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Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, Campbell OMR. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. Arch Dis Child 2023; 108:956-969. [PMID: 37339859 DOI: 10.1136/archdischild-2022-324884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps. METHODS We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association. FINDINGS We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting. INTERPRETATION Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations. PROSPERO REGISTRATION NUMBER CRD42021268843.
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Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Eman Sharara
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine El Rashidi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Gurusinghe S, Tambay A, Sethna CB. Developmental Origins and Nephron Endowment in Hypertension. Front Pediatr 2017; 5:151. [PMID: 28706894 PMCID: PMC5489607 DOI: 10.3389/fped.2017.00151] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/15/2017] [Indexed: 12/27/2022] Open
Abstract
Primary hypertension continues to be one of the main risk factors for cardiovascular disease worldwide. A stable intrauterine environment is critical for the future development and health of the fetus. The developing kidney has been found to be especially vulnerable during this time period, and epidemiological studies have demonstrated that an adverse in utero environment is associated with an increased risk of hypertension and chronic kidney disease. Macro- and micronutrient deficiencies as well as exposure to tobacco, alcohol, and certain medications during gestation have been shown to negatively impact nephrogenesis and reduce one's nephron number. In 1988, Brenner et al. put forth the controversial hypothesis that a reduced nephron complement is a risk factor for hypertension and chronic kidney disease in adulthood. Since then numerous animal and human studies have confirmed this relationship demonstrating that there is an inverse association between blood pressure and nephron number. As our understanding of the developmental programming of hypertension and other non-communicable diseases improves, more effective preventive health measures can be developed in the future.
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Affiliation(s)
- Shari Gurusinghe
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New York, NY, United States
| | - Anita Tambay
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New York, NY, United States
| | - Christine B Sethna
- Department of Pediatrics, Division of Pediatric Nephrology, Cohen Children's Medical Center of New York, New York, NY, United States
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Kwok MK, Au Yeung SL, Leung GM, Schooling CM. Birth weight, infant growth, and adolescent blood pressure using twin status as an instrumental variable in a Chinese birth cohort: “Children of 1997”. Ann Epidemiol 2014; 24:509-15. [DOI: 10.1016/j.annepidem.2014.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/04/2014] [Accepted: 04/17/2014] [Indexed: 11/29/2022]
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Araújo de França GV, Restrepo-Méndez MC, Loret de Mola C, Victora CG. Size at birth and abdominal adiposity in adults: a systematic review and meta-analysis. Obes Rev 2014; 15:77-91. [PMID: 24112242 DOI: 10.1111/obr.12109] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 01/08/2023]
Abstract
We performed a systematic literature review on the associations between birth size and abdominal adiposity in adults, while also investigating the role of the adjustment for adult body mass index (BMI). MEDLINE, Scopus, Web of Science, LILACS and SciELO databases were searched for articles published up to February 2013. Only prospective studies were included. After screening 2,570 titles, we selected 31 publications for the narrative synthesis, of which 13 were considered to be of high methodological quality. Six main indicators of birth size were identified, and birth weight (BW) was the most extensively studied. Most studies relied on anthropometric measurements as proxies for abdominal fatness or as indicators of body fat distribution. Few studies assessed abdominal adiposity through imaging methods, generally with small sample sizes. Eleven articles could be included in the meta-analyses. BW was found to be positively associated with waist circumference in adulthood, but the association disappeared after adjustment for adult BMI. In contrast, there was no association between BW and waist-to-hip ratio, whereas a strong negative association became evident after controlling for adult BMI. In conclusion, BW seems to be associated with larger adult size in general, including both waist and hip circumferences. The marked change in coefficients after adjustment for adult BMI suggests that post-natal growth strongly affects relative central adiposity, whereas BW per se does not play a role. Given the potential impact of post-natal growth, further research is needed to identify different growth trajectories that lead to abdominal adiposity, as well as studies on interactions of foetal and post-natal growth patterns.
