Birth weight, subsequent growth, and cholesterol metabolism in children 8-12 years old born preterm

Presence of metabolic syndrome markers in very low birth weight ex-premature infants during early adolescence

OBJECTIVES

To investigate the association of growth patterns with overweight/obesity and markers of metabolic syndrome in ex-premature adolescents; to assess the relationship between the increase (1 SD) in Z-score weight at term and at 2 years with outcomes in adolescents with or without intrauterine growth restriction; and to evaluate the association between the Cook criteria and overweight/obesity according to body mass index.

METHODS

Cohort, retrospective, analytical study. Population: adolescents born weighting<1,500 g.

RESULTS

One hundred twenty-seven adolescents (11.3 years) were included. There is an association between the 1 SD increase in the percentile (Pc) of weight at 40 weeks and at 2 years in the population with adequate birth weight (PCA) with insulin levels, resistance, and sensitivity at 11 years. Catch-up at 2 years was associated with significantly higher proportion of HDL value<41 (18.75 vs. 5.36 %) OR 4.08 95% CI (1.04-16.05) p=0.031. Overweight/obesity was associated with waist circumference index>0.5, HDL<41, and with blood pressure greater than Pc 90 for sex and height.

CONCLUSIONS

In preterm infants, a 1 SD increase in weight Z score at 40 weeks and 2 years was predictive of metabolic and cardiovascular disorders in adolescence.

Size at birth, growth trajectory in early life, and cardiovascular and metabolic risks in early adulthood: EPICure study

OBJECTIVE

To investigate whether size at birth and growth trajectories in infancy and childhood are associated with determinants of cardiovascular and metabolic risks in young adults born extremely preterm (EP, <26 weeks of gestation).

METHODS

We used longitudinal data from the EPICure study of 129 EP survivors up to 19 years in the UK and Ireland in 1995. Determinants of cardiovascular and metabolic risks at 19 years included the presence of metabolic syndrome, body mass index (BMI) and systolic blood pressure (SBP). Predictors were birth weight for gestation and gain in weight z-scores in the following periods: birth-postmenstrual age of 40 weeks (term), infancy (term-2.5 years), early childhood (2.5-6.0 years) and late childhood (6-11 years).

RESULTS

Metabolic syndrome was present in 8.7% of EP participants at 19 years. Compared with subjects without metabolic syndrome, those with metabolic syndrome tended to have a smaller size at birth (difference in means: -0.55 SD, 95% CI -1.10 to 0.01, p=0.053) and a greater increase in weight z-scores from term to 2.5 years (difference in means: 1.00 SD, 95% CI -0.17 to 2.17, p=0.094). BMI at 19 years was positively related to growth from 2.5 to 6.0 years ( β : 1.03, 95% CI 0.31 to 1.75, p=0.006); an inverse association with birthweight z-scores was found in the lower socioeconomic status group ( β : -1.79, 95% CI -3.41 to -0.17, p=0.031). Central SBP was positively related to growth from 2.5 to 6.0 years ( β : 1.75, 95% CI 0.48 to 3.02, p=0.007).

CONCLUSION

Size at EP birth and increased catch-up in weight from 2.5 to 6.0 years were associated with BMI and central SBP in early adulthood.

Monozygotic Twins with Birth-Weight Differences: Metabolic Health Influenced more by Genetics or by Environment?

BACKGROUND

Low birth-weight (bw), low birth-length (bl), unfavourable intrauterine conditions and post-natal catch-up growth can have an impact on growth and metabolic health later in life.

OBJECTIVE

We studied genetically identical twins with intra-twin bw-differences due to twin-twin transfusion syndrome from birth to adolescence and analysed the long-term impact of bw and catch-up growth on metabolic parameters.

SUBJECTS AND METHODS

Forty-three postpubertal monozygotic twin-pairs (mean age 17.4 years) were examined. Twenty-two pairs were discordant (intra-twin bw- and/or bl-difference ≥1 SDS) of which 12 (55%) experienced catch-up growth. Auxological parameters and blood pressure were measured, a fasting blood sample was collected and bio-impedance spectroscopy was carried out.

