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Cadario F. Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture. Nutrients 2022; 14:nu14224887. [PMID: 36432570 PMCID: PMC9699239 DOI: 10.3390/nu14224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, University of Piemonte Orientale, 28100 Novara, Italy;
- Diabetes Research Institute Federation, Miami, FL 33163, USA
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Eitmann S, Németh D, Hegyi P, Szakács Z, Garami A, Balaskó M, Solymár M, Erőss B, Kovács E, Pétervári E. Maternal overnutrition impairs offspring's insulin sensitivity: A systematic review and meta-analysis. MATERNAL AND CHILD NUTRITION 2020; 16:e13031. [PMID: 32567808 PMCID: PMC7503101 DOI: 10.1111/mcn.13031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Abstract
This systematic review and meta‐analysis aimed to investigate the association between maternal overnutrition and offspring's insulin sensitivity—following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement. Studies published in English before April 22, 2019, were identified through searches of four medical databases. After selection, 15 studies aiming to explore the association between prepregnancy body mass index (ppBMI) or gestational weight gain (GWG) of non‐diabetic mothers and their offspring's insulin sensitivity (fasting insulin or glucose level and Homeostatic Measurement Assessment for Insulin Resistance [HOMA‐IR]) were included in the meta‐analysis. Associations of ppBMI and GWG with offspring's insulin sensitivity were analysed by pooling regression coefficients or standardized differences in means with 95% confidence intervals (CIs). Maternal ppBMI showed significant positive correlations with the level of both fasting insulin and HOMA‐IR in offspring (standardized regression coefficient for fasting insulin: 0.107, CI [0.053, 0.160], p < 0.001 and that for HOMA‐IR: 0.063, CI [0.006, 0.121], p = 0.031). However, the result of the analysis on coefficients adjusted for offspring's actual anthropometry (BMI and adiposity) was not significant. Independent from ppBMI, GWG tended to show a positive correlation with insulin level, but not after adjustment for offspring's anthropometry. Offspring of mothers with excessive GWG showed significantly higher HOMA‐IR than those of mothers with optimal GWG (p = 0.004). Our results demonstrate that both higher ppBMI and GWG increase the risk of offspring's insulin resistance, but the effect of ppBMI on insulin sensitivity in offspring may develop as consequence of their adiposity.
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Affiliation(s)
- Szimonetta Eitmann
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - András Garami
- Department of Thermophysiology, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Enikő Kovács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Erika Pétervári
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
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Oliveira-Santos J, Santos R, Moreira C, Abreu S, Lopes L, Agostinis-Sobrinho C, Stratton G, Mota J. Associations between anthropometric indicators in early life and low-grade inflammation, insulin resistance and lipid profile in adolescence. Nutr Metab Cardiovasc Dis 2019; 29:783-792. [PMID: 31248718 DOI: 10.1016/j.numecd.2019.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS The long-term relations between excessive adiposity in early childhood and unfavourable cardiometabolic profiles in later ages are not yet completely understood. We aimed to assess the associations between birth weight (BW) and BMI from 6 months to 6 years of age, with biomarkers indicative of low-grade inflammation, insulin resistance and lipid profiles in adolescence. METHODS AND RESULTS Retrospective school-based study with 415 Portuguese adolescents (220 girls), mean age of 14.08 ± 1.6 years old. Anthropometric data from birth to 6 years old was extracted from individual child health book records. Actual weight and height were measured and BMI calculated. Participants were classified at each time point as normal weight or overweight according to WHO reference values. Biomarkers were obtained from venous blood samples. Linear regressions were used to explore the associations between the biomarkers and early life anthropometric indicators. From 2 years onwards, BMI associated positively with the inflammatory score and HOMA-IR in adolescence. Children who were overweight/obese from 2 to 6 years of age presented significantly higher inflammatory score and HOMA-IR later in adolescence. TC/HDL ratio was also positively associated with BMI from the age of 5 years onwards. The associations between BMI and cardiometabolic outcomes remained positive in adolescence, with overweight adolescents presenting a higher inflammatory score, HOMA-IR and TC/HDL than normal weight adolescents. CONCLUSION A high BMI from an early age was consistently associated with worse inflammatory and lipid profiles and insulin resistance in adolescence. No associations were found between BW and the same studied outcomes.
