Lifecourse childhood adiposity trajectories associated with adolescent insulin resistance

The impact of the obesity onset on the inflammatory and glycemic profile of women with severe obesity

BACKGROUND

The stage of life at the onset of obesity is an important factor in assessing inflammatory state and cardiometabolic risk.

OBJECTIVES

This study aimed to evaluate the relationship between the obesity onset and the inflammatory profile in women with severe obesity.

SETTING

Public hospital, Brazil.

METHODS

Forty-eight women with severe obesity (20-59 yr old) were evaluated according to weight, height, neck circumference (NC), waist circumference (WC), and hip circumference, as well blood metabolic and inflammatory parameters. The participants were grouped according to obesity onset stage of life (early group: ≤19 yr; late group: >19 yr).

RESULTS

The demographic means of the participants were: age of 39.7 years, weight of 122.7 kg and body mass index (BMI) of 48.4 kg/m2. The late group presented significantly higher values of leptin (lep)/adiponectin (adipo) ratio and homeostatic model assessment for insulin resistance (HOMA-IR) than the early group. The late group also had a lower adipo/lep ratio. Moreover, the late group showed correlations between the lep/adipo ratio and BMI (r = .460, P = .021), NC (r = .478, P = .016), and WC (r = .535, P = .006). Adipo was also correlated with NC (r = -.418, P = .038), WC (r = -.437, P = .029), and glycated hemoglobin (HbA1C) (r = -.485, P = .019). By contrast, in the early group, the lep/adipo ratio showed correlations with insulin (r = .647, P = .004) and HOMA-B (r = .564, P = .015).

CONCLUSIONS

The inflammatory profile is correlated with anthropometric values in women with late-onset obesity. Inflammatory markers seemed to correlate with the glycemic profile in women with early-onset obesity. Furthermore, inflammation was higher in women with late-onset obesity compared to those with early-onset obesity.

Reassessing type 2 diabetes in adolescents and its management strategies based on insulin resistance

With changes in lifestyle behaviors, including dietary structure and habits, the prevalence of Youth-onset Type 2 Diabetes Mellitus (YODM) has increased 2 to 3 times compared to 30 years ago. YODM patients experience complications earlier, progress faster, and exhibit more severe symptoms. However, limited and inconclusive direct evidence, coupled with poor patient compliance, poses challenges in the clinical management of YODM. Apart from the continuous decline in pancreatic β-cell function and quantity, tissue-specific insulin resistance (IR) is also a typical characteristic of YODM. The main mechanisms of IR in YODM involve different aspects such as obesity, dietary imbalance, abnormal substance metabolism, chronic inflammation, oxidative stress, and hormonal fluctuations during adolescence. For the comprehensive management of YODM, besides achieving good control of blood glucose levels, it may be necessary to apply the most appropriate methods considering the uniqueness of the patient population and the specifics of the disease. Early identification and detection of the disease are crucial. Precise screening of patients with well-functioning pancreatic insulin β-cells, primarily characterized by IR and obesity, represents the population most likely to achieve diabetes remission or reversal through lifestyle modifications, medications, or even surgical interventions. Additionally, considering potential emotional disorders or the impact of adolescent hormones in these patients, health education for patients and caregivers is essential to make them aware of the long-term benefits of well-controlled blood glucose. In conclusion, adopting comprehensive management measures to achieve diabetes remission or reversal is the ideal goal. Controlling high blood glucose, obesity, and other risk factors related to diabetes complications is the next priority to delay the occurrence and progression of complications. A comprehensive perspective on IR provides insights and references for identifying YODM and its management strategies.

Associations of early childhood body mass index trajectories with body composition and cardiometabolic markers at age 10 years: the Ethiopian infant anthropometry and body composition (iABC) birth cohort study

BACKGROUND

Variability in body mass index (BMI) (kg/m2) trajectories is associated with body composition and cardiometabolic markers in early childhood, but it is unknown how these associations track to later childhood.

OBJECTIVES

We aimed to assess associations of BMI trajectories from 0 to 5 y with body composition and cardiometabolic markers at 10 y.

METHODS

In the Ethiopian infant anthropometry and body composition (iABC) birth cohort, we previously identified 4 distinct BMI trajectories from 0 to 5 y: stable low BMI (19.2%), normal BMI (48.8%), rapid growth to high BMI (17.9%), and slow growth to high BMI (14.1%). At 10 y, we obtained data from 320 children on anthropometry, body composition, abdominal subcutaneous and visceral fat, and cardiometabolic markers. Associations of BMI trajectories and 10-y outcomes were analyzed using multiple linear regression.

RESULTS

Compared with children with the normal BMI trajectory, those with rapid growth to high BMI had 1.7 cm (95% CI: 0.1, 3.3) larger waist circumference and those with slow growth to high had 0.63 kg/m2 (95% CI: 0.09, 1.17) greater fat mass index and 0.19 cm (95% CI: 0.02, 0.37) greater abdominal subcutaneous fat, whereas those with stable low BMI had -0.28 kg/m2 (95% CI: -0.59, 0.03) lower fat-free mass at 10 y. Although the confidence bands were wide and included the null value, children with rapid growth to high BMI trajectory had 48.6% (95% CI: -1.4, 123.8) higher C-peptide concentration and those with slow growth to high BMI had 29.8% (95% CI: -0.8, 69.8) higher insulin and 30.3% (95% CI: -1.1, 71.6) higher homeostasis model assessment of insulin resistance, whereas those with rapid growth to high BMI had -0.23 mmol/L (95% CI: -0.47, 0.02) lower total cholesterol concentration. The trajectories were not associated with abdominal visceral fat, blood pressure, glucose, and other lipids at 10 y.

CONCLUSIONS

Children with rapid and slow growth to high BMI trajectories before 5 y tend to show higher measures of adiposity and higher concentrations of markers related to glucose metabolism at 10 y.

CLINICAL TRIAL REGISTRY

ISRCTN46718296 (https://www.isrctn.com/ISRCTN46718296).

Body mass index z-scores in the first 2 years of life were associated with adverse metabolic and anthropometric outcomes at 3 years of age

AIM

We investigated associations between body mass index (BMI) z-scores for children aged 0-2 years and the BMI z-scores, body fat percentage and metabolic risk factors at 3 years of age.

METHODS

This was a secondary analysis of the Lifestyle in Pregnancy and Offspring randomised controlled trial, carried out at two university hospitals in Denmark. It comprised 149 mothers with BMI ≥30 kg/m2 who did or did not receive a lifestyle intervention during pregnancy and a reference group of 97 mothers with normal-weight, with follow-up of their 3-year-old offspring. The children in these three groups were pooled for the data analyses, due to similar characteristics between groups. The BMI z-scores were calculated at 5 weeks, 5 months and 1, 2 and 3 years, using Danish reference groups. Their anthropometrics and metabolic outcomes were examined at 3 years of age.

RESULTS

BMI z-scores at 5 months to 2 years were associated with BMI z-scores and body fat percentage at 3 years of age and BMI z-scores were not associated with metabolic risk factors at 3 years.

CONCLUSION

BMI z-scores from 5 weeks of age were associated with adverse anthropometric outcomes but not with metabolic risk factors at 3 years of age.

Sedentary Bout Patterns and Metabolic Health in the Hispanic Community Health Study/Study of Latino Youth (SOL Youth)

Background There is limited evidence on the potential negative metabolic health impacts of prolonged and uninterrupted sedentary bouts in structurally disadvantaged youth. This study investigated associations between sedentary bout variables and metabolic health markers in the Hispanic Community Health Study/SOL Youth (Study of Latino Youth). Methods and Results SOL Youth was a population-based cohort of 1466 youth (age range, 8-16 years; 48.5% female); 957 youth were included in the analytic sample based on complete data. Accelerometers measured moderate-to-vigorous physical activity (MVPA), total sedentary time, and sedentary bout patterns (daily time spent in sedentary bouts ≥30 minutes, median sedentary bout duration, and number of daily breaks from sedentary time). Clinical measures included body mass index, waist circumference, fasting glucose, glycated hemoglobin, fasting insulin, and the homeostasis model assessment of insulin resistance. After adjusting for sociodemographics, total sedentary time, and MVPA, longer median bout durations and fewer sedentary breaks were associated with a greater body mass index percentile (bbouts=0.09 and bbreaks=-0.18), waist circumference (bbouts=0.12 and bbreaks=-0.20), and fasting insulin (bbouts=0.09 and bbreaks=-0.21). Fewer breaks were also associated with a greater homeostasis model assessment of insulin resistance (b=-0.21). More time in bouts lasting ≥30 minutes was associated with a greater fasting glucose (b=0.18) and glycated hemoglobin (b=0.19). Conclusions Greater accumulation of sedentary time in prolonged and uninterrupted bouts had adverse associations with adiposity and glycemic control over and above total sedentary time and MVPA. Findings suggest interventions in Hispanic/Latino youth targeting both ends of the activity spectrum (more MVPA and less prolonged/uninterrupted sedentary patterns) may provide greater health benefits than those targeting only MVPA.

