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Zhang Z, Liu X, Huang N, Jin M, Zhuang Z, Yang Z, Liu X, Huang T, Li N. Joint association and interaction of birth weight and lifestyle with hypertension: A cohort study in UK Biobank. J Clin Hypertens (Greenwich) 2024; 26:483-490. [PMID: 38491763 PMCID: PMC11088426 DOI: 10.1111/jch.14792] [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: 12/21/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
Low birth weight and unhealthy lifestyle are both associated with an increased risk of hypertension. The authors aimed to assess the joint association and interaction of birth weight and lifestyle with incident hypertension. The authors included 205 522 participants free of hypertension at baseline from UK Biobank. A healthy lifestyle score was constructed using information on body mass index, physical activity, diet, smoking status and alcohol intake. Cox proportional hazard models were used to investigate the impact of birth weight, healthy lifestyle score and their joint effect on hypertension. The authors documented 13 548 (6.59%) incident hypertension cases during a median of 8.6 years of follow-up. The multivariate adjusted hazard ratios and 95% confidence intervals were 1.12 (1.09, 1.15) per kg lower birth weight and 0.76 (0.75, 0.77) per score increment in healthy lifestyle score. Healthy lifestyle reduced the risk of hypertension in any category of different birth weight groups. The preventive effect of healthy lifestyle on hypertension was the most pronounced at lower birth weight with <2500 g and 2500-2999 g, respectively. Addictive interaction between birth weight and healthy lifestyle score was observed with the relative excess risk due to interaction of 0.04 (0.03, 0.05). Our findings emphasized the importance of healthy lifestyle for hypertension prevention, especially among the high-risk population with lower birth weight.
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Affiliation(s)
- Ziyi Zhang
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Institute of Reproductive and Child HealthPeking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of ChinaBeijingChina
| | - Xiaowen Liu
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Institute of Reproductive and Child HealthPeking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of ChinaBeijingChina
| | - Ninghao Huang
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
| | - Ming Jin
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Institute of Reproductive and Child HealthPeking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of ChinaBeijingChina
| | - Zhenhuang Zhuang
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
| | - Zeping Yang
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Institute of Reproductive and Child HealthPeking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of ChinaBeijingChina
| | - Xiaojing Liu
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Institute of Reproductive and Child HealthPeking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of ChinaBeijingChina
| | - Tao Huang
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of EducationBeijingChina
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking UniversityBeijingChina
| | - Nan Li
- Department of Epidemiology & BiostatisticsSchool of Public Health, Peking UniversityBeijingChina
- Institute of Reproductive and Child HealthPeking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of ChinaBeijingChina
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Alvarez-Elias AC, Brenner BM, Luyckx VA. Climate change and its influence in nephron mass. Curr Opin Nephrol Hypertens 2024; 33:102-109. [PMID: 37800660 PMCID: PMC10715706 DOI: 10.1097/mnh.0000000000000932] [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] [Indexed: 10/07/2023]
Abstract
PURPOSE OF REVIEW The consequences of climate change, including heat and extreme weather events impact kidney function in adults and children. The impacts of climate change on kidney development during gestation and thereby on kidney function later in life have been poorly described. Clinical evidence is summarized to highlight possible associations between climate change and nephron mass. RECENT FINDINGS Pregnant women are vulnerable to the effects of climate change, being less able to thermoregulate, more sensitive to the effects of dehydration, and more susceptible to infections. Exposure to heat, wildfire smoke, drought, floods and climate-related infections are associated with low birth weight, preterm birth and preeclampsia. These factors are associated with reduced nephron numbers, kidney dysfunction and higher blood pressures in offspring in later life. Exposure to air pollution is associated with higher blood pressures in children and has variable effects on estimated glomerular filtration rate. SUMMARY Climate change has important impacts on pregnant women and their unborn children. Being born too small or too soon is associated with life-time risk of kidney disease. Climate change may therefore have a dual effect of impacting fetal kidney development and contributing to cumulative postnatal kidney injury. The impact on population kidney health of future generations may be significant.
