Childhood precursors of high blood pressure and elevated cholesterol

Vascular aging and cardiac maladaptation in growth-restricted preterm infants

OBJECTIVE

To assess arterial morphology and mechanics in preterm infants with fetal growth restriction (FGR) compared with those appropriate for gestational age (AGA) in the early neonatal period.

STUDY DESIGN

This observational study involved 20 preterm FGR infants (28 to 32 weeks) of gestational age (GA) and birth weight (BW) <10th centile and 20 preterm AGA infants. Vascular ultrasound was performed to measure aortic properties.

RESULTS

GA and BW of FGR and AGA infants were 29.8±1.3 vs 30±0.9 weeks (P=0.78) and 923.4±168 vs 1403±237 g (P<0.001), respectively. At 10.5±1.3 (s.d.) days after birth, blood pressure (systolic 51±3 vs 46±4 mm Hg, P<0.001) and maximum aorta intima-media thickness (621±76 vs 479±54 μm; P<0.001) were significantly higher in FGR infants. Arterial wall stiffness and peripheral resistance were also increased in the FGR infants (2.36±0.24 vs 2.14±0.24, P=0.008 and 22.2±5 vs 13.7±2.3 mm Hg min ml^-1, P<0.001), respectively. Significant correlations between vascular mechanics and cardiac function were observed (resistance vs E/E', r=0.7 and Tei index, r=0.79).

CONCLUSION

Maladaptive arterial-ventricular coupling was noted. Early detection may aid in early therapeutic strategies such as afterload reduction.

Relative validity of an FFQ for pre-school children in the mother–child ‘Rhea’ birth cohort in Crete, Greece

Objective

To examine the relative validity of an FFQ based on parental report for pre-school children in the mother–child ‘Rhea’ birth cohort.

Design

The children’s mothers completed an FFQ that referred to the children’s dietary intake for the previous year by telephone interview. Mothers completed also three food records, two on weekdays and one on a weekend day. Spearman correlation coefficients were calculated for the energy-adjusted values. Weighted kappa statistics (κw) and the Bland–Altman technique were used to test the degree of agreement between the two dietary methods.

Setting

Heraklion, Crete, Greece, 2011–2012.

Subjects

A total of ninety-nine mothers (corresponding to fifty-one boys and forty-eight girls) participated in the validation study.

Results

The mean and median values of all food group and nutrient intakes did not differ significantly between the two dietary methods. Overall, fair agreement was observed between the FFQ and the food records for ranking participants based on their intake, with κw ranging from 0·21 to 0·40 for most foods and nutrients. On average, 88 % of participants were classified into the same or adjacent tertiles for nutrient and food group intakes by both dietary methods. The degree of agreement was also confirmed by the visual examination of the Bland–Altman plots.

Conclusions

The study indicates that the Rhea 4 years FFQ is a relatively accurate tool for assessing habitual food group and nutrient intakes among pre-school children in Crete, Greece.

Obesity in arabic-speaking countries

Obesity has reached epidemic proportions throughout the globe, and this has also impacted people of the Arabic-speaking countries, especially those in higher-income, oil-producing countries. The prevalence of obesity in children and adolescents ranges from 5% to 14% in males and from 3% to 18% in females. There is a significant increase in the incidence of obesity with a prevalence of 2%-55% in adult females and 1%-30% in adult males. Changes in food consumption, socioeconomic and demographic factors, physical activity, and multiple pregnancies may be important factors that contribute to the increased prevalence of obesity engulfing the Arabic-speaking countries.

Association between overweight and early sexual maturation in Portuguese boys and girls

OBJECTIVE

The purpose of this study was to examine the relationship between sexual maturation (SM), and the prevalence of overweight among boys and girls.

SUBJECTS AND METHODS

The sample of this cross-sectional study included 819 children and adolescents (382 boys and 437 girls), aged 10-15 years old randomly selected from 30 schools in the Porto region. Anthropometrical measurements (body height, weight and skinfolds thickness) were determined by standard anthropometrical methods. Body mass index (BMI) was calculated from the ratio weight/height(2) (kg/m(2)). The sum of tricipital and subscapular skinfolds (TriSub) was also used. Physicians collected data on Tanner stages during physical examination. Subjects were grouped using the quartiles of the decimal age adjusted for Tanner stages of SM and gender.

