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Skowronski AA, Leibel RL, LeDuc CA. Neurodevelopmental Programming of Adiposity: Contributions to Obesity Risk. Endocr Rev 2024; 45:253-280. [PMID: 37971140 PMCID: PMC10911958 DOI: 10.1210/endrev/bnad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
This review analyzes the published evidence regarding maternal factors that influence the developmental programming of long-term adiposity in humans and animals via the central nervous system (CNS). We describe the physiological outcomes of perinatal underfeeding and overfeeding and explore potential mechanisms that may mediate the impact of such exposures on the development of feeding circuits within the CNS-including the influences of metabolic hormones and epigenetic changes. The perinatal environment, reflective of maternal nutritional status, contributes to the programming of offspring adiposity. The in utero and early postnatal periods represent critically sensitive developmental windows during which the hormonal and metabolic milieu affects the maturation of the hypothalamus. Maternal hyperglycemia is associated with increased transfer of glucose to the fetus driving fetal hyperinsulinemia. Elevated fetal insulin causes increased adiposity and consequently higher fetal circulating leptin concentration. Mechanistic studies in animal models indicate important roles of leptin and insulin in central and peripheral programming of adiposity, and suggest that optimal concentrations of these hormones are critical during early life. Additionally, the environmental milieu during development may be conveyed to progeny through epigenetic marks and these can potentially be vertically transmitted to subsequent generations. Thus, nutritional and metabolic/endocrine signals during perinatal development can have lifelong (and possibly multigenerational) impacts on offspring body weight regulation.
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Affiliation(s)
- Alicja A Skowronski
- Division of Molecular Genetics, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Rudolph L Leibel
- Division of Molecular Genetics, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Charles A LeDuc
- Division of Molecular Genetics, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center, New York, NY 10032, USA
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Heltbech MS, Jensen CL, Girma T, Abera M, Admassu B, Kæstel P, Wells JCK, Michaelsen KF, Friis H, Andersen GS, Wibæk R. The Associations of Breastfeeding Status at 6 Months with Anthropometry, Body Composition, and Cardiometabolic Markers at 5 Years in the Ethiopian Infant Anthropometry and Body Composition Birth Cohort. Nutrients 2023; 15:4595. [PMID: 37960248 PMCID: PMC10647349 DOI: 10.3390/nu15214595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Breastfeeding (BF) has been shown to lower the risk of overweight and cardiometabolic disease later in life. However, evidence from low-income settings remains sparse. We examined the associations of BF status at 6 months with anthropometry, body composition (BC), and cardiometabolic markers at 5 years in Ethiopian children. (2) Methods: Mother-child pairs from the iABC birth cohort were categorised into four BF groups at 6 months: 1. "Exclusive", 2. "Almost exclusive", 3. "Predominantly" and 4. "Partial or none". The associations of BF status with anthropometry, BC, and cardiometabolic markers at 5 years were examined using multiple linear regression analyses in three adjustment models. (3) Results: A total of 306 mother-child pairs were included. Compared with "Exclusive", the nonexclusive BF practices were associated with a lower BMI, blood pressure, and HDL-cholesterol at 5 years. Compared with "Exclusive", "Predominantly" and "Almost exclusive" had shorter stature of -1.7 cm (-3.3, -0.2) and -1.2 cm (-2.9, 0.5) and a lower fat-free mass index of -0.36 kg/m2 (-0.71, -0.005) and -0.38 kg/m2 (-0.76, 0.007), respectively, but a similar fat mass index. Compared with "Exclusive", "Predominantly" had higher insulin of 53% (2.01, 130.49), "Almost exclusive" had lower total and LDL-cholesterol, and "Partial or none" had a lower fat mass index. (5) Conclusions: Our data suggest that children exclusively breastfed at 6 months of age are overall larger at 5 years, with greater stature, higher fat-free mass but similar fat mass, higher HDL-cholesterol and blood pressure, and lower insulin concentrations compared with predominantly breastfed children. Long-term studies of the associations between BF and metabolic health are needed to inform policies.
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Affiliation(s)
- Mathilde S. Heltbech
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Bitiya Admassu
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Gregers S. Andersen
- Clinical Research, Copenhagen University Hospital–Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Rasmus Wibæk
- Clinical Research, Copenhagen University Hospital–Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
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Fu C, Ni J, Huang R, Gao Y, Li S, Li Y, JinjinLi, Zhong K, Zhang P. Sex different effect of antibiotic and probiotic treatment on intestinal microbiota composition in chemically induced liver injury rats. Genomics 2023; 115:110647. [PMID: 37217087 DOI: 10.1016/j.ygeno.2023.110647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/10/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
Differences in the gut microbiota and metabolic processes between males and females may explain differences in the risk of liver injury; however, the sex-specific effects of antibiotics and probiotics on these relationships are not clear. We evaluated differences in the gut microbiota and the risk of liver injury between male and female rats after the oral administration of antibiotics or probiotics followed by a period of diethylnitrosamine treatment to chemically induce liver injuryusing high-throughput sequencing of fecal microbiota combined with histological analyses of liver and colon tissues. Our results suggest that the ratio of gram-positive to gram-negative bacteria in kanamycin-treated rats was significantly higher than that of other groups, and this difference persisted for the duration of the experiment. Antibiotics significantly changed the composition of the gut microbiota of experimental rats. Clindamycin caused more diethylnitrosamine-induced damage to livers of male rats. Probiotics did not influencethe gut microbiota; however, they hadprotective effects against liver injury induced by diethylnitrosamine, especially in female rats. These results strengthen our understanding of sex differences in the indirect effects of antibiotics or probiotics on metabolism and liver injury in hosts via the gut microbiota.
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Affiliation(s)
- Chaoyi Fu
- General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Jiajia Ni
- General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; Research and Development Center, Guangdong Meilikang Bio-Sciences Ltd., Foshan 528200, China; Dongguan Key Laboratory of Medical Bioactive Molecular Developmental and Translational Research, Guangdong Medical University, Dongguan 523808, China.
| | - Rong Huang
- Department of Neonatal Surgery, Guangdong Women and Children Hospital, Guangzhou 511400, China
| | - Yi Gao
- General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou 510515, China.
| | - Shao Li
- General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yang Li
- General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - JinjinLi
- School of Life Sciences, Qilu Normal University, Jinan 250200, China
| | - Kebo Zhong
- General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Peng Zhang
- Department of Organ Transplantation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
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Martins BMR, de Abranches AD, Méio MDBB, Gomes-Junior SCS, Moreira MEL. Early growth and body composition assessed by air displacement plethysmography in infants born with simple gastroschisis. J Pediatr Surg 2023; 58:741-746. [PMID: 36588037 DOI: 10.1016/j.jpedsurg.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/29/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastroschisis is an abdominal wall malformation usually associated with impaired growth. OBJECTIVE To evaluate the growth and body composition of infants born with simple gastroschisis in a referral center. METHODS This was a single-center, prospective case series of infants with simple gastroschisis who were measured at birth, at discharge, and at 3 months. Body composition was assessed via air-displacement plethysmography at discharge and at 3 months. The results were compared with those reported for healthy infants at an equivalent gestational age. RESULTS Simple gastroschisis infants were lighter and smaller at birth and remained similar at 3 months. All anthropometric z scores decreased from birth to discharge, followed by an increase but not a full recovery toward 3 months. Overall, gastroschisis infants had a similar FM percentage, FM% (11.1 ± 4.7), but a lower FFM, FFM (2481 ± 478 g), at discharge. FM% (18.5 ± 5.3) decreased at 3 months, and FFM remained lower (3788 ± 722 g) but improved between the two exams. Boys had significantly more FFM than girls at both evaluations. The multiple regression analysis showed that male sex, prematurity, total parenteral nutrition duration, and exclusive breast milk diets were associated with differences in body composition. CONCLUSIONS Infants with simple gastroschisis cared for in a referral center experienced growth failure at discharge and showed a similar FM% but lower FFM than healthy infants. At 3 months, they exhibited smaller FM% and FFM, but FFM improved after the first exam, representing a better protein accretion. TYPE OF STUDY Prognostic. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Bianca M R Martins
- Department of Surgery, Surgical NICU, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Andrea Dunshee de Abranches
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria D B B Méio
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Saint Clair S Gomes-Junior
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria E L Moreira
- Clinical Research Unit, Instituto Fernandes Figueira - Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
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Viswanathan S, Osborn E, Jadcherla S. Predictive ability of postnatal growth failure for adverse feeding-related outcomes in preterm infants: an exploratory study comparing Fenton with INTERGROWTH-21st preterm growth charts. J Matern Fetal Neonatal Med 2022; 35:5470-5477. [PMID: 33573451 DOI: 10.1080/14767058.2021.1882986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Postnatal growth failure (PGF) can impact the short- and long-term health outcomes in preterm infants. However, PGF rates vary according to the way it is defined and the growth chart used to monitor the postnatal growth. Fenton-2013 growth charts which suggest following intrauterine fetal growth compared to INTERGROWTH-21st, one specifically constructed for monitoring preterm extrauterine growth. OBJECTIVE Exploratory study to determine the PGF definition at first per oral (PO) that is most predictive of adverse oral feeding-related outcomes in preterm infants. METHODS Prospectively collected data of preterm infants 24-32 weeks gestation, who were started on cue-based oral feeds at ≤34 weeks gestation were reviewed. Anthropometric data at first PO (weight, length, and head circumference) were compared according to Fenton and INTERGROWTH-21st growth charts. PGF was defined either as <10th percentile, Z-score change (ZSC) of ≥-1.5 from birth, or ZSC of ≥-2.0. Top-quartile (Q4) of feeding-related outcomes (days from first PO to full PO, post-menstrual age at full PO, days from first PO to discharge, and length of hospital stay) was considered as adverse outcome. RESULTS Of the 125 infants included, the median birth gestation and weight were 29.4 weeks and 1235 g, respectively. Incidence of appropriate, small, and large for gestational age was similar at birth by both growth charts. ZSC -1.5 for weight by Fenton was significantly higher at first PO vs. INTERGROWTH-21st (p=.02), while percentile <10th and ZSC -2.0 rates were similar. The PGF definition based on individual anthropometrics at first PO that has the best area under the curve (AUC) for adverse feeding-related outcomes was used to create a combined PGF definition for each growth chart. The AUC for the combined PGF for the Fenton and INTERGROWTH-21st was similar (p>.05) and both have moderate sensitivity and negative predictive value, but have low specificity, positive predictive value, and positive likelihood ratio for adverse feeding-related outcomes. CONCLUSIONS The tested definitions of PGF at first PO have only small to moderate predictive ability for adverse feeding-related outcomes in preterm infants.
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Affiliation(s)
- Sreekanth Viswanathan
- Department of Pediatrics, Division of Neonatology, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Erika Osborn
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.,Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sudarshan Jadcherla
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.,Innovative Infant Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Role of Adipose Tissue microRNAs in the Onset of Metabolic Diseases and Implications in the Context of the DOHaD. Cells 2022; 11:cells11233711. [PMID: 36496971 PMCID: PMC9739499 DOI: 10.3390/cells11233711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
The worldwide epidemic of obesity is associated with numerous comorbid conditions, including metabolic diseases such as insulin resistance and diabetes, in particular. The situation is likely to worsen, as the increase in obesity rates among children will probably lead to an earlier onset and more severe course for metabolic diseases. The origin of this earlier development of obesity may lie in both behavior (changes in nutrition, physical activity, etc.) and in children's history, as it appears to be at least partly programmed by the fetal/neonatal environment. The concept of the developmental origin of health and diseases (DOHaD), involving both organogenesis and epigenetic mechanisms, encompasses such programming. Epigenetic mechanisms include the action of microRNAs, which seem to play an important role in adipocyte functions. Interestingly, microRNAs seem to play a particular role in propagating local insulin resistance to other key organs, thereby inducing global insulin resistance and type 2 diabetes. This propagation involves the active secretion of exosomes containing microRNAs by adipocytes and adipose tissue-resident macrophages, as well as long-distance communication targeting the muscles and liver, for example. Circulating microRNAs may also be useful as biomarkers for the identification of populations at risk of subsequently developing obesity and metabolic diseases.
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Kytö M, Markussen LT, Marttinen P, Jacucci G, Niinistö S, Virtanen SM, Korhonen TE, Sievänen H, Vähä-Ypyä H, Korhonen I, Heinonen S, Koivusalo SB. Comprehensive self-tracking of blood glucose and lifestyle with a mobile application in the management of gestational diabetes: a study protocol for a randomised controlled trial (eMOM GDM study). BMJ Open 2022; 12:e066292. [PMID: 36344008 PMCID: PMC9644362 DOI: 10.1136/bmjopen-2022-066292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Gestational diabetes (GDM) causes various adverse short-term and long-term consequences for the mother and child, and its incidence is increasing globally. So far, the most promising digital health interventions for GDM management have involved healthcare professionals to provide guidance and feedback. The principal aim of this study is to evaluate the effects of comprehensive and real-time self-tracking with eMOM GDM mobile application (app) on glucose levels in women with GDM, and more broadly, on different other maternal and neonatal outcomes. METHODS AND ANALYSIS This randomised controlled trial is carried out in Helsinki metropolitan area. We randomise 200 pregnant women with GDM into the intervention and the control group at gestational week (GW) 24-28 (baseline, BL). The intervention group receives standard antenatal care and the eMOM GDM app, while the control group will receive only standard care. Participants in the intervention group use the eMOM GDM app with continuous glucose metre (CGM) and activity bracelet for 1 week every month until delivery and an electronic 3-day food record every month until delivery. The follow-up visit after intervention takes place 3 months post partum for both groups. Data are collected by laboratory blood tests, clinical measurements, capillary glucose measures, wearable sensors, air displacement plethysmography and digital questionnaires. The primary outcome is fasting plasma glucose change from BL to GW 35-37. Secondary outcomes include, for example, self-tracked capillary fasting and postprandial glucose measures, change in gestational weight gain, change in nutrition quality, change in physical activity, medication use due to GDM, birth weight and fat percentage of the child. ETHICS AND DISSEMINATION The study has been approved by Ethics Committee of the Helsinki and Uusimaa Hospital District. The results will be presented in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NCT04714762.
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Affiliation(s)
- Mikko Kytö
- Department of IT Management, Helsinki University Hospital, Helsinki, Finland
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Lisa Torsdatter Markussen
- Department of IT Management, Helsinki University Hospital, Helsinki, Finland
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Pekka Marttinen
- Department of Computer Science, Aalto University, Aalto, Finland
| | - Giulio Jacucci
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Sari Niinistö
- Department of Public Health, Welfare Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Suvi M Virtanen
- Department of Public Health and Welfare, The National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, Unit of Health Sciences, University of Tampere, Tampere, Finland
| | - Tuuli E Korhonen
- Department of Public Health, Welfare Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Harri Sievänen
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Henri Vähä-Ypyä
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ilkka Korhonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
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Human milk oligosaccharides in breast milk and 2-year outcome in preterm infants: An exploratory analysis. Clin Nutr 2022; 41:1896-1905. [DOI: 10.1016/j.clnu.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/13/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022]
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Richardson BS, Rajagopaul A, de Vrijer B, Eastabrook G, Regnault TRH. Fetal sex impacts birth to placental weight ratio and umbilical cord oxygen values with implications for regulatory mechanisms. Biol Sex Differ 2022; 13:35. [PMID: 35768846 PMCID: PMC9245359 DOI: 10.1186/s13293-022-00445-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background We determined the effect of fetal sex on birth/placental weight and umbilical vein and artery oxygen values with implications for placental efficiency and regulatory mechanisms underlying fetal–placental growth differences.
Methods A hospital database was used to obtain birth/placental weight, cord PO2 and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA > 34 weeks (N = 69,836). Oxygen saturation was calculated from the cord PO2 and pH data, while fractional O2 extraction was calculated from the oxygen saturation data. The effect of fetal sex on birth/placental weight, cord PO2, O2 saturation, and fractional O2 extraction was examined in all patients adjusting for pregnancy and labor/delivery covariates, and in a subset of low-risk patients. Results Birth/placental weights were lower in females indicating decreased placental efficiency. Umbilical vein oxygen values were higher in females attributed to increased uterine blood flow, while artery oxygen values were lower in females attributed to decreased hemoglobin and umbilical blood flow, and increased oxygen consumption. Fetal O2 extraction was increased in females confirming increased O2 consumption relative to delivery. Conclusions Sex-related differences in uterine/umbilical blood flows, placental development, and fetal O2 consumption can be linked to the differences observed in cord oxygen. The lower umbilical artery oxygen in females as a measure of systemic oxygenation signaling growth could account for their decreased birth weights, while slower development in female placentae could account for their lower placental weights, which could be differentially effected contributing to their lower birth/placental weights. Birth/placental wt is decreased in females as a measure of placental efficiency. Cord vein O2 is increased in females as a measure of placental O2 transport. Cord artery O2 is decreased in females as a measure of fetal systemic O2 levels. Sex differences in placental development link to cord O2-birth/placental wt findings.
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Affiliation(s)
- Bryan S Richardson
- Department of Obstetrics and Gynecology, Western University, London, Canada. .,Department of Physiology and Pharmacology, Western University, London, Canada. .,Department of Pediatrics, Western University, London, Canada. .,Children's Health Research Institute, London, Canada. .,Department of Obstetrics and Gynecology, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road E, London, ON, N6A 5W9, Canada.
| | - Akasham Rajagopaul
- Department of Physiology and Pharmacology, Western University, London, Canada
| | - Barbra de Vrijer
- Department of Obstetrics and Gynecology, Western University, London, Canada.,Children's Health Research Institute, London, Canada
| | - Genevieve Eastabrook
- Department of Obstetrics and Gynecology, Western University, London, Canada.,Children's Health Research Institute, London, Canada
| | - Timothy R H Regnault
- Department of Obstetrics and Gynecology, Western University, London, Canada.,Department of Physiology and Pharmacology, Western University, London, Canada.,Children's Health Research Institute, London, Canada
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The newborn metabolome: associations with gestational diabetes, sex, gestation, birth mode, and birth weight. Pediatr Res 2022; 91:1864-1873. [PMID: 34526650 DOI: 10.1038/s41390-021-01672-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pathways towards many adult-onset conditions begin early in life, even in utero. Maternal health in pregnancy influences this process, but little is known how it affects neonatal metabolism. We investigated associations between pregnancy and birth factors and cord blood metabolomic profile in a large, population-derived cohort. METHODS Metabolites were measured using nuclear magnetic resonance in maternal (28 weeks gestation) and cord serum from 912 mother-child pairs in the Barwon Infant Study pre-birth cohort. Associations between maternal (metabolites, age, BMI, smoking), pregnancy (pre-eclampsia, gestational diabetes (GDM)), and birth characteristics (delivery mode, gestational age, weight, infant sex) with 72 cord blood metabolites were examined by linear regression. RESULTS Delivery mode, sex, gestational age, and birth weight were associated with specific metabolite levels in cord blood, including amino acids, fatty acids, and cholesterols. GDM was associated with higher cord blood levels of acetoacetate and 3-hydroxybutyrate. CONCLUSIONS Neonatal factors, particularly delivery mode, were associated with many cord blood metabolite differences, including those implicated in later risk of cardiometabolic disease. Associations between GDM and higher offspring ketone levels at birth are consistent with maternal ketosis in diabetic pregnancies. Further work is needed to determine whether these neonatal metabolome differences associate with later health outcomes. IMPACT Variations in blood metabolomic profile have been linked to health status in adults and children, but corresponding data in neonates are scarce. We report evidence that pregnancy complications, mode of delivery, and offspring characteristics, including sex, are independently associated with a range of circulating metabolites at birth, including ketone bodies, amino acids, cholesterols, and inflammatory markers. Independent of birth weight, exposure to gestational diabetes is associated with higher cord blood ketone bodies and citrate. These findings suggest that pregnancy complications, mode of delivery, gestational age, and measures of growth influence metabolic pathways prior to birth, potentially impacting later health and development.
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Tan K, Tint MT, Michael N, Yap F, Chong YS, Tan KH, Godfrey KM, Larbi A, Lee YS, Chan SY, Fortier MV, Eriksson JG, Karnani N. Determinants of cord blood adipokines and association with neonatal abdominal adipose tissue distribution. Int J Obes (Lond) 2022; 46:637-645. [PMID: 34864815 PMCID: PMC8873009 DOI: 10.1038/s41366-021-00975-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/09/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cord blood leptin and adiponectin are adipokines known to be associated with birth weight and overall infant adiposity. However, few studies have investigated their associations with abdominal adiposity in neonates. We examined maternal factors associated with cord blood leptin and adiponectin, and the association of these adipokines with neonatal adiposity and abdominal fat distribution measured by magnetic resonance imaging (MRI) in an Asian mother-offspring cohort. METHODS Growing Up in Singapore Towards healthy Outcomes (GUSTO), is a prospective mother-offspring birth cohort study in Singapore. Cord blood plasma leptin and adiponectin concentrations were measured using Luminex and Enzyme-Linked Immunosorbent Assay respectively in 816 infants. A total of 271 neonates underwent MRI within the first 2-weeks after delivery. Abdominal superficial (sSAT), deep subcutaneous (dSAT), and intra-abdominal (IAT) adipose tissue compartment volumes were quantified from MRI images. Multivariable regression analyses were performed. RESULTS Indian or Malay ethnicity, female sex, and gestational age were positively associated with cord blood leptin and adiponectin concentrations. Maternal gestational diabetes (GDM) positively associated with cord blood leptin concentrations but inversely associated with cord blood adiponectin concentrations. Maternal pre-pregnancy body mass index (BMI) showed a positive relationship with cord blood leptin but not with adiponectin concentrations. Each SD increase in cord blood leptin was associated with higher neonatal sSAT, dSAT and IAT; differences in SD (95% CI): 0.258 (0.142, 0.374), 0.386 (0.254, 0.517) and 0.250 (0.118, 0.383), respectively. Similarly, each SD increase in cord blood adiponectin was associated with higher neonatal sSAT and dSAT; differences in SD (95% CI): 0.185 (0.096, 0.274) and 0.173 (0.067, 0.278), respectively. The association between cord blood adiponectin and neonatal adiposity was observed in neonates of obese mothers only. CONCLUSIONS Cord blood leptin and adiponectin concentrations were associated with ethnicity, maternal BMI and GDM, sex and gestational age. Both adipokines showed positive association with neonatal abdominal adiposity.
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Affiliation(s)
- Karen Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
| | - Fabian Yap
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- Department of Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
- National Technological University (NTU)-Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- National Technological University (NTU)-Lee Kong Chian School of Medicine, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital, Southampton, United Kingdom
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
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12
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Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112311565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.
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13
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Alja'nini Z, Merlino-Barr S, Brumfiel A, McNelis K, Viswanathan S, Collin M, Groh-Wargo S. Effect of parenteral nutrition duration on patterns of growth and body composition in very low-birth-weight premature infants. JPEN J Parenter Enteral Nutr 2021; 45:1673-1682. [PMID: 34638161 DOI: 10.1002/jpen.2278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) is essential to support premature infants' growth and varies with enteral nutrition (EN) advancement rates. Data on PN duration's impact on premature infants' growth are limited. The aim of this multicenter observational study was to determine the effect of early PN duration on body composition at term corrected gestational age (CGA) in very low-birth-weight (VLBW) premature infants. METHODS VLBW infants exposed to PN in the first week of life and exposed to significantly different EN regimens were divided into two groups on the basis of early PN duration. Infants with a birth weight (BW) <1000 g and PN duration <28 days and infants with a BW 1000-1500 g and PN duration <14 days were assigned to the "short-PN" group. Infants receiving PN for longer durations were assigned to the "long-PN" group. Body composition was assessed via air displacement plethysmography at term CGA or before discharge. RESULTS Sixty-two and 53 infants were assigned to the short-PN and long-PN groups, respectively. The two groups were significantly different in BW and GA, so a nested case-control study was conducted after matching 36 infant pairs. Infants in the long-PN group had significantly lower fat-free mass (FFM) z-scores, but both groups had comparable fat mass (FM) z-scores. Long PN was a significant negative predictor of FFM z-score in the multivariate regression analysis. CONCLUSION In VLBW premature infants, PN duration is negatively associated with FFM z-scores at term CGA without affecting FM z-scores.
