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Jo Driscoll D, Kiely E, O'Keeffe LM, Khashan AS. Poverty trajectories and child and mother well-being outcomes in Ireland: findings from an Irish prospective cohort. J Epidemiol Community Health 2024:jech-2023-221794. [PMID: 38688701 DOI: 10.1136/jech-2023-221794] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood. OBJECTIVE To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and mother indicators of physical health and psychopathology in Ireland. METHODS We used a nationally representative, prospective cohort (Growing Up in Ireland-Infant Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9 months, and 3, 5, 9 years. We used group-based multitrajectory cluster modelling to classify trajectories of poverty. Using multivariable logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9 months to 9 years with child outcomes (overweight, any longstanding illness and psychopathology) at age 9 years and the same poverty trajectories over the same 9-year period with mother outcomes (overweight, any longstanding illness and depression). RESULTS Of 11 134 participants, 4 trajectories were identified: never in poverty (43.1%), material/subjective>monetary poverty (16.1%), monetary>material poverty (25.6%) and persistent poverty (15.2%). Children in persistent poverty compared with those in never in poverty experienced higher odds of being overweight at 9 years (adjusted OR (aOR) 1.70, 95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51, 95% CI 1.20, 1.91), and psychopathology (aOR 2.06, 95% CI 1.42, 2.99). The outcomes for primary parents (99.7% were mothers) were as follows: having higher odds of being overweight (aOR 1.49, 95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13, 95% CI 1.63, 2.79), and depression (aOR 3.54, 95% CI 2.54, 4.94). CONCLUSIONS Any poverty trajectory was associated with poorer psychopathology and physical well-being in late childhood for children and their mothers in Ireland.
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Affiliation(s)
- David Jo Driscoll
- School of Public Health, University College Cork, Cork, Ireland
- Specialist Neurodevelopmental ADHD Pathway (SNAP), Cork and Kerry Child and Adolescent Mental Health Services, Cork, Ireland
| | - Elizabeth Kiely
- School of Applied Social Studies, University College Cork, Cork, Ireland
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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Stamenic D, Fitzgerald AP, Gajewska KA, O'Neill KN, Bermingham M, Cronin J, Lynch BM, O'Brien SM, McHugh SM, Buckley CM, Kavanagh PM, Kearney PM, O'Keeffe LM. Health care utilization and the associated costs attributable to cardiovascular disease in Ireland: a cross-sectional study. Eur Heart J Qual Care Clin Outcomes 2024:qcae014. [PMID: 38383606 DOI: 10.1093/ehjqcco/qcae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality and disability globally. We examined healthcare service utilization and costs attributable to CVD in Ireland in the period before the introduction of a major healthcare reform in 2016. METHODS Secondary analysis of data from 8 113 participants of the first wave of The Irish Longitudinal Study on Ageing. CVD was defined as having a self-reported doctor's diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Participants self-reported the utilization of healthcare services in the year preceding the interview. Negative binomial regression with average marginal effects (AME) was used to estimate the incremental number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department attendances and hospitalisations in population with CVD relative to population without CVD. We calculated the corresponding costs at individual and population levels, by gender and age groups. RESULTS The prevalence of CVD was 18.2% (95% CI: 17.3, 19.0) Participants with CVD reported higher utilization of all healthcare services. In adjusted models, having CVD was associated with incremental 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits. There were twice as many incremental hospitalisations in males with CVD compared to females with CVD (AME (95% CI): 0.20 (0.16, 0.23) vs 0.10 (0.07, 0.14)). The incremental cost of healthcare service use in population with CVD was an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. CONCLUSION We identified substantially increased use of healthcare services attributable to CVD in Ireland. Continued efforts aimed at CVD primary prevention and management are required.
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Affiliation(s)
- Danko Stamenic
- School of Public Health, University College Cork, Cork, Ireland
| | - Anthony P Fitzgerald
- School of Public Health, University College Cork, Cork, Ireland
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - Katarzyna A Gajewska
- School of Public Health, University College Cork, Cork, Ireland
- Diabetes Ireland, Dublin, Ireland
| | - Kate N O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Margaret Bermingham
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Jodi Cronin
- Centre for Policy Studies, Cork University Business School, Cork, Ireland
| | - Brenda M Lynch
- Centre for Policy Studies, Cork University Business School, Cork, Ireland
| | - Sarah M O'Brien
- Office of the National Clinical Advisor and Programme Group Lead for Chronic Disease, Clinical Design & Innovation, Office of the Chief Clinical Officer, HSE South, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork, Ireland
- National Office of Public Health, HSE, Ireland
| | - Paul M Kavanagh
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Public Health and Epidemiology, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Ireland
- National Office of Public Health, HSE, Ireland
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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O Driscoll DJ, Kiely E, O'Keeffe LM, Khashan AS. Household energy poverty and trajectories of emotional and behavioural difficulties in children and adolescents: findings from two prospective cohort studies. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02616-2. [PMID: 38342824 DOI: 10.1007/s00127-024-02616-2] [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: 10/29/2022] [Accepted: 01/01/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE The aim of this study is to examine the association between household energy poverty (EP) and trajectories of emotional and behavioural difficulties during childhood. METHODS The Growing up in Ireland study is two nationally representative prospective cohorts of children. The Infant Cohort (n = 11,134) were recruited at age 9 months (9 m) and followed up at 3, 5, 7 and 9 years (y). The Child Cohort (n = 8,538) were recruited at age 9 y and followed up at 13 y and 17/18 y. EP was a composite of two relative measures of EP. Emotional and behavioural difficulties were repeatedly measured using the strengths and difficulties questionnaire (SDQ). Linear spline multilevel models were used, adjusted for confounders to examine the association between (1) EP (9 m or 3 y) and trajectories of emotional and behavioural difficulties from 3 to 9 y in the Infant Cohort and (2) EP at 9 y and the same trajectories from 9 to 18 y in the Child Cohort. RESULTS In adjusted analyses, EP at 9 m or 3 y of age was associated with higher total difficulties score at 3 y (0.66, 95% CI 0.41, 0.91) and 5 y (0.77, 95% CI 0.48, 1.05) but not at 7 y or 9 y. EP at 9 y was associated with higher total difficulties score at 9 y (1.73, 95% CI 1.28, 2.18), with this difference reducing over time leading to 0.68 (95% CI 0.19, 1.17) at 17/18 y. CONCLUSIONS Our study demonstrates a potential association between early life EP and emotional and behavioural difficulties that may be transient and attenuate over time during childhood. Further studies are required to replicate these findings and to better understand if these associations are causal.
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Affiliation(s)
- David J O Driscoll
- School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland.
| | - Elizabeth Kiely
- School of Applied Social Studies, William Thompson House, Donovan's Road, Cork, Ireland
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ali S Khashan
- School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
- INFANT Research Centre, Cork University Hospital, University College Cork, Cork, Ireland
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Rooney DJ, Conway M, O'Keeffe LM, McDonnell CM, Bartels HC, Yelverton C, Segurado R, Mehegan J, McAuliffe FM. Dietary intakes of iron, folate, and vitamin B12 during pregnancy and correlation with maternal hemoglobin and fetal growth: findings from the ROLO longitudinal birth cohort study. Arch Gