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Kawabe H, Azegami T, Takeda A, Kanda T, Saito I, Saruta T, Hirose H. Features of and preventive measures against hypertension in the young. Hypertens Res 2019; 42:935-948. [PMID: 30894695 PMCID: PMC8075862 DOI: 10.1038/s41440-019-0229-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
The Japanese hypertension guidelines report that essential hypertension is detected in 1–3% of upper elementary and high school students during blood pressure (BP) screenings. Hypertension in these age groups is an emerging public health concern mainly attributed to the rising rate of pediatric obesity. Considering the existence of BP tracking phenomenon, early preventive education and instruction are necessary, especially for male students with moderately elevated BP showing a tendency toward obesity, despite the low prevalence of hypertension in high school students. Students with a positive family history of hypertension and those born with low birth weight need the same measures. Lifestyle habits, such as increased alcohol intake, dramatically change once students begin university; thus, early education and instruction regarding the factors influencing BP are necessary. In particular, for male students with higher BP during high school, caution regarding increased body weight is required irrespective of their level of obesity. Young adults aged <40 years should be educated about the association between body weight and hypertension. Particular caution surrounding lifestyle habits, including drinking and smoking, is warranted in male hypertensive subjects because hypertension at a young age is strongly associated with obesity. BP monitoring and the management of obesity should be considered efficient approaches to the detection and treatment of hypertension. For the lifetime prevention of hypertension, it is essential to be aware of one’s health status and learn about healthy lifestyles beginning in childhood. BP measurement may be an appropriate means to achieve this goal.
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Affiliation(s)
- Hiroshi Kawabe
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Tatsuhiko Azegami
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Health Center, Keio University, Kanagawa, Japan
| | - Ayano Takeda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Health Center, Keio University, Kanagawa, Japan
| | - Takeshi Kanda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ikuo Saito
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takao Saruta
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Hirose
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Health Center, Keio University, Kanagawa, Japan
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Inomata S, Yoshida T, Koura U, Tamura K, Hatasaki K, Imamura H, Mase D, Kigawa M, Adachi Y, Inadera H. Effect of preterm birth on growth and cardiovascular disease risk at school age. Pediatr Int 2015; 57:1126-30. [PMID: 26083964 DOI: 10.1111/ped.12732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/19/2015] [Accepted: 05/08/2015] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Satomi Inomata
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Uta Koura
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Kentaro Tamura
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | | | | | | | - Mika Kigawa
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
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Malin GL, Morris RK, Riley RD, Teune MJ, Khan KS. When is birthweight at term (≥37 weeks' gestation) abnormally low? A systematic review and meta-analysis of the prognostic and predictive ability of current birthweight standards for childhood and adult outcomes. BJOG 2015; 122:634-42. [PMID: 25601001 PMCID: PMC4413055 DOI: 10.1111/1471-0528.13282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Health outcomes throughout the life course have been linked to fetal growth restriction and low birthweight. A variety of measures exist to define low birthweight, with a lack of consensus regarding which predict adverse outcome. OBJECTIVES To evaluate the relationship between birthweight standards and childhood and adult outcomes in term-born infants (≥37 weeks' gestation). SEARCH STRATEGY MEDLINE (1966-January 2011), EMBASE (1980-January 2011), and the Cochrane Library (2011:1) and MEDION were included. SELECTION CRITERIA Studies comprising live term-born infants (gestation ≥37 completed weeks), with weight or other anthropometric measurements recorded at birth along with childhood and adult outcomes. DATA COLLECTION AND ANALYSIS Data were extracted to populate 2 × 2 tables relating birthweight standard with outcome, and meta-analysis was performed where possible. MAIN RESULTS Fifty-nine articles (2 600 383 individuals) were selected. There was no significant relationship between birthweight <2.5 kg (odds ratio [OR] 0.98, 95% confidence intervals [CI] 0.87-1.10) and composite measure of childhood morbidity. Weight <10th centile on the population nomogram showed a small association (OR 1.49, 95% CI 1.02-2.19) for the same outcome. There was no significant association between either of the above measures and adult morbidity. The relationship between other measures and individual outcomes varied. AUTHOR'S CONCLUSIONS The association between low birthweight, by any definition, and childhood and adult morbidity was inconsistent. None of the current standards of low birthweight was a good predictor of adverse outcome.
