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Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Ko Zaw K, Zdrojewski T, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Cisneros JZ, Zuziak M, Ezzati M, Filippi S. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 2021; 10:e60060. [PMID: 33685583 PMCID: PMC7943191 DOI: 10.7554/elife.60060] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nayu Ikeda
- National Institutes of Biomedical Innovation, Health and Nutrition
| | | | | | | | - Jing Liu
- Capital Medical University Beijing An Zhen Hospital
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- University of Copenhagen
- Copenhagen University Hospital
| | | | | | | | | | | | | | - Ali Ahmadi
- Shahrekord University of Medical Sciences
| | | | | | | | | | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics
| | | | | | | | | | | | | | | | | | | | | | | | - Eman Aly
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | - Parisa Amiri
- Research Center for Social Determinants of Health
| | | | | | | | | | | | | | | | | | - Joana Araújo
- Institute of Public Health of the University of Porto
| | | | | | | | | | | | | | | | | | | | | | | | - Shina Avi
- Tel-Aviv University
- Hebrew University of Jerusalem
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- Baqai Institute of Diabetology and Endocrinology
| | | | | | | | | | | | | | | | | | | | | | | | - Judith Benedics
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | - Hongsheng Bi
- Shandong University of Traditional Chinese Medicine
| | - Yufang Bi
- Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - João Breda
- World Health Organization Regional Office for Europe
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- Council for Agricultural Research and Economics
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- The Gertner Institute for Epidemiology and Health Policy Research
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- Canadian Fitness and Lifestyle Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | - Luc Dauchet
- University of Lille
- Lille University Hospital
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- Beijing Center for Disease Prevention and Control
| | | | | | | | | | | | | | - Anar Dushpanova
- Scuola Superiore Sant'Anna
- Al-Farabi Kazakh National University
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- Swiss Tropical and Public Health Institute
- University of Basel
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- World Health Organization Regional Office for the Eastern Mediterranean
| | | | | | | | | | | | | | | | | | | | | | | | - Mihai Gafencu
- Victor Babes University of Medicine and Pharmacy Timisoara
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- Institut National de la Santé et de la Recherche Médicale
- Paris University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yin Guo
- Capital Medical University Beijing Tongren Hospital
| | | | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute
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- Beijing Institute of Ophthalmology
| | | | | | | | | | | | | | - Yuan He
- National Research Institute for Health and Family Planning
| | - Yuna He
- Chinese Center for Disease Control and Prevention
| | | | | | | | | | | | - Ana Henriques
- Institute of Public Health of the University of Porto
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- Institute of Molecular and Clinical Ophthalmology Basel
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- French National Research Institute for Sustainable Development
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- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | | | | | | | | | - Roya Kelishadi
- Research Institute for Primordial Prevention of Non-communicable Disease
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- PASs Hirszfeld Institute of Immunology and Experimental Therapy
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- French National Research Institute for Sustainable Development
| | - Vera Lanska
- Institute for Clinical and Experimental Medicine
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- University of Chinese Academy of Sciences
| | | | | | | | | | | | - Lijuan Liu
- Capital Medical University Beijing Tongren Hospital
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- National Research Institute for Health and Family Planning
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- Institute of Neuroscience of the National Research Council
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- French National Research Institute for Sustainable Development
| | | | | | - Päivi Mäki
- Finnish Institute for Health and Welfare
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- CIBERCV
- Institut Hospital del Mar d'Investigacions Mèdiques
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- Capital Institute of Pediatrics
| | | | | | | | | | | | | | - GK Mini
- Women’s Social and Health Studies Foundation
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- University of Strasbourg
- Strasbourg University Hospital
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- Instituto Conmemorativo Gorgas de Estudios de la Salud
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- Banska Bystrica Regional Authority of Public Health
| | | | | | | | | | | | | | | | | | | | - Keiu Nelis
- National Institute for Health Development
| | - Liis Nelis
- National Institute for Health Development
| | | | | | | | | | | | | | | | - Yury P Nikitin
- SB RAS Federal Research Center Institute of Cytology and Genetics
| | - Guang Ning
- Shanghai Jiao-Tong University School of Medicine
| | | | | | - Marianna Noale
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | | | | | | | | | | | - Eha Nurk
- National Institute for Health Development
| | | | | | | | | | | | | | - Kyungwon Oh
- Korea Centers for Disease Control and Prevention
| | | | - Claes Ohlsson
- University of Gothenburg
- Sahlgrenska University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Domenico Palli
- Institute for Cancer Research, Prevention and Clinical Network
