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Zhu MQ, Cnattingius S, O'Brien LM, Villamor E. Maternal early pregnancy body mass index and risk of insomnia in the offspring. Sleep 2025; 48:zsae236. [PMID: 39373215 DOI: 10.1093/sleep/zsae236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 09/18/2024] [Indexed: 10/08/2024] Open
Abstract
STUDY OBJECTIVES To investigate the association between maternal early pregnancy body mass index (BMI) and risk of offspring insomnia. METHODS We conducted a nationwide cohort study among 3 281 803 singleton live births in Sweden born 1983-2015. Using national registries with prospectively recorded information, we followed participants for an insomnia diagnosis from 2 to up to 35 years of age. We compared insomnia risks by early pregnancy BMI categories using hazard ratios (HR) with 95% confidence intervals (CI) from adjusted Cox models. To assess unmeasured shared familial confounding, we conducted sibling-controlled analyses among 1 724 473 full siblings and studied the relation of maternal full sisters' BMI and insomnia risk in 1 185 998 offspring. RESULTS There were 7154 insomnia diagnoses over a median follow-up age of 17.9 years. Compared with women with normal BMI, adjusted HR (95% CI) of offspring insomnia for early pregnancy BMI categories overweight, obesity class I, and obesity classes II or III were, respectively, 1.22 (1.14, 1.30), 1.60 (1.45, 1.77), and 2.11 (1.83, 2.45). Corresponding adjusted HR (95% CI) in sibling comparisons were, respectively, 1.32 (1.05, 1.65), 1.48 (1.03, 2.14), and 1.56 (0.91, 2.65). Associations with maternal sisters' BMI were attenuated, suggesting a weak role for unmeasured shared factors. Other pregnancy, birth, and neonatal complications were associated with the risk of insomnia in offspring but did not substantially mediate the association. CONCLUSIONS The dose-response relation between maternal overweight and obesity severity with offspring insomnia risk is not fully explained by shared familial factors.
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Affiliation(s)
- Mia Q Zhu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Louise M O'Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Villamor E, Cnattingius S. Grandmaternal body mass index in early pregnancy and risk of infant mortality in grandoffspring: a population-based multigeneration cohort study. Am J Clin Nutr 2024; 120:1156-1164. [PMID: 39475386 PMCID: PMC11600072 DOI: 10.1016/j.ajcnut.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 11/09/2024] Open
Abstract
BACKGROUND Maternal obesity increases risk of infant mortality. Because obesity is highly inheritable, grandmaternal obesity could also play a role. However, it is unknown whether grandmaternal obesity is related to grandoffspring infant mortality risk. OBJECTIVES We investigated the associations of grandmaternal early pregnancy body mass index [BMI (in kg/m2)] and grandoffspring infant mortality risk. METHODS Using Swedish nationwide registers, we estimated infant mortality hazard ratios (HRs) by levels of maternal grandmaternal early pregnancy BMI among 315,461 singleton live-born grandoffspring. We examined whether the association was mediated through maternal body size. In a subset of 164,095 grandsoffspring we evaluated the role of paternal grandmaternal BMI. To explore whether factors shared within families explained these associations, we studied the relations of maternal or paternal full sisters' BMI and infant mortality. RESULTS Maternal grandmaternal overweight or obesity (BMI ≥ 25.0) was associated with increased grandoffspring infant mortality risk. Compared with the population median BMI (21.7), estimated adjusted hazard ratios [HRs (95% confidence interval [CI])] of grandoffspring mortality for BMI 25.0 and 30.0 were, respectively, 1.60 (1.14, 2.23) and 1.61 (1.13, 2.27). Maternal high birth weight-for-gestational age and early pregnancy obesity (BMI ≥ 30.0) were also associated with increased infant mortality risk. The association between maternal grandmaternal overweight or obesity and grandoffspring infant mortality was mostly (62%) mediated through maternal overweight or obesity. Maternal sisters' BMI was unrelated to infant mortality. Paternal grandmaternal obesity was associated with increased infant mortality risk (HR [95% CI] for BMI 30.0 compared with 21.7: 1.65 [1.02, 2.67]); associations with paternal sisters' BMI were not statistically significant. CONCLUSIONS Maternal grandmaternal overweight or obesity is associated with increased risk of grandoffspring infant mortality; factors shared within families may not play a major role. The association is mediated through the maternal early pregnancy BMI. Whether the association with paternal grandmaternal BMI is explained by shared familial factors warrants future confirmation.
