1
|
Mendes FC, Garcia-Larsen V, Moreira A. Obesity and Asthma: Implementing a Treatable Trait Care Model. Clin Exp Allergy 2024. [PMID: 38938020 DOI: 10.1111/cea.14520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
Recognition of obesity as a treatable trait of asthma, impacting its development, clinical presentation and management, is gaining widespread acceptance. Obesity is a significant risk factor and disease modifier for asthma, complicating treatment. Epidemiological evidence highlights that obese asthma correlates with poorer disease control, increased severity and persistence, compromised lung function and reduced quality of life. Various mechanisms contribute to the physiological and clinical complexities observed in individuals with obesity and asthma. These encompass different immune responses, including Type IVb, where T helper 2 cells are pivotal and driven by cytokines like interleukins 4, 5, 9 and 13, and Type IVc, characterised by T helper 17 cells and Type 3 innate lymphoid cells producing interleukin 17, which recruits neutrophils. Additionally, Type V involves immune response dysregulation with significant activation of T helper 1, 2 and 17 responses. Finally, Type VI is recognised as metabolic-induced immune dysregulation associated with obesity. Body mass index (BMI) stands out as a biomarker of a treatable trait in asthma, readily identifiable and targetable, with significant implications for disease management. There exists a notable gap in treatment options for individuals with obese asthma, where asthma management guidelines lack specificity. For example, there is currently no evidence supporting the use of incretin mimetics to improve asthma outcomes in asthmatic individuals without Type 2 diabetes mellitus (T2DM). In this review, we advocate for integrating BMI into asthma care models by establishing clear target BMI goals, promoting sustainable weight loss via healthy dietary choices and physical activity and implementing regular reassessment and referral as necessary.
Collapse
Affiliation(s)
- Francisca Castro Mendes
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional Em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vanessa Garcia-Larsen
- Program in Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
| | - André Moreira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional Em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| |
Collapse
|
2
|
Deng R, Li WQ, Li XX, Wei LM, Hu J, Leng JH, Dong B. Maternal weight and its association with risk of overweight in offspring: a trajectory analysis from a birth cohort in China. World J Pediatr 2024; 20:496-505. [PMID: 37389783 DOI: 10.1007/s12519-023-00736-4] [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: 01/31/2023] [Accepted: 05/21/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Most studies on the association of maternal pregnancy weight with offspring weight trajectory have a short follow-up time. This study aimed to explore the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight trajectories in a 7-year birth cohort. METHODS A total of 946 mother-child pairs (467 boys and 479 girls) from a longitudinal birth cohort in Tianjin City, China, were included in this study, ranging from pregnancy to offspring at 7 years. The outcome variable was defined as overweight or not overweight in offspring at the last round. A group-based trajectory model was applied to identify childhood BMI trajectory groups. RESULTS Five discrete BMI trajectory groups were identified and characterized as constant underweight (25.2%), constant normal weight (42.8%), and high or increasing trajectory [at risk of overweight (16.9%), progressive overweight (11.0%) and progressive obesity (4.1%)]. Maternal prepregnancy overweight was associated with 1.72 (95% CI 1.14-2.60, P = 0.01) to 4.02 (95% CI 1.94-8.36, P < 0.001) times the risk of all high or increasing trajectory groups, and excessive GWG was related to groups at risk of overweight [relative risk ratio (RRR) 2.09, 95% CI 1.27-3.46, P = 0.004] and progressive obesity (RRR 3.33, 95% CI 1.13-9.79, P = 0.029). Children in all high or increasing trajectory groups were associated with greater overweight risk at the last round [risk ratios (RRs) ranged from 3.54 (95% CI 2.53-4.95, P < 0.001) to 6.18 (95% CI 4.05-9.42, P < 0.001)]. CONCLUSION Maternal prepregnancy overweight and excessive gestational weight gain were associated with increasing or high-level childhood body mass index trajectories as well as a greater risk of overweight at 7 years.