| | | | | | | | | | | | - Francesco Panza
- IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis
| | | | | | - Suyeon Park
- Korea Centers for Disease Control and Prevention
| | | | | | - Ionela M Pascanu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS
| | | | | | | | | | | | | | | | | | | | | | - Raluca M Pop
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | - Miquel Porta
- Institut Hospital del Mar d'Investigacions Mèdiques
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Puiu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | - Manu Raj
- Amrita Institute of Medical Sciences
| | | | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe
| | | | | | | | | | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Rito
- National Institute of Health Doutor Ricardo Jorge
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paola Russo
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | - Nader Saki
- Ahvaz Jundishapur University of Medical Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Savvas Savva
- Research and Education Institute of Child Health
| | - Mathilde Savy
- French National Research Institute for Sustainable Development
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aletta E Schutte
- University of New South Wales
- The George Institute for Global Health
| | | | | | | | - Abhijit Sen
- Center for Oral Health Services and Research Mid-Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfonso Siani
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | | | | | | | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Igor Spiroski
- Institute of Public Health
- Ss. Cyril and Methodius University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lucjan Szponar
- National Institute of Public Health – National Institute of Hygiene
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- French National Research Institute for Sustainable Development
| | | | | | | | - Oanh TH Trinh
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | | | | | | | | | | | | | | | - Gilad Twig
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | - Eunice Ugel
- Universidad Centro-Occidental Lisandro Alvarado
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- Copenhagen University Hospital
- University of Copenhagen
| | | | | | | | - Tomas Vega
- Consejería de Sanidad Junta de Castilla y León
| | | | | | | | | | | | | | | | - Lucie Viet
- National Institute for Public Health and the Environment
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ningli Wang
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | - Adelheid Weber
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogdan Wojtyniak
- National Institute of Public Health - National Institute of Hygiene
| | | | | | | | | | - Jean Woo
- The Chinese University of Hong Kong
| | | | | | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine
| | | | | | - Haiquan Xu
- Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs
| | - Liang Xu
- Beijing Institute of Ophthalmology
| | | | | | - Weili Yan
- Children's Hospital of Fudan University
| | | | | | - Yang Yang
- Shanghai Educational Development Co. Ltd
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- Peking University
- Duke University
| | | | | | - Dong Zhao
- Capital Medical University Beijing An Zhen Hospital
| | | | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Control and Prevention
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- Chinese Center for Disease Control and Prevention
| | - Dan Zhu
- Inner Mongolia Medical University
| | - Marie Zins
- Institut National de la Santé et de la Recherche Médicale
- Paris University
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X, Yiallouros PK, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zocalo Y, Zuñiga Cisneros J, Zuziak M, Ezzati M. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020; 396:1511-1524. [PMID: 33160572 PMCID: PMC7658740 DOI: 10.1016/s0140-6736(20)31859-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING Wellcome Trust, AstraZeneca Young Health Programme, EU.
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Korevaar TIM, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, Carty DM, Meems M, Vaidya B, Shields B, Ghafoor F, Popova PV, Mosso L, Oken E, Suvanto E, Hisada A, Yoshinaga J, Brown SJ, Bassols J, Auvinen J, Bramer WM, López-Bermejo A, Dayan C, Boucai L, Vafeiadi M, Grineva EN, Tkachuck AS, Pop VJM, Vrijkotte TG, Guxens M, Chatzi L, Sunyer J, Jiménez-Zabala A, Riaño I, Murcia M, Lu X, Mukhtar S, Delles C, Feldt-Rasmussen U, Nelson SM, Alexander EK, Chaker L, Männistö T, Walsh JP, Pearce EN, Steegers EAP, Peeters RP. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis. JAMA 2019; 322:632-641. [PMID: 31429897 PMCID: PMC6704759 DOI: 10.1001/jama.2019.10931] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
Importance Maternal hypothyroidism and hyperthyroidism are risk factors for preterm birth. Milder thyroid function test abnormalities and thyroid autoimmunity are more prevalent, but it remains controversial if these are associated with preterm birth. Objective To study if maternal thyroid function test abnormalities and thyroid autoimmunity are risk factors for preterm birth. Data Sources and Study Selection Studies were identified through a search of the Ovid MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar databases from inception to March 18, 2018, and by publishing open invitations in relevant journals. Data sets from published and unpublished prospective cohort studies with data on thyroid function tests (thyrotropin [often referred to as thyroid-stimulating hormone or TSH] and free thyroxine [FT4] concentrations) or thyroid peroxidase (TPO) antibody measurements and gestational age at birth were screened for eligibility by 2 independent reviewers. Studies in which participants received treatment based on abnormal thyroid function tests were excluded. Data Extraction and Synthesis The primary authors provided individual participant data that were analyzed using mixed-effects models. Main Outcomes and Measures The primary outcome was