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Wong TCY, Yeung KHT, Khalikova VR, Hui LL, Chow KM, Lau EYY, Nelson EAS. Online ethnography of breastfeeding discussions in social networking sites for Hong Kong mothers. Food Sci Nutr 2024; 12:843-850. [PMID: 38370074 PMCID: PMC10867471 DOI: 10.1002/fsn3.3796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 02/20/2024] Open
Abstract
With the growth of social networking, parents are increasingly sharing their experiences and opinions or seeking help with childcare through online platforms. This study explored breastfeeding-related topics that Hong Kong mothers raise on social networking sites and how other mothers respond; and how these sites could be a facilitator or barrier to breastfeeding. An online ethnographic approach was used to collect breastfeeding-related discussions (posts and responses) among mothers from three sources: two closed moderated Facebook groups with more than 1000 members, and one open unmoderated forum (Baby Kingdom) (26 December 2021-26 May 2022). Posts not related to breastfeeding (e.g., about formula feeding only) were excluded. Data were collected by a nonparticipatory approach to avoid disrupting the dynamics of the groups. In total, 131 original posts and their 802 responses were collected, of which the common topics discussed were breastfeeding technique, breastfeeding-related health issues, breastfeeding mothers returning to work, and COVID-19 vaccination/infection during breastfeeding. The responses to the queries on breastfeeding technique and health issues in the closed groups were mostly about sharing breastfeeding knowledge and health information to provide timely emotional support and practical solutions. Although similar responses were observed in the open forum, sharing experiences in using formula milk were frequently observed in the responses to posts related to breastfeeding. Social networking sites could be facilitators and barriers to breastfeeding. The potential for infant formula promotion in open forums requires further monitoring and evaluation. Moderation and support from trained professionals or peers could be important.
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Affiliation(s)
- Toma Chun Yip Wong
- Department of Paediatrics, Faculty of MedicineThe Chinese University of Hong KongNew TerritoriesHong Kong
| | - Karene Hoi Ting Yeung
- Department of Paediatrics, Faculty of MedicineThe Chinese University of Hong KongNew TerritoriesHong Kong
| | - Venera R. Khalikova
- Department of AnthropologyThe Chinese University of Hong KongNew TerritoriesHong Kong
| | - Lai Ling Hui
- Department of Paediatrics, Faculty of MedicineThe Chinese University of Hong KongNew TerritoriesHong Kong
- Department of Food Science and NutritionThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongNew TerritoriesHong Kong
| | - Esther Yuet Ying Lau
- Department of PsychologyThe Education University of Hong KongNew TerritoriesHong Kong
| | - E. Anthony S. Nelson
- Department of Paediatrics, Faculty of MedicineThe Chinese University of Hong KongNew TerritoriesHong Kong
- School of MedicineThe Chinese University of Hong KongShenzhenGuangdongChina
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Hui LL, Liao E, Yeung KHT, Ip PLS, Lam HS, Nelson EAS. Reducing admissions for neonatal jaundice are needed to maximise benefits of breastfeeding promotion. Acta Paediatr 2024; 113:362-364. [PMID: 37941088 DOI: 10.1111/apa.17028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Lai Ling Hui
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily Liao
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China
| | - Karene Hoi Ting Yeung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Edmund Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Medicine, The Chinese University of Hong Kong Shenzhen, Shenzhen, China
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Sun K, Zhao JV, Nelson EAS, Wong VWS, Lam HSHS, Hui LL. Iron status and non-alcoholic fatty liver disease: A Mendelian randomization study. Nutrition 2024; 118:112295. [PMID: 38103266 DOI: 10.1016/j.nut.2023.112295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES The aim of this study was to assess the association of genetically determined iron status with the risk for non-alcoholic fatty liver disease (NAFLD) using two-sample Mendelian randomization (MR) analysis. METHODS We applied single nucleotide polymorphisms (SNPs) associated at genome-wide significance with iron status proxied by serum iron, ferritin, transferrin, and transferrin saturation from the Genetics of Iron status Consortium (N = 48 793), in a genome-wide association study of 1664 NAFLD cases and 400 055 controls from the United Kingdom Biobank. A SNP associated with multiple markers of iron status was only applied to one marker with the strongest association in the main analysis. Their effects on NAFLD were calculated using inverse variance weighting after excluding SNPs associated with alkaline phosphatase and lipid metabolism. RESULTS The risk for NAFLD is negatively associated with genetically predicted serum transferrin level with a 20% reduction in NAFLD risk per SD (0.65g/L) increase in transferrin (95% confidence interval [CI], 0.66-0.97), and trending positive association with transferrin saturation (odds ratio [OR], 1.50; 95% CI, 0.96-2.35) but it was not associated with serum iron (OR, 0.90; 95% CI, 0.63-1.29) and ferritin (OR, 1.33; 95% CI, 0.54-3.30). CONCLUSIONS MR analysis provided evidence that genetically predicted higher serum transferrin, indicating lower iron status, may be protective against NAFLD, whereas higher transferrin saturation, indicating higher iron status, might increase the risk for NAFLD and its pathogenesis.
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Affiliation(s)
- Kexin Sun
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Jie V Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, PR China
| | - Edmund Anthony Severn Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China; School of Medicine, The Chinese University of Hong Kong, Shenzhen, PR China
| | - Vincent Wai Sun Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Hugh Simon Hung San Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Lai Ling Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China; Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong SAR, PR China.
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Wang X, Hui LL, Cole TJ, Nelson EAS, Lam HS. Fitness of INTERGROWTH-21st birth weight standards for Chinese-ethnicity babies. Arch Dis Child Fetal Neonatal Ed 2023; 108:517-522. [PMID: 36854618 DOI: 10.1136/archdischild-2022-325066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To determine the fitness of the INTERGROWTH-21st birth weight standards (INTERGROWTH21) for ethnic Chinese babies compared with a local reference (FOK2003). DESIGN Population-based analysis of territory-wide birth data. SETTING All public hospitals in Hong Kong. PARTICIPANTS Live births between 24 and 42 complete weeks' gestation during 2006-2017. MAIN OUTCOME MEASURES Babies' birth weight Z-scores were calculated using published methods. The two references were compared in three aspects: (1) the proportions of large-for-gestational-age (LGA) or small-for-gestational-age (SGA) infants, (2) the gestation-specific and sex-specific mean birth weight Z-scores and (3) the predictive power for SGA-related complications. RESULTS 488 896 infants were included. Using INTERGROWTH21, among neonates born <33 weeks' gestation, the mean birth weight Z-scores per week were closer to zero (-0.2 to 0.05), while most of them were further from zero (0.06 to 0.34) after excluding infants with a high risk of abnormal intrauterine growth. Compared with FOK2003, INTERGROWTH21 classified smaller proportions of infants as SGA (8.3% vs 9.6%) and LGA (6.6% vs 7.9%), especially SGA among preterm infants (13.1% vs 17.0%). The area under the receiver operating characteristic curve for predicting SGA-related complications was greater with FOK2003 (0.674, 95% CI 0.670 to 0.677) than INTERGROWTH21 (0.658, 95% CI 0.655 to 0.661) (p<0.001). CONCLUSIONS INTERGROWTH21 performed less well than FOK2003, a local reference for ethnic Chinese babies, especially in infants born <33 weeks' gestation. Although the differences are clinically small, both these references performed poorly for extremely preterm infants, and thus a more robust chart based on a larger sample of appropriately selected infants is needed.
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Affiliation(s)
- Xuelian Wang
- Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, People's Republic of China
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Lai Ling Hui
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, People's Republic of China
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - E Anthony S Nelson
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- School of Medicine, The Chinese University of Hong Kong-Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Hugh Simon Lam
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Hui LL, Yeung KH, Chow KM, Poon LC, Ip PL, Nelson EAS. Breastfeeding challenges and opportunities during COVID-19 in Hong Kong. J Paediatr Child Health 2023; 59:609-612. [PMID: 37021632 DOI: 10.1111/jpc.16238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 04/07/2023]
Abstract
Barriers to sustain breastfeeding could be time and place specific. Here, we summarise new and old challenges to breastfeeding during COVID-19 pandemic in Hong Kong, some of which were obtained from qualitative in-depth interviews with health-care professionals. We document how unnecessary massive mother-baby separations in hospitals and doubts in COVID-19 vaccine safety seriously harm breastfeeding. We also discuss how the trends and increase in acceptance of receiving post-natal care from family doctors, online-antenatal class, work-from-home policy and telemedicine implicate new strategies to protect, promote and support breastfeeding during and after the pandemic. The challenges from the COVID-19 pandemic on breastfeeding have revealed new opportunities to support breastfeeding in Hong Kong and similar settings where exclusive breastfeeding for 6 months is still not the norm.
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Affiliation(s)
- Lai Ling Hui
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Karene Ht Yeung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patricia Ls Ip
- Baby Friendly Hospital Initiative Hong Kong Association, Hong Kong, China
| | - E Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Medicine, The Chinese University of Hong Kong Shenzhen, Guangdong, Shenzhen, China
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Hui LL, Ho FK, Wright CM, Cole TJ, Lam HS, Deng HB, So HK, Ip P, Nelson EAS. World variation in head circumference for children from birth to 5 years and a comparison with the WHO standards. Arch Dis Child 2023; 108:373-378. [PMID: 36927619 DOI: 10.1136/archdischild-2022-324661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/11/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE A recent review reported that the WHO 2006 growth standards reflect a smaller head circumference at 24 months than seen in 18 countries. Whether this happens in early infancy and to what extent populations differ is not clear. This scooping review aimed to estimate the rates of children in different populations identified as macrocephalic or microcephalic by WHO standards. METHODS We reviewed population-representative head circumference-for-age references. For each reference, we calculated the percentages of head circumferences that would be classified as microcephalic (<3rd WHO centile) or macrocephalic (>97th WHO centile) at selected ages. RESULTS Twelve references from 11 countries/regions (Belgium, China, Ethiopia, Germany, Hong Kong, India, Japan, Norway, Saudi Arabia, UK and USA) were included. Median head circumference was larger than that for the Multicentre Growth Reference Study populations in both sexes in all these populations except for Japanese and Chinese children aged 1 month and Indians. Overall, at 12/24 months, 8%-9% children would be classified as macrocephalic and 2% would be classified as microcephalic, compared with the expected 3%. However at 1 month, there were geographic differences in the rate of macrocephaly (6%-10% in Europe vs 1%-2% in Japan and China) and microcephaly (1%-3% vs 6%-14%, respectively). CONCLUSIONS Except for Indians and some Asian neonates, adopting the WHO head circumference standards would overdiagnose macrocephaly and underdiagnose microcephaly. Local population-specific cut-offs or references are more appropriate for many populations. There is a need to educate healthcare professionals about the limitations of the WHO head circumference standards.
