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Wang Y, Crowe M, Knibbs LD, Fuller-Tyszkiewicz M, Mygind L, Kerr JA, Wake M, Olsson CA, Enticott PG, Peters RL, Daraganova G, Mavoa S, Lycett K. Greenness modifies the association between ambient air pollution and cognitive function in Australian adolescents, but not in mid-life adults. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 324:121329. [PMID: 36822308 DOI: 10.1016/j.envpol.2023.121329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/31/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Exposure to ambient air pollution has been associated with reduced cognitive function in childhood and later life, with too few mid-life studies to draw conclusions. In contrast, residential greenness has been associated with enhanced cognitive function throughout the lifecourse. Here we examine the extent to which (1) ambient air pollution and residential greenness predict later cognitive function in adolescence and mid-life, and (2) greenness modifies air pollution-cognitive function associations. PARTICIPANTS 6220 adolescents (51% male) and 2623 mid-life adults (96% mothers) from the Longitudinal Study of Australian Children. MEASURES Exposures: Annual average particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2) and greenness (Normalised Difference Vegetation Index) for residential addresses from validated land-use regression models over a 10-13-year period. OUTCOMES Cognitive function from CogState tests of attention, working memory and executive function, dichotomised into poorer (worst quartile) versus not poor. ANALYSES Adjusted mixed-effects generalised linear models with residential greenness assessed as an effect modifier (high vs. low divided at median). The annual mean for PM2.5 and NO2 across exposure windows was 6.3-6.8 μg/m3, and 5.5-7.1 ppb, respectively. For adolescents, an IQR increment of NO2 was associated with 19-24% increased odds of having poorer executive function across all time windows, while associations weren't observed between air pollution and other outcomes. For adults, high NO2 predicted poorer cognitive function across all outcomes, while high PM2.5 predicted poorer attention only. There was little evidence of associations between greenness and cognitive function in adjusted models for both generations. Interactions were found between residential greenness, air pollutants and cognitive function in adolescents, but not adults. The magnitude of effects was similar across generations and exposure windows. Findings highlight the potential benefits of cognitive health associated with the regulation of air pollution and urban planning strategies for increasing green spaces and vegetation.
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Affiliation(s)
- Yichao Wang
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia; Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
| | - Mallery Crowe
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
| | - Luke D Knibbs
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia; Public Health Unit, Sydney Local Health District, Camperdown, NSW, 2050, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
| | - Lærke Mygind
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, VIC, 3125, Australia; Unit of Medical Psychology, University of Copenhagen, Copenhagen, 1353, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, The Capital Region of Denmark, Copenhagen, 2000, Denmark
| | - Jessica A Kerr
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia; Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia; Department of Psychological Medicine, University of Otago Christchurch, New Zealand
| | - Melissa Wake
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia; Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia; Liggins Institute, University of Auckland, New Zealand
| | - Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia; Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia; Psychological Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, VIC, 3125, Australia
| | - Rachel L Peters
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia; Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Galina Daraganova
- Psychological Sciences, University of Melbourne, Parkville, VIC, 3010, Australia; Business Intelligence, South Eastern Melbourne Primary Health Network, Melbourne, VIC, 3202, Australia
| | - Suzanne Mavoa
- Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia; Environmental Public Health Branch, Environment Protection Authority Victoria, Melbourne, VIC, 3001, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Kate Lycett
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, 3220, Australia; Population Health Theme, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
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Kerr JA, Liu RS, Gasser CE, Mensah FK, Burgner D, Lycett K, Gillespie AN, Juonala M, Clifford SA, Olds T, Saffery R, Gold L, Liu M, Azzopardi P, Edwards B, Dwyer T, Wake M. Diet quality trajectories and cardiovascular phenotypes/metabolic syndrome risk by 11-12 years. Int J Obes (Lond) 2021; 45:1392-1403. [PMID: 33824404 DOI: 10.1038/s41366-021-00800-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate associations between early-life diet trajectories and preclinical cardiovascular phenotypes and metabolic risk by age 12 years. METHODS Participants were 1861 children (51% male) from the Longitudinal Study of Australian Children. At five biennial waves from 2-3 to 10-11 years: Every 2 years from 2006 to 2014, diet quality scores were collected from brief 24-h parent/self-reported dietary recalls and then classified using group-based trajectory modeling as 'never healthy' (7%), 'becoming less healthy' (17%), 'moderately healthy' (21%), and 'always healthy' (56%). At 11-12 years: During children's physical health Child Health CheckPoint (2015-2016), we measured cardiovascular functional (resting heart rate, blood pressure, pulse wave velocity, carotid elasticity/distensibility) and structural (carotid intima-media thickness, retinal microvasculature) phenotypes, and metabolic risk score (composite of body mass index z-score, systolic blood pressure, high-density lipoproteins cholesterol, triglycerides, and glucose). Associations were estimated using linear regression models (n = 1100-1800) adjusted for age, sex, and socioeconomic position. RESULTS Compared to 'always healthy', the 'never healthy' trajectory had higher resting heart rate (2.6 bpm, 95% CI 0.4, 4.7) and metabolic risk score (0.23, 95% CI 0.01, 0.45), and lower arterial elasticity (-0.3% per 10 mmHg, 95% CI -0.6, -0.1) and distensibility (-1.2%, 95% CI -1.9, -0.5) (all effect sizes 0.3-0.4). Heart rate, distensibility, and diastolic blood pressure were progressively poorer for less healthy diet trajectories (linear trends p ≤ 0.02). Effects for systolic blood pressure, pulse wave velocity, and structural phenotypes were less evident. CONCLUSIONS Children following the least healthy diet trajectory had poorer functional cardiovascular phenotypes and metabolic syndrome risk, including higher resting heart rate, one of the strongest precursors of all-cause mortality. Structural phenotypes were not associated with diet trajectories, suggesting the window to prevent permanent changes remains open to at least late childhood.
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Affiliation(s)
- Jessica A Kerr
- Murdoch Children's Research Institute, Parkville, VIC, Australia. .,The University of Melbourne, Parkville, VIC, Australia.
| | - Richard S Liu
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Constantine E Gasser
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Australian Institute of Family Studies, Southbank, VIC, Australia
| | - Fiona K Mensah
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Monash University, Clayton, VIC, Australia
| | - Kate Lycett
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Deakin University, Burwood, VIC, Australia
| | - Alanna N Gillespie
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Internal Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Susan A Clifford
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Tim Olds
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Lisa Gold
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Mengjiao Liu
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Maternal and Child Health Program, International Development Discipline, Burnet Institute, Melbourne, Australia
| | - Ben Edwards
- Australian National University Centre for Social Research and Methods, Canberra, ACT, Australia
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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3
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Juonala M, Lewis S, McLachlan R, Hammarberg K, Kennedy J, Saffery R, McBain J, Welsh L, Cheung M, Doyle LW, Amor DJ, Burgner DP, Halliday J. American Heart Association ideal cardiovascular health score and subclinical atherosclerosis in 22-35-year-old adults conceived with and without assisted reproductive technologies. Hum Reprod 2021; 35:232-239. [PMID: 31834929 DOI: 10.1093/humrep/dez240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Is ART related with the association of American Heart Association (AHA) ideal cardiovascular health score and markers of subclinical atherosclerosis? SUMMARY ANSWER The associations between AHA score and markers of subclinical atherosclerosis in ART and non-ART groups were similar in magnitude. WHAT IS KNOWN ALREADY Long-term consequences of ART on cardiovascular health are unknown. STUDY DESIGN, SIZE, DURATION The study cohort for the cross-sectional analyses consisted of 172 ART-conceived and 78 non-ART conceived individuals of same age (range 22-35 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Cardiovascular risk factor status was evaluated with American Heart Association (AHA) ideal cardiovascular health score consisting of seven factors (body mass index, blood pressure, total cholesterol, glucose, diet and physical activity, non-smoking). Carotid artery intima-media thickness (cIMT), arterial pulse-wave velocity (PWV) and retinal microvascular parameters were evaluated as markers of early atherosclerosis. Group comparisons in continuous variables were performed with t-tests. For categorical variables, comparisons were performed with chi-square tests. The relationships between AHA score and the markers of atherosclerosis were examined with linear regression analyses adjusted for age and sex. MAIN RESULTS AND THE ROLE OF CHANCE There was no difference in AHA ideal health score between the ART and non-ART groups; mean (SD) scores were 4.1(1.4) versus 4.0(1.5), respectively, P = 0.65. No differences were observed between groups for any individual ideal health metric (P always >0.2). AHA score was not associated with cIMT or retinal measures in either group (P always >0.05). An inverse association was observed between AHA score and PWV in the ART group (beta (95% CI) -0.18(-0.26 to -0.10)). A numerically similar relationship was observed in the smaller non-ART group (-0.19(-0.39 to 0.01)). LIMITATIONS, REASONS FOR CAUTION Even though this cohort is among the largest ART studies with extensive cardiovascular data, the sample is still relatively small and the statistical power is limited. As the study population was still in early adulthood, we were not able to evaluate the associations with clinical cardiovascular events, but utilized non-invasive methods to assess early markers of subclinical atherosclerosis. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that ART-conceived individuals do not have increased vulnerability for cardiovascular risk factors. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by a National Health & Medical Research Council Project Grant (APP1099641), The Royal Children's Hospital Research Foundation, Monash IVF Research and Education Foundation, and Reproductive Biology Unit Sperm Fund, Melbourne IVF. The authors have no conflicts of interest relevant to this article to disclose.