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Affiliation(s)
- J Oliveira-Santos
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal.
| | - R Santos
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal; Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, NSW, Australia
| | - C Moreira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal
| | - S Abreu
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal
| | - L Lopes
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal
| | - C Agostinis-Sobrinho
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal; Faculty of Health and Sciences, Klaipeda University, Lithuania
| | - G Stratton
- Research Centre in Applied Sports, Technology Exercise and Medicine, College of Engineering, Swansea University, Wales, UK
| | - J Mota
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Portugal
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Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JM. Infant milk-feeding practices and diabetes outcomes in offspring: a systematic review. Am J Clin Nutr 2019; 109:817S-837S. [PMID: 30982877 PMCID: PMC6500931 DOI: 10.1093/ajcn/nqy311] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND During the Pregnancy and Birth to 24 Months Project, the US Departments of Agriculture and Health and Human Services initiated a review of evidence on diet and health in these populations. OBJECTIVES The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding, and 4) feeding a lower versus higher intensity of human milk to mixed-fed infants with type 1 and type 2 diabetes in offspring. METHODS The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published January 1980-March 2016, dual-screened the results according to predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. RESULTS The 4 systematic reviews included 21, 37, 18, and 1 articles, respectively. Observational evidence suggests that never versus ever feeding human milk (limited evidence) and shorter versus longer durations of any (moderate evidence) and exclusive (limited evidence) human milk feeding are associated with higher type 1 diabetes risk. Insufficient evidence examined type 2 diabetes. Limited evidence suggests that the durations of any and exclusive human milk feeding are not associated with intermediate outcomes (e.g., fasting glucose, insulin resistance) during childhood. CONCLUSIONS Limited to moderate evidence suggests that feeding less or no human milk is associated with higher risk of type 1 diabetes in offspring. Limited evidence suggests no associations between the durations of any and exclusive human milk feeding and intermediate diabetes outcomes in children. Additional research is needed on infant milk-feeding practices and type 2 diabetes and intermediate outcomes in US populations, which may have distinct metabolic risk.
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Affiliation(s)
- Darcy Güngör
- Panum Group, Bethesda, MD,Address correspondence to DG (e-mail: )
| | | | | | | | | | - Nancy Terry
- National Institutes of Health Library, Bethesda, MD
| | - Steve A Abrams
- Dell Medical School at the University of Texas, Austin, TX
| | - Leila Beker
- US Food and Drug Administration, contractor, College Park, MD
| | | | | | | | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA and Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
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Sauder KA, Hockett CW, Ringham BM, Glueck DH, Dabelea D. Fetal overnutrition and offspring insulin resistance and β-cell function: the Exploring Perinatal Outcomes among Children (EPOCH) study. Diabet Med 2017; 34. [PMID: 28636758 PMCID: PMC5603388 DOI: 10.1111/dme.13417] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS To examine the associations of intrauterine exposure to maternal diabetes and obesity with offspring insulin resistance, β-cell function and oral disposition index in a longitudinal observational study of ethnically diverse offspring. METHODS A total of 445 offspring who were exposed (n=81) or not exposed (n=364) to maternal diabetes in utero completed two fasting blood measurements at mean (sd) ages of 10.5 (1.5) and 16.5 (1.2) years, respectively, and an oral glucose tolerance test at the second visit. We used linear mixed models and general linear univariate models to evaluate the associations of maternal diabetes and pre-pregnancy BMI with offspring outcomes. RESULTS Maternal diabetes in utero predicted increased insulin resistance [18% higher updated homeostatic model assessment of insulin resistance (HOMA2-IR), P=0.01; 19% lower Matsuda index, P=0.01 and 9% greater updated homeostatic model assessment of β-cell function (HOMA2-β), P=0.04]. Each 5-kg/m2 increase in pre-pregnancy BMI predicted increased insulin resistance (11% greater HOMA2-IR, P<0.001; 10% lower Matsuda index, P<0.001; 6% greater HOMA2-β, P<0.001). Similar results were obtained in a combined model with both exposures. After adjustment for offspring BMI, only maternal diabetes was associated with higher HOMA2-IR (β=1.12, P=0.03) and lower Matsuda index (β=0.83, P=0.01). Neither exposure was associated with early insulin response or oral disposition index. CONCLUSIONS Intrauterine exposure to diabetes or obesity is associated with greater offspring insulin resistance than non-exposure, supporting the hypothesis that fetal overnutrition results in metabolic abnormalities during childhood and adolescence.