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Affiliation(s)
- Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States.
| | - Sven Cnattingius
- Section of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Zhu MQ, Cnattingius S, O’Brien LM, Villamor E. Maternal early pregnancy body mass index and risk of sleep apnea in the offspring. J Clin Sleep Med 2024; 20:1675-1684. [PMID: 38916278 PMCID: PMC11446132 DOI: 10.5664/jcsm.11228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024]
Abstract
STUDY OBJECTIVES We investigated the association between maternal early pregnancy body mass index (BMI) and offspring sleep apnea diagnosis. METHODS We conducted a nationwide cohort study among 3,281,803 singleton live births in Sweden born 1983-2015. Using national registers with prospectively recorded information, we followed participants for a sleep apnea diagnosis from 2 to up to 35 years of age. We compared sleep apnea risks by early pregnancy BMI categories using hazard ratios with 95% confidence intervals from adjusted Cox models. To address confounding by factors shared within families, we conducted sibling-controlled analyses and studied the relation of siblings' maternal BMI with index offspring's sleep apnea risk. RESULTS There were 17,830 sleep apnea diagnoses. Maternal early pregnancy BMI was positively associated with offspring sleep apnea risk; compared with women with normal BMI (18.5-24.9), adjusted hazard ratios (95% confidence intervals) of offspring sleep apnea for maternal BMI categories 25.0-29.9 (overweight), 30.0-34.9 (obesity class I), and ≥35.0 (obesity class II or III) were, respectively, 1.14 (1.09, 1.19), 1.28 (1.20, 1.36), and 1.40 (1.27, 1.54). Corresponding hazard ratios from sibling-controlled analyses representing risk change for maternal BMI differences between pregnancies were, respectively, 1.13 (1.01, 1.26), 1.17 (0.97, 1.42), and 1.32 (0.97, 1.80). Hazard ratios by siblings' maternal BMI were attenuated, suggesting a weak role for shared familial factors. Other pregnancy, birth, and neonatal complications were associated with offspring sleep apnea risk but did not substantially mediate the association with maternal obesity. CONCLUSIONS Maternal overweight and obesity are associated with offspring sleep apnea risk in a dose-response manner. CITATION Zhu MQ, Cnattingius S, O'Brien LM, Villamor E. Maternal early pregnancy body mass index and risk of sleep apnea in the offspring. J Clin Sleep Med. 2024;20(10):1675-1684.
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Affiliation(s)
- Mia Q. Zhu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Louise M. O’Brien
- Division of Sleep Medicine, Department of Neurology and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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Villamor E, Cnattingius S. Grandmaternal body mass index in early pregnancy and risk of grandoffspring stillbirth: a nationwide, 3-generation cohort study. Am J Epidemiol 2024; 193:874-882. [PMID: 38051665 PMCID: PMC11466863 DOI: 10.1093/aje/kwad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023] Open
Abstract
We investigated the association between maternal grandmaternal early pregnancy body mass index (BMI) and grandoffspring stillbirth risk in a Swedish population-based 3-generation cohort of 176 908 grandmothers (F0), 197 579 mothers (F1), and 316 459 grandoffspring (F2) born 1997-2016. There were 998 stillbirths (risk, 3.2 per 1000 births). Compared with grandmaternal BMI 18.5-24.9, adjusted relative risks (RRs) of grandoffspring stillbirth for BMIs of 25.0-29.9 and ≥30.0 were, respectively, 1.41 (95% CI, 1.15-1.72) and 1.62 (95% CI, 1.14-2.30). RRs for corresponding maternal (F1) BMI categories were, respectively, 1.32 (95% CI, 1.06-1.65) and 1.77 (95% CI, 1.39-2.25). Maternal BMI mediated only 19% of this relationship. Grandmaternal preeclampsia and maternal small-for-gestational age (SGA) birth were related to increased F2 stillbirth risk but did not mediate the association between grandmaternal BMI and grandoffspring stillbirth risk. To explore whether this association was explained by factors shared within families, we studied the relationship of maternal full sisters' BMI and stillbirth risk in 101 368 pregnancies. Stillbirth RRs for full sisters' BMI 25.0-29.9 and ≥30.0 compared with 18.5-24.9 were, respectively, 0.76 (95% CI, 0.51-1.13) and 0.88 (95% CI, 0.55-1.40). In conclusion, grandmaternal overweight and obesity were associated with grandoffspring stillbirth. This association is not fully explained by shared familial factors.
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Affiliation(s)
- Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, 171 76 Stockholm, Sweden
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Beer RJ, Cnattingius S, Susser ES, Wang L, Villamor E. Maternal early pregnancy body mass index and bipolar disorder in the offspring. Bipolar Disord 2024; 26:348-355. [PMID: 37986665 PMCID: PMC11102928 DOI: 10.1111/bdi.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To investigate the association between maternal early pregnancy body mass index (BMI) and offspring bipolar disorder (BPD). METHODS We conducted a nationwide cohort study among 1,507,056 non-malformed singleton live-births in Sweden born 1983-2004. Using national registries with prospectively recorded information, we followed participants for a BPD diagnosis from ages 13 to up to 35 years. We compared BPD risks by early pregnancy BMI using hazard ratios (HR) with 95% confidence intervals (CI) from adjusted Cox models. We also conducted sibling-controlled analyses among 874,047 full siblings. RESULTS There were 9970 BPD diagnoses. Risk of BPD was 0.72% through 25 years of age. Maternal early pregnancy BMI was positively associated with offspring BPD risk. Compared with normal BMI (18.5-24.9), adjusted HR (95% CI) for overweight (BMI 25-29.9), obesity grade 1 (BMI 30-34.9), and obesity grades 2-3 (BMI ≥35) were 1.08 (1.02, 1.15), 1.26 (1.14, 1.40), and 1.31 (1.07, 1.60), respectively. Adjusted HR per unit BMI was 1.015 (95% CI 1.009, 1.021). A similar trend was observed among siblings. Pregnancy and neonatal complications did not substantially mediate the association between maternal obesity (BMI ≥30) and offspring BPD. CONCLUSIONS Maternal BMI ≥25 is associated with offspring BPD risk in a dose-response manner.