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Affiliation(s)
- G V Araújo de França
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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5
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Parkinson JRC, Hyde MJ, Gale C, Santhakumaran S, Modi N. Preterm birth and the metabolic syndrome in adult life: a systematic review and meta-analysis. Pediatrics 2013; 131:e1240-63. [PMID: 23509172 DOI: 10.1542/peds.2012-2177] [Citation(s) in RCA: 311] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm birth is associated with features of the metabolic syndrome in later life. We performed a systematic review and meta-analysis of studies reporting markers of the metabolic syndrome in adults born preterm. METHODS Reports of metabolic syndrome-associated features in adults (≥18 years of age) born at <37-week gestational age and at term (37- to 42-week gestational age) were included. Outcomes assessed were BMI, waist-hip ratio, percentage fat mass, systolic (SBP) and diastolic (DBP) blood pressure, 24-hour ambulatory SBP and DBP, flow-mediated dilatation, intima-media thickness, and fasting glucose, insulin, and lipid profiles. RESULTS Twenty-seven studies, comprising a combined total of 17,030 preterm and 295,261 term-born adults, were included. In adults, preterm birth was associated with significantly higher SBP (mean difference, 4.2 mm Hg; 95% confidence interval [CI], 2.8 to 5.7; P < .001), DBP (mean difference, 2.6 mm Hg; 95% CI, 1.2 to 4.0; P < .001), 24-hour ambulatory SBP (mean difference, 3.1 mm Hg; 95% CI, 0.3 to 6.0; P = .03), and low-density lipoprotein (mean difference, 0.14 mmol/L; 95% CI, 0.05 to 0.21; P = .01). The preterm-term differences for women was greater than the preterm-term difference in men by 2.9 mm Hg for SBP (95% CI [1.1 to 4.6], P = .004) and 1.6 mm Hg for DBP (95% CI [0.3 to 2.9], P = .02). CONCLUSIONS For the majority of outcome measures associated with the metabolic syndrome, we found no difference between preterm and term-born adults. Increased plasma low-density lipoprotein in young adults born preterm may represent a greater risk for atherosclerosis and cardiovascular disease in later life. Preterm birth is associated with higher blood pressure in adult life, with women appearing to be at greater risk than men.
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Affiliation(s)
- James R C Parkinson
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London SW10 9NH, United Kingdom
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Peak growth velocity in infancy is positively associated with blood pressure in school-aged children. J Hypertens 2012; 30:1114-21. [PMID: 22573080 DOI: 10.1097/hjh.0b013e328352d699] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Rapid growth velocity in early life may be a risk factor for obesity, elevated blood pressure, and adverse metabolic markers in childhood, but results are not consistent. We analysed the association between peak growth velocity during the first 2 years of life and blood pressure, fasting glucose and insulin at 10 years of age. METHODS A prospective German birth cohort (LISAplus) provided data on growth, blood pressure, glucose, and insulin for 1127 children up to the age of 10 years. All children had a birth weight of at least 2500 g. Growth was modelled using nonlinear mixed-effect Reed1 models. Associations between peak growth velocities and metabolic outcomes were calculated with linear regression models. Potential confounders were sequentially adjusted for. RESULTS Higher peak height velocity (PHV) and peak weight velocity (PWV) in infancy were associated with significant increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in children at 10 years. For each 10.2 cm/year [2 standard deviation (SD)] increase in PHV, SBP increased by 2.94 mmHg [95% confidence interval (CI) 1.34, 4.54] after adjustment for potential confounders including birth weight and body mass index. A 5.1 kg/year (2 SD) higher PWV was associated with a 2.13 mmHg (95% CI 0.51, 3.74) increase in SBP and a 1.91 mmHg (95% CI 0.52, 3.30) increase in DBP. No consistent associations were found between PHV or PWV and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index after multiple adjustments. CONCLUSIONS Blood pressure and metabolic outcomes at school age may be associated with growth patterns in early life, regardless of relative weight during school age.