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Affiliation(s)
- K A Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - C W Hockett
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - B M Ringham
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - D H Glueck
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - D Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Muhardi L, Abrahamse-Berkeveld M, Acton D, van der Beek EM. Differences in the anthropometry of Asian children and its role in metabolic health in later life: A narrative review. Obes Res Clin Pract 2016; 10 Suppl 1:S3-S16. [PMID: 27389317 DOI: 10.1016/j.orcp.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The increasing incidence of childhood obesity in Asia could be a reflection of early life programming in which environmental/nutritional challenges during pregnancy and first two years of life (the so-called first 1000 days) influence later health. OBJECTIVE OF NARRATIVE REVIEW To assess differences/similarities of anthropometric measures in early life and their influences on metabolic health risk in later life among children in Asia. METHODS Literature search for publication in English using selected key words from Medline (PubMed), Scopus, Science Direct and Google Scholar published from 1994 to October 2014. Some comparisons with Caucasian setting were made when relevant. RESULTS From 152 publications selected for this narrative review, differences in foetal growth and birth weight were deducted between Asian and Caucasian children. Infants in India and Hong Kong had increased fat mass at birth and early infancy as compared to those from other parts of the world. Pre- and during pregnancy conditions influenced birth weight; feeding practices and gender influenced post-natal growth and body composition development. High and low birth weights followed by rapid postnatal growth were linked to increased risks of obesity, insulin resistance and high blood pressure in later life. CONCLUSION Foetal and postnatal growth trajectories are different between countries within and outside Asia. Extremes in birth weight followed by rapid postnatal growth were linked to increased risks of metabolic health of children in this region. As there is limited evidence in Asia, it is important to conduct thorough investigations by using longitudinal studies on early life programming.
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Affiliation(s)
- Leilani Muhardi
- Nutricia Research - Danone Nutricia Early Life Nutrition, Matrix Building #05-01b, 30 Biopolis Street, Singapore 138667, Singapore.
| | | | - Dennis Acton
- Nutricia Research - Danone Early Life Nutrition, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands
| | - Eline M van der Beek
- Nutricia Research - Danone Nutricia Early Life Nutrition, Matrix Building #05-01b, 30 Biopolis Street, Singapore 138667, Singapore; Nutricia Research - Danone Early Life Nutrition, Uppsalalaan 12, 3584 CT Utrecht, The Netherlands
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Maftei O, Whitrow MJ, Davies MJ, Giles LC, Owens JA, Moore VM. Maternal body size prior to pregnancy, gestational diabetes and weight gain: associations with insulin resistance in children at 9-10 years. Diabet Med 2015; 32:174-80. [PMID: 25407383 DOI: 10.1111/dme.12637] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Abstract
AIMS To investigate whether maternal body size pre-pregnancy, gestational diabetes and weight gain are independently associated with subsequent insulin resistance in children; and to examine the potential mediating role of child's body size in any associations. METHODS At 9-10 years, 443 children took part in a follow-up of a prospective cohort. Of those, 163 children elected to provide a fasting blood sample and child insulin resistance was estimated by homeostasis model assessment. Generalized linear models with log link function and Gaussian family were used to assess associations with antenatal exposures. Potential confounders were considered as well as the role of the child's size. RESULTS Prior to pregnancy, 23% of mothers were overweight and another 17% obese. All women were screened for gestational diabetes, with 6% diagnosed. On average, women gained an estimated 14 kg during pregnancy. Gestational diabetes was positively associated with child insulin resistance. In addition, maternal pre-pregnancy body mass index (BMI) was associated with child insulin resistance in a non-linear manner: a positive, progressive association was observed until BMI of 30 kg/m² was reached, but not thereafter. Estimated gestational weight gain was not associated with child insulin resistance. These findings were not accounted for by size of the child at birth or at 9-10 years. CONCLUSIONS Maternal body size prior to pregnancy is positively associated with increases in child insulin resistance, at least until the 'obese' category is reached. This is independent of gestational diabetes and not mediated by body size of the child, suggesting genetic and/or developmental programming origins.