RESULTS

The prevalence of overweight was higher in early maturing boys (30.5%) and early maturing girls (32.7%). The late maturers presented a lower prevalence (p < 0.05) of overweight (20.3% boys and 18.3% girls). Logistic regression analysis illustrates that early maturing is associated with an increased risk for overweight or obesity for boys (OR: 1.87 and 95% CI: 0.99-3.50) and girls (OR: 2.14 and 95% CI: 1.12-4.07), when compared with the boys and girls of the fourth quartile (p < 0.05).

CONCLUSIONS

We conclude that there is an association between early SM and the prevalence of overweight in both genders.

Relationship between birthweight and arterial elasticity in childhood

There is a considerable debate about the potential influence of ‘fetal programming’ on cardiovascular diseases in adulthood. In the present prospective epidemiological cohort study, the relationship between birthweight and arterial elasticity in 472 children between 5 and 8 years of age was assessed. LAEI (large artery elasticity index), SAEI (small artery elasticity index) and BP (blood pressure) were assessed using the HDI/PulseWave™ CR-2000 CardioVascular Profiling System. Blood concentrations of glucose, total cholesterol and its fractions [LDL (low-density lipoprotein)-cholesterol and HDL (high-density lipoprotein)-cholesterol] and triacylglycerols (triglycerides) were determined by automated enzymatic methods. Insulin was assessed by a chemiluminescent method, insulin resistance by HOMA (homoeostasis model assessment) and CRP (C-reactive protein) by immunonephelometry. Two linear regression models were applied to investigate the relationship between the outcomes, LAEI and SAEI, and the following variables: birthweight, gestational age, glucose, LDL-cholesterol, HDL-cholesterol, triacylglycerols, insulin, CRP, HOMA, age, gender, waist circumference, per capita income, SBP (systolic BP) and DBP (diastolic BP). LAEI was positively associated with birthweight (P=0.036), waist circumference (P<0.001) and age (P<0.001), and negatively associated with CRP (P=0.024) and SBP (P<0.001). SAEI was positively associated with birthweight (P=0.04), waist circumference (P=0.001) and age (P<0.001), and negatively associated with DBP (P<0.001). Arterial elasticity was decreased in apparently healthy children who had lower birthweights, indicating an earlier atherogenetic susceptibility to cardiovascular diseases in adolescence and adult life. Possible explanations for the results include changes in angiogenesis during critical phases of intrauterine life caused by periods of fetal growth inhibition and local haemodynamic anomalies as a way of adaptation to abnormal pressure and flow.

Combined effects of dietary fat and birth weight on serum cholesterol concentrations: the Hertfordshire Cohort Study

BACKGROUND

Blood cholesterol responses to the manipulation of dietary fat vary widely between persons. Although epidemiologic evidence suggests that prenatal growth and nutrition influence adult cholesterol homeostasis, whether prenatal growth modifies the association between dietary fat intake and serum cholesterol concentration in adults is unknown.

OBJECTIVE

The aim was to examine the relation between fat intake and serum cholesterol concentrations in men and women whose birth weights were known.

DESIGN

We studied a cohort of men and women aged 59-71 y. Diet was assessed with a food-frequency questionnaire. Total, HDL-, and LDL-cholesterol concentrations and the ratio of HDL to LDL cholesterol were measured in fasting blood samples from 574 men and 562 women who did not have coronary heart disease.

RESULTS

Total and saturated fat intakes were not associated with serum cholesterol concentrations in men or women. However, subdivision by birth weight showed associations in men but not in women. High intakes of total and saturated fat were associated with reduced HDL-cholesterol concentrations in men with birth weights < or =3.2 kg (7 lb) but not in men with higher birth weights. Similar effects on the HDL-to-LDL cholesterol ratio were observed (P for interaction = 0.02 for total fat and 0.01 for saturated fat). When 32 men taking cholesterol-lowering medication were excluded, the interactions were strengthened (P = 0.008 and 0.006, respectively).