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Affiliation(s)
- Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children's Research Institute, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Clayton, Australia
- Monash IVF Group Pty Ltd, Richmond, Australia
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Karin Hammarberg
- Global Public Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Joanne Kennedy
- Murdoch Children's Research Institute, Parkville, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - John McBain
- Reproductive Services, Royal Women's Hospital, Parkville, Australia
| | - Liam Welsh
- Murdoch Children's Research Institute, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Research Office, The Royal Women's Hospital, Parkville, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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4
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Saraf S, Grobler A, Liu RS, Liu M, Wake M, Olds T, Lycett K, Juonala M, Ranganathan S, Burgner D, Kerr JA. Takeaway food, sugar-sweetened beverages and preclinical cardiometabolic phenotypes in children and adults. Eur J Prev Cardiol 2020; 28:1784-1794. [PMID: 33624030 DOI: 10.1093/eurjpc/zwaa070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/03/2020] [Accepted: 09/04/2020] [Indexed: 01/09/2023]
Abstract
AIMS To investigate relationships between takeaway food and sugar-sweetened beverage (SSB) consumption with cardiometabolic phenotypes during childhood and mid-adulthood. METHOD Design: Cross-sectional Child Health CheckPoint within the national population-representative Longitudinal Study of Australian Children. Participants: 1838 children (mean age 11.5 years; 49.1% female) and 1846 adults (mean age 43.7 years; 87.6% female). Exposures: Self-reported takeaway food and SSB consumption ('frequent': ≥ weekly). Outcomes: Functional (pulse wave velocity (PWV), blood pressure (BP)) and structural (carotid intima-media thickness, retinal microvascular calibre) preclinical cardiovascular phenotypes; lipids (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides). Analysis: Linear regression (exposure: takeaway or SSB consumption, individually or together) adjusted for age, sex and socio-economic position; and mediation analysis for body mass index (BMI). RESULTS Associations were small among children (standardized mean difference (SMD) ≤0.15). In adults, associations were stronger with functional, but not structural, cardiovascular phenotypes and lipids, particularly for frequent takeaway food consumption (e.g. PWV (0.20 m/s; 95% confidence interval (CI) 0.03 to 0.37); systolic (3.3 mmHg; 95% CI 1.3 to 5.3) and diastolic BP (1.4 mmHg; 95% CI 0.2 to 2.6); LDL (0.10 mmol/L; 95% CI 0.02 to 0.18); HDL (-0.14 mmol/L; 95% CI -0.19 to -0.10) and triglycerides (0.30 mmol/L; 95% CI 0.12 to 0.48)]. BMI mediated associations between takeaway food consumption and PWV, BP, HDL and TG (proportion of mediation 34% to 75%), while mediation effects were smaller for SSB consumption. CONCLUSIONS Frequent takeaway food consumption in adults was associated with adverse blood lipids and vascular function (mainly via BMI). Lack of strong associations in children highlights opportunities for prevention.
