique longitudinal weight trajectory groupings might inform comprehensive efforts targeted at improving healthy maternal weight and infant outcomes.
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Affiliation(s)
- Hlengiwe P Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa.
| | - Angela M Bengtson
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Luke Hannan
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Dorothy Nyemba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
| | - Andrew Boulle
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
- Health Impact Assessment Unit, Western Cape Department of Health, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Western Cape, Cape Town, South Africa
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4
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Yang MN, Huang R, Zheng T, Dong Y, Wang WJ, Xu YJ, Mehra V, Zhou GD, Liu X, He H, Fang F, Li F, Fan JG, Zhang J, Ouyang F, Briollais L, Li J, Luo ZC. Genome-wide placental DNA methylations in fetal overgrowth and associations with leptin, adiponectin and fetal growth factors. Clin Epigenetics 2022; 14:192. [PMID: 36585686 PMCID: PMC9801645 DOI: 10.1186/s13148-022-01412-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fetal overgrowth "programs" an elevated risk of type 2 diabetes in adulthood. Epigenetic alterations may be a mechanism in programming the vulnerability. We sought to characterize genome-wide alterations in placental gene methylations in fetal overgrowth and the associations with metabolic health biomarkers including leptin, adiponectin and fetal growth factors. RESULTS Comparing genome-wide placental gene DNA methylations in large-for-gestational-age (LGA, an indicator of fetal overgrowth, n = 30) versus optimal-for-gestational-age (OGA, control, n = 30) infants using the Illumina Infinium Human Methylation-EPIC BeadChip, we identified 543 differential methylation positions (DMPs; 397 hypermethylated, 146 hypomethylated) at false discovery rate < 5% and absolute methylation difference > 0.05 after adjusting for placental cell-type heterogeneity, maternal age, pre-pregnancy BMI and HbA1c levels during pregnancy. Twenty-five DMPs annotated to 20 genes (QSOX1, FCHSD2, LOC101928162, ADGRB3, GCNT1, TAP1, MYO16, NAV1, ATP8A2, LBXCOR1, EN2, INCA1, CAMTA2, SORCS2, SLC4A4, RPA3, UMAD1,USP53, OR2L13 and NR3C2) could explain 80% of the birth weight variations. Pathway analyses did not detect any statistically significant pathways after correcting for multiple tests. We validated a newly discovered differentially (hyper-)methylated gene-visual system homeobox 1 (VSX1) in an independent pyrosequencing study sample (LGA 47, OGA 47). Our data confirmed a hypermethylated gene-cadherin 13 (CDH13) reported in a previous epigenome-wide association study. Adiponectin in cord blood was correlated with its gene methylation in the placenta, while leptin and fetal growth factors (insulin, IGF-1, IGF-2) were not. CONCLUSIONS Fetal overgrowth may be associated with a large number of altered placental gene methylations. Placental VSX1 and CDH13 genes are hypermethylated in fetal overgrowth. Placental ADIPOQ gene methylations and fetal circulating adiponectin levels were correlated, suggesting the contribution of placenta-originated adiponectin to cord blood adiponectin.
