Lifetime growth and blood pressure in adolescence: Hong Kong's "Children of 1997" birth cohort

Rapid Growth in Malnutrition Children Associated with Higher Systolic Blood Pressure in Adolescent

BACKGROUND: Several studies found that children experiencing rapid growth earlier in life might increase the risk of chronic disease. Cardiovascular disease and hypertension are common risk factors and have been the leading cause of death worldwide. However, studies investigating the effects of rapid growth in early life on blood pressure later in life are limited. AIM: This study aimed to analyze the association between rapid growth after the first 1000 days of life and blood pressure at 17−19 years old. METHODS: We analyzed 17-year follow-up cohort using secondary data from the Indonesian Family Life Survey from the second (1997), third (2000), and fifth wave (2014). The survey was conducted in 13 provinces in Indonesia. No more than 672 children under 2 years old were included in the study. Rapid growth was defined as an alteration in length or height-per-age and weight-per-age z-score, based on WHO Child Growth Standard, on 1997 and 2000 time frame which was greater than 0.67, experienced by children with malnutrition (low birth weight, stunted, underweight, and wasting). Blood pressure was measured three times by an oscillometric method in 2014. In addition, we used a one-way ANOVA (analysis of variance) test to assess the association of rapid growth on systolic blood pressure. RESULTS: Malnutrition children at 0-2-year-old that grow rapidly in length or height, had higher systolic blood pressure than normal children (p = 0.029). In contrast, there was no difference observed in systolic blood pressure in children with malnutrition and children who did not experience rapid growth in weight. CONCLUSIONS: Children who had a history of malnutrition earlier in life (0−23 months) and had rapid growth in length or height after the first 1000 days of life had higher systolic blood pressure than normal children and children with malnutrition who did not grow rapidly.

Associations of growth from birth to puberty with blood pressure and lipid profile at ~17.5 years: evidence from Hong Kong's "Children of 1997" birth cohort

The role of early growth in later health is controversial. We examined the associations of growth at different phases from birth to puberty with blood pressure and lipid profile at ~17.5 years. In the population-representative "Children of 1997" birth cohort, growth was measured as (i) weight-for-age z score (WAZ) at birth and WAZ gains from 0 to 2 and 2 to 8 years and (ii) body-mass-index-for-age z score (BAZ) and length/height-for-age z score (LAZ) at 3 months and BAZ and LAZ gains from 3 months to 3 years, 3 to 8 years and 8 to 14 years, based on the World Health Organization growth standards/references. Adjusted partial least squares regression was used to assess simultaneously the associations of growth with height-, age- and sex-specific systolic (SBPZ) and diastolic blood pressure z scores (DBPZ), low- (LDL) and high-density lipoprotein (HDL) and triglycerides (TG) at ~17.5 years. Among 3410 children, higher WAZ, BAZ and LAZ gains from initial size to 8 years were associated with higher SBPZ. Higher gains in WAZ and BAZ from 2 to 8 years were consistently associated with higher DBPZ, LDL and TG and lower HDL. Lower LAZ at 3 months and higher LAZ gain from 3 months to 3 years were associated with lower HDL and higher TG. Greater growth in weight, body mass index and length/height had negative associations with blood pressure and lipid profile at ~17.5 years, but the differences by growth measure, phase and outcome suggest a complex underlying process.

Adolescent cohorts assessing growth, cardiovascular and cognitive outcomes in low and middle-income countries

Introduction

Life-course studies are needed to explore how exposures during adolescence, particularly puberty, contribute to later cardiovascular risk and cognitive health in low and middle-income countries (LMIC), where 90% of the world’s young people live. The extent of any existing cohorts investigating these outcomes in LMIC has not previously been described.

Methods

We performed a systematic literature review to identify population cohort studies of adolescents in LMIC that assessed anthropometry and any of cardiovascular risk (blood pressure, physical activity, plasma glucose/lipid profile and substance misuse), puberty (age at menarche, Tanner staging, or other form of pubertal staging) or cognitive outcomes. Studies that recruited participants on the basis of a pre-existing condition or involved less than 500 young people were excluded.