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Affiliation(s)
- Lai Ling Hui
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.,Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong SAR, People's Republic of China
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Charlotte Margaret Wright
- Department of Child Health, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hugh Simon Lam
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Han-Bing Deng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Hung-Kwan So
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China .,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, People's Republic of China
| | - E Anthony S Nelson
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China .,Faculty of Medicine, The Chinese University of Hong Kong - Shenzhen, Shenzhen, Guangdong, People's Republic of China
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Hui LL, Nelson EAS, Deng HB, Leung TY, Ho CH, Chong JSC, Fung GPG, Hui J, Lam HS. The view of Hong Kong parents on secondary use of dried blood spots in newborn screening program. BMC Med Ethics 2022; 23:105. [PMID: 36319979 PMCID: PMC9628108 DOI: 10.1186/s12910-022-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks.
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Affiliation(s)
- L L Hui
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - E A S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - H B Deng
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - T Y Leung
- Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - C H Ho
- Academia Sinica, Taipei, Taiwan
| | - J S C Chong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - G P G Fung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - J Hui
- Private paediatrician, Hong Kong SAR, PR China
| | - H S Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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Lai CY, Wong MKW, Tong WH, Lau KY, Chu SY, Tam AML, Hui LL, Lao TTH, Leung TY. The impact of antenatal massage practice on intrapartum massage application and their associations with the use of analgesics during labour : Sub-analysis of a randomised control trial. BMC Pregnancy Childbirth 2022; 22:420. [PMID: 35585620 PMCID: PMC9118716 DOI: 10.1186/s12884-022-04743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Massage during labour is one form of intrapartum non-pharmacological pain relief but it is not known whether the frequency of practicing these massage techniques among couples during the antenatal period could enhance the effectiveness of intrapartum massage. This study was to evaluate the association between compliance of antenatal massage practice with intrapartum application and their impact on the use of analgesics during labour. Methods This was a sub-analysis of a childbirth massage programme which was carried out in two public hospitals with total births of around 8000 per year. Data from women who were randomized to the massage group were further analysed. After attending the pre-birth training class on massage at 36 weeks gestation, couples would be encouraged to practice at home. Their compliance with massage at home was classified as good if they had practiced for at least 15 minutes for three or more days in a week, or as poor if the three-day threshold had not been reached. Application of intrapartum massage was quantified by the duration of practice divided by the total duration of the first stage of labour. Women’s application of intrapartum massage were then divided into above and below median levels according to percentage of practice. Logistic regression was used to assess the use of epidural analgesia or pethidine, adjusted for duration of labour and gestational age when attending the massage class. Results Among the 212 women included, 103 women (48.6%) achieved good home massage compliance. No significant difference in the maternal characteristics or birth outcomes was observed between the good and poor compliance groups. The intrapartum massage application (median 21.1%) was inversely associated with duration of first stage of labour and positively associated with better home massage practice compliance (p = 0.04). Lower use of pethidine or epidural analgesia (OR 0.33 95% CI 0.12, 0.90) was associated with above median intrapartum massage application but not antenatal massage compliance, adjusted for duration of first stage of labour. Conclusions More frequent practice of massage techniques among couples during antenatal period could enhance the intrapartum massage application, which may reduce the use of pethidine and epidural analgesia. Trial registration (CCRBCTR) Unique Trial Number CUHK_ CCRB00525.
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Affiliation(s)
- Chit Ying Lai
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Margaret Kit Wah Wong
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Wing Hung Tong
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kam Yan Lau
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Suk Yin Chu
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Kowloon, Hong Kong
| | - Agnes Mei Lee Tam
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Lai Ling Hui
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Terence T H Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
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Lai CY, Wong MKW, Tong WH, Chu SY, Lau KY, Tan AML, Hui LL, Lao TTH, Leung TY. Effectiveness of a childbirth massage programme for labour pain relief in nulliparous pregnant women at term: a randomised controlled trial. Hong Kong Med J 2021; 27:405-412. [PMID: 34924363 DOI: 10.12809/hkmj208629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The effect of massage for pain relief during labour has been controversial. This study investigated the efficacy of a programme combining intrapartum massage, controlled breathing, and visualisation for non-pharmacological pain relief during labour. METHODS This randomised controlled trial was conducted in two public hospitals in Hong Kong. Participants were healthy low-risk nulliparous Chinese women ≥18 years old whose partners were available to learn massage technique. Recruitment was performed at 32 to 36 weeks of gestation; women were randomised to attend a 2-hour childbirth massage class at 36 weeks of gestation or to receive usual care. The primary outcome variable was the intrapartum use of epidural analgesia or intramuscular pethidine injection. RESULTS In total, 233 and 246 women were randomised to the massage and control groups, respectively. The use of epidural analgesia or pethidine did not differ between the massage and control groups (12.0% vs 15.9%; P=0.226). Linear-by-linear analysis demonstrated a trend whereby fewer women used strong pharmacological pain relief in the massage group, and a greater proportion of women had analgesic-free labour (29.2% vs 21.5%; P=0.041). Cervical dilatation at the time of pethidine/epidural analgesia request was significantly greater in the massage group (3.8 ± 1.7 cm vs 2.3 ± 1.0 cm; P<0.001). CONCLUSION The use of a massage programme appeared to modulate pain perception in labouring women, such that fewer women requested epidural analgesia and a shift was observed towards the use of weaker pain relief modalities; in particular, more women in the massage group were analgesic-free during labour.
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Affiliation(s)
- C Y Lai
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - M K W Wong
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
| | - W H Tong
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
| | - S Y Chu
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - K Y Lau
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
| | - A M L Tan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
| | - L L Hui
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - T T H Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
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Cheng TS, Leung GM, Hui LL, Leung JYY, Kwok MK, Au Yeung SL, Schooling CM. Associations of growth from birth to puberty with blood pressure and lipid profile at ~17.5 years: evidence from Hong Kong's "Children of 1997" birth cohort. Hypertens Res 2020; 42:419-427. [PMID: 30559401 DOI: 10.1038/s41440-018-0170-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of early growth in later health is controversial. We examined the associations of growth at different phases from birth to puberty with blood pressure and lipid profile at ~17.5 years. In the population-representative "Children of 1997" birth cohort, growth was measured as (i) weight-for-age z score (WAZ) at birth and WAZ gains from 0 to 2 and 2 to 8 years and (ii) body-mass-index-for-age z score (BAZ) and length/height-for-age z score (LAZ) at 3 months and BAZ and LAZ gains from 3 months to 3 years, 3 to 8 years and 8 to 14 years, based on the World Health Organization growth standards/references. Adjusted partial least squares regression was used to assess simultaneously the associations of growth with height-, age- and sex-specific systolic (SBPZ) and diastolic blood pressure z scores (DBPZ), low- (LDL) and high-density lipoprotein (HDL) and triglycerides (TG) at ~17.5 years. Among 3410 children, higher WAZ, BAZ and LAZ gains from initial size to 8 years were associated with higher SBPZ. Higher gains in WAZ and BAZ from 2 to 8 years were consistently associated with higher DBPZ, LDL and TG and lower HDL. Lower LAZ at 3 months and higher LAZ gain from 3 months to 3 years were associated with lower HDL and higher TG. Greater growth in weight, body mass index and length/height had negative associations with blood pressure and lipid profile at ~17.5 years, but the differences by growth measure, phase and outcome suggest a complex underlying process.
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Affiliation(s)
- Tuck Seng Cheng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - June Yue Yan Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China. .,School of Public Health and Health Policy, City University of New York, New York, NY, USA.
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11
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Chan PHY, Chan KYY, Schooling CM, Hui LL, Chan MHM, Li AM, Cheung RCK, Lam HS. Association between genetic variations in GSH-related and MT genes and low-dose methylmercury exposure in children and women of childbearing age: a pilot study. Environ Res 2020; 187:109703. [PMID: 32480025 DOI: 10.1016/j.envres.2020.109703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Genetic variations in glutathione (GSH)-related and metallothionein (MT) genes, which are involved in producing enzymes in the methylmercury (MeHg) metabolism pathway, have been proposed as one of the reasons for the individual variability in MeHg toxicokinetics. OBJECTIVE To investigate the impact of genetic variations in MT and GSH-related genes on the association of fish consumption with body burden of MeHg, as measured by hair Hg concentrations among young children and women of childbearing age. METHODS A total of 179 unrelated children and 165 mothers with either high or low fish consumption were recruited from the community. Their hair total Hg (tHg) and MeHg levels and genotypes for SNPs located on the GCLC, GCLM, GPX1, GSTA1, GSTP1, MT1A, MT2A, and MT4 genes were determined. Based on their 14-day food records, the amounts of fish consumed and their MeHg intakes were estimated. The impact of genetic variations on hair Hg concentrations was examined by using Mann-Whitney tests and multivariable linear regression analyses. RESULTS The presence of minor alleles of GCLC-129 (rs17883901), GPX1-198 (rs1050450) and MT1M (rs9936741) were associated with significantly lower hair tHg levels in mothers whereas mothers with minor alleles of GSTP1-105(rs1695) and MT1M (rs2270836) have significantly higher hair tHg levels. After adjustment for fish consumption and other confounding factors, apart from MT1M (rs2270836), all of the above SNPs remain significant in the multivariable linear regression models. CONCLUSIONS Our results in a group of children and women show that genetic variants of GSH-related and MT genes are associated with hair Hg concentrations. These genetic variations are likely to significantly affect MeHg metabolism and thus influence the accumulation of Hg in the human body.