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Affiliation(s)
- Ana Catalina Alvarez-Elias
- Renal Research Institute, New York City, New York, USA
- Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
- University of Toronto, IHPME & Sick Kids Research Institute, Toronto, Canada
| | - Barry M. Brenner
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valerie A. Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Starr MC, Gilley SP, See EJ, Slagle C, Soranno DE. Adults are just big kids: pediatric considerations for adult critical care nephrology. Curr Opin Crit Care 2023; 29:580-586. [PMID: 37861193 DOI: 10.1097/mcc.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW In recent years, there has been growing attention to pediatric kidney health, especially pediatric acute kidney injury (AKI). However, there has been limited focus on the role of pediatric AKI on adult kidney health, specifically considerations for the critical care physician. RECENT FINDINGS We summarize what is known in the field of pediatric AKI to inform adult medical care including factors throughout the early life course, including perinatal, neonatal, and pediatric exposures that impact survivor care later in adulthood. SUMMARY The number of pediatric AKI survivors continues to increase, leading to a higher burden of chronic kidney disease and other long-term co-morbidities later in life. Adult medical providers should consider pediatric history and illnesses to inform the care they provide. Such knowledge may help internists, nephrologists, and intensivists alike to improve risk stratification, including a lower threshold for monitoring for AKI and kidney dysfunction in their patients.
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Affiliation(s)
- Michelle C Starr
- Indiana University School of Medicine, Department of Pediatrics, Pediatric Nephrology
- Child Health Service Research Division, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephanie P Gilley
- University of Colorado School of Medicine, Department of Pediatrics, Section of Nutrition, Aurora, Colorado, USA
| | - Emily J See
- Royal Melbourne Hospital, Departments of Intensive Care and Nephrology, Melbourne, VIC, Australia
| | - Cara Slagle
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Department of Pediatrics, Cincinnati, Ohio
| | - Danielle E Soranno
- Indiana University School of Medicine, Department of Pediatrics, Pediatric Nephrology
- Purdue University, Weldon School of Bioengineering, Department of Bioengineering, West Lafayette, Indiana, USA
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CAKUT: A Pediatric and Evolutionary Perspective on the Leading Cause of CKD in Childhood. Pediatr Rep 2023; 15:143-153. [PMID: 36810342 PMCID: PMC9944871 DOI: 10.3390/pediatric15010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The global prevalence of chronic kidney disease (CKD) is increasing rapidly, due to increasing environmental stressors through the life cycle. Congenital anomalies of kidney and urinary tract (CAKUT) account for most CKD in children, with a spectrum that can lead to kidney failure from early postnatal to late adult life. A stressed fetal environment can impair nephrogenesis, now recognized as a significant risk factor for the development of adult CKD. Congenital urinary tract obstruction is the leading cause of CKD due to CAKUT and can itself impair nephrogenesis as well as contribute to progressive nephron injury. Early diagnosis by ultrasonography in fetal life by an obstetrician/perinatologist can provide important information for guiding prognosis and future management. This review focuses on the critical role played by the pediatrician in providing timely evaluation and management of the patient from the moment of birth to the transfer to adult care. In addition to genetic factors, vulnerability of the kidney to CKD is a consequence of evolved modulation of nephron number in response to maternal signaling as well as to susceptibility of the nephron to hypoxic and oxidative injury. Future advances in the management of CAKUT will depend on improved biomarkers and imaging techniques.