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Affiliation(s)
- Shweta Saraf
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Anneke Grobler
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Richard S Liu
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Mengjiao Liu
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tim Olds
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Kate Lycett
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Internal Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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5
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Risk factors during first 1,000 days of life for carotid intima-media thickness in infants, children, and adolescents: A systematic review with meta-analyses. PLoS Med 2020; 17:e1003414. [PMID: 33226997 PMCID: PMC7682901 DOI: 10.1371/journal.pmed.1003414] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The first 1,000 days of life, i.e., from conception to age 2 years, could be a critical period for cardiovascular health. Increased carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis. We performed a systematic review with meta-analyses to assess (1) the relationship between exposures or interventions in the first 1,000 days of life and CIMT in infants, children, and adolescents; and (2) the CIMT measurement methods. METHODS AND FINDINGS Systematic searches of Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) were performed from inception to March 2019. Observational and interventional studies evaluating factors at the individual, familial, or environmental levels, for instance, size at birth, gestational age, breastfeeding, mode of conception, gestational diabetes, or smoking, were included. Quality was evaluated based on study methodological validity (adjusted Newcastle-Ottawa Scale if observational; Cochrane collaboration risk of bias tool if interventional) and CIMT measurement reliability. Estimates from bivariate or partial associations that were least adjusted for sex were used for pooling data across studies, when appropriate, using random-effects meta-analyses. The research protocol was published and registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42017075169). Of 6,221 reports screened, 50 full-text articles from 36 studies (34 observational, 2 interventional) totaling 7,977 participants (0 to 18 years at CIMT assessment) were retained. Children born small for gestational age had increased CIMT (16 studies, 2,570 participants, pooled standardized mean difference (SMD): 0.40 (95% confidence interval (CI): 0.15 to 0.64, p: 0.001), I2: 83%). When restricted to studies of higher quality of CIMT measurement, this relationship was stronger (3 studies, 461 participants, pooled SMD: 0.64 (95% CI: 0.09 to 1.19, p: 0.024), I2: 86%). Only 1 study evaluating small size for gestational age was rated as high quality for all methodological domains. Children conceived through assisted reproductive technologies (ART) (3 studies, 323 participants, pooled SMD: 0.78 (95% CI: -0.20 to 1.75, p: 0.120), I2: 94%) or exposed to maternal smoking during pregnancy (3 studies, 909 participants, pooled SMD: 0.12 (95% CI: -0.06 to 0.30, p: 0.205), I2: 0%) had increased CIMT, but the imprecision around the estimates was high. None of the studies evaluating these 2 factors was rated as high quality for all methodological domains. Two studies evaluating the effect of nutritional interventions starting at birth did not show an effect on CIMT. Only 12 (33%) studies were at higher quality across all domains of CIMT reliability. The degree of confidence in results is limited by the low number of high-quality studies, the relatively small sample sizes, and the high between-study heterogeneity. CONCLUSIONS In our meta-analyses, we found several risk factors in the first 1,000 days of life that may be associated with increased CIMT during childhood. Small size for gestational age had the most consistent relationship with increased CIMT. The associations with conception through ART or with smoking during pregnancy were not statistically significant, with a high imprecision around the estimates. Due to the large uncertainty in effect sizes and the limited quality of CIMT measurements, further high-quality studies are needed to justify intervention for primordial prevention of cardiovascular disease (CVD).
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6
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Lycett K, Juonala M, Magnussen CG, Norrish D, Mensah FK, Liu R, Clifford SA, Carlin JB, Olds T, Saffery R, Kerr JA, Ranganathan S, Baur LA, Sabin MA, Cheung M, Dwyer T, Liu M, Burgner D, Wake M. Body Mass Index From Early to Late Childhood and Cardiometabolic Measurements at 11 to 12 Years. Pediatrics 2020; 146:peds.2019-3666. [PMID: 32632021 DOI: 10.1542/peds.2019-3666] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine how overweight and obesity at specific ages and overall BMI growth patterns throughout childhood predict cardiometabolic phenotypes at 11 to 12 years. METHODS In a population-based sample of 5107 infants, BMI was measured every 2 years between ages 2 to 3 and 10 to 11 years. We identified 5 BMI trajectories using growth curve models. At ages 11 to 12 years, 1811 children completed assessments for metabolic syndrome risk scores, carotid-femoral pulse wave velocity, and carotid intima-media thickness. Multivariable regression models were used to estimate associations, adjusted for potential confounders (eg, age, sex, smoking exposure, and small for gestational age). RESULTS Overweight and obesity from early childhood onward were strongly associated with higher cardiometabolic risk at 11 to 12 years of age. At age 6 to 7 years, compared with those with a healthy weight, children with overweight had higher metabolic syndrome risk scores by 0.23 SD units (95% confidence interval 0.05 to 0.41) and with obesity by 0.76 SD units (0.51-1.01), with associations almost doubling by age 10 to 11 years. Obese (but not overweight) children had higher outcome pulse wave velocity (0.64-0.73 SD units) from ages 6 to 7 years and slightly higher outcome carotid intima-media thickness (0.20-0.30 SD units) at all ages. Cumulative exposure to high BMI from 2 to 3 years of age carried the greatest cardiometabolic risk, with a gradient of risk across trajectories. CONCLUSIONS High early-childhood BMI is already silently associated with the development of cardiometabolic risk by 11 to 12 years, highlighting the urgent need for effective action to reduce overweight and obesity in early childhood.