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Affiliation(s)
- Meng-Nan Yang
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China ,grid.17063.330000 0001 2157 2938Lunenfeld-Tanenbaum Research Institute, Prosserman Centre for Population Health Research, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, L5-240, Murray Street 60, Toronto, ON M5G 1X5 Canada
| | - Rong Huang
- grid.17063.330000 0001 2157 2938Lunenfeld-Tanenbaum Research Institute, Prosserman Centre for Population Health Research, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, L5-240, Murray Street 60, Toronto, ON M5G 1X5 Canada
| | - Tao Zheng
- grid.16821.3c0000 0004 0368 8293Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Yu Dong
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Wen-Juan Wang
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Ya-Jie Xu
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Vrati Mehra
- grid.17063.330000 0001 2157 2938Lunenfeld-Tanenbaum Research Institute, Prosserman Centre for Population Health Research, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, L5-240, Murray Street 60, Toronto, ON M5G 1X5 Canada
| | - Guang-Di Zhou
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Xin Liu
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Hua He
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Fang Fang
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Fei Li
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Jian-Gao Fan
- grid.16821.3c0000 0004 0368 8293Center for Fatty Liver, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092 China
| | - Jun Zhang
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Fengxiu Ouyang
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China
| | - Laurent Briollais
- grid.17063.330000 0001 2157 2938Lunenfeld-Tanenbaum Research Institute, Prosserman Centre for Population Health Research, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, L5-240, Murray Street 60, Toronto, ON M5G 1X5 Canada
| | - Jiong Li
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200 Aathus, Denmark
| | - Zhong-Cheng Luo
- grid.16821.3c0000 0004 0368 8293Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Early Life Health Institute, Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092 China ,grid.17063.330000 0001 2157 2938Lunenfeld-Tanenbaum Research Institute, Prosserman Centre for Population Health Research, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, L5-240, Murray Street 60, Toronto, ON M5G 1X5 Canada
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Childhood obesity and adverse cardiometabolic risk in large for gestational age infants and potential early preventive strategies: a narrative review. Pediatr Res 2022; 92:653-661. [PMID: 34916624 DOI: 10.1038/s41390-021-01904-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 02/08/2023]
Abstract
Accumulating evidence indicates that obesity and cardiometabolic risks become established early in life due to developmental programming and infants born as large for gestational age (LGA) are particularly at risk. This review summarizes the recent literature connecting LGA infants and early childhood obesity and cardiometabolic risk and explores potential preventive interventions in early infancy. With the rising obesity rates in women of childbearing age, the LGA birth rate is about 10%. Recent literature continues to support the higher rates of obesity in LGA infants. However, there is a knowledge gap for their lifetime risk for adverse cardiometabolic outcomes. Potential factors that may modify the risk in early infancy include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. The early postnatal period may be a critical window of opportunity for active interventions to mitigate or prevent obesity and potential adverse metabolic consequences in later life. A variety of promising candidate biomarkers for the early identification of metabolic alterations in LGA infants is also discussed. IMPACT: LGA infants are the greatest risk category for future obesity, especially if they experience rapid postnatal growth during infancy. Potential risk modifying secondary prevention strategies in early infancy in LGA infants include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. LGA infants may be potential low-hanging fruit targets for early preventive interventions in the fight against childhood obesity.
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6
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Kondracki AJ, Valente MJ, Ibrahimou B, Bursac Z. Risk of large for gestational age births at early, full and late term in relation to pre-pregnancy body mass index: Mediation by gestational diabetes status. Paediatr Perinat Epidemiol 2022; 36:566-576. [PMID: 34755381 DOI: 10.1111/ppe.12809] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Maternal pre-pregnancy body mass index (BMI) is strongly associated with infant birthweight and the risk differs in pregnancies complicated by gestational diabetes (GDM). OBJECTIVES To examine the risk of large for gestational age (LGA) (≥97th percentile) singleton births at early term, full term and late term in relation to maternal pre-pregnancy BMI status mediated through GDM. METHODS We analysed data from the 2018 U.S. National Vital Statistics Natality File restricted to singleton term births (N = 3,229,783). In counterfactual models for causal inference, we estimated the total effect (TE), natural direct effect (NDE) and natural indirect effect (NIE) for the association of pre-pregnancy BMI with subcategories of LGA births at early, full and late term mediated through GDM, using log-binomial regression and adjusting for race/ethnicity, age, education, parity and infant sex. Proportion mediated was calculated on the risk difference scale and potential unmeasured confounders were assessed using the E-value. RESULTS Overall, 6.4% of women had GDM, and there were 3.6% LGA singleton term births. The highest prevalence of GDM was among pre-gestational overweight/obesity that also had the highest rates of LGA births at term. The TE estimates for the risk of LGA births were the strongest across women with higher pre-pregnancy BMI compared to women with normal pre-pregnancy BMI. The NDE estimates were higher than the NIE estimates for overweight/obese BMI status. The proportion mediated, which answers the causal question to what extent the total effect of the association between pre-pregnancy BMI and LGA births is accounted for through GDM, was the highest (up to 16%) for early term births. CONCLUSIONS Term singleton births make up the largest proportion in a cohort of newborns. While the percentage mediated through GDM was relatively small, health risks arising from pre-pregnancy overweight, and obesity can be substantial to both mothers and their offspring.