Associations Between Life-Course Lipid Trajectories and Subclinical Atherosclerosis in Midlife

IMPORTANCE

Childhood lipid levels have been associated with adult subclinical atherosclerosis; however, life-course lipid trajectories and their associations with cardiovascular disease risk are poorly characterized.

OBJECTIVES

To examine the associations of lipid levels at different ages and discrete lipid trajectory patterns from childhood to adulthood with subclinical atherosclerosis in midlife.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the Bogalusa Heart Study, a prospective, population-based cohort study conducted in a semirural, biracial community in Bogalusa, Louisiana, with follow-up from 1973 to 2016 (median follow-up, 36.8 years). Participants had 4 to 16 repeated measurements of lipids, including total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), from childhood to midlife and adult measurement of carotid intima-media thickness (IMT). Statistical analyses were conducted from July 1 to December 31, 2021.

EXPOSURES

Age-specific lipid levels were estimated, and lipid trajectory patterns were identified using latent mixture modeling.

MAIN OUTCOMES AND MEASURES

Subclinical atherosclerosis measured by carotid IMT.

RESULTS

The study evaluated 1201 adults (mean [SD] age, 45.7 [6.8] years; 691 [57.5%] women and 510 [42.5%] men; 392 Black [32.6%] and 809 White [67.4%] individuals). Levels of all lipids at each age from 5 to 45 years were significantly associated with adult IMT. The magnitude of associations generally increased with age, and non-HDL-C (age 5 y: β, 0.040; 95% CI, 0.025-0.055; age 45 y, β, 0.049; 95% CI, 0.026-0.072) and LDL-C (age 5 y: β, 0.039; 95% CI, 0.024-0.054; age 45 y, β, 0.043; 95% CI, 0.023-0.063) showed the strongest associations. After adjusting for race, sex, and other cardiovascular risk factors, mean IMT values were significantly higher in the low-slow increase, low-rapid increase, and high-stable trajectory groups for TC (eg, high-stable group: mean difference, 0.152 mm; 95% CI, 0.059-0.244 mm), the low-slow increase, low-rapid increase, moderate-stable, and high-stable trajectory groups for non-HDL-C (eg, low-slow increase group: mean difference, 0.048 mm; 95% CI, 0.012-0.085 mm) and LDL-C (eg, low-rapid increase group: mean difference, 0.104 mm; 95% CI, 0.056-0.151 mm) and the low-rapid increase and moderate-stable trajectory groups for TG (eg, moderate-stable group: mean difference, 0.071 mm; 95% CI, 0.019-0.122 mm) vs the corresponding low-stable trajectory groups. These associations were slightly attenuated after further adjustment for lipid levels at baseline or follow-up. There were no significant differences in mean IMT among HDL-C trajectory groups.

CONCLUSIONS AND RELEVANCE

In this cohort study, discrete life-course lipid trajectories were associated with the development of atherosclerosis in midlife. The findings emphasize the importance of maintaining optimal lipid levels across the lifespan.

A retrospective cohort study on the association between poor sleep quality in junior high school students and high hemoglobin A1c level in early adults with higher body mass index values

BACKGROUND

Few epidemiological studies have been performed to clarify the association between glucose metabolism disorders in early adults (20 years old) and physiological and environmental factors, including body mass index (BMI) in junior high school days. Therefore, we examined the association between hemoglobin A1c (HbA1c) level and body size (BMI) in early adulthood and lifestyles, including sleep habits and BMI in junior high school days in Shika town, a small town in Japan, by conducting a retrospective cohort study.

METHODS

We examined the HbA1c levels and body size (BMI) of 99 early adults who turned 20 years old between 2016 and 2020 and were residing in Shika town, Ishikawa Prefecture. We obtained the information on lifestyles and living environment factors, including BMI, from a questionnaire survey conducted among the subjects during their junior high school days (13-15 years old) from 2009 to 2013.

RESULTS

No correlations were observed between the HbA1c levels and the BMI values of the early adults. A two-way analysis of covariance (with the HbA1c levels and BMI values of the early adults as main factors) of the body size and lifestyle habits of the junior high school students revealed that "sleep quality in junior high school" was significantly poorer in the high HbA1c group than in the low HbA1c group in the early adults with high BMI values only. This result was also supported by the logistic regression analysis result.

CONCLUSIONS

The present results indicate that poor sleep quality in junior high school was associated with the high HbA1c levels of the early adults with higher BMI values, which suggests that good sleep quality in junior high school prevents the development of hyperglycemia. However, the present study did not find any relationship between early-adult BMI and HbA1c level.

Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence

We explored the association between the trajectory of the continuous metabolic syndrome score (cMetS) in childhood with high-sensitivity C-reactive protein (hs-CRP) and carotid intima-media thickness (CIMT), which are known to increase cardiovascular disease risk in adolescence. The trajectory of cMetS in childhood (from 3 to 12 years of age) was identified in 833 children who participated in the Ewha Birth and Growth Study. The associations between cMetS and hs-CRP and CIMT were analyzed in 204 out of 833 children who participated in the follow-up at 13-15 years of age and measured hs-CRP and CIMT. Among the 833 children, three groups were classified: cMetS maintained at a low level (n = 198, 23.77%), middle level (n = 530, 63.63%), and at high levels (n = 105, 12.61%). The group with a stable-high cMetS trajectory showed significantly higher hs-CRP levels, and the statistical significance was maintained after adjusting for covariates. This study found that a consistently high cMetS in childhood was significantly associated with higher hs-CRP levels in adolescents, suggesting that it is necessary to intervene in metabolic risk factors early in life to reduce the risk of cardiovascular disease later in life.

Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes

Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.

Musculoskeletal Changes Across the Lifespan: Nutrition and the Life-Course Approach to Prevention

Aging is characterized by the progressive decline of muscle mass and function, the so-called sarcopenia. Also bone loss is widespread among older people. Sarcopenia and osteopenia/osteoporosis are associated with several adverse outcomes including falls, risk of fractures, functional decline, frailty, and mortality. Recently, the life-course approach to prevent or delay functional decline has become very popular. Regarding musculoskeletal health, there is suggestive evidence that acting during critical or sensitive periods of life in which each person build-up its biological reserves may influence the rate of functional decline in the later stages of life. A life-course approach to musculoskeletal health should take place during early life when plasticity allows more easily the attainment of the peak of the musculoskeletal system driven by environmental stimuli. The rate of the subsequent decline will depend on the peak previously reached. Nutrition and physical exercise are important environmental factors that can influence musculoskeletal development by favoring and maintaining peak bone and muscle mass and strength. Here we provide an overview of body composition changes occurring across the lifespan and strategies based on nutrition and physical exercise to support musculoskeletal health as well as minimizing losses during older life.

Sleep duration, physical activity, and caloric intake are related to weight status in Mexican American children: a longitudinal analysis

BACKGROUND

Obesity is a serious issue, spanning all ages, and, in the U.S., disproportionately affects Latinos and African Americans. Understanding sleep, physical activity and dietary behaviors that may predict childhood obesity can help identify behavioral intervention targets.

METHODS

Data were drawn from a U.S. cohort study of 323 Mexican American 8-10-year-old children and their mothers, who participated in a longitudinal study over a 2-year period. Measures were collected at baseline (BL; child mean age = 8.87, SD = 0.83), year 1 (FU1) and year 2 (FU2). Mothers reported on household income and acculturation at BL. Child height and weight were collected and BMI z-scores (BMIz) were calculated for weight status at BL, FU1, and FU2. Accelerometer-estimated sleep duration (hours) and moderate-to-vigorous physical activity (MVPA; minutes) were collected across 3 days at BL, FU1, and FU2. Two 24-h dietary recalls were performed at each time point; from these, average energy intake (EI, kcals/day) was estimated. Cross-lagged panel analysis was used to examine behavioral predictors on BMIz at each time point and across time.

RESULTS

At BL and FU1, longer sleep duration (β = - 0.22, p < 0.001; β = - 0.17, p < 0.05, respectively) and greater MVPA (β = - 0.13, p < 0.05; β = - 0.20, p < 0.01, respectively) were concurrently related to lower BMIz. At FU2, longer sleep duration (β = - 0.18, p < 0.01) was concurrently related to lower BMIz, whereas greater EI (β = 0.16, p < 0.01) was related to higher BMIz. Longer sleep duration at BL predicted lower BMIz at FU1 (β = - 0.05, p < 0.01).