preterm birth (<37 weeks' gestational age). Results From 2526 published reports, 35 cohorts were invited to participate. After the addition of 5 unpublished data sets, a total of 19 cohorts were included. The study population included 47 045 pregnant women (mean age, 29 years; median gestational age at blood sampling, 12.9 weeks), of whom 1234 (3.1%) had subclinical hypothyroidism (increased thyrotropin concentration with normal FT4 concentration), 904 (2.2%) had isolated hypothyroxinemia (decreased FT4 concentration with normal thyrotropin concentration), and 3043 (7.5%) were TPO antibody positive; 2357 (5.0%) had a preterm birth. The risk of preterm birth was higher for women with subclinical hypothyroidism than euthyroid women (6.1% vs 5.0%, respectively; absolute risk difference, 1.4% [95% CI, 0%-3.2%]; odds ratio [OR], 1.29 [95% CI, 1.01-1.64]). Among women with isolated hypothyroxinemia, the risk of preterm birth was 7.1% vs 5.0% in euthyroid women (absolute risk difference, 2.3% [95% CI, 0.6%-4.5%]; OR, 1.46 [95% CI, 1.12-1.90]). In continuous analyses, each 1-SD higher maternal thyrotropin concentration was associated with a higher risk of preterm birth (absolute risk difference, 0.2% [95% CI, 0%-0.4%] per 1 SD; OR, 1.04 [95% CI, 1.00-1.09] per 1 SD). Thyroid peroxidase antibody-positive women had a higher risk of preterm birth vs TPO antibody-negative women (6.6% vs 4.9%, respectively; absolute risk difference, 1.6% [95% CI, 0.7%-2.8%]; OR, 1.33 [95% CI, 1.15-1.56]). Conclusions and Relevance Among pregnant women without overt thyroid disease, subclinical hypothyroidism, isolated hypothyroxinemia, and TPO antibody positivity were significantly associated with higher risk of preterm birth. These results provide insights toward optimizing clinical decision-making strategies that should consider the potential harms and benefits of screening programs and levothyroxine treatment during pregnancy.
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Affiliation(s)
- T I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, School of Medicine, Cardiff University, Cardiff, England
| | - Marcel Meima
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sofie Bliddal
- Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David M Carty
- Department of Diabetes, Endocrinology, and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, Scotland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Margreet Meems
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, England
| | - Beverley Shields
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, England
| | - Farkhanda Ghafoor
- National Health Research Complex, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Polina V Popova
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Lorena Mosso
- Department of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Aya Hisada
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Juha Auvinen
- Medical Research Center Oulu, Oulu University Hospital, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute, Dr Josep Trueta Hospital, Girona, Spain
| | - Colin Dayan
- Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, England
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York
| | - Marina Vafeiadi
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Elena N Grineva
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Alexandra S Tkachuck
- Almazov National Medical Research Centre, St Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St Petersburg Pavlov State Medical University, St Petersburg, Russia
| | - Victor J M Pop
- Departments of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Pastorino S, Bishop T, Crozier SR, Granström C, Kordas K, Küpers LK, O'Brien EC, Polanska K, Sauder KA, Zafarmand MH, Wilson RC, Agyemang C, Burton PR, Cooper C, Corpeleijn E, Dabelea D, Hanke W, Inskip HM, McAuliffe FM, Olsen SF, Vrijkotte TG, Brage S, Kennedy A, O'Gorman D, Scherer P, Wijndaele K, Wareham NJ, Desoye G, Ong KK. Associations between maternal physical activity in early and late pregnancy and offspring birth size: remote federated individual level meta-analysis from eight cohort studies. BJOG 2019; 126:459-470. [PMID: 30230190 PMCID: PMC6330060 DOI: 10.1111/1471-0528.15476] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evidence on the impact of leisure time physical activity (LTPA) in pregnancy on birth size is inconsistent. We aimed to examine the association between LTPA during early and late pregnancy and newborn anthropometric outcomes. DESIGN Individual level meta-analysis, which reduces heterogeneity across studies. SETTING A consortium of eight population-based studies (seven European and one US) comprising 72 694 participants. METHODS Generalised linear models with consistent inclusion of confounders (gestational age, sex, parity, maternal age, education, ethnicity, BMI, smoking, and alcohol intake) were used to test associations between self-reported LTPA at either early (8-18 weeks gestation) or late pregnancy (30+ weeks) and the outcomes. Results were pooled using random effects meta-analyses. MAIN OUTCOME MEASURES Birth weight, large-for-gestational age (LGA), macrosomia, small-for-gestational age (SGA), % body fat, and ponderal index at birth. RESULTS Late, but not early, gestation maternal moderate to vigorous physical activity (MVPA), vigorous activity, and LTPA energy expenditure were modestly inversely associated with BW, LGA, macrosomia, and ponderal index, without heterogeneity (all: I2 = 0%). For each extra hour/week of MVPA, RR for LGA and macrosomia were 0.97 (95% CI: 0.96, 0.98) and 0.96 (95% CI: 0.94, 0.98), respectively. Associations were only modestly reduced after additional adjustments for maternal BMI and gestational diabetes. No measure of LTPA was associated with risk for SGA. CONCLUSIONS Physical activity in late, but not early, pregnancy is consistently associated with modestly lower risk of LGA and macrosomia, but not SGA. TWEETABLE ABSTRACT In an individual participant meta-analysis, late pregnancy moderate to vigorous physical activity modestly reduced birth size outcomes.