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Affiliation(s)
- Rachael J. Beer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ezra S. Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York, NY, United States
| | - Lu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Beer RJ, Cnattingius S, Susser ES, Villamor E. Associations of pregnancy complications and neonatal characteristics with bipolar disorder in the offspring: Nationwide cohort and sibling-controlled studies. Bipolar Disord 2023; 25:312-322. [PMID: 37081589 PMCID: PMC10330672 DOI: 10.1111/bdi.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To investigate associations of neonatal characteristics and pregnancy complications with bipolar disorder (BPD) in offspring. METHODS We conducted a nationwide cohort study among 2,059,578 non-malformed singleton live-births in Sweden born 1983-2004. Using national registries with prospectively recorded information, we followed participants for a BPD diagnosis from 13 up to 34 years of age. We compared BPD risks between exposure categories using hazard ratios (HR) with 95% confidence intervals (CI) from adjusted Cox models. We also conducted sibling-controlled analyses among 1,467,819 full siblings. RESULTS There were 14,998 BPD diagnoses. Risk of BPD was 0.74% through 25 years of age. Very/extremely preterm birth (22 to 31 weeks) was related to increased BPD HRs in sibling-controlled analyses; compared with a gestational age of 37 weeks, adjusted HR (95% CI) for 31, 28, and 22 weeks were, respectively, 1.31 (0.99, 1.74), 2.09 (1.15, 3.79), and 5.74 (1.15, 28.63). Spontaneous but not medically indicated very/extremely preterm birth was associated with increased risk. Compared with vaginal birth, caesarean section birth was associated with 1.20 (1.08, 1.33) and 1.58 (1.06, 2.36) times higher BPD risk in general and sibling cohorts, respectively. Small-for-gestational age (SGA) birth was related to increased BPD HRs in general cohort and sibling analyses (HRs [95% CI] were 1.22 [1.06, 1.39] and 1.68 [1.13, 2.50], respectively); only term SGA was associated with increased risk. Head circumference-for-gestational age, gestational diabetes, preeclampsia, and placental abruption were not associated with BPD. CONCLUSIONS Very/extremely preterm birth, caesarean birth, and SGA are related to BPD incidence.
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Affiliation(s)
- Rachael J. Beer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ezra S. Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, and New York State Psychiatric Institute, New York, NY, United States
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States
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Villamor E, Susser ES, Cnattingius S. Defective placentation syndromes and autism spectrum disorder in the offspring: population-based cohort and sibling-controlled studies. Eur J Epidemiol 2022; 37:827-836. [PMID: 35789304 PMCID: PMC9464710 DOI: 10.1007/s10654-022-00884-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/20/2022] [Indexed: 11/03/2022]
Abstract
Defective placentation underlies diverse syndromic manifestations that could affect brain development including: (1) placental abruption, (2) term preeclampsia with a small-for-gestational age (SGA) infant, (3) preterm preeclampsia, and (4) spontaneous preterm birth. We investigated the relations between these defective placentation syndromes and the incidence of Autism Spectrum Disorder (ASD) in offspring. We conducted a population-based cohort study of 1,645,455 non-malformed singleton infants born in Sweden 2000-2016 who were followed for up to 17 years using national registers. We compared ASD rates for children prenatally exposed and unexposed to defective placentation syndromes with use of adjusted hazard ratios (HR) with 95% confidence intervals (CI) from Cox regression. We also conducted sibling-controlled analyses among 1,092,132 full siblings. The association of the syndromes with ASD independent of preterm birth was estimated in mediation analyses. There were 23,810 cases of ASD. In both general cohort and sibling analyses, adjusted HRs (95% CI) of ASD were increased in children of mothers with term preeclampsia combined with SGA [1.5 (1.3, 1.9) and 1.9 (1.1, 3.3), respectively], preterm preeclampsia < 34 weeks [1.8 (1.4, 2.2) and 4.2 (2.1, 8.5), respectively], and spontaneous very or extremely preterm birth (≤ 31 weeks) [2.6 (2.2, 3.0) and 2.4 (1.5, 3.8), respectively]. Placental abruption was associated with increased HR of ASD in general cohort analysis only. The association between preeclampsia and ASD was not fully explained by preterm birth. In conclusion, syndromes linked to defective placentation are associated with increased incidence of ASD in the offspring.