RESULTS

Irrespective of differences in birth parameters and postnatal catch-up growth, a significant intra-twin correlation was found for nearly all measured parameters of body composition (skinfold, waist-hip circumference, relative body fat/lean body mass) and metabolic health (total, and low-density lipoprotein-C/high-density lipoprotein-C, Apolipoprotein A and B, C-peptide). As an exception to this, and only for the former smaller twins who showed postnatal catch-up growth, a significantly higher fasting insulin level was found compared to that of the co-twins (mean insulin level: 8.4 vs. 5.7 µIU/mL; p < 0.01). Auxology remained different until adulthood: even in subjects with catch-up growth the former smaller twins were significantly lighter (mean-body mass index-SDS: -0.42 vs. 0.21; p < 0.05) and shorter (mean height-SDS: -0.07 vs. 0.37; p < 0.05) than their co-twins.

CONCLUSION

In this special group of monozygotic twins with intra-twin bw-differences and catch-up growth, we found that the genetic background was a more important factor in determining later metabolic health than bw and/or catch-up growth.

Intrauterine Growth Restriction: New Insight from the Metabolomic Approach

Recognizing intrauterine growth restriction (IUGR) is a matter of great concern because this condition can significantly affect the newborn's short- and long-term health. Ever since the first suggestion of the "thrifty phenotype hypothesis" in the last decade of the 20th century, a number of studies have confirmed the association between low birth weight and cardiometabolic syndrome later in life. During intrauterine life, the growth-restricted fetus makes a number of hemodynamic, metabolic, and hormonal adjustments to cope with the adverse uterine environment, and these changes may become permanent and irreversible. Despite advances in our knowledge of IUGR newborns, biomarkers capable of identifying this condition early on, and stratifying its severity both pre- and postnatally, are still lacking. We are also still unsure about these babies' trajectory of postnatal growth and their specific nutritional requirements with a view to preventing, or at least limiting, long-term complications. In this setting, untargeted metabolomics-a relatively new field of '-omics' research-can be a good way to investigate the metabolic perturbations typically associated with IUGR. The aim of this narrative review is to provide a general overview of the pathophysiological and clinical aspects of IUGR, focusing on evidence emerging from metabolomic studies. Though still only preliminary, the reports emerging so far suggest an "early" pattern of glucose intolerance, insulin resistance, catabolite accumulation, and altered amino acid metabolism in IUGR neonates. Further, larger studies are needed to confirm these results and judge their applicability to clinical practice.

Insights into infancy weight gain patterns for term small-for-gestational-age babies

BACKGROUND

Too fast or slow weight gain in infancy is bad for health in later life. In this study, we aim to investigate the optimal weight gain pattern during the first 2 y of life for term small-for-gestational-age (SGA) infants.

METHOD

We employed data from a longitudinal, community-based cohort study on the growth and development of SGAs collected between 2004 and 2010 in Shanghai, China. Latent class growth analysis (LCGA) was applied to identify weight gain patterns among 3004 SGAs. BMI curves for each latent class from 1 mo to 5 y were produced through mixed-effects regression analysis. Multivariable regression was performed to examine the association between various classes and adverse outcomes (overweight/obesity/ malnutrition) during 2-5 y.

RESULT

Five weight gain patterns aged 0-2 y of 3004 term SGAs were identified and labeled as follows--class 1: excessively rapid catch-up growth (10.7%); class 2: rapid catch-up growth (19.7%); class 3: appropriate catch-up growth (55.7%); class 4: slow catch-up growth (10.2%); class 5: almost no catch-up growth (3.7%). A decreasing age at adiposity rebound (AR) and an increasing BMI value were observed from class 5 to 1. Class 1 and 2 showed an early appearance of AR (< 4 y). SGAs in class 1 and 2 had a higher BMI in 2-5 y of life. After adjustment for potential confounding variables, class 1 and 2 were found to have an increased risk of being overweight/ obese. At the same time, we found the risk of malnutrition was especially prominent among SGAs in classes 4 and 5.

CONCLUSION

Our results suggest that for term SGA infants, catch-up growth that crossing two centile levels, that is, from < 10th to the interval between 25th and 50th (ΔWAZ> 1.28) in the first several months, along with on track growth and maintenance at a median level by age 2 may be the optimal catch-up growth trajectory, minimizing risk of childhood adverse health outcomes.

Effect of preterm birth on growth and cardiovascular disease risk at school age

BACKGROUND

Low birthweight is associated with increased risk for cardiovascular disease (CVD) in later life, but whether premature birth is also a risk factor for CVD has not been fully determined. The aim of this study was to investigate the relationship between gestational age and risk factors for CVD at school age.