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Affiliation(s)
- G L Malin
- School of Medicine, The University of Nottingham, Nottingham, UK
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Chen W, Srinivasan SR, Yao L, Li S, Dasmahapatra P, Fernandez C, Xu J, Berenson GS. Low birth weight is associated with higher blood pressure variability from childhood to young adulthood: the Bogalusa Heart Study. Am J Epidemiol 2012; 176 Suppl 7:S99-105. [PMID: 23035149 DOI: 10.1093/aje/kws298] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The association between birth weight and long-term within-individual variability of blood pressure (BP) was examined in a longitudinal cohort of 1,454 adults (939 whites and 515 blacks; adulthood age = 19-50 years) enrolled in the Bogalusa Heart Study in Bogalusa, Louisiana, in 1973-2010. BP variability was depicted as standard deviation, coefficient of variation, and deviation from age-predicted values using 6-15 serial BP measurements from childhood to adulthood over an average of 25.7 years. Birth weight was significantly and negatively associated with adulthood BP levels, long-term BP levels, and rate of change. Importantly, low birth weight was significantly associated with increased BP variability in terms of standard deviation, coefficient of variation, and deviation. As evaluated using the regression coefficients, a 1-kg lower birth weight was associated with increases in systolic BP variability measures (-0.38 mm Hg, P = 0.04 for standard deviation; -0.004 mm Hg, P = 0.01 for coefficient of variation; and -0.16 mm Hg, P = 0.04 for deviation) after adjustment for race, age, sex, mean BP levels, and gestational age; similar trends in the associations were noted for diastolic BP variability measures. In conclusion, these findings suggest that birth weight affects not only BP levels but also the magnitude of within-individual BP fluctuations over time through fetal programming in BP regulation mechanisms.
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Affiliation(s)
- Wei Chen
- Tulane Center for Cardiovascular Health, Department of Epidemiology, Tulane University, New Orleans, Louisiana, USA
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Perinatal programming of childhood asthma: early fetal size, growth trajectory during infancy, and childhood asthma outcomes. Clin Dev Immunol 2012; 2012:962923. [PMID: 22400043 PMCID: PMC3287283 DOI: 10.1155/2012/962923] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/31/2011] [Indexed: 12/23/2022]
Abstract
The “fetal origins hypothesis” or concept of “developmental programming” suggests that faltering fetal growth and subsequent catch-up growth are implicated in the aetiology of cardiovascular disease. Associations between reduced birth weight, rapid postnatal weight gain, and asthma suggest that there are fetal origins to respiratory disease. The present paper first summarises the literature relating birth weight and post natal growth trajectories to asthma outcomes. Second, issues regarding the interpretation of antenatal fetal ultrasound measurements are discussed. Finally, recent reports linking antenatal measurement and growth trajectory to early childhood asthma outcomes are discussed. Understanding the nature and timing of factors which influence antenatal growth may give important insight into the antecedents of early-onset asthma with implications for interventions.
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Cournil A, Coly AN, Diallo A, Simondon KB. Enhanced post-natal growth is associated with elevated blood pressure in young Senegalese adults. Int J Epidemiol 2009; 38:1401-10. [PMID: 19661279 DOI: 10.1093/ije/dyp255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence suggests that intrauterine growth restriction followed by rapid post-natal growth is associated with high blood pressure. We assessed the effect of early size and post-natal growth on blood pressure in a population from West Africa, where fetal growth retardation and childhood malnutrition are common. METHODS A total of 1288 Senegalese subjects were followed from infancy to young adulthood (mean age 17.9 years). Adult systolic blood pressure (SBP) was regressed on infant and adult anthropometric characteristics. RESULTS In unadjusted analyses, infant size was positively associated with adult SBP (1.1 +/- 0.3; P = 0.001 for weight; 0.7 +/- 0.3; P = 0.04 for length). With adjustment for current size, the regression coefficients for infant size were reversed (-0.2 +/- 0.3; P = 0.51 for weight; -0.3 +/- 0.3; P = 0.35 for length). SBP increased by 4.1 and 2.9 mmHg for 1 standard deviation (SD) increase in current weight or height, respectively. No interaction between infant size and current size was found in the overall models (P = 0.11 for weight, P = 0.95 for height), but this term interacted with sex for weight effect. A negative interaction was found in males (-0.9 +/- 0.4; P = 0.02) but not in females (0.3 +/- 0.4; P = 0.46). The association of current weight with SBP was stronger in lighter weight male infants. CONCLUSIONS These findings support the hypothesis that subjects who were small in early life and experienced enhanced post-natal growth have higher levels of SBP, even in low-income settings.