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Affiliation(s)
- Anthony J Kondracki
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work Florida, International University, Miami, FL, USA
| | - Matthew J Valente
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work Florida, International University, Miami, FL, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work Florida, International University, Miami, FL, USA
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Alyafei F, Soliman A, De Sanctis V, Hamed N, Alaaraj N, Ahmad S, AlKhori F, Abbasi S. Postnatal Growth and Prevalence of Obesity in Infants Born Large-for-Gestational Age during the First 3 years of Life: Personal Experience and Exploration of Current Literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022327. [PMID: 36533739 PMCID: PMC9828894 DOI: 10.23750/abm.v93i6.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/16/2022] [Indexed: 01/21/2023]
Abstract
AIMS OF THE STUDY We evaluated the growth patterns in a cohort of infants (n = 120) born large-for-gestational-age (LGA) [birth weight (Bwt) > 4 kg] from birth to age 3 years of age in comparison with normal age and sex-matched children (WHO). RESULTS LGA infants had high weight for age Z score (WAZ) at birth that decreased significantly during the first 6 months of life (by a mean of - 0.67 SD) that was followed by significant gain during the following 6 months of life (around + 0.4 SD). These children grew on a higher centile of WAZ with no significant change during the second and third years of life. The prevalence of obesity (WAZ > 2) increased markedly from 24% at the end of their first year to 34% and 36% at the end of their second and third years of life, respectively. The mean length for age Z score (LAZ) decreased significantly during the first 6 months (by a mean of -0.9 SD) but was maintained at high centile (> 1 SD) during the second and 3rd years. The weight for length SDS (WLZ) increased significantly during the first 18 months of life and decreases gradually during the second half of the 2nd year and the 3rd year. Their head circumference SDS decreased significantly in the first 6 months and then sustained around the 70th centiles (+1 SD) in the following 18 months. CONCLUSION Our study showed that in LGA babies obesity increased progressively after the first year of life to reach 36% at the end of the third year. Therefore, it is important to apply the early nutritional intervention to decrease the occurrence of obesity and reduce later cardiometabolic risks.
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Affiliation(s)
- Fawzia Alyafei
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Noor Hamed
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Nada Alaaraj
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Shayma Ahmad
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Fatima AlKhori
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
| | - Saleha Abbasi
- Department of Pediatrics, Hamad General Hospital, Doha, Qatar
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8
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Goldberg DL, Becker PJ. Applying the recommended indicators for the diagnosis of preterm and neonatal malnutrition: Answers to frequently asked questions. Nutr Clin Pract 2021; 37:50-58. [PMID: 34967988 DOI: 10.1002/ncp.10814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In 2018, a committee of expert preterm/neonatal registered dietitian nutritionists published recommended indicators for the diagnosis of malnutrition in preterm infants and neonates. This was in response to a need for indicators appropriate to the preterm/neonatal population, given the emphasis on diagnosing malnutrition in the pediatric and adult population. Since the publication, the authors have received numerous questions regarding the application and use of the indicators. This paper answers questions regarding the three categories of indicators and billing and reimbursement. The goal is to develop uniformity in the application of the malnutrition indicators for quality improvement and research efforts.
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9
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Dunn RK, Uhing M, Goday PS. Catch-down growth in infants born large for gestational age. Nutr Clin Pract 2021; 36:1215-1219. [PMID: 34245486 DOI: 10.1002/ncp.10727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Infants born large for gestational age (LGA) not exhibiting catch-down growth (a decline of weight z-score by 1) have a higher likelihood of future obesity. We aimed to identify the term LGA infants in our neonatal intensive care unit (NICU) and document nutrition interventions that may influence growth. Our 10-year retrospective review identified 47 term LGA infants who had a NICU length of stay (LOS) ≥7 days. We obtained demographic data, nutrition interventions in the NICU, and data regarding growth patterns. Of the 47 infants, 31 (66%), demonstrated catch-down growth at discharge at ≥7 days. Overall, 39 of 47 patients (83%) received interventions during their NICU stay, including 32 (69%) who had nasogastric tubes placed, and 24 (51%) had formula fortification to augment weight gain. Among patients with LOS ≥14 days, 23 of 23 patients without catch-down growth and four of five patients with catch-down growth had nutrition interventions performed. Of the overall population, only 38% of those who did not demonstrate catch-down growth had an LOS of ≥14 days vs 77% of all infants that did exhibit catch-down growth (P = .01). Our data suggest that nutrition interventions in LGA infants are common in the NICU. Our study highlights the need for further clinical studies to help direct care in this population of infants.