METHODS

Using medical check-up data of school children, the relationship between gestational age and height, weight, body mass index, blood pressure, and lipid profiles at ages 9 and 12 years were investigated in children born preterm and admitted to neonatal intensive care unit at birth (n = 182; 115 boys and 67 girls). These data were also compared between preterm small for gestational age (SGA) children and preterm appropriate for gestational age (AGA) children.

RESULTS

Gestational age was positively associated with height, and inversely associated with systolic blood pressure at school age. Preterm SGA children were significantly shorter and lighter at 9 and 12 years of age compared with preterm AGA children, but there were no significant differences in any CVD risk factors between the groups.

CONCLUSIONS

In preterm infants, a shorter duration of gestation is associated with higher systolic blood pressure at school age.

Postnatal growth in preterm infants and later health outcomes: a systematic review

In preterm infants, poor postnatal growth is associated with adverse neurocognitive outcomes; conversely, rapid postnatal growth is supposedly harmful for future development of metabolic diseases.

CONCLUSION

In this systematic review, observational studies reported consistent positive associations between postnatal weight or head growth and neurocognitive outcomes; however, there was limited evidence from the few intervention studies. Evidence linking postnatal weight gain to later adiposity and other cardiovascular disease risk factors in preterm infants was also limited.

Behaviour influences cholesterol plasma levels in a pig model

Little is known about the relationship between feed intake behaviour and cholesterol levels in humans. This can be attributed to the fact that feed intake behaviour in humans is difficult to assess. The relationships between feed intake, feed efficiency and feed intake behaviour, and cholesterol and triglyceride levels were investigated at an average age of 187 days, in a pig model consisting of 202 Duroc barrows. Feed intake and feed intake behaviour were recorded individually and daily by means of an electronic identification system. Animals with high levels of total cholesterol also had high levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol and triglycerides. Animals with high levels of HDL also had high levels of LDL and triglycerides, and animals with high levels of LDL also had high levels of triglycerides. Animals with higher BW, higher backfat thickness, higher BW gain, higher gain of backfat deposition, higher feed intake, higher residual feed intake (RFI) and higher feed intake rate had higher levels of total, HDL and LDL plasma cholesterol. Results indicate that the relationship between feed intake and cholesterol levels is a long-term relationship, while the relationship between RFI and cholesterol levels is more of a short-term nature. The relationship between intake rate and cholesterol plasma levels disappeared after correction for the amount of feed consumed. Results indicate that feed intake independent of metabolic BW, growth and fatness, i.e. 'RFI', was positively correlated with cholesterol plasma levels. This suggests that eating food over and above the maintenance and growth requirements constitutes a health risk independent of the level of fatness.

Early-life determinants of total and HDL cholesterol concentrations in 8-year-old children; the PIAMA birth cohort study

BACKGROUND

Adult cholesterol concentrations might be influenced by early-life factors, such as breastfeeding and birth weight, referred to as "early programming". How such early factors exert their influence over the life course is still poorly understood. Evidence from studies in children and adolescents is scarce and conflicting. We investigated the influence of 6 different perinatal risk factors on childhood total and HDL cholesterol concentrations and total-to-HDL cholesterol ratio measured at 8 years of age, and additionally we studied the role of the child's current Body Mass Index (BMI).

METHODS

Anthropometric measures and blood plasma samples were collected during a medical examination in 751 8-year-old children participating in the prospective Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study. Linear and logistic regression were performed to estimate associations of total and HDL cholesterol concentrations with breastfeeding, birth weight, infant weight gain, maternal overweight before pregnancy, gestational diabetes and maternal smoking during pregnancy, taking into account the child's current BMI.

RESULTS

Linear regressions showed an association between total-to-HDL cholesterol ratio and maternal pre-pregnancy overweight (β = 0.15, Confidence Interval 95% (CI): 0.02, 0.28), rapid infant weight gain (β = 0.13, 95%CI: 0.01, 0.26), and maternal smoking during pregnancy (β = 0.14, 95%CI: 0.00, 0.29). These associations were partly mediated by the child's BMI.

CONCLUSION

Total-to-HDL cholesterol ratio in 8-year-old children was positively associated with maternal pre-pregnancy overweight, maternal smoking during pregnancy and rapid infant weight gain.

Fortification of maternal milk for very low birth weight (VLBW) pre-term neonates

Human milk is the best food for all neonates; however, in pre-term infants, especially those with a very low birth weight, it may lead to insufficient intake of protein and energy. The use of fortified human milk produces adequate growth in premature infants and satisfies the specific nutritional requirements of these babies. To improve the nutritional management of pre-term infants < or =35 weeks' gestational age, an individualised human milk fortification system based on the analysis of maternal milk was evaluated.