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Affiliation(s)
- Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Ezra S Susser
- Department of Epidemiology, Mailman School of Public Health, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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Villatoro-Santos CR, Ramirez-Zea M, Villamor E. Urinary sodium, iodine, and volume in relation to metabolic syndrome in Mesoamerican children and their parents. Nutr Metab Cardiovasc Dis 2022; 32:1774-1783. [PMID: 35637087 DOI: 10.1016/j.numecd.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The roles of sodium or iodine intake on the metabolic syndrome (MetS) etiology remain controversial. We evaluated the associations of 24 h urinary sodium and iodine with MetS among Mesoamerican children and their adult parents. METHODS AND RESULTS We conducted a cross-sectional study among 217 school-age children and 478 parents from 9 Mesoamerican cities. Exposures were high 24 h urinary sodium excretion and concentration (>2000 mg/d or mg/L, respectively) and high 24 h urinary iodine excretion and concentration (≥300 μg/d or μg/L, respectively). In children, the outcome was a standardized metabolic score from five criteria analogous to the Adult Treatment Panel (ATP) III criteria. In adults, MetS was defined according to the ATP III criteria. We estimated adjusted mean differences in the metabolic risk score and adjusted prevalence ratios of MetS between exposure categories using multivariable regression. In children, high sodium concentration was associated with a 0.10 units (43% of a SD) higher score (P = 0.001) and high iodine concentration was related to a 0.09 units (39% of a SD) higher score (P = 0.009). Unexpectedly, high 24 h urinary volume was associated with a lower metabolic score. In adults, high 24 h sodium excretion was related to hypertension and high iodine concentration was related to increased MetS prevalence. CONCLUSION High sodium and iodine concentrations, but not 24 h iodine excretion, are significantly associated with MetS in children, whereas high 24 h urinary volume is related to a decreased metabolic score. In adults, high iodine concentration tends to be related to increased MetS prevalence, but not 24 h iodine excretion.
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Affiliation(s)
- C R Villatoro-Santos
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - E Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Villamor E, Susser ES, Cnattingius S. Defective Placentation Syndromes and Intellectual Disability in the Offspring: Nationwide Cohort and Sibling-Controlled Studies. Am J Epidemiol 2022; 191:1557-1567. [PMID: 35380610 PMCID: PMC9618159 DOI: 10.1093/aje/kwac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 01/29/2023] Open
Abstract
We investigated the relationships between syndromic manifestations of defective placentation and the incidence of intellectual disability (ID) in offspring by conducting a population-based cohort study of 1,581,200 nonmalformed, live singleton infants born in Sweden between 1998 and 2014. Exposures were: 1) placental abruption, 2) preterm preeclampsia (<34 weeks of gestation), 3) preeclampsia combined with infant being small for gestational age (SGA) at birth, and 4) spontaneous preterm birth. The outcome was an ID diagnosis after 3 years of age. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for each syndrome using Cox regression and robust variances. There were 9,451 children with ID (5.5 per 10,000 child-years). ID incidence rates increased with placental abruption (HR = 2.8, 95% CI: 2.3, 3.5), preterm preeclampsia (HR = 3.7, 95% CI: 2.9, 4.7), preeclampsia combined with SGA (HR = 3.3, 95% CI: 2.6, 4.1), and spontaneous preterm birth (for 32-36 and 22-31 weeks, respectively, HR = 1.6 (95% CI: 1.4, 1.8) and 5.2 (95% CI: 4.3, 6.2)). The same pattern of results was evident in sibling-controlled analyses among 1,043,158 full siblings. The strength of associations increased with ID severity. Preterm birth only partly explained the associations of placental abruption, preeclampsia, or SGA with ID. We conclude that defective placentation is related to increased incidence of ID in the offspring.
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Affiliation(s)
- Eduardo Villamor
- Correspondence to Dr. Eduardo Villamor, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 (e-mail: )
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Garfein J, Flannagan KSJ, Mora-Plazas M, Oliveros H, Marín C, Villamor E. Prospective associations between leukocyte telomere length and adiposity in childhood. Pediatr Obes 2022; 17:e12868. [PMID: 34761561 DOI: 10.1111/ijpo.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Leukocyte telomere length (LTL) is associated with obesity and may be involved in its aetiology, but few studies have focused on children and most have been cross-sectional. We assessed the relation of LTL with adiposity development in a prospective study of Colombian children. We quantified LTL at enrollment in 722 children aged 5-12 years and measured anthropometry annually for a median 6 years. Using mixed effects models, we estimated changes in adiposity measures including BMI and waist circumference (WC)-for-age z-scores in relation to baseline LTL z-score. In girls, longer LTL was linearly related to a lower increase in WC z-score from age 6 to 16 years. Every 1 SD LTL was associated with an adjusted 0.13 units lower increase in WC (95% CI: -0.23, -0.03; p = 0.01). In conclusion, longer LTL among girls in middle childhood is associated with smaller increases in WC, an indicator of abdominal adiposity.