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Affiliation(s)
- S Pastorino
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - T Bishop
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - SR Crozier
- MRC Lifecourse Epidemiology Unit (University of Southampton)Southampton General HospitalSouthamptonUK
| | - C Granström
- Department of Epidemiology ResearchCentre for Fetal ProgrammingState Serum InstituteCopenhagenDenmark
| | - K Kordas
- Epidemiology and Environmental HealthSchool of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNYUSA
| | - LK Küpers
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
- MRC Integrative Epidemiology UnitSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - EC O'Brien
- Obstetrics & GynaecologyUCD Perinatal Research CentreSchool of MedicineUniversity College DublinNational Maternity HospitalDublinIreland
| | - K Polanska
- Department of Environmental EpidemiologyNofer Institute of Occupational MedicineLodzPoland
| | - KA Sauder
- Department of PediatricsUniversity of Colorado School of MedicineAuroraCOUSA
| | - MH Zafarmand
- Department of Public HealthAmsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Obstetrics & GynaecologyAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAmsterdam Public Health Research InstituteAmsterdam UMCUniversity of Amsterdamthe Netherlands
| | - RC Wilson
- Institute of Health and SocietyNewcastle UniversityNewcastleUK
| | - C Agyemang
- Department of Public HealthAmsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - PR Burton
- Institute of Health and SocietyNewcastle UniversityNewcastleUK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit (University of Southampton)Southampton General HospitalSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust and University of SouthamptonSouthamptonUK
| | - E Corpeleijn
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - D Dabelea
- Department of EpidemiologyColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusDenverCOUSA
| | - W Hanke
- Department of Environmental EpidemiologyNofer Institute of Occupational MedicineLodzPoland
| | - HM Inskip
- MRC Lifecourse Epidemiology Unit (University of Southampton)Southampton General HospitalSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust and University of SouthamptonSouthamptonUK
| | - FM McAuliffe
- Obstetrics & GynaecologyUCD Perinatal Research CentreSchool of MedicineUniversity College DublinNational Maternity HospitalDublinIreland
| | - SF Olsen
- Department of Epidemiology ResearchCentre for Fetal ProgrammingState Serum InstituteCopenhagenDenmark
| | - TG Vrijkotte
- Department of Public HealthAmsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - S Brage
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - A Kennedy
- 3U Diabetes Consortium and School of Health and Human PerformanceDublin City UniversityDublinIreland
- School of Biological SciencesDublin Institute of TechnologyDublinIreland
| | - D O'Gorman
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust and University of SouthamptonSouthamptonUK
| | - P Scherer
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - K Wijndaele
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - NJ Wareham
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - G Desoye
- Department of Obstetrics & GynaecologyMedical University of GrazGrazAustria
| | - KK Ong
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Birks LE, Struchen B, Eeftens M, Huss A, Gajšek P, Kheifets L, Gallastegi M, Wel LV, Dalmau-Bueno A, Estarlich M, Fernandez M, Meder IK, Ferrero A, Jiménez-Zabala A, Torrent M, Vrijkotte TGM, Cardis E, Olsen J, Valič B, Vermeulen R, Vrijheid M, Röösli M, Guxens M. OP VI – 5 Spatial and temporal variability of personal exposure to radio frequency electromagnetic fields in children in europe. Radiation 2018. [DOI: 10.1136/oemed-2018-iseeabstracts.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Casas M, Cordier S, Martínez D, Barros H, Bonde JP, Burdorf A, Costet N, dos Santos AC, Danileviciute A, Eggesbø M, Fernandez M, Fevotte J, García AM, Gražuleviciene R, Hallner E, Hanke W, Kogevinas M, Kull I, Stemann Larsen P, Melaki V, Monfort C, Nordby KC, Nybo Andersen AM, Patelarou E, Polanska K, Richiardi L, Santa Marina L, Snijder C, Tardón A, van Eijsden M, Vrijkotte TGM, Zugna D, Nieuwenhuijsen M, Vrijheid M. Maternal occupation during pregnancy, birth weight, and length of gestation: combined analysis of 13 European birth cohorts. Scand J Work Environ Health 2015; 41:384-396. [DOI: 10.5271/sjweh.3500] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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8