CONCLUSION

The adverse effects of high intakes of total and saturated fat on serum cholesterol concentrations in men may be confined to those with lower birth weights.

Systematic Review of the Influence of Childhood Socioeconomic Circumstances on Risk for Cardiovascular Disease in Adulthood

PURPOSE

Adverse socioeconomic circumstances in childhood may confer a greater risk for adult cardiovascular disease (CVD). The purpose of this review is to systematically evaluate evidence for an association between socioeconomic circumstances during childhood and specific CVD subtypes, independent of adult socioeconomic conditions.

METHODS

We systematically retrieved individual-level studies of morbidity and mortality from CVD and specific CVD subtypes linked to early life influences, including coronary heart disease (CHD), ischemic and hemorrhagic stroke, peripheral vascular disease, markers of atherosclerosis (carotid intima-media thickness and stenosis), and rheumatic heart disease. Indicators of socioeconomic position in childhood varied, although most studies relied on father's occupation.

RESULTS

We located 40 studies (24 prospective, 11 case-control, and 5 cross-sectional) reported in 50 publications. Thirty-one studies (19 prospective, 7 case-control, and all 5 cross-sectional) found a robust inverse association between childhood circumstances and CVD risk, although findings sometimes varied among specific outcomes, socioeconomic measures, and sex. Case-control studies reported mixed results. The association was stronger for stroke and, in particular, hemorrhagic stroke, than for CHD. Childhood socioeconomic conditions remained important predictors of CVD, even in younger cohorts.

CONCLUSION

Childhood and adulthood socioeconomic circumstances are important determinants of CVD risk. The specific contribution of childhood and adulthood characteristics varies across different CVD subtypes. Disease-specific mechanisms are likely to explain the childhood origins of these adult health inequalities.

Early menarche and the development of cardiovascular disease risk factors in adolescent girls: the Fels Longitudinal Study

The purpose of this study was to evaluate the influence of menarcheal age on changes in insulin, glucose, lipids, and blood pressure during adolescence and to assess whether body composition modifies this relationship. We examined 391 girls, a subset of Fels Longitudinal Study female participants (8-21 yr of age). Self-reported menarcheal age was classified based on the National Health and Nutrition Examination Survey III distribution, in which early menarche was at the 25th percentile or less (11.9 yr). Age at menarche was examined in relation to measures of body composition [e.g. fat-free mass (FFM) and percent body fat (PBF)], insulin resistance, blood pressure, and lipid profile. The effects of menarcheal age and body composition on cardiovascular disease risk factor changes were analyzed with serial data mixed models. Median menarcheal age was 12.7 yr (range, 9.8-17.0 yr), with 91 girls (23%) classified as early menarche. Girls with early menarche had more deleterious changes in insulin, glucose, blood pressure, FFM, and PBF levels than girls with average or late menarche. Menarcheal age adversely affected cardiovascular disease risk factor changes independent of age and changes in FFM or PBF. Girls with early menarche exhibited elevated blood pressure and glucose intolerance compared with later maturing girls, independent of body composition.

Associations of Parental, Birth, and Early Life Characteristics With Systolic Blood Pressure at 5 Years of Age

Background— We examined the associations of a range of parental and early life characteristics with systolic blood pressure at 5 years of age.

Methods and Results— Information from 3864 children who were followed up prospectively from their mother’s first antenatal clinic assessment was used. Maternal age, body mass index, and smoking during pregnancy were all positively associated with offspring systolic blood pressure at 5 years of age. The systolic blood pressure of children whose mothers had smoked throughout pregnancy was on average 0.92 mm Hg (95% CI 0.17 to 1.68) greater than that of children whose mothers had never smoked, after full adjustment. Children who had been breast fed until at least 6 months had lower systolic blood pressure than those who were breast fed for a shorter duration. Paternal body mass index and child’s weight, height, and body mass index were all positively associated with blood pressure at age 5.