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Affiliation(s)
- Joshua Garfein
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kerry S J Flannagan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Henry Oliveros
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Constanza Marín
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Garfein J, Flannagan KS, Rittman D, Ramirez-Zea M, Villamor E. Leukocyte telomere length is inversely associated with a metabolic risk score in Mesoamerican children. Am J Hum Biol 2021; 34:e23596. [PMID: 33720476 DOI: 10.1002/ajhb.23596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Leukocyte telomere length (LTL) may be involved in the etiology of the metabolic syndrome (MetS). We examined the associations of LTL with MetS and its components among Mesoamerican children and their adult parents, in a region where MetS prevalence is high. METHODS We conducted a cross-sectional study of 151 children aged 7-12 years and 346 parents from the capitals of Belize, Honduras, Nicaragua, Costa Rica, Panama, and Chiapas State, Mexico. We quantified LTL by qPCR on DNA extracted from whole blood. In children, we created an age- and sex-standardized metabolic risk score using waist circumference (WC), the homeostasis model of insulin resistance (HOMA-IR), blood pressure, serum high-density lipoprotein (HDL) cholesterol, and serum triglycerides. In adults, MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III definition. We estimated mean differences in metabolic risk score and prevalence ratios of MetS across quartiles of LTL using multivariable-adjusted linear and Poisson regression models, respectively. RESULTS In children, every 1 LTL z-score was related to an adjusted 0.05 units lower (95% CI: -0.09, -0.02, P = 0.005) MetS risk score, through WC, HOMA-IR, and HDL. Among adults, LTL was not associated with MetS prevalence; however, every 1 LTL z-score was associated with an adjusted 34% lower prevalence of high fasting glucose (95% CI: 3%, 55%, p = .03). CONCLUSIONS Among Mesoamerican children, LTL is associated with an improved metabolic profile; among adults, LTL is inversely associated with the prevalence of high fasting glucose.
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Affiliation(s)
- Joshua Garfein
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kerry S Flannagan
- Eunice Kennedy Shriver National Institute of Child Health and Development, Rockville, Maryland, USA
| | - Danielle Rittman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Abstract
OBJECTIVE To examine the associations between vitamins of the methionine-homocysteine (Hcys) cycle (B6, B12 and folate) and Hcys with metabolic syndrome (MetS) among Mesoamerican children and their adult parents. DESIGN We conducted a cross-sectional study. Exposures were plasma vitamins B6 and B12 concentrations, erythrocyte folate and plasma Hcys. In children, the outcome was a continuous metabolic risk score calculated through sex- and age standardisation of waist circumference, the homoeostatic model assessment for insulin resistance, mean arterial pressure (MAP), serum HDL-cholesterol and serum TAG. In parents, the outcome was the prevalence of MetS according to the Adult Treatment Panel III Criteria. We estimated mean differences in the metabolic risk score and prevalence ratios of MetS between quartiles of the exposures using multivariable-adjusted linear and Poisson regression models, respectively. SETTING Capital cities of Belize, Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica and Chiapas State in Mexico. PARTICIPANTS In total, 237 school-aged children and 524 parents. RESULTS Among children, vitamin B12 was inversely associated with the metabolic risk score (quartiles 4-1 adjusted difference = -0·13; 95 % CI: -0·21, -0·04; Ptrend = 0·008) through MAP, HDL-cholesterol and TAG. In contrast, folate was positively associated with the metabolic risk score (quartiles 4-1 adjusted difference = 0·11; 95 % CI: 0·01, 0·20; Ptrend = 0·02). In adults, vitamin B6 was inversely associated with MetS prevalence, whereas vitamin B12 and folate were positively related to this outcome. CONCLUSIONS Vitamins of the methionine-Hcys cycle are associated with MetS in different directions. The associations differ between children and adults.
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Ohuma EO. Response to Professor Cole's commentary: Methods for calculating growth trajectories and constructing growth centiles. Stat Med 2020; 38:3580-3583. [PMID: 31298429 DOI: 10.1002/sim.8128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/25/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Micronutrient status and leukocyte telomere length in school-age Colombian children. Eur J Nutr 2019; 59:1055-1065. [DOI: 10.1007/s00394-019-01966-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/07/2019] [Indexed: 12/18/2022]
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Ohuma EO, Altman DG. Statistical methodology for constructing gestational age-related charts using cross-sectional and longitudinal data: The INTERGROWTH-21 st project as a case study. Stat Med 2018; 38:3507-3526. [PMID: 30488491 PMCID: PMC6767451 DOI: 10.1002/sim.8018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 11/06/2022]
Abstract
Most studies aiming to construct reference or standard charts use a cross-sectional design, collecting one measurement per participant. Reference or standard charts can also be constructed using a longitudinal design, collecting multiple measurements per participant. The choice of appropriate statistical methodology is important as inaccurate centiles resulting from inferior methods can lead to incorrect judgements about fetal or newborn size, resulting in suboptimal clinical care. Reference or standard centiles should ideally provide the best fit to the data, change smoothly with age (eg, gestational age), use as simple a statistical model as possible without compromising model fit, and allow the computation of Z-scores from centiles to simplify assessment of individuals and enable comparison with different populations. Significance testing and goodness-of-fit statistics are usually used to discriminate between models. However, these methods tend not to be useful when examining large data sets as very small differences are statistically significant even if the models are indistinguishable on actual centile plots. Choosing the best model from amongst many is therefore not trivial. Model choice should not be based on statistical considerations (or tests) alone as sometimes the best model may not necessarily offer the best fit to the raw data across gestational age. In this paper, we describe the most commonly applied methodologies available for the construction of age-specific reference or standard centiles for cross-sectional and longitudinal data: Fractional polynomial regression, LMS, LMST, LMSP, and multilevel regression methods. For illustration, we used data from the INTERGROWTH-21st Project, ie, newborn weight (cross-sectional) and fetal head circumference (longitudinal) data as examples.