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Affiliation(s)
- Zaineh Alja'nini
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephanie Merlino-Barr
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexa Brumfiel
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kera McNelis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Marc Collin
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
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14
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Zheng Y, Ye PP, Zhou Y, Wu SY, Liu XT, Du B, Tang BH, Kan M, Nie AQ, Yin R, Wang M, Hao GX, Song LL, Yang XM, Huang X, Su LQ, Wang WQ, van den Anker J, Zhao W. LPS-Induced Inflammation Affects Midazolam Clearance in Juvenile Mice in an Age-Dependent Manner. J Inflamm Res 2021; 14:3697-3706. [PMID: 34377007 PMCID: PMC8349217 DOI: 10.2147/jir.s321492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Inflammation has a significant impact on CYP3A activity. We hypothesized that this effect might be age dependent. Our objective was to conduct a population pharmacokinetic study of midazolam in mice at different developmental stages with varying degrees of inflammation to verify our hypothesis. Methods Different doses (2 and 5 mg/kg) of lipopolysaccharide (LPS) were used to induce different degrees of systemic inflammation in Swiss mice (postnatal age 9–42 days, n = 220). The CYP3A substrate midazolam was selected as the pharmacological probe to study CYP3A activity. Postnatal age, current body weight, serum amyloid A protein 1 (SAA1) levels and LPS doses were collected as covariates to perform a population pharmacokinetic analysis using NONMEM 7.2. Results A population pharmacokinetic model of midazolam in juvenile and adult mice was established. Postnatal age and current body weight were the most significant and positive covariates for clearance and volume of distribution. LPS dosage was the most significant and negative covariate for clearance. LPS dosage can significantly reduce the clearance of midazolam by 21.8% and 38.7% with 2 mg/kg and 5 mg/kg, respectively. Moreover, the magnitude of the reduction was higher in mice with advancing postnatal age. Conclusion Both inflammation and ontogeny have an essential role in CYP3A activity in mice. The effect of LPS-induced systemic inflammation on midazolam clearance in mice is dependent on postnatal age.
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Affiliation(s)
- Yi Zheng
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Pan-Pan Ye
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
| | - Yue Zhou
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Su-Ying Wu
- Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Xi-Ting Liu
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Bin Du
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Bo-Hao Tang
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Min Kan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Ai-Qing Nie
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Rui Yin
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Meng Wang
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Guo-Xiang Hao
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
| | - Lin-Lin Song
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
| | - Xin-Mei Yang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
| | - Xin Huang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
| | - Le-Qun Su
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
| | - Wen-Qi Wang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA.,Departments of Pediatrics, Pharmacology & Physiology, Genomics & Precision Medicine, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.,Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Wei Zhao
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China.,Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, 250014, People's Republic of China
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15
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Maternal dietary fat intake during pregnancy and newborn body composition. J Perinatol 2021; 41:1007-1013. [PMID: 33510420 PMCID: PMC8119319 DOI: 10.1038/s41372-021-00922-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/30/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Increased infant birth weight and adiposity are associated with an altered risk of adult chronic diseases. The objective was to investigate the association between maternal dietary fat intake during pregnancy and newborn adiposity. STUDY DESIGN The study included 79 singleton pregnancies. Associations between maternal dietary fat intake during each trimester and infant adiposity at birth were assessed. RESULT Average total grams of maternal total dietary fat and unsaturated fat intake during pregnancy correlated with infant percent body fat after adjusting for potential confounding variables (r = 0.23, p = 0.045; r = 0.24, p = 0.037). Maternal average daily intake of total fat, saturated fat, and unsaturated fat during the second trimester of pregnancy were each associated with infant percent body fat (r = 0.25, p = 0.029; r = 0.23, p = 0.046; r = 0.25, p = 0.031; respectively). CONCLUSIONS The second trimester of pregnancy is a key time period for fetal adipose tissue metabolic programming and therefore a target for nutritional intervention.
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16
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Reliability of routine anthropometric measurements to estimate body composition in term infants. Pediatr Res 2021; 89:1751-1755. [PMID: 32919389 DOI: 10.1038/s41390-020-01136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Birth weight percentiles provide limited information on qualitative infant growth. Body composition provides estimates of fat mass, fat-free mass, and body fat percentage (adiposity). We sought to implement assessment of body composition at birth into clinical practice using a validated anthropometric equation and to evaluate measurement reliability. METHODS Body composition was incorporated into newborn nursery admission procedure. Body fat percentage derived from skinfold measurements performed by clinical nurses were compared to a historical database of similar measurements performed on newborns by experienced research staff. Body Mass Index (BMI) and Ponderal Index (PI) were used as surrogates for adiposity. Comparison of correlations between groups assessed measurement reliability. P < 0.05 was considered significant. RESULTS Nine hundred and ninety-one infants had body composition evaluated. Correlations were similar between BMI and %BF for measurements performed by research and clinical nurses (r2 = 0.82 versus r2 = 0.80; P = 0.142 for the difference between correlation coefficients) demonstrating good reliability. Similar results were found using PI (r2 = 0.58 versus r2 0.53; P = 0.105). CONCLUSIONS Body composition can be assessed at birth using a validated anthropometric equation. Measurements performed by clinical RNs were found to be reliable, allowing for a qualitative measure of growth beyond birth weight. IMPACT Assessment of neonatal body composition at birth can be implemented into routine clinical practice using an anthropometric equation to estimate fat free-mass, fat mass, and percentage body fat. It provides a detailed, reproducible protocol to incorporate into routine practice. Assessment of fat mass, fat-free mass, and adiposity at birth allows for a qualitative measure of intrauterine growth beyond birth weight. Routine assessment of body composition provides a foundation for longitudinal follow-up of metabolic health in infancy and childhood.
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17
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Wiechers C, Balles LS, Kirchhof S, Weber R, Avellina V, Pauluschke-Fröhlich J, Hallschmid M, Fritsche L, Preißl H, Fritsche A, Poets CF, Franz AR. Body composition in term offspring after maternal gestational diabetes does not predict postnatal hypoglycemia. BMC Pediatr 2021; 21:111. [PMID: 33676430 PMCID: PMC7936473 DOI: 10.1186/s12887-021-02578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Offspring of mothers with gestational diabetes mellitus (GDM) have an increased risk of neonatal complications like birth trauma due to macrosomia or postnatal hypoglycemia, as well as long-term metabolic sequelae. Neonatal body composition may be a sensitive marker of metabolic effects on the fetus caused by suboptimal glycemic control during pregnancy. OBJECTIVE To determine body composition in offspring of mothers with GDM compared to a reference cohort of healthy term neonates and to assess whether increased body fat would be associated with postnatal hypoglycemia. METHODS This prospective, observational, cross-sectional study included 311 full-term, singleton infants born between June 2014 and July 2015. Body composition was measured within 96 h of birth using air displacement plethysmography. Results are indicated as median (1st Quartile - 3rd Quartile). RESULTS Of 311 infants, 40 (12.9%) were born to mothers with GDM. Birth weight standard deviation scores (SDS) (0.24 vs. - 0.07, p = 0.04), fat mass (370 g vs. 333 g, p = 0.02) as well as fat mass/total body mass (BF%; 11.4% vs. 10.8%, p = 0.03) were significantly higher in infants following maternal GDM than in controls. In GDM offspring, anthropometric parameters, fat mass or BF% did not differ between infants with or without postnatal hypoglycemia. In this cohort, SDS for birth weight, fat mass, fat free mass, BF% or postnatal hypoglycemia were not associated with maternal blood glucose levels measured at an oral glucose tolerance test. CONCLUSIONS SDS for birth weight, neonatal fat mass, and BF% were significantly higher in newborns following maternal GDM. In these infants born to mothers with GDM, body composition did not differ between those with or without postnatal hypoglycemia.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany.
| | - Lena S Balles
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Sara Kirchhof
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Romy Weber
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Vanessa Avellina
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department of Obstetrics and Gynecology, University Hospital, Eberhard Karls University, Calwerstraße 7, 72076, Tübingen, Germany
| | - Manfred Hallschmid
- Institute for Medical Psychology and Behavioural Neurobiology, Eberhard Karls University, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.,German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany
| | - Louise Fritsche
- German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany
| | - Hubert Preißl
- German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany.,Department of Internal Medicine IV, Eberhard Karls University, Tuebingen, Germany
| | - Andreas Fritsche
- German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany.,Department of Internal Medicine IV, Eberhard Karls University, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Calwerstr. 7, 72076, Tuebingen, Germany.,Center for Pediatric Clinical Studies, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
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18
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Cardoso M, Virella D, Macedo I, Silva D, Pereira-da-Silva L. Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020823. [PMID: 33477964 PMCID: PMC7835734 DOI: 10.3390/ijerph18020823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.
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Affiliation(s)
- Manuela Cardoso
- Nutrition Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, 2890-495 Lisbon, Portugal;
| | - Daniel Virella
- Research Unit, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal;
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
| | - Israel Macedo
- Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, 2890-495 Lisbon, Portugal;
| | - Diana Silva
- Faculdade de Ciências de Nutrição e da Alimentação, Universidade do Porto, 4150-180 Porto, Portugal;
| | - Luís Pereira-da-Silva
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
- Nutrition Lab., Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Medicine of Woman, Childhood and Adolescence, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
- Correspondence: ; Tel.: +351-917-235-528
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19
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Nehab SRG, Villela LD, Abranches AD, Rocha DM, Silva LMLD, Amaral YNV, Junior SCG, Soares FVM, Méio MDBB, Moreira MEL. Influence of gestational and perinatal factors on body composition of full-term newborns. J Pediatr (Rio J) 2020; 96:771-777. [PMID: 31711787 PMCID: PMC9432018 DOI: 10.1016/j.jped.2019.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the influence of gestational and perinatal factors on body composition and birth weight of full-term newborns. METHOD This was a cross-sectional study, within a prospective cohort, consisting of 124 postpartum women and their newborns. Data included the following: maternal age; ethnicity; pre-gestational body mass index; gestational weight gain; parity; gestational morbidities (hypertension and gestational diabetes mellitus); gestational age at birth; birth weight; and newborn's gender. Anthropometric and body composition data of the newborns were collected using air-displacement plethysmography (PeaPod® Infant Body Composition System-LMI; Concord, CA, USA). The stepwise technique was applied to a multiple linear regression model. RESULTS The significant variables in the model that explained 84% of the variation in neonatal fat-free mass were: birth weight; maternal age; newborn's gender and gestational age. For body fat mass: birth weight; newborn's gender; gestational arterial hypertension; gestational diabetes; and gestational weight gain. These variables explained 60% and 46% of fat mass, in grams and as a percentage, respectively. Regarding birth weight, the significant factors were gestational age, pre-gestational BMI, and gestational weight gain. Female newborns showed higher body fat mass and male newborns had higher fat-free mass. CONCLUSION Gestational and perinatal factors influence neonatal body composition. Early identification of these gestational factors, which may be modifiable, is necessary to prevent obesity and chronic noncommunicable diseases in the future.