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Affiliation(s)
- Peggy Hiu Ying Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Kathy Yuen Yee Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Catherine Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; CUNY School of Public Health and Health Policy, NY, USA.
| | - Lai Ling Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Michael Ho Ming Chan
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Robert Chi Keung Cheung
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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12
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Zhang T, Au Yeung SL, Kwok MK, Hui LL, Leung GM, Schooling CM. Association of Sugar-Sweetened Beverage Frequency with Adiposity: Evidence from the "Children of 1997" Birth Cohort. Nutrients 2020; 12:nu12041015. [PMID: 32272690 PMCID: PMC7231010 DOI: 10.3390/nu12041015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 01/04/2023] Open
Abstract
Background: Observationally, sugar-sweetened beverage (SSB) consumption is associated with adiposity in Western children but could be confounded. We examined the association of SSB frequency with adiposity in the non-Western setting of Hong Kong. Methods: We examined the associations of SSB consumption frequency at 11 and 13 years assessed by using a food frequency questionnaire with subsequent body mass index (BMI) z-score and overweight/obesity up to 18 years using generalized estimating equations, and with waist circumference, waist-to-hip ratio, and body fat percentage at 16–19 years using linear regression in a population-representative Chinese birth cohort “Children of 1997” (n = 3628). Results: At 11 and 13 years, 6.8% and 8.2% of children respectively consumed SSB daily. Neither SSB frequency at 11 nor at 13 years was associated with subsequent BMI z-score or overweight/obesity up to 18 years, or with waist circumference, waist-to-hip ratio, or body fat percentage at 16–19 years adjusted for age, sex, socioeconomic position, health status, physical activity and other food consumption, although bias to the null from under-reporting cannot be eliminated. Conclusion: Although we cannot definitively exclude a small association of SSB frequency with adiposity, lack of association of SSB frequency with adiposity in a non-Western setting with low SSB consumption suggests that the role of SSB in adiposity appears to be minor.
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Affiliation(s)
- Ting Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (T.Z.); (S.L.A.Y.); (M.K.K.); (L.L.H.); (G.M.L.)
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (T.Z.); (S.L.A.Y.); (M.K.K.); (L.L.H.); (G.M.L.)
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (T.Z.); (S.L.A.Y.); (M.K.K.); (L.L.H.); (G.M.L.)
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (T.Z.); (S.L.A.Y.); (M.K.K.); (L.L.H.); (G.M.L.)
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (T.Z.); (S.L.A.Y.); (M.K.K.); (L.L.H.); (G.M.L.)
| | - C. Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; (T.Z.); (S.L.A.Y.); (M.K.K.); (L.L.H.); (G.M.L.)
- CUNY School of Public Health and Health Policy, New York, NY 10027, USA
- Correspondence: ; Tel.: (852) 3917 6732; Fax: (852) 3520 1945
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13
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Chan KCC, Au CT, Hui LL, Wing YK, Li AM. Childhood OSA is an independent determinant of blood pressure in adulthood: longitudinal follow-up study. Thorax 2020; 75:422-431. [PMID: 32209641 DOI: 10.1136/thoraxjnl-2019-213692] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Current literature supports cross-sectional association between childhood obstructive sleep apnoea (OSA) and elevated blood pressure (BP). However, long-term cardiovascular outcomes in children with OSA remain unexplored. OBJECTIVE To evaluate the associations of childhood OSA with BP parameters in a prospective 10 year follow-up study. METHODS Participants were recruited from a cohort established for our previous OSA epidemiological study. They were invited to undergo clinical examination, overnight polysomnography and 24-hour ambulatory BP monitoring. Multivariate linear regression was used to assess the associations of baseline childhood OSA with BP outcomes at follow-up. Multivariable log-binomial regression was used with inverse probability weighting to assess the adjusted associations of childhood OSA with hypertension and non-dipping of nocturnal BP in adulthood. RESULTS 243 participants (59% male) attended the follow-up visit. The mean age was 9.8 (SD ±1.8) and 20.2 (SD ±1.9) years at baseline and follow-up respectively, with a mean follow-up duration of 10.4 (SD ±1.1) years. Childhood moderate-to-severe OSA was associated with higher nocturnal systolic blood pressure (SBP) (difference from normal controls: 6.5 mm Hg, 95% CI 2.9 to 10.1) and reduced nocturnal dipping of SBP (-4.1%, 95% CI -6.3% to 1.8%) at follow-up, adjusted for age, sex, Body Mass Index and height at baseline, regardless of the presence of OSA at follow-up. Childhood moderate-to-severe OSA was also associated with higher risk of hypertension (relative risk (RR) 2.5, 95% CI 1.2 to 5.3) and non-dipping of nocturnal SBP (RR 1.3, 95% CI 1.0 to 1.7) at follow-up. CONCLUSION Childhood OSA was found to be an independent risk factor for adverse BP outcomes in adulthood.
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Affiliation(s)
- Kate Ching-Ching Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun Ting Au
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lai Ling Hui
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kwok Wing
- Sleep Assessment Unit, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
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14
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Liu J, Au Yeung SL, Kwok MK, Leung JYY, Hui LL, Leung GM, Schooling CM. The effect of liver enzymes on body composition: A Mendelian randomization study. PLoS One 2020; 15:e0228737. [PMID: 32045441 PMCID: PMC7012438 DOI: 10.1371/journal.pone.0228737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Higher alanine transaminase (ALT), indicating poor liver function, is positively associated with diabetes but inversely associated with body mass index (BMI) in Mendelian randomization (MR) studies, suggesting liver function affects muscle mass. To clarify, we assessed the associations of liver enzymes with muscle and fat mass observationally with two-sample MR as a validation. Methods In the population-representative “Children of 1997” birth cohort (n = 3,455), we used multivariable linear regression to assess the adjusted associations of ALT and alkaline phosphatase (ALP) at ~17.5 years with muscle mass and body fat percentage observationally. Genetic variants predicting ALT, ALP and gamma glutamyltransferase (GGT) were applied to fat-free and fat mass in the UK Biobank (n = ~331,000) to obtain unconfounded MR estimates. Results Observationally, ALT was positively associated with muscle mass (0.11 kg per IU/L, 95% confidence interval (CI) 0.10 to 0.12) and fat percentage (0.15% per IU/L, 95% CI 0.13 to 0.17). ALP was inversely associated with muscle mass (-0.03 kg per IU/L, 95% CI -0.04 to -0.02) and fat percentage (-0.02% per IU/L, 95% CI -0.03 to -0.01). Using MR, ALT was inversely associated with fat-free mass (-0.41 kg per 100% in concentration, 95% CI -0.64 to -0.19) and fat mass (-0.58 kg per 100% in concentration, 95% CI -0.85 to -0.30). ALP and GGT were unclearly associated with fat-free mass or fat mass. Conclusion ALT reducing fat-free mass provides a possible pathway for the positive association of ALT with diabetes and suggests a potential target of intervention.
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Affiliation(s)
- Junxi Liu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - June Yue Yan Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C. Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- City University of New York Graduate School of Public Health and Health Policy, New York, New York, United States of America
- * E-mail:
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15
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Lu J, Cheng YKY, Ho SYS, Sahota DS, Hui LL, Poon LC, Leung TY. The predictive value of cervical shear wave elastography in the outcome of labor induction. Acta Obstet Gynecol Scand 2019; 99:59-68. [PMID: 31691266 PMCID: PMC6973099 DOI: 10.1111/aogs.13706] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/12/2019] [Indexed: 01/08/2023]
Abstract
Introduction Bishop score, the traditional method to assess cervical condition, is not a promising predictive tool of the outcome of labor induction. As an objective assessment tool, many cervical ultrasound measurements have been proposed to represent the individual components of the Bishop score, but none of them can measure the cervical stiffness. Cervical shear wave elastography is a novel tool to assess the cervical stiffness quantitatively. Material and methods A total of 475 women who required labor induction were studied prospectively. Prior to routine digital assessment of the Bishop score, transvaginal sonographic measurement of cervical length, posterior cervical angle, angle of progression and shear wave elastography was performed. Shear wave elastography measurement was made at the inner, middle and outer regions of the cervix to assess homogeneity. Association of labor induction outcomes including the overall cesarean section and subgroups of cesarean section for failure to enter active phase, with cervical sonographic parameters and the Bishop score, were assessed using multivariate regression analyses. The predictive accuracy of the outcomes using models based on ultrasound measurement and the Bishop score was compared using the area under the receiver‐operating characteristics curves. Results Among 475 women, 82 (17.3%) required cesarean section. Shear wave elasticity was significantly higher in the inner cervical region than in other regions, indicating a greater stiffness (P < 0.001). Both inner cervical shear wave elasticity and cervical length were independent predictors of overall cesarean section (respective adjusted odds ratio [95% CI] 1.338 [1.001‐1.598] and 1.717 [1.077‐1.663]) and cesarean section for failure to enter active phase (respective adjusted odds ratio [95% CI] 1.689 [1.234‐2.311] and 2.556 [1.462‐4.467]), after adjusting for other covariates. Outcome prediction models using inner cervical shear wave elasticity and cervical length, had increased area under curve compared with models using the Bishop score (0.888 vs 0.819, P = 0.009). Conclusions The cervix is not a homogenous structure, with the inner cervix having the highest stiffness, which is an independent predictor of overall cesarean section, and specifically for those indicated because of failure to enter active phase. Models based on shear wave elastography and cervical length had higher predictive accuracy than models based on the Bishop score.
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Affiliation(s)
- Jing Lu
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yvonne Kwun Yue Cheng
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Sin Yee Stella Ho
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L L Hui
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Tak Yeung Leung
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
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16
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Cheng TS, Leung GM, Hui LL, Leung JYY, Kwok MK, Au Yeung SL, Schooling CM. Associations of growth from birth to puberty with glycemic indicators at ~17.5 years: Evidence from Hong Kong's "Children of 1997" birth cohort. Pediatr Diabetes 2019; 20:380-388. [PMID: 30805996 DOI: 10.1111/pedi.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/26/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND From an evolutionary biology perspective, where growth and reproduction trade-off against longevity, we assessed the associations of growth from birth to puberty by phase with later glycemic indicators and any differences by sex. METHODS In the population-representative Hong Kong Chinese "Children of 1997" birth cohort (n = 8327), the relation of initial size (weight-for-age z score (WAZ) at birth, length/height-for-age z score (LAZ) at 3 months or body-mass-index-for-age z score (BAZ) at 3 months based on the World Health Organization growth standards/references) and growth at different phases (WAZ gains from 0 to 2 and 2 to 8 years, LAZ or BAZ gains from 3 months to 3 years, 3 to 8 years and 8 to 14 years) with fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) at ~17.5 years, was assessed using adjusted partial least squares regression. Additional analyses further considered growth in late and early infancy. RESULTS This study included 3276 of the cohort participants. Higher WAZ gain from 2 to 8 years, LAZ and BAZ gains from 3 to 8 years were consistently associated with higher FPG, adjusted for maternal and infant characteristics, family history of diabetes and household income. Also, higher BAZ gain from 3 to 8 years was associated with higher HbA1c. These associations did not differ by sex. CONCLUSIONS Our findings suggest different mechanisms could underlie the pathogenesis of glucose intolerance. Factors that drive specific growth at different phases need to be evaluated to better inform child growth management for long-term health outcomes.