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Affiliation(s)
- Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.,Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine University of Oxford, Old Road Campus, Oxford OX3 7BN, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
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Flannagan KS, Ramirez-Zea M, Roman AV, Das AK, Villamor E. Sociodemographic, Anthropometric, and Dietary Predictors of Polyunsaturated Fatty Acids in Adipose Tissue Among Mesoamerican Children and Their Parents. Food Nutr Bull 2018; 39:495-511. [PMID: 30458642 DOI: 10.1177/0379572118808639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Polyunsaturated fatty acid (PUFA) intake is low throughout Latin America. Improving PUFA status could be an effective intervention against chronic disease, but information on sociodemographic and dietary patterning of PUFA status in the region is limited. OBJECTIVE To characterize sociodemographic, anthropometric, and dietary predictors of PUFA status biomarkers in adipose tissue among children and their parents from Mesoamerica. METHODS This was a cross-sectional study of 220 children aged 7 to 12 years and 471 parents from capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, and Belize, as well as Tuxtla Gutiérrez in Mexico. The PUFA from gluteal adipose tissue was quantified using gas chromatography. Participants reported sociodemographic information and the type of vegetable oil used for cooking. We estimated percent mean differences in linoleic acid (LA), total long-chain n-6 PUFA (n-6 LCPUFA), α-linolenic acid (ALA), and total long-chain n-3 PUFA (n-3 LCPUFA) between levels of predictors using multivariable-adjusted linear regression models. RESULTS Country was the strongest predictor of any PUFA, whereas body mass index was positively associated with n-6 LCPUFA in children and adults. Cooking primarily with soybean oil was positively associated with LA in children and adults and ALA in adults. Cooking with canola oil was positively related to n-6 LCPUFA in adults and n-3 LCPUFA in children and adults. Cooking with palm oil was associated with low adipose tissue levels of all n-6 and n-3 PUFA. CONCLUSIONS Adipose tissue PUFA status in Mesoamerica is associated with country of origin and the type of oil used for cooking.
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Affiliation(s)
- Kerry S Flannagan
- 1 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Manuel Ramirez-Zea
- 2 INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Ana Victoria Roman
- 2 INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Arun K Das
- 3 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Eduardo Villamor
- 1 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.,4 Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
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Ohuma EO, Altman DG. Design and other methodological considerations for the construction of human fetal and neonatal size and growth charts. Stat Med 2018; 38:3527-3539. [PMID: 30352489 PMCID: PMC6767035 DOI: 10.1002/sim.8000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 07/26/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
This paper discusses the features of study design and methodological considerations for constructing reference centile charts for attained size, growth, and velocity charts with a focus on human growth charts used during pregnancy. Recent systematic reviews of pregnancy dating, fetal size, and newborn size charts showed that many studies aimed at constructing charts are still conducted poorly. Important design features such as inclusion and exclusion criteria, ultrasound quality control measures, sample size determination, anthropometric evaluation, gestational age estimation, assessment of outliers, and chart presentation are seldom well addressed, considered, or reported. Many of these charts are in clinical use today and directly affect the identification of at‐risk newborns that require treatment and nutritional strategies. This paper therefore reiterates some of the concepts previously identified as important for growth studies, focusing on considerations and concepts related to study design, sample size, and methodological considerations with an aim of obtaining valid reference or standard centile charts. We discuss some of the key issues and provide more details and practical examples based on our experiences from the INTERGROWTH‐21st Project. We discuss the statistical methodology and analyses for cross‐sectional studies and longitudinal studies in a separate article in this issue.
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Affiliation(s)
- Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.,Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
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Razaz N, Cnattingius S. Association between maternal body mass index in early pregnancy and anorexia nervosa in daughters. Int J Eat Disord 2018; 51:906-913. [PMID: 30051496 DOI: 10.1002/eat.22921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The etiology of anorexia nervosa is poorly understood. Although genetic factors play a major role, maternal factors, and obstetric complications are possible environmental causes. We investigated the association between maternal overweight and obesity in early pregnancy and risk of anorexia nervosa in daughters. METHODS A retrospective cohort study including all live singleton females born in Sweden from 1992 through 2002. Anorexia nervosa diagnosis was identified by using the nation-wide Swedish Patient and Cause of Death Registers. Multivariable Cox hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% CIs, adjusting for confounders. Stratified Cox regressions were applied to data on siblings to adjust for unmeasured familial confounding. RESULTS Among 486,688 live singleton females, 2,414 (0.50%) were diagnosed with anorexia nervosa through 2012. The aHR of anorexia nervosa decreased linearly by maternal BMI (p-value for trend < .001). When compared with daughters of normal weight mothers (body mass index [BMI] 18.5-24.9), aHRs (95%CI) of anorexia nervosa were 0.74 (0.65-0.84) in daughters of overweight mothers (BMI 25-29.9) and 0.61 (0.47-0.78) in daughters of mothers with obesity Grade I (BMI 30-34.9). In sibling control analysis, no associations were observed between maternal BMI and aHRs of anorexia nervosa in offspring. CONCLUSIONS The rate of anorexia nervosa decreased with maternal overweight and obesity in a dose-response manner. However, the sibling control analysis suggests that these findings are not consistent with causals effects of maternal BMI on anorexia nervosa in offspring.