Findings

1829 studies were identified, and 24 cohorts fulfilled inclusion criteria based in Asia (10), Africa (6) and South / Central America (8). 14 (58%) of cohorts identified were based in one of four countries; India, Brazil, Vietnam or Ethiopia. Only 2 cohorts included a comprehensive cardiovascular assessment, tanner pubertal staging, and cognitive outcomes.

Conclusion

Improved utilisation of existing datasets and additional cohort studies of adolescents in LMIC that collect contemporaneous measures of growth, cognition, cardiovascular risk and pubertal development are needed to better understand how this period of the life course influences future non-communicable disease morbidity and cognitive outcomes.

Pathways from parental educational attainment to adolescent blood pressure

OBJECTIVES

Lower parental education is associated with higher adolescent blood pressure (BP). We examined the contribution of modifiable risk factors from infancy to adolescence that could potentially explain the link between parental education and SBP and DBP in the offspring.

METHODS

In a prospective Chinese birth cohort, 'Children of 1997' of 5604 adolescents (68% follow-up), we analyzed the relation between parental educational attainment and sex-specific, age-specific and height-specific BP z-scores at ∼13 years. Using mediation analysis, we examined the contribution of household income at birth (both absolute income and relative income deprivation), exposures during infancy (breastfeeding and early life second-hand smoking), lifestyles during childhood (diet, physical activity and screen-time), weight or BMI status during fetal, infancy, childhood and puberty, pubertal stage as well as parental BMI.

RESULTS

We found that adolescent BMI, but not birth weight or infant growth or childhood BMI, mediated the inverse association of parental education with adolescent SBP (proportion mediated: 24%), followed by maternal BMI (proportion mediated: 18%). Factors explaining the link between parental education and DBP were less clear. Absolute income, breastfeeding, childhood diet and physical activity, pubertal stage and paternal BMI did not mediate the association between parental education and adolescent BP.

CONCLUSION

Low parental education is a risk factor for high SBP and, to a lesser extent, DBP in adolescents. Important mediators of this relation include adolescent and maternal body weight.

Associations of Infant Feeding and Timing of Weight Gain and Linear Growth during Early Life with Childhood Blood Pressure: Findings from a Prospective Population Based Cohort Study

Objective

Small birth size and rapid postnatal growth have been associated with higher future blood pressure. The timing of these effects, the relative importance of weight gain and linear growth and the role of infant feeding need to be clarified.

Methods

We assessed how blood pressure relates to birth weight, infant and childhood growth and infant feeding (duration of exclusive breastfeeding and timing of introduction of complementary feeding) in 2227 children aged 5 years from a prospective cohort study (Amsterdam Born Children and their Development). Postnatal growth was represented by statistically independent measures of relative weight gain (weight gain independent of height) and linear growth in four age periods during infancy (0–1 month; 1–3 months; 3–6 months; 6–12 months) and from 12 months to 5 years.

Results

Lower birth weight was associated with higher childhood diastolic blood pressure (-0.38 mm Hg.SD^-1; P = 0.007). Faster relative weight gain and linear growth after 1 month were positively associated with systolic and diastolic blood pressure. Associations of linear growth with systolic blood pressure ranged from 0.47 to 1.49 mm Hg.SD^-1; P<0.01 for all. Coefficients were similar for different periods of infancy and also for relative weight gain and linear growth. Compared to breastfeeding <1 month, breastfeeding >1 month was associated with lower blood pressure (e.g. >6 months -1.56 mm Hg systolic blood pressure; P<0.001). Compared to >6 months, introduction of complementary feeding <6 months was associated with higher blood pressure (e.g. 4–6 months 0.91 mm Hg systolic blood pressure; P = 0.004).

Conclusions

After the age of one month faster growth in either weight or height is associated with higher childhood blood pressure. It is unknown whether faster weight gain and linear growth carry the same risk for adult hypertension and cardiovascular morbidity. Longer breastfeeding and delayed introduction of complementary feeding may be associated with lower adult blood pressure.

Differences in the anthropometry of Asian children and its role in metabolic health in later life: A narrative review

BACKGROUND

The increasing incidence of childhood obesity in Asia could be a reflection of early life programming in which environmental/nutritional challenges during pregnancy and first two years of life (the so-called first 1000 days) influence later health.

OBJECTIVE OF NARRATIVE REVIEW

To assess differences/similarities of anthropometric measures in early life and their influences on metabolic health risk in later life among children in Asia.