Conclusions— Because childhood blood pressure tracks into adulthood, interventions aimed at early life risk factors, such as quitting smoking during pregnancy, breast feeding, and prevention of obesity in all family members, may be important for reducing the population distribution of blood pressure and thus cardiovascular disease risk.

Usefulness of the American Academy of Pediatrics recommendations for identifying youths with hypercholesterolemia

OBJECTIVE

To determine the usefulness of parent history of hypercholesterolemia and cardiovascular disease as a screening criterion for hypercholesterolemia in youths.

METHODS

Data were available from a population-based survey of 3665 Quebec youths aged 9, 13, and 16 years (81.2% of eligible subjects). Blood specimens were collected from 2475 subjects (54.8% of those eligible), and questionnaire data were obtained from 3048 parents (67.5% of those eligible). Lipids were measured in a Centers for Disease Control and Prevention standardized laboratory. Usefulness of parent history in identifying borderline/high low-density lipoprotein cholesterol (LDL-C) (> or =2.8 mmol/L [> or =110 mg/dL]) and high LDL-C (> or =3.4 mmol/L [> or =130 mg/dL]) was assessed according to test performance statistics (sensitivity, specificity, positive predictive value, and negative predictive value).

RESULTS

The prevalence of a positive parent history was 25.6%; 18.3% of subjects had borderline/high LDL-C, and 4.8% had high LDL-C. Sensitivity, specificity, positive predictive value, and negative predictive value of parent history were 33.1%, 76.0%, 23.7%, and 83.5%, respectively, for identifying borderline/high LDL-C; they were 40.7%, 75.1%, 7.7%, and 96.1% for identifying high LDL-C. Test performance statistics were not improved in subgroups defined according to age, gender, parent education, household income, family status, and family origin (French Canadian, other); neither were they improved by adding screening criteria (parent history of diabetes or hypertension, or youth overweight).

CONCLUSION

Parent history screening criteria offer little improvement over random population screening in identifying youths with hypercholesterolemia.

Prevalence and covariates of obesity in Lebanon: findings from the first epidemiological study

OBJECTIVE

To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population.

RESEARCH METHODS AND PROCEDURES

A cross-sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI.

RESULTS

For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age > or = 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI > or = 30 kg/m(2)) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity.

DISCUSSION

The results from this national population-based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.

Childhood body mass index and later cancer risk: A 50-year follow-up of the Boyd Orr study

Associations between childhood BMI and adult cancer risk were investigated in a historical cohort study based on the Carnegie ("Boyd Orr") Survey of Diet and Health in Pre-War Britain (1937-9). In 14 centres in England and Scotland, children had their height and weight measured. We included 2,347 individuals aged between 2 and 14 years 9 months at the time of measurement, who were traced through the National Health Service Central Register. Relative cancer risk (registration or death) was estimated in relation to age- and sex-specific BMI SD scores. We studied associations with (i) all cancers, (ii) cancer groups stratified according to their relationship to smoking and (iii) certain site-specific cancers. In the 50 years of follow-up, 188 men and 192 women developed cancer. There was a 9% increase (95% CI -3 to 22%) in risk of cancer in adulthood per SD increase in BMI measured in childhood. There was no evidence of confounding by childhood or adulthood socioeconomic position, other anthropometric variables, childhood energy intake or birth order. There was a 30% increase (95% CI 10-54%) in risk of smoking-related cancers per SD increase in childhood BMI. There was no relationship between BMI and cancers not related to smoking. Associations for all cancers and non-smoking-related cancers tended to be stronger in children who were measured at an older (>8 years) rather than a younger (< or =8 years) age. We conclude that childhood BMI is related to increased risk of cancer in later life, particularly smoking-related cancers.