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Affiliation(s)
- Tuck Seng Cheng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - June Yue Yan Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.,Environmental, Occupational, and Geospatial Health Sciences, City University of New York, School of Public Health, New York, New York
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17
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Hui LL, Kwok MK, Nelson EAS, Lee SL, Leung GM, Schooling CM. Breastfeeding in Infancy and Lipid Profile in Adolescence. Pediatrics 2019; 143:peds.2018-3075. [PMID: 30967484 DOI: 10.1542/peds.2018-3075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Breast milk has higher cholesterol than formula. Infants who are breastfed have different cholesterol synthesis and metabolism in infancy than infants who are formula fed. Little is known as to whether breastfeeding is associated with subsequent lipid profile, independent of adiposity. We assessed the association of breastfeeding in early infancy with lipid profile and adiposity at ∼17.5 years in a setting where exclusive breastfeeding is not associated with higher socioeconomic position. METHODS We used multivariable linear regression with multiple imputation and inverse probability weighting to examine the associations of contemporaneously reported feeding in the first 3 months of life (exclusive breastfeeding [7.5%], mixed feeding [40%], or always formula feeding [52%]) with lipids and adiposity at ∼17.5 years in 3261 participants in the Hong Kong Chinese birth cohort Children of 1997, adjusting for sex, birth weight, gestational weeks, parity, pregnancy characteristics, parents' highest education, mother's place of birth, and age at follow-up. RESULTS Exclusive breastfeeding, but not mixed feeding at 0 to 3 months, compared with formula feeding was associated with lower total cholesterol and low-density lipoprotein cholesterol but not with high-density lipoprotein cholesterol at ∼17.5 years. BMI and fat percentage measured by bioimpedance did not differ by type of infant feeding. CONCLUSIONS Exclusive breastfeeding in early infancy may promote a healthier lipid profile in late adolescence through mechanisms unrelated to adiposity, implicating its potential long-term benefits for cardiovascular health.
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Affiliation(s)
- L L Hui
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and
| | - E Anthony S Nelson
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - So Lun Lee
- Department of Pediatrics and Adolescent Medicine and
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and .,CUNY, School of Public Health, New York, New York
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18
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Chan KC, Au CT, Hui LL, Ng SK, Wing YK, Li AM. How OSA Evolves From Childhood to Young Adulthood: Natural History From a 10-Year Follow-up Study. Chest 2019; 156:120-130. [PMID: 30922948 DOI: 10.1016/j.chest.2019.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/08/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Understanding the natural history of childhood OSA can help to determine disease prognosis and to guide risk stratification and management strategies. METHODS To evaluate the natural history of childhood OSA and factors associated with spontaneous remission and persistent and incident OSA from childhood to late adolescence/early adulthood, a longitudinal analysis of a prospective community-based cohort was designed. Subjects from a cohort established for an OSA prevalence study were invited to participate in this 10-year follow-up study. RESULTS Two hundred and forty-three participants (59% male) took part, and their mean age was 9.8 (SD, ± 1.8) and 20.2 (SD, ± 1.9) years at baseline and follow-up, respectively. The mean follow-up duration was 10.4 (SD, ± 1.1) years. Associations between baseline and follow-up log-transformed obstructive apnea-hypopnea index (OAHI) differed by age; a significant positive association was observed only among participants aged 10 years or older at baseline. Overall polysomnographic remission rate (with OAHI < 1 event/h at follow-up) of childhood OSA was 30%, and 69% had an OAHI < 5 events/h at follow-up. Complete remission of OSA was associated with female sex. Incidence of adolescent/adult OSA with an OAHI ≥ 5 events/h at follow-up was 22%. Male sex and higher baseline BMI z score were associated with incident OSA. CONCLUSIONS A proportion of children with OSA, particularly female children, had complete resolution during transition to late adolescence or early adulthood. Childhood and adolescent OSA are distinct entities, with the latter more likely to persist into adulthood. Obesity and male sex are consistent key risk factors for incident OSA.
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Affiliation(s)
- Kate C Chan
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun T Au
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - L L Hui
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Siu-Kwan Ng
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun K Wing
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Albert M Li
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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19
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Hui LL, Lam HS, Lau EYY, Nelson EAS, Wong TW, Fielding R. Prenatal exposure to dioxins and subsequent neurocognitive and developmental function in Hong Kong Chinese children. Hong Kong Med J 2019; 25 Suppl 3:35-39. [PMID: 30792372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong
| | - H S Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong
| | - E Y Y Lau
- Department of Psychology, The University of Hong Kong
| | - E A S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong
| | - T W Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - R Fielding
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
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20
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Wang J, Kwok MK, Au Yeung SL, Li AM, Lam HS, Leung JYY, Hui LL, Leung GM, Schooling CM. Sleep duration and risk of diabetes: Observational and Mendelian randomization studies. Prev Med 2019; 119:24-30. [PMID: 30508554 DOI: 10.1016/j.ypmed.2018.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Inadequate sleep could contribute to type 2 diabetes, but observational studies are inconsistent and open to biases, particularly from confounding. We used Mendelian randomization (MR) to obtain an unconfounded estimate of the effect of sleep duration on diabetes, fasting glucose (FG) and hemoglobin A1c (HbA1c), and an observation study to assess differences by sex. Using MR, we assessed the effects of genetically instrumented sleep on diabetes, based on 68 single nucleotide polymorphisms (SNPs), applied to the DIAbetes Genetics Replication and meta-analysis case (n = 26,676)-control (n = 132,532) study and on FG and HbA1c, based on 55 SNPs, applied to the Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC) study of FG (n = 122,743) and HbA1c (n = 123,665). In the population-representative Hong Kong Chinese "Children of 1997" birth cohort we assessed whether associations of sleep duration at ~17.5 years with FG and HbA1c differed by sex. Using inverse variance weighting with multiplicative random effects, sleep duration was not associated with diabetes (odds ratio (OR) 0.85 per hour of sleep, 95% confidence interval (CI) 0.64 to 1.13), FG (-0.032 mmol/l per hour of sleep, 95% CI -0.126 to 0.063) or HbA1c (-0.022% per hour of sleep, 95% CI -0.069 to 0.024). In "Children of 1997", the associations of sleep duration with FG differed by sex (p for interaction 0.05) but not with HbA1c. Overall sleep duration does not appear to be related to diabetes, FG or HbA1c, but the possibility of sex differences merits investigation.
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Affiliation(s)
- Jiao Wang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Albert Martin Li
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hugh Simon Lam
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - June Yue Yan Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Catherine Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; CUNY School of Public Health and Health Policy, New York, USA.
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He B, Huang JV, Kwok MK, Au Yeung SL, Hui LL, Li AM, Leung GM, Schooling CM. The association of early-life exposure to air pollution with lung function at ~17.5 years in the "Children of 1997" Hong Kong Chinese Birth Cohort. Environ Int 2019; 123:444-450. [PMID: 30622069 DOI: 10.1016/j.envint.2018.11.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Early-life air pollution exposure is associated with lung function in children and adolescents. However, whether the association of prenatal and early postnatal exposure to air pollution with lung function continues into adulthood remains unclear. OBJECTIVE To investigate the associations of early exposure to air pollution with lung function at ~17.5 years in a non-western developed setting with more concentrated air pollutants. METHODS We examined the associations of exposure to particular matter with an aerodynamic diameter of <10 μm (PM10), nitrogen dioxides (NO2), nitric oxide (NO), sulfur dioxide (SO2) in standard deviations (SD)) at different early life stages with lung function (indicated by forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25%-75% of the pulmonary volume (FEF25%-75%)) in SD at ~17.5 years, personal history of wheezing and asthma in the population-representative Hong Kong Chinese birth cohort "Children of 1997"(n = 2942). RESULTS Higher in utero and infancy and toddlerhood NO2 were associated with lower FEV1 (-0.022, 95% confidence interval (CI) -0.029 to -0.015 and - 0.026, 95% CI -0.033 to -0.019), FEV1/FVC (-0.035, 95% CI -0.050 to -0.021 and -0.052, 95% CI -0.066 to -0.038) and FEF25%-75% (-0.031, 95% CI -0.040 to -0.022 and -0.043, 95% CI -0.051 to -0.035). A similar association was observed for NO. Weak associations of NO2 and NO with FVC were observed (-0.011, 95% CI -0.018 to -0.003 and -0.010, 95% CI -0.020 to -0.001). NOx was associated with higher risk of wheezing (1.08, 95% CI 1.03 to 1.14) but not asthma (1.02, 95% CI 0.94 to 1.11). SO2 and PM10 were not clearly associated with lung function, wheezing or asthma. CONCLUSION Our findings suggest that early exposure to air pollution from NO2 may have long-term effects on lung function, which could affect respiratory health throughout life.
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Affiliation(s)
- Baoting He
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jian V Huang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Albert M Li
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; City University of New York Graduate School of Public Health and Health Policy, New York, United States.
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Cao Z, Hui LL, Wong MY. New approaches to obtaining individual peak height velocity and age at peak height velocity from the SITAR model. Comput Methods Programs Biomed 2018; 163:79-85. [PMID: 30119859 DOI: 10.1016/j.cmpb.2018.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We compared three methods for estimating the individual peak height velocity (PHV) and age at peak height velocity (APHV) from the SuperImposition by Translation and Rotation (SITAR) model. METHODS We fitted the SITAR model using simulated data and heights of 12 girls from the Chard Growth Study and obtained individual PHVs and APHVs from three methods: the model method, the quadratic function method and the numerical method, which are available in our newly developed R package"iapvbs". The mean, interquartile range, range of biases in estimated APHV and PHV as well as the rates of warning and unreasonable cases, i.e. estimated APHVs being outside the range of age measurements, from the three methods were presented and compared. RESULTS When the growth curves of all individuals were well fitted by the SITAR model, all three methods estimated individual APHVs with similarly small biases, with a few unreasonable cases (0.16%) observed when the model method was used while more computation time required for the numerical method. When the growth curves of some individuals were not very well fitted, the model method generated more unreasonable individual APHV (8.15%) and more bias in PHV and APHV, compared to those estimated by the numerical method and quadratic function method. In line with the observations from the simulated data, the real data analysis demonstrated that the numerical method generated more reliable PHV and APHV for individuals with growth curve not well fitted by the SITAR model. CONCLUSION The performance of different methods estimating individual APHV depends largely on how well the growth curves are fitted by the SITAR model. The quadratic function method is more superior when growth curves of all individuals are well fitted by the SITAR model; otherwise, the numerical method should be adopted for getting most robust estimates of PHV and APHV. The model method generates unreasonable APHV estimates, particularly when the growth curves are not well fitted.