METHODS

Literature search for publication in English using selected key words from Medline (PubMed), Scopus, Science Direct and Google Scholar published from 1994 to October 2014. Some comparisons with Caucasian setting were made when relevant.

RESULTS

From 152 publications selected for this narrative review, differences in foetal growth and birth weight were deducted between Asian and Caucasian children. Infants in India and Hong Kong had increased fat mass at birth and early infancy as compared to those from other parts of the world. Pre- and during pregnancy conditions influenced birth weight; feeding practices and gender influenced post-natal growth and body composition development. High and low birth weights followed by rapid postnatal growth were linked to increased risks of obesity, insulin resistance and high blood pressure in later life.

CONCLUSION

Foetal and postnatal growth trajectories are different between countries within and outside Asia. Extremes in birth weight followed by rapid postnatal growth were linked to increased risks of metabolic health of children in this region. As there is limited evidence in Asia, it is important to conduct thorough investigations by using longitudinal studies on early life programming.

Functional Class in Children with Idiopathic Dilated Cardiomyopathy. A pilot Study

BACKGROUND

Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children.

OBJECTIVE

The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification.

METHOD

Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification.

RESULTS

Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04).

CONCLUSION

Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.

Birth weight and adult cardiovascular risk factors using multiple birth status as an instrumental variable in the 1958 British Birth Cohort

BACKGROUND

Birth weight is classified as a risk factor for cardiovascular disease by the World Health Organization, but appropriate preventive interventions remain unclear because the observations have not been confirmed in experiments and appear to be contextually specific.

METHODS

Using 9452 participants of the 1958 British Birth Cohort at age 42years in 2000 (58% follow-up), we examined the credibility of multiple birth status as an instrumental variable (IV) for birth weight and, if appropriate, use it to obtain less confounded estimates of the associations of birth weight with cardiovascular disease risk factors including self-reported height, body mass index and hypertension than conventional regression in 2014.

RESULTS

Multiple birth (203 twins and 6 triplets) was associated with older maternal age, but not with paternal occupation or maternal smoking. Multiple births had lower birth weight-for-gestational age z-score. Multiple birth status was not directly associated with height, BMI or hypertension. Using IV estimates birth weight-for-gestational age z-score was not clearly associated with height (0.99cm, 95% confidence interval (CI) -0.27, 2.25), body mass index (BMI) (0.42kg/m(2), 95% CI -0.17, 1.01) or hypertension (risk ratio 0.82, 95% CI 0.54, 1.23) adjusted for maternal age, with a first-stage F statistic of 145.3 from IV analysis.

CONCLUSIONS

Multiple birth status is a credible IV for obtaining a less confounded estimate of the association of birth weight with height, BMI and blood pressure. Such analysis suggests that birth weight may be spuriously related to height, BMI and blood pressure, and thus not an effective target for intervention.

Low Birth Weight as a Predictor of Cardiovascular Risk Factors in Childhood and Adolescence? The PEP Family Heart Study

BACKGROUND

Low birth weight is considered a risk factor for cardiovascular disease (CVD) in later life. Because data in children and adolescents are sparse and controversial, we assessed the association of birth weight with CVD risk factors in German youths.

METHODS

We categorized 843 urban children and adolescents aged 3-18 years by quintiles of birth weight and measured nine traditional risk factors in terms of body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, total cholesterol (TC), LDL-C, HDL-C, Non HDL-C and triglycerides (TG). SPSS 21 was used for statistical analysis.

RESULTS

Mean values and prevalence of nine anthropometric and lipid risk variables were equally distributed over the five birth weight groups. Though risk factors clustered between 3.0 kg and 4.0 kg of birth weight in both genders we found only one significant correlation of birth weight with TG for males and females and another one for HDL-C in males. The strongest clustering of significant regression coefficients occurred in the 2(nd) birth weight quintile for SBP (ß 0.018), TC (ß -0.050), LDL-C (ß -0.039), non LDL-C (ß -0.049) and log TG (ß -0.001) in males and females.

CONCLUSIONS

Overall we did not find significant associations between birth weight and nine traditional cardiovascular risk factors in children and adolescents. However, the 2(nd) quintile of birth weight might suggest clustering of risk factors.

Tobacco exposure, weight status, and elevated blood pressure in adolescents

The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.