Life course exposure and later disease: a follow-up study based on medical examinations carried out in Glasgow University (1948-68)

Evidence for the relationship between exposures in fetal life, infancy, childhood and early adulthood, and risk of chronic disease in later middle-age continues to accumulate. Further understanding of the associations between exposures acting over the life course and current morbidity and mortality in middle-age and later must depend upon the follow-up of previously established cohorts. This paper describes the design of, and background to, a follow-up of individuals who participated in a survey of student health in the University of Glasgow between 1948 and 1968. 15 332 students, almost a quarter of whom were female, had detailed medical information collected from a doctor-administered questionnaire and physical examination. Participation was voluntary; approximately 50% of the student population took part and these students were rep-resentative of the entire student population. Data collected include: socio-demographic, behavioural, developmental, anthropometric, and clinical details, as well as details of medical history and family health and structure. Data are over 95% complete for most variables. Over 40% of students were examined on two or more occasions with 1026 students (6.8%) having four or more examinations. Over 90% of students were from social classes I-III. Eighty-two per cent (12 533/15 322) of the students have been traced and flagged through the National Health Service Central Register and attempts are on-going to increase this figure. Those study members who have been traced are representative of the original cohort. To date 1111 (7.2%) of those traced have died. These data constitute a unique record of the health and physical development of a large cohort of students from Glasgow. Follow-up to investigate the relationship between indices of health and development, (height, weight, blood pressure), health behaviours and social circumstances in childhood and young adulthood, and mortality and morbidity in later adulthood is under way.

Blood pressure during adolescence: a study among Belgian adolescents selected from a high cardiovascular risk population

INTRODUCTION

The Belgian province of Luxembourg has a high incidence of cardiovascular (CV) disease according to the MONICA register. Surveys conducted in adults and children have also found high CV risk factor levels in this province.

DESIGN

cross-sectional study. OBJECTIVE OF THE PRESENT STUDY: To collect data about blood pressure (BP) and its determinants in adolescents from this high CV risk population and to analyse their relationship.

PARTICIPANTS

1526 adolescents (12-17 years) in 24 secondary schools of the province.

RESULTS

Mean systolic BP levels were 125 mm Hg (sd = 12 mm Hg) and 122 mm Hg (sd = 11 mm Hg) for boys and girls, respectively. Mean diastolic BP was equal to 74 mm Hg (sd = 10 mm Hg) in both genders. Systolic BP increased with age and differed significantly between genders from 15 years onwards. Body fatness indices increased with age except waist-to-hip ratio in girls and triceps skinfold in boys. Regression models including age, anthropometric indices and physical activity explained a small percentage of BP variance (for systolic BP, r2 = 0.21 and 0.12 for boys and girls, respectively). Weight was the first parameter related to BP in correlation and regression analyses.

CONCLUSIONS

This study showed high BP and body fatness indices in adolescents from a high CV risk population. The model under study showed a moderate relationship between body fatness and BP. This finding suggests other influences as a genetic component to account for the high levels observed.

Worldwide distribution of blood lipids and lipoproteins in childhood and adolescence: a review study

Review and pooled analysis of the relevant worldwide literature was investigated from 1975 to 1996. Eighteen surveys out of 54 were suitable for analysis according to the selection criteria. This represents a total of 60494 observations from 26 countries all over the world. Data suggests differences as great as 76 mg/dl when comparing northern European countries to black African children. The overall curve of cholesterol with age observed in the pooled population indicates a pre-adolescent peak and then a slightly inverse change is observed for both boys and girls, from 3 to 12 years old being almost coincident absolute values. Beyond age 12, values for boys continue to slightly decrease to age 16, while for girls values tend to increase through this age-range. The curve in the late teens (16-18 years) tends to reach pre-teen levels for both sexes, although girls have consistently higher absolute values than boys. There is a great variation in the specific age-sex and race levels of cholesterol among different populations or even in the same populations over a period of time. However, an apparently universal pattern of an early rise, a fall, and a subsequent rise in mean values of total cholesterol by age from the preadolescence to late teens is observed. More data are needed on total cholesterol and lipid fractions between late school age and mid-adulthood.