CONCLUSIONS

Longer sleep duration was concurrently related to lower weight status at each time point from ages 8-10 to 10-12. Higher MVPA was concurrently related to lower weight status in earlier childhood (ages 8-10 and 9-11) and higher EI was concurrently related to higher weight status toward the end of childhood (ages 10-12 years). Furthermore, longer sleep in earlier childhood was protective of children's lower weight status 1 year later. These findings suggest that sleep duration plays a consistent and protective role against childhood obesity; in addition, MVPA and healthy EI remain important independent factors for obtaining a healthy weight.

Fat Mass Accretion from Birth to 5 Years and Metabolic Homeostasis in Childhood: the Healthy Start Study

CONTEXT

It is unclear how fat mass accretion in early life is related to glucose-insulin homeostasis.

OBJECTIVE

Examine associations of fat and fat-free mass accretion from birth to early childhood with glucose-insulin homeostasis in early childhood in a multi-ethnic cohort.

METHODS

Observational Healthy Start study with data collection from 2010 to 2020. Air displacement plethysmography at birth and 4.8 (SD 0.7) years estimated fat mass percent (FMP, %), fat mass index (FMI, kg/m2), and fat-free mass index (FFMI, kg/m2). General population recruited from academic obstetrics clinics in Denver, Colorado, consisting of 419 mother/offspring dyads. The main outcome measures were fasting glucose, insulin, homeostasis model assessment-2 insulin resistance (HOMA2-IR), and beta-cell function (HOMA2-B) at 4.8 years.

RESULTS

Greater fat mass accretion from birth to early childhood was associated with higher fasting glucose (ΔFMP β = 0.20 [95% CI 0.06-0.34], ΔFMI β = 0.90 [0.30-1.50]) in participants of Hispanic, Black, and Other races/ethnicities, while greater fat-free mass accretion was associated with higher fasting glucose in non-Hispanic White participants (ΔFFMI β = 0.76 [0.21-1.32]). Overall, greater fat, but not fat-free, mass accretion was also associated with higher insulin (ΔFMP β = 0.14 [0.09-0.18], ΔFMI 0.71 [0.51-0.92]), HOMA2-IR (FMP β = 0.02 [0.01-0.02], ΔFMI β = 0.09 [0.06-0.12]), and HOMA2-B (ΔFMP β = 0.92 [0.18-1.36], ΔFMI β = 4.76 [2.79-6.73]).

CONCLUSION

Greater fat mass accretion in infancy and childhood is associated with shifts in fasting glucose in children of Hispanic, Black, and Other races/ethnicities at 5 years of age. Body composition beginning in early life is relevant for metabolic health, and precise assessments of adiposity in pediatric research are needed.

Ascending Growth is Associated with Offspring Adiposity in Pregnancies Complicated with Obesity or Gestational Diabetes

CONTEXT

Early growth is associated with childhood adiposity, but the influence of lifestyle remains unknown.

OBJECTIVE

This work aimed to investigate the association of growth profiles from high-risk pregnancies with adiposity at age 5 years, taking into account lifestyle and several antenatal/postnatal exposures.

METHODS

This prospective cohort study.

INCLUDED

609 children born during the Finnish Gestational Diabetes Prevention Study (RADIEL), recruiting women with body mass index (BMI) greater than or equal to 30 and/or prior gestational diabetes mellitus (GDM) (2008-2013). Altogether 332 children attended the 5-year follow-up (2014-2017). Main outcome measures included growth profiles based on ponderal index (PI = weight/height3), investigated using latent class mixed models. Adiposity was assessed with anthropometrics and body composition (InBody720).

RESULTS

We identified 3 growth profiles: ascending (n = 82), intermediate (n = 351), and descending (n = 149). Children with ascending growth had a higher body fat percentage, ISO-BMI, and waist circumference (P < .05) at age 5 years. Ascending (β 4.09; CI, 1.60-6.58) and intermediate (β 2.27; CI, 0.50-4.03) profiles were associated with higher fat percentage, even after adjustment for age, sex, gestational age, diet, physical activity, education, and prepregnancy BMI. Similar associations existed with ISO-BMI. After adjusting for age and education, ascending growth was associated with prepregnancy BMI (odds ratio [OR] 1.06; CI, 1.01-1.12), primiparity (OR 3.07; CI, 1.68-5.62), cesarean delivery (OR 2.23; CI, 1.18-4.21), and lifestyle intervention (OR 2.56; CI, 1.44-4.57). However, meeting the intervention goals and exclusive breastfeeding for 3 months or more were associated with lower odds of ascending growth.

CONCLUSION

Accelerated early growth was associated with higher adiposity in 5-year-old children from high-risk pregnancies, even when adjusted for lifestyle. Reducing cesarean deliveries and promoting breastfeeding may be beneficial for postnatal growth.

The impact of body weight trajectory from childhood on chronic inflammation in adulthood: The Bogalusa Heart Study

IMPORTANCE

The impact of long-term burden of excessive body weight, beginning in childhood, on inflammatory status in adulthood has been poorly described.

OBJECTIVE

To characterize the longitudinal body mass index (BMI) trajectory from childhood and examine its relationship with inflammatory status in adulthood.

METHODS

We included 1285 adults who had 4-15 repeat measurements of BMI from childhood to adulthood. The area under the curve (AUC) of growth curves was calculated to characterize long-term burden (total AUC) and trends (incremental AUC) of BMI.

RESULTS

After adjusting for covariates, higher values of BMI in terms of childhood and adulthood, as well as total and incremental AUC, were strongly associated with elevated levels of adult C-reactive protein (CRP) in the four race-sex groups. There were significant differences in linear and nonlinear curve parameters between the normal and high CRP groups for all race-sex groups (P < 0.01). Compared with participants who had consistently low BMI in both childhood and adulthood, participants with high BMI in adulthood had higher CRP levels (P < 0.001), irrespective of their childhood BMI status; participants with high BMI in childhood but low BMI in adulthood had similar adult CRP levels.

INTERPRETATION

The impact of excessive body weight on inflammation is cumulative and exacerbated over time. The influence of childhood overweight/obesity on inflammatory status in adulthood can be alleviated by reducing adiposity in adulthood.

Practical Guidance for Food Consumption to Prevent Cardiovascular Disease

This dietary guidance, informed by best contemporary evidence, aims to assist medical practitioners and allied health professionals in advising patients for the primary and secondary prevention of cardiovascular disease (CVD). While differing in some details from other current guidelines, the core messages accord with those published in 2019 by the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Atherosclerosis Society; the National Lipid Association in 2014 and the NH&MRC Australian Dietary Guidelines in 2013. These were assessed through the Appraisal of Guidelines for Research and Evaluation (AGREE II) and the levels of evidence and classes of a recommendation developed using the GRADE system. Recommendations with high levels of evidence include increased consumption of plant based foods comprising mainly complex, fibre enriched carbohydrates (wholegrains, fruits and vegetables) while limiting intake of refined starches; partial replacement of saturated fats with monounsaturated or polyunsaturated fats and oils; reduced salt intake; achievement and maintenance of healthy weight; and low-to-moderate consumption of alcohol. Additional guidance but with moderate levels of evidence includes increased consumption of fish (and fish oils where indicated); reduction in sugar-sweetened beverages and added sugars; avoidance of butter and cream especially in those at increased CVD risk but encouragement of yoghurt; allow moderate consumption of lean meat but limit intake of processed meats; and limit cholesterol-rich foods such as eggs and crustaceans for those at increased CVD risk. Guidance has been formulated qualitatively on food categories of commonly eaten foods while avoiding prescriptive quantitative measures that are less readily translatable. This approach accords with current guidelines such as the American College of Cardiology/American Heart Association 2019 guidelines and is understandable and readily implemented.

Associations between body mass index trajectories in childhood and cardiovascular risk factors in adulthood

BACKGROUND AND AIMS

Children with a growth trajectory of overweight have higher levels of cardiovascular disease (CVD) risk factors than children with a normal-weight trajectory. However, less is known about how trajectories of body mass index (BMI) across the rest of the BMI spectrum relate to CVD risk factors and whether adult BMI affects these associations. Our aim was to examine associations between childhood BMI trajectories and adult CVD risk factors.

METHODS

We included 2466 individuals with childhood weights and heights (ages 6-14) from the Copenhagen School Health Records Register and adult CVD risk factors (ages 20-81) from the Copenhagen City Heart Study. Associations between childhood BMI trajectories identified by latent class modelling and CVD risk factors were examined using generalized linear regression analyses with and without adjustment for adult BMI. Normal-weight and overweight were defined by growth references from the Centers for Disease Control and Prevention.