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Affiliation(s)
- Sylvia Reis Gonçalves Nehab
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Letícia D Villela
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Andrea D Abranches
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Daniele M Rocha
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Leila M L da Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Yasmin N V Amaral
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Saint Clair G Junior
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Fernanda V M Soares
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Maria Dalva Barborsa Beker Méio
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Maria Elisabeth L Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente, Instituto Fernandes Figueira (IFF), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
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20
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Anthropometry-based prediction of body fat in infants from birth to 6 months: the Baby-bod study. Eur J Clin Nutr 2020; 75:715-723. [PMID: 33057177 DOI: 10.1038/s41430-020-00768-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/09/2020] [Accepted: 09/22/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Prediction equations generated from anthropometric measures are frequently used to quantify paediatric body composition. We tested the agreeability and predictive power of select (Lingwood and Aris) fat mass prediction equations against body fat measured via ADP; and generated and evaluated new anthropometry-based models for use in the first 6 months of life. SUBJECTS/METHODS Data were obtained from 278 white European Australian infants at birth, 3 and 6 months. Prediction models (i.e. Baby-bod models) were generated for each time point via stepwise linear regression and compared for agreeability with ADP via limits of agreement, mean difference and total bias in Bland-Altman analyses. Predictive power of all equations in comparison to ADP were assessed using linear regression analysis. RESULTS Overall, there was poor agreeability between percent body fat predicted via published equations and ADP. Proportional bias was detected for both methods (i.e. published equations and Baby-bod models) of body fat prediction. At birth, both Lingwood and BB0 equations overestimated percent body fat at the lower end of the FM spectrum. This trend was repeated at 3 months with all equations displaying a propensity to overestimate body fat at lower FM levels and underestimate at higher FM levels. CONCLUSIONS The results indicate that anthropometry, although less costly and relatively easier to implement, does not always produce comparable results with objective measures such as ADP. Given the importance of the accurate assessment of physical growth, including body composition in early life, it is timely to recommend the increased utilisation of techniques such as ADP.
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21
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Kennedy RAK, Reynolds CME, Cawley S, O'Malley E, McCartney DM, Turner MJ. A web-based dietary intervention in early pregnancy and neonatal outcomes: a randomized controlled trial. J Public Health (Oxf) 2020; 41:371-378. [PMID: 30010835 DOI: 10.1093/pubmed/fdy117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes. METHODS Women <18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women. RESULTS Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05). CONCLUSIONS We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women's engagement and modifies dietary behaviour.
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Affiliation(s)
- R A K Kennedy
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland.,School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin 8, Ireland
| | - C M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland
| | - S Cawley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland.,School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin 8, Ireland
| | - E O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland
| | - D M McCartney
- School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin 8, Ireland
| | - M J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland
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22
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Wallace JM, Milne JS, Aitken BW, Aitken RP, Adam CL. Ovine prenatal growth-restriction and sex influence fetal adipose tissue phenotype and impact postnatal lipid metabolism and adiposity in vivo from birth until adulthood. PLoS One 2020; 15:e0228732. [PMID: 32059008 PMCID: PMC7021317 DOI: 10.1371/journal.pone.0228732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
Adipose tissue development begins in utero and is a key target of developmental programming. Here the influence of nutritionally-mediated prenatal growth-restriction on perirenal adipose tissue (PAT) gene expression and adipocyte phenotype in late fetal life was investigated in both sexes in an ovine model. Likewise circulating leptin concentrations and non-esterified fatty acid (NEFA) and glycerol responses to glucose challenge were determined in relation to offspring adiposity at key stages from birth to mid-adult life. In both studies' singleton-bearing adolescent sheep were fed control or high nutrient intakes to induce normal or growth-restricted pregnancies, respectively. Fetal growth-restriction at day 130 of gestation (32% lighter) was characterised by greater body-weight-specific PAT mass and higher PAT expression of peroxisome proliferator-activated receptor gamma (PPARɤ), glycerol-3-phosphate dehydrogenase, hormone sensitive lipase (HSL), insulin-like growth factor 1 receptor, and uncoupling protein 1. Independent of prenatal growth, females had a greater body-weight-specific PAT mass, more multilocular adipocytes, higher leptin and lower insulin-like growth factor 1 mRNA than males. Growth-restricted offspring of both sexes (42% lighter at birth) were characterised by higher plasma NEFA concentrations across the life-course (post-fasting and after glucose challenge at 7, 32, 60, 85 and 106 weeks of age) consistent with reduced adipose tissue insulin sensitivity. Circulating plasma leptin correlated with body fat percentage (females>males) and restricted compared with normal females had more body fat and increased abundance of PPARɤ, HSL, leptin and adiponectin mRNA in PAT at necropsy (109 weeks). Therefore, prenatal nutrient supply and sex both influence adipose tissue development with consequences for lipid metabolism and body composition persisting throughout the life-course.
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Affiliation(s)
| | - John S Milne
- Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Beth W Aitken
- Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Raymond P Aitken
- Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Clare L Adam
- Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
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23
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Longitudinal body composition assessment in healthy term-born infants until 2 years of age using ADP and DXA with vacuum cushion. Eur J Clin Nutr 2020; 74:642-650. [PMID: 32055012 DOI: 10.1038/s41430-020-0578-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Accelerated gain in fat mass (FM) in early life increases the risk for adult diseases. Longitudinal data on infant body composition are crucial for clinical and research use, but very difficult to obtain due to limited measurement tools and unsuccessful measurements between age 6-24 months. We compared FM% by dual-energy X-ray absorptiometry (DXA), with cushion to reduce movement artifacts, with FM% by air-displacement plethysmography (ADP) and evaluated the reliability of this cushion during DXA by comparing FM% with and without cushion. Subsequently, we constructed sex-specific longitudinal body composition charts from 1-24 months. METHODS In 692 healthy, term-born infants (Sophia Pluto Cohort), FM% was measured by ADP from 1-6 months and DXA with cushion from 6-24 months. At 6 months, FM% was measured in triplicate by ADP and DXA with and without cushion(n = 278), later on in smaller numbers. RESULTS At 6 months, mean FM% by DXA with cushion was 24.1 and by ADP 25.0, mean difference of 0.9% (Bland-Altman p = 0.321, no proportional bias). Mean FM% by DXA without cushion was 12.5% higher compared to ADP (Bland-Altman p < 0.001). DXA without cushion showed higher mean FM% compared to DXA with cushion (+11.6%, p < 0.001) at 6 months. Longitudinally, FM% increased between 1-6 months and decreased from 6-24 months(both p < 0.001). CONCLUSIONS In infants, DXA scan with cushion limits movement artifacts and shows reliable FM%, comparable to ADP. This allowed us to construct longitudinal body composition charts until 24 months. Our study shows that FM% increases from 1-6 months and gradually declines until 24 months.
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24
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Dissanayake HU, Anderson L, McMullan RL, Caterson ID, Hyett JA, Phang M, Raynes-Greenow C, Polson JW, Skilton MR, Gordon A. Influence of maternal and placental factors on newborn body composition. J Paediatr Child Health 2020; 56:224-230. [PMID: 31392795 DOI: 10.1111/jpc.14565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 01/10/2019] [Accepted: 07/03/2019] [Indexed: 11/27/2022]
Abstract
AIM The objective of this study was to assess whether maternal characteristics, placental size or histological chorioamnionitis was associated with newborn body composition. Furthermore, we sought to determine whether placental weight may mediate the association between maternal pre-pregnancy weight and age with newborn body composition. METHODS A cross-sectional study was conducted at Royal Prince Alfred Hospital, Sydney, Australia. This study included 136 healthy, singleton, term-born newborns. Recruitment was stratified by newborn body fat percentiles (gender and gestational adjusted). Body fat was assessed by air displacement plethysmography. Placental examination was conducted by an anatomical pathologist. Maternal (chorioamnionitis) and fetal (chorionic and umbilical vasculitis, funisitis) inflammatory responses were classified according to Redline criteria. RESULTS Maternal pre-pregnancy weight, parity, labour, placental weight and surface area were associated with newborn fat mass and fat-free mass. Gestational diabetes and maternal age were associated with newborn fat mass but not fat-free mass. There was no association between histological chorioamnionitis and newborn body composition; however, spontaneous onset of labour was strongly associated with the presence of histological chorioamnionitis. Only 25-31% of the association of maternal weight and age with newborn fat mass was mediated via the placenta. CONCLUSIONS Maternal factors associated with newborn fat mass and fat-free mass differed, indicating that different mechanisms control fat mass and fat-free mass. Our mediation analysis suggests that placental weight partly mediates the association of maternal factors with newborn body composition. Histological chorioamnionitis was not associated with newborn body composition.
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Affiliation(s)
- Hasthi U Dissanayake
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, D17 - Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Anderson
- Sydney Medical School, D17 - Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Tissue Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rowena L McMullan
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, D17 - Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian D Caterson
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
| | - Jon A Hyett
- Sydney Medical School, D17 - Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Melinda Phang
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jaimie W Polson
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, D17 - Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Sydney Medical School, D17 - Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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25
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Body composition in very preterm infants before discharge is associated with macronutrient intake. Br J Nutr 2020; 123:800-806. [DOI: 10.1017/s000711451900343x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractVery preterm infants experience poor postnatal growth relative to intra-uterine growth rates but have increased percentage body fat (%fat). The aim of the present study was to identify nutritional and other clinical predictors of infant %fat, fat mass (FM) (g) and lean mass (LM) (g) in very preterm infants during their hospital stay. Daily intakes of protein, carbohydrate, lipids and energy were recorded from birth to 34 weeks postmenstrual age (PMA) in fifty infants born <32 weeks. Clinical illness variables and anthropometric data were also collected. Body composition was assessed at 34–37 weeks PMA using the PEA POD Infant Body Composition System. Multiple regression analysis was used to identify independent predictors of body composition (%fat, FM or LM). Birth weight, birth weight z-score and PMA were strong positive predictors of infant LM. After adjustment for these factors, the strongest nutrient predictors of LM were protein:carbohydrate ratios (102–318 g LM/0·1 increase in ratio, P = 0·006–0·015). Postnatal age (PNA) and PMA were the strongest predictors of infant FM or %fat. When PNA and PMA were accounted for a higher intake of energy (–1·41 to –1·61 g FM/kJ per kg per d, P = 0·001–0·012), protein (–75·5 to –81·0 g FM/g per kg per d, P = 0·019–0·038) and carbohydrate (–27·2 to –30·0 g FM/g per kg per d, P = 0·012–0·019) were associated with a lower FM at 34–37 weeks PMA. Higher intakes of energy, protein and carbohydrate may reduce fat accumulation in very preterm infants until at least 34–37 weeks PMA.
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Bruckner M, Khan Z, Binder C, Morris N, Windisch B, Holasek S, Urlesberger B. Extremely Preterm Infants Have a Higher Fat Mass Percentage in Comparison to Very Preterm Infants at Term-Equivalent Age. Front Pediatr 2020; 8:61. [PMID: 32219084 PMCID: PMC7078645 DOI: 10.3389/fped.2020.00061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Early nutritional support of preterm infants is important because it influences long-term health and development. Body composition has an influence on cardiovascular disease, metabolic syndrome, and neurocognitive outcome in the long term. Objective: To assess body composition in preterm infants <32 weeks of gestation at term-equivalent age and to analyze the influence of an optimized nutritional approach. Methods: This is a prespecified secondary outcome analysis of a prospective observational study comparing the body composition in regard to gestational age. The preterm infants were classified according to gestational age as extremely preterm infants (<28 weeks gestation at birth) and very preterm infants (≥28 weeks gestation at birth) and according to weight percentile as appropriate for gestational age and small for gestational age. Body composition was determined by air displacement plethysmography using the PEA POD. The preterm infants obtained nutrition according to the ESPGHAN 2010 Guidelines. Results: Seventy-four preterm infants were analyzed. The mean (SD) gestational age was 28.7 (2.4) weeks, and birth weight was 1,162 (372) g. Fat mass percentage was significantly higher in extremely preterm infants in comparison to very preterm infants [17.0, 95% confidence interval (CI) 15.9-18.1 vs. 15.5, 95% CI 14.7-16.2]. There was no significant difference of fat mass percentage according to weight percentiles. Conclusions: Extremely preterm infants had a significantly higher fat mass percentage compared to very preterm infants at term-equivalent age. There was no significant difference of fat mass percentage according to weight percentiles.