The Kahnawake Schools Diabetes Prevention Project: intervention, evaluation, and baseline results of a diabetes primary prevention program with a native community in Canada

OBJECTIVES

Kahnawake Schools Diabetes Prevention Project is a 3-year community-based, primary prevention program for non-insulin-dependent diabetes mellitus in a Mohawk community near Montreal, Canada. Objectives are to improve healthy eating and encourage more physical activity among elementary school children.

METHODS

Intervention incorporates behavior change theory, Native learning styles, the Ottawa Charter for Health Promotion, and a health promotion planning model. Evaluation uses a mixed longitudinal and cross-sectional design to measure obesity, fitness, eating habits, and physical activity of elementary school children in the experimental and comparison communities. Intermediate variables are self-efficacy and perceived parental support. Process evaluation provides feedback to the intervention.

RESULTS

During 3 years, 63 distinct interventions that included a Health Education Program reinforced by school events, a new Community Advisory Board, a recreation path, and community-based activities promoting healthy lifestyles were implemented. Baseline consent rates were 87 and 71% in the experimental and comparison schools. As expected, anthropometric data increase with age. Between 9 and 10 years there are increased weight, height, BMI, and skinfold thicknesses; decreased fitness; and increased television watching.

CONCLUSIONS

Implementing a Native community-based diabetes prevention program is feasible through participatory research that incorporates Native culture and local expertise.

Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension

There is much evidence that people who had low birthweight tend to have higher blood pressure in later life. However, the mechanisms that mediate this relation are unknown. We argue that, in fetuses whose growth is impaired, synthesis of elastin in the walls of the aorta and large arteries may be deficient, and that this deficiency would lead to permanent changes in the mechanical properties of these vessels. Over a lifetime, such changes could predispose an individual to higher blood pressure, increased left-ventricular mass, and cardiovascular disease.

Development of cardiovascular risk factors from ages 8 to 18 in Project HeartBeat! Study design and patterns of change in plasma total cholesterol concentration

BACKGROUND

Project HeartBeat! is a longitudinal study of the development of cardiovascular risk factors as growth processes. Patterns of serial change, or trajectories, from ages 8 to 18 years for plasma total cholesterol concentration (TC) and percent body fat illustrate the design and synthetic cohort approach of the study.

METHODS AND RESULTS

Six hundred seventy-eight children (49.1% female, 20.1% black) entered the study at ages 8, 11, and 14 years and were followed up with examinations every 4 months for < or = 4 years. Multilevel analysis demonstrated trajectories for population mean values of TC and percent body fat in sex-specific synthetic cohorts from ages 8 to 18 years. Polyphasic patterns of change in TC were confirmed, with notable sex differences in age patterns and with minimum mean values of TC of 3.85 mmol/L for females and 3.59 for males. As illustrated by data for males, the approximate 75th percentile values of mean TC ranged from 4.78 mmol/L at its early peak to 4.06 at its late-teen nadir. Percent body fat exhibited a trajectory closely parallel with that for TC only for males and appeared to be unrelated for females.

CONCLUSIONS

The polyphasic trajectory for TC from ages 8 to 18 years differs between females and males, indicates marked age variation in 75th percentile values and, in males only, closely parallels the trajectory for percent body fat. These and other results indicate the value of both follow-up every 4 months across age intervals to detect rapid risk factor change and the synthetic cohort approach for gaining new insights into the dynamics and possible determinants of this change from ages 8 to 18 years.

Birthweight, adult risk factors and incident coronary heart disease: the Caerphilly Study

OBJECTIVE

To determine the relationships between birthweight, the incidence of coronary heart disease, and a range of coronary heart disease risk factors that operate during adult life.

DESIGN

Cohort study with a 10-year follow-up period.

SETTING

The town of Caerphilly, South Wales, and five adjacent villages.

SUBJECTS

1,258 men aged 45-59 at time of recruitment between 1979 and 1983.

MAIN OUTCOME MEASURES

All deaths, coronary heart disease deaths, non-fatal CHD events.