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Affiliation(s)
- Rachel K Dunn
- Division of Pediatric Gastroenterology, Peyton Manning Children's Hospital, Indianapolis, Indiana, USA
| | - Michael Uhing
- Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Praveen S Goday
- Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Nordman H, Jääskeläinen J, Voutilainen R. Birth Size as a Determinant of Cardiometabolic Risk Factors in Children. Horm Res Paediatr 2021; 93:144-153. [PMID: 32846418 DOI: 10.1159/000509932] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/06/2020] [Indexed: 11/19/2022] Open
Abstract
The association between birth size and cardiometabolic disease risk may be U-shaped. Being born small for gestational age (SGA) has a definitive association with later cardiovascular risk, but the impact of being born large for gestational age (LGA) on cardiometabolic health is more controversial. In addition to birth size, early postnatal growth pattern and later weight gain affect cardiometabolic risk in adulthood. Most SGA-born children have catch-up and LGA-born children have catch-down growth during the first years of life. The extent of this early compensatory growth may contribute to the adverse health outcomes. Both SGA- and LGA-born children are at an increased risk for overweight and obesity. This may have a long-term impact on cardiometabolic health as overweight tends to track to adulthood. Other cardiometabolic risk factors, including alterations in glucose metabolism, dyslipidemia, hypertension, and low-grade inflammation are associated with birth weight. Many of these risk factors are related to overweight or adverse fat distribution. Since later cardiometabolic risk is often mediated by early growth pattern and later overweight in SGA and LGA children, it is important to focus on staying normal weight throughout life. Hence, effective interventions to reduce cardiometabolic risk in LGA and SGA children should be developed.
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Affiliation(s)
- Henrikki Nordman
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland,
| | - Jarmo Jääskeläinen
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Raimo Voutilainen
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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11
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Hong YH, Lee JE. Large for Gestational Age and Obesity-Related Comorbidities. J Obes Metab Syndr 2021; 30:124-131. [PMID: 34053939 PMCID: PMC8277589 DOI: 10.7570/jomes20130] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 01/11/2023] Open
Abstract
Both small for gestational age and large for gestational age (LGA) size at birth are associated with metabolic complications throughout life. The long-term consequences of LGA have been investigated in only a few studies. LGA is thought to be associated with early obesity and metabolic risk. Understanding how LGA can influence later obesity risk is important for pediatric obesity interventions. Pregnant women who are overweight or obese are at high risk of having LGA babies. Infants born LGA are at increased risk of becoming overweight or obese children, adolescents, and young adults and can have an increased risk of metabolic syndrome later in life and giving birth to LGA offspring. Education and intervention for weight control before and during pregnancy should be conducted to prevent LGA births. Particular attention is needed for women of childbearing age who are diabetic and obese, which could be the starting point for lifelong management of obesity.
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Affiliation(s)
- Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji-Eun Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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12
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Martorell-Marugán J, González-Rumayor V, Carmona-Sáez P. mCSEA: detecting subtle differentially methylated regions. Bioinformatics 2020; 35:3257-3262. [PMID: 30753302 DOI: 10.1093/bioinformatics/btz096] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/09/2019] [Accepted: 02/10/2019] [Indexed: 12/31/2022] Open
Abstract
MOTIVATION The identification of differentially methylated regions (DMRs) among phenotypes is one of the main goals of epigenetic analysis. Although there are several methods developed to detect DMRs, most of them are focused on detecting relatively large differences in methylation levels and fail to detect moderate, but consistent, methylation changes that might be associated to complex disorders. RESULTS We present mCSEA, an R package that implements a Gene Set Enrichment Analysis method to identify DMRs from Illumina450K and EPIC array data. It is especially useful for detecting subtle, but consistent, methylation differences in complex phenotypes. mCSEA also implements functions to integrate gene expression data and to detect genes with significant correlations among methylation and gene expression patterns. Using simulated datasets we show that mCSEA outperforms other tools in detecting DMRs. In addition, we applied mCSEA to a previously published dataset of sibling pairs discordant for intrauterine hyperglycemia exposure. We found several differentially methylated promoters in genes related to metabolic disorders like obesity and diabetes, demonstrating the potential of mCSEA to identify DMRs not detected by other methods. AVAILABILITY AND IMPLEMENTATION mCSEA is freely available from the Bioconductor repository. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Jordi Martorell-Marugán