Current growth status and metabolic parameters of Korean adolescents born small for gestational age: results from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2010-2011

BACKGROUND

Currently, little information is available on current growth status and metabolic syndrome (MetS) components according to birthweight at gestational age (BWGA) on Korean adolescents. Herein, the current height and weight and MetS components of Korean adolescents who were born as small for gestational age (SGA) were compared to those of the appropriate for GA (AGA) or large for GA (LGA) groups.

METHODS

Data for 2018 adolescents (aged 10-18 years) recorded in the Fifth Korean National Health and Nutrition Examination Survey 2010-2011 conducted by the Korean Ministry of Health and Welfare were assessed in this cross-sectional study. A total of 1750 subjects were assessed for current growth according to BWGA, and 792 were assessed for MetS components according to BWGA.

RESULTS

From the birth history of 1750 adolescents, the prevalence of SGA, AGA, and LGA was 11.4% (n = 193), 77.7% (n = 1366), and 10.9% (n = 191), respectively. Current height-standard deviation score (SDS) and weight-SDS were significantly positively related to BWGA in all Korean adolescents (P < 0.0001). Of the 792 adolescents, the prevalence of MetS was 1.2% (n = 9). There were no differences in MetS components in Korean adolescents between SGA and AGA or LGA group.

CONCLUSION

BWGA is related to current height and weight in Korean adolescents but is not related to individual components of MetS.

Simulated growth trajectories and blood pressure in adolescence: Hong Kong's Chinese Birth Cohort

BACKGROUND

Patterns and amounts of growth may determine adult blood pressure. Growth at different phases is correlated and affects current size, making effects on blood pressure difficult to distinguish. We decomposed growth to 13 years into independent associations with blood pressure and estimated how reaching the same size by different routes could affect adolescent blood pressure.

METHODS

Using estimates from partial least squares for the associations of birth weight, height, and BMI at 3 months, growth at 3-9 months, 9-36 months, 3-8 years and 8-13 years and size at 13 years with SBP and DBP in 5247 term births (67% follow-up) from Hong Kong's 'Children of 1997' Birth Cohort, we estimated SBP and DBP at 13 years for 99 simulated growth trajectories resulting in the same size using nonparametric bootstrapping.

RESULTS

High birth weight followed by slower growth was associated with lower SBP in both sexes and DBP in boys. Greater height to 3 years followed by slower height growth was associated with lower SBP in boys. Higher BMI until 9 months followed by slower BMI growth was associated with lower blood pressure in boys.

CONCLUSION

High birth weight or larger early size was associated with lower blood pressure if followed by slower later growth, consistent with the fetal origin hypothesis. However, whether these patterns are due to fetal and infant metabolic programming or to allowing slower growth at periods when rapid growth is harmful is unknown.

Breastfeeding and adolescent blood pressure: evidence from Hong Kong's "Children of 1997" Birth Cohort

Observationally, breastfeeding is associated with lower blood pressure in Western developed settings, whereas little association exists in developing settings. However, postnatal characteristics (e.g., breast milk substitutes, infection rates, underweight, and pubertal timing) differ between these settings. We examined the association of breastfeeding with blood pressure at ∼13 years, using multivariable linear regression, in 5,247 term births in 1997 from a population-representative Hong Kong Chinese birth cohort where socioeconomic patterning of breastfeeding differs from that of Western and developing settings but standard of living, social infrastructure, and postnatal characteristics are similar to those of Western settings. Higher education is associated with short-term breastfeeding but recent migration with longer-term breastfeeding. Compared with never breastfeeding, exclusive breastfeeding for ≥3 months was not associated with blood pressure (systolic mean difference = 0.82 mm Hg, 95% confidence interval (CI): -0.46, 2.11 and diastolic mean difference = 0.49 mm Hg, 95% CI: -0.22, 1.21), nor was partial breastfeeding for any length of time or exclusive breastfeeding for <3 months (systolic mean difference = 0.01 mm Hg, 95% CI: -0.64, 0.66 and diastolic mean difference = 0.16 mm Hg, 95% CI: -0.20, 0.52), adjusted for socioeconomic position and infant characteristics. Lack of association in a non-Western developed setting further suggests that observations concerning breastfeeding and blood pressure vary with setting, thereby casting doubt on causality.