Collapse
Affiliation(s)
- Rui Deng
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Wei-Qin Li
- Tianjin Women and Children's Health Center, No. 96 Guizhou Rd, Heping District, Tianjin, 300070, China
| | - Xing-Xiu Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Liu-Mei Wei
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Jie Hu
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, 4111, Australia
| | - Jun-Hong Leng
- Tianjin Women and Children's Health Center, No. 96 Guizhou Rd, Heping District, Tianjin, 300070, China.
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, No.38 Xueyuan Rd, Haidian District, Beijing, 100191, China.
| |
Collapse
|
3
|
Boone-Heinonen J, Lyon-Scott K, Springer R, Schmidt T, Vesco KK, Booman A, Dinh D, Fortmann SP, Foster BA, Hauschildt J, Liu S, O'Malley J, Palma A, Snowden JM, Stratton K, Tran S. Pregnancy health in a multi-state U.S. population of systemically underserved patients and their children: PROMISE cohort design and baseline characteristics. BMC Public Health 2024; 24:886. [PMID: 38519895 PMCID: PMC10960496 DOI: 10.1186/s12889-024-18257-8] [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: 05/12/2023] [Accepted: 03/02/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a routinely monitored aspect of pregnancy health, yet critical gaps remain about optimal GWG in pregnant people from socially marginalized groups, or with pre-pregnancy body mass index (BMI) in the lower or upper extremes. The PROMISE study aims to determine overall and trimester-specific GWG associated with the lowest risk of adverse birth outcomes and detrimental infant and child growth in these underrepresented subgroups. This paper presents methods used to construct the PROMISE cohort using electronic health record data from a network of community-based healthcare organizations and characterize the cohort with respect to baseline characteristics, longitudinal data availability, and GWG. METHODS We developed an algorithm to identify and date pregnancies based on outpatient clinical data for patients 15 years or older. The cohort included pregnancies delivered in 2005-2020 with gestational age between 20 weeks, 0 days and 42 weeks, 6 days; and with known height and adequate weight measures needed to examine GWG patterns. We linked offspring data from birth records and clinical records. We defined study variables with attention to timing relative to pregnancy and clinical data collection processes. Descriptive analyses characterize the sociodemographic, baseline, and longitudinal data characteristics of the cohort, overall and within BMI categories. RESULTS The cohort includes 77,599 pregnancies: 53% had incomes below the federal poverty level, 82% had public insurance, and the largest race and ethnicity groups were Hispanic (56%), non-Hispanic White (23%) and non-Hispanic Black (12%). Pre-pregnancy BMI groups included 2% underweight, 34% normal weight, 31% overweight, and 19%, 8%, and 5% Class I, II, and III obesity. Longitudinal data enable the calculation of trimester-specific GWG; e.g., a median of 2, 4, and 6 valid weight measures were available in the first, second, and third trimesters, respectively. Weekly rate of GWG was 0.00, 0.46, and 0.51 kg per week in the first, second, and third trimesters; differences in GWG between BMI groups were greatest in the second trimester. CONCLUSIONS The PROMISE cohort enables characterization of GWG patterns and estimation of effects on child growth in underrepresented subgroups, ultimately improving the representativeness of GWG evidence and corresponding guidelines.
Collapse
Affiliation(s)
- Janne Boone-Heinonen
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA.