RESULTS

We identified four childhood trajectories within the normal-weight spectrum and one trajectory of overweight. Compared to the trajectory with the lowest BMI level, several higher BMI trajectories were associated with worse circumference, HDL and glucose homeostasis in adulthood. The highest trajectory was additionally associated with higher total cholesterol and triglycerides. When adjusting for adult BMI, the higher BMI trajectories had lower waist circumference, blood pressure and triglycerides.

CONCLUSIONS

Trajectories of BMI within the normal-weight range and in the overweight range are associated with a worse CVD risk profile than in the lowest BMI trajectory, and these associations are modifiable by growth after childhood.

Body mass index trajectory across childhood and subsequent risk of elevated blood pressure

We investigated the relationship between the body mass index (BMI) trajectory across childhood and the subsequent occurrence of elevated blood pressure (BP) in the Chinese pediatric population. The study cohort from the China Health and Nutrition Survey comprised 1484 children, each of whom underwent three BP and BMI assessments during childhood and had a non-elevated BP during the first childhood assessment. A group-based trajectory model was used to identify four distinct BMI trajectories across childhood: lean-stable increase, medium-marked increase, heavy marked decrease, and heavy marked increase. Elevated BP in childhood was as defined in the China's national BP reference for children. Covariate-adjusted logistic regression models were used to assess the associations of BMI trajectories with elevated BP. Overall, 27.6% of all participants between 3 and 13 years of age during the first childhood assessment developed elevated BP during a mean 6.5-year follow-up. Compared with participants in the lean-stable increase group, those in the medium-marked increase and heavy marked increase groups were more likely to have elevated BP (odds ratio [95% confidence interval], OR [95% CI]: 1.46 [1.08, 1.96] and 5.29 [2.44, 11.48], respectively; P_s < .05). The OR for the heavy marked decrease group was not statistically significant (OR [95% CI]: 1.58 [0.80, 3.13]; P = .192). In summary, distinct BMI trajectories conferred significantly different odds of elevated BP upon children, thus underscoring the importance of weight management in early life.

Body Mass Index From Early to Late Childhood and Cardiometabolic Measurements at 11 to 12 Years

OBJECTIVES

To examine how overweight and obesity at specific ages and overall BMI growth patterns throughout childhood predict cardiometabolic phenotypes at 11 to 12 years.

METHODS

In a population-based sample of 5107 infants, BMI was measured every 2 years between ages 2 to 3 and 10 to 11 years. We identified 5 BMI trajectories using growth curve models. At ages 11 to 12 years, 1811 children completed assessments for metabolic syndrome risk scores, carotid-femoral pulse wave velocity, and carotid intima-media thickness. Multivariable regression models were used to estimate associations, adjusted for potential confounders (eg, age, sex, smoking exposure, and small for gestational age).

RESULTS

Overweight and obesity from early childhood onward were strongly associated with higher cardiometabolic risk at 11 to 12 years of age. At age 6 to 7 years, compared with those with a healthy weight, children with overweight had higher metabolic syndrome risk scores by 0.23 SD units (95% confidence interval 0.05 to 0.41) and with obesity by 0.76 SD units (0.51-1.01), with associations almost doubling by age 10 to 11 years. Obese (but not overweight) children had higher outcome pulse wave velocity (0.64-0.73 SD units) from ages 6 to 7 years and slightly higher outcome carotid intima-media thickness (0.20-0.30 SD units) at all ages. Cumulative exposure to high BMI from 2 to 3 years of age carried the greatest cardiometabolic risk, with a gradient of risk across trajectories.

CONCLUSIONS

High early-childhood BMI is already silently associated with the development of cardiometabolic risk by 11 to 12 years, highlighting the urgent need for effective action to reduce overweight and obesity in early childhood.

The association between body mass index trajectories and cardiometabolic risk in young children

BACKGROUND

Rapid growth is associated with increased cardiometabolic risk (CMR) in adolescence and adulthood. Little is known about whether the association between rapid growth and increased CMR originates in early childhood.

OBJECTIVES

To identify age and sex standardized body mass index (zBMI) trajectories and to examine the association between zBMI trajectories and CMR outcomes in children 0 to 60 months.

STUDY DESIGN

A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) in Toronto, Canada. Participants had repeated measures of weight and length or height performed from birth to 60 months of age. Latent class mixed modelling was used to identify the zBMI trajectories. Linear regressions were performed to determine the association between zBMI trajectories and the primary outcome, a CMR score, quantified as the sum of age- and sex- standardized waist circumference, systolic blood pressure, glucose, log-triglycerides and negative high-density lipoprotein cholesterol (HDL-C), divided by √5. Secondary outcomes were the individual components of the CMR formula as well as diastolic blood pressure and non-HDL-C.

RESULTS

Four BMI trajectories were identified among the 1166 children. After adjusting for all covariates, children in the rapidly accelerating trajectory had increased total CMR score (β = 1.38, 95% CI 0.77; 1.99, P < .001) and increased waist circumference score (β = 2.39, 95% CI 1.92; 2.86, P < .001) compared to the stable low group.

CONCLUSIONS

Rapid growth during early childhood is associated with increased CMR in preschool children, largely driven by larger waist circumference.

Childhood social preference and adolescent insulin resistance: Accounting for the indirect effects of obesity

Insulin resistance, hyperinsulinemia, and Type II diabetes are increasingly common among young people in the United States. The quality of social relationships is a predictor of cardiometabolic health among adults, but has not been studied as a predictor of earlier insulin resistance. The purpose of this study was to test whether social preference (likeability) during childhood predicts insulin resistance and a measure of central adiposity during adolescence. Obesity also was examined as one mechanism through which this association occurs. Data came from a long-term longitudinal community study. At approximately age 7, 240 children were rated by their classmates on how liked and how disliked they were (difference score indexes social preference). Nine years later, at age 16, the same children visited the university laboratory where height, weight, and several measures of central adiposity (waist circumference, sagittal diameter, and waist-to-height ratio) were assessed by trained interviewers. Adolescents also provided fasted blood samples, from which HOMA-estimated insulin resistance was assessed. A path model yielded adequate to good fit indices, χ2 (3, N = 240) = 6.689, p = .08, CFI = .97, RMSEA = .07 [95% CI = .00, .14], sRMR = .03. Results indicated that greater social preference at age 7 was significantly associated with lower IR at age 16. These findings suggest that children who are less liked by their classmates are more likely to demonstrate increased risk of IR. Additionally, BMI at age 15 was positively associated with both IR and WC at age 16. A bootstrapping procedure (10,000 draws) indicated that a child's likeability is associated with IR and WC through the association of likeability with later weight status. The quality of social relationships in childhood is important to consider when trying to understand the recent rise in adolescents' cardiometabolic risk and when considering intervention strategies.

Body mass index trajectories in early childhood in relation to cardiometabolic risk profile and body composition at 5 years of age

BACKGROUND

Both impaired and accelerated postnatal growth have been associated with adult risks of obesity and cardiometabolic diseases, like type 2 diabetes and cardiovascular disease. However, the timing of the onset of cardiometabolic changes and the specific growth trajectories linking early growth with later disease risks are not well understood.

OBJECTIVES

The aim of this study was to identify distinct trajectories of BMI growth from 0 to 5 y and examine their associations with body composition and markers of cardiometabolic risk at age 5 y.

METHODS

In a prospective birth cohort study of 453 healthy and term Ethiopian children with BMIs assessed a median of 9 times during follow-up, we identified subgroups of distinct BMI trajectories in early childhood using latent class trajectory modeling. Associations of the identified growth trajectories with cardiometabolic markers and body composition at 5 y were analyzed using multiple linear regression analyses in 4 adjustment models for each outcome.

RESULTS

We identified 4 heterogeneous BMI growth trajectories: stable low BMI (19.2%), normal BMI (48.8%), rapid catch-up to high BMI (17.9%), and slow catch-up to high BMI (14.1%). Compared with the normal BMI trajectory, children in the rapid catch-up to high BMI trajectory had higher triglycerides (TGs) (range of β-coefficients in Models 1-4: 19-21%), C-peptides (23-25%), fat masses (0.48-0.60 kg), and fat-free masses (0.50-0.77 kg) across the 4 adjustment models. Children in the stable low BMI trajectory had lower LDL cholesterol concentrations (0.14-0.17 mmol/L), HDL cholesterol concentrations (0.05-0.09 mmol/L), fat masses (0.60-0.64 kg), and fat-free masses (0.35-0.49 kg), but higher TGs (11-13%).

CONCLUSIONS

The development of obesity and cardiometabolic risks may be established already in early childhood; thus, our data provide a further basis for timely interventions targeted at young children from low-income countries with unfavorable growth patterns. The birth cohort was registered at ISRCTN as ISRCTN46718296.