Activation of the aryl hydrocarbon receptor during different critical windows in pregnancy alters mammary epithelial cell proliferation and differentiation

Exposure to the aryl hydrocarbon receptor (AhR) agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) during pregnancy causes severe defects in mammary gland development and function; however, the underlying mechanism remains unclear. Alterations in epithelial cell proliferation, differentiation, and apoptosis during pregnancy-related mammary development can lead to failed lactogenesis. To determine which of these processes are affected and at what time periods, we examined proliferation, differentiation and apoptosis in mammary glands following exposure to TCDD during early, mid or throughout pregnancy. Although AhR activation throughout pregnancy did not cause early involution, there was a 50% decrease in cell proliferation, which was observed as early as the sixth day of pregnancy (DP). TCDD treatment on the day of impregnation only reduced development and proliferation in early and mid-pregnancy, followed by partial recovery by DP17. However, when AhR activation was delayed to DP7, developmental impairment was not observed in mid-pregnancy, but became evident by DP17, whereas proliferation was reduced at all times. Thus, early exposure to TCDD was neither necessary nor sufficient to cause persistent defects in lactogenesis. These varying outcomes in mammary development due to exposure at different times in pregnancy suggest there are critical windows during which AhR activation impairs mammary epithelial cell proliferation and differentiation.

Growth patterns in the growth-retarded premature infant

Approximately 10% of all infants are born prematurely. A large proportion of these infants show evidence of postnatal growth impairment irrespective of whether birth weight was appropriate or small for gestational age. The timing and magnitude of catch-up growth is very variable, with the most immature infants showing markedly delayed catch up which is often incomplete. Long-term studies suggest that final stature may be affected significantly. Growth impairment in itself is of concern and there are suggestions that this group of infants should be eligible for growth hormone treatment. However, in addition, there is increasing evidence to suggest that there should be additional concerns in this group of infants, as abnormal early growth may influence disease susceptibility in adult life. This review assesses the patterns of postnatal growth and the possible later implications of early aberrant growth patterns in later life.

The timing of nutrient restriction during rat pregnancy/lactation alters metabolic syndrome phenotype

OBJECTIVE

Modulation of growth of intrauterine growth restricted (IUGR) newborns causes either adult obesity or normalization of body weight and fat. We investigated the impact of rapid versus delayed catch-up growth of IUGR offspring on glucose and lipid profiles.

STUDY DESIGN

From 10 days to term gestation and through lactation, control pregnant rats received ad libitum food, whereas study rats were 50% food restricted. Cross-fostering techniques were used to examine effects of food restriction during pregnancy and/or lactation periods. Glucose and lipid profiles were determined in offspring at ages 1 day, 3 weeks, and 9 months.

RESULTS

Food restriction during pregnancy produced hypoglycemic IUGR pups. Those permitted rapid catch-up growth demonstrated adult obesity with insulin resistance (hyperglycemia/hyperinsulinemia) and hypertriglyceridemia. Conversely, IUGR exhibiting delayed catch-up growth demonstrated normal adult body weight and insulin deficiency (hyperglycemia/hypoinsulinemia) and elevated cholesterol levels as compared with controls. However, these adult offspring had higher glucose though similar insulin levels as control offspring nursed by food restricted dam.

CONCLUSION

The timing and the rate of IUGR newborn catch-up growth causes markedly altered adult phenotypes. Although delayed newborn catch-up growth may be beneficial in the prevention of adult obesity, there may be significant adverse effects on pancreatic function.

Birthweight and risk factors for cardiovascular diseases in Japanese schoolchildren

BACKGROUND

Low birthweight (LBW) is associated with an increased risk for atherosclerotic coronary heart disease (ACHD) later in life. However, little information is currently available on the relationship between birthweight (BW) and risk factors for ACHD in children.

METHODS

The relationship between BW and risk factors for ACHD was evaluated in 330 Japanese children (187 boys and 143 girls) aged between 7 and 12 years, who underwent screening for lifestyle-related diseases in Okinawa, Japan. Routine chemical methods were used to determine the serum concentrations of lipids, apolipoproteins, uric acid and glucose. Serum insulin and adiponectin were measured by sandwich enzyme-linked immunosorbent assay.