| | | | - Rachel Springer
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | | | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, USA
| | - Anna Booman
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| | - Dang Dinh
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Stephen P Fortmann
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, USA
| | - Byron A Foster
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | | | - Shuling Liu
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Jean O'Malley
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
- OCHIN, Inc., Portland, OR, 1881 SW Naito Pkwy, USA
| | - Amy Palma
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| | - Jonathan M Snowden
- OHSU School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Kalera Stratton
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| | - Sarah Tran
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd. Mail code: VPT, Portland, OR, USA
| |
Collapse
|
4
|
Mannino A, Sarapis K, Mourouti N, Karaglani E, Anastasiou CA, Manios Y, Moschonis G. The Association of Maternal Weight Status throughout the Life-Course with the Development of Childhood Obesity: A Secondary Analysis of the Healthy Growth Study Data. Nutrients 2023; 15:4602. [PMID: 37960255 PMCID: PMC10649313 DOI: 10.3390/nu15214602] [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: 10/02/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Maternal weight-status at various time-points may influence child obesity development, however the most critical time-point remains unidentified. We used data from the Healthy Growth Study, a cross-sectional study of 2666 Greek schoolchildren aged 9-13 years, exploring associations between childhood obesity and maternal weight-status at pre-pregnancy, during pregnancy/gestational weight gain, and at the child's pre-adolescence. Logistic regression analyses examined associations between maternal weight-status being "below" or "above" the recommended cut-off points (WHO BMI thresholds or IOM cut-off points), at the three time-points, individually or combined into weight-status trajectory groups to determine the strongest associations with child obesity in pre-adolescence. Adjusted models found significant associations and the highest odds ratios [95% Confidence Intervals] for mothers affected by obesity before pregnancy (4.16 [2.47, 7.02]), those with excessive gestational weight gain during pregnancy (1.50 [1.08, 2.08]), and those affected by obesity at their child's pre-adolescence (3.3 [2.29, 4.87]). When combining these weight-status groups, mothers who were above-above-below (3.24 [1.10, 9.55]), and above-above-above (3.07 [1.95, 4.85]) the healthy weight recommendation-based thresholds in each time-point, had a three-fold higher likelihood of child obesity, compared to the below-below-below trajectory group. Maternal obesity across all examined time-points was significantly associated with childhood obesity. Effective childhood obesity preventive initiatives should commence at pre-conception, targeting maternal weight throughout the life-course and childhood developmental stages.
Collapse
Affiliation(s)
- Adriana Mannino
- Department of Food, Nutrition and Dietetics, School Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC 3086, Australia; (A.M.); (K.S.)
| | - Katerina Sarapis
- Department of Food, Nutrition and Dietetics, School Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC 3086, Australia; (A.M.); (K.S.)
| | - Niki Mourouti
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (N.M.); (E.K.); (C.A.A.); (Y.M.)
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300 Sitia, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (N.M.); (E.K.); (C.A.A.); (Y.M.)
| | - Costas A. Anastasiou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (N.M.); (E.K.); (C.A.A.); (Y.M.)
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (N.M.); (E.K.); (C.A.A.); (Y.M.)
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, 71410 Heraklion, Greece
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School Allied Health, Human Services & Sport, La Trobe University, Melbourne, VIC 3086, Australia; (A.M.); (K.S.)
| |
Collapse
|
5
|
Wang K, Shang B, Ye P, Wei Q, Zhang Y, Shi H. Prospective Association between Total and Trimester-Specific Gestational Weight Gain Rate and Physical Growth Status in Children within 24 Months after Birth. Nutrients 2023; 15:4523. [PMID: 37960175 PMCID: PMC10649666 DOI: 10.3390/nu15214523] [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: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
In this study, our aim was to investigate the potential correlation between the mother's total gestational weight gain (GWG) rate and the trimester-specific GWG rate (GWGR) with the physical development status of the child within 24 months of age. We utilized linear regression models and linear mixed effects models to explore both time point and longitudinal relationships between GWGR and children's anthropometric outcome z-scores at 0, 1, 2, 4, 6, 9, 12, 18, and 24 months. To examine the critical exposure windows, we employed multiple informant models. We also conducted a stratified analysis considering pre-pregnancy BMI and the gender of the children. Our findings revealed notable positive associations between total GWGR and z-scores for body mass index for age (BMIZ), head circumference for age (HCZ), weight for age (WAZ), length for age (LAZ), and weight for length (WHZ) across different trimesters of pregnancy (pint < 0.05). The GWGR during the first two trimesters mainly influenced the relationship between total GWGR and BMIZ, WAZ, and LAZ, while the GWGR during the first trimester had a significant impact on the correlation with HCZ (0.206, 95% CI 0.090 to 0.322). Notably, the associations of GWGR and children's BMIZ were pronounced in male children and pre-pregnancy normal-weight women. In conclusion, our study findings indicated that a higher GWGR during each trimester was associated with greater physical growth during the first 24 months of life, especially GWGR in the first and second trimesters.