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Skogen JC, Overland S. The fetal origins of adult disease: a narrative review of the epidemiological literature. JRSM SHORT REPORTS 2012; 3:59. [PMID: 23301147 PMCID: PMC3434434 DOI: 10.1258/shorts.2012.012048] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The fetal origins of adult disease (FOAD) hypothesis suggests that risk factors from intrauterine environmental exposures affect the fetus' development during sensitive periods, and increases the risk of specific diseases in adult life. This link was initially observed between prenatal exposures and adult coronary heart disease, but corresponding observations have later been published for a range of chronic conditions. Although the hypothesis has been praised as an essential shift in our understanding of determinants for health, the hypothesis has also been criticized on a number of accounts, both methodologically and theoretically. The aim of this paper is to critically discuss the FOAD-hypothesis, in relation to the epidemiological evidence. We conclude that much of the research literature on the FOAD-hypothesis finds support for the hypothesis. Despite this, it is still unclear if the effects are independent and what the public health relevance is. Notwithstanding the heart of the hypothesis – that environmental influences during gestation have an effect on later development – should be considered a major insight and constitutes a complement to a focus on genetic and more proximal factors (such as adult lifestyle) as causes of adult disease. As the search for determinants for disease and health continues, the FOAD-hypothesis is likely to remain an important perspective. It may however be better positioned as part of a broader life course perspective, rather than as an independent hypothesis.
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Affiliation(s)
- Jens Christoffer Skogen
- Research Centre for Health Promotion and Development, Faculty of Psychology, University of Bergen , N-5015 Bergen , Norway ; Norwegian Institute of Public Health, Division of Mental Health, Department of Public Mental Health , N-0403 Bergen , Norway
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Chen W, Srinivasan SR, Berenson GS. Amplification of the association between birthweight and blood pressure with age: the Bogalusa Heart Study. J Hypertens 2010; 28:2046-52. [PMID: 20616754 PMCID: PMC3105358 DOI: 10.1097/hjh.0b013e32833cd31f] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Although low birthweight is associated with elevated blood pressure (BP) levels, whether the strength of this relationship is amplified with age is still debated. This study tested the hypothesis that the magnitude of the birthweight-BP association increases with age from childhood to adulthood. METHODS The study cohort included 6251 individuals (64.5% whites and 35.6% blacks, 50.0% males) enrolled in the Bogalusa Heart Study. Individuals were examined 1-15 times for BP from childhood to adulthood, with 24 363 observations. Information on birthweight and gestational age was obtained from Louisiana State birth certificates. RESULTS After adjusting for race, sex, age and gestational age, low birthweight (kg) was associated with higher SBP levels (mmHg) in adolescence (aged 12-17 years, regression coefficient β = -0.80, P = 0.004) and adulthood (aged 18-50 years, β = -1.34, P = 0.010). Adjustment for current BMI yielded considerably stronger association. Importantly, the magnitude of the birthweight-SBP relationship, measured as standardized β(unit = SD), was significantly amplified with increasing age, regardless of adjustment for current BMI and race. Further, the strengthened association (the increase in standardized β ranging 0.02-0.12) by adjustment for current BMI was closely related to the BMI-SBP and birthweight-BMI correlations, especially noted in childhood. CONCLUSION These findings on the potentiating effect of increasing age on the birthweight-BP relationship suggest that the fetal programming and the increasing cumulative burden with age of unhealthy lifestyle behaviors affect the development of adult hypertension in a synergistic manner.
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Affiliation(s)
- Wei Chen
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane Center for Cardiovascular Health, New Orleans, Louisiana 70112, USA
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Intrauterine growth restriction: no unifying risk factor for the metabolic syndrome in young adults. ACTA ACUST UNITED AC 2009; 17:314-20. [DOI: 10.1097/hjr.0b013e328331d2c3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Abstract
The intrauterine milieu impacts fetal growth directly during gestation. It is now clear, however, that postnatal phenotype is also influenced by prenatal conditions. A variety of disorders in the adult have been linked to fetal size at birth; these include glucose intolerance, cardiovascular disease, and the subjects of this review, obesity and hypertension. We will review recent data regarding these associations and the pathophysiologic mechanisms underlying them in humans as well as in animal models.
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Affiliation(s)
- Donald A Novak
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610, USA.