Long-Term Burden of Increased Body Mass Index from Childhood on Adult Dyslipidemia: The i3C Consortium Study

Background: Data are limited regarding the association of cumulative burden and trajectory of body mass index (BMI) from early life with adult lipid disorders. Methods: The study cohort consisted of 5195 adults who had BMI repeatedly measured 4 to 21 times from childhood and had blood lipid measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) and information on lipid-lowering medications in the last adult survey. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI. Results: Participants with dyslipidemia, high LDL-C, low HDL-C and high TG had consistently and significantly higher BMI levels from childhood to adulthood compared to those with normal lipid levels. After adjusting for age, race, sex, and cohort, increased risk of adult dyslipidemia was significantly associated with higher values of childhood BMI, adulthood BMI, total AUC and incremental AUC, with odds ratio (95% confidence interval) = 1.22 (1.15–1.29), 1.85 (1.74–1.97), 1.61 (1.52–1.71), and 1.59 (1.50–1.69), respectively, and p < 0.001 for all. The association patterns were similar in most race–sex subgroups. Conclusions: Adults with dyslipidemia versus normal lipid levels have consistently higher levels and distinct life-course trajectories of BMI, suggesting that the impact of excessive body weight on dyslipidemia originates in early life.

Variation in the 11-year trajectories of medical care seeking behaviors in diabetes patients under a single payer system: persisting gaps to be filled

BACKGROUND

Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan.

METHODS

We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied.

RESULTS

Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings.

CONCLUSIONS

This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.

Rate of change in body mass index at different ages during childhood and adult obesity risk

BACKGROUND

Childhood body mass index (BMI) predicts adult obesity. How growth trajectories during childhood relate to adult obesity risk is not well defined.

OBJECTIVE

We aimed to characterize BMI growth trajectories from childhood to midlife and to examine the associations between BMI growth rates at childhood age points and adult obesity risk.

METHODS

The longitudinal study included 2732 participants with repeated BMI measurements from childhood (4-19 y) to adulthood (20-51 y). A random-effects model was used to construct BMI growth curves by race and sex. Model-estimated levels and linear growth rates of BMI were linked to adult obesity in separate multivariable logistic regression models at individual childhood age points.

RESULTS

BMI followed cubic growth curves. Childhood BMI linear slope estimates were higher in adults with obesity than in adults without obesity (P < 0.001). The association between childhood BMI growth rate and adult obesity was significantly higher in puberty and postpuberty (12-19 y) than in early childhood (4-11 y) with a peak at age 14 (odds ratio = 3.1 and 95% confidence interval, 2.7-3.5).

CONCLUSIONS

Rates of change in BMI at different childhood ages are differentially associated with adult obesity. Puberty and postpuberty are crucial periods for the development of obesity in later life.

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

OBJECTIVE

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

Pacific Islands Families Study: Physical growth to age 14 and metabolic risk

BACKGROUND

The relationships between the trajectories of weight gain from early childhood to adolescence and risk for metabolic disease are not well understood.

OBJECTIVE

The objective of the study is to examine the relationships between weight gain from 2 to 14 years and metabolic risk factors at age 14 years in Pacific Island children.

METHODS

z scores for weight were calculated at each of the ages 2.5, 4, 6, 9, 11, and 13.5 years in 1053 children. Growth trajectories were determined by estimating the linear trend of z scores with age for each child. In a subgroup of 204 children, biomarkers of metabolic risk were measured and related to linear trend intercepts and slopes.

RESULTS

More rapid growth (greater slope of z score trajectory) was associated with higher concentrations of insulin, leptin (boys), urate, and markers of liver function, insulin resistance and inflammation. Children with higher weights in early life (greater intercept) showed fewer associations with metabolic markers, but considered together, intercept and slope were independently associated with a range of metabolic risk factors.

CONCLUSIONS

Both rapid weight gain and a higher body weight in early childhood were associated with higher risk for metabolic disease. Monitoring growth trajectories may help target interventions to optimize nutrition, physical activity, and growth.

Body mass index trajectories from adolescent to young adult for incident high blood pressure and high plasma glucose

Objectives

To explore the association between sex-specific adiposity trajectories among Adolescents to early adulthood with incident high blood pressure (HBP) and high plasma glucose (HPG).

Methods

We studied body mass index (BMI) trajectories among1159 (male = 517) and 664 (male = 263) Iranian adolescents, aged 12–20 years, for incident HPG and HBP, respectively. Latent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to determine sex-specific and distinct BMI trajectories. Logistic regressions were applied to estimate the relationship between latent class membership with HBP and HPG, considering normal trajectory as the reference.

Results

For both HBP and HPG, LCGMM determined two and three distinct BMI trajectories in males and females, respectively. During a follow-up of 12Years 104 (male = 62) and 111(male = 59) cases of HPG and HBP were found, respectively. Among females, faster BMI increases (i.e. overweight to early obese trajectory) but not overweight (i.e. those with BMI = 27.3 kg/m² at baseline) trajectories increased the risk of HPG by adjusted odds ratios (ORs), 2.74 (1.10–5.80) and 0.79 (0.22–2.82), respectively; regarding HBP, the corresponding value for overweight to late obese trajectory was 3.72 (1.37–11.02). Among males, for HBP, the overweight trajectory increased the risk [2.09 (1.04–4.03)]; however, for incident HPG, none of the trajectories showed significant risk.

Conclusions

Among females, trend of increasing BMI parallel with age can be a better predictor for risk of developing HPG and HBP than those with higher BMI at baseline.

Relationship between umbilical cord sex hormone binding globulin, sex steroids, and age at menarche: a prospective cohort study

OBJECTIVE

To study the role of the prenatal environment in regulating reproductive development by measuring the prospective association between umbilical cord concentrations of sex hormone binding globulin (SHBG; principal regulator of sex steroid activity), bioavailable sex steroids, and age at menarche.

DESIGN

Prospective population-based cohort.

SETTING

Not applicable.

PATIENT(S)

In 286 female members of the Western Australian Pregnancy (Raine) cohort, concentrations of SHBG and steroids (estrogens: estrone, estradiol, estriol and estetrol [E4]; androgens: total testosterone, Δ4-androstenedione, androstenedione and dehydroepiandrosterone) were measured by liquid chromatography-tandem mass spectrometry from archived umbilical cord blood samples collected at birth. Bioavailable concentrations of testosterone and estradiol were calculated along with total composite measures of androgen and estrogen bioactivity. SHBG was measured by ELISA.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Age of menarche was calculated from date of menarche, collected prospectively by questionnaire sent home with participants at the year 10 follow-up.

RESULT(S)

Higher maternal education, higher body mass index, and the presence of antepartum hemorrhage were all significantly associated with earlier age at menarche. The bioavailable sex steroid measures accounted for 8.3% of the variance in age at menarche. Further, both SHBG and E4 concentrations accounted for a significant proportion of unique variance in age at menarche.

CONCLUSION(S)

Lower SHBG and higher E4 concentrations in umbilical cord blood were associated with earlier age at menarche. These results suggest that the prenatal sex steroid environment contributes toward pubertal development and age at menarche.

A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood

Background: Childhood obesity is a serious public health issue. In Australia, 1 in 4 children is already affected by overweight or obesity at the time of school entry. Governments around the world have recognized this problem through investment in the prevention of pediatric obesity, yet few interventions in early childhood have been subjected to economic evaluation. Information on cost-effectiveness is vital to decisions about program implementation. A challenge in evaluating preventive interventions in early childhood is to capture long-term costs and outcomes beyond the duration of an intervention, as the benefits of early obesity prevention will not be realized until some years into the future. However, decisions need to be made in the present, and modeling is one way to inform such decisions. Objective: To describe the conceptual structure of a new health economic model (the Early Prevention of Obesity in CHildhood (EPOCH) model) for evaluating childhood obesity interventions; and to validate the epidemiologic predictions. Methods and Results: We use an individual-level (micro-simulation) method to model BMI trajectories and the progression of obesity from early childhood to adolescence. The equations predicting individual BMI change underpinning our model were derived from data from the population-representative study, the Longitudinal Study of Australian Children (LSAC). Our approach is novel because it will account for costs and benefits accrued throughout childhood and adolescence. As a first step to validate the epidemiological predictions of the model, we used input data representing over 250,000 children aged 4/5 years, and simulated BMI and obesity trajectories until adolescence. Simulated mean BMI and obesity prevalence for boys and girls were verified by nationally-representative data on children at 14/15 years of age. Discussion: The EPOCH model is epidemiologically sound in its prediction of both BMI trajectories and prevalence of obesity for boys and girls. Future developments of the model will include socio-economic position and will incorporate the impacts of obesity on healthcare costs. The EPOCH model will help answer: when is it best to intervene in childhood; what are the most cost-effective approaches and which population groups will benefit most from interventions.