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Affiliation(s)
- O Maftei
- Discipline of Public Health, School of Population Health, The University of Adelaide, Australia; Discipline of Obstetrics & Gynaecology, School of Paediatrics & Reproductive Health, The University of Adelaide, Australia; Robinson Research Institute, The University of Adelaide, Australia
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van den Berg G, van Eijsden M, Vrijkotte TGM, Gemke RJBJ. Socioeconomic inequalities in lipid and glucose metabolism in early childhood in a population-based cohort: the ABCD-Study. BMC Public Health 2012; 12:591. [PMID: 22852830 PMCID: PMC3490773 DOI: 10.1186/1471-2458-12-591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/18/2012] [Indexed: 11/25/2022] Open
Abstract
Background Socioeconomic inequalities in cardiovascular disease are pervasive, yet much remains to be understood about how they originate. The objective of this study was to explore the relations of socioeconomic status to lipid and glucose metabolism as indicators of cardiovascular health in 5–6 year olds. Additionally to explore the explanatory role of maternal factors, birth outcome, and child factors. Methods In 1308 5–6 year old ethnic Dutch children from the ABCD cohort study, lipids (cholesterol, LDL, HDL, triglycerides), glucose and C-peptide were measured after an overnight-fast. Results There were no differences in cholesterol, HDL, LDL, and triglycerides between socioeconomic groups, as indicated by maternal education and income adequacy. However, children of low educated mothers had on average a higher glucose (β = 0.15; 95% confidence interval (CI) 0.03 – 0.27), logC-peptide (β = 0.07; 95% CI 0.04 – 0.09), and calculated insulin resistance (HOMA-IR) (β = 0.15; 95% CI 0.08 – 0.22) compared to children of high educated mothers. Only childhood BMI partly explained these differences (models controlled for age, height, and sex). Conclusions The socioeconomic gradient in cardiovascular risk factors seems to emerge in early childhood. In absence of underlying mechanisms these empirical findings are relevant for public health care and further explanatory research.
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Affiliation(s)
- Gerrit van den Berg
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
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Silva AAM, Santos CJN, Amigo H, Barbieri MA, Bustos P, Bettiol H, Rona RJ. Birth weight, current body mass index, and insulin sensitivity and secretion in young adults in two Latin American populations. Nutr Metab Cardiovasc Dis 2012; 22:533-539. [PMID: 21543197 DOI: 10.1016/j.numecd.2010.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 08/18/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Although studies have shown association of birth weight (BW) and adult body mass index (BMI) with insulin sensitivity in adults, there is limited evidence that BW is associated with insulin secretion. We assessed the associations between BW and current BMI with insulin sensitivity and secretion in young Latin American adults. METHODS AND RESULTS Two birth cohorts, one from Ribeirao Preto, Brazil, based on 1984 participants aged 23-25 years, and another from Limache, Chile, based on 965 participants aged 22-28 years were studied. Weight and height at birth, and current fasting plasma glucose and insulin levels were measured. Insulin sensitivity (HOMA%S) and secretion (HOMA%β) were estimated using the Homeostatic Model Assessment (HOMA2). Multiple linear regression analyses were carried out to test the associations between BW and adult BMI z-scores on log HOMA%S and log HOMA%β. BW z-score was associated with HOMA%S in the two populations and HOMA%β in Ribeirao Preto when adult BMI z-score was included in the model. BW z-score was associated with decreasing insulin secretion even without adjusting for adult BMI, but only in Ribeirao Preto. BMI z-score was associated with low HOMA%S and high HOMA%β. No interactions between BW and BMI z-scores on insulin sensitivity were shown. CONCLUSIONS This study supports the finding that BW may affect insulin sensitivity and secretion in young adults. The effect size of BW on insulin status is small in comparison to current BMI.
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Affiliation(s)
- A A M Silva
- Department of Public Health, Federal University of Maranhao, 65075630 Sao Luis, Brazil.
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10
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Size at birth is associated with blood pressure but not insulin resistance in 6–8 year old children in rural Nepal. J Dev Orig Health Dis 2010; 1:114-22. [DOI: 10.1017/s2040174410000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Earlier, we reported that antenatal micronutrient supplementation reduced the risk of metabolic syndrome and microalbuminuria among offspring at 6–8 years of age in rural Nepal. In the same birth cohort, we examined associations of size at birth (weight, length and ponderal index), and gestational age, with cardiometabolic risk factors in childhood across all antenatal micronutrient interventions. There was an inverse association between birth weight and systolic blood pressure (SBP,β= −1.20 mm Hg/kg; 95% confidence interval (CI): −1.93, −0.46) and diastolic blood pressure (DBP,β= −1.24 mm Hg/kg; 95% CI: −2.00, −0.49). Current child body mass index was positively associated with SBP but not with DBP. Birth weight was unassociated with insulin resistance, but each kilogram of increase was associated with a reduced risk of high triglycerides (odds ratio (OR) = 0.64/kg; 95% CI: 0.41, 0.97) and an increased risk of high waist circumference (OR = 3.16/kg; 95% CI: 2.47, 4.41). In this rural Nepalese population of children 6–8 years of age with a high prevalence of undernutrition, size at birth was inversely associated with blood pressure and triglycerides and positively associated with waist circumference.