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Affiliation(s)
- Neda Razaz
- Department of Medicine, Solna Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine, Solna Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Aris IM, Bernard JY, Chen LW, Tint MT, Pang WW, Lim WY, Soh SE, Saw SM, Godfrey KM, Gluckman PD, Chong YS, Yap F, Kramer MS, Lee YS. Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort. Int J Epidemiol 2018; 46:513-525. [PMID: 27649801 DOI: 10.1093/ije/dyw232] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/14/2022] Open
Abstract
Background : Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. Methods : We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child's BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. Results : Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m 2 , 16.5 (5.3) mm and 3.8 (1.3) kg/m 2 , respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m 2 and pre-peak velocity of 0.7 (0.3) kg/m 2 /month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [-0.45 kg/m 2 (-0.69, -0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12-1.62) for age; 1.89 (1.60-2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. Conclusions : Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations.
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Affiliation(s)
- Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore
| | - Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wai Yee Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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Razaz N, Tedroff K, Villamor E, Cnattingius S. Maternal Body Mass Index in Early Pregnancy and Risk of Epilepsy in Offspring. JAMA Neurol 2017; 74:668-676. [PMID: 28384785 DOI: 10.1001/jamaneurol.2016.6130] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance There is growing concern about the long-term neurologic effects of prenatal exposure to maternal overweight and obesity. The causes of epilepsy are poorly understood and, in more than 60% of the patients, no definitive cause can be determined. Objectives To investigate the association between early pregnancy body mass index (BMI) and the risk of childhood epilepsy and examine associations between obesity-related pregnancy and neonatal complications and risks of childhood epilepsy. Design, Setting, and Participants A population-based cohort study of 1 441 623 live single births at 22 or more completed gestational weeks in Sweden from January 1, 1997, to December 31, 2011, was conducted. The diagnosis of epilepsy as well as obesity-related pregnancy and neonatal complications were based on information from the Sweden Medical Birth Register and National Patient Register. Multivariate Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) and 95% CIs after adjusting for maternal age, country of origin, educational level, cohabitation with partner, height, smoking, maternal epilepsy, and year of delivery. Data analysis was conducted from June 1 to December 15, 2016. Main Outcomes and Measures Risk of childhood epilepsy. Results Of the 1 421 551 children born between January 1, 1997, and December 31, 2011, with covariate information available, 7592 (0.5%) were diagnosed with epilepsy through December 31, 2012. Of these 3530 (46.5%) were female. The overall incidence of epilepsy in children aged 28 days to 16 years was 6.79 per 10 000 child-years. Compared with offspring of normal-weight mothers (BMI 18.5 to <25.0), adjusted HRs of epilepsy by maternal BMI categories were as follows: overweight (BMI 25.0 to <30.0), 1.11 (95% CI, 1.04-1.17); obesity grade I (BMI 30.0 to <35.0), 1.20 (95% CI, 1.10-1.31); obesity grade II (BMI 35.0 to <40.0), 1.30 (95% CI, 1.12-1.50); and obesity grade III (BMI≥40.0), 1.82 (95% CI, 1.46-2.26). The rates of epilepsy were considerably increased for children with malformations of the nervous system (adjusted HR, 46.4; 95% CI, 42.2-51.0), hypoxic ischemic encephalopathy (adjusted HR, 23.6; 95% CI, 20.6-27.1), and neonatal convulsions (adjusted HR, 33.5; 95% CI, 30.1-37.4). The rates of epilepsy were doubled among children with neonatal hypoglycemia (adjusted HR, 2.10; 95% CI, 1.90-2.33) and respiratory distress syndrome (adjusted HR, 2.43; 2.21-2.66), and neonatal jaundice was associated with more than a 50% increased risk of epilepsy (adjusted HR, 1.47; 95% CI, 1.33-1.63). The elevated risk of epilepsy in children of overweight or obese mothers was not explained by obesity-related pregnancy or neonatal complications. Conclusions and Relevance The rates of childhood epilepsy increased with maternal overweight or obesity in a dose-response manner. Given that overweight and obesity are modifiable, prevention of obesity may be an important public health strategy to reduce the incidence of childhood epilepsy.
