Childhood environmental and genetic predictors of adulthood obesity: the cardiovascular risk in young Finns study

Lower abdominal adipose tissue cannabinoid type 1 receptor availability in young men with overweight

OBJECTIVE

Cannabinoid type 1 receptors (CB1R) modulate feeding behavior and energy homeostasis, and the CB1R tone is dysgulated in obesity. This study aimed to investigate CB1R availability in peripheral tissue and brain in young men with overweight versus lean men.

METHODS

Healthy males with high (HR, n = 16) or low (LR, n = 20) obesity risk were studied with fluoride 18-labeled FMPEP-d₂ positron emission tomography to quantify CB1R availability in abdominal adipose tissue, brown adipose tissue, muscle, and brain. Obesity risk was assessed by BMI, physical exercise habits, and familial obesity risk, including parental overweight, obesity, and type 2 diabetes. To assess insulin sensitivity, fluoro-[¹⁸ F]-deoxy-2-D-glucose positron emission tomography during hyperinsulinemic-euglycemic clamp was performed. Serum endocannabinoids were analyzed.

RESULTS

CB1R availability in abdominal adipose tissue was lower in the HR than in the LR group, whereas no difference was found in other tissues. CB1R availability of abdominal adipose tissue and brain correlated positively with insulin sensitivity and negatively with unfavorable lipid profile, BMI, body adiposity, and inflammatory markers. Serum arachidonoyl glycerol concentration was associated with lower CB1R availability of the whole brain, unfavorable lipid profile, and higher serum inflammatory markers.

CONCLUSIONS

The results suggest endocannabinoid dysregulation already in the preobesity state.

Obesity risk is associated with brain glucose uptake and insulin resistance

OBJECTIVE

To investigate whether alterations in brain glucose uptake (BGU), insulin action in the brain-liver axis and whole-body insulin sensitivity occur in young adults in pre-obese state.

METHODS

Healthy males with either high risk (HR; n = 19) or low risk (LR; n = 22) for developing obesity were studied with [18F]fluoro-d-glucose ([18F]FDG)-positron emission tomography during hyperinsulinemic-euglycemic clamp. Obesity risk was assessed according to BMI, physical activity and parental overweight/obesity and type 2 diabetes. Brain, skeletal muscle, brown adipose tissue (BAT), visceral adipose tissue (VAT) and abdominal and femoral s.c. adipose tissue (SAT) glucose uptake (GU) rates were measured. Endogenous glucose production (EGP) was calculated by subtracting the exogenous glucose infusion rate from the rate of disappearance of [18F]FDG. BGU was analyzed using statistical parametric mapping, and peripheral tissue activity was determined using Carimas Software imaging processing platform.

RESULTS

BGU was higher in the HR vs LR group and correlated inversely with whole-body insulin sensitivity (M value) in the HR group but not in the LR group. Insulin-suppressed EGP did not differ between the groups but correlated positively with BGU in the whole population, and the correlation was driven by the HR group. Skeletal muscle, BAT, VAT, abdominal and femoral SAT GU were lower in the HR group as compared to the LR group. Muscle GU correlated negatively with BGU in the HR group but not in the LR group.

CONCLUSION

Increased BGU, alterations in insulin action in the brain-liver axis and decreased whole-body insulin sensitivity occur early in pre-obese state.

Influence of adipose tissue immune dysfunction on childhood obesity

In recent decades, a dramatic rise has been observed in the prevalence of obesity in childhood and adolescence, along with an increase in fetal microsomia rates. The increased risk of obesity during this key period in development negatively affects the health of the individual later in life. Immune cells residing and recruited to white adipose tissue have been highlighted as important factors contributing to the pathogenesis of childhood obesity. Immune dysfunction in the context of obesity begins early in childhood, which is different from the pathological characteristics and influencing factors of adipose immunity in adults. Here, we explore the current understanding of the roles of childhood and early life events that result in high risks for obesity by influencing adipose tissue immune dysfunction under the pathological condition of obesity. Such knowledge will help in determining the mechanisms of childhood and early life obesity in efforts to ameliorate chronic inflammation-related metabolic diseases.

Obesity risk is associated with altered cerebral glucose metabolism and decreased μ-opioid and CB1 receptor availability

BACKGROUND

Obesity is a pressing public health concern worldwide. Novel pharmacological means are urgently needed to combat the increase of obesity and accompanying type 2 diabetes (T2D). Although fully established obesity is associated with neuromolecular alterations and insulin resistance in the brain, potential obesity-promoting mechanisms in the central nervous system have remained elusive. In this triple-tracer positron emission tomography study, we investigated whether brain insulin signaling, μ-opioid receptors (MORs) and cannabinoid CB₁ receptors (CB₁Rs) are associated with risk for developing obesity.

METHODS

Subjects were 41 young non-obese males with variable obesity risk profiles. Obesity risk was assessed by subjects' physical exercise habits, body mass index and familial risk factors, including parental obesity and T2D. Brain glucose uptake was quantified with [¹⁸F]FDG during hyperinsulinemic euglycemic clamp, MORs were quantified with [¹¹C]carfentanil and CB₁Rs with [¹⁸F]FMPEP-d₂.

RESULTS

Subjects with higher obesity risk had globally increased insulin-stimulated brain glucose uptake (19 high-risk subjects versus 19 low-risk subjects), and familial obesity risk factors were associated with increased brain glucose uptake (38 subjects) but decreased availability of MORs (41 subjects) and CB₁Rs (36 subjects).

CONCLUSIONS

These results suggest that the hereditary mechanisms promoting obesity may be partly mediated via insulin, opioid and endocannabinoid messaging systems in the brain.

The impact of lifestyle and socioeconomic parameters on body fat level in early childhood

The aim of this study was to examine the differences between selected lifestyle and socioeconomic parameters among preschool (3-7 years of age) children of differing adiposity status. The study was conducted from February to June 2018 in 20 randomly selected kindergartens in Kraków, Poland. Triceps, biceps, subscapular, suprailiac, abdominal and calf skinfold thicknesses were measured. The sum of all six skinfolds was calculated and the children were subsequently characterized by low (≤-1 SD [standard deviation]), normal (-1 to 1 SD) or high body fat (≥1 SD). Socioeconomic and lifestyle characteristics were obtained using a questionnaire filled out by the children's parents or legal guardians. Preschool children in the high adiposity category had, on average, fewer siblings and longer screen time; additionally, their parents had lower education and more often worked in manual jobs, in comparison to the children in the low and average adiposity categories. In conclusion, it was observed that children in different adiposity categories varied in terms of some socioeconomic as well as lifestyle characteristics. Knowledge regarding the influence that those factors can have on the metabolic health of children is essential for children's present as well as future well-being. Moreover, it can help health care professionals and parents decide what intervention and/ or preventive measures should be undertaken to ensure the best possible outcomes, as the development of successful obesity prevention strategies should rely on evidence-based information. Nonetheless, future research examining the issue of factors influencing the metabolic health of children, as well as these outcomes later in life, is crucial. Well-planned studies including a large number of individuals, as well as longitudinal research, will be particularly beneficial in this regard.

Association between diet quality index and cardiometabolic risk factors in adolescents: Study of Cardiovascular Risks in Adolescents (ERICA)

OBJECTIVE

This study evaluated the association between diet quality, assessed by the Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR), and cardiometabolic markers in adolescents.