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11
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Fetal and postnatal growth and blood pressure at the age of 2 years. The Generation R Study. J Hypertens 2009; 27:1152-7. [DOI: 10.1097/hjh.0b013e3283299973] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Adair LS, Martorell R, Stein AD, Hallal PC, Sachdev HS, Prabhakaran D, Wills AK, Norris SA, Dahly DL, Lee NR, Victora CG. Size at birth, weight gain in infancy and childhood, and adult blood pressure in 5 low- and middle-income-country cohorts: when does weight gain matter? Am J Clin Nutr 2009; 89:1383-92. [PMID: 19297457 PMCID: PMC2720838 DOI: 10.3945/ajcn.2008.27139] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Promoting catch-up growth in malnourished children has health benefits, but recent evidence suggests that accelerated child weight gain increases adult chronic disease risk. OBJECTIVE We aimed to determine how birth weight (BW) and weight gain to midchildhood relate to blood pressure (BP) in young adults. DESIGN We pooled data from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa. We used conditional weight (CW), a residual of current weight regressed on prior weights, to represent deviations from expected weight gain from 0 to 12, 12 to 24, 24 to 48 mo, and 48 mo to adulthood. Adult BP and risk of prehypertension or hypertension (P/HTN) were modeled before and after adjustment for adult body mass index (BMI) and height. Interactions of CWs with small size-for-gestational age (SGA) at birth were tested. RESULTS Higher CWs were associated with increased BP and odds of P/HTN, with coefficients proportional to the contribution of each CW to adult BMI. Adjusted for adult height and BMI, no child CW was associated with adult BP, but 1 SD of BW was related to a 0.5-mm Hg lower systolic BP and a 9% lower odds of P/HTN. BW and CW associations with systolic BP and P/HTN were not different between adults born SGA and those with normal BW, but higher CW at 48 mo was associated with higher diastolic BP in those born SGA. CONCLUSIONS Greater weight gain at any age relates to elevated adult BP, but faster weight gains in infancy and young childhood do not pose a higher risk than do gains at other ages.
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Affiliation(s)
- Linda S Adair
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dahly DL, Adair LS, Bollen KA. A structural equation model of the developmental origins of blood pressure. Int J Epidemiol 2009; 38:538-48. [PMID: 19039006 PMCID: PMC2663718 DOI: 10.1093/ije/dyn242] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2008] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Birth-size is a problematic proxy for the fetal environment, and regression models testing for associations between birth-size and blood pressure have been criticized. METHODS We modelled fetal environment as a latent variable determined by maternal height and arm fat area (AFA) during pregnancy using structural equation modelling. We tested for associations between latent fetal environment (LFE) and systolic blood pressure (SBP) while controlling for birth weight (BW) and current weight (CW). Data are from 1435 male and 1218 female young adult Filipinos (2005; mean age 21 years) enrolled in the Cebu Longitudinal Heath and Nutrition Survey, an ongoing, community-based study of a one-year birth cohort. Using AMOS 6.0, LFE was modelled as a determinant of BW, CW and SBP; CW was modelled as a determinant of SBP. RESULTS Overall model fit was excellent (chi2: 32.14, 27 df, P=0.23). The estimated direct relationship between LFE and SBP was inverse for both males ((-0.43) -0.26 (-0.10)) and females ((-0.29) -0.18 (-0.07)). CONCLUSIONS These results are consistent with the hypothesis that maternal height and AFA impact fetal development in a manner that is positively associated with fetal growth (as reflected by BW) and inversely associated with SBP in young adulthood.
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Affiliation(s)
- D L Dahly
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
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Silveira VMFD, Horta BL. [Birth weight and metabolic syndrome in adults: meta-analysis]. Rev Saude Publica 2008; 42:10-8. [PMID: 18200335 DOI: 10.1590/s0034-89102008000100002] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess published evidences of the effect of birth weight on metabolic syndrome in adults. METHODS PubMed and LILACS databases were searched for articles published from 1966 through May 2006. The terms used were: "birth weight", "birthweight", "intra-uterine growth restriction (IUGR)", "fetal growth retardation", "metabolic syndrome", "syndrome X", "Reaven's X syndrome". Two hundred and twenty-four studies reporting estimates of the association between birth weight and metabolic syndrome or its components were considered eligible. Eleven studies provided odds ratios and were included in the meta-analysis. RESULTS All but two studies reported an inverse relationship between birth weight and metabolic syndrome. A comparison between low birth weight vs. normal birth weight subjects showed the random effects odds ratio for metabolic syndrome was 2.53 (95% CI: 1.57;4.08). The funnel plot graphic suggests a publication bias but, even in the studies with more than 400 subjects, the results remained significant (pooled odds ratio: 2.37 (95% CI: 1.15;4.90). CONCLUSIONS Low birth weight increases the risk of metabolic syndrome in adults.