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Clapp Iii JF, Lopez B. Size at birth, obesity and blood pressure at age five. Metab Syndr Relat Disord 2008; 5:116-26. [PMID: 18370820 DOI: 10.1089/met.2006.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The fetal origins hypothesis indicates that morphometric evidence of fetal nutritional deprivation is predictive of excessive weight gain/obesity, insulin resistance, and cardiovascular disease after birth. However, it is unclear whether these effects are present in offspring with "normal" birth weights in contemporary Western society, whether they are population specific, and how early in life they appear. This study was designed to examine these questions in a select populace of morphometrically diverse offspring to test the null hypothesis that morphometric evidence of nutritional restriction in utero has no effect on the presence of either obesity or increased blood pressure at ages 5 and 6. METHODS We present a prospective study of 101 offspring born of well-nourished, middle and upper socioeconomic-class women who participated in studies of diet and exercise during pregnancy. At birth and age 5 to 6 the offspring underwent morphometric evaluation with the additional measurement of blood pressure at age 5 to 6. RESULTS There were no significant negative correlations between neonatal morphometrics and either blood pressure or obesity at age 5 to 6. There were, however, direct positive correlations between birth weight and both weight and BMI at age 5 to 6 (p < 0.0001). CONCLUSIONS In this specific populace, morphometrics at age 5 to 6 correlated with size at birth. However, there was no relationship between mophometric evidence of in utero nutritional deprivation at birth and either blood pressure or obesity at age 5 to 6.
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Affiliation(s)
- James F Clapp Iii
- The Departments of Reproductive Biology and Obstetrics and Gynecology and The Schwartz Center for Metabolism and Nutrition at The MetroHealth Campus of Case Western Reserve University School of Medicine, Cleveland, Ohio., The Department of Obstetrics and Gynecology, University of Vermont College of Medicine Burlington, Vermont
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Mechanisms underlying developmental programming of elevated blood pressure and vascular dysfunction: evidence from human studies and experimental animal models. Clin Sci (Lond) 2008; 114:1-17. [PMID: 18047465 DOI: 10.1042/cs20070113] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiovascular-related diseases are the leading cause of death in the world in both men and women. In addition to the environmental and genetic factors, early life conditions are now also considered important contributing elements to these pathologies. The concept of 'fetal' or 'developmental' origins of adult diseases has received increased recognition over the last decade, yet the mechanism by which altered perinatal environment can lead to dysfunction mostly apparent in the adult are incompletely understood. This review will focus on the mechanisms and pathways that epidemiological studies and experimental models have revealed underlying the adult cardiovascular phenotype dictated by the perinatal experience, as well as the probable key causal or triggering elements. Programmed elevated blood pressure in the adult human or animal is characterized by vascular dysfunction and microvascular rarefaction. Developmental mechanisms that have been more extensively studied include glucocorticoid exposure, the role of the kidneys and the renin-angiotensin system. Other pathophysiological pathways have been explored, such as the role of the brain and the sympathetic nervous system, oxidative stress and epigenetic changes. As with many complex diseases, a unifying hypothesis linking the perinatal environment to elevated blood pressure and vascular dysfunction in later life cannot be presumed, and a better understanding of those mechanisms is critical before clinical trials of preventive or 'deprogramming' measures can be designed.