METHODS

The DQIA-BR and cardiometabolic markers were assessed in 36 956 Brazilian adolescents (12-17 y old) enrolled in the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional multicenter study in Brazil. For analyses, the sample was stratified by sex and nutritional status. Multiple linear regressions were used to investigate the association between DQIA-BR and cardiometabolic markers (total cholesterol, HDL-c, LDL-c, triglycerides, fasting glucose and HOMA-IR). Adjusted models were constructed with two input levels of covariates. The first model was adjusted for sex, age, and socioeconomic status; in the second model, total energy intake, physical activity, and sedentary behavior were included.

RESULTS

A higher DQIA-BR score was associated with a better cardiometabolic profile in girls with normal weight; however, no association was observed in those with overweight/obesity. In boys with overweight/obesity, a better quality of diet was associated with lower concentrations of total cholesterol (β = -0.338, 95% confidence interval [CI]: -0.611 to -0.066) and LDL-c (β = -0.227, 95% CI: -0.448 to -0.005), but only LDL-c remained significant in those with normal weight (β = -0.115, 95% CI: -0.224 to 0.005).

CONCLUSION

The effects of diet quality on cardiometabolic risk factors differ according to sex and the presence of overweight/obesity. Overall, DQIA-BR is a suitable tool to evaluate the association between diet quality and cardiometabolic markers in normal-weight adolescents, but not for adolescents, especially girls, with overweight/obesity.

BDNF Gene as a Precision Skill of Obesity Management

The scarcity of the results obtained for the treatment of obesity leads us to consider new strategies, contemplating all the factors involved in the development of the disease. One of the key molecules for controlling body weight and energy homeostasis is the brain-derived neurotrophic factor (BDNF). This work summarizes the mechanisms in which BDNF gene regulates this multifactorial disease. In addition, we discuss the role of other BDNF polymorphisms as genetic determinants of obesity. In this context, a total of 14 SNPs near or inside BDNF/BDNF-AS related to BMI were identified in various GWASs. Finally, we assess gene-diet interaction as a novel tool to prevent obesity and formulate solid and personalized nutritional management. Our research group has performed the first study on the association of BDNF-AS rs925946 polymorphism and calcium intake as potential modulators of the nutritional status. Although these results should be confirmed in future studies, they open the path for new prevention opportunities.

Relationship between abdominal adiposity, cardiovascular fitness, and biomarkers of cardiovascular risk in British adolescents

BACKGROUND

Puberty is a critical time in the development of overweight and obesity. The aim of this study was to examine relationships between measures of adiposity, cardiovascular fitness, and biomarkers of cardiovascular disease risk in adolescents.

METHODS

In a cross-sectional study design, 129 girls and 95 boys aged 12.9-14.4 years at various stages of puberty were included, along with their mothers (n = 217) and fathers (n = 207). Anthropometric assessments of adiposity were made, along with cardiovascular physical fitness, using the 20-m shuttle run test, and biomarkers associated with cardiovascular risk, including glucose, insulin, triglyceride, fibrinogen, and C-reactive protein (CRP) concentrations.

RESULTS

Waist-to-height ratio values were similar in boys and girls and correlated positively with diastolic blood pressure, insulin, triglyceride, fibrinogen, and CRP concentrations, and inversely with cardiovascular fitness scores. Skinfold thickness measurements were higher in girls. High-molecular-weight adiponectin concentrations were lower in boys than girls, particularly in late puberty, and CRP levels were higher. Cardiovascular fitness, maternal body mass index (BMI), and paternal BMI contributed independently to the variance in waist measurements in girls and boys. Gender, triceps skinfold thickness, and weight-to-height ratio, but not parental BMI, contributed independently to the variance in cardiovascular fitness.

CONCLUSION

There is a relationship between measures of adolescent adiposity and parental weight that involves factors other than cardiovascular fitness. Adolescent boys have relatively more abdominal fat than girls and a tendency to have a proinflammatory profile of biomarkers. These observations suggest that family and social environmental interventions are best undertaken earlier in childhood, particularly among boys.

Overconsumption of sugar-sweetened beverages: Why is it difficult to control?

The consumption of sugar-sweetened beverages is a known contributory factor of childhood obesity that is documented around the globe. More importantly, reducing the consumption of sugar-sweetened beverages could reduce weight gain among overweight or obese children. Although sugar is present in many natural foods, artificial sugar is added into sugar-sweetened beverages, which has little or no nutritional value. However, the calories obtained from the sugar-sweetened beverages are linked to overweight and obesity, and an increase serving sizes of sugar-sweetened beverages over the years partly contributed to the alarming rise of childhood obesity around the globe. The sugar-sweetened beverages not only contain a high amount of sugar, but also contain a high amount of phosphate, and the possibility exists for an enhancing dual adverse health effects of sugar and phosphate. Increasing health awareness and limiting marketing approaches targeted towards the younger population are essential to reduce long-term health burdens that are linked to the overconsumption of sugar-sweetened beverages.

Quantity not composition of dietary fats represents the dominant contributor to experimental obesity: Relevance to human pathophysiology

Plant fats are low in saturated fats but high in unsaturated fats compared to animal fats, and are supposedly less obesogenic. This study compared the obesogenic effects of plant and animal derived fatty diets in Wistar rats. Rats of each gender were divided into three dietary (standard chow (SC), high fat diet rich in animal fat (HFDaf) and a high fat diet rich in plant fat (HFDpf)) groups of ten each and fed for 17 weeks. Anthropometric, Adiposity and nutritive variables were assessed using standard methods. Comparing HFDpf to HFDaf: Abdominal circumference (AC),initial feed intaken (IFI), final feed intake(FFI), final body weight (FBW), white adipose tissue (WAT) were increased but brown adipose tissue (BAT) decreased in male rats fed with HFDpf; also, there were increased body length, IFI, FFI but decreased AC, FBW, BAT in female rats fed with HFDpf. Comparing male to female rats: Thoracic circumference, IFI, FFI, energy intake were increased while Adiposity index decreased across diet groups in male rats; the AC, FBW increased while WAT, BAT decreased in HFDpf fed group, also, BAT was increased but AC, FBW decreased in HFDaf fed group in male rats. Palatability and high feed efficiency of consumed diets were more associated with obesogenic risk than just the level of saturation. Therefore, Obesogenic effects of fatty diets in both genders is more dependent on the quantity (amount) of fatty diet consumed than the dietary fat composition alone.

Weight Gain Trajectories from Birth to Adolescence and Cardiometabolic Status in Adolescence

OBJECTIVE

To assess the influence of the trajectory of weight gain from birth to adolescence on cardiovascular and metabolic risk. We studied childhood body mass index (BMI) trajectories from birth to age 14 years and cardiometabolic risk factors at age 14 years.

STUDY DESIGN

In total, 410 children with weight and height measurements were assessed from birth throughout childhood, from the Childhood Asthma Prevention Study, a prospective community-based cohort. BMI trajectory groups were determined by latent basis growth mixture models. Of these subjects, 190 had detailed cardiometabolic risk factors assessed at age 14 years.

RESULTS

Three BMI trajectory groups were identified; normal BMI, "early rising" excess BMI from 2 years, and "late rising" excess BMI from 5 years. Differences were found between normal and excess BMI in children at 14 years of age. In addition, children with an early rising BMI trajectory had statistically significantly higher central adiposity and a more atherogenic lipoprotein profile at age 14 years than children with a late rising BMI trajectory (P < .05). No differences between BMI trajectory groups in vascular structure or function was identified at age 14 years.

CONCLUSIONS

Earlier onset of an elevated BMI trajectory persisting from birth to age 14 years results in an unfavorable cardiometabolic risk profile at age 14 years, including central adiposity and more atherogenic lipoproteins, independent of achieved BMI.