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Affiliation(s)
- Marlies Bruckner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Zahra Khan
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicholas Morris
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernadette Windisch
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Centre, Medical University Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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27
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Wiechers C, Kirchhof S, Balles L, Avelina V, Weber R, Maas C, Pauluschke-Fröhlich J, Hallschmid M, Preißl H, Fritsche A, Poets CF, Franz AR. Neonatal body composition: crossectional study in healthy term singletons in Germany. BMC Pediatr 2019; 19:488. [PMID: 31830928 PMCID: PMC6907196 DOI: 10.1186/s12887-019-1837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND During pregnancy, a variety of factors can influence fetal growth and development. Intrauterine growth may impact on later life and health. Neonatal body composition may be a more sensitive marker for the intrauterine environment than established anthropometric parameters at birth. METHODS To study neonatal body composition determined by air displacement plethysmography in healthy, term singletons as national reference data, and to establish factors impacting on neonatal body composition in this population. This prospective cross-sectional observational study included 271 healthy, full-term, singletons born between June 2014 and July 2015. Body composition was measured within 96 h of birth using air displacement plethysmography. RESULTS Median (Q1, Q2) fat mass / total body mass (BF%) in German singletons was 10.8% (7.7-13.4) and fat free mass (FFM) 2843 g (2606-3099). Female infants had significantly increased BF% compared to male infants (11.2% (8.7-14.0) vs. 9.6% (7.2-12.1)). On multiple regression analysis, BF% and fat mass increased with female gender, maternal pre-pregnancy body mass index, non-smoking mother and parity, whereas FFM increased with male gender and increasing gestational age at birth. Gestational weight gain category, birth mode, and postnatal age at measurement were not associated with BF%, FFM or fat mass. CONCLUSIONS We generated BF% and FFM centiles for healthy, term, singletons born in Germany; these are similar to those found in other European countries. Infant body composition at birth was associated with modifiable (pre-pregnancy body mass index, smoking), and given factors (gender, gestational age at birth, parity).
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Sara Kirchhof
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Lena Balles
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Vanessa Avelina
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Romy Weber
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Christoph Maas
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department of Obstetrics and Gynecology, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Manfred Hallschmid
- Institute for Medical Psychology and Behavioural Neurobiology, Eberhard Karls University, Tuebingen, Germany
- German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany
| | - Hubert Preißl
- German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany
- Department of Internal Medicine IV, Eberhard Karls University, Tuebingen, Germany
| | - Andreas Fritsche
- German Center for Diabetes Research, Eberhard Karls University, Tuebingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the Eberhard Karls University, Tuebingen, Germany
- Department of Internal Medicine IV, Eberhard Karls University, Tuebingen, Germany
| | - Christian F. Poets
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
| | - Axel R. Franz
- Department of Neonatology, University Children’s Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany
- Center for Pediatric Clinical Studies, University Children’s Hospital, Eberhard Karls University, Tuebingen, Germany
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Shaw M, Lutz T, Gordon A. Does low body fat percentage in neonates greater than the 5th percentile birthweight increase the risk of hypoglycaemia and neonatal morbidity? J Paediatr Child Health 2019; 55:1424-1428. [PMID: 30977155 DOI: 10.1111/jpc.14433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/17/2019] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
AIM Low body fat percentage (BF%) has been shown to predict morbidity and possible hypoglycaemia in newborns. Hypoglycaemia in neonates is associated with significant neonatal morbidity. Early detection and prevention are critical. To identify if low BF% (>1 standard deviation below the mean) in non-small-for-gestational-age neonates (>5th percentile body weight) increases the risk of short-term morbidity, with specific attention to hypoglycaemia. METHODS All term neonates who had their BF% measured as part of the Newborn Early Assessment Programme between 28 January 2014 and 9 August 2016 were included in the study. Neonates whose weight was below the 5th percentile and neonates of diabetic mothers were excluded as blood sugar level monitoring is routinely performed on these babies. Neonatal morbidity and blood sugar levels were obtained from electronic records, and the individual patient's paper records were reviewed. A composite score for neonatal morbidity (poor feeding AND hypothermia AND prolonged length of stay) was calculated. Statistics were analysed using SPSS. RESULTS A total of 247 neonates met the inclusion criteria (3.3% of total births). Hypoglycaemia was found in 8.5% of the study population. The risk of hypoglycaemia did not change significantly in neonates with birthweight of the 5th-10th percentile and >10th percentile (8 vs. 8.8%); 4.9% of babies met the combined morbidity criteria. CONCLUSIONS Non-small-for-gestational-age babies (>5th percentile) with low BF% are at risk of hypoglycaemia and short-term morbidity. These infants will not be identified by current hypoglycaemia screening methods in centres that do not measure BF%.
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Affiliation(s)
- Mark Shaw
- Paediatric Department, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Tracey Lutz
- Neonatal Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Medicine Department, University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Neonatal Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Medicine Department, University of Sydney, Sydney, New South Wales, Australia
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Enhanced Protein Diet for Preterm Infants: A Prospective, Randomized, Double-blind, Controlled Trial. J Pediatr Gastroenterol Nutr 2019; 69:218-223. [PMID: 31058772 DOI: 10.1097/mpg.0000000000002376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate dietary protein's effect on fat accretion and weight gain in hospitalized preterm infants. METHODS Prospective, randomized, double-blind, controlled trial of 36 infants born at <32 weeks, hospitalized in a tertiary neonatal intensive care unit. After achieving full enteral volume, infants were randomized to either an enhanced protein diet (EPD) (protein-energy ratio [PER] 4 g/100 calories) or a standard protein diet (SPD) (PER 3 g/100 calories). Macronutrients were calculated using published values for formula, donor milk bank analysis, or weekly analysis of a 24-hour pooled maternal milk sample. Human milk fortifier and/or liquid protein were used to achieve the target PER until discharge or a maximum of 4 weeks. Body composition was measured weekly using air displacement plethysmography. The principal outcomes, rates of weight gain and fat accretion, were compared between groups in linear mixed models. RESULTS Thirty-three infants received approximately 17 days of the study diet. Relative weight gain was 21.6 g · kg · day (95% confidence interval [CI] 19.5-23.8) for the EPD group (n = 16) versus 19.1 g · kg · day (95% CI 17.0-21.2) for the SPD group (n = 17), P = 0.095. Baseline percent fat mass (FM) in the EPD group was 5.15% (95% CI 3.58%-6.72%) compared with 7.29% (95% CI 5.73%-8.84%) in the SPD group, P = 0.0517. Percent FM increased 0.398%/day (95% CI 0.308-0.488) for the EPD group versus 0.284%/day (95% CI 0.190-0.379) for the SPD group (P = 0.0878). CONCLUSIONS Preterm infants with a lower baseline FM percentage who received an EPD demonstrated a more pronounced catch-up percentage of fat accretion.
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Farabi SS, Barbour LA, Heiss K, Hirsch NM, Dunn E, Hernandez TL. Obstructive Sleep Apnea Is Associated With Altered Glycemic Patterns in Pregnant Women With Obesity. J Clin Endocrinol Metab 2019; 104:2569-2579. [PMID: 30794722 PMCID: PMC6701202 DOI: 10.1210/jc.2019-00159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/19/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Often unrecognized, obstructive sleep apnea (OSA) worsens over pregnancy and is associated with poorer perinatal outcomes. The association between OSA in late pregnancy and metabolic biomarkers remains poorly understood. We tested the hypothesis that OSA in pregnant women with obesity is positively correlated with 24-hour patterns of glycemia and IR despite controlling for diet. DESIGN Pregnant women (32 to 34 weeks' gestation; body mass index, 30 to 40 kg/m2) wore a continuous glucose monitor for 3 days. OSA was measured in-home by WatchPAT 200™ [apnea hypopnea index (AHI), oxygen desaturation index (ODI; number per hour)]. Fasting blood was collected followed by a 2-hour, 75-g, oral glucose tolerance test to measure IR. Association between AHI and 24-hour glucose area under the curve (AUC) was the powered outcome. RESULTS Of 18 women (29.4 ± 1.4 years of age [mean ± SEM]), 12 (67%) had an AHI ≥5 (mild OSA). AHI and ODI were correlated with 24-hour glucose AUC (r = 0.50 to 0.54; P ≤ 0.03) and mean 24-hour glucose (r = 0.55 to 0.59; P ≤ 0.02). AHI and ODI were correlated with estimated hepatic IR (r = 0.59 to 0.74; P < 0.01), fasting free fatty acids (fFFAs; r = 0.53 to 0.56; P < 0.05), and waking cortisol (r = 0.49 to 0.64; P < 0.05). CONCLUSIONS Mild OSA is common in pregnant women with obesity and correlated with increased glycemic profiles, fFFAs, and estimates of hepatic IR. OSA is a potentially treatable target to optimize maternal glycemia and metabolism, fetal fuel supply, and pregnancy outcomes.
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Affiliation(s)
- Sarah S Farabi
- Office of Nursing Research, Goldfarb School of Nursing, St. Louis, Missouri
- Correspondence and Reprint Requests: Sarah S. Farabi, PhD, Goldfarb School of Nursing, Office of Nursing Research, Mailstop 90-36-697, 4483 Duncan Avenue, St. Louis, Missouri 63110. E-mail:
| | - Linda A Barbour
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristy Heiss
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nicole M Hirsch
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Emily Dunn
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Teri L Hernandez
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Abstract
Breastfeeding may reduce obesity risk, but this association could be confounded by breastfeeding families' characteristics. We investigated if body composition differs at birth among infants who were either exclusively breast- or formula-fed. We hypothesized the two groups would differ in body composition, even at birth, prior to their post-natal feeding experience. Healthy primiparous carrying singleton pregnancy were recruited at 15 weeks' gestation. PEA POD® measured body composition within 72 hours of delivery and infant feeding was prospectively captured. Out of the 1,152 infants recruited, 117 (10.2%) and 239 (20.7%) went on to be either exclusively breast- or formula-fed, respectively. Breastfed infants were heavier at birth, but their percentage fat mass (FM) was lower than that of exclusively formula-fed infants (covariate adjusted β = -1.91 percentage points of FM; 95% CI -2.82 to -1.01). Differences in intra-uterine exposures, irrespective of early diet, may partly explain an infant's obesity risk.
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Dissanayake HU, McMullan RL, Gordon A, Caterson ID, Celermajer DS, Phang M, Raynes-Greenow C, Skilton MR, Polson JW. Noninvasive assessment of autonomic function in human neonates born at the extremes of fetal growth spectrum. Physiol Rep 2019; 6:e13682. [PMID: 29687617 PMCID: PMC5913591 DOI: 10.14814/phy2.13682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 01/23/2023] Open
Abstract
Birth weight is associated with adult cardiovascular disease, such that those at both ends of the spectrum are at increased risk. This may be driven in part by modification to autonomic control, a mechanistic contributor to hypertension. However, birth weight is a relatively crude surrogate of fetal growth; and newborn body composition may more accurately identify the "at risk" infant. Accordingly, we sought to determine whether newborns with high or low body fat have altered autonomic control of vasomotor function and cardiac contractility. Body fat was assessed by air-displacement plethysmography <24 h postnatal. Measures of spontaneous baroreflex sensitivity (sBRS), blood pressure variability (BPV), and dP/dtmax variability were compared between newborns categorized according to established body fat percentiles: high body fat (HBF, >90th percentile, n = 7), low body fat (LBF, ≤10th percentile, n = 12), and normal body fat (control, >25th to ≤75th percentile, n = 23). BPV was similar across body fat percentiles; similarly, low frequency dP/dtmax variability was similar across body fat percentiles. sBRS was reduced in HBF compared to controls (11.0 ± 6.0 vs. 20.1 ± 9.4 msec/mmHg, P = 0.03), but LBF did not differ (18.4 ± 6.0 msec/mmHg, P = 0.80). Across the entire body fat spectrum (n = 62), there was a nonlinear association between newborn body fat and sBRS (P = 0.03) that was independent of birth weight (P = 0.04). Autonomic modulation of vasomotor function and cardiac contractility in the newborn did not differ by body fat, but newborns born with high body fat show depressed baroreflex sensitivity.