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Affiliation(s)
- Kate Lycett
- Centre for Social & Early Emotional Development, Deakin University, Burwood, Victoria, Australia; .,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Internal Medicine and.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Research School of Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - David Norrish
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Research School of Computer Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Fiona K Mensah
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Liu
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan A Clifford
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - John B Carlin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Tim Olds
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Louise A Baur
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Terence Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Mengjiao Liu
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; and
| | - Melissa Wake
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
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7
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De Smidt JJA, Odendaal HJ, Nel DG, Nolan H, Du Plessis C, Brink LT, Oelofse A. In utero teratogen exposure and cardiometabolic risk in 5-year-old children: a prospective pediatric study. J Matern Fetal Neonatal Med 2019; 34:3740-3749. [PMID: 31762362 DOI: 10.1080/14767058.2019.1692337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Aorta and carotid intima-media thickness (IMT) is a measure of subclinical atherosclerosis and useful to assess cardiometabolic risk in the young. The in utero milieu may involve cardiometabolic programing and the development of cardiometabolic risk factors in children. Maternal smoking, alcohol consumption, and micronutrient deficiencies during pregnancy influence the development of the cardiovascular system through a process of DNA methylation.Aim: To explore an association between maternal smoking and alcohol consumption during pregnancy and intima media thickness in 5-year-old children for a low-income setting.Methods: Data were collected from 500 mother-child pairs at antenatal clinic visit, at birth, and at age 5 years. Anthropometric measurements were collected at birth and again at age 5 years. As well as clinical and ultrasound measurements at age 5 years. Clinical measurements, at age 5 years, included blood pressure, mean arterial pressure, and heart rate. Ultrasound measurements of the aorta and carotid arteries IMT were performed at age 5 years. Main outcome of interest was effect of dual teratogen exposure on the ultrasound measures IMT as indication of cardiometabolic risk.Results: cIMT was significantly higher in children exposed to both alcohol and nicotine during pregnancy compared to those not exposed (p = .008). In separate linear models, dual in utero exposure (beta = 0.12; p = .01) and male sex (beta = 0.14; p = .01) were associated with higher right cIMT values (F(6,445) = 5.20; R2 = 0.07, p < .01); male sex (beta = 0.13; p = .01) and low birth weight (beta = 0.07; p = .01) with higher left cIMT value (F(4,491) = 4.49; R2 = 0.04; p = .01); and males sex (beta = 0.11; p = .02) with higher aorta IMT (F(6,459) = 5.63; R2 = 0.07; p < .01). Significant positive correlations between maternal measures of adiposity, maternal MUAC (r = 0.10; p = .03), and maternal BMI (r = 0.12; p < .01) and right cIMT measurements adjusted for the BMI of the child at age 5 years as covariate. Blood pressure measurements at age 5 years were not significantly associated with IMT but, instead, correlated significantly and positively with the BMI of the child at age 5 years (p < .01).Conclusion: Children exposed to both maternal smoking and alcohol consumption during pregnancy presented with cardiometabolic risk factors 5 years after birth. In addition, maternal adiposity, male sex, and low birth weight were associated with higher IMT at age 5 years.