Pathways Linking Birth Weight and Insulin Sensitivity in Early Adolescence: A Double Mediation Analysis

PURPOSE

We examined pathways linking birth weight, weight gain from 0 to 2 years, and adiposity during childhood with insulin sensitivity in early adolescence.

METHODS

Data were from a longitudinal cohort of 630 Quebec white children with a parental history of obesity (Quebec Adipose and Lifestyle Investigation in Youth study). In a subsample of children born at term (n = 395), weight-for-length z score (zWFL) from 0 to 2 years were computed. At 8 to 10 years, the percentage of body fat was assessed using dual energy X-ray absorptiometry. At 10 to 12 years, the Matsuda insulin sensitivity index (ISI) and the homeostasis model assessment for insulin resistance were determined. A linear regression-based approach for mediation analysis was used to estimate the distinct pathways linking zWFL at 0 to 2 years to insulin sensitivity.

RESULTS

Every additional unit in zWFL at birth was associated with a 10% (95% CI, 5.26% to 14.85%) increase in the Matsuda ISI in early adolescence, independently of the weight at 0 to 2 years and in childhood. An indirect effect of zWFL at birth on the Matsuda ISI was also observed but in the opposite direction (-4.44; 95% CI, -7.91 to -1.05). This relation was mediated by childhood adiposity but not by weight gain from 0 to 2 years. The indirect effect of weight gain from 0 to 2 years, via childhood adiposity, also led to lower insulin sensitivity (-4.83%, 95% CI, -7.34 to -2.53). The findings were similar for the homeostasis model assessment for insulin resistance or when restricted to children with appropriate-for-gestational-age birth weights.

CONCLUSIONS

A greater birth weight-for-length resulted in improved insulin sensitivity in early adolescence. However, in the presence of excess childhood adiposity, both a greater birth weight and a faster rate of weight gain from 0 to 2 years resulted in lower insulin sensitivity.

Body Mass Index Changes in Early Childhood

OBJECTIVE

To longitudinally investigate body mass index (BMI) in young children in Ireland and identify factors and critical time points associated with changes in BMI.

STUDY DESIGN

Data on 11 134 children were collected in the nationally representative Growing Up in Ireland infant cohort study. Height and weight were measured at 9 months, 3 years, and 5 years of age. Multilevel regression was used to identify risk factors associated with changes in BMI over time (n = 10 377), combining a unique set of covariates collected from the child and the 2 main caregivers (usually the mother and father).

RESULTS

The proportion of children ≥85th percentile of World Health Organization growth criteria was 39% at 9 months, 44% at 3 years, and 30% at 5 years. Children born large for gestational age (13%) and those with rapid infant weight gain (25%) consistently had higher BMI. Low average BMIs were consistently seen in children born small for gestational age (10%) or before 37 weeks (7%). Smaller variations in BMI existed for other factors including ethnicity, household structure, caregiver weight status, breastfeeding, sex, socioeconomic status, sleeping hours, childcare, and region.

CONCLUSIONS

In this study, differences at birth and in infancy appear to be most strongly associated with variation in BMI at all ages. Nevertheless, belonging to a number of other high-risk groups cumulatively could lead children to develop critical weight states. Policy-makers should target families with interventions before and during pregnancy when dominant risk factors are still modifiable. Longer-term follow-up of children may be needed to study associations later in childhood.

Trajectories of Body Mass Index from Childhood to Young Adulthood among Patients with Type 1 Diabetes-A Longitudinal Group-Based Modeling Approach Based on the DPV Registry

OBJECTIVE

To identify distinct longitudinal patterns of body mass index (BMI) z score in type 1 diabetes from childhood to young adulthood and secondly to determine sex differences as well as associated clinical covariates.

STUDY DESIGN

A total of 5665 patients with type 1 diabetes (51% male) with follow-up from 8 to 20 years of age from the multicenter diabetes prospective registry DPV were studied (baseline diabetes duration ≥1 years, BMI z score aggregated per year of life). Latent class growth modeling (SAS: PROC TRAJ) was applied to analyze BMI z score over time.

RESULTS

Six distinct BMI z score trajectories were identified (group 1: 7% of patients, group 2: 22%, group 3: 20%, group 4: 16%, group 5: 25%, and group 6: 10%). Group 1, 2, 5, and 6 had an almost stable BMI z score, either in the low, near-normal, high stable, or chronic overweight range. Group 3 (60% girls) increased their BMI during puberty, whereas group 4 (65% boys) had a BMI decrease. Similar patterns were observed for girls only, whereas boys followed nearly stable trajectories without fluctuation over time. Between the near-normal and the other groups, significant differences (P < .05) in sex ratio, migration background, mental health, height z score, glycated hemoglobin A1c, diabetes treatment, dyslipidemia, hypertension, and smoking were observed.

CONCLUSIONS

In youth with type 1 diabetes, a great heterogeneity of BMI z score trajectories exists that highlight the importance of personalized sex-specific intervention programs for subjects at risk for unfavorable BMI development.

Exercise in Pregnancy and Children's Cardiometabolic Risk Factors: a Systematic Review and Meta-Analysis

BACKGROUND

Maternal metabolic health during the prenatal period is an established determinant of cardiometabolic disease risk. Many studies have focused on poor offspring outcomes after exposure to poor maternal health, while few have systematically appraised the evidence surrounding the role of maternal exercise in decreasing this risk. The aim of this study is to characterize and quantify the specific impact of prenatal exercise on children's cardiometabolic health markers, at birth and in childhood.

METHODS

A systematic review of Scopus, MEDLINE, EMBASE, CENTRAL, CINAHL, and SPORTDiscus up to December 2017 was conducted. Randomized controlled trials (RCTs) and prospective cohort studies of prenatal aerobic exercise and/or resistance training reporting eligible offspring outcomes were included. Four reviewers independently identified eligible citations and extracted study-level data. The primary outcome was birth weight; secondary outcomes, specified a priori, included large-for-gestational age status, fat and lean mass, dyslipidemia, dysglycemia, and blood pressure. We included 73 of the 9804 citations initially identified. Data from RCTs was pooled using random effects models. Statistical heterogeneity was quantified using the I2 test. Analyses were done between June and December 2017 and the search was updated in December 2017.

RESULTS

Fifteen observational studies (n = 290,951 children) and 39 RCTs (n = 6875 children) were included. Observational studies were highly heterogeneous and had discrepant conclusions, but globally showed no clinically relevant effect of exercise on offspring outcomes. Meta-analyzed RCTs indicated that prenatal exercise did not significantly impact birth weight (mean difference [MD] - 22.1 g, 95% confidence interval [CI] - 51.5 to 7.3 g, n = 6766) or large-for-gestational age status (risk ratio 0.85, 95% CI 0.51 to 1.44, n = 937) compared to no exercise. Sub-group analyses showed that prenatal exercise reduced birth weight according to timing (starting after 20 weeks of gestation, MD - 84.3 g, 95% CI - 142.2, - 26.4 g, n = 1124), type of exercise (aerobic only, MD - 58.7 g, 95% CI - 109.7, - 7.8 g; n = 2058), pre-pregnancy activity status (previously inactive, MD - 34.8 g, 95% CI - 69.0, - 0.5 g; n = 2829), and exercise intensity (light to moderate intensity only, MD - 45.5 g, 95% CI - 82.4, - 8.6 g; n = 2651). Fat mass percentage at birth was not altered by prenatal exercise (0.19%, 95% CI - 0.27, 0.65%; n = 130); however, only two studies reported this outcome. Other outcomes were too scarcely reported to be meta-analyzed.

CONCLUSIONS

Prenatal exercise does not causally impact birth weight, fat mass, or large-for-gestational-age status in a clinically relevant way. Longer follow up of offspring exposed to prenatal exercise is needed along with measures of relevant metabolic variables (e.g., fat and lean mass).

PROTOCOL REGISTRATION

Protocol registration number: CRD42015029163 .

Fifteen-year Weight and Disordered Eating Patterns Among Community-based Adolescents

INTRODUCTION

The current study aims to characterize weight-change trajectories and their concomitant associations with prospectively measured dieting and other disordered eating behaviors among initially nonoverweight adolescents during the transition to adulthood.

METHODS

A population-based sample (n=1,091) self-reported their height/weight, dieting, unhealthy weight-control behaviors, and binge eating at 5-year intervals between 1998/1999 and 2013/2014, spanning early/middle adolescence through middle/late young adulthood. Data were analyzed in 2016/2017.