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Affiliation(s)
- Hasthi U Dissanayake
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, D17- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rowena L McMullan
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, D17- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Sydney Medical School, D17- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian D Caterson
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
| | - David S Celermajer
- Sydney Medical School, D17- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Melinda Phang
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Medical School, D17- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Jaimie W Polson
- School of Medical Sciences & Bosch Institute, The University of Sydney, Sydney, New South Wales, Australia
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Norris T, Ramel SE, Catalano P, Caoimh CN, Roggero P, Murray D, Fields DA, Demerath EW, Johnson W. New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life. Am J Clin Nutr 2019; 109:1353-1360. [PMID: 31051509 DOI: 10.1093/ajcn/nqy377] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/10/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Air-displacement plethysmography (ADP) is a good candidate for monitoring body composition in newborns and young infants, but reference centile curves are lacking that allow for assessment at birth and across the first 6 mo of life. OBJECTIVE Using pooled data from 4 studies, we aimed to produce new charts for assessment according to gestational age at birth (30 + 1 to 41 + 6 wk) and postnatal age at measurement (1-27 wk). METHODS The sample comprised 222 preterm infants born in the United States who were measured at birth; 1029 term infants born in Ireland who were measured at birth; and 149 term infants born in the United States and 57 term infants born in Italy who were measured at birth, 1 and 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Infants whose birth weights were <3rd or >97th centile of the INTERGROWTH-21st standard were excluded, thereby ensuring that the charts depict body composition of infants whose birth weights did not indicate suboptimal fetal growth. Sex-specific centiles for fat mass (kg), fat-free mass (kg), and percentage body fat were estimated using the lambda-mu-sigma (LMS) method. RESULTS For each sex and measure (e.g., fat mass), the new charts comprised 2 panels. The first showed centiles according to gestational age, allowing term infants to be assessed at birth and preterm infants to be monitored until they reached term. The second showed centiles according to postnatal age, allowing all infants to be monitored to age 27 wk. The LMS values underlying the charts were presented, enabling researchers and clinicians to convert measurements to centiles and z scores. CONCLUSIONS The new charts provide a single tool for the assessment of body composition, according to ADP, in infants across the first 6 mo of life and will help enhance early-life nutritional management.
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Affiliation(s)
- Tom Norris
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Sara E Ramel
- Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Patrick Catalano
- Maternal Infant Research Institute, Tufts University School of Medicine, Friedman School of Nutrition Science and Policy, Boston, MA
| | - Carol Ni Caoimh
- Irish Centre for Fetal and Neonatal Translational Research (INFANT) Centre, University College Cork, Cork, Ireland
| | - Paola Roggero
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione I.R.C.C.S. "Ca' Granda" Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Deirdre Murray
- Departments of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center and CMRI Metabolic Research Program, Oklahoma City, OK
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Lowe WL, Lowe LP, Kuang A, Catalano PM, Nodzenski M, Talbot O, Tam WH, Sacks DA, McCance D, Linder B, Lebenthal Y, Lawrence JM, Lashley M, Josefson JL, Hamilton J, Deerochanawong C, Clayton P, Brickman WJ, Dyer AR, Scholtens DM, Metzger BE. Maternal glucose levels during pregnancy and childhood adiposity in the Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study. Diabetologia 2019; 62:598-610. [PMID: 30648193 PMCID: PMC6421132 DOI: 10.1007/s00125-018-4809-6] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/12/2018] [Indexed: 01/04/2023]
Abstract
AIMS/HYPOTHESIS Maternal type 2 diabetes during pregnancy and gestational diabetes are associated with childhood adiposity; however, associations of lower maternal glucose levels during pregnancy with childhood adiposity, independent of maternal BMI, remain less clear. The objective was to examine associations of maternal glucose levels during pregnancy with childhood adiposity in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) cohort. METHODS The HAPO Study was an observational epidemiological international multi-ethnic investigation that established strong associations of glucose levels during pregnancy with multiple adverse perinatal outcomes. The HAPO Follow-up Study (HAPO FUS) included 4832 children from ten HAPO centres whose mothers had a 75 g OGTT at ~28 weeks gestation 10-14 years earlier, with glucose values blinded to participants and clinical caregivers. The primary outcome was child adiposity, including: (1) being overweight/obese according to sex- and age-specific cut-offs based on the International Obesity Task Force (IOTF) criteria; (2) IOTF-defined obesity only; and (3) measurements >85th percentile for sum of skinfolds, waist circumference and per cent body fat. Primary predictors were maternal OGTT and HbA1c values during pregnancy. RESULTS Fully adjusted models that included maternal BMI at pregnancy OGTT indicated positive associations between maternal glucose predictors and child adiposity outcomes. For one SD difference in pregnancy glucose and HbA1c measures, ORs for each child adiposity outcome were in the range of 1.05-1.16 for maternal fasting glucose, 1.11-1.19 for 1 h glucose, 1.09-1.21 for 2 h glucose and 1.12-1.21 for HbA1c. Associations were significant, except for associations of maternal fasting glucose with offspring being overweight/obese or having waist circumference >85th percentile. Linearity was confirmed in all adjusted models. Exploratory sex-specific analyses indicated generally consistent associations for boys and girls. CONCLUSIONS/INTERPRETATION Exposure to higher levels of glucose in utero is independently associated with childhood adiposity, including being overweight/obese, obesity, skinfold thickness, per cent body fat and waist circumference. Glucose levels less than those diagnostic of diabetes are associated with greater childhood adiposity; this may have implications for long-term metabolic health.
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Affiliation(s)
- William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Lynn P Lowe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alan Kuang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patrick M Catalano
- MetroHealth Medical Center, Cleveland, OH, USA
- Nutrition Obesity Research Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Nodzenski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Octavious Talbot
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Wing-Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - David A Sacks
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Yael Lebenthal
- Schneider Children's Medical Center of Israel, Petah-Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Michele Lashley
- School of Clinical Medicine and Research, Queen Elizabeth Hospital, University of the West Indies, St Michael, Barbados
| | - Jami L Josefson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Jill Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Peter Clayton
- Royal Manchester Children's Hospital, Royal Manchester University Hospitals, NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Wendy J Brickman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Alan R Dyer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Boyd E Metzger
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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The relationship between IGF-I and -II concentrations and body composition at birth and over the first 2 months. Pediatr Res 2019; 85:687-692. [PMID: 30745570 PMCID: PMC6435390 DOI: 10.1038/s41390-019-0331-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/26/2019] [Accepted: 02/01/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Insulin-like growth factor (IGF)-I and -II play an important role in prenatal growth. During the first 2 months from birth, body fat doubles, and rapid weight gain during this time increases future risk of cardiometabolic disease. The aim of this study was to determine whether IGF measurements at birth associate with body composition and the trajectory of its changes in the first 2 months. METHODS Umbilical cord IGF-I and -II concentrations were measured in term infants. Air displacement plethysmography was performed at birth and 2 months. Fat mass (FM) and fat-free mass (FFM) were corrected for infant length (L) to FM/L3 and FFM/L2, respectively. RESULTS In 601 (317 male) infants, IGF-I concentrations at birth were associated with FM/L3 and FFM/L2 Z-scores at birth (R2 = 0.05 and 0.04, respectively, P < 0.001), and IGF-II concentrations were associated with FFM/L2 Z-scores at birth (R2 = 0.01, P = 0.02). Lower IGF-I concentrations were weakly associated with increases in FM/L3 Z-scores over the first 2 months (R2 = 0.01, P = 0.003). CONCLUSION IGF-I concentrations at birth are associated with adiposity and lean mass at birth and inversely with the trajectory of FM accumulation over the first 2 months. IGF-I measurements only account for a small amount of the variance in these measures.
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Andersson-Hall UK, Järvinen EAJ, Bosaeus MH, Gustavsson CE, Hårsmar EJ, Niklasson CA, Albertsson-Wikland KG, Holmäng AB. Maternal obesity and gestational diabetes mellitus affect body composition through infancy: the PONCH study. Pediatr Res 2019; 85:369-377. [PMID: 30705398 DOI: 10.1038/s41390-018-0248-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND To determine how maternal obesity or gestational diabetes mellitus (GDM) affect infant body size and body composition during the first year of life. METHODS Eighty three normal-weight (NW) women, 26 obese (OB) women, and 26 women with GDM were recruited during pregnancy. Infant body composition was determined by air-displacement plethysmography at 1 and 12 weeks, and anthropometric measurements made until 1 year of age. RESULTS Girl infants born to OB women and women with GDM had a higher body-fat percentage (BF%) at 1 and 12 weeks of age than girls born to NW women. Girls had higher BF% than boys in OB and GDM groups only. Maternal HbA1c and fasting plasma glucose correlated with girl infant BF% at 1 week of age. Maternal weight at start of pregnancy correlated with birthweight in NW and OB groups, but not the GDM group. OB group infants showed greater BMI increases from 1 week to 1 year than both NW and GDM group infants. CONCLUSION Results show that both maternal glycaemia and obesity are determinants of increased early life adiposity, especially in girls, with glycaemic levels being more influential than maternal weight for infants born to women with GDM.
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Affiliation(s)
- Ulrika K Andersson-Hall
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Evelina A J Järvinen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marja H Bosaeus
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carolina E Gustavsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ellen J Hårsmar
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Aimon Niklasson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Agneta B Holmäng
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dahly DL, Li X, Smith HA, Khashan AS, Murray DM, Kiely ME, O'B Hourihane J, McCarthy FP, Kenny LC, Kearney PM. Associations between maternal lifestyle factors and neonatal body composition in the Screening for Pregnancy Endpoints (Cork) cohort study. Int J Epidemiol 2019; 47:131-145. [PMID: 29136159 DOI: 10.1093/ije/dyx221] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal body composition likely mediates fetal influences on life long chronic disease risk. A better understanding of how maternal lifestyle is related to newborn body composition could thus inform intervention efforts. Methods Using Cork participant data (n = 1754) from the Screening for Pregnancy Endpoints (SCOPE) cohort study [ECM5(10)05/02/08], we estimated how pre-pregnancy body size, gestational weight gain, exercise, alcohol, smoking and diet were related to neonatal fat and fat-free mass, as well as length and gestational age at birth, using quantile regression. Maternal factors were measured by a trained research midwife at 15 gestational weeks, in addition to a 3rd trimester weight measurement used to calculate weight gain. Infant body composition was measured using air-displacement plethysmography. Results Healthy (versus excess) gestational weight gain was associated with lower median fat-free mass [-112 g, 95% confidence interval (CI): -47 to -176) and fat mass (-33 g, 95% CI: -1 to -65) in the offspring; and a 103 g decrease in the 95th centile of fat mass (95% CI: -33 to -174). Maternal normal weight status (versus obesity) was associated with lower median fat mass (-48 g, 95% CI: -12 to -84). At the highest centiles, fat mass was lower among infants of women who engaged in frequent moderate-intensity exercise early in the pregnancy (-92 g at the 95th centile, 95% CI: -168 to -16). Lastly, women who never smoked tended to have longer babies with more fat mass and fat-free mass. No other lifestyle factors were strongly related to infant body composition. Conclusions These results suggest that supporting healthy maternal lifestyles could reduce the risk of excess fat accumulation in the offspring, without adversely affecting fat-free mass development, length or gestational age.