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Affiliation(s)
- Vera Maria Freitas da Silveira
- Programa de Pós graduação em Epidemiologia, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
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Ben-Shlomo Y, McCarthy A, Hughes R, Tilling K, Davies D, Smith GD. Immediate postnatal growth is associated with blood pressure in young adulthood: the Barry Caerphilly Growth Study. Hypertension 2008; 52:638-44. [PMID: 18768401 DOI: 10.1161/hypertensionaha.108.114256] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a consistent inverse association between birth weight and systolic blood pressure; however, few studies have been able to examine the immediate postnatal period. We have examined whether accelerated postnatal growth predicts adult systolic and diastolic blood pressure. We followed up participants from the Barry Caerphilly Growth Study. Blood pressure data were obtained on 679 of the original 951 subjects (73%) aged approximately 25 years. Both multivariable linear regression and spline models were used to examine the association among weight, length, and growth velocities with systolic blood pressure and diastolic blood pressure. Both statistical approaches showed that birth weight was inversely associated with systolic blood pressure. Only the spline models found that immediate (0 to 5 months) weight gain (beta coefficient: 1.29 mm Hg; 95% CI: 0.36 to 2.23; P=0.007) and weight gain between 1 year and 9 months to 5 years (beta coefficient: 1.44 mm Hg; 95% CI: 0.31 to 2.57; P=0.01) were independently associated with systolic blood pressure, whereas only immediate weight gain (beta coefficient: 0.74 mm Hg; 95% CI: 0.08 to 1.41; P=0.03) was associated with diastolic blood pressure. This is the first study to demonstrate that only immediate postnatal growth predicts diastolic blood pressure in term births, whereas it adds further evidence that both birth weight and postnatal growth are associated with systolic blood pressure in support of both the fetal origins and growth acceleration hypotheses.
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Affiliation(s)
- Yoav Ben-Shlomo
- Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
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de Boo HA, Harding JE. The developmental origins of adult disease (Barker) hypothesis. Aust N Z J Obstet Gynaecol 2008; 46:4-14. [PMID: 16441686 DOI: 10.1111/j.1479-828x.2006.00506.x] [Citation(s) in RCA: 395] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many studies have provided evidence for the hypothesis that size at birth is related to the risk of developing disease in later life. In particular, links are well established between reduced birthweight and increased risk of coronary heart disease, diabetes, hypertension and stroke in adulthood. These relationships are modified by patterns of postnatal growth. The most widely accepted mechanisms thought to underlie these relationships are those of fetal programming by nutritional stimuli or excess fetal glucocorticoid exposure. It is suggested that the fetus makes physiological adaptations in response to changes in its environment to prepare itself for postnatal life. These changes may include epigenetic modification of gene expression. Less clear at this time are the relevance of fetal programming phenomena to twins and preterm babies, and whether any of these effects can be reversed after birth. Much current active research in this field will be of direct relevance to future obstetric practice.
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Affiliation(s)
- Hendrina A de Boo
- Liggins Institute, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Tu YK, Gilthorpe MS, Ellison GTH. What is the effect of adjusting for more than one measure of current body size on the relation between birthweight and blood pressure? J Hum Hypertens 2006; 20:646-57. [PMID: 16691183 DOI: 10.1038/sj.jhh.1002044] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The statistical validity of the negative associations observed between birthweight and disease in later life has recently been questioned, because these associations might be due, in part, to inappropriate adjustment for current body size, creating a statistical artefact known as the 'reversal paradox'. The aim of this study was to explore the effect of adjusting for more than one measure of current body size on the association between birthweight and disease in later life using simulations and meta-analyses of empirical studies. The simulations examined the relation between birthweight and adult systolic blood pressure before and after adjusting for one, two or three measures of current body size by including current weight and subsequently adding body mass index and height in successive analytical models. Meta-analyses were then performed to compare the effect sizes observed among empirical studies reporting associations between birthweight and blood pressure before and after adjusting for one or two measures of current body size. The meta-analyses confirmed the results of the simulations - both showed that associations between birthweight and blood pressure tend to become increasingly negative following adjustment for current body size, and that this effect is enhanced after adjusting for additional measures of current body size.