Longitudinal associations between attachment quality in infancy, C-reactive protein in early childhood, and BMI in middle childhood: preliminary evidence from a CPS-referred sample

In the current pilot study, we examined whether insecure or disorganized attachment was associated with elevated inflammation (i.e. C-reactive protein [CRP]) in children with histories of child protective services (CPS) involvement, and whether early childhood CRP predicted body mass index (BMI) in middle childhood. Participants included 45 CPS-referred children and 39 low-risk comparison children, for whom we assessed levels of CRP in early childhood (Mean age = 4.9 years). For the CPS-referred children, who were drawn from an ongoing longitudinal study, we had attachment classifications (assessed during infancy with the Strange Situation) and BMI data (assessed during early and middle childhood); these data were not available for the low-risk comparison group. CPS-referred children who had insecure or disorganized attachments during infancy had higher levels of CRP in early childhood than CPS-referred children who had secure attachments, who had similar levels of CRP to low-risk comparison children. Among CPS-referred children, early childhood CRP predicted age 8 BMI, controlling for BMI at age 4. Findings offer preliminary support for the association between attachment quality and inflammation in early childhood, which may have implications for later physical health.

Neighborhood and Social Environmental Influences on Child Chronic Disease Prevalence

We investigate how distinct residential environments uniquely influence chronic child disease. Aggregating over 200,000 pediatric geocoded medical records to the census tract of residence and linking them to neighborhood-level measures, we use multiple data analysis techniques to assess how heterogeneous exposures of social and environmental neighborhood conditions influence an index of child chronic disease (CCD) prevalence for the neighborhood. We find there is a graded relationship between degree of overall neighborhood disadvantage and children's chronic disease such that the highest neighborhood CCD scores reside in communities with the highest concentrated disadvantage. Finally, results show that higher levels of neighborhood concentrated disadvantage and air pollution exposure associate with higher risks of having at least one chronic condition for children after also considering their individual- and family-level characteristics. Overall, our analysis serves as a comprehensive start for future researchers interested in assessing which neighborhood factors matter most for child chronic health conditions.

Clinical relevance and validity of tools to predict infant, childhood and adulthood obesity: a systematic review

OBJECTIVE

To determine the global availability of a multicomponent tool predicting overweight/obesity in infancy, childhood, adolescence or adulthood; and to compare their predictive validity and clinical relevance.Design/SettingThe PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The databases PubMed, EMBASE, CINAHL, Web of Science and PsycINFO were searched. Additional articles were identified via reference lists of included articles. Risk of bias was assessed using the Academy of Nutrition and Dietetics' Quality Criteria Checklist. The National Health and Medical Research Council's Levels of Evidence hierarchy was used to assess quality of evidence. Predictive performance was evaluated using the ABCD framework.

SUBJECTS

Eligible studies: tool could be administered at any life stage; quantified the risk of overweight/obesity onset; used more than one predictor variable; and reported appropriate prediction statistical outcomes.

RESULTS

Of the initial 4490 articles identified, twelve articles (describing twelve tools) were included. Most tools aimed to predict overweight and/or obesity within childhood (age 2-12 years). Predictive accuracy of tools was consistently adequate; however, the predictive validity of most tools was questioned secondary to poor methodology and statistical reporting. Globally, five tools were developed for dissemination into clinical practice, but no tools were tested within a clinical setting.

CONCLUSIONS

To our knowledge, a clinically relevant and highly predictive overweight/obesity prediction tool is yet to be developed. Clinicians can, however, act now to identify the strongest predictors of future overweight/obesity. Further research is necessary to optimise the predictive strength and clinical applicability of such a tool.

Prediction of Adulthood Obesity Using Genetic and Childhood Clinical Risk Factors in the Cardiovascular Risk in Young Finns Study

BACKGROUND

Obesity is a known risk factor for cardiovascular disease. Early prediction of obesity is essential for prevention. The aim of this study is to assess the use of childhood clinical factors and the genetic risk factors in predicting adulthood obesity using machine learning methods.

METHODS AND RESULTS

A total of 2262 participants from the Cardiovascular Risk in YFS (Young Finns Study) were followed up from childhood (age 3-18 years) to adulthood for 31 years. The data were divided into training (n=1625) and validation (n=637) set. The effect of known genetic risk factors (97 single-nucleotide polymorphisms) was investigated as a weighted genetic risk score of all 97 single-nucleotide polymorphisms (WGRS97) or a subset of 19 most significant single-nucleotide polymorphisms (WGRS19) using boosting machine learning technique. WGRS97 and WGRS19 were validated using external data (n=369) from BHS (Bogalusa Heart Study). WGRS19 improved the accuracy of predicting adulthood obesity in training (area under the curve [AUC=0.787 versus AUC=0.744, P<0.0001) and validation data (AUC=0.769 versus AUC=0.747, P=0.026). WGRS97 improved the accuracy in training (AUC=0.782 versus AUC=0.744, P<0.0001) but not in validation data (AUC=0.749 versus AUC=0.747, P=0.785). Higher WGRS19 associated with higher body mass index at 9 years and WGRS97 at 6 years. Replication in BHS confirmed our findings that WGRS19 and WGRS97 are associated with body mass index.

CONCLUSIONS

WGRS19 improves prediction of adulthood obesity. Predictive accuracy is highest among young children (3-6 years), whereas among older children (9-18 years) the risk can be identified using childhood clinical factors. The model is helpful in screening children with high risk of developing obesity.

Maternal inheritance of BDNF deletion, with phenotype of obesity and developmental delay in mother and child

Childhood obesity is a significant world health problem. Understanding the genetic and environmental factors contributing to the development of obesity in childhood is important for the rational design of strategies for obesity prevention and treatment. Brain-derived neurotrophic factor (BDNF) plays an important role in the growth and development of the central nervous system, there is also an evidence that BDNF plays a role in regulation of appetite. Disruption of the expression of this gene in a child has been previously reported to result in a phenotype of severe obesity, hyperphagia, impaired cognitive function, and hyperactivity. We report a mother and child, both with micro-deletions encompassing the BDNF gene locus, who both have obesity and developmental delay, although without hyperactivity. This report highlights the maternal inheritance of a rare genetic cause of childhood obesity.

The Association Between Social Support, Body Mass Index and Increased Risk of Prediabetes: the Cardiovascular Risk in Young Finns Study

PURPOSE

The psychosocial determinants of prediabetes are poorly understood. The aims of our study were (1) to analyse the association between perceived social support in young adulthood and fasting glucose levels and prediabetes in mid-adulthood in a cohort of healthy Finns, (2) to explore whether body mass index (BMI), inflammation or depression mediate this relationship, (3) and to examine the association between social support trajectory groups and fasting glucose.

METHOD

A prospective design was used with an analytic sample of 1250 participants aged 3-18 years at baseline (1980) and aged 12-39 years when social support was measured. Fasting glucose and prediabetes were assessed 32 years after baseline. Linear and logistic regression was used to examine the association between social support and the outcome measures. A bootstrapping technique was used to examine mediation effects.

RESULTS

Social support was associated with future glucose levels in women after adjusting for childhood socioeconomic status (SES) and youth depression (β = -0.136, p = 0.001) and also predicted prediabetes in women after adjusting for childhood SES (β = 1.31, 95 % CI 1.02 to 1.69, p = 0.031). Both associations were attenuated after adjusting for BMI in mid-adulthood. BMI was found to mediate the relationship between social support and prediabetes in women (β for indirect effect β = 0.09, SE = 0.03, CI = 0.03 to 0.16).