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Beilin L, Huang RC. PERINATAL AND CHILDHOOD PRECURSORS OF ADULT CARDIOVASCULAR DISEASE. Clin Exp Pharmacol Physiol 2007; 34 Suppl 1:S2-4. [DOI: 10.1111/j.1440-1681.2007.04758.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Hughson MD. Low birth weight and kidney function: is there a relationship and is it determined by the intrauterine environment? Am J Kidney Dis 2007; 50:531-4. [PMID: 17900450 DOI: 10.1053/j.ajkd.2007.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 07/25/2007] [Indexed: 11/11/2022]
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Lin CM, Chen CW, Chen PT, Lu TH, Li CY. Risks and causes of mortality among low-birthweight infants in childhood and adolescence. Paediatr Perinat Epidemiol 2007; 21:465-72. [PMID: 17697077 DOI: 10.1111/j.1365-3016.2007.00853.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The purpose of the study was to estimate the risks of mortality among infants with low birthweight (LBW, <2500 g) during their childhood and adolescence using a prospective cohort design. A total of 341 249 livebirths were registered in the 1985 Taiwan Birth Registry. We identified the 11 701 LBW singletons and randomly selected the same number of normal-birthweight (NBW) singletons. Study subjects of both LBW and NBW groups were linked, through the individual's unique personal identification number, to the Taiwan Death Registry to identify those who died between 1985 and 2003. Using the life-table method, we calculated the age-specific and cumulative survival rate for both LBW and NBW groups. We used Cox's proportional hazard model with adjustment for potential confounders to estimate the age-specific hazard ratio (HR) of mortality. Age-specific causes of mortality were presented for both groups. The result showed that the cumulative survival rate over an 18-year period for the LBW and NBW subjects was estimated at 95.83% and 99.37%, respectively. Significantly increased adjusted HR of mortality associated with LBW was limited to ages <1 year (boys: 8.99; girls: 8.29) and 1-4 years (boys: 2.19; girls: 2.25). Conditions originating in the perinatal period and congenital anomalies were the most prevalent cause of death among LBW and NBW, respectively. Between ages 1 and 18 years, injury and poisoning became the top ranked causes of death irrespective of birthweight and gender. Although there were small numbers of congenital anomalies, they were still a leading cause of death for LBW subjects, but not for NBW subjects, at ages 5-18 years. The LBW subjects were also likely to suffer from respiratory causes at 5-18 years. This study suggested, therefore, that LBW infants tended to have significantly elevated mortality rates under the age of 5 years, and were vulnerable to more non-injury deaths in their childhood and adolescence.
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Affiliation(s)
- Chih-Ming Lin
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
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Tu YK, Manda SOM, Ellison GTH, Gilthorpe MS. Revisiting the interaction between birth weight and current body size in the foetal origins of adult disease. Eur J Epidemiol 2007; 22:565-75. [PMID: 17641977 DOI: 10.1007/s10654-007-9159-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Accepted: 06/05/2007] [Indexed: 11/29/2022]
Abstract
The four models proposed for exploring the foetal origins of adult disease (FOAD) hypothesis use the product term between size at birth and current size to determine the relative importance of pre- and post-natal growth on disease in later life. This is a common approach for testing the interaction between an exposure (in this instance size at birth) and an effect modifier (in this instance current size)--incorporating the product term obtained by multiplying the exposure and effect modifier variables within a statistical regression model. This study examines the mathematical basis for this approach and uses computer simulations to demonstrate two potential statistical flaws that might generate misleading findings. The first of these is that the expected value of the partial regression coefficient for the product term (between exposure and effect modifier) will be zero when the outcome, exposure and effect modifier are all continuously distributed and follow a multivariate normal distribution. This is because testing the product interaction term amounts to testing for multivariate normality among the three variables, irrespective of the pair-wise correlations amongst them. The second flaw is that it is possible to generate a statistically significant interaction between exposure and effect modifier, even when none exists, simply by categorising either or both of these variables. These flaws pose a serious challenge to the four models approach proposed for exploring the FOAD hypothesis. The interaction between exposure and effect modifier variables should be interpreted with caution both here and elsewhere in epidemiological analyses.
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Affiliation(s)
- Yu-Kang Tu
- Biostatistics Unit, Centre for Epidemiology & Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, 30/32 Hyde Terrace, Leeds LS2 9LN, UK.