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Affiliation(s)
- J J A De Smidt
- Department of Medical Biosciences, University of the Western Cape, South Africa
| | - H J Odendaal
- Department of Obstetrics and Gynecology, Stellenbosch University, Stellenbosch, South Africa
| | - D G Nel
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - H Nolan
- Department of Obstetrics and Gynecology, Stellenbosch University, Stellenbosch, South Africa
| | - C Du Plessis
- Department of Obstetrics and Gynecology, Stellenbosch University, Stellenbosch, South Africa
| | - L T Brink
- Department of Obstetrics and Gynecology, Stellenbosch University, Stellenbosch, South Africa
| | - A Oelofse
- Department of Medical Biosciences, University of the Western Cape, South Africa
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8
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Juonala M, Ellul S, Lawlor DA, Santos Ferreira DL, Carlin JB, Cheung M, Dwyer T, Wake M, Saffery R, Burgner DP. A Cross-Cohort Study Examining the Associations of Metabolomic Profile and Subclinical Atherosclerosis in Children and Their Parents: The Child Health CheckPoint Study and Avon Longitudinal Study of Parents and Children. J Am Heart Assoc 2019; 8:e011852. [PMID: 31286813 PMCID: PMC6662147 DOI: 10.1161/jaha.118.011852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background High-throughput nuclear magnetic resonance profiling of circulating metabolites is suggested as an adjunct for cardiovascular risk evaluation. The relationship between metabolites and subclinical atherosclerosis remains unclear, particularly among children. Therefore, we examined the associations of metabolites with carotid intima-media thickness ( cIMT ) and arterial pulse wave velocity ( PWV ). Methods and Results Data from two independent population-based studies was examined; (1) cross-sectional associations with cIMT and PWV in 1178 children (age 11-12 years, 51% female) and 1316 parents (mean age 45 years, 87% female) from the CheckPoint study (Australia); and (2) longitudinal associations in 4249 children (metabolites at 7-8 years, PWV at 10-11 years, 52% female), and cross-sectional associations in 4171 of their mothers (mean age 48 years, cIMT data) from ALSPAC (The Avon Longitudinal Study of Parents and Children; UK ). Metabolites were measured by the same nuclear magnetic resonance platform in both studies, comprising of 69 biomarkers. Biophysical assessments included body mass index, blood pressure, cIMT and PWV . In linear regression analyses adjusted for age, sex, body mass index, and blood pressure, there was no evidence of metabolite associations in either children or adults for cIMT at a 10% false discovery threshold. In CheckPoint adults, glucose was positively, and some high-density lipoprotein-cholesterol derived measures and amino acids (glutamine, histidine, tyrosine) inversely associated with PWV. Conclusions These data suggest that in children circulating metabolites have no consistent association with cIMT and PWV once adjusted for body mass index and blood pressure. In their middle-aged parents, some evidence of metabolite associations with PWV were identified that warrant further investigation.
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Affiliation(s)
- Markus Juonala
- 1 Department of Medicine University of Turku Finland.,2 Division of Medicine Turku University Hospital Turku Finland.,3 Murdoch Children's Research Institute Parkville Victoria Australia
| | - Susan Ellul
- 3 Murdoch Children's Research Institute Parkville Victoria Australia
| | - Debbie A Lawlor
- 4 The Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,5 National Institute for Health Research Bristol Biomedical Research Centre Bristol United Kingdom.,6 Population Health Science Bristol Medical School University of Bristol United Kingdom
| | - Diana L Santos Ferreira
- 4 The Medical Research Council Integrative Epidemiology Unit at the University of Bristol Bristol United Kingdom.,6 Population Health Science Bristol Medical School University of Bristol United Kingdom
| | - John B Carlin
- 3 Murdoch Children's Research Institute Parkville Victoria Australia
| | - Michael Cheung
- 3 Murdoch Children's Research Institute Parkville Victoria Australia.,7 Royal Children's Hospital Parkville Victoria Australia
| | - Terence Dwyer
- 8 The George Institute for Global Health University of Oxford United Kingdom
| | - Melissa Wake
- 3 Murdoch Children's Research Institute Parkville Victoria Australia.,9 Department of Pediatrics University of Melbourne Parkville Victoria Australia
| | - Richard Saffery
- 3 Murdoch Children's Research Institute Parkville Victoria Australia.,9 Department of Pediatrics University of Melbourne Parkville Victoria Australia
| | - David P Burgner
- 3 Murdoch Children's Research Institute Parkville Victoria Australia.,7 Royal Children's Hospital Parkville Victoria Australia.,9 Department of Pediatrics University of Melbourne Parkville Victoria Australia.,10 Department of Pediatrics Monash University Clayton Victoria Australia
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9
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Davis A, Liu R, Kerr JA, Wake M, Grobler A, Juonala M, Liu M, Baur L, Burgner D, Lycett K. Inflammatory diet and preclinical cardiovascular phenotypes in 11–12 year-olds and mid-life adults: A cross-sectional population-based study. Atherosclerosis 2019; 285:93-101. [DOI: 10.1016/j.atherosclerosis.2019.04.212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