Collapse
Affiliation(s)
- Ke Wang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Yixueyuan Road, 138, Shanghai 200032, China; (K.W.); (B.S.); (P.Y.); (Q.W.)
| | - Bingzi Shang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Yixueyuan Road, 138, Shanghai 200032, China; (K.W.); (B.S.); (P.Y.); (Q.W.)
| | - Peiqi Ye
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Yixueyuan Road, 138, Shanghai 200032, China; (K.W.); (B.S.); (P.Y.); (Q.W.)
| | - Qian Wei
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Yixueyuan Road, 138, Shanghai 200032, China; (K.W.); (B.S.); (P.Y.); (Q.W.)
| | - Yunhui Zhang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Environmental Health, School of Public Health, Fudan University, Yixueyuan Road, 138, Shanghai 200032, China;
| | - Huijing Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Yixueyuan Road, 138, Shanghai 200032, China; (K.W.); (B.S.); (P.Y.); (Q.W.)
| |
Collapse
|
6
|
Cristian A, Tarry-Adkins JL, Aiken CE. The Uterine Environment and Childhood Obesity Risk: Mechanisms and Predictions. Curr Nutr Rep 2023; 12:416-425. [PMID: 37338777 PMCID: PMC10444661 DOI: 10.1007/s13668-023-00482-z] [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] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW Childhood obesity is a growing health problem in many populations, hence the urgent need to unravel the underlying mechanisms. Some evidence suggests that exposure to suboptimal intrauterine environments can program foetal metabolic health, with adverse consequences in later life, including susceptibility to childhood obesity. FINDINGS Factors such as high and low foetal birth weight, excessive gestational-weight-gain, maternal stress and smoking are all associated with increased risk of childhood obesity in observational studies. Animal models, where both genetic background and the postnatal environment can be carefully controlled, suggest that several different mechanisms, including epigenetic changes, dysregulation of adipose tissue development and programming of appetite, may be key drivers of developmental programming of childhood obesity. However, the influence of genetics and the post-natal environment are much more difficult to disentangle as independent effects in human studies, which are also complicated by low follow-up rates. Suboptimal intrauterine environments interact with maternal and foetal genetics and with the postnatal environment to contribute to the risk of childhood obesity. Maternal metabolic challenges, for example obesity and insulin resistance, contribute to the risk of foetal overgrowth and subsequent adiposity in childhood. To protect the long-term health of populations, research focusing on effective means of identifying and intervening in the transgenerational cycle of childhood obesity is required.
Collapse
Affiliation(s)
- Andreea Cristian
- Department of Obstetrics and Gynaecology, University of CambridgeThe Rosie HospitalandNIHR Cambridge Biomedical Research Centre, Box 223, Cambridge, CB2 0SW, UK
- Wellcome-MRC Institute of Metabolic Science and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Jane L Tarry-Adkins
- Department of Obstetrics and Gynaecology, University of CambridgeThe Rosie HospitalandNIHR Cambridge Biomedical Research Centre, Box 223, Cambridge, CB2 0SW, UK
| | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, University of CambridgeThe Rosie HospitalandNIHR Cambridge Biomedical Research Centre, Box 223, Cambridge, CB2 0SW, UK.