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Affiliation(s)
- Zhiqiang Cao
- Department of Mathematics, The Hong Kong University of Science & Technology, Hong Kong SAR, China
| | - L L Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Y Wong
- Department of Mathematics, The Hong Kong University of Science & Technology, Hong Kong SAR, China.
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Hui LL, Lee SL, Kwok MK, Yu CW, Schooling CM. Formula-feeding and the risk of type-2 diabetes mellitus among Hong Kong adolescents. Hong Kong Med J 2018; 24 Suppl 4:20-23. [PMID: 30135270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - S L Lee
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong
| | - M K Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - C W Yu
- Department of Health and Physical Education, The Education University of Hong Kong
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- CUNY School of Public Health and Hunter College, New York, USA
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24
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Liu JX, Au Yeung SL, Kwok MK, Leung JYY, Lin SL, Hui LL, Leung GM, Schooling CM. Birth weight, gestational age and late adolescent liver function using twin status as instrumental variable in a Hong Kong Chinese birth cohort: "Children of 1997". Prev Med 2018; 111:190-197. [PMID: 29545162 DOI: 10.1016/j.ypmed.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/25/2018] [Accepted: 03/09/2018] [Indexed: 02/04/2023]
Abstract
Birth weight (BW) is inversely associated with diabetes and liver function in Mendelian Randomization studies. Observationally, lower BW is usually also associated with poorer liver function. However, these studies could be confounded by socioeconomic position. Here we assessed if BW is associated with liver function in a unique population with little socio-economic patterning of BW, using both instrumental variable and an observational analysis. We used instrumental variable analysis (IVA) to assess the association of BW with liver function (alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, and albumin) at ~17 years with twin status as an instrumental variable in the prospective population-representative "Children of 1997" birth cohort (n = 8327). We also conducted an observational analysis adjusted for sex, maternal age, maternal migrant status, smoking and parental socio-economic position. A generalized linear model with gamma family was used for ALT, ALP, and bilirubin because they are not normally distributed. Using IVA, BW was not associated with ALT, ALP or bilirubin, but was possibly negatively associated with albumin (-1.12 g/L, 95% confidence interval (CI) -2.08 to -0.16). Observationally, BW was negatively associated with ALT (-1.23 IU/L, 95% CI -2.16 to -0.30), ALP (-1.72 IU/L, 95% CI -3.43 to -0.01) and higher albumin (-0.23 g/L, 95% CI -0.40 to -0.06). Poor liver function may be a pathway by which the risks of lower BW are actuated. This insight might help identify post-natal targets of intervention to mitigate the adverse health effects of lower birth weight.
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Affiliation(s)
- Jun Xi Liu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - June Yue Yan Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shi Lin Lin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA.
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25
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Hui LL, Li AM, Nelson EAS, Leung GM, Lee SL, Schooling CM. In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference? Int J Obes (Lond) 2018; 42:1317-1325. [PMID: 29777227 DOI: 10.1038/s41366-018-0077-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy. METHODS In the prospective Chinese birth cohort "Children of 1997" (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2- < 8 years) and adolescence (8-16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life. RESULTS In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (-0.13, 95% confidence interval (CI) -0.22, -0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4). CONCLUSIONS In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.
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Affiliation(s)
- L L Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A M Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - E A S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S L Lee
- Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. .,CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
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26
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Hui LL, Nelson EAS, Wong MY, Chung TWH, Lee KKY, Leung GM, Schooling CM. The Association of Intergenerational Mismatch With Adiposity and Blood Pressure in Childhood and Adolescence. J Adolesc Health 2018; 62:100-106. [PMID: 29056438 DOI: 10.1016/j.jadohealth.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE An intergenerational "mismatch," a transition from limited to plentiful living conditions over generations, may increase cardiovascular disease risks. In a migrant population within a homogenous culture, we tested the hypothesis that an intergenerational mismatch in childhood living condition is associated with higher body mass index (BMI) and blood pressure in childhood and adolescence. METHODS We used data from 6,965 native born Chinese in Hong Kong (participated in "Children of 1997" birth cohort) and migrant Chinese born elsewhere in China in 1997 (N = 9,845). We classified children into those with intergenerational mismatch (child migrants or first-generation migrants) or those without (second+-generation migrants). Generalized estimating equations were used to examine the associations of migration status (child migrants, first-generation migrants or second+-generation migrants) with age- and sex-specific BMI z-score at 8-15 years and age-, sex-, and height-specific blood pressure z-score at 11-13 years, adjusted for sex, month of birth, and age. RESULTS Compared with second+-generation migrants, first-generation migrants had higher diastolic blood pressure z-score (.04, 95% confidence interval (CI) .02, .06) and BMI z-score (.12, 95% CI .06, .18), whereas child migrants had higher diastolic blood pressure z-score (.03, 95% CI .01, .05) regardless of age at migration and higher BMI z-score if they had migrated in infancy (.17, 95% CI .11, .23). CONCLUSION Different relations for blood pressure and BMI suggest that intergenerational mismatch and proximal exposures may have different impacts on adiposity and blood pressure.
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Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hongkong; Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hongkong
| | - E Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hongkong
| | - M Y Wong
- Department of Mathematics, The Hong Kong University of Science & Technology, Hongkong
| | - Thomas W H Chung
- Department of Health, Student Health Service, Hong Kong Special Administrative Region
| | - Karen K Y Lee
- Department of Health, Student Health Service, Hong Kong Special Administrative Region
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hongkong
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hongkong; City University of New York Graduate School of Public Health and Health Policy, New York, New York.
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27
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Hui LL, Kwok MK, Nelson EAS, Lee SL, Leung GM, Schooling CM. The association of breastfeeding with insulin resistance at 17 years: Prospective observations from Hong Kong's "Children of 1997" birth cohort. Matern Child Nutr 2017; 14. [PMID: 28776916 DOI: 10.1111/mcn.12490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 05/22/2017] [Accepted: 06/18/2017] [Indexed: 01/27/2023]
Abstract
Breastfeeding has many benefits for mother and infant. Whether breastfeeding also protects against type 2 diabetes is unclear. To clarify the role of breastfeeding in type 2 diabetes, we assessed the association of breastfeeding with insulin resistance in late adolescence in a birth cohort from a non-Western setting where breastfeeding was not associated with higher socio-economic position. We used multivariable linear regression, with multiple imputation and inverse probability weighting, to examine the adjusted associations of contemporaneously reported feeding in the first 3 months of life (exclusively breastfed, mixed feeding, or always formula-fed) with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) at 17 years in a subset (n = 710, 8.6% of entire cohort) of the Hong Kong Chinese birth cohort "Children of 1997." We found a graded association of breastfeeding exclusivity in the first 3 months of life with lower fasting insulin and HOMA-IR (p-for-trend < .05), but not fasting glucose, at 17 years. Exclusively breastfed adolescents (7%) had nonsignificantly lowest fasting insulin and HOMA-IR, adjusted for sex, birth weight, parity, length of gestation, pregnancy characteristics, parents' education, and mother's place of birth. Exclusively breastfeeding for 3 months may be causally associated with lower insulin resistance in late adolescence. Further follow-up studies into adulthood are required to clarify the long-term protection of breastfeeding from type 2 diabetes.
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Affiliation(s)
- Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - E Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - So Lun Lee
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,CUNY School of Public Health, New York, New York, USA
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28
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Hui LL, Wong MY, Chung TW, Lee KK, Schooling CM. Migration status and cardiovascular disease risks in Hong Kong adolescents. Hong Kong Med J 2016; 22 Suppl 6:19-23. [PMID: 27807312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - M Y Wong
- Department of Mathematics, The Hong Kong University of Science and Technology
| | - T Wh Chung
- Student Health Service, Department of Health, Hong Kong SAR, China
| | - K Ky Lee
- Student Health Service, Department of Health, Hong Kong SAR, China
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- CUNY School of Public Health, New York, USA
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29
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Hui LL, Lam HS, Lau EYY, Nelson EAS, Wong TW, Fielding R. Prenatal dioxin exposure and neurocognitive development in Hong Kong 11-year-old children. Environ Res 2016; 150:205-212. [PMID: 27295410 DOI: 10.1016/j.envres.2016.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/30/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES In utero exposure to dioxins and related compounds have been associated with adverse neurocognitive development in infants. It is unclear whether neurodevelopmental deficits persist to childhood. We assessed the association of prenatal dioxin exposure with neurocognitive function in 11-year-old children, and to test whether the association is modified by duration of breastfeeding. METHODS In this prospective study of 161 children born in Hong Kong in 2002, prenatal dioxin exposure was proxied by the dioxin toxicity equivalence (TEQ) in breast milk collected during the early postnatal period as determined by the Chemical-Activated LUciferase gene eXpression (CALUX) bioassay. We used multivariate linear regression analyses to assess the association of prenatal dioxin exposure with the performance on the Wechsler Intelligence Scale for Children-IV, Hong Kong, the Hong Kong List Learning Test, the Tests for Everyday Attention for Children and the Grooved Pegboard Test, adjusting for child's sex, mother's place of birth, mother's habitual seafood consumption, mother's age at delivery and socioeconomic position. RESULTS Measures of neurocognitive and intellectual function, including full-scale IQ, fine motor coordination, verbal and non-verbal reasoning, learning ability and attention at 11 years old did not show significant variations with prenatal dioxin exposures (proxied by CALUX-TEQ total dioxin load in early breast milk). None of these associations varied by breastfeeding duration or sex. CONCLUSIONS Neurocongitive function, as measured with psychological tests, in 11-year-old children was not associated with prenatal dioxin exposure to background levels of dioxins in the 2000s in Hong Kong.