CONCLUSION

Low perceived social support in young adulthood is associated with high fasting glucose and prediabetes in mid-adulthood in women but not men. The association between social support and prediabetes in women can be partly explained by BMI.

Obesity anthropometric indicators associated with cardiometabolic risk in Portuguese children and adolescents

The purpose of this study was to determine the association between cardiometabolic risk with body mass index and skinfold independently or in combination in youth. This cross-sectional study comprised a convenience sample of 450 children and adolescents (255 girls), aged 10 to 18 years old. Indicators of body composition were measured, and hemodynamic assessment completed. The association between body mass index and/or sum of skinfolds and cardiometabolic risk (z score of the sum of triglycerides/high density lipoprotein cholesterol, waist circumference, and mean blood pressure), was calculated using Generalized Linear Models Regression. The results showed that youngsters classified as overweight or obese with the highest skinfold measurements had the strongest association with cardiometabolic risk (< beta >: 2.60; IC 95%: 2.25–3.0) when compared with those exhibiting normal skinfold thickness (< beta >: 1.78; IC 95%: 1.30–2.20). Body mass index was most strongly associated with cardiometabolic risk (< beta >: 1.78; IC 95%: 1.3–2.2), in comparison to skinfold thickness, which was associated to a lesser extent (< beta >: 0.41; IC 95%: 0.34–0.49). Results of this cross-sectional study indicate that body mass index is more strongly associated with cardiometabolic risk than skinfold thickness. However when these two measures of overweight/obesity are combined, prediction of cardiometabolic risk is further improved. It is therefore important that public health professionals consider both body mass index and sum of skinfolds to better predict cardiometabolic risk in overweight and obese youth. Implications for future research include the use of longitudinal designs and inclusion of children from other racial/ethnic groups.

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Body mass index and skinfold improved the prediction of cardiometabolic risk.

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Body mass index seems to be the best indicator of cardiometabolic risk factors.

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Anthropometric indicators are cost-effective screening of overweight/obesity.

Does high optimism protect against the inter-generational transmission of high BMI? The Cardiovascular Risk in Young Finns Study

OBJECTIVE

The transmission of overweight from one generation to the next is well established, however little is known about what psychosocial factors may protect against this familial risk. The aim of this study was to examine whether optimism plays a role in the intergenerational transmission of obesity.

METHODS

Our sample included 1043 participants from the prospective Cardiovascular Risk in Young FINNS Study. Optimism was measured in early adulthood (2001) when the cohort was aged 24-39years. BMI was measured in 2001 (baseline) and 2012 when they were aged 35-50years. Parental BMI was measured in 1980. Hierarchical linear regression and logistic regression were used to examine the association between optimism and future BMI/obesity, and whether an interaction existed between optimism and parental BMI when predicting BMI/obesity 11years later.

RESULTS

High optimism in young adulthood demonstrated a negative relationship with high BMI in mid-adulthood, but only in women (β=-0.127, p=0.001). The optimism×maternal BMI interaction term was a significant predictor of future BMI in women (β=-0.588, p=0.036). The logistic regression results confirmed that high optimism predicted reduced obesity in women (OR=0.68, 95% CI, 0.55-0.86), however the optimism × maternal obesity interaction term was not a significant predictor (OR=0.50, 95% CI, 0.10-2.48).

CONCLUSIONS

Our findings supported our hypothesis that high optimism mitigated the intergenerational transmission of high BMI, but only in women. These findings also provided evidence that positive psychosocial factors such as optimism are associated with long-term protective effects on BMI in women.

Impact of Pregestational Weight and Weight Gain during Pregnancy on Long-Term Risk for Diseases

OBJECTIVE

The aim of this study was to analyse the impact of maternal BMI at start of pregnancy and maternal weight gain during pregnancy on the risk of various diseases later in life.

METHODS

In a population-based cohort from southern Sweden, women with at least one delivery registered in the Swedish Medical Birth Register ten or more years before answering a health questionnaire were identified (n = 13,608). Complete data were found in 3,539 women.

RESULTS

Women with BMI >25 at start of pregnancy had increased risk of developing obesity (OR 21.9), diabetes (OR 6.4), cardiac disease (OR 2.7), endocrine diseases (OR 2.3), and other morbidity (OR 1.4), compared with women of normal weight. A high weight gain (>15 kg) during pregnancy was associated to later risk of overweight (OR 2.0) and obesity (OR 2.2), but not diabetes, cardiac disease, or endocrine diseases. A positive association was found between low weight gain and the risk of developing psychiatric disorders (OR 1.6).

CONCLUSIONS

A high BMI at start of pregnancy significantly increased the risk of several diseases later in life. However, a high weight gain during pregnancy was only significant for future overweight and obesity. These findings have implications for both pregestational intervention and post gestational follow up of obese and overweight women.

High perceived social support protects against the intergenerational transmission of obesity: The Cardiovascular Risk in Young Finns Study

AIMS

Our aims were to assess whether offspring social support moderates the relationship between parental body mass index (BMI) and offspring BMI.

METHODS

A prospective design was used with an analytic sample of 1049 participants from Finland (the offspring) who were 35-50years old in 2012 when adulthood BMI was measured. Parental BMI was self-reported at baseline in 1980. Offspring social support was measured in 2007 when participants were 30-45years old. Linear and logistic regression was used to examine whether there was an interaction between parental BMI and offspring social support when predicting offspring BMI in adulthood. An analysis of simple slopes and multilevel growth curve modeling were used to further examine the interaction.

RESULTS

The interaction between maternal BMI and offspring social support was significantly and negatively related to offspring BMI in adulthood (β=-0.068, R(2) change=0.005, p=0.015) in the fully adjusted model which also adjusted for parental occupational status and offspring depressive symptoms. The logistic regression supported these results, with the interaction between maternal overweight (BMI≥25kg/m(2)) and offspring social support negatively associated with offspring overweight in adulthood (odds ratio=0.74, 95% confidence interval, 0.56 to 0.98). The growth curve analysis further demonstrated that high maternal BMI predicts more rapidly rising offspring BMI in those reporting low social support compared to high social support.

CONCLUSIONS

Our results suggest that social support protects against the intergenerational transmission of obesity and therefore presents an important opportunity for obesity prevention efforts.

Effect of birth weight on life-course blood pressure levels among children born premature: the Cardiovascular Risk in Young Finns Study

OBJECTIVES

Both fetal growth restriction and prematurity have been associated with elevated blood pressure (BP). However, their combined effects on adult BP are unclear.

METHODS

Our analyses were based on 1756 participants in the population-based Cardiovascular Risk in Young Finns Study who had information on birth weight and gestational age, together with longitudinal data on cardiovascular risk markers from age 3-18 years in 1980 to age 34-49 years in 2011. Three groups were defined by birth data: those born at term (term); those born preterm (<37 weeks) with an appropriate birth weight (>-1 SD z score according to national sex and gestational week-stratified data) for gestational age (preterm appropriate birth weight for gestational age); and those born preterm with low birth weight (≤-1 SD z score) for gestational age [preterm small birth weight for gestational age (SGA)].

RESULTS

There were no differences between the three groups in BP at baseline, but at the 31-year follow-up (mean age 41 years), mean SBP in the preterm SGA group was 7.2 mmHg (95% confidence interval = 2.3-12.1 mmHg, P = 0.004) higher than the preterm appropriate birth weight for gestational age group and 7.3 mmHg (95% confidence interval = 5.2-9.4 mmHg, P < 0.0001) higher than the term group, adjusted for age and sex. In addition, preterm SGA individuals had a higher prevalence of adult hypertension compared with those born at term (36.9 vs. 25.4%; age, sex, and risk factors adjusted P = 0.006).