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Abstract
Chronic diseases that are typical of adulthood may originate in intra-uterine life through inadequate fetal development. The present epidemiological cohort study of 506 healthy children aged 5–8 years evaluated the relationship between birth weight and insulin resistance in an age group that has been assessed in few similar studies. Insulin concentration was determined by chemiluminescence and insulin resistance by the homeostasis model assessment (HOMA). Blood glucose, total cholesterol and fractions (LDL cholesterol and HDL cholesterol) and TAG concentrations were determined by automated enzymatic methods. Linear regression analysis investigated the relationship between birth weight (assessed as a continuous variable and in three categories: small for gestational age, SGA; adequate for gestational age and large for gestational age) and the HOMA index, using backward stepwise selection and biological models to explain the causal pathway of the relationship. There were negative associations between birth weight (P < 0·001), SGA (P = 0·027) and the HOMA index, and a positive association between waist circumference (P < 0·001) and the HOMA index. Considering the significant associations between birth weight and waist circumference (P < 0·001) and waist circumference and insulin resistance (P < 0·001), we can probably suspect that lower birth weight is a common cause of higher waist circumference and insulin resistance. In summary, the results of the present study showed increased insulin resistance in apparently healthy, young children, who had lower weight at birth and higher measurements of waist circumference. There is a need to develop public health policies that adopt preventive measures to promote adequate maternal-fetal and child development and enable early diagnosis of metabolic abnormalities.
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Corvalán C, Uauy R, Stein AD, Kain J, Martorell R. Effect of growth on cardiometabolic status at 4 y of age. Am J Clin Nutr 2009; 90:547-55. [PMID: 19640961 DOI: 10.3945/ajcn.2008.27318] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risks are increasingly being diagnosed in children and track into adulthood. Growth is associated with CVD risk in adulthood; however, its contribution to CVD risks in children facing the obesity epidemic is unclear. OBJECTIVE The objective was to assess relations between growth from age 0 to 4 y and CVD status at 4 y in 323 Chilean children with normal birth weight. DESIGN From health records we obtained weight and height every 6 mo from age 0 to 3 y and calculated body mass index (BMI; weight/height(2)). At age 4 y, we measured height, waist circumference, insulin, glucose, and plasma lipids; infant feeding information was provided by the mothers. Outcomes were metabolic score (waist-to-height ratio + glucose + insulin + triglycerides - HDL-cholesterol z scores/5), total cholesterol (TC):HDL cholesterol, and homeostasis model of assessment of insulin resistance. RESULTS At 4 y, the prevalence of obesity was 13%. Changes in BMI, particularly from 6 to 24 mo, predicted a higher metabolic score (standardized regression coefficient = 0.29; 95% CI: 0.16, 0.42) but were unrelated to homeostasis model of assessment of insulin resistance and TC:HDL cholesterol. Height changes were not associated with CVD risks at the age of 4 y. Mode of infant feeding was unrelated to CVD status at 4 y; however, in children who were exclusively breastfed at 4 mo, an increase in BMI from 0 to 6 mo was positively associated with TC:HDL cholesterol at 4 y (standardized regression coefficient = 0.24; 95% CI: -0.02, 0.50), whereas in children who were partially or nonbreastfed at 4 mo, it was negatively associated with TC:HDL cholesterol at 4 y (standardized regression coefficient = -0.30; 95% CI: -0.52, -0.08). CONCLUSION In children with normal birth weight and a high prevalence of obesity at 4 y, changes in BMI after 6 mo predicted a higher overall CVD risk at 4 y.