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van Deutekom AW, Chinapaw MJM, Vrijkotte TGM, Gemke RJBJ. Study protocol: the relation of birth weight and infant growth trajectories with physical fitness, physical activity and sedentary behavior at 8-9 years of age - the ABCD study. BMC Pediatr 2013; 13:102. [PMID: 23835159 PMCID: PMC3710272 DOI: 10.1186/1471-2431-13-102] [Citation(s) in RCA: 14] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birth weight and accelerated infant growth have been identified as independent risk factors for childhood and adult obesity and cardiovascular disease. This led to the 'Developmental Origins of Health and Disease' (DOHaD) hypothesis, stating that environmental factors during pregnancy and early postnatal life affect disease risk in later life. There is growing evidence that perinatal factors may influence adult health through the programming of energy balance regulation, including sedentary behavior and physical activity. The present study focuses on the influence of birth weight and infant growth on physical fitness, physical activity and sedentary behavior in 8-9 year old children, as this might partly explain the higher obesity and cardiovascular risk associated with low birth weight and accelerated infant growth. In addition, this study provides the opportunity for a validation study of a linguistic and cross-cultural translated physical activity questionnaire compared to accelerometer data. This article describes the study protocol for this study. METHODS/DESIGN This is a study embedded in the Amsterdam Born Children and their Development (ABCD) birth cohort. In 200 children of Dutch ethnicity, physical fitness, physical activity and sedentary behavior were assessed at age 8-9. We measured aerobic fitness using the 20 meter multistage shuttle run test, and neuromuscular fitness using the standing broad jump and handgrip strength test. Sedentary behavior and physical activity levels were measured using accelerometry. All children also completed a translated physical activity questionnaire, the scores of which will be compared to accelerometry data to assess the construct validity of the questionnaire in Dutch school-aged children. DISCUSSION This study will be the first population-based prospective cohort study to address the association of both prenatal and postnatal growth with physical fitness and objectively-assessed physical activity and sedentary behavior. This will contribute to a better understanding of the way perinatal growth relate to lifestyle and obesity in later life. The results may guide both future studies in the field of DOHaD, and public health strategies in the prevention of childhood obesity.
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Affiliation(s)
- Arend W van Deutekom
- Department of Pediatrics, EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, the Netherlands
| | - Mai JM Chinapaw
- Department of Public and Occupational Health, EMGO institute for Health & Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Tanja GM Vrijkotte
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinoud JBJ Gemke
- Department of Pediatrics, EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, the Netherlands
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van Dijk AE, van Eijsden M, Stronks K, Gemke RJBJ, Vrijkotte TGM. Cardio-metabolic risk in 5-year-old children prenatally exposed to maternal psychosocial stress: the ABCD study. BMC Public Health 2010; 10:251. [PMID: 20470407 PMCID: PMC2882911 DOI: 10.1186/1471-2458-10-251] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 05/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent evidence, both animal and human, suggests that modifiable factors during fetal and infant development predispose for cardiovascular disease in adult life and that they may become possible future targets for prevention. One of these factors is maternal psychosocial stress, but so far, few prospective studies have been able to investigate the longer-term effects of stress in detail, i.e. effects in childhood. Therefore, our general aim is to study whether prenatal maternal psychosocial stress is associated with an adverse cardio-metabolic risk profile in the child at age five. METHODS/DESIGN Data are available from the Amsterdam Born Children and their Development (ABCD) study, a prospective birth cohort in the Netherlands. Between 2003-2004, 8,266 pregnant women filled out a questionnaire including instruments to determine anxiety (STAI), pregnancy related anxiety (PRAQ), depressive symptoms (CES-D), parenting stress (PDH scale) and work stress (Job Content Questionnaire). Outcome measures in the offspring (age 5-7) are currently collected. These include lipid profile, blood glucose, insulin sensitivity, body composition (body mass index, waist circumference and bioelectrical impedance analysis), autonomic nervous system activity (parasympathetic and sympathetic measures) and blood pressure. Potential mediators are maternal serum cortisol, gestational age and birth weight for gestational age (intrauterine growth restriction). Possible gender differences in programming are also studied. DISCUSSION Main strengths of the proposed study are the longitudinal measurements during three important periods (pregnancy, infancy and childhood), the extensive measurement of maternal psychosocial stress with validated questionnaires and the thorough measurement of the children's cardio-metabolic profile. The availability of several confounding factors will give us the opportunity to quantify the independent contribution of maternal stress during pregnancy to the cardio-metabolic risk profile of her offspring. Moreover, the mediating role of maternal cortisol, intrauterine growth, gestational age and potential gender differences can be explored extensively. If prenatal psychosocial stress is indeed found to be associated with the offspring's cardio-metabolic risk, these results support the statement that primary prevention of cardiovascular disease may start even before birth by reducing maternal stress during pregnancy.