CONCLUSION

These longitudinal data suggest that elevated BP levels associated with prematurity are more likely to be present in those with fetal growth restriction.

Genetically predicted body mass index and Alzheimer's disease-related phenotypes in three large samples: Mendelian randomization analyses

Observational research shows that higher body mass index (BMI) increases Alzheimer's disease (AD) risk, but it is unclear whether this association is causal. We applied genetic variants that predict BMI in Mendelian randomization analyses, an approach that is not biased by reverse causation or confounding, to evaluate whether higher BMI increases AD risk. We evaluated individual-level data from the AD Genetics Consortium (ADGC: 10,079 AD cases and 9613 controls), the Health and Retirement Study (HRS: 8403 participants with algorithm-predicted dementia status), and published associations from the Genetic and Environmental Risk for AD consortium (GERAD1: 3177 AD cases and 7277 controls). No evidence from individual single-nucleotide polymorphisms or polygenic scores indicated BMI increased AD risk. Mendelian randomization effect estimates per BMI point (95% confidence intervals) were as follows: ADGC, odds ratio (OR) = 0.95 (0.90-1.01); HRS, OR = 1.00 (0.75-1.32); GERAD1, OR = 0.96 (0.87-1.07). One subscore (cellular processes not otherwise specified) unexpectedly predicted lower AD risk.

Interaction of smoking and obesity susceptibility loci on adolescent BMI: The National Longitudinal Study of Adolescent to Adult Health

BACKGROUND

Adolescence is a sensitive period for weight gain and risky health behaviors, such as smoking. Genome-wide association studies (GWAS) have identified loci contributing to adult body mass index (BMI). Evidence suggests that many of these loci have a larger influence on adolescent BMI. However, few studies have examined interactions between smoking and obesity susceptibility loci on BMI. This study investigates the interaction of current smoking and established BMI SNPs on adolescent BMI. Using data from the National Longitudinal Study of Adolescent to Adult Health, a nationally-representative, prospective cohort of the US school-based population in grades 7 to 12 (12-20 years of age) in 1994-95 who have been followed into adulthood (Wave II 1996; ages 12-21, Wave III; ages 18-27), we assessed (in 2014) interactions of 40 BMI-related SNPs and smoking status with percent of the CDC/NCHS 2000 median BMI (%MBMI) in European Americans (n = 5075), African Americans (n = 1744) and Hispanic Americans (n = 1294).

RESULTS

Two SNPs showed nominal significance for interaction (p < 0.05) between smoking and genotype with %MBMI in European Americans (EA) (rs2112347 (POC5): β = 1.98 (0.06, 3.90), p = 0.04 and near rs571312 (MC4R): β 2.15 (-0.03, 4.33) p = 0.05); and one SNP showed a significant interaction effect after stringent correction for multiple testing in Hispanic Americans (HA) (rs1514175 (TNNI3K): β 8.46 (4.32, 12.60), p = 5.9E-05). Stratifying by sex, these interactions suggest a stronger effect in female smokers.

CONCLUSIONS

Our study highlights potentially important sex differences in obesity risk by smoking status in adolescents, with those who may be most likely to initiate smoking (i.e., adolescent females), being at greatest risk for exacerbating genetic obesity susceptibility.

Objectively measured physical activity and sedentary-time are associated with arterial stiffness in Brazilian young adults

OBJECTIVE

To examine the associations between objectively measured physical activity and sedentary time with pulse wave velocity (PWV) in Brazilian young adults.

METHODS

Cross-sectional analysis with participants of the 1982 Pelotas (Brazil) Birth Cohort who were followed-up from birth to 30 years of age. Overall physical activity (PA) assessed as the average acceleration (mg), time spent in moderate-to-vigorous physical activity (MVPA - min/day) and sedentary time (min/day) were calculated from acceleration data. Carotid-femoral PWV (m/s) was assessed using a portable ultrasound. Systolic and diastolic blood pressure (SBP/DBP), waist circumference (WC) and body mass index (BMI) were analyzed as possible mediators. Multiple linear regression and g-computation formula were used in the analyses.

RESULTS

Complete data were available for 1241 individuals. PWV was significantly lower in the two highest quartiles of overall PA (0.26 m/s) compared with the lowest quartile. Participants in the highest quartile of sedentary time had 0.39 m/s higher PWV (95%CI: 0.20; 0.57) than those in the lowest quartile. Individuals achieving ≥30 min/day in MVPA had lower PWV (β = -0.35; 95%CI: -0.56; -0.14). Mutually adjusted analyses between MVPA and sedentary time and PWV changed the coefficients, although results from sedentary time remained more consistent. WC captured 44% of the association between MVPA and PWV. DBP explained 46% of the association between acceleration and PWV.

CONCLUSIONS

Physical activity was inversely related to PWV in young adults, whereas sedentary time was positively associated. Such associations were only partially mediated by WC and DBP.

Infection-Related Hospitalization in Childhood and Adult Metabolic Outcomes

BACKGROUND AND OBJECTIVES

Identifying childhood determinants of adult cardiometabolic disease would facilitate early-life interventions. There are few longitudinal data on the contribution of childhood infections. Therefore, we investigated whether hospitalization with childhood infection is associated with adult anthropometric and metabolic outcomes in a large, well-phenotyped longitudinal cohort.

METHODS

A total of 1376 subjects from the Cardiovascular Risk in Young Finns Study, aged 3 to 9 years at baseline (1980), who had lifetime data from birth onward on infection-related hospitalization (IRH) had repeated assessments through childhood and adolescence and at least once in adulthood (age 30-45 years in 2001-2011). Early childhood (<5 years), childhood/adolescence (5-18 years), adult (>18 years), and total lifetime IRHs were related to adiposity, BMI, and metabolic syndrome in adulthood. Analyses were adjusted for childhood and adulthood risk factors and potential confounders.

RESULTS

Early-childhood IRH correlated with adverse adult but not childhood metabolic variables: increased BMI (P = .02) and metabolic syndrome (risk ratio: 1.56; 95% confidence interval: 1.03-2.35; P = .03), adjusted for age, gender, birth weight, childhood BMI and other risk factors, and family income. The age at which differences in adult BMI became persistent was related to age of IRH in childhood. The greatest increase in adult BMI occurred in those with >1 childhood IRH.

CONCLUSIONS

Childhood IRH was independently associated with adverse adult metabolic variables. This finding suggests that infections and/or their treatment in childhood may contribute to causal pathways leading to adult cardiometabolic diseases.

Sugar-Sweetened Beverages and Obesity among Children and Adolescents: A Review of Systematic Literature Reviews

BACKGROUND

The prevalence of overweight and obesity among children and adolescents has increased worldwide and has reached alarming proportions. Currently, sugar-sweetened beverages (SSBs) are the primary source of added sugar in the diet of children and adolescents. Contradictive findings from studies and reviews have fueled an endless debate on the role of SSBs in the development of childhood obesity.

OBJECTIVES

The primary aim of the present review of reviews was to assess how review- and study-level methodological factors explain conflicting results across reviews and meta-analyses by providing an up-to-date synthesis of recent evidence regarding the association between SSB consumption and weight gain, overweight, and obesity in a population of 6-month-old to 19-year-old children and adolescents. The secondary aim was to assess the quality of included reviews using the Assessment of Multiple SysTemAtic Reviews (AMSTAR) measurement tool.