RESULTS

Groups were categorized as those who were never overweight (n=562), were overweight during at least one measurement point and gained weight more rapidly (n=246) or gradually (n=238) than their peers, or were overweight during at least one measurement point but returned to nonoverweight status by middle/late young adulthood (n=45). Thus, nearly half of adolescents became overweight during the transition to adulthood. Those who were never overweight had the lowest rates of dieting (males: F[9, 1,314]=2.54, p=0.0069, females: F[9, 1,927]=3.02, p=0.0014) and unhealthy weight-control behaviors (males: F[9, 1,313]=3.30, p=0.0005, females: F[9, 1,927]=3.02, p=0.0014), whereas some of these behaviors tended to track with weight gain in rapid and gradual weight gainers.

CONCLUSIONS

Although adolescents who are already overweight are most frequently targeted for weight-gain prevention and early intervention programs, results suggest that healthy lifestyle interventions could also benefit individuals who may be perceived as low risk for overweight in adulthood by nature of being nonoverweight in adolescence. Dieting and unhealthy weight-control behaviors tended to be associated with weight gain, suggesting that they are ineffective in addition to being potentially harmful.

Weight Trajectories from Birth and Bone Mineralization at 7 Years of Age

OBJECTIVE

To assess whether different trajectories of weight gain since birth influence bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age.

STUDY DESIGN

We studied a subsample of 1889 children from the Generation XXI birth cohort who underwent whole-body dual-energy radiograph absorptiometry. Weight trajectories identified through normal mixture modeling for model-based clustering and labeled "normal weight gain," "weight gain during infancy," "weight gain during childhood," and "persistent weight gain" were used. Differences in subtotal BMC, aBMD, and size-corrected BMC (scBMC) at age 7 years according to weight trajectories were estimated through analysis of covariance.

RESULTS

Compared with the "normal weight gain" trajectory, children in the remaining trajectories had significantly greater BMC, aBMD, and scBMC at age 7 years, with the strongest associations for "persistent weight gain" (girls [BMC: 674.0 vs 559.8 g, aBMD: 0.677 vs 0.588 g/cm², scBMC: 640.7 vs 577.4 g], boys [BMC: 689.4 vs 580.8 g, aBMD: 0.682 vs 0.611 g/cm², scBMC: 633.0 vs 595.6 g]). After adjustment for current weight, and alternatively for fat and lean mass, children with a "weight gain during childhood" trajectory had greater BMC and aBMD than those with a "normal weight gain" trajectory, although significant differences were restricted to girls (BMC: 601.4 vs 589.2 g, aBMD: 0.618 vs 0.609 g/cm²).

CONCLUSION

Overall, children following a trajectory of persistent weight gain since birth had clearly increased bone mass at 7 years, but weight gain seemed slightly more beneficial when it occurred later rather than on a normal trajectory during the first 7 years of life.

Eating frequency predicts changes in regional body fat distribution in healthy adults

BACKGROUND

Eating frequency (EF) has been associated with generalized obesity.

AIM

We aimed to prospectively investigate potential associations of frequency of eating episodes with regional fat layers.

DESIGN

EF was evaluated at baseline in 115 subjects free of clinically overt cardiovascular disease (54 ± 9.1 years, 70 women) in a prospective, observational study.

METHODS

Metabolic parameters known to be associated with dietary factors and anthropometric markers including ultrasound assessment of subcutaneous (Smin) and pre-peritoneal (Pmax) fat and their ratio Smin/Pmax (AFI) were evaluated at baseline and at follow-up, 5 years later.

RESULTS

EF at baseline positively correlated with Pmax, even after adjustment for potential confounders. EF above median was also an independent predictor for Pmax (beta coefficient = -0.192, P = 0.037) and AFI (beta coefficient = 0.199, P = 0.049) at follow up. Multivariable linear mixed models analysis demonstrated that subjects with increased EF presented a lower progression rate of Pmax (beta = -0.452, P = 0.006) and a higher progression rate of AFI (beta = 0.563, P = 0.003) over time, independently of age, sex, progression of BMI, energy intake, smoking and changes in parameters of glucose metabolism.

CONCLUSIONS

High EF is associated with lower progression rate of pre-peritoneal fat accumulation. Future interventional studies should further investigate the clinical utility of these findings.

Body mass index trajectories in the first two years and subsequent childhood cardio-metabolic outcomes: a prospective multi-ethnic Asian cohort study

We investigated body mass index (BMI) trajectories in the first 2 years of life in 1170 children from an Asian mother-offspring cohort in Singapore, and examined their predictors and associations with childhood cardio-metabolic risk measures at 5 years. Latent class growth mixture modelling analyses were performed to identify distinct BMI z-score (BMIz) trajectories. Four trajectories were identified: 73.2%(n = 857) of the children showed a normal BMIz trajectory, 13.2%(n = 155) a stable low-BMIz trajectory, 8.6%(n = 100) a stable high-BMIz trajectory and 5.0%(n = 58) a rapid BMIz gain after 3 months trajectory. Predictors of the stable high-BMIz and rapid BMIz gain trajectories were pre-pregnancy BMI, gestational weight gain, Malay and Indian ethnicity, while predictors of stable low-BMIz trajectory were preterm delivery and Indian ethnicity. At 5 years, children with stable high-BMIz or rapid BMIz gain trajectories had increased waist-to-height ratios [B(95%CI) 0.02(0.01,0.03) and 0.03(0.02,0.04)], sum of skinfolds [0.42(0.19,0.65) and 0.70(0.36,1.03)SD units], fat-mass index [0.97(0.32,1.63)SD units] and risk of obesity [relative risk 3.22(1.73,6.05) and 2.56 (1.19,5.53)], but not higher blood pressure. BMIz trajectories were more predictive of adiposity at 5 years than was BMIz at 2 years. Our findings on BMIz trajectories in the first 2 years suggest important ethnic-specific differences and impacts on later metabolic outcomes.

Growth Trajectories of Body Mass Index during Childhood: Associated Factors and Health Outcome at Adulthood

OBJECTIVE

To identify body mass index (BMI) trajectories from birth to age 10 years and to assess their association with child and parental characteristics and with adult nutritional status and metabolic risk factors.

STUDY DESIGN

Retrospective cohort study with 1188 subjects aged 20-60 years. Childhood growth was assessed using measured weight and height data collected retrospectively from health booklets, which also provided information on gestational age, birth weight, and early nutrition. Height, weight, waist circumference, fasting blood glucose, lipids profile, and blood pressure were measured at adulthood. Participants self-reported parental silhouette based on a 9-figural scale. Group-based modeling was applied to identify BMI trajectories. Associations were assessed using ANOVA and multiple logistic regression.

RESULTS

Five growth trajectories following or crossing BMI percentiles emerged: stable-25th (15.3% of the sample), stable-50th (35.9%), stable-75th (28.0%), ascending-75th (19.2%), and ascending-obesity (1.6%). Overall, associated factors from early life were mother's corpulence (higher in the ascending-obesity group), gestational age (higher in the stable-50th, stable-75th, and in the ascending-obesity groups), and birth weight (higher in the ascending-obesity group) (all P < .05). Childhood trajectories were associated with adult BMI and waist circumference (higher in the stable-75th and in the ascending groups) (all P < .0001).

CONCLUSIONS

This study shows heterogeneity in patterns of growth trajectories. Specific trajectories were associated with greater BMI and waist circumference during adulthood. Monitoring growth trajectories may improve chronic disease prevention.

The stability of children's weight status over time, and the role of television, physical activity, and diet

Weight-related behaviors such as sedentary activity, physical activity, and diet have been the focus of efforts to prevent and reduce the occurrence of obesity and overweight in children, but few longitudinal studies have examined the effects of weight-related behaviors on changes in weight status over time in children. This study examines the effects of weight-related behaviors on subsequent changes in weight during childhood. We used the Early Childhood Longitudinal Study Kindergarten Cohort (ECLS-K), a nationally representative prospective cohort of children in the United States. Data, including anthropometric measures, were collected six times across 1998-2007 (analytic sample=4938). We employed an autoregressive cross-lagged model in a structural equation model framework to assess the effects of behavioral factors -intake of fruit, vegetables, fast food and sugar-sweetened beverages, television viewing, and physical activity - on weight stability over time. BMI z-scores were highly stable throughout childhood: the standardized parameter estimates of BMI z-scores on subsequent-period BMI z-scores ranged from 0.79 to 0.86. BMI z-scores were least stable between Kindergarten and 1st grade but became highly stable between 3rd and 5th grades. After accounting for prior weight, behavioral factors had little effect on subsequent weight. The most important behavioral factor was TV viewing in the 1st and 3rd grades: an additional hour of daily TV viewing was associated with 0.04 higher BMI z-score. It is important to prevent excessive weight gain early in childhood, as weight patterns are long-lasting; the most important behavioral factor may be limiting children's screen time.