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Affiliation(s)
- Y-K Tu
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
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Jaddoe VWV, Witteman JCM. Hypotheses on the Fetal Origins of Adult Diseases: Contributions of Epidemiological Studies. Eur J Epidemiol 2006; 21:91-102. [PMID: 16518677 DOI: 10.1007/s10654-005-5924-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2005] [Indexed: 10/25/2022]
Abstract
Epidemiological studies have demonstrated associations between low birth weight and cardiovascular disease, type 2 diabetes and their risk factors in adult life. These findings have led to sharp debates in the literature concerning potential methodological study flaws and the effect size and causality of the associations. More recent studies seem to have overcome most methodological flaws and suggest a small effect size of low birth weight on adult diseases for the individual. However, the effect size may still be important on a population level. Various causal pathways have been hypothesized as mechanisms underlying these associations. These hypotheses have proposed central roles for (1) fetal undernutrition, (2) increased cortisol exposure, (3) genetic susceptibility and (4) accelerated post-natal growth. These hypotheses have been studied in various epidemiological study designs. Thus far, it is still not known which mechanisms underlie the associations between low birth weight and diseases in adult life. The causal pathways linking low birth weight to diseases in later life seem to be complex and may include combined environmental and genetic mechanisms in various periods of life. Well-designed epidemiological studies are necessary to estimate the population effect size and to identify the underlying mechanisms. This knowledge is needed to develop strategies for identifying groups at risk and prevention focused on early life.
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Affiliation(s)
- Vincent W V Jaddoe
- Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Terrin N, Schmid CH, Lau J. In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. J Clin Epidemiol 2005; 58:894-901. [PMID: 16085192 DOI: 10.1016/j.jclinepi.2005.01.006] [Citation(s) in RCA: 329] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 12/16/2004] [Accepted: 01/30/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Publication bias and related biases can lead to overly optimistic conclusions in systematic reviews. The funnel plot, which is frequently used to detect such biases, has not yet been subjected to empirical evaluation as a visual tool. We sought to determine whether researchers can correctly identify publication bias from visual inspection of funnel plots in typical-size systematic reviews. METHODS A questionnaire with funnel plots containing 10 studies each (the median number in medical meta-analyses) was completed by 41 medical researchers, including clinical research fellows in a meta-analysis class, faculty in clinical care research, and experienced systematic reviewers. RESULTS On average, participants correctly identified 52.5% (95% CI 50.6-54.4%) of the plots as being affected or unaffected by publication bias. The weighted mean percent correct, which adjusted for the fact that asymmetric plots are more likely to occur in the presence of publication bias, was also low (48.3 to 62.8%, depending on the presence or absence of publication bias and heterogeneous study effects). CONCLUSION Researchers who assess for publication bias using the funnel plot may be misled by its shape. Authors and readers of systematic reviews need to be aware of the limitations of the funnel plot.
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Affiliation(s)
- Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, 750 Washington Street, Box 63, Boston, MA 02111, USA.
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Abstract
Over the past 20 years a large and varied body of research has attempted to make the case for the developmental origins of elevated adult blood pressure (BP). Experimental animal research has identified plausible biological mechanisms through which fetal nutritional insufficiency may affect adult BP. The majority of human epidemiologic studies demonstrate an inverse association of birth weight (the most commonly used marker of fetal nutrition) with adult BP and higher risk of hypertension among individuals with lower weight at birth. The most adverse BP outcomes occur among individuals who were small at birth but relatively large as adults, a finding that suggests a role for postnatal growth. We critically review the literature on proposed mechanisms and epidemiologic evidence for developmental origins of adult BP and hypertension, considering associations with birth weight, maternal nutrition during pregnancy, child growth patterns, and infant feeding.
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Affiliation(s)
- Linda Adair
- Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, North Carolina 27599-8120, USA.