- Wellcome-MRC Institute of Metabolic Science and Medical Research Council Metabolic Diseases Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
7
|
Harville EW, Kracht CL, Cohen NL, Sutton EF, Kebbe M, Redman LM. Trends in Gestational Weight Gain in Louisiana, March 2019 to March 2022. JAMA Netw Open 2023; 6:e2331277. [PMID: 37642960 PMCID: PMC10466167 DOI: 10.1001/jamanetworkopen.2023.31277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023] Open
Abstract
Importance Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued. Objective To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic. Design, Setting, and Participants This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023. Exposure Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022). Main Outcomes and Measures The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates. Results Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted β [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted β [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted β [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment. Conclusions and Relevance In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.
Collapse
Affiliation(s)
- Emily W. Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Nicole L. Cohen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Maryam Kebbe
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | |
Collapse
|
8
|
Mo J, Liu X, Huang Y, He R, Zhang Y, Huang H. Developmental origins of adult diseases. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:450-470. [PMID: 37724166 PMCID: PMC10388800 DOI: 10.1515/mr-2022-0027] [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: 08/29/2022] [Accepted: 10/11/2022] [Indexed: 09/20/2023]
Abstract
The occurrence and mechanisms of developmental adult diseases have gradually attracted attention in recent years. Exposure of gametes and embryos to adverse environments, especially during plastic development, can alter the expression of certain tissue-specific genes, leading to increased susceptibility to certain diseases in adulthood, such as diabetes, cardiovascular disease, neuropsychiatric, and reproductive system diseases, etc. The occurrence of chronic disease in adulthood is partly due to genetic factors, and the remaining risk is partly due to environmental-dependent epigenetic information alteration, including DNA methylation, histone modifications, and noncoding RNAs. Changes in this epigenetic information potentially damage our health, which has also been supported by numerous epidemiological and animal studies in recent years. Environmental factors functionally affect embryo development through epimutation, transmitting diseases to offspring and even later generations. This review mainly elaborated on the concept of developmental origins of adult diseases, and revealed the epigenetic mechanisms underlying these events, discussed the theoretical basis for the prevention and treatment of related diseases.
Collapse
Affiliation(s)
- Jiaying Mo
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xuanqi Liu
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yutong Huang
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Renke He
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yu Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Hefeng Huang
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
- The Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Hunt KJ, Ferguson PL, Neelon B, Commodore S, Bloom MS, Sciscione AC, Grobman WA, Kominiarek MA, Newman RB, Tita AT, Nageotte MP, Palomares K, Skupski DW, Zhang C, Hinkle S, Wapner R, Vena JE. The association between maternal pre-pregnancy BMI, gestational weight gain and child adiposity: A racial-ethnically diverse cohort of children. Pediatr Obes 2022; 17:e12911. [PMID: 35289494 PMCID: PMC9283205 DOI: 10.1111/ijpo.12911] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The prevalence of obesity in US children has more than tripled in the past 40 years; hence, it is critical to identify potentially modifiable factors that may mitigate the risk. OBJECTIVES To examine the association between maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and child adiposity as measured by BMI, waist circumference and percent body fat in a racial-ethnically diverse cohort. METHODS In a prospective cohort study of healthy women without chronic disease, we examined the association between pre-pregnancy BMI, GWG and child adiposity. Children ages 4-8 years (n = 816) in the Environmental Influences on Child Health Outcomes-NICHD Fetal Growth Studies were assessed. Trained study staff ascertained maternal pre-pregnancy BMI, GWG and child adiposity. RESULTS The odds of child obesity (≥95th BMI percentile) increased independently for each unit increase in maternal pre-pregnancy BMI [OR = 1.12 (95% CI: 1.08, 1.17)] and for each 5-kg increase in GWG [OR = 1.25 (95% CI: 1.07, 1.47)]. The odds of child waist circumference (≥85th percentile) also increased independently for pre-pregnancy BMI [OR = 1.09 (95% CI: 1.05, 1.12)] and GWG [OR = 1.18 (95% CI: 1.04, 1.34)]. CONCLUSIONS Maternal pre-pregnancy BMI and GWG were each independently and positively associated with child obesity and high child waist circumference.