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Gazzard SE, van der Wolde J, Haruhara K, Bertram JF, Cullen‐McEwen LA. Nephron deficit and low podocyte density increase risk of albuminuria and glomerulosclerosis in a model of diabetes. Physiol Rep 2023; 11:e15579. [PMID: 36695822 PMCID: PMC9875819 DOI: 10.14814/phy2.15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Podocytes are terminally differentiated epithelial cells in glomeruli. Podocyte injury and loss are features of many diseases leading to chronic kidney disease (CKD). The developmental origins of health and disease hypothesis propose an adverse intrauterine environment can lead to CKD later in life, especially when a second postnatal challenge is experienced. The aim of this study was to examine whether a suboptimal maternal environment would result in reduced podocyte endowment, increasing susceptibility to diabetes-induced renal injury. Female C57BL/6 mice were fed a low protein diet (LPD) to induce growth restriction or a normal protein diet (NPD) from 3 weeks before mating until weaning (postnatal Day 21, P21) when nephron and podocyte endowment were assessed in one male and one female offspring per litter. Littermates were administered streptozotocin or vehicle at 6 weeks of age. Urinary albumin excretion, glomerular size, and podometrics were assessed following 18 weeks of hyperglycemia. LPD offspring were growth restricted and had lower nephron and podocyte number at P21. However, by 24 weeks the podocyte deficit was no longer evident and despite low nephron endowment neither albuminuria nor glomerulosclerosis were observed. Podocyte number was unaffected by 18 weeks of hyperglycemia in NPD and LPD offspring. Diabetes increased glomerular volume reducing podocyte density, with more pronounced effects in LPD offspring. LPD and NPD diabetic offspring developed mild albuminuria with LPD demonstrating an earlier onset. LPD offspring also developed glomerular pathology. These findings indicate that growth-restricted LPD offspring with low nephron number and normalized podocyte endowment were more susceptible to alterations in glomerular volume and podocyte density leading to more rapid onset of albuminuria and renal injury than NPD offspring.
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Affiliation(s)
- Sarah E. Gazzard
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery InstituteMonash UniversityMelbourneAustralia
| | - James van der Wolde
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery InstituteMonash UniversityMelbourneAustralia
| | - Kotaro Haruhara
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery InstituteMonash UniversityMelbourneAustralia
- Division of Nephrology and Hypertension, Department of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - John F. Bertram
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery InstituteMonash UniversityMelbourneAustralia
- ARC Training Centre for Cell and Tissue Engineering TechnologiesMelbourneAustralia
| | - Luise A. Cullen‐McEwen
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery InstituteMonash UniversityMelbourneAustralia
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Taggart MJ, Tribe RM. Physiological resilience across the lifecourse: in utero and beyond. Exp Physiol 2022; 107:395-397. [PMID: 35415849 DOI: 10.1113/ep090320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Michael J Taggart
- Biosciences Institute, International Centre for Life, Newcastle University, Newcastle Upon Tyne, UK
| | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course and Population Science, King's College London, London, UK
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Nobile S, Di Sipio Morgia C, Vento G. Perinatal Origins of Adult Disease and Opportunities for Health Promotion: A Narrative Review. J Pers Med 2022; 12:jpm12020157. [PMID: 35207646 PMCID: PMC8877993 DOI: 10.3390/jpm12020157] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
The “developmental origins of health and disease” (DOHaD) hypothesis refers to the influence of early developmental exposures and fetal growth on the risk of chronic diseases in later periods. During fetal and early postnatal life, cell differentiation and tissue formation are influenced by several factors. The interaction between genes and environment in prenatal and early postnatal periods appears to be critical for the onset of multiple diseases in adulthood. Important factors influencing this interaction include genetic predisposition, regulation of gene expression, and changes in microbiota. Premature birth and intrauterine growth restriction (IUGR) are other important factors considered by the DOHaD hypothesis. Preterm birth is associated with impaired or arrested structural or functional development of key organs/systems, making preterm infants vulnerable to cardiovascular, respiratory, and chronic renal diseases during adulthood. Growth restriction, defined as impaired fetal growth compared to expected biological potential in utero, is an additional negative factor increasing the risk of subsequent diseases. Environmental factors implicated in the developmental programming of diseases include exposure to pollution, stress, drugs, toxic agents, nutrition, and exercise. The DOHaD may explain numerous conditions, including cardiovascular, metabolic, respiratory, neuropsychiatric, and renal diseases. Potential antenatal and postnatal preventive measures, interventions, and future directions are discussed.
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