RESULTS

BW was significantly correlated with serum concentrations of adiponectin (r= 0.163, P= 0.003) and uric acid (r=-0.166. P= 0.003), but not with insulin, lipids or apolipoproteins. These correlations were still significant even after adjusting for age, gender and body mass index (BMI) percentile (BW and adiponectin, r= 0.239, P= 0.000; BW and uric acid, r=-0.247, P= 0.000). In addition, BW was correlated with high-density lipoprotein-cholesterol (HDL-C) only after adjusting for age, gender and BMI percentile (r= 0.117, P= 0.034). In a stepwise multiple regression analysis, BW was a significant predictive variable for adiponectin and uric acid. However, weight velocity (weight gain/year) was a stronger predictive variable than BW for both adiponectin and uric acid. BW was not a significant predictive variable for HDL-C. Adiponectin was the strongest predictive variable for HDL-C.

CONCLUSION

BW is related to serum concentrations of adiponectin and uric acid. However, weight velocity was a stronger determinant of serum adiponectin and uric acid levels than BW in Japanese schoolchildren. Thus, it may be important to control weight gain to prevent the development of ACHD in children, especially in children with LBW.

Glucose and lipid metabolism in small-for-gestational-age infants at 72 hours of age

CONTEXT

Reduced birth weight is associated with increased risk for the insulin resistance syndrome. Part of this risk is hypothesized to originate from intrauterine growth retardation.

OBJECTIVE

The aim of this study is to determine whether or not the components of the insulin resistance syndrome are associated with reduced fetal growth.

DESIGN

This was a case-control study.

SETTING

The study was conducted in Beijing, China.

PARTICIPANTS

Included in this study were 296 singleton neonates (177 males and 119 females), including 76 (37 preterm and 39 full-term newborns) classified as small for gestational age (SGA) and 220 who were appropriate for gestational age (AGA) (84 preterm and 136 full-term newborns).

MAIN OUTCOME MEASURES

The main outcome measures were postabsorptive glucose, insulin, and lipids levels on the third day after birth.

RESULTS

Both full-term and preterm SGA neonates had higher insulin concentrations (mean +/- SEM, 17.11 +/- 1.15 vs.6.80 +/- 0.62 microIU/ml in full-term, P < 0.01; 11.99 +/- 1.18 vs.8.37 +/- 0.78 microIU/ml in preterm, P = 0.03), insulin to glucose ratios (4.48 +/- 0.37 vs. 1.78 +/- 0.20 in full-term, P < 0.01; 3.28 +/- 0.38 vs. 2.30 +/- 0.26 in preterm, P = 0.03), triglycerides (2.29 +/- 0.23 vs.1.57 +/- 0.13 mmol/liter in full-term, P < 0.01; 2.27 +/- 0.16 vs. 1.34 +/- 0.11 mmol/liter in preterm, P < 0.01), total cholesterol (2.35 +/- 0.12 vs. 1.82 +/- 0.22 mmol/liter in full-term, P = 0.04; 2.57 +/- 0.22 vs. 1.95 +/- 0.15 mmol/liter in preterm, P = 0.02), and low-density lipoprotein cholesterol (2.11 +/- 0.58 vs. 1.24 +/- 0.61 mmol/liter in full-term, P = 0.01; 1.87 +/- 0.60 vs. 1.38 +/- 0.59 mmol/liter in preterm, P < 0.01) concentrations than did AGA neonates; however, they had similar glucose levels. Among AGA infants, insulin concentration, insulin to glucose ratios, and lipids levels did not significantly differ between full-term and preterm babies.

CONCLUSIONS

In this study, SGA neonates displayed profiles suggestive of lower insulin sensitivity and less favorable lipid metabolism in the early postnatal period.

Compensatory growth impairs adult cognitive performance

Several studies have demonstrated that poor early nutrition, followed by growth compensation, can have negative consequences later in life. However, it remains unclear whether this is attributable to the nutritional deficit itself or a cost of compensatory growth. This distinction is important to our understanding both of the proximate and ultimate factors that shape growth trajectories and of how best to manage growth in our own and other species following low birth weight. We reared sibling pairs of zebra finches on different quality nutrition for the first 20 d of life only and examined their learning performance in adulthood. Final body size was not affected. However, the speed of learning a simple task in adulthood, which involved associating a screen colour with the presence of a food reward, was negatively related to the amount of growth compensation that had occurred. Learning speed was not related to the early diet itself or the amount of early growth depression. These results show that the level of compensatory growth that occurs following a period of poor nutrition is associated with long-term negative consequences for cognitive function and suggest that a growth-performance trade-off may determine optimal growth trajectories.