Body mass index growth trajectories associated with the different parameters of the metabolic syndrome at adulthood

BACKGROUND

Growth trajectories have shown to be related to obesity and metabolic risks in later life, however body mass index (BMI) trajectories according to the presence or absence of metabolic syndrome (MS) and its parameters in adulthood are scarce in literature.

OBJECTIVES

To investigate BMI trajectories during childhood in relation to MS and its parameters in adult age.

METHODS

A total of 1919 subjects (43.4% male, 20-60 y) participated in this retrospective cohort study. Height, weight, waist circumference (WC), blood glucose, high-density lipoprotein cholesterol, triglycerides and blood pressure were measured at adulthood. Childhood weight and height were collected retrospectively from health booklets. Differences between BMI growth curves of subjects with and without MS were assessed using mixed models for correlated data.

RESULTS

BMI trajectories differed according to the presence or not of MS at adulthood, from the age of 4 years forward (all P<0.05), to the presence or not of hypertriglyceridemia from 1.5 years forward (all P<0.05), and to WC>94 cm (men) / 80 cm (women) compared to lower WC, at all ages (all P<0.05).

CONCLUSIONS

BMI growth curves differ according to the presence or not of MS at adulthood, but differences only appeared after the age of 4 years. Changes vary according to the MS parameters considered. Deviation of the MS-associated BMI curve from normal pattern could correspond to alteration in body composition. These differences in BMI trajectories during childhood support the theory of an early origin of the MS, justifying early prevention.

Development of Distinct Body Mass Index Trajectories Among Children Before Age 5 Years: A Population-Based Study

The prevalence of childhood obesity has increased over the past 3 decades. This study was designed to understand how childhood body mass index (BMI) influences later risk of obesity. We calculated BMIs for children residing in Olmsted County, Minnesota, between January 1, 2005 and December 31, 2012 using medical records data. We defined homogenous BMI trajectory clusters using a nonparametric hill-climbing algorithm. Overall, 16,538 (47%) children had >3 weight assessments at least 1 year apart and were included in the analyses. Within the 8-year follow-up period, children who were younger than 2 years and overweight had a 3- fold increase of obesity (adjusted hazard ratio [HR] = 3.24; 95% confidence interval [CI] = 2.69-3.89) and those aged 5 years and overweight had a 10-fold increased risk of obesity (adjusted HR = 9.97, 95% CI = 8.55-11.62). Three distinct BMI trajectories could be distinguished prior to 5 years of age. The risk of developing obesity in those who are overweight increased dramatically with increasing age. Interventions to prevent obesity need to occur prior to school age to prevent children from entering unhealthy BMI trajectories.

Maternal blood cadmium, lead and arsenic levels, nutrient combinations, and offspring birthweight

Background

Cadmium (Cd), lead (Pb) and arsenic (As) are common environmental contaminants that have been associated with lower birthweight. Although some essential metals may mitigate exposure, data are inconsistent. This study sought to evaluate the relationship between toxic metals, nutrient combinations and birthweight among 275 mother-child pairs.

Methods

Non-essential metals, Cd, Pb, As, and essential metals, iron (Fe), zinc (Zn), selenium (Se), copper (Cu), calcium (Ca), magnesium (Mg), and manganese (Mn) were measured in maternal whole blood obtained during the first trimester using inductively coupled plasma mass spectrometry. Folate concentrations were measured by microbial assay. Birthweight was obtained from medical records. We used quantile regression to evaluate the association between toxic metals and nutrients due to their underlying wedge-shaped relationship. Ordinary linear regression was used to evaluate associations between birth weight and toxic metals.

Results

After multivariate adjustment, the negative association between Pb or Cd and a combination of Fe, Se, Ca and folate was robust, persistent and dose-dependent (p < 0.05). However, a combination of Zn, Cu, Mn and Mg was positively associated with Pb and Cd levels. While prenatal blood Cd and Pb were also associated with lower birthweight. Fe, Se, Ca and folate did not modify these associations.

Conclusion

Small sample size and cross-sectional design notwithstanding, the robust and persistent negative associations between some, but not all, nutrient combinations with these ubiquitous environmental contaminants suggest that only some recommended nutrient combinations may mitigate toxic metal exposure in chronically exposed populations. Larger longitudinal studies are required to confirm these findings.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4225-8) contains supplementary material, which is available to authorized users.

Paediatric obesity and cardiovascular risk factors - A life course approach

Childhood obesity is increasingly prevalent worldwide, and Portugal presents one of the highest prevalence of obesity and overweight among the European countries. Since childhood obesity is a risk factor for obesity in adulthood, the high prevalence of overweight and obesity in paediatric age currently experienced is expected to lead to even higher prevalence of obesity in adulthood in future decades. It is well known that the prenatal period and infancy are critical or sensitive periods for obesity development, but a growing body of evidence also suggests a relevant role of childhood and adolescence. The exposure to some factors during these periods or specific time frames within these periods may confer additional risk for obesity development. Paediatric obesity is associated with cardiovascular risk factors both in the short or medium-term, but also in the long term, conferring additional risk for future adult health. However, it is not clear whether the relation between paediatric obesity and adult health is independent of adult adiposity. There is a moderate to high tracking of obesity from paediatric age into adulthood, which may partially explain the association with adult outcomes. Therefore, there has been increasing interest on life course frameworks to study the effect of the dynamics of adiposity across paediatric age on adult outcomes, namely on the cardiovascular disease risk. The use of this approach to study determinants and consequences of obesity raises methodological challenges to summarize the exposure to adiposity/obesity across the life span, being the identification of growth trajectories and the quantification of the duration of obesity among the most used methods. However, further investigation is still needed to explore the best methods to summarize exposure to adiposity and its variation across time.

Weight Gain Trajectories Associated With Elevated C-Reactive Protein Levels in Chinese Adults

BACKGROUND

Recent longitudinal work suggests that weight change is an important risk factor for inflammation across the full range of BMI. However, few studies have examined whether the risk of inflammation differs by patterns of weight gain over time. Using latent class trajectory analysis, we test whether patterns of weight gain are associated with elevated high-sensitivity C-reactive protein (hs-CRP 2-10 mg/L).

METHODS AND RESULTS

Data come from China Health and Nutrition Survey (CHNS) participants (n=5536), aged 18 at baseline to 66 years in 2009, with measured weight over 18 years. Latent class trajectory analysis was used to identify weight-change trajectories in 6 age and sex strata. Multivariable general linear mixed-effects models fit with a logit link were used to assess the risk of elevated hs-CRP across weight trajectory classes. Models were fit within age and sex strata, controlling for baseline weight, adult height, and smoking, and included random intercepts to account for community-level correlation. Steeper weight-gain trajectories were associated with greater risk of elevated hs-CRP compared to more moderate weight-gain trajectories in men and women. Initially high weight gain followed by weight loss was associated with lower risk of elevated hs-CRP in women aged 18 to 40.

CONCLUSIONS

Latent class trajectory analysis identified heterogeneity in adult weight change associated with differential risk of inflammation independently of baseline weight and smoking. These results suggest that trajectories of weight gain are an important clinical concern and may identify those at risk for inflammation and the development of cardiometabolic disease.

Dual Energy X-Ray Absorptiometry Compared with Anthropometry in Relation to Cardio-Metabolic Risk Factors in a Young Adult Population: Is the 'Gold Standard' Tarnished?

Background and Aims

Assessment of adiposity using dual energy x-ray absorptiometry (DXA) has been considered more advantageous in comparison to anthropometry for predicting cardio-metabolic risk in the older population, by virtue of its ability to distinguish total and regional fat. Nonetheless, there is increasing uncertainty regarding the relative superiority of DXA and little comparative data exist in young adults. This study aimed to identify which measure of adiposity determined by either DXA or anthropometry is optimal within a range of cardio-metabolic risk factors in young adults.

Methods and Results

1138 adults aged 20 years were assessed by DXA and standard anthropometry from the Western Australian Pregnancy Cohort (Raine) Study. Cross-sectional linear regression analyses were performed. Waist to height ratio was superior to any DXA measure with HDL-C. BMI was the superior model in relation to blood pressure than any DXA measure. Midriff fat mass (DXA) and waist circumference were comparable in relation to glucose. For all the other cardio-metabolic variables, anthropometric and DXA measures were comparable. DXA midriff fat mass compared with BMI or waist hip ratio was the superior measure for triglycerides, insulin and HOMA-IR.

Conclusion

Although midriff fat mass (measured by DXA) was the superior measure with insulin sensitivity and triglycerides, the anthropometric measures were better or equal with various DXA measures for majority of the cardio-metabolic risk factors. Our findings suggest, clinical anthropometry is generally as useful as DXA in the evaluation of the individual cardio-metabolic risk factors in young adults.

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.