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10
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Liu RS, Wake M, Grobler A, Cheung M, Lycett K, Ranganathan S, Edwards B, Dwyer T, Azzopardi P, Juonala M, Burgner DP. Cross-sectional associations between Ideal Cardiovascular Health scores and vascular phenotypes in 11- to 12-year-olds and their parents: The Longitudinal Study of Australian Children. Int J Cardiol 2018; 277:258-265. [PMID: 30449694 DOI: 10.1016/j.ijcard.2018.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/24/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Understanding early-life relationships between the Ideal Cardiovascular Health (ICVH) score and vascular phenotypes could inform likely effectiveness and timing of cardiovascular disease prevention strategies. We aimed to describe associations between ICVH scores and vascular phenotypes in 11- to 12-year-old children and their parents. METHODS AND RESULTS Cross-sectional ICVH scores (range 0-7, higher indicating better health), derived by summing dichotomized metrics for cholesterol, glucose, blood pressure (BP), body mass index (BMI), diet, physical activity and smoking, were constructed for 1235 adults (89% female, mean age 43 years) and 1028 children (48% female, 12 years). The median scores were 4 and 5 for adults and children respectively. Child ICVH scores were associated with parent scores (0.18 higher child score per additional point in parent's score, 95% CI 0.12 to 0.22, P < 0.001). Each additional point in the adult ICVH score was associated with slower carotid-femoral pulse wave velocity (PWV, -0.32 m/s, 95% CI -0.37 to -0.27), greater carotid elasticity (0.017%/mm Hg, 95% CI 0.014 to 0.020) and reduced carotid intima-media thickness (IMT, -7.3 μm, 95% CI -12.0 to -2.5). An additional point in the child score was associated with functional phenotypes (PWV -0.07 m/s, 95% CI -0.11 to -0.03; carotid elasticity 0.009%/mm Hg, 95% CI 0.004 to 0.015) but not structural phenotypes (IMT -1.8 μm, 95% CI -5.2 to 1.5). CONCLUSION Few Australian children and even fewer parents have ideal cardiovascular health. Lower ICVH scores were associated with adverse adult vascular phenotypes and adverse child vascular function. Family-based interventions optimizing ICVH metrics may delay onset and progression of subclinical atherosclerosis and later cardiovascular disease.
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Affiliation(s)
- Richard S Liu
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Melissa Wake
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Auckland, Auckland, New Zealand; The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Anneke Grobler
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Michael Cheung
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Royal Children's Hospital, Parkville, Australia
| | - Kate Lycett
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Royal Children's Hospital, Parkville, Australia
| | - Ben Edwards
- ANU Centre for Social Research and Methods, Research School of Social Sciences, College of Arts and Social Sciences, The Australian National University, Canberra, Australia
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Peter Azzopardi
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Maternal and Child Health Program, Discipline of International Development, Burnet Institute, Melbourne, Australia; Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - David P Burgner
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
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11
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Vohr BR, Heyne R, Bann C, Das A, Higgins RD, Hintz SR. High Blood Pressure at Early School Age Among Extreme Preterms. Pediatrics 2018; 142:peds.2018-0269. [PMID: 30054344 PMCID: PMC6317552 DOI: 10.1542/peds.2018-0269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Former preterm infants are at increased risk of hypertension with increasing age. Our objective was to identify rates of high blood pressure (BP) (≥90th percentile) and hypertension (BP ≥95th percentile) and associated risk factors among extreme preterm (EPT) infants at 6 to 7 years of age. METHODS Assessment included BP and anthropometrics. Comparisons were made by BP ≥90th versus <90th percentile. Regressions were run to identify relative risk (RR) of factors associated with BP ≥90th percentile. RESULTS Among 379 EPT infants, 20.6% had systolic high BP, 10.8% systolic hypertension, 21.4% diastolic high BP, and 11.4% diastolic hypertension. Children with systolic high BP had higher rates of BMI, triceps skinfolds >85th percentile, and waist circumference >90th percentile. In regression analyses, weight gain velocity from 18 months to school age (RR = 1.36), and maternal gestational diabetes (MGD) (RR = 2.04) predicted systolic and either systolic and/or diastolic high BP (RR = 1.27 and RR = 1.67). Among children with BMI <85th percentile, 17% had systolic and 19% had diastolic high BP. Regression analysis for normal weight children indicated public insurance (RR = 2.46) and MGD (RR = 2.16) predicted systolic high BP, and MGD (RR = 2.08) predicted either systolic or diastolic high BP. CONCLUSIONS Both overweight and normal weight EPT children are at risk for high BP and hypertension. Public insurance, MGD, and weight gain velocity are risk factors. Findings of high BP among EPT children at early school age are worrisome and indicate a need for close follow-up.