- Bioinformatics Unit. GENYO. Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, Granada, Spain.,Atrys Health, Barcelona, Spain
| | | | - Pedro Carmona-Sáez
- Bioinformatics Unit. GENYO. Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, Granada, Spain
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13
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Dong B, Dong YH, Yang ZG, Wang XJ, Zou ZY, Wang Z, Ma J. Healthy Body Weight may Modify Effect of Abnormal Birth Weight on Metabolic Syndrome in Adolescents. Obesity (Silver Spring) 2019; 27:462-469. [PMID: 30699246 DOI: 10.1002/oby.22391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to examine the association between birth weight (BW) and metabolic syndrome (MetS) in adolescents and to further investigate whether having a healthy body weight could modify the potential adverse influence of abnormal BW on MetS risk. METHODS A total of 6,206 participants aged 10 to 17 years were recruited using data from a Chinese national survey conducted in 2012. Gestational age-specific BW percentiles were used to classify small for gestational age (SGA), appropriate for gestational age, and large for gestational age (LGA). Fractional polynomial regression, logistic regression, and population-attributable risk (PAR) were used to assess the relationship between BMI and BW with MetS. RESULTS MetS risk increased by 73% (OR = 1.73, 95% CI: 1.06-2.84) in SGA adolescents with overweight or obesity, but not in those without overweight, compared with their counterparts with BW appropriate for gestational age. A huge difference between PAR percent of MetS because of SGA and PAR percent because of overweight or obesity was detected. For example, PAR percent of SGA was 2.4% (95% CI: 0.1%-4.6%) in adolescents with overweight or obesity, while PAR percent of overweight or obesity was 44.2% (95% CI: 33.3%-53.2%) in those who were SGA infants. CONCLUSIONS These findings suggest that healthy body weight could relieve the adverse impact of SGA on MetS in adolescents.
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Affiliation(s)
- Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yan-Hui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhao-Geng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xi-Jie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhi-Yong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhiqiang Wang
- Centre for Chronic Disease, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
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14
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Schneider CR, Catalano PM, Biggio JR, Gower BA, Chandler-Laney PC. Associations of neonatal adiponectin and leptin with growth and body composition in African American infants. Pediatr Obes 2018; 13:485-491. [PMID: 29573242 PMCID: PMC6457440 DOI: 10.1111/ijpo.12274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/22/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cord blood adiponectin and leptin concentrations are associated with birth weight and adiposity. Birth size and rate of infant weight gain are associated with future obesity risk. However, it is unclear whether biomarkers reflecting the intrauterine environment are predictive of infant prospective body composition change. OBJECTIVES To examine whether cord blood adiponectin and leptin are predictive of neonatal adiposity and fat mass (FM) accrual to 3 months of age. METHODS Participants (n = 36) were healthy African American infants. Leptin and adiponectin concentrations were measured in umbilical cord blood. At 2 weeks and 3 months, infant body composition was assessed via air displacement plethysmography. Weight-for-length z-scores (WLZ) were calculated using World Health Organization standards. Multiple linear regression was used to examine associations of cord blood adiponectin and leptin with birth WLZ; WLZ, FM and fat-free mass at 2 weeks, and the conditional change in these variables from 2 weeks to 3 months (body composition at 3 months adjusted for body composition at 2 weeks). RESULTS Adiponectin was positively associated with FM at 2 weeks (r = 0.45, P < 0.01), but inversely associated with conditional FM change from 2 weeks to 3 months of age (r = -0.38, P < 0.05). Leptin was not significantly associated with infant body composition. CONCLUSIONS Adiponectin may be a marker for FM accrual in African American infants, a relatively understudied population with a high long-term obesity risk. Mechanistic studies are needed to determine whether adiponectin directly influences infant growth or is simply a maker reflective of other ongoing biological changes after birth.