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Bergvall N, Iliadou A, Tuvemo T, Cnattingius S. Birth Characteristics and Risk of High Systolic Blood Pressure in Early Adulthood. Epidemiology 2005; 16:635-40. [PMID: 16135939 DOI: 10.1097/01.ede.0000172134.45742.49] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although an inverse association between size at birth and blood pressure has been found in several studies, few studies have adjusted for the influence of socioeconomic and familial effects. METHODS We investigated whether the association between birth weight and systolic blood pressure in young men is confounded by socioeconomic factors in adolescence or familial factors (ie, common genes and shared environment). Our population-based cohort study comprised 330,768 Swedish men born between 1973 and 1981, and conscripted for military service between 1991 and 2000. The analyses of family effects were restricted to 89,856 siblings from the initial cohort. A high systolic blood pressure at conscription was defined as a systolic blood pressure >/=140 mm Hg. Birth weight for gestational age <-2 standard deviation scores was considered "light for gestational age." RESULTS Compared with men who had normal birth weight for gestational age, men who had been born light for gestational age were at increased risk of high systolic blood pressure (odds ratio = 1.14; 95% confidence interval = 1.07-1.22), even after adjustment for important confounders such as socioeconomic status. The increase in risk of high systolic blood pressure related to 1 standard deviation score decrease in birth weight for gestational age was similar within families (1.08; 1.04-1.12) and between families (1.05; 1.03-1.08). CONCLUSIONS This study suggests that low birth weight for gestational age slightly increases the risk of high systolic blood pressure, and that the association appears not to be confounded by socioeconomic or familial effects.
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Affiliation(s)
- Niklas Bergvall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Keijzer-Veen MG, Finken MJJ, Nauta J, Dekker FW, Hille ETM, Frölich M, Wit JM, van der Heijden AJ. Is blood pressure increased 19 years after intrauterine growth restriction and preterm birth? A prospective follow-up study in The Netherlands. Pediatrics 2005; 116:725-31. [PMID: 16140714 DOI: 10.1542/peds.2005-0309] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether intrauterine growth restriction (IUGR) is a predisposing factor for high blood pressure (BP) in 19-year-olds who were born (very) preterm. METHODS A prospective follow-up study was conducted at age 19 in individuals who born preterm in the Netherlands in 1983. Systolic, diastolic, and mean BP values and plasma renin activity concentration were obtained in 422 young adults who were born with a gestational age (GA) <32 weeks. BP values were also measured in 174 individuals who born with a GA of > or =32 weeks and a birth weight of <1500 g. RESULTS An increased prevalence of hypertension and probably also of prehypertensive stage was found. IUGR, birth weight, GA, and plasma renin activity were not associated with BP. Current weight and BMI were the best predicting factors for systolic BP at the age of 19 years. CONCLUSIONS The prevalence of hypertension is high in individuals who were born preterm when compared with the general population. In the individuals who were born very preterm, no support to the hypothesis that low birth weight is associated with increased BP at young adult age can be given.
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Affiliation(s)
- Mandy G Keijzer-Veen
- Department of Pediatric Nephrology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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McMillen IC, Robinson JS. Developmental origins of the metabolic syndrome: prediction, plasticity, and programming. Physiol Rev 2005; 85:571-633. [PMID: 15788706 DOI: 10.1152/physrev.00053.2003] [Citation(s) in RCA: 1294] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The "fetal" or "early" origins of adult disease hypothesis was originally put forward by David Barker and colleagues and stated that environmental factors, particularly nutrition, act in early life to program the risks for adverse health outcomes in adult life. This hypothesis has been supported by a worldwide series of epidemiological studies that have provided evidence for the association between the perturbation of the early nutritional environment and the major risk factors (hypertension, insulin resistance, and obesity) for cardiovascular disease, diabetes, and the metabolic syndrome in adult life. It is also clear from experimental studies that a range of molecular, cellular, metabolic, neuroendocrine, and physiological adaptations to changes in the early nutritional environment result in a permanent alteration of the developmental pattern of cellular proliferation and differentiation in key tissue and organ systems that result in pathological consequences in adult life. This review focuses on those experimental studies that have investigated the critical windows during which perturbations of the intrauterine environment have major effects, the nature of the epigenetic, structural, and functional adaptive responses which result in a permanent programming of cardiovascular and metabolic function, and the role of the interaction between the pre- and postnatal environment in determining final health outcomes.