Collapse
Affiliation(s)
- Kelly J Hunt
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pamela L Ferguson
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah Commodore
- Environmental and Occupational Health, Indiana University, Bloomington, Indiana, USA
| | - Michael S Bloom
- Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Anthony C Sciscione
- Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware, USA
| | - William A Grobman
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roger B Newman
- Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alan T Tita
- Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael P Nageotte
- Obstetrics and Gynecology, Miller Children's and Women's Hospital, Long Beach, California, USA
| | - Kristy Palomares
- Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Daniel W Skupski
- Obstetrics and Gynecology, New York Presbyterian Queens Hospital, Queens, New York, USA
| | - Cuilin Zhang
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stefanie Hinkle
- Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ronald Wapner
- Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - John E Vena
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
11
|
Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana. J Nutr Sci 2022; 11:e43. [PMID: 35754984 PMCID: PMC9201873 DOI: 10.1017/jns.2022.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.
Collapse
|
12
|
Yuan Z, Wang HJ, Su T, Yang J, Chen J, Peng Y, Zhou S, Bao H, Luo S, Wang H, Liu J, Han N, Ji Y. The First-Trimester Gestational Weight Gain Associated With de novo Hypertensive Disorders During Pregnancy: Mediated by Mean Arterial Pressure. Front Nutr 2022; 9:862323. [PMID: 35495902 PMCID: PMC9045728 DOI: 10.3389/fnut.2022.862323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
The relationship between first-trimester GWG (T1GWG) and risk of hypertensive disorders of pregnancy (HDP) remained uncertain. This study aimed to investigate the association between T1GWG and risk of de novo HDP. Meanwhile, we explored the mediated effect and constructed an early GWG category to evaluate the predictive capacity for HDP. T1GWG was defined as the weight difference between 13 ± 1 gestational weeks and pre-conception. HDP group was defined as having diagnosis of de novo HDP, including gestational hypertension or de novo pre-eclampsia (PE) during the current pregnancy. Early GWG category was constructed according to the risk of HDP within each pre-pregnancy body mass index (BMI) group. Cox regression model was utilized to check the association between the T1GWG and HDP. Serial mediation model was adopted to evaluate the potential mediators including mean arterial pressure (MAP) at 13th and 20th week. The logistic regression model with bootstrap was performed to assess the predictive capacity of Early GWG category and MAP for the risk of HDP. A total of 17,901 pregnant women (mean age, 29.0 years) were recruited from 2013 to 2017 at the Tongzhou Maternal and Child Health Hospital in Beijing, China. Compared to women in Class 1 of early GWG category, women in the Class 2, 3, 4 have increased risks of HDP by 1.42, 4.27, and 4.62 times, respectively (hazard ratio [HR] = 2.42, 95% CI: 2.11–2.77; HR = 5.27, 95% CI: 4.05–6.86; HR = 5.62, 95% CI: 4.05–7.79). The MAP measured at 13th and 20th week totally mediated 33.1 and 26.7% of association between T1GWG GWG and HDP in total participants and overweight/obesity pregnancies, respectively. The area under receiver operator characteristic curve for predictive model utilizing early GWG category and MAP measured at 13th and 20th week for the risk of HDP is 0.760 (95% CI: 0.739–0.777). The T1GWG was associated with de novo HDP, which was partially mediated by MAP measured at 13th and 20th week. Early GWG category showed a better predictive capacity for the risk of HDP compared to the National Academy of Medicine criteria for T1GWG.
Collapse
Affiliation(s)
- Zhichao Yuan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Tao Su
- Maternal and Child Health Care Hospital of Tongzhou District, Beijing, China
| | - Jie Yang
- Maternal and Child Health Care Hospital of Tongzhou District, Beijing, China
| | - Junjun Chen
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Yuanzhou Peng
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Heling Bao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hui Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Na Han
- Maternal and Child Health Care Hospital of Tongzhou District, Beijing, China
| | - Yuelong Ji
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
- *Correspondence: Yuelong Ji,
| |
Collapse
|