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Affiliation(s)
- Darren L Dahly
- HRB Clinical Research Facility Cork.,School of Public Health, University College Cork, Cork, Ireland
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland.,Irish Centre for Fetal and Neonatal Translational Research (INFANT)
| | - Deirdre M Murray
- Department of Paediatrics and Child Health.,Irish Centre for Fetal and Neonatal Translational Research (INFANT)
| | - Mairead E Kiely
- Department of Paediatrics and Child Health.,Department of Food Science and Nutrition, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Department of Paediatrics and Child Health.,Irish Centre for Fetal and Neonatal Translational Research (INFANT)
| | - Fergus P McCarthy
- Department of Paediatrics and Child Health.,Women's Health Academic Centre KHP, St Thomas's Hospital, London, UK
| | - Louise C Kenny
- Irish Centre for Fetal and Neonatal Translational Research (INFANT)
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Roy SM, Fields DA, Mitchell JA, Hawkes CP, Kelly A, Wu GD, DeRusso PA, Elovitz MA, Ford E, Drigo D, Zemel BS, McCormack SE. Body Mass Index Is a Better Indicator of Body Composition than Weight-for-Length at Age 1 Month. J Pediatr 2019; 204:77-83.e1. [PMID: 30268397 PMCID: PMC6309630 DOI: 10.1016/j.jpeds.2018.08.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/24/2018] [Accepted: 08/07/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess whether body mass index (BMI) provides a better assessment of measured adiposity at age 1 month compared with weight-for-length (WFL). STUDY DESIGN Participants were healthy term-born infants in the Infant Growth and Microbiome (n = 146) and the Baby Peas (n = 147) studies. Length, weight, and body composition by air displacement plethysmography were measured at 1 month. World Health Organization-based WFL and BMI z-scores were calculated. Within-cohort z-scores of percent fat-Z, fat mass-Z, fat mass/length2-Z, fat mass/length3-Z, fat-free mass-Z, and fat-free mass/length2-Z were calculated. Correlation and multiple linear regression (adjusted for birth weight) analyses tested the associations between body composition outcomes and BMI-Z vs WFL-Z. Quantile regression was used to test the stability of these associations across the distribution of body compositions. RESULTS The sample was 52% female and 56% African American. Accounting for birth weight, both BMI-Z and WFL-Z were strongly associated with fat mass-Z (coefficients 0.56 and 0.35, respectively), FM/L2-Z (0.73 and 0.51), and FM/L3-Z (0.79 and 0.58), with stronger associations for BMI-Z compared with WFL-Z (P < .05). Even after accounting statistically for birth weight, BMI-Z was persistently more strongly associated than WFL-Z with body composition outcomes across the distribution of body composition outcomes. CONCLUSIONS We demonstrate in 2 distinct cohorts that BMI is a better indicator of adiposity in early infancy compared with WFL. Our findings support the preferred use of BMI for growth and nutritional status assessment in infancy.
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Affiliation(s)
- Sani M Roy
- Division of Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - David A Fields
- Division of Endocrinology and Diabetes, Oklahoma University Health Sciences Center, Oklahoma City, OK
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gary D Wu
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patricia A DeRusso
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michal A Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eileen Ford
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Danielle Drigo
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shana E McCormack
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Alur P. Sex Differences in Nutrition, Growth, and Metabolism in Preterm Infants. Front Pediatr 2019; 7:22. [PMID: 30792973 PMCID: PMC6374621 DOI: 10.3389/fped.2019.00022] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/18/2019] [Indexed: 01/07/2023] Open
Abstract
Biological differences between the sexes are apparent even from the early part of the pregnancy. The crown-rump length is larger in male fetuses compared to females in the first trimester. Placentae of male and female fetuses have different protein and gene expressions, especially in adverse conditions. Even within the intrauterine milieu, the same extracellular micro RNA may show upregulation in females and downregulation in male fetuses. There appears to be a natural survival advantage for females. Maternal glucocorticoids (GC) play an important role in fetal growth and organ maturation. However, excess glucocorticoids can not only affect growth but the response may be sex-specific and probably mediated through glucocorticoid receptors (GR) in the placenta. Mild pre-eclampsia and asthma are associated with normal growth pattern in males, but in female fetuses, they are associated with a slowing of growth rate without causing IUGR probably as an adaptive response for future adverse events. Thus, female fetuses survive while male fetuses exhibit IUGR, preterm delivery and even death in the face of another adverse event. It is thought that the maternal diet may not influence growth but may influence the programming for adult disease. There is growing evidence that maternal pre-pregnancy overweight or obesity status is directly associated with a higher risk of obesity in a male child, but not in a female child, at 1 year of age. It is observed that exposure to gestational diabetes is a risk factor for childhood overweight in boys but not in girls. It is fascinating that male and female fetuses respond differently to the same intrauterine environment, and this suggests a fundamental biological variation most likely at the cellular and molecular level.
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Affiliation(s)
- Pradeep Alur
- Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
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Barbour LA, Hernandez TL. Maternal Lipids and Fetal Overgrowth: Making Fat from Fat. Clin Ther 2018; 40:1638-1647. [PMID: 30236792 PMCID: PMC6195465 DOI: 10.1016/j.clinthera.2018.08.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022]
Abstract
There is increasing recognition that maternal glucose concentrations lower than those previously used for diagnosis of gestational diabetes mellitus (GDM) and targeted for treatment can result in excess fetal growth. Yet, mothers with GDM who appear to have optimal glycemic control and mothers with obesity and normal glucose tolerance still have a significantly increased risk for delivering infants who are large for gestational age, or even more importantly, who have increased adiposity at birth. What is less appreciated is that in addition to glucose, maternal lipids are also substrates for fetal fat accretion and that placental lipases can hydrolyze maternal triglycerides (TGs) to free fatty acids for fetal-placental availability. Maternal TG levels are 40% to 50% higher on average in mothers with obesity and GDM compared to those in normal-weight mothers early in pregnancy and are sustained at higher levels throughout gestation. Increasing evidence supports that maternal TG, both fasting and postprandial, are also predictors of newborn adiposity (newborn %fat), a risk factor for childhood obesity, and that early exposure is at least as strong of a risk factor as later exposure in mothers with obesity. In the setting of maternal nutrient excess and maternal insulin resistance, which lead to fetal hyperinsulinemia, excess free fatty acid exposure in the fetus may result in lipid storage and fetal fat development in subcutaneous and possibly other depots. In this commentary, we provide further evidence to make a case for targeting maternal fasting and postprandial TG in mothers with obesity who have elevated TG in early pregnancy to determine whether a TG-lowering interventional approach might limit fetal overgrowth and potentially mitigate the intrauterine contribution to childhood obesity and metabolic disease.
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Affiliation(s)
- Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes. University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes. University of Colorado, Anschutz Medical Campus, Aurora, Colorado; College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Dissanayake HU, McMullan RL, Kong Y, Caterson ID, Celermajer DS, Phang M, Raynes-Greenow C, Polson JW, Gordon A, Skilton MR. Body Fatness and Cardiovascular Health in Newborn Infants. J Clin Med 2018; 7:jcm7090270. [PMID: 30208579 PMCID: PMC6162858 DOI: 10.3390/jcm7090270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/04/2018] [Accepted: 09/08/2018] [Indexed: 11/16/2022] Open
Abstract
Birth weight is associated with cardiovascular disease, with those at both ends of the spectrum at increased risk. However, birth weight is a crude surrogate of fetal growth. Measures of body composition may more accurately identify high risk infants. We aimed to determine whether aortic wall thickening, cardiac autonomic control, and cardiac structure/function differ in newborns with high or low body fatness compared to those with average body fatness. 189 healthy singleton term born neonates were recruited and stratified by body fat percentiles (sex and gestation-specific). Infants with low body fat had higher aortic intima-media thickness (43 µm (95% confidence interval (CI) 7, 78), p = 0.02), lower heart rate variability (log total power, -0.5 (95% CI -0.8, -0.1), p = 0.008), and thicker ventricular walls (posterior wall thickness, 3.1 mm (95% CI 1.6, 4.6), p < 0.001) compared to infants with average body fatness. Infants with high body fat showed no differences in aortic intima-media thickness (-2 µm (95% CI -37, 33), p = 0.91) or cardiac structure compared to average body fatness, although stroke volume (-0.3 mL/kg (95% CI -0.6, -0.0), p = 0.003) and heart rate variability were lower (log total power, -0.8 (95% CI -1.1, -0.5), p < 0.001). The non-linear association of body fatness with heart rate variability was independent of birth weight. Infants born with low or high body fat have altered markers of cardiovascular health. Assessment of body fatness alongside birth weight may assist in identifying high risk individuals.
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Affiliation(s)
- Hasthi U Dissanayake
- Boden Institute of Obesity, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Rowena L McMullan
- Boden Institute of Obesity, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Yang Kong
- Boden Institute of Obesity, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Ian D Caterson
- Boden Institute of Obesity, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
| | - David S Celermajer
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Melinda Phang
- Boden Institute of Obesity, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Jaimie W Polson
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
- School of Medical Sciences & Bosch Institute, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Adrienne Gordon
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Michael R Skilton
- Boden Institute of Obesity, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia.
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Dearden L, Bouret SG, Ozanne SE. Sex and gender differences in developmental programming of metabolism. Mol Metab 2018; 15:8-19. [PMID: 29773464 PMCID: PMC6066743 DOI: 10.1016/j.molmet.2018.04.007] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The early life environment experienced by an individual in utero and during the neonatal period is a major factor in shaping later life disease risk-including susceptibility to develop obesity, diabetes, and cardiovascular disease. The incidence of metabolic disease is different between males and females. How the early life environment may underlie these sex differences is an area of active investigation. SCOPE OF REVIEW The purpose of this review is to summarize our current understanding of how the early life environment influences metabolic disease risk in a sex specific manner. We also discuss the possible mechanisms responsible for mediating these sexually dimorphic effects and highlight the results of recent intervention studies in animal models. MAJOR CONCLUSIONS Exposure to states of both under- and over-nutrition during early life predisposes both sexes to develop metabolic disease. Females seem particularly susceptible to develop increased adiposity and disrupted glucose homeostasis as a result of exposure to in utero undernutrition or high sugar environments, respectively. The male placenta is particularly vulnerable to damage by adverse nutritional states and this may underlie some of the metabolic phenotypes observed in adulthood. More studies investigating both sexes are needed to understand how changes to the early life environment impact differently on the long-term health of male and female individuals.
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Affiliation(s)
- Laura Dearden
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Cambridge, CB2 0QQ, United Kingdom
| | - Sebastien G Bouret
- The Saban Research Institute, Developmental Neuroscience Program & Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, 90027, USA; Inserm, Jean-Pierre Aubert Research Center, U1172, University Lille 2, Lille, 59045, France
| | - Susan E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Treatment Centre, Addenbrooke's Hospital, Level 4, Box 289, Cambridge, CB2 0QQ, United Kingdom.
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Barbour LA, Farabi SS, Friedman JE, Hirsch NM, Reece MS, Van Pelt RE, Hernandez TL. Postprandial Triglycerides Predict Newborn Fat More Strongly than Glucose in Women with Obesity in Early Pregnancy. Obesity (Silver Spring) 2018; 26:1347-1356. [PMID: 29931812 PMCID: PMC6107410 DOI: 10.1002/oby.22246] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/04/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Maternal obesity (OB) accounts for the majority of large-for-gestational-age infants, and newborn percent fat (NB%fat) correlates strongest with childhood OB. In addition to maternal glucose, fasting triglycerides (TGs) may contribute, but postprandial triglycerides (PPTGs) are unstudied. It was hypothesized that fasting TGs and PPTGs are higher in women with OB compared with women with normal weight (NW) throughout pregnancy, correlate more strongly with NB%fat than glucose, and may relate to dietary chylomicron TGs. METHODS Fasting TGs and PPTGs, free fatty acids, glucose, and insulin were prospectively measured 10 times over 4 hours after a controlled liquid breakfast early (14-16 weeks) and later (26-28 weeks) in pregnancy in 27 mothers with NW and 27 with OB. NB%fat was measured by dual x-ray absorptometry. RESULTS Fasting TGs and PPTGs were already ≥ 30% higher in mothers with OB at 14 to 16 weeks (P < 0.001) versus mothers with NW. In mothers with OB, a simple 1-hour (r = 0.71; P < 0.01) or 2-hour (r = 0.69; P < 0.01) PPTG at 14 to 16 weeks correlated strongest with NB%fat. In mothers with NW, the increase in TGs from early to later pregnancy correlated strongest with NB%fat (r = 0.57; P < 0.01). Maternal glucose did not statistically add to prediction models. CONCLUSIONS These novel data suggest that 1- or 2-hour PPTGs might be a new target for early intervention in pregnancies with OB to prevent excess newborn adiposity and attenuate child OB risk.