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Affiliation(s)
- Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Esther Yuet Ying Lau
- Department of Psychological Studies, The Education University of Hong Kong, Hong Kong Special Administrative Region; Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong Special Administrative Region; Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Edmund Anthony Severn Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Tze Wai Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Richard Fielding
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
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30
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Hui LL, Chan MHM, Lam HS, Chan PHY, Kwok KM, Chan IHS, Li AM, Fok TF. Impact of fetal and childhood mercury exposure on immune status in children. Environ Res 2016; 144:66-72. [PMID: 26562044 DOI: 10.1016/j.envres.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Mercury exposure have been shown to affect immune status in animals as reflected by cytokine expression. It is unclear whether low levels of exposure during fetal and/or childhood periods could impact on immune status in humans. OBJECTIVES To test the hypothesis that fetal and childhood mercury exposure is associated with childhood cytokine profiles and to investigate whether childhood selenium levels interact with any of the associations found. METHODS Children were recruited from a previously established birth cohort between the ages of 6-9 years for assessment and measurement of blood mercury, selenium and cytokine profile (interleukin (IL)-4, IL-6, IL-8, IL-10, IL-13 and TNF-alpha). Multivariable linear regression models were used to assess the adjusted association of cord blood mercury concentration and current mercury concentrations with levels of the cytokine levels. We tested whether the association with current mercury level varied by current selenium level and cord blood mercury level. RESULTS IL-10 was negatively associated with current blood mercury concentration. The effect was greatest in cases with low cord blood mercury and low current selenium concentrations. None of the other cytokine levels were associated with either cord blood or current blood mercury concentrations, except that cord blood mercury was negatively associated with IL-6. CONCLUSIONS Childhood mercury exposure was negatively associated with childhood IL-10 levels. It is postulated that while selenium is protective, low levels of fetal mercury exposure may increase the degree of this negative association during childhood. Further studies into the clinical significance of these findings are required.
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Affiliation(s)
- Lai Ling Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael Ho Ming Chan
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Peggy Hiu Ying Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ka Ming Kwok
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Iris Hiu Shuen Chan
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Tai Fai Fok
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Hui LL, Schooling CM, Heys M, Wong MY. Association of infant growth and pubertal adiposity: implications for future cardiovascular health and immunological benefits. Hong Kong Med J 2015; 21 Suppl 6:23-28. [PMID: 26645879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong & CUNY School of Public Health and Hunter College, New York, USA
| | - M Heys
- Department of Population Health Sciences, Faculty of Population Health Sciences, University College London, London, UK
| | - M Y Wong
- Department of Mathematics, The Hong Kong University of Science & Technology
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Hui LL, Lam HS, Leung GM, Schooling CM. Late prematurity and adiposity in adolescents: Evidence from "Children of 1997" birth cohort. Obesity (Silver Spring) 2015; 23:2309-14. [PMID: 26381497 DOI: 10.1002/oby.21267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/06/2015] [Accepted: 07/01/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The association of late prematurity with later adiposity is unclear, and the mediating role of infant growth is seldom studied. We assessed the association of late prematurity with markers of adiposity in adolescence and tested whether accelerated infant weight gain mediated the association. METHODS In the Chinese birth cohort "Children of 1997," we used multivariable linear regression to assess the adjusted association of late premature (n = 295), compared to term (n = 6874), births with markers of adiposity at 14 years. We tested whether any association was mediated by accelerated weight gain from birth to 12 months, i.e., a change in weight z-score ≥0.67. RESULTS Late premature births had greater body mass index (BMI) z-score (0.21, 95% confidence interval (CI) 0.07, 0.35), waist-hip ratio z-score (0.16, 95% CI 0.03, 0.29), and waist-height ratio z-score (0.27, 95% CI 0.14, 0.40) than term births in adolescence. The association of late prematurity with higher adolescent BMI, but not waist ratios, was mediated by accelerated infant weight gain. CONCLUSIONS Late prematurity was associated with higher BMI and waist ratios in adolescence, but only the association with BMI was mediated by infant weight gain, suggesting vulnerability to metabolic risk in late premature births may arise through multiple pathways.
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Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Hugh S Lam
- Department of Paediatrics, Faculty of Medicine, the Chinese University of Hong Kong, Pokfulam, Hong Kong
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Catherine M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
- CUNY School of Public Health and Hunter College, New York, USA
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Hui LL, Wong MY, Leung GM, Schooling CM. The Association of Infant Growth Patterns with Adiposity in Adolescence: Prospective Observations from Hong Kong's 'Children of 1997' Birth Cohort. Paediatr Perinat Epidemiol 2015; 29:326-34. [PMID: 26111444 DOI: 10.1111/ppe.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of infant growth in adiposity remains unclear. METHODS We used multivariable linear regression, with inverse probability weighting and multiple imputation to account for loss to follow-up, in a population-representative Chinese birth cohort, 'Children of 1997' in Hong Kong, to examine, in terms births, the adjusted association of infant (birth to 12 months) weight growth trajectories with body mass index (BMI) (n = 6861, 88% follow-up), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) (n = 5398, 69% follow-up) at ∼ 14 years. RESULTS Infant weight growth trajectories had graded associations with adolescent BMI and WHtR but not with WHR, such that compared with adolescents born light with slow infant growth, adolescents born heavy with fast infant growth had higher BMI z-score [0.60, 95% confidence interval (CI) 0.49, 0.70], higher WHtR z-score (0.17, 95% CI 0.08, 0.26) but similar WHR z-score (-0.02, 95% CI -0.11, 0.08), adjusted for sex, gestational age, parental education, parental BMI, parental height, and parental place of birth. CONCLUSIONS Varying associations of infant growth with different adiposity measures suggest a complex role of infant growth in long-term health, perhaps because infant growth, or its underlying drivers, influences build and body composition as well as adiposity.
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Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - M Y Wong
- Department of Mathematics, The Hong Kong University of Science & Technology, Hong Kong
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong.,Hunter College and CUNY School of Public Health, New York, USA
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George DA, Hui LL, Rattehalli D, Lovatt T, Perry I, Green M, Robinson K, Walters JRF, Brookes MJ. The role of near-patient coeliac serology testing in the follow-up of patients with coeliac disease. Frontline Gastroenterol 2014; 5:20-25. [PMID: 28839746 PMCID: PMC5369711 DOI: 10.1136/flgastro-2013-100342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/19/2013] [Accepted: 07/24/2013] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This pilot study was undertaken to assess the validity and effectiveness of near-patient coeliac immunological testing, compared to standard laboratory immunological techniques, used in the context of dietician-led coeliac disease follow-up clinics. DESIGN The study was designed in two phases, each assessing the near-patient test and standard laboratory immunological techniques. Phase 1 analysed stored serum samples; Phase 2 analysed whole blood from patients attending the dietician-led coeliac disease clinics. SETTING Patients were recruited from New Cross Hospital, Wolverhampton (n=50), and Imperial College London (n=30), between March 2010 and February 2011. PATIENTS Those with a diagnosis of coeliac disease for greater than 12 months attending dietician-led coeliac disease clinics. INTERVENTIONS In addition to whole blood taken for routine analysis, patients required a capillary finger-prick blood sample. MAIN OUTCOME MEASURE To determine if the whole blood and serum near-patient test results were in correlation with outcomes of standard laboratory evaluation. RESULTS Phase 1 demonstrated that the near-patient serum test had a sensitivity of 93.5% (95% CI 0.79% to 0.98%), specificity of 94.9% (0.83% to 0.99%), when compared to standard laboratory ELISA. Phase 2, involving patients whole blood, had a sensitivity of 77.8% (0.45% to 0.93%), and specificity of 100% (0.94% to 1%). CONCLUSIONS This pilot study has demonstrated that there appears to be a role for near-patient testing in coeliac disease, but further studies are recommended.
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Affiliation(s)
- D A George
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - L L Hui
- Department of Gastroenterology, Imperial College London, London, UK
| | - D Rattehalli
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - T Lovatt
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - I Perry
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - M Green
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - K Robinson
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - J R F Walters
- Department of Gastroenterology, Imperial College London, London, UK
| | - M J Brookes
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
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Schooling CM, Hui LL, Cowling BJ, Ho LM, Leung GM. Are the 2006 World Health Organization standards for infant growth applicable to Hong Kong Chinese? Universalistic standards or epidemiological transition stage-specific norms. Hong Kong Med J 2013; 19 Suppl 9:30-32. [PMID: 24473587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
1. Parental socio-economic status was positively associated with length and body mass index of Hong Kong Chinese infants at 9 months. 2. Maternal smoking in pregnancy was negatively associated with infant length at 9 months. 3. Some of the World Health Organization (WHO) criteria for an optimal nurturing environment contributed positively to growth. At 36 months, Hong Kong Chinese infants were generally shorter and fatter than the WHO growth references.
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Affiliation(s)
- C M Schooling
- Department of Community Medicine and School of Public Health, The University of Hong Kong
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Hui LL, Leung GM, Wong MY, Lam TH, Schooling CM. Small for gestational age and age at puberty: evidence from Hong Kong's "Children of 1997" birth cohort. Am J Epidemiol 2012; 176:785-93. [PMID: 23077286 DOI: 10.1093/aje/kws159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The predictive-adaptive response paradigm postulates that slow fetal growth advances puberty as a life-history strategy for reproductive success, when constraints on postnatal growth are minimal. The authors examined the association of birth weight for gestational age and small for gestational age (SGA) status (birth weight for gestational age <10th percentile, 6.9%) with clinically assessed age at onset of Tanner stage II in a non-Western developed population using interval-censored regression in 7,366 children (89% follow-up) from a population-representative Chinese birth cohort, "Children of 1997" in Hong Kong. Neither SGA status nor birth weight z score for gestational age was associated with age at onset of puberty, adjusted for sex, mother's place of birth, parental height, income, and parental education. Greater childhood height and linear growth were associated with younger age at onset of puberty. SGA status was associated with earlier puberty after adjustment for childhood height (time ratio = 0.984, 95% confidence interval: 0.972, 0.995) but later puberty after adjustment for linear growth (time ratio = 1.017, 95% confidence interval: 1.005, 1.030). In this developed city of China, SGA status was not associated with timing of puberty. However, the observation may be contextually specific depending on how other attributes, such as childhood growth, differ between SGA and other children.
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Affiliation(s)
- L L Hui
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Lin SL, Lee SL, Hui LL, Au Yeung SL, Tse MA, Leung GM, Schooling CM. Pubertal muscle mass and diabetes markers in Chinese adolescents. Am J Hum Biol 2012; 24:183-5. [PMID: 22287498 DOI: 10.1002/ajhb.22210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 09/30/2011] [Accepted: 11/16/2011] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Diabetes is common in China despite a relatively nonobese population. We hypothesized that testosterone driven muscle mass acquisition at puberty may be relevant. We examined the associations of testosterone with muscle mass and of muscle mass with fasting glucose in Chinese adolescents. METHODS In 40 adolescents (20 boys and 20 girls, age 12.9 ± 0.1 years) from Hong Kong's "Children of 1997" birth cohort, we used multivariable linear regression to assess adjusted associations of testosterone and fasting glucose (from a morning blood sample) with muscle and fat mass from a dual-energy X-ray absorptiometry scan. RESULTS Testosterone was positively associated with muscle mass (0.05 kg, 95% confidence interval (CI) 0.01 to 0.09, per pg/ml testosterone). Muscle mass was associated with lower glucose (-0.04 mmol/l, 95% CI -0.08 to -0.01 per kg muscle mass) adjusted for sex and fat mass. CONCLUSIONS Environmentally driven muscle mass acquisition at puberty could influence diabetes.