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Affiliation(s)
- Aimée E van Dijk
- Department of Public Health, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, the Netherlands
| | - Manon van Eijsden
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam (GGD), Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
| | - Reinoud JBJ Gemke
- Department of Paediatrics, VU University Medical Center, Amsterdam, the Netherlands
| | - Tanja GM Vrijkotte
- Department of Public Health, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands
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de Beer M, van Eijsden M, Vrijkotte TGM, Gemke RJBJ. Early growth patterns and cardiometabolic function at the age of 5 in a multiethnic birth cohort: the ABCD study. BMC Pediatr 2009; 9:23. [PMID: 19317894 PMCID: PMC2667393 DOI: 10.1186/1471-2431-9-23] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/24/2009] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The relation between fetal growth retardation and cardiovascular and metabolic diseases in later life has been demonstrated in many studies. However, debate exists around the potential independent role of postnatal growth acceleration. Furthermore, it is unknown whether a potential effect of growth acceleration on cardiovascular and metabolic function is confined to certain time frames.The present study assesses the (predictive) role of prenatal and postnatal growth on 5 components of cardiovascular and metabolic function in children aged 5. The potential association of timing of postnatal growth acceleration with these outcomes will be explored. METHODS AND DESIGN Prospective multiethnic community-based cohort study of 8266 pregnancies (Amsterdam Born Children and their Development, ABCD study). Up till now, anthropometry of 5104 children from the original cohort was followed during the first 5 years of life, with additional information about birth weight, pregnancy duration, and various potential confounding variables.At age 5, various components of cardiovascular and metabolic function are being measured. Outcome variables are body size, body composition and fat distribution, insulin sensitivity, lipid profile, blood pressure and autonomic regulation of cardiovascular function. DISCUSSION This study will be one of the first population-based prospective cohort studies to address the association between measures of both prenatal and postnatal growth and various components of cardiovascular and metabolic function. Specific attention is paid to the timing of acceleration in growth and its potential association with the outcome variables. Importantly, the longitudinal design of this study gives us the opportunity to gain more insight into growth trajectories associated with adverse outcomes in later life. If identified as an independent risk factor, this provides further basis for the hypothesis that accelerated growth during the first years of life is a modifiable factor for the prevention of cardiovascular and metabolic disorders in later life. Moreover, identification of specific vulnerable periods during development may reveal suitable time frames for early interventions.
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Affiliation(s)
- Marieke de Beer
- Department of Pediatrics, EMGO Institute, Institute for Cardiovascular Research VU, VU University Medical Centre, Amsterdam, the Netherlands
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, the Netherlands
| | - Manon van Eijsden
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, the Netherlands
| | - Tanja GM Vrijkotte
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Reinoud JBJ Gemke
- Department of Pediatrics, EMGO Institute, Institute for Cardiovascular Research VU, VU University Medical Centre, Amsterdam, the Netherlands
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Abstract
BACKGROUND Serum C-reactive protein (CRP) has been identified in prospective epidemiological research as an independent risk marker for cardiovascular disease. In this paper, short-term biological variation of CRP is documented and a strategy to test the reliability of a single CRP sample is proposed. METHODS Data were obtained from three groups of healthy volunteers: men, no oral contraceptives (OC-)using women and OC-using women. Blood samples were obtained 3 times in men and twice in women during a workweek. RESULTS AND DISCUSSION CRP values were highest in the OC-using women, followed by the men, and lowest in the no OC-using women. Averaged over the three groups the within-subject coefficients of variation (CVi) was 49.24% for CRP, and 29.90% for lnCRP. Using the repeated measures, individual samples were identified that reflected a 'suspicious' unreliable high value, i.e. a value that was more than 2 standard deviations higher than the lowest value obtained from the same subject. In an a posteriori analysis, three strategies to identify these suspicious high CRP values were then tested. In terms of maximizing detection of suspicious values and minimizing unnecessary resampling, best results were obtained for the most pragmatic criterion of using an absolute level, stratified for gender, and OC-use, to decide whether a second sample should be obtained. CONCLUSION A single high CRP value must be followed by re-sampling when it is above 1.75 mg/l for men, above 1.00 mg/l for no OC-using women, and above 2.00 mg/l for OC-using women.