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14
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Clapp Iii JF, Lopez B. Size at birth, obesity and blood pressure at age five. Metab Syndr Relat Disord 2008; 5:116-26. [PMID: 18370820 DOI: 10.1089/met.2006.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The fetal origins hypothesis indicates that morphometric evidence of fetal nutritional deprivation is predictive of excessive weight gain/obesity, insulin resistance, and cardiovascular disease after birth. However, it is unclear whether these effects are present in offspring with "normal" birth weights in contemporary Western society, whether they are population specific, and how early in life they appear. This study was designed to examine these questions in a select populace of morphometrically diverse offspring to test the null hypothesis that morphometric evidence of nutritional restriction in utero has no effect on the presence of either obesity or increased blood pressure at ages 5 and 6. METHODS We present a prospective study of 101 offspring born of well-nourished, middle and upper socioeconomic-class women who participated in studies of diet and exercise during pregnancy. At birth and age 5 to 6 the offspring underwent morphometric evaluation with the additional measurement of blood pressure at age 5 to 6. RESULTS There were no significant negative correlations between neonatal morphometrics and either blood pressure or obesity at age 5 to 6. There were, however, direct positive correlations between birth weight and both weight and BMI at age 5 to 6 (p < 0.0001). CONCLUSIONS In this specific populace, morphometrics at age 5 to 6 correlated with size at birth. However, there was no relationship between mophometric evidence of in utero nutritional deprivation at birth and either blood pressure or obesity at age 5 to 6.
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Affiliation(s)
- James F Clapp Iii
- The Departments of Reproductive Biology and Obstetrics and Gynecology and The Schwartz Center for Metabolism and Nutrition at The MetroHealth Campus of Case Western Reserve University School of Medicine, Cleveland, Ohio., The Department of Obstetrics and Gynecology, University of Vermont College of Medicine Burlington, Vermont
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15
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Long-term adverse outcomes of low birth weight, increased somatic growth rates, and alterations of body composition in the premature infant: review of the evidence. J Pediatr Gastroenterol Nutr 2007; 45 Suppl 3:S147-51. [PMID: 18185081 DOI: 10.1097/01.mpg.0000302961.01170.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In appropriate-for-gestational-age preterm infants, data are reviewed to support that both high and low nutrient intakes, as well as fast or slow rates of growth in the neonatal intensive care unit, have long-term adverse (or even positive) effects on body weight and the metabolic syndrome later in life. Though more studies are needed, it is concluded that it is likely that any such effects will be relatively small compared with other risk factors such as parental weight and various lifestyle factors. At the present time, there is little evidence that negates the goal of maximizing nutritional support for the very low birth weight infant in the neonatal period.
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16
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Bibliography. Current world literature. Obesity and nutrition. Curr Opin Endocrinol Diabetes Obes 2007; 14:421-6. [PMID: 17940474 DOI: 10.1097/med.0b013e3282f0ca40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Clapp JF, Lopez B. Low-Versus High-Glycemic Index Diets in Women: Effects on Caloric Requirement, Substrate Utilization and Insulin Sensitivity. Metab Syndr Relat Disord 2007; 5:231-42. [DOI: 10.1089/met.2006.0040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James F. Clapp
- Department of Reproductive Biology, The MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio
- Department of Obstetrics and Gynecology, The MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio
- The Schwartz Center for Metabolism and Nutrition, The MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio
| | - Beth Lopez
- Department of Obstetrics and Gynecology, The MetroHealth Medical Campus of Case Western Reserve University, Cleveland, Ohio
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18
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Abstract
The offspring of women with diabetes during pregnancy are at high risk of developing diabetes before they reach childbearing age, resulting in a vicious cycle of diabetes and pregnancy. New cases of diabetes enter the cycle as a result of the effects of the increasing obesity among our youth. Solutions need to be found to break this cycle by preventing diabetes or delaying its onset until later in life and by normalizing glucose regulation during pregnancy.
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Affiliation(s)
- David J Pettitt
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105, USA.
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19
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Rauh-Pfeiffer A, Koletzko B. Übergewicht und Adipositas im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1508-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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20
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Abstract
PURPOSE OF REVIEW Provides an update on the metabolic syndrome in childhood. RECENT FINDINGS The metabolic syndrome is increasingly recognized among children. It is nearly exclusively encountered in overweight and obese individuals and is associated with atherosclerosis. Development and clustering of cardiovascular risk factors is influenced by many characteristics including heritable traits, prenatal and infantile influences, diet, physical activity, and socioeconomic status. SUMMARY Epidemiological data have become mature in this area. Efforts to design and implement systems to prevent and treat the metabolic syndrome are required.
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Affiliation(s)
- Jeffrey M Saland
- Department of Pediatrics, The Mount Sinai School of Medicine, New York, NY 10029, USA.
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