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Affiliation(s)
- Camille R Schneider
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patrick M Catalano
- Department of Obstetrics and Gynecology, Center for Reproductive Health/MetroHealth Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula C Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Pinto LA, Guerra S, Anto JM, Postma D, Koppelman GH, de Jongste JC, Gehring U, Smit HA, Wijga AH. Increased risk of asthma in overweight children born large for gestational age. Clin Exp Allergy 2018; 47:1050-1056. [PMID: 28599075 DOI: 10.1111/cea.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/09/2017] [Accepted: 05/10/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Being born large for gestational age (LGA) is a marker of increased growth velocity in fetal life and a risk factor for childhood overweight. Both being born LGA and childhood overweight may influence the development of asthma, although the role of overweight in the association between LGA and childhood asthma is unclear. Importantly, recent studies have suggested that the association between overweight and asthma may be related to non-allergic pathways. If this also applies to the association between LGA and asthma, the association between being born LGA and asthma may be different for atopic and non-atopic children. OBJECTIVE We investigated the association of being LGA with the prevalence of asthma at age 8 in atopic and non-atopic children and the role of overweight in this association. METHODS Complete data on asthma, anthropometry and atopy at age of 8 years, and potential confounders were available for 1608 participants of the PIAMA birth cohort. Odds ratios for the association between LGA and asthma in atopic and non-atopic children were estimated by logistic regression analysis adjusting for potential confounders. Overweight was assessed as a potential modifier of the association between LGA and asthma. RESULTS Being born LGA was not significantly associated with asthma at age of 8 in atopic and non-atopic children. However, overweight at age of 8 years modified the association between asthma at age of 8 and LGA. In non-atopic children, children who were born LGA and were overweight at age of 8 years had a significantly increased odds of asthma compared to non-LGA, non-overweight children (adj OR 7.04; 95% CI 2.2-24). CONCLUSIONS We observed that non-atopic children born LGA, who were overweight by 8 years have an increased risk of asthma. If confirmed, these findings suggest that non-atopic children born LGA may be identified early in life as a high-risk group for asthma.
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Affiliation(s)
- L A Pinto
- ISGlobal, Centre for Research and Environmental Epidemiology (CREAL), Barcelona, Spain.,Centro Infant, Institute of Biomedical Research, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - S Guerra
- ISGlobal, Centre for Research and Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - J M Anto
- ISGlobal, Centre for Research and Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - D Postma
- Department of Pulmonology, GRIAC Research Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - G H Koppelman
- Paediatric Pulmonology and Pediatric Allergology, Groningen Research Institute for Asthma and COPD, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J C de Jongste
- Department of Paediatrics, Division Paediatric Respiratory Medicine, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - U Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - H A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A H Wijga
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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16
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Di Giovanni I, Marcovecchio ML, Chiavaroli V, de Giorgis T, Chiarelli F, Mohn A. Being born large for gestational age is associated with earlier pubertal take-off and longer growth duration: a longitudinal study. Acta Paediatr 2017; 106:61-66. [PMID: 27743496 DOI: 10.1111/apa.13633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/19/2016] [Accepted: 10/12/2016] [Indexed: 11/27/2022]
Abstract
AIM Perinatal factors seem to influence the onset of puberty, but there is limited information on the potential effect of large size at birth on pubertal growth. This study evaluated pubertal growth in children born large for gestational age (LGA) compared to children born appropriate for gestational age (AGA). METHODS Longitudinal growth data collected from 70 children - 40 AGA and 30 LGA - were analysed. The ages at take-off, peak height velocity, final height and pubertal growth spurts were calculated using the Preece-Baines model I. RESULTS Large for gestational age children showed an earlier age at take-off compared to AGA children (10.1 ± 1.2 versus 11.0 ± 1.4 years, p = 0.007), whereas the age at peak height velocity and at final height was similar. LGA children showed a longer growth spurt duration (2.5 ± 1 versus 1.5 ± 1.2 years, p < 0.001) and total pubertal duration (5.3 ± 1.2 versus 4.6 ± 1.2 years, p = 0.036) than AGA children. Results were similar when stratified by sex. CONCLUSION Being born LGA was associated with an earlier pubertal take-off and longer growth duration. These unique findings, due to the lack of studies on pubertal growth patterns in LGA children, might lead the way to novel research and a different approach to LGA children at the onset of pubertal growth.
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Affiliation(s)
| | - M. Loredana Marcovecchio
- Department of Pediatrics; University ‘G. D'Annunzio’; Chieti Italy
- Aging and Translational Medicine Research Center; CeSI-MeT; Chieti Italy
| | | | | | - Francesco Chiarelli
- Department of Pediatrics; University ‘G. D'Annunzio’; Chieti Italy
- Aging and Translational Medicine Research Center; CeSI-MeT; Chieti Italy
| | - Angelika Mohn
- Department of Pediatrics; University ‘G. D'Annunzio’; Chieti Italy
- Aging and Translational Medicine Research Center; CeSI-MeT; Chieti Italy
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17
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Chiavaroli V, Derraik JGB, Hofman PL, Cutfield WS. Born Large for Gestational Age: Bigger Is Not Always Better. J Pediatr 2016; 170:307-11. [PMID: 26707580 DOI: 10.1016/j.jpeds.2015.11.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/27/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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