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Affiliation(s)
- Shi Lin Lin
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Li H, Xu WL, Shen HL, Chen QY, Hui LL, Long LL, Zhu XL. Methylenetetrahydrofolate reductase genotypes and haplotypes associated with susceptibility to colorectal cancer in an eastern Chinese Han population. Genet Mol Res 2011; 10:3738-46. [PMID: 22194208 DOI: 10.4238/2011.december.14.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) plays an important role in folate metabolism and is involved in DNA synthesis, DNA repair and DNA methylation. The two common functional polymorphisms of MTHFR, C677T and A1298C have been associated with several diseases, including cancer. We made a case-control study to analyze a possible association of MTHFR gene polymorphisms C677T and A1298C with risk for colorectal cancer in an eastern Chinese Han population of 137 patients with a confirmed histopathological diagnosis of CRC and 145 age- and gender-matched controls with no history of cancer. DNA was isolated from peripheral blood samples and the genotypes were determined by PCR-RFLP. The concentrations of folate in plasma were measured by chemiluminescence immunoassay. The MTHFR 677TT genotype had a protective effect against colorectal cancer, with an odds ratio (OR) = 0.467 (95% confidence interval (CI) = 0.225-0.966). The 1298CC genotype was significantly correlated with a reduced risk of colorectal cancer (OR = 0.192; 95%CI = 0.040-0.916). Compared with the MTHFR 677CC and MTHFR 1298 AA genotypes, for individuals who carried both MTHFR 677CC and 1298CC genotypes, the OR of colorectal cancer was 0.103 (95%CI = 0.012-0.900); among individuals who carried both MTHFR 677TT and 1298AC genotypes, the OR for risk of colorectal cancer was 0.169 (95%CI = 0.044-0.654). MTHFR 677TT+CT genotypes had a significantly lower plasma folate concentration than those with the MTHFR 677CC genotype. MTHFR 1298AC+CC genotypes had a lower plasma folate concentration than those with the MTHFR 1298AA genotype (P < 0.05). In conclusion, subjects with the MTHFR 677TT and MTHFR 1298CC genotypes appeared to have a significantly lower risk for colorectal cancer. MTHFR haplotypes 677CC/1298CC and 677TT/1298AC were less common in cases than in controls. These haplotypes, when compared to the most common haplotype 677CC/1298AA, were associated with a decreased risk for colorectal cancer. We conclude that plasma folate level is influenced by MTHFR genotypes.
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Affiliation(s)
- H Li
- Department of Central Laboratory, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
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Hui LL, Leung GM, Lam TH, Schooling CM. Inter-generational influences on age at onset of puberty: Hong Kong's ‘Children of 1997’ birth cohort. Int J Epidemiol 2011; 41:292-300. [DOI: 10.1093/ije/dyr163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Lin SL, Leung GM, Hui LL, Lam TH, Schooling CM. Is informal child care associated with childhood obesity? Evidence from Hong Kong's "Children of 1997" birth cohort. Int J Epidemiol 2011; 40:1238-46. [PMID: 21624932 DOI: 10.1093/ije/dyr086] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In Western populations, informal child care is associated with childhood obesity. However, informal child care and obesity share social patterning making evidence from other settings valuable. METHODS We used multivariable linear and logistic regression models to estimate the association of child care at 6 months and at 3, 5 and 11 years with body mass index (BMI) z-score and overweight (including obesity) at 11 years in a Hong Kong Chinese birth cohort. We assessed whether associations varied with sex or socio-economic position (SEP). We used multiple imputation for missing exposures and confounders. RESULTS Of the original 8327 cohort members, 7933 are alive, participating and living in Hong Kong. At ~11 years, 6796 had their BMI clinically assessed. Higher SEP was associated with informal care. After imputation, informal care at each of 3, 5 or 11 years was separately associated with higher BMI z-score [3 years 0.10, 95% confidence interval (CI) 0.03-0.18, 5 years 0.12, 95% CI 0.04-0.21, 11 years 0.17, 95% CI 0.04-0.31] and with the presence of overweight [odds ratio (OR) 3 years 1.19, 95% CI 1.03-1.37, 5 years OR 1.20, 95% CI 1.03-1.40, 11 years OR 1.21, 95% CI 1.02-1.45], adjusted for sex, SEP and birth weight z-score. Current informal care had the strongest association. However, informal child care at 5 years also contributed. There was no evidence of differences by sex or SEP. CONCLUSIONS In a developed, non-Western setting, informal child care was associated with childhood obesity. Modifiable attributes of informal child care warrant investigation for obesity prevention.
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Affiliation(s)
- Shi Lin Lin
- Lifestyle and Life Course Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Affiliation(s)
- C Mary Schooling
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Hedley AJ, Hui LL, Kypke K, Malisch R, van Leeuwen FXR, Moy G, Wong TW, Nelson EAS. Residues of persistent organic pollutants (POPs) in human milk in Hong Kong. Chemosphere 2010; 79:259-265. [PMID: 20199797 DOI: 10.1016/j.chemosphere.2010.01.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 01/22/2010] [Accepted: 01/23/2010] [Indexed: 05/28/2023]
Abstract
Data on pesticide body load in the south China region are scarce. Here, we report the concentrations of 24 persistent organic pollutants (POPs), in 10 pools of human milk samples, collected at 2-6weeks postpartum from 238 primiparous women living in Hong Kong and south China, who participated in the 2002-2003 WHO exposure study. Residues were determined by gas chromatography with electron capture detector and confirmed by gas chromatography with mass spectrometry. The mean levels of alpha-HCH (mean 0.6ngg(-1) fat), beta-HCH (940ngg(-1) fat), gamma-HCH (1.8ngg(-1) fat), dieldrin (1.0ngg(-1) fat) and HCB (21.8ngg(-1) fat) were much lower than the 1985 estimates. Mean levels of alpha-HCH, gamma-HCH, dieldrin, cis-heptachlor-epoxide (0.7ngg(-1) fat), sum-chlordane (6.1ngg(-1) fat), trans-nonachlor (12.0ngg(-1) fat), BDE 47 (1.9ngg(-1) fat) and sum PBDE (3.4ngg(-1) fat) were comparable to the international median levels of the 15 other countries participating in the 2002-03 WHO exposure study. Hong Kong had the highest level of beta-HCH, possibly a residual effect of previous high exposures in the 1970s. Body loads of beta-HCH and chlordane were lower among mothers with younger age while mothers born in mainland China had lower levels of beta-HCH, cis-heptachlor-epoxide, oxy-chlordane and trans-nonachlor. Levels of toxaphene, endrin, endosulfan, bromcyclene and nitrofen were not detected in all or almost all of the milk pools. Continuous monitoring of POPs in human milk, especially beta-HCH, is needed for surveillance and interpretation of time trends, and for linkage to strict enforcement of agricultural regulations.
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Affiliation(s)
- A J Hedley
- Department of Community Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Schooling CM, Hui LL, Leung SSL, Ho LM, Mak KH, Leung GM. Short- and medium-term outcomes of accelerated infant growth in a Hong Kong Chinese birth cohort. Hong Kong Med J 2009; 15 Suppl 2:17-21. [PMID: 19258628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
1. In a large, population representative,Chinese birth cohort, higher birth weight and rapid growth, particularly at 0-3 months, were associated with higher body mass index (BMI) at 7 years. 2. Boys born heavy who had grown fast had the highest BMI, but rapid growth had the largest impact in lighter-born boys. 3. Rapid growth at 0-3 months or 3-12 months was not associated with a compensatory lower risk of serious infectious morbidity. 4. The ability to grow fast may be an embodiment of good health status, rather than fast growth being causally protective.
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Affiliation(s)
- C M Schooling
- Department of Community Medicine and School of Public Health, The University of Hong Kong, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Hui LL, Hedley AJ, Kypke K, Cowling BJ, Nelson EAS, Wong TW, van Leeuwen FXR, Malisch R. DDT levels in human milk in Hong Kong, 2001-02. Chemosphere 2008; 73:50-55. [PMID: 18640700 DOI: 10.1016/j.chemosphere.2008.05.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 05/16/2008] [Accepted: 05/19/2008] [Indexed: 05/26/2023]
Abstract
High levels of p,p'-DDT were detected in Hong Kong breast milk sampled in 1976 and 1985. Monitoring DDT levels in human breast milk in this region is important to identify trends in exposure. As part of the 2002-03 WHO/EURO coordinated exposure study, the concentrations of DDT and its metabolites were determined in 10 pooled milk samples classified by geographic origin and dietary history, comprising milk samples from 238 primiparous mothers giving birth in Hong Kong. Analysis was performed by Gas Chromatography (GC) with electron capture detector and confirmed by GC/Mass Spectrometry. The sum-DDT concentration (range: 0.92-2.05 mg/kg fat) was age-dependent and indicated a decreasing trend since the 1970s. Mothers who recently came from mainland China had higher p,p'-DDT to p,p'-DDE ratios, suggesting a more recent exposure compared to women mainly residing in Hong Kong. The average Hong Kong sum-DDT level (1.50 mg/kg fat) was among the highest of the contemporary levels (range: 0.12-1.97 mg/kg fat; median: 0.40 mg/kg fat) in the 16 countries/regions participating in the 2002-03 WHO/EURO exposure study. This is probably due to the previous extensive DDT exposure and continuing use of DDT in agriculture in mainland China. Despite the apparent decrease of DDT body load over 30 years, the environmental health hazard from DDT contamination in the Pearl River Delta region remains a concern. Measures to eradicate illegal use of DDT in mainland China and regular food monitoring programs are needed in the region. Despite the presence of DDT and other persistent organic pollutants in human breast milk, breastfeeding should continue to be strongly supported for its life-long benefits to infants.