METHODS

Systematic literature reviews and meta-analyses were included. The literature search was performed through the platforms Pubmed/Medline, Cinahl, and Web of Knowledge.

RESULTS

Thirteen reviews and meta-analyses were included. Nine reviews concluded that there was a direct association between SSBs and obesity in children and adolescents and four others did not. The quality of the included reviews was low to moderate, and the two reviews with the highest quality scores showed discrepant results.

CONCLUSIONS

The majority of reviews concluded that there was a direct association between SSB consumption and weight gain, overweight, and obesity in children and adolescents. However, recent evidence from well-conducted meta-analyses shows discrepant results regarding the association between SSB and weight gain, overweight, and obesity among children and adolescents. Improving methodological quality of studies and reviews as well as ensuring responsible conduct of research and scientific integrity is essential for the provision of objective results.

Is dispositional optimism or dispositional pessimism predictive of ideal cardiovascular health? The Young Finns Study

OBJECTIVE

We examined the independent association between dispositional optimism compared to dispositional pessimism and ideal cardiovascular health (defined by the American Heart Association).

DESIGN

A prospective design with a study sample of 1113 participants aged 24-39 years from the longitudinal Young Finns Study.

MAIN OUTCOME MEASURES

Ideal cardiovascular health (comprised of seven ideal cardiovascular health metrics) was measured in 2001. The ideal cardiovascular health metrics were reassessed in 2007.

RESULTS

Low pessimism rather than high optimism was a better predictor of ideal cardiovascular health in 2007. When examining the association between optimism and pessimism and the seven ideal cardiovascular health metrics in 2007 (BMI, diet, physical activity, smoking status, blood pressure, total cholesterol and plasma glucose), low pessimism predicted non-smoking status, ideal physical activity and eating a healthy diet, while high optimism was associated with eating a healthy diet.

CONCLUSION

Our findings suggest that low pessimism rather than high optimism is associated with ideal cardiovascular health, especially with health behaviours such as not smoking, being physically active and eating a healthy diet. Socio-economic status was the potential mediating or confounding factor. Future studies should examine the differential meaning of the optimism/pessimism concepts to further clarify their relation to health outcomes.

Factors associated with six-year weight change in young and middle-aged adults in the Young Finns Study

OBJECTIVE

To examine factors associated with weight change and obesity risk in young and middle-aged adults.

SUBJECTS/METHODS

The Young Finns Study with its 923 women and 792 men aged 24-39 years at baseline were followed for six years. Variables associated with the weight change were investigated with regression models.

RESULTS

The average weight change was 0.45 kg/year in women and 0.58 kg/year in men. In women, weight change was steady across all ages. In men, weight changes were more pronounced in younger age groups. In women (weight gain > 2 kg, n = 490), medication for anxiety, low occupational status, high baseline BMI (body mass index), high intake of sweet beverages, high childhood BMI, high salt (NaCl and/or KCl) use, low number of children, low childhood family income, high stature and low level of dependence (a temperament subscale) were associated with increased weight gain (in the order of importance). In men (weight gain > 2 kg, n = 455), high stature, high intake of french fries, low intake of sweet cookies, young age, recent divorce, low intake of cereals, high intake of milk, depressive symptoms, rural childhood origin, high baseline BMI and unemployment were associated with more pronounced weight gain. Sedentarity (screen-time) was associated with weight gain only in young men. Physical activity and genetic risk for high BMI (score of 31 known variants) were not consistently associated with weight change.

CONCLUSIONS

Socio-economic factors, temperamental and physical characteristics, and some dietary factors are related with weight change in young/middle-aged adults. The weight change occurring in adulthood is also determined by childhood factors, such as high BMI and low family income.

Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis

BACKGROUND

Childhood obesity is a public health concern. One-third of North American children and youth are overweight or obese. We reviewed the evidence of behavioural and pharmacological weight-management interventions on body mass index (BMI), BMI z-score and the prevalence of overweight and obesity in children and youth.

METHODS

We updated the search of a previous review. We searched 4 databases up to August 2013. We included randomized trials of primary care-relevant behavioural (diet, exercise, lifestyle) and pharmacological (orlistat) interventions for treating overweight and obesity in children and youth aged 2-18 years if 6-month post-baseline data were provided for BMI, BMI z-score or prevalence of overweight and obesity. In addition, we examined secondary health outcomes such as lipid and glucose levels, blood pressure, quality of life and physical fitness. We included any study reporting harms. We performed meta-analyses when possible, and we examined the features of interventions that showed benefits.

RESULTS

Thirty-one studies (29 behavioural, 2 pharmacological and behavioural) were included. Both intervention types showed a significant effect on BMI or BMI z-score in favour of treatment (behavioural: standardized mean difference [SMD] -0.54, 95% confidence interval [CI] -0.73 to -0.36; orlistat plus behavioural: SMD -0.43, 95% CI -0.60 to -0.25). Studies reported no significant difference between groups in the likelihood of reduced prevalence of overweight or overweight and obesity. Pooled estimates for blood pressure and quality of life showed significant benefits in favour of treatment (systolic blood pressure mean difference [MD] -3.42, 95% CI -6.65 to -0.29; diastolic blood pressure MD -3.39, 95% CI -5.17 to -1.60; quality of life MD 2.10, 95% CI 0.60 to 3.60). Gastrointestinal difficulties were more common in youth taking orlistat than in the control group (risk ratio 3.77, 95% CI 2.56 to 5.55). We saw much variability across efficacious interventions.

INTERPRETATION

Low- to moderate-quality evidence suggests behavioural treatments are associated with a medium effect in terms of reduced BMI or BMI z-score compared with a small effect shown by combined pharmacological-behavioural interventions. Future research should evaluate active weight maintenance interventions in adolescents with longer follow-up and examine the effectiveness of combined pharmacological and behavioural interventions.

REGISTRATION

PROSPERO no. CRD42012002754.

Adolescent and adult African Americans have similar metabolic dyslipidemia

BACKGROUND

African Americans (AAs) have lower triglyceride (TG) and higher high-density lipoprotein cholesterol (HDL-C) than other ethnic groups; yet, they also have higher risk for developing diabetes mellitus despite the strong relationship of dyslipidemia with insulin resistance. No studies directly compare adolescents and adults with regard to relationships among dyslipidemia, high-sensitivity C-reactive protein (hs-CRP), and insulin resistance. Here, we compare AA adolescents to adults with regard to the relationships of adiposity-related lipid risk markers (TG-to-HDL ratio and non-HDL-C) with body mass index (BMI), waist circumference (WC), homeostasis model of insulin resistance (HOMA), and hs-CRP.

METHODS

Two cohorts of healthy AA were recruited from the same urban community. Participants in each cohort were stratified by TG-to-HDL ratio (based on adult tertiles) and non-HDL-C levels. BMI, WC, HOMA, and hs-CRP were compared in adolescents and adults in the low-, middle-, and high-lipid strata.