The speed with which adult zebra finches learned a new association task inversely correlates not with the degree of nutritional deprivation experienced early in life, but with the level of compensatory growth.

Accelerated postnatal head growth follows preterm birth

BACKGROUND

Poor growth after preterm birth, particularly poor head growth, is associated with impaired neurodevelopmental outcome.

OBJECTIVE

To evaluate weight gain and head growth between birth and term in a contemporary cohort of preterm infants, taking into account breast milk intake and illness severity.

METHODS

Subjects were inborn infants <or=32 weeks gestation who remained in the neonatal unit up to >or=37 weeks postmenstrual age. Weight and head circumference (HC) were expressed as standard deviation score (SDS), growth between birth and discharge as SDS gain (SDSG), and illness severity and breast milk exposure as the number of days of level 1 (full) intensive care (%L1IC) and the number of days on which breast milk was received (%BM) as a percentage of days from birth to discharge.

RESULTS

Infants showed poor postnatal weight gain but accelerated head growth. There was a highly significant fall in mean (SD) weight SDS between birth and discharge (-0.31 (0.96) and -1.32 (1.02) respectively, p<0.001) and a highly significant increase in HC SDS (-0.52 (0.95) and -0.03 (1.25) respectively, p = 0.003). %L1IC had a highly significant negative impact on weight SDSG (p = 0.006), and %BM had a significant positive impact on HC SDSG (p = 0.043).

CONCLUSIONS

Accelerated postnatal head growth suggests catch up after antenatal restraint. This raises the possibility that poor neurocognitive outcomes after extremely preterm birth may in part be consequent on poor intrauterine brain growth. As postnatal head growth may be facilitated by breast milk, there is an urgent need to evaluate the optimal use of breast milk in preterm neonates. Illness severity is a significant determinant of poor postnatal weight gain.

Sex differences in the association between birth weight and total cholesterol. A meta-analysis

PURPOSE

Determine whether a sex difference exists in the association between birth weight and total cholesterol later in life.

METHODS

Meta-analysis of within-study differences in regression coefficients of cholesterol on birth weight.

RESULTS

A total of 34 regression coefficients from 30 studies were included in the analyses; these provided data on 33,650 males and 23,129 females. There was evidence that the inverse association between birth weight and total cholesterol was stronger in males compared to females. The pooled within-study difference in age-adjusted regression coefficients was -0.03 mmol/l (-0.06, -0.01), p = 0.02 and the pooled within-study difference in age and body mass index adjusted regression coefficients was -0.04 mmol/l (-0.07, -0.02), p = 0.002. There was no evidence of heterogeneity in these meta-analyses (both p values > 0.6).

CONCLUSIONS

These results provide some evidence for a sex difference in the birth weight-total cholesterol association. This is consistent with studies of fetal growth which suggest that birth size reflects different biological processes for females and males. However, other very large studies are required to confirm this finding.

Maternal birth weight in relation to plasma lipid concentrations in early pregnancy

OBJECTIVE

The purpose of this study was to determine the extent to which, if at all, maternal weight at birth is related to dyslipidemia during early pregnancy, which is a risk factor for preeclampsia.

STUDY DESIGN

This hospital-based prospective cohort study included 1000 women who initiated prenatal care before 16 weeks of gestation. Participants provided information about their birth weight and other sociodemographic and reproductive covariates. Plasma triglyceride, high-density lipoprotein cholesterol, and total cholesterol concentrations were measured at approximately 13 weeks of gestation. beta coefficients and standard errors were estimated by multiple linear regression; odds ratios and 95% confidence intervals were estimated by logistic regression.

RESULTS

Maternal birth weight was correlated negatively with triglycerides (r =-0.12; P =.001) and was correlated positively with high-density lipoprotein cholesterol (r =0.08; p =.02) but not statistically significantly related with total cholesterol (r =-0.004; P=.91). After adjusting for potential confounders, women who weighed <2500 g at birth had higher triglyceride and total cholesterol concentrations (beta=23.4 mg/dL [P<.001]; beta =2.6 mg/dL [P =.585], respectively) and lower high-density lipoprotein cholesterol concentrations (beta =-3.2 mg/dL; P=.105), when compared with women who weighed 3000 to 3499 g at birth. Women who were born small (<2500 g) and became overweight (body mass index, >or=25 kg/m(2)) in adulthood had less favorable lipid profiles than their counterparts who weighed >or=2500 g at birth and remained lean (body mass index, <25 kg/m(2)).