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Affiliation(s)
- L L Hui
- Department of Community Medicine, The University of Hong Kong, Faculty of Medicine, 5/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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Hui LL, Schooling CM, Cowling BJ, Leung SSL, Lam TH, Leung GM. Are universal standards for optimal infant growth appropriate? Evidence from a Hong Kong Chinese birth cohort. Arch Dis Child 2008; 93:561-5. [PMID: 17556396 DOI: 10.1136/adc.2007.119826] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In 2006 the World Health Organization (WHO) published new optimal growth standards for all healthy infants worldwide. To assess their general applicability to a recently transitioned Chinese population, we compared them with infant growth patterns in a representative sample of Hong Kong infants. DESIGN AND SETTINGS Weight at birth and at 1, 3, 9, 12, 18 and 36 months, length at 3 and 9 months and height at 36 months were obtained for over 80% of all infants born in April and May 1997 (3880 boys and 3536 girls). Age and sex specific z scores were calculated relative to the WHO growth standards for term singletons. RESULTS Weight for age was close to the 50th percentile of the WHO growth standards for both boys (mean z score: 0.00) and girls (0.04) at most time points before 3 years of age. However, our participants were shorter at 3 years, where the z scores in height were -0.34 and -0.38 for boys and girls, respectively. Restricting the analysis to a subset matching the WHO criteria for healthy infants without restrictions on growth gave similar results. CONCLUSIONS Although the WHO study group concluded there was a striking similarity in length/height among different populations, Hong Kong Chinese toddlers are, on average, shorter. Epigenetic constraints on growth coupled with the rapid epidemiological transition in Hong Kong may not have allowed sufficient generations for infants and children to reach their full genetic height potential, and with it the WHO standards. A universal infant growth standard may not be appropriate across all populations.
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Affiliation(s)
- L L Hui
- The University of Hong Kong, Department of Community Medicine, 5/F William MW Mong Block, Room 5-21, 21 Sassoon Road, Pokfulam, Hong Kong, People's Republic of China
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Hui LL, Schooling CM, Leung SSL, Mak KH, Ho LM, Lam TH, Leung GM. Birth weight, infant growth, and childhood body mass index: Hong Kong's children of 1997 birth cohort. ACTA ACUST UNITED AC 2008; 162:212-8. [PMID: 18316657 DOI: 10.1001/archpediatrics.2007.62] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the association between birth weight, infant growth rate, and childhood adiposity as a proxy for adult metabolic or cardiovascular risk in a Chinese population with a history of recent and rapid economic development. DESIGN Prospective study in a population-representative birth cohort. SETTING Hong Kong Chinese population. PARTICIPANTS Six thousand seventy-five term births (77.5% successful follow-up). Main Exposures Birth weight and growth rate (change in the weight z score) at ages 0 to 3 and 3 to 12 months. Main Outcome Measure Body mass index (BMI) (calculated as the weight in kilograms divided by the height in meters squared) z score at about age 7 years. RESULTS Each unit increase in the weight z score at ages 0 to 3 and 3 to 12 months increased the BMI z score by 0.52 and 0.33, respectively. Children in the highest birth weight and growth rate tertiles had the highest BMI z scores. In the lowest birth weight tertile, increases in the weight z score at ages 0 to 3 months had a larger effect on the BMI z score in boys (mean difference, 0.88; 95% confidence interval 0.69-1.07) than in girls (mean difference, 0.52; 95% confidence interval, 0.33-0.71); these differences by birth weight, growth rate at ages 0 to 3 months, and sex were significant (P = .007). CONCLUSIONS Faster prenatal and postnatal growth were associated with higher childhood BMI in a population with a recent history of rapid economic growth and relatively low birth weight, suggesting that maximal growth may not be optimal for metabolic risk. However, there may be a developmental trade-off between metabolic risk and other outcomes.
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Affiliation(s)
- L L Hui
- Department of Community Medicine and School of Public Health, The University of Hong Kong, 5/F William M. W. Mong Block, 21 Sassoon Rd, Pokfulam, Hong Kong, China
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Hui LL, Hedley AJ, Nelson EAS, Malisch R, Wong TW, Cowling BJ. Agreement between breast milk dioxin levels by CALUX bioassay and chemical analysis in a population survey in Hong Kong. Chemosphere 2007; 69:1287-94. [PMID: 17618674 DOI: 10.1016/j.chemosphere.2007.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 05/14/2007] [Accepted: 05/15/2007] [Indexed: 05/16/2023]
Abstract
Chemically-activated luciferase gene expression (CALUX) bioassay and gas chromatography/mass spectrometry (GC/MS) are used to determine dioxin levels in food and humans. Valid measures of the agreement between the two methods would improve interpretation of bioassay results. Paired breast milk samples from 250 mothers, as 11 pooled samples, were analysed by GC/MS for total WHO-TEQ (7 polychlorinated dibenzo-para-dioxins, 10 polychlorinated dibenzofurans and 12 dioxin-like polychlorinated biphenyls) and as individual samples by CALUX. Mean difference between total WHO-TEQ (weighted by TEF system derived in 1997) and mean CALUX-TEQ in each pool was 1.6 pg/g fat (95% CI: 0.7, 2.4), indicating a statistically significant overestimation of CALUX-TEQ compared to WHO-TEQ, probably due to the presence of Ah-receptor agonists. CALUX estimated toxicity of 13 pg/g fat was greater than the WHO-TEQ by 0.9, 3.1 and 0.3 pg/g fat for mothers from Hong Kong, mainland China and overseas territories, respectively. When the 2005 TEF system was applied, a reduction of 14-26% in the WHO-TEQ and a larger but less disperse discrepancy between WHO-TEQ and CALUX-TEQ (3.9 pg/g fat, 95% CI: 3.5, 4.4) were observed. Our study suggested that the mothers' place of residence explained the discrepancy between CALUX-TEQ and WHO-TEQ and should be considered in inter-country comparisons for CALUX-TEQ. For regulatory purposes bioassays for detecting quantitative dioxin contents in any setting must be combined with adequate extraction, clean-up and validation with WHO-TEQs. The larger difference between the two measurements after using the new TEF system warrants further investigation.
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Affiliation(s)
- L L Hui
- Department of Community Medicine, The University of Hong Kong, 5/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
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Nelson EAS, Hui LL, Wong TW, Hedley AJ. Demographic and lifestyle factors associated with dioxin-like activity (CALUX-TEQ) in human breast milk in Hong Kong. Environ Sci Technol 2006; 40:1432-8. [PMID: 16568753 DOI: 10.1021/es052164r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Maternal exposure to dioxins and related compounds before conception may affect the health of the fetus. To identify factors affecting dioxin body load in Hong Kong, in 2002, total dioxin-like activity was estimated in 250 individual milk samples at 2-6 weeks postpartum, from a representative group of primiparous mothers, aged 18-42 years (mean 29 +/- 5 years), by a chemically activated luciferase expression (CALUX) bioassay. Associations between the CALUX-TEQ and 20 socio-demographic and dietary variables were examined separately in mothers younger than 30 years (n = 114) and 30 years or older (n = 119), by multiple linear regression analysis. CALUX-TEQ (mean 14.5 +/- 5.8 pg/g fat) significantly increased by 0.4-0.5 pg/g fat for every year of the mother's age. Mothers born in Guangdong province of China had a significantly higher CALUX-TEQ. Higher seafood consumption (older mothers; p = 0.07) and having a female baby (younger mothers; p = 0.002) were associated with a higher maternal CALUX-TEQ level. Age was the strongest factor affecting human dioxin levels in Hong Kong. Birthplace and residence are important indicators of variations in exposure to environmental pollution in the Asia Pacific region. Temporal trends in body loads of dioxins remain to be established and continuous monitoring of dioxins in humans and foods is necessary as a precautionary approach to guide environmental control measures and prevent exposure to infants.
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Affiliation(s)
- E A S Nelson
- Department of Paediatrics, The Chinese University of Hong Kong, 6/F Clinical and Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong
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Abstract
There are no previous reports from South China on chemically determined polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and dioxin-like polychlorinated biphenyls (PCBs) in human breast milk expressed as World Health Organization (WHO) toxic equivalents (TEQs). In a 2002-2003 WHO exposure study, 13 pools of breast milk comprising samples from 316 primiparous women in Hong Kong in 2002 were analyzed by gas chromatography/mass spectrometry for 29 PCDD/F and dioxin-like PCB congeners. Total WHO-TEQs ranged from 8.97 to 16.7 pg/g fat (weighted mean, 12.9 pg; weighted median, 13.4 pg). Variations in TEQs included positive associations with age (R2 = 0.73, p < 0.0005), higher consumption of dairy products and seafood, and lower TEQs in overseas mothers and ever-smokers. Congener profiles indicated geographic specificity of exposure in Hong Kong, mainland China, and overseas Asian countries, including higher proportions of PCB-TEQs (overseas) and PCDF-TEQs (mainland China). The median TEQs of PCDD/Fs (8.69 pg/g fat) and PCBs (4.73 pg/g fat) in Hong Kong were highest among the five Asian Pacific countries but lower than the levels for at least half of the European countries that participated in the WHO study. However, future international studies should incorporate mother's age in the design of the pooling strategy to allow standardization by other exposure factors and valid comparisons among different countries. The findings allow support for the WHO breast-feeding advisory. Trends in human dioxin levels in the region cannot yet be determined, and rigorous controls are needed to reduce emissions of dioxins and human exposure in mainland China.
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Affiliation(s)
- Anthony J Hedley
- Department of Community Medicine, University of Hong Kong, Hong Kong, People's Republic of China
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Abstract
OBJECTIVE To describe the pattern of meal glycaemic load of children in Hong Kong and to determine whether the meal glycaemic load is associated with childhood overweight. METHOD Dietary records (3-day) of 316 Hong Kong children aged 6-7 years were collected. Glycaemic load was calculated from the estimated weight (WT), carbohydrate content (%CHO) and glycaemic index (GI) of each food taken using the equation: (% CHO x GI x WT/100). The meal glycaemic load was then the sum of the glycaemic loads of all food taken in each meal. Logistic regression analyses were used to compare the average meal glycaemic load (of breakfast, lunch and dinner) and other dietary parameters between overweight children and normal-weight children. RESULTS Breakfast, lunch, dinner and snacks provided, respectively, 17, 29, 29 and 25% of the total glycaemic load in a day. White rice (excluding congee (rice porridge) and glutinous rice) contributed almost half of the total glycaemic load. Adjusted logistic regression showed that the meal glycaemic load was not significantly associated with childhood overweight after adjusting for parental obesity, birth weight, sleeping duration, mean energy intake and paternal smoking. CONCLUSION Meal glycaemic load calculated from current diet was not an independent factor associated with childhood overweight in children aged 6-7 years. Our data suggested that modifying the type of rice/staple consumed and choosing low-GI snacks could have a major influence on the total meal glycaemic load of young Hong Kong children.
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Affiliation(s)
- L L Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
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