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Affiliation(s)
- Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Tedroff
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Eduardo Villamor
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden3Department of Epidemiology, School of Public Health, and Center for Human Growth and Development, University of Michigan, Ann Arbor
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, Neovius M. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. BMJ 2017; 357:j2563. [PMID: 28615173 PMCID: PMC5470075 DOI: 10.1136/bmj.j2563] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy.Design Population based cohort study.Setting Nationwide Swedish registries.Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages.Exposure Maternal BMI at the first prenatal visit.Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year.Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.
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Affiliation(s)
- Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Eduardo Villamor
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Björn Pasternak
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
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Flannagan KS, Jansen EC, Rozek LS, Rentschler KM, Roman AV, Ramirez‐Zea M, Villamor E. Sociodemographic correlates and family aggregation of leukocyte telomere length in adults and children from Mesoamerica. Am J Hum Biol 2016; 29. [DOI: 10.1002/ajhb.22942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/19/2016] [Accepted: 11/06/2016] [Indexed: 01/18/2023] Open
Affiliation(s)
- Kerry S. Flannagan
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn Arbor Michigan
| | - Erica C. Jansen
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn Arbor Michigan
| | - Laura S. Rozek
- Department of Environmental Health SciencesUniversity of Michigan School of Public HealthAnn Arbor Michigan
| | - Katie M. Rentschler
- Department of Environmental Health SciencesUniversity of Michigan School of Public HealthAnn Arbor Michigan
| | - Ana Victoria Roman
- INCAP Research Center for the Prevention of Chronic DiseasesGuatemala City Guatemala
| | - Manuel Ramirez‐Zea
- INCAP Research Center for the Prevention of Chronic DiseasesGuatemala City Guatemala
| | - Eduardo Villamor
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn Arbor Michigan
- Center for Human Growth and Development University of MichiganAnn Arbor Michigan
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Prevalence and sociodemographic correlates of metabolic syndrome in school-aged children and their parents in nine Mesoamerican countries. Public Health Nutr 2016; 20:255-265. [PMID: 27609776 DOI: 10.1017/s1368980016002342] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To ascertain the prevalence and sociodemographic correlates of cardiometabolic risk factors in adults and school-aged children from Mesoamerica. DESIGN Cross-sectional study with convenience sampling. In adults, metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP III) criteria. In children, we calculated a continuous sex- and age-standardized metabolic risk score using variables corresponding to adult ATP III criteria. Metabolic syndrome prevalence in adults and risk score distribution in children were compared across levels of sociodemographic characteristics with use of Poisson and linear regression, respectively. SETTING Capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, the Mexican State of Chiapas (Tuxtla Gutiérrez city) and Belize. SUBJECTS Families (n 267), comprising one child aged 7-12 years and their biological parents. RESULTS The prevalence of metabolic syndrome was 37·9 % among women and 35·3 % among men. The most common component was low HDL cholesterol, 83·3 % in women and 78·9 % in men. Prevalence was positively associated with age. In women, metabolic syndrome was inversely related to education level whereas in men it was positively associated with household food security and height, after adjustment. The metabolic risk score in children was inversely related to parental height, and positively associated with height-for-age and with having parents with the metabolic syndrome. CONCLUSIONS Metabolic syndrome is highly prevalent in Mesoamerica. The burden of metabolic risk factors disproportionately affects women and children of lower socio-economic status and men of higher socio-economic status.
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Villamor E, Cnattingius S. Interpregnancy weight change and risk of preterm delivery. Obesity (Silver Spring) 2016; 24:727-34. [PMID: 26833699 DOI: 10.1002/oby.21384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/02/2015] [Accepted: 10/10/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prepregnant weight gain increases risk of obstetric complications, but its effect on preterm delivery is unknown. This study aimed to investigate the associations between change in body mass index (BMI) from first to second pregnancies and risk of preterm delivery in the second pregnancy according to the type and severity of preterm delivery. METHODS A nationwide cohort study was conducted in 465,836 Swedish women with their first two consecutive singleton live births between 1992 and 2012. Rates of very (22-31 gestational weeks) and moderately (32-36 gestational weeks) preterm delivery in the second pregnancy, classified as spontaneous or medically indicated, were compared between categories of interpregnancy BMI change. RESULTS Among women with first pregnancy BMI < 25, BMI gain ≥ 4 kg/m(2) and BMI loss > 2 kg/m(2) were related to 24% (95% CI, 5-46%) and 18% (95% CI, 5-33%) higher rates of spontaneous moderately preterm delivery, respectively. BMI gain ≥ 4 kg/m(2) was related to increased risk of medically indicated very preterm delivery. Weight loss was associated with reduced rates of medically indicated moderately preterm delivery among women with BMI ≥ 25. CONCLUSIONS High weight gain or loss in normal-weight women is associated with spontaneous moderately preterm delivery. High interpregnancy weight gain is related to increased risks of medically indicated preterm delivery.
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Affiliation(s)
- Eduardo Villamor
- Department of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- T J Cole
- a Population, Policy and Practice Programme, UCL Institute of Child Health , London WC1N 1EH , UK
| | - M Cortina Borja
- a Population, Policy and Practice Programme, UCL Institute of Child Health , London WC1N 1EH , UK
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