CONCLUSION

Our findings suggest that factors that are related to growth in utero may help to predict the subsequent risk of altered lipid metabolism during pregnancy, which may, in turn, be causally related to the occurrence of preeclampsia.

Birth weight and lipids in a national birth cohort study

OBJECTIVE

To investigate the association between birth weight and lipid levels in a 53-year-old birth cohort from England, Scotland, and Wales.

METHODS AND RESULTS

Lipid levels were obtained from nonfasting blood samples, collected at the most recent follow-up of the MRC National Survey of Health and Development, for 2559 men and women. Regression models indicated that in men, a 1-kg increase in birth weight was associated with a 0.13-mmol/L decrease (95% CI: -0.23, -0.01) in total cholesterol at age 53 years (P=0.03), compared with a 0.02-mmol/L (95% CI: -0.11, 0.15) increase in women and a 0.06-mmol/L (95% CI: -0.15, 0.02) decrease in men and women combined. Adjustment for current height and body mass index (BMI) in men reduced the size of the relationship, with height being responsible for the reduction. Adult height and height at 2 and 4 years were significantly associated with total cholesterol in men and in men and women combined. The negative association between total cholesterol and birth weight was strongest among men with high BMI at age 53 years (P=0.03 for test for interaction between birth weight and BMI). There was no significant association between birth weight and LDL or HDL cholesterol in men or women before adjustment, but there was a positive association with HDL in women. When both sexes were analyzed together, an association was seen after adjustment for current body size. No confounding of these findings with social class was observed in this study.

CONCLUSIONS

Our results suggest that the small effect of birth weight on lipid levels at age 53 years has a limited public health impact. The findings suggest that childhood height growth may be more important than prenatal growth.

Birth weight and blood cholesterol level: a study in adolescents and systematic review

OBJECTIVE

To examine the relationship between birth weight and blood total cholesterol (TC) and to compare its strength with that of the relationship between current body mass index and TC.

METHODS

1). Cross-sectional study of adolescents, with retrospective ascertainment of birth weight from birth records or parental recall; 2). systematic review of studies examining the relations between birth weight and cholesterol at all ages.

PARTICIPANTS

1). 1532 individuals (92% white, 55% male) in 10 British towns; 2). 28 studies with 32 observations showing the change in TC per 1 kg increase in birth weight-6 in infancy, 14 in adolescents, 12 in adults.

RESULTS

In the cross-sectional study, there was a weak inverse relation between birth weight and TC level (-.061 mmol/L fall in TC per kg increase in birth weight, 95% confidence interval -.131 to.008 mmol/L per kg) which was little affected by adjustment for current body size. The difference in TC corresponding to an interquartile range increase in birth weight (-.03 mmol/L) was approximately a quarter of that for an equivalent increase in body mass index (.11 mmol/L). In the systematic review, an inverse association between birth weight and TC of a similar size to that in the cross-sectional study was observed (-.048 mmol/L per kg, 95% confidence interval -.078 to -.018 mmol/L per kg) similar in strength at all ages.

CONCLUSION

The relation of fetal nutrition to TC appears to be weak and is probably of limited public health importance when compared with the effects of childhood obesity.

Fetal programming for adult disease: where next?

The Barker hypothesis of fetal programming for adult cardiovascular and metabolic diseases has attracted much interest over the past few years. In this review, we summarize the main studies in this field, give a brief outline of some of the laboratory models used to investigate this hypothesis and discuss potential mechanisms underlying these clinical observations that are amenable to future research.

Serum Cholesterol, Triglyceride, VLDL-c, LDL-c,and HDL-c Levels in Healthy Children