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Affiliation(s)
- Betty R. Vohr
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Roy Heyne
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carla Bann
- Division of Statistical and Data Sciences, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Division of Biostatistics and Epidemiology, RTI International, Rockville, Maryland
| | - Rosemary D. Higgins
- Neonatal Research Network, National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
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12
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Lambert MA, Weir-McCall JR, Salsano M, Gandy SJ, Levin D, Cavin I, Littleford R, MacFarlane JA, Matthew SZ, Nicholas RS, Struthers AD, Sullivan F, Henderson SA, White RD, Belch JJF, Houston JG. Prevalence and Distribution of Atherosclerosis in a Low- to Intermediate-Risk Population: Assessment with Whole-Body MR Angiography. Radiology 2018; 287:795-804. [PMID: 29714681 PMCID: PMC5979784 DOI: 10.1148/radiol.2018171609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To quantify the burden and distribution of asymptomatic atherosclerosis in a population with a low to intermediate risk of cardiovascular disease. Materials and Methods Between June 2008 and February 2013, 1528 participants with 10-year risk of cardiovascular disease less than 20% were prospectively enrolled. They underwent whole-body magnetic resonance (MR) angiography at 3.0 T by using a two-injection, four-station acquisition technique. Thirty-one arterial segments were scored according to maximum stenosis. Scores were summed and normalized for the number of assessable arterial segments to provide a standardized atheroma score (SAS). Multiple linear regression was performed to assess effects of risk factors on atheroma burden. Results A total of 1513 participants (577 [37.9%] men; median age, 53.5 years; range, 40-83 years) completed the study protocol. Among 46 903 potentially analyzable segments, 46 601 (99.4%) were interpretable. Among these, 2468 segments (5%) demonstrated stenoses, of which 1649 (3.5%) showed stenosis less than 50% and 484 (1.0%) showed stenosis greater than or equal to 50%. Vascular stenoses were distributed throughout the body with no localized distribution. Seven hundred forty-seven (49.4%) participants had at least one stenotic vessel, and 408 (27.0%) participants had multiple stenotic vessels. At multivariable linear regression, SAS correlated with age (B = 3.4; 95% confidence interval: 2.61, 4.20), heart rate (B = 1.23; 95% confidence interval: 0.51, 1.95), systolic blood pressure (B = 0.02; 95% confidence interval: 0.01, 0.03), smoking status (B = 0.79; 95% confidence interval: 0.44, 1.15), and socioeconomic status (B = -0.06; 95% confidence interval: -0.10, -0.02) (P < .01 for all). Conclusion Whole-body MR angiography identifies early vascular disease at a population level. Although disease prevalence is low on a per-vessel level, vascular disease is common on a per-participant level, even in this low- to intermediate-risk cohort. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Marco Salsano
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Stephen J. Gandy
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Daniel Levin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Ian Cavin
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Roberta Littleford
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jennifer A. MacFarlane
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shona Z. Matthew
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard S. Nicholas
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Allan D. Struthers
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Frank Sullivan
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Shelley A. Henderson
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Richard D. White
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - Jill J. F. Belch
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
| | - J. Graeme Houston
- From the Division of Molecular and Clinical Medicine, College of
Medicine, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY,
Scotland (M.A.L., J.R.W.M., M.S., D.L., R.L., S.Z.M., A.D.S., J.J.F.B., J.G.H.);
NHS Tayside Medical Physics, Ninewells Hospital, Dundee, Scotland (S.J.G., I.C.,
J.A.M., R.S.N., S.A.H.); Department of Research and Innovation, North York
General Hospital, University of Toronto, Toronto, Canada (F.S.); and Department
of Clinical Radiology, University Hospital of Wales, Cardiff, Wales
(R.D.W.)
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