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Affiliation(s)
- Harriëtte Riese
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tanja GM Vrijkotte
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Piet Meijer
- Gaubius Laboratory, TNO-PG, Leiden, The Netherlands
| | - Cees Kluft
- Gaubius Laboratory, TNO-PG, Leiden, The Netherlands
| | - Eco JC de Geus
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
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12
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Abstract
OBJECTIVE To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. DESIGN Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings (1) in a controlled laboratory experiment and (2) during long-term recording in a true naturalistic setting. PARTICIPANTS Six normotensive subjects participated in the laboratory study. A total of 109 male white-collar workers underwent ambulatory monitoring, of which 30 were mildly hypertensive. METHODS Four different laboratory conditions (postures: lying, sitting, standing, walking), repeated twice, were used to assess the short-term effects of cuff inflation on the HR. To test the actual ambulatory validity, participants simultaneously wore a continuous HR recorder and the ABP monitor from early morning to late evening on 2 workdays and one non-workday. Diary and vertical accelerometery information was used to obtain periods of fixed posture and (physical) activity across which HR from both devices was compared. RESULTS Laboratory results showed that the ABP device reliably detected HR during blood pressure measurement, but that this HR was systematically lower than the HR directly before and after the blood pressure measurement. The ambulatory study confirmed this systematic underestimation of the ongoing HR, but additionally showed that its amount increased when subjects went from sitting to standing to light physical activity (2.9; 4.3 and 9.1 bpm (beats/min), respectively). In spite of this activity-dependent underestimation of HR, the correlation of continuous ECG and intermittent ABP-derived HR was high (median r= 0.81). Also, underestimation was not different for normotensives and mild hypertensives. CONCLUSIONS A direct effect of cuff inflation leads to the underestimation of ongoing HR during cuff-based ABP measurement. Additional underestimation of HR occurs during periods with physical activity, probably due to behavioural freezing during blood pressure measurements. HR underestimation was not affected by hypertensive state. When its limitations are taken into account, ABP-derived ambulatory HR can be considered a reliable and valid measure.
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Affiliation(s)
- T G Vrijkotte
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
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Abstract
Work stress has repeatedly been associated with an increased risk for cardiovascular disease. This study tested whether this relationship could be explained by exaggerated cardiovascular reactivity to work or impaired recovery in leisure time. Vagal tone was assessed as a possible determinant of these work stress effects. Participants included 109 male white-collar workers (age, 47.2+/-5. 3) who were monitored on 2 workdays and 1 nonworkday for ambulatory blood pressure, heart rate, and heart rate variability. Chronic work stress was defined according to Siegrist's model as (1) high imbalance, a combination of high effort and low reward at work, or (2) high overcommitment, an exhaustive work-related coping style indexing the inability to unwind. All findings were adjusted for possible differences in posture and physical activity between the work stress groups. High imbalance was associated with a higher heart rate during work and directly after work, a higher systolic blood pressure during work and leisure time, and a lower 24-hour vagal tone on all 3 measurement days. Overcommitment was not associated with an unfavorable ambulatory profile. Logistic regression analysis revealed that heart rate [odds ratio 1-SD increase 1.95 (95% CI, 1.02 to 3.77)] and vagal tone [odds ratio 1-SD decrease 2.67 (95% CI, 1.24 to 5.75)] were independently associated with incident mild hypertension. Surprisingly, the values during sleep were more predictive for mild hypertension than the values during work. The results from the present study suggest that the detrimental effects of work stress are partly mediated by increased heart rate reactivity to a stressful workday, an increase in systolic blood pressure level, and lower vagal tone.