RESULTS

Prevalence of TG-to-HDL ratio greater than 2.028 (high group) was 16% (44 of 283) in adolescents and 33% (161 of 484) in adults; prevalence of non-HDL-C above 145 and 160, respectively, was 8% (22 of 283) in adolescents and 12% (60 of 484) in adults. Values of hs-CRP were lower, and HOMA values were higher in adolescents (both P < .01). As both TG-to-HDL ratio and non-HDL-C strata increased, BMI, WC, HOMA, and hs-CRP increased in both adolescents and adults. In the high TG-to-HDL ratio and non-HDL-C groups, BMI and WC were similar in adolescents vs adults (BMI, 34 kg/m(2) vs 32 kg/m(2); WC, 101 cm vs 101 cm). After adjusting for non-HDL-C and other covariates, a 2-fold increase in TG-to-HDL ratio was associated with increases of 10.4% in hs-CRP (95% CI, 1.1%-20.5%) and 24.2% in HOMA (95% CI, 16.4%-32.6%). Non-HDL-C was not significant in models having TG-to-HDL ratio.

CONCLUSION

The elevated TG-to-HDL ratio is associated with similar inflammation and metabolic risk relationships in adolescent and adult AAs.

Stabilization of overweight prevalence and improvement of dietary habits in French children between 2004 and 2008

Objective

The objective of the present study was to describe changes in overweight and obesity prevalence and eating habits among 7·5–10·5-year-old children in Aquitaine (France) between 2004 and 2008, and to assess how the programme ‘Nutrition, Prevention and Health of children and teenagers in Aquitaine’ implemented in 2004 may have impacted these changes.

Design

Two cross-sectional studies were conducted in two samples of children: the ‘before programme’ sample during the school year 2004/2005 and the ‘after programme’ sample during the school year 2008/2009.

Settings

Data were collected on gender, age, weight, height, area of residence (rural/urban) and socio-economic status of the school (non-low socio-economic/low socio-economic). Multivariate analyses were used to assess the effect of the regional programme intervention on the evolution of overweight and obesity prevalence and eating habits independently.

Subjects

The ‘before programme’ sample included 1836 children from 163 schools during the school year 2004/2005 and the ‘after programme’ sample included 3483 children from 210 schools during the school year 2008/2009.

Results

After adjustment of the model for age, residential area and socio-economic status of the area of residence, the prevalence of overweight including obesity (OR=1·05; 95 % CI 0·89, 1·23, P=0·56) and of obesity (OR=0·99; 95 % CI 0·71, 1·39, P=0·96) was found to have stabilized and eating habits had improved: intake of light afternoon meals had increased (OR=1·38; 95 % CI 1·13, 1·69, P=0·002) while snacking in the morning (OR=0·50; 95 % CI 0·45, 0·57, P<0·001) and nibbling (OR=0·81; 95 % CI 0·70, 0·93, P<0·001) had decreased.

Conclusions

These results encourage the promotion and implementation of regional and national interventions among children regarding their eating habits in order to stabilize or decrease the prevalence of overweight.

Current guidelines for weight loss surgery in adolescents: a review of the literature

INTRODUCTION

The purpose of this review was to synthesize current clinical practice guidelines for weight loss surgery in adolescents in the United States and Canada to guide pediatric nurse practitioners in decisions regarding appropriate patient referral and counseling.

METHOD

A comprehensive search of the literature from 2007 until April 2013 was conducted using the PubMed, Embase, and CINAHL databases, including a hand search of references lists of identified articles. Guidelines pertaining exclusively to the use of weight loss surgery and general obesity treatment guidelines that included recommendations about weight loss surgery in adolescents were included in the review.

RESULTS

Variation exists among the guidelines regarding criteria for appropriate age, body mass index, comorbidity, exclusion, and preoperative management. Validation for laparoscopic weight loss surgery techniques in adolescents is provided.

DISCUSSION

Weight loss surgery for morbidly obese adolescents is a medically and psychologically complex decision, and primary care providers need to be equipped to address this decision with their patients and families.

Obesity associated inflammation in African American adolescents and adults

BACKGROUND

C-reactive protein (CRP) is related to adiposity and metabolic risk and predicts events in adults. The objective was to determine if relationships between adiposity and CRP have similar magnitudes in adolescents as adults.

METHODS

Healthy African Americans (484 adults and 282 adolescents) were recruited from similar environments. In both cohorts, measurements included anthropometrics, blood pressure (BP), metabolic risk factors and inflammatory markers. After stratification by high-sensitivity CRP (hsCRP: ≤1, 1-≤3, >3 mg/dL), adults and adolescents were compared with regard to body mass index (BMI; kg/m), waist circumference (WC; cm), BP and other risk factors. hsCRP was regressed on BMI and WC with covariates including cohort, age, sex, BP, insulin resistance, smoking, alcohol and other biomarkers. Interaction terms and a subset of the covariates were subject to a supervised variable selection procedure for a final model. Skewed variables were log transformed and summarized by geometric means (GMs) with 1st and 3rd quartiles (Q1, Q3).

RESULTS

Among adolescents (16.3%) and adults (34.1%) having high hsCRP(>3 mg/dL), BMI was distributed similarly (GM = 36.4 [32.7, 43.1] and GM = 34.7 [28.8, 40.8], respectively) as was WC (GM = 104.2 [93.0, 119.0] and GM = 104.9 [93.0, 117.2], respectively). In an adjusted regression model, for a given BMI, elevated WC was associated with elevated hsCRP (P = 0.02). Although elevated BMI was significantly associated with elevated hsCRP, the relationship was stronger among adolescents (interaction P = 0.04).

CONCLUSIONS

These findings demonstrate that, in African Americans, obesity is associated with inflammation and adverse changes in metabolic parameters among both adolescents and young adults.

When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood

PURPOSE OF REVIEW

To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood.

RECENT FINDINGS

Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor.

SUMMARY

Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.

Childhood lifestyle and clinical determinants of adult ideal cardiovascular health: the Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Princeton Follow-Up Study

BACKGROUND

The American Heart Association recently defined ideal cardiovascular health by simultaneous presence of seven health behaviors and factors. The concept is associated with cardiovascular disease incidence, and cardiovascular disease and all-cause mortality. To effectively promote ideal cardiovascular health already early in life, childhood factors predicting future ideal cardiovascular health should be investigated. Our aim was thus to comprehensively explore childhood determinants of adult ideal cardiovascular health in population based cohorts from three continents.

METHODS

The sample comprised a total of 4409 participants aged 3-19 years at baseline from the Cardiovascular Risk in Young Finns Study (YFS; N = 1883) from Finland, Childhood Determinants of Adult Health Study (CDAH; N = 1803) from Australia and Princeton Follow-up Study (PFS; N = 723) from the United States. Participants were re-examined 19-31 years later when aged 30-48 years.

RESULTS

In multivariable analyses, independent childhood predictors of adult ideal cardiovascular health were family socioeconomic status (P < 0.01; direct association) and BMI (P < 0.001; inverse association) in all cohorts. In addition, blood pressure (P = 0.007), LDL-cholesterol (P < 0.001) and parental smoking (P = 0.006) in the YFS, and own smoking (P = 0.001) in CDAH were inversely associated with future ideal cardiovascular health.

CONCLUSIONS

Among several lifestyle and clinical indicators studied, higher family socioeconomic status and non-smoking (parental/own) in childhood independently predict ideal cardiovascular health in adulthood. As atherosclerotic cardiovascular diseases are rooted in childhood, our findings suggest that special attention could be paid to children who are from low socioeconomic status families, and who smoke or whose parents smoke, to prevent cardiovascular disease morbidity and mortality.

Long work hours and obesity in Korean adult workers

OBJECTIVES

The present study was designed to identify the association between work hours and obesity in Korean adult manual and nonmanual workers, and to determine whether there is a gender difference in this association.