RESULTS

The validity of the birthweight data was supported by the strong graded associations between birthweight and anthropometric measures in adulthood, particularly height, body mass index, triceps, skinfold thickness and percentage body fat. An inverse relationship was found between birthweight and incident fatal and non-fatal CHD, (P = 0.01), though no relationship was found between birthweight and all-cause mortality. Amongst the major CHD risk factors, only fibrinogen shows a statistically significant relationship with birthweight (P = 0.008), fibrinogen levels being lower among the men with lower birthweights. When social and biological variables are included in models relating incident CHD and birthweight, the relationship between birthweight and incident fatal and non-fatal CHD remains essentially unchanged.

CONCLUSION

A graded association between low birthweight and later CHD has been demonstrated in this cohort. This inverse association cannot be explained by the measured social or behavioural variables, or by other risk factors operating in adult life.

Thinness at birth and glucose tolerance in seven-year-old children

Adults who had low birthweight and were thin at birth have an increased risk of Type 2 diabetes and impaired glucose tolerance. To discover whether thinness at birth is associated with reduced glucose tolerance in children, 250 7-year-old children underwent an abbreviated oral glucose tolerance test. Children who were thin at birth, as measured by a low ponderal index (birthweight length-3) had higher plasma glucose concentrations. Plasma glucose concentration 30 min after a glucose load rose by 0.07 mmol l-1 (95% confidence interval 0.00 to 0.14; p = 0.04) for every unit (kg m-3) fall in ponderal index. Children in the lowest quarter of the distribution of ponderal index (23 kg m-3 or less) had a mean 30 min plasma glucose concentration of 8.49 mmol l-1 compared to a mean of 7.97 mmol l-1 for those in the highest quarter (> 27.5 kg m-3). These associations were independent of duration of gestation, gender, social class or the child's current weight. This is consistent with the hypothesis that Type 2 diabetes originates in utero.

Growth in utero and serum cholesterol concentrations in adult life

OBJECTIVE

To see whether reduced rates of fetal growth are related to raised serum cholesterol concentrations in adult life.

DESIGN

Follow up study of men and women whose size at birth had been recorded.

SETTING

Jessop and Northern General Hospitals, Sheffield.

SUBJECTS

219 men and women born in the Jessop Hospital during 1939-40.

MAIN OUTCOME MEASURES

Serum concentrations of total cholesterol, low density lipoprotein cholesterol, and apolipoprotein B.

RESULTS

Men and women who had had a small abdominal circumference at birth had raised serum concentrations of total and low density lipoprotein cholesterol and apolipoprotein B. This was independent of the duration of gestation. Serum concentrations of total cholesterol fell by 0.25 mmol/l (95% confidence interval 0.09 to 0.42) with each 1 in (2.54 cm) increase in abdominal circumference. The corresponding figure for serum low density lipoprotein cholesterol was 0.26 mmol/l (0.11 to 0.42) and for serum apolipoprotein B 0.04 g/l (0.02 to 0.07). Small head and chest circumferences at birth and short length were each associated with raised serum low density lipoprotein cholesterol concentrations but the trends disappeared in a simultaneous regression with abdominal circumference at birth. The association between abdominal circumference at birth and low density lipoprotein cholesterol concentration was independent of social class, current body weight, cigarette smoking, and alcohol consumption.

CONCLUSION

Raised serum cholesterol concentrations in adult life are associated with impaired growth during late gestation, when fetal undernutrition has a disproportionate effect on liver growth. Impaired liver growth may permanently alter low density lipoprotein cholesterol metabolism.

Childhood prevention of essential hypertension

Childhood prevention of essential hypertension requires knowledge of alterable determinants of blood pressure in children; these include obesity and sodium intake and perhaps physical activity and intake of potassium and calcium. Altering these determinants may involve two general preventive strategies. The first is a population strategy, which attempts to lower blood pressure (or keep it from rising) among all children. Population strategies may require educating children to active participants in changing their behaviors (active approach) or may merely change their environment (passive approach). The second general strategy aims to focus on children at high risk of developing hypertension as adults. To determine the usefulness of this high-risk strategy, more information is needed about prediction of adult blood pressure from childhood values and about the efficacy of interventions to control blood pressure levels in high-risk children.