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Affiliation(s)
- I Caroline McMillen
- Discipline of Physiology, School of Molecular and Biomeducal Sciences, and Department of Obstetrics and Gynaecology, University of Adelaide, Australia.
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Järvelin MR, Sovio U, King V, Lauren L, Xu B, McCarthy MI, Hartikainen AL, Laitinen J, Zitting P, Rantakallio P, Elliott P. Early Life Factors and Blood Pressure at Age 31 Years in the 1966 Northern Finland Birth Cohort. Hypertension 2004; 44:838-46. [PMID: 15520301 DOI: 10.1161/01.hyp.0000148304.33869.ee] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Data on the birth weight-blood pressure relationship are inconsistent. Although an inverse association has been suggested in several large studies, interpretation is complicated by publication and other biases. Few data are available on the relationship between other early growth measures and blood pressure. We examined the shape and size of association between determinants of fetal growth, size at birth, growth in infancy, and adult systolic and diastolic blood pressure at 31 years in the prospective northern Finnish 1966 birth cohort of 5960 participants. Birth weight, birth length, gestational age, ponderal index, and birth weight relative to gestational age showed a significant inverse association with blood pressure at age 31. Rapid growth in infancy ("change-up") was positively associated with blood pressure. Adjusted regression coefficients for birth weight indicated systolic/diastolic blood pressure lower by -1.7 (95% confidence interval [CI], -2.5, -1.0)/-0.7 (95% CI, -1.4, -0.02) mm Hg for 1 kg higher birth weight. The significant inverse association between birth weight and systolic blood pressure persisted without adjustment for adult body mass index for males. Among females, gestational age showed a stronger association with blood pressure than birth weight: gestational age higher by 7 weeks (equivalent to an average of 1 kg higher birth weight) among singletons associated with -2.9 (95% CI, -4.7, -1.1) mm Hg lower systolic blood pressure. Our results support the concept that birth weight, other birth measures, and infant growth are important determinants of blood pressure and hence cardiovascular disease risk in later life.
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Affiliation(s)
- Marjo-Riitta Järvelin
- Department of Epidemiology and Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom.
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Burke V, Beilin LJ, Blake KV, Doherty D, Kendall GE, Newnham JP, Landau LI, Stanley FJ. Indicators of Fetal Growth Do Not Independently Predict Blood Pressure in 8-Year-Old Australians. Hypertension 2004; 43:208-13. [PMID: 14718353 DOI: 10.1161/01.hyp.0000113296.77924.28] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inverse associations between size at birth and blood pressure (BP) in later life are commonly statistically significant only after adjustment for current size, consistent with change in size as the determinant. Few studies have been prospective or have included a range of potential confounders. Using regression models, including maternal and demographic variables, we examined associations between size at birth and BP in Australian children followed from week 16 of gestation to the age of 8 years. BP measurements were available from 1417 children born after 37 weeks gestation without congenital abnormalities. In models adjusted only for sex, the birthweight (BW), birth length, ponderal index, head circumference, chest circumference, abdominal girth, mid-arm circumference, triceps skinfold, placental weight, or BW/placental weight ratio did not significantly predict SBP in 8-year-olds. With adjustment for current size, associations were inverse but not statistically significant (regression coefficients: BW, −1.11; 95% confidence limits [CL], −2.22, 0.01; birth length, −0.25; 95% CL, −0.52, 0.24) and remained nonsignificant after adjustment for confounders. Current weight, height, or body mass index significantly predicted SBP and DBP (
P
<0.001) with differences of 8/4 mm Hg between upper and lower quartiles; effects were similar in infants with lower and higher BW. These findings are consistent with postnatal change in size as the major determinant of BP in 8-year-olds and are important in the context of the worldwide “epidemic” of obesity in childhood as a likely precursor of increasing rates of hypertension in adults.
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Affiliation(s)
- Valerie Burke
- The University of Western Australia, School of Medicine and Pharmacology, Royal Perth Hospital and Western Australian Institute for Medical Research, Perth, Australia.
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