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Huang RC, Burke V, Newnham JP, Stanley FJ, Kendall GE, Landau LI, Oddy WH, Blake KV, Palmer LJ, Beilin LJ. Perinatal and childhood origins of cardiovascular disease. Int J Obes (Lond) 2006; 31:236-44. [PMID: 16718281 DOI: 10.1038/sj.ijo.0803394] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Features of the metabolic syndrome comprise a major risk for cardiovascular disease and will increase in prevalence with rising childhood obesity. We sought to identify early life influences on development of obesity, hypertension and dyslipidemia in children. METHODS AND RESULTS Cluster analysis was used on a subset of a longitudinal Australian birth cohort who had blood samples at age 8 (n=406). A quarter of these 8-year-olds fell into a cluster with higher body mass index, blood pressure (BP), more adverse lipid profile and a trend to higher serum glucose resembling adult metabolic syndrome. There was a U-shaped relationship between percentage of expected birth weight (PEBW) and likelihood of being in the high-risk cluster. The high-risk cluster had elevated BP and weight as early as 1 and 3 years old. Increased likelihood of the high-risk cluster group occurred with greatest weight gain from 1 to 8 years old (odds ratio (OR)=1.4, 95% confidence interval (CI)=1.3-1.5/kg) and if mothers smoked during pregnancy (OR=1.82, CI=1.05-3.2). Risk was lower if children were breast fed for >/=4 months (OR=0.6, 95% CI=0.37-0.97). Newborns in the upper two quintiles for PEBW born to mothers who smoked throughout pregnancy were at greatest risk (OR=14.0, 95% CI=3.8-51.1) compared to the nadir PEBW quintile of non-smokers. CONCLUSION A U-shaped relationship between birth weight and several components of the metabolic syndrome was confirmed in a contemporary, well-nourished Western population of full-term newborns, but post-natal weight gain was the dominant factor associated with the high-risk cluster. There was a prominence of higher as well as lowest birth weights in those at risk. Future health programs should focus on both pre- and post-natal factors (reducing excess childhood weight gain and smoking during pregnancy), and possibly the greatest benefits may arise from targeting the heaviest, as well as lightest newborns, especially with a history of maternal smoking during pregnancy.
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Affiliation(s)
- R C Huang
- School of Medicine and Pharmacology, The University of Western Australia (UWA) (M570), Royal Perth Hospital, Perth, Western Australia, Australia.
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Rostand SG, Cliver SP, Goldenberg RL. Racial disparities in the association of foetal growth retardation to childhood blood pressure. Nephrol Dial Transplant 2005; 20:1592-7. [PMID: 15840672 DOI: 10.1093/ndt/gfh833] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Foetal growth retardation (FGR), defined as less than the 10th percentile of birth weight for gestational age, is reported to be an important contributor to hypertension and cardiovascular disease in children and adults, but findings are not consistent. For this reason we re-examined the role of FGR in childhood blood pressure. METHODS We performed univariate and multivariate analyses on data gathered from 262 children, age 5 years, born to mothers at risk for pre-term delivery or FGR infant. The characteristics of the mothers and the children were evaluated using Student's t-test. Rates and proportions were compared using either chi-square or Fisher's exact test. Linear regression models evaluated the effect of birth weight and body mass index on systolic and diastolic blood pressure. Multivariate linear regression was used to model the effects of FGR, gestational age, body mass index, race, gender, maternal smoking, maternal gestational diabetes on blood pressure while adjusting for possible confounders. RESULTS Systolic blood pressure was inversely associated with birth weight in white children while a small direct association was noted in African Americans. Body mass index was positively associated with systolic blood pressure in both groups. Multiple linear regression analyses showed FGR and early gestational age were associated with higher blood pressure in white but not African American children, accounting for a 13.2 mmHg difference between FGR and appropriate for gestational age groups. Blood pressure in African Americans was strongly affected by maternal gestational diabetes and smoking. CONCLUSIONS Birth weight influences childhood blood pressure but the effects may vary depending on ethnic group. The relative importance of birth weight on blood pressure may depend on other prenatal and post-partum risks.
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Affiliation(s)
- Stephen G Rostand
- Division of Nephrology, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
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Jennings G. Arterial pulse waveforms: defined at birth or barking up the wrong arterial tree? J Hypertens 2005; 23:1337-9. [PMID: 15942454 DOI: 10.1097/01.hjh.0000173514.75857.2e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Abstract
This paper presents a signpost for hypertension research, emphasizing areas most likely to yield major clinical and public health benefits. Specific questions are posed in the context of fetal and maternal precursors of cardiovascular disease, vascular biology, resistant hypertension, antihypertensive drugs, primary aldosteronism, lifestyle and genetic interactions and translational research. Worldwide increasing rates of obesity and diabetes demonstrate the need for a global approach to cardiovascular risk and the need for more effective use of existing knowledge. Equal emphasis is given to the critical importance of the fundamental research required to defeat hypertensive cardiovascular disease in the long run.
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Affiliation(s)
- Lawrence J Beilin
- School of Medicine and Pharmacology and West Australian Institute for Medical Research, Royal Perth Hospital, University of Western Australia, Perth, Western Australia.
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