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Affiliation(s)
- T G Vrijkotte
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
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14
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Abstract
OBJECTIVE A high level of work stress has been associated with cardiovascular disease. However, the pathophysiological mechanisms underlying this association remain unclear. This study examined the effect of work stress on a cluster of metabolic and hemostatic risk factors. METHODS Blood was collected three times, on the first, third, and fifth day of a work week, from 124 middle-aged, white-collar workers. Metabolic measures were insulin, glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol. Hemostatic measures were fibrinogen, tissue-type plasminogen activator activity, tissue-type plasminogen activator antigen, and type 1 plasminogen activator inhibitor antigen. Chronic work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (effort-reward imbalance) or 2) high overcommitment (an exhaustive work-related coping style). RESULTS Overcommitment, but not imbalance or the imbalance-overcommitment interaction, was associated with an impaired fibrinolytic system, as reflected in decreased tissue-type plasminogen activator activity levels and increased type 1 plasminogen activator inhibitor antigen levels on all three measurement occasions. After controlling for body mass index, total cholesterol, triglycerides, high-density lipoprotein/low-density lipoprotein cholesterol ratio, glucose, and insulin, the relation between overcom-mitment and the fibrinolytic factors was attenuated but remained significant. CONCLUSIONS The results suggest that individuals with an exhaustive coping style at work have an impaired fibrinolytic capacity that is possibly due to the effects of chronic stress on insulin resistance.
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Affiliation(s)
- T G Vrijkotte
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
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15
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Out L, Vrijkotte TG, van Soest AJ, Bobbert MF. Influence of the parameters of a human triceps surae muscle model on the isometric torque-angle relationship. J Biomech Eng 1996; 118:17-25. [PMID: 8833070 DOI: 10.1115/1.2795940] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [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: 02/02/2023]
Abstract
This study investigates the influence of parameter values of the human triceps surae muscle on the torque-angle relationship. The model used consisted of three units, each containing a contractile, a series elastic and a parallel elastic element. Parameter values were based on morphological characteristics, which made it possible to model individual units. However, for a number of parameters the values reported in the literature vary considerably. It was investigated how sensitive model results were for variation of these parameters. Slack length of the series elastic element, mean moment arm, maximum force, and length of the contractile element appeared to be the most important determinants of the behavior. For mean moment arm and contractile element length, morphology-based methods of estimation could be recommended. Slack length and maximum force were obtained through optimization. It was concluded that the model does not contain parameters on which its output depends strongly and which are difficult to estimate as well, with two exceptions: slack length of the series elastic element and maximum force.
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Affiliation(s)
- L Out
- Department of Functional Anatomy, Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
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Havenith G, Luttikholt VG, Vrijkotte TG. The relative influence of body characteristics on humid heat stress response. Eur J Appl Physiol Occup Physiol 1995; 70:270-9. [PMID: 7607204 DOI: 10.1007/bf00238575] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present study was designed to determine the relative importance of individual characteristics such as maximal oxygen uptake (VO2max), adiposity, DuBois body surface area (AD), surface to mass ratio (AD: mass) and body mass, for the individual's reaction to humid heat stress. For this purpose 27 subjects (19 men, 8 women), with heterogeneous characteristics (VO2max 1.86-5.28 1.min-1; fat% 8.0%-31.9%; mass 49.8-102.1 kg; AD 1.52-2.33 m2) first rested (30 min) and then exercised (60 W for 1 h) on a cycle ergometer in a warm humid climate (35 degrees C, 80% relative humidity). Their physiological responses at the end of exercise were analysed to assess their relationship with individual characteristics using a stepwise multiple regression technique. Dependent variables (with ranges) included final values of rectal temperature (Tre 37.5-39.0 degrees C), mean skin temperature (Tsk 35.7-37.5 degrees C), body heat storage (S 3.2-8.1 J.g-1), heart rate (HR 100-172 beat.min-1), sweat loss (397-1403 g), mean arterial blood pressure (BPa, 68-96 mmHg), forearm blood flow (FBF, 10.1-33.9 ml.100ml-1.min-1) and forearm vascular conductance (FVC = FBF/BPa, 0.11-0.49 ml.100ml-1.min-1.mmHg-1). The Tre, Tsk and S were (34%-65%) determined in the main by VO2max or by exercise intensity expressed as a percentage of VO2max (% VO2max). For Tre, AD: mass ratio also contributed to the variance explained, with about half the effect of VO2max. For Tsk, fat% contributed to the variance explained with about two-third the effect of VO2max. Total body sweat loss was highly dependent (50%) on body size (AD or mass) with regular activity level having a quarter of the effect of body size on sweat loss. The HR, similar to Tre, was determined by VO2max (48%-51%), with less than half the effect of AD or AD:mass (20%). Other circulatory parameters (FBF, BPa, FVC) showed little relationship with individual characteristics (< 36% of variance explained). In general, the higher the VO2max and/or the bigger the subject, the lower the heat strain observed. The widely accepted concept, that body core temperature is determined by exercise intensity expressed as % VO2max and sweat loss by absolute heat load, was only partially supported by the results. For both variables, other individual characteristics were also shown to contribute.
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Affiliation(s)
- G Havenith
- TNO Human Factors Research Institute, Soesterberg, The Netherlands
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