METHODS

The study was conducted using Korean National Health and Nutrition Examination Survey data collected between 2007 and 2010. Individuals aged below 25 or over 64 years, pregnant women, part-time workers, soldiers, housewives and students were excluded. The total number of individuals included in the analysis was 8,889 (5,241 male and 3,648 female subjects). The outcome variable was obesity, defined as body mass index ≥25 kg/m(2). Variables considered in the model were age, education, income, marital status, alcohol drinking, smoking, daily energy intake, physical activity, sleep hours per day, the type of job, work hours, and work schedule. Work hours were categorized as <40, 40-48 (reference), 49-60, and >60 hours per week.

RESULTS

In the multiple SURVEYLOGISTIC regression analyses, the adjusted odds ratio of obesity for long work hours (>60 hours per week) in male manual workers was 1.647 (95% confidence interval 1.262-2.151). Long work hours did not significantly increase the odds ratio for obesity in male nonmanual workers and female manual and nonmanual workers.

CONCLUSIONS

More than 60 work hours per week increased the risk of obesity in Korean male manual workers. This result might be helpful in preventing obesity in Korean adult workers, especially male manual workers.

Sedentary behaviours and obesity in adults: the Cardiovascular Risk in Young Finns Study

OBJECTIVE

Sedentary behaviour may contribute to the development of obesity. We investigated the relations between different types of sedentary behaviour and adiposity markers in a well-characterised adult population after controlling for a wide range of potential confounders.

DESIGN

Cross-sectional study.

SETTING

The Cardiovascular Risk in Young Finns Multicenter Study. Participants Sedentary time (TV viewing, computer time, reading, music/radio listening and other relaxation) was assessed with a questionnaire for 1084 women and 909 men aged 30-45 years. Other study variables included occupational and leisure-time physical activity, sleep duration, socioeconomic status, smoking, alcohol consumption, energy intake, adherence to the recommended diet, multiple individual food items, age and genetic variants associated with body mass index (BMI). Primary outcome measures BMI in kg/m(2) and waist circumference (WC in cm).

RESULTS

Of the different sedentary behaviour types, TV viewing was most consistently related to higher BMI and WC, both in men and women. One additional daily TV hour was associated with a 1.81±0.44 cm larger WC in women and 2 cm±0.44 cm in men (both p<0.0001). The association with TV was diluted, but remained highly significant after adjustments with all measured covariates, including several potentially obesogenic food items associated with TV viewing. The intakes of food items such as sausage, beer and soft drinks were directly associated with TV viewing, while the intakes of oat and barley, fish, and fruits and berries were associated indirectly. After these adjustments, non-TV sedentary behaviour remained associated with adiposity indices only in women.

CONCLUSIONS

Out of the different types of sedentary behaviour, TV viewing was most consistently associated with adiposity markers in adults. Partial dilution of these associations after adjustments for covariates suggests that the obesogenic effects of TV viewing are partly mediated by other lifestyle factors.

Factors predicting overweight in US kindergartners

BACKGROUND

Childhood overweight is a substantial public-health problem, but little is known about predictors of early childhood overweight.

OBJECTIVE

We aimed to identify factors--alone and in combination--that predict kindergarten overweight.

DESIGN

We analyzed nationally representative data from the Early Childhood Longitudinal Study-Birth Cohort, a longitudinal cohort study of 6800 children followed from birth through kindergarten. Multivariable logistic regression and recursive partitioning analysis (RPA) were performed to identify individual and clusters of parental, prenatal/pregnancy, infant, and toddler factors predicting kindergarten overweight. The main outcome was kindergarten overweight [body mass index (BMI) ≥85th percentile, which includes obesity].

RESULTS

The prevalence of kindergarten overweight was 32%. By using combinations (derived from 131 factors) of a weight-for-length or BMI ≥85th percentile at earlier ages, race/ethnicity, a maternal gestational diabetes history, birth weight, and ages at solid-food introduction and the child pulling to a stand, the RPA identified 6 groups with a particularly high prevalence of kindergarten overweight (56-100%) and 2 groups with a particularly low prevalence (11-15%). An especially high prevalence was noted for children with a ≥85th BMI percentile at preschool age (77%) and in children with a ≥85th BMI percentile at 2 y old, for white children whose mother had gestational diabetes (100%), and for minority children with a birth weight <2695.5 g and who pulled themselves to a stand at <7.5 mo old (89%).

CONCLUSION

Clusters of parental, prenatal/pregnancy, infant, and toddler factors can be used to predict which children are at particularly high and low risk of becoming overweight kindergartners.

Higher maternal body mass index is associated with an increased risk for later type 2 diabetes in offspring

OBJECTIVES

To investigate whether the body mass index (BMI) of a child's mother is associated with an increased future risk of type 2 diabetes, independent of genetic risk or childhood metabolic, behavioral, and environmental factors.

STUDY DESIGN

The analyses were based on the Cardiovascular Risk in Young Finns Study including 1835 individuals aged 3-18 years at baseline with data on maternal BMI, childhood metabolic factors, as well as 34 newly identified type 2 diabetes susceptibility alleles. These subjects were then followed-up over 21-27 years.

RESULTS

Maternal BMI (OR for 1-SD increase 1.54 [95% CI 1.12-2.11], P = .008) and child's systolic blood pressure (1.54 [1.01-2.35], P = .04) were significantly associated with increased odds for later type 2 diabetes, in a multivariable analysis adjusted for age, sex, type 2 diabetes genetic risk score, childhood BMI, insulin, lipids, dietary factors, socioeconomic status, and mother's age, and history of type 2 diabetes. A risk prediction model, which included maternal BMI status outperformed one which utilized only child's BMI data (area under the receiver operating characteristic curve 0.720 vs 0.623, P = .02). The inclusion of genetic risk score and other baseline risk variables did not additionally improve prediction (area under the receiver operating characteristic curve 0.720 vs 0.745, P = .40).

CONCLUSIONS

Maternal BMI is a useful variable in determining offspring risk of developing type 2 diabetes.

A prospective study of LINE-1DNA methylation and development of adiposity in school-age children

Background

Repetitive element DNA methylation is related to prominent obesity-related chronic diseases including cancer and cardiovascular disease; yet, little is known of its relation with weight status. We examined associations of LINE-1 DNA methylation with changes in adiposity and linear growth in a longitudinal study of school-age children from Bogotá, Colombia.

Methods

We quantified methylation of LINE-1 elements from peripheral leukocytes of 553 children aged 5–12 years at baseline using pyrosequencing technology. Anthropometric characteristics were measured periodically for a median of 30 months. We estimated mean change in three age-and sex-standardized indicators of adiposity: body mass index (BMI)-for-age Z-score, waist circumference Z-score, and subscapular-to-triceps skinfold thickness ratio Z-score according to quartiles of LINE-1 methylation using mixed effects regression models. We also examined associations with height-for-age Z-score.

Results

There were non-linear, inverse relations of LINE-1 methylation with BMI-for-age Z-score and the skinfold thickness ratio Z-score. After adjustment for baseline age and socioeconomic status, boys in the lowest quartile of LINE-1 methylation experienced annual gains in BMI-for-age Z-score and skinfold thickness ratio Z-score that were 0.06 Z/year (P = 0.04) and 0.07 Z/year (P = 0.03), respectively, higher than those in the upper three quartiles. The relation of LINE-1 methylation and annual change in waist circumference followed a decreasing monotonic trend across the four quartiles (P trend = 0.02). DNA methylation was not related to any of the adiposity indicators in girls. There were no associations between LINE-1 methylation and linear growth in either sex.

Conclusions

Lower LINE-1 DNA methylation is related to development of adiposity in boys.