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Affiliation(s)
- Linda A Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah S Farabi
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jacob E Friedman
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, Section of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicole M Hirsch
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Melanie S Reece
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachael E Van Pelt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Air displacement plethysmography (pea pod) in full-term and pre-term infants: a comprehensive review of accuracy, reproducibility, and practical challenges. Matern Health Neonatol Perinatol 2018; 4:12. [PMID: 29951209 PMCID: PMC6011189 DOI: 10.1186/s40748-018-0079-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/20/2018] [Indexed: 01/03/2023] Open
Abstract
Air displacement plethysmography (ADP) has been widely utilised to track body composition because it is considered to be practical, reliable, and valid. Pea Pod is the infant version of ADP that accommodates infants up to the age of 6 months and has been widely utilised to assess the body composition of full-term infants, and more recently pre-term infants. The primary goal of this comprehensive review is to 1) discuss the accuracy/reproducibility of Pea Pod in both full- and pre-term infants, 2) highlight and discuss practical challenges and potential sources of measurement errors in relation to Pea Pod operating principles, and 3) make suggestions for future research direction to overcome the identified limitations.
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Frondas-Chauty A, Simon L, Flamant C, Hanf M, Darmaun D, Rozé JC. Deficit of Fat Free Mass in Very Preterm Infants at Discharge is Associated with Neurological Impairment at Age 2 Years. J Pediatr 2018; 196:301-304. [PMID: 29336797 DOI: 10.1016/j.jpeds.2017.12.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/11/2017] [Accepted: 12/06/2017] [Indexed: 01/02/2023]
Abstract
Preterm infants have a deficit of fat-free mass accretion during hospitalization. This study suggests that z score of fat-free mass at discharge is associated with neurologic outcome (P = .003) at 2 years of age, independent of sex, gestational age, and birth weight z score. Interventions to promote quality of growth should be considered.
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Affiliation(s)
- Anne Frondas-Chauty
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France; INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France.
| | - Laure Simon
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France; INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France
| | - Cyril Flamant
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France; INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France; INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France; INSERM UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Versailles Saint Quentin University, Villejuif, France
| | - Dominique Darmaun
- INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France; Nantes University, IMAD, Nantes, France
| | - Jean-Christophe Rozé
- Department of Neonatal Medicine, University Hospital of Nantes, Nantes, France; INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, IMAD, CRNH Ouest, Nantes, France; INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
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Huvanandana J, Carberry AE, Turner RM, Bek EJ, Raynes-Greenow CH, McEwan AL, Jeffery HE. An anthropometric approach to characterising neonatal morbidity and body composition, using air displacement plethysmography as a criterion method. PLoS One 2018; 13:e0195193. [PMID: 29601596 PMCID: PMC5877876 DOI: 10.1371/journal.pone.0195193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
Background With the greatest burden of infant undernutrition and morbidity in low and middle income countries (LMICs), there is a need for suitable approaches to monitor infants in a simple, low-cost and effective manner. Anthropometry continues to play a major role in characterising growth and nutritional status. Methods We developed a range of models to aid in identifying neonates at risk of malnutrition. We first adopted a logistic regression approach to screen for a composite neonatal morbidity, low and high body fat (BF%) infants. We then developed linear regression models for the estimation of neonatal fat mass as an assessment of body composition and nutritional status. Results We fitted logistic regression models combining up to four anthropometric variables to predict composite morbidity and low and high BF% neonates. The greatest area under receiver-operator characteristic curves (AUC with 95% confidence intervals (CI)) for identifying composite morbidity was 0.740 (0.63, 0.85), resulting from the combination of birthweight, length, chest and mid-thigh circumferences. The AUCs (95% CI) for identifying low and high BF% were 0.827 (0.78, 0.88) and 0.834 (0.79, 0.88), respectively. For identifying composite morbidity, BF% as measured via air displacement plethysmography showed strong predictive ability (AUC 0.786 (0.70, 0.88)), while birthweight percentiles had a lower AUC (0.695 (0.57, 0.82)). Birthweight percentiles could also identify low and high BF% neonates with AUCs of 0.792 (0.74, 0.85) and 0.834 (0.79, 0.88). We applied a sex-specific approach to anthropometric estimation of neonatal fat mass, demonstrating the influence of the testing sample size on the final model performance. Conclusions These models display potential for further development and evaluation in LMICs to detect infants in need of further nutritional management, especially where traditional methods of risk management such as birthweight for gestational age percentiles may be variable or non-existent, or unable to detect appropriately grown, low fat newborns.
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Affiliation(s)
- Jacqueline Huvanandana
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
- * E-mail:
| | - Angela E. Carberry
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Robin M. Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Emily J. Bek
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Alistair L. McEwan
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Heather E. Jeffery
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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Heerwagen MJR, Gumina DL, Hernandez TL, Van Pelt RE, Kramer AW, Janssen RC, Jensen DR, Powell TL, Friedman JE, Winn VD, Barbour LA. Placental lipoprotein lipase activity is positively associated with newborn adiposity. Placenta 2018; 64:53-60. [PMID: 29626981 DOI: 10.1016/j.placenta.2018.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 03/04/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recent data suggest that in addition to glucose, fetal growth is related to maternal triglycerides (TG). To reach the fetus, TG must be hydrolyzed to free fatty acids (FFA) and transported across the placenta, but regulation is uncertain. Placental lipoprotein lipase (pLPL) hydrolyzes TG, both dietary chylomicron TG (CM-TG) and very-low density lipoprotein TG (VLDL-TG), to FFA. This may promote fetal fat accretion by increasing the available FFA pool for placental uptake. We tested the novel hypothesis that pLPL activity, but not maternal adipose tissue LPL activity, is associated with newborn adiposity and higher maternal TG. METHODS Twenty mothers (n = 13 normal-weight; n = 7 obese) were prospectively recruited. Maternal glucose, insulin, TG (total, CM-TG, VLDL-TG), and FFA were measured at 14-16, 26-28, and 36-37 weeks, and adipose tissue LPL was measured at 26-28 weeks. At term delivery, placental villous biopsies were immediately analyzed for pLPL enzymatic activity. Newborn percent body fat (newborn %fat) was assessed by skinfolds. RESULTS Placental LPL activity was positively correlated with birthweight (r = 0.48;P = 0.03) and newborn %fat (r = 0.59;P = 0.006), further strengthened by correcting for gestational age at delivery (r = 0.75;P = 0.0001), but adipose tissue LPL was not. Maternal TG and BMI were not correlated with pLPL activity. Additionally, pLPL gene expression, while modestly correlated with enzymatic activity (r = 0.53;P < 0.05), was not correlated with newborn adiposity. DISCUSSION This is the first study to show a positive correlation between pLPL activity and newborn %fat. Placental lipase regulation and the role of pLPL in pregnancies characterized by nutrient excess and fetal overgrowth warrant further investigation.
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Affiliation(s)
- Margaret J R Heerwagen
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, Division of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Diane L Gumina
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael E Van Pelt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anita W Kramer
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel C Janssen
- Department of Pediatrics, Division of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dalan R Jensen
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Theresa L Powell
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Pediatrics, Division of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob E Friedman
- Department of Pediatrics, Division of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Linda A Barbour
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Abstract
OBJECTIVES Increasing evidence demonstrates that body composition in early life contributes to the programming of health later in life in both full-term and preterm infants. Given the important role of body composition, the increased availability of easy, noninvasive, and accurate techniques for its assessment has been recommended. The aim of the present study was to identify basic characteristics and anthropometric measurements that best correlate with body composition in infants. METHODS Anthropometric measurements and body composition assessed by air-displacement plethysmography were assessed either at birth or at term-corrected age in 1239 infants (654 full-term, 585 preterm). The associations of sex, GA (gestational age), and weight with FFM (fat-free mass) and FM (fat mass) adjusted by length (g/cm) were investigated by multiple linear regression models. Bland-Altman tests were performed, and an equation for calculating FFM was determined. RESULTS Preterm infants exhibited increased FM and reduced FFM compared with full-term infants (477.6 ± 204 vs 259.7 ± 147 g and 2583 ± 494 vs 2770 ± 364 g, respectively). GA, male sex, and weight were positively associated with FFM (r = 0.806, P < 0.0001; 6.1 g of average bias). GA and male sex were negatively associated with FM, whereas weight was positively associated with FM (r = 0.641, P < 0.0001; 4.9 g of average bias). CONCLUSIONS The assessment of body composition represents the criterion standard. When body composition assessment is not feasible, the equation based on sex, GA, and anthropometric measurements can be useful in predicting body composition in both full-term and preterm infants.
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Parlapani E, Agakidis C, Karagiozoglou-Lampoudi T. Anthropometry and Body Composition of Preterm Neonates in the Light of Metabolic Programming. J Am Coll Nutr 2018; 37:350-359. [PMID: 29425475 DOI: 10.1080/07315724.2017.1400479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The improved survival of preterm infants has led to increased interest regarding their health as adults. In the context of metabolic programming, the connection between perinatal and early postnatal nutrition and growth with health in later life has brought to the fore the role of catch-up growth during the first months of preterm infants' lives and its association with body fat and obesity in childhood or puberty. A state-of-the art review was conducted in order to assess the way catch-up is evaluated, in terms of timing and rate. Adequate growth is of major importance for neurodevelopment; however, it may compete with adiposity or metabolic health. Studies based on body composition assessment have given conflicting results as regards the effect of early versus late and rapid versus slow catch-up growth on later health, mainly attributed to the lack of established criteria and definitions. Given that adequate early nutrition is crucial for the neurodevelopment of preterm infants, further studies are needed on the role of catch-up growth in long-term outcome, using generally accepted qualitative and quantitative criteria.
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Affiliation(s)
- Elisavet Parlapani
- a Clinical Nutrition Lab, Nutrition/Dietetics Department , Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , Greece.,b 1st Department of Neonatology and NICU , Faculty of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital , Thessaloniki , Greece
| | - Charalampos Agakidis
- c 1st Department of Pediatrics , Faculty of Medicine, Aristotle University of Thessaloniki, Ippokration Hospital , Thessaloniki , Greece
| | - Thomais Karagiozoglou-Lampoudi
- a Clinical Nutrition Lab, Nutrition/Dietetics Department , Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , Greece
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Mckenzie KM, Dissanayake HU, McMullan R, Caterson ID, Celermajer DS, Gordon A, Hyett J, Meroni A, Phang M, Raynes-Greenow C, Polson JW, Skilton MR. Quantity and Quality of Carbohydrate Intake during Pregnancy, Newborn Body Fatness and Cardiac Autonomic Control: Conferred Cardiovascular Risk? Nutrients 2017; 9:nu9121375. [PMID: 29257088 PMCID: PMC5748825 DOI: 10.3390/nu9121375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
The fetal environment has an important influence on health and disease over the life course. Maternal nutritional status during pregnancy is potentially a powerful contributor to the intrauterine environment, and may alter offspring physiology and later life cardio-metabolic risk. Putative early life markers of cardio-metabolic risk include newborn body fatness and cardiac autonomic control. We sought to determine whether maternal dietary carbohydrate quantity and/or quality during pregnancy are associated with newborn body composition and cardiac autonomic function. Maternal diet during pregnancy was assessed in 142 mother-infant pairs using a validated food frequency questionnaire. Infant adiposity and body composition were assessed at birth using air-displacement plethysmography. Cardiac autonomic function was assessed as heart rate variability. The quantity of carbohydrates consumed during pregnancy, as a percentage of total energy intake, was not associated with meaningful differences in offspring birth weight, adiposity or heart rate variability (p > 0.05). There was some evidence that maternal carbohydrate quality, specifically higher fibre and lower glycemic index, is associated with higher heart rate variability in the newborn offspring (p = 0.06). This suggests that poor maternal carbohydrate quality may be an important population-level inter-generational risk factor for later cardiac and hemodynamic risk of their offspring.
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Affiliation(s)
- Kirsty M Mckenzie
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Hasthi U Dissanayake
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Rowena McMullan
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Ian D Caterson
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - David S Celermajer
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Adrienne Gordon
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Jonathan Hyett
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Alice Meroni
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Melinda Phang
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Camille Raynes-Greenow
- Sydney School of Public Health, Edward Ford Building, Fisher Road, University of Sydney, Sydney, NSW 2006, Australia.
| | - Jaimie W Polson
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- School of Medical Science & Bosch Institute, Anderson Stuart Building (F13), University of Sydney, Sydney, NSW 2006, Australia.
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
- Sydney Medical School, D17-Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia.
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