The aim of this study is to determine the normal values of serum cholesterol, triglyceride, VLDL-C, LDL-C, and HDL-C to obtain the reference values for diagnostic tests in healthy children. The study group included 420 healthy children (209 male, 211 female) ranging from 0 to 15 years. The cases were divided in 4 groups of age: 0-12 month (Group I), 13 month-6 year (Group II), 7-11 year (Group III), and 12-15 year (Group IV). Mean cholesterol, triglyceride, HDL-C, LDL-C and VLDL-C levels were 102.01 +/- 27.91, 96.32 +/- 37.57, 32.13 +/- 11.69, 46.64 +/- 21.97 and 24.19m +/- 10.56 in group I, 142. 58 +/- 30.12, 91.57 +/- 37.27, 45.68 +/- 13.86, 78.41 +/- 32.23 and 21.55 +/- 10.75 in group II, 139.85 +/- 28.06, 95.42 +/- 43.12, 46.04 +/- 14.03, 71.44 +/- 27.05 and 21.69 +/- 12.51 in group III, and 153.98 +/- 26.71, 101.72 +/- 46.66, 45.84 +/- 13.06, 83.33 +/- 27.25 and 25.17 +/- 12.66 in group IV, respectively. There is no significant difference in serum lipid levels between males and females in any age groups. Mean values of cholesterol, HDL-C and LDL-C are significantly higher in older age group.

The association between low birth weight and high levels of cholesterol is not due to an increased cholesterol synthesis or absorption: analysis in twins

Low birth weight may be associated with high levels of cholesterol in later life through genetic factors that affect both birth weight and cholesterol metabolism. Alterations in cholesterol synthesis and absorption may play an important role in this association. We examined birth weight and plasma ratios of a precursor of cholesterol, lathosterol (an estimate of cholesterol synthesis), and plant sterols, campesterol and beta-sitosterol (estimates of cholesterol absorption), to cholesterol in 53 dizygotic and 58 monozygotic adolescent twin pairs. After adjustment for current weight, birth weight was not associated with the ratios of lathosterol, campesterol, and beta-sitosterol either in the overall sample [+0.07 micro mol/mmol/kg (95% confidence interval: -0.11 to 0.25), p = 0.5; +0.02 micro mol/mmol/kg (-0.33 to 0.37), p = 0.9; and -0.04 micro mol/mmol/kg (-0.23 to 0.15), p = 0.8, respectively] or in the intrapair analysis in dizygotic twins [+0.27 micro mol/mmol/kg (-0.28 to 0.82), p = 0.3; -0.03 micro mol/mmol/kg (-1.07 to 1.01), p = 1.0; and +0.04 micro mol/mmol/kg (-0.56 to 0.64), p = 0.9, respectively] or in the intrapair analysis in monozygotic twins [+0.54 micro mol/mmol/kg (-0.09 to 1.18), p = 0.09; -0.60 micro mol/mmol/kg (-1.59 to 0.39), p = 0.2; and -0.43 micro mol/mmol/kg (-0.99 to 0.14), p = 0.14, respectively]. Plasma levels of lathosterol, campesterol, and beta-sitosterol, which are indicators of cholesterol synthesis and absorption, thus do not explain the association of low birth weight with high levels of total and LDL cholesterol. As an alternative hypothesis, we suggest that a decrease in cholesterol clearance may play an important role.

Should pediatric patients with hyperlipidemia receive drug therapy?

Hyperlipidemia is now established as a major risk factor for causation of coronary heart disease (CHD) in adults; however, there is much debate on the level of coronary risk at which lipid-lowering drugs should be used. These issues of possible harm or lack of benefit from long-term use of lipid-lowering therapy, and cost effectiveness, are also pertinent in the pediatric setting. Evidence from several countries indicates that children have an increasing prevalence of obesity, hyperlipidemia and type 2 diabetes mellitus. Children who have high serum lipids 'track' these increased levels into adulthood. In some countries there is a trend to screen children for hypercholesterolemia. Family history itself is a poor discriminator in determining which children need to be screened and treated. Estimation of apolipoprotein B and/or apolipoprotein E genotype can improve prediction. Measuring high density lipoprotein cholesterol also helps, but obesity appears to be the best marker for screening children at high risk. These considerations should not cloud the need for case finding and treatment of children with genetic disorders. Low fat diets have been shown to be well tolerated and effective in children; however, there are no major long-term studies demonstrating harm or benefit in those on lipid-lowering drugs. Nevertheless, concerns regarding the psychological effect and the theoretical metabolic effects of long-term lipid lowering remain. Lipid-lowering drugs should be generally restricted to children with genetic disorders of lipid metabolism. Children with diabetes mellitus, hypertension or nonlipid-related inherited disorders leading to premature CHD in adults should be treated with diet, and with lipid-lowering drugs when they reach adulthood. Children with secondary hyperlipidemia should be assessed individually. A number of drugs and nutriceuticals are available for use in children, but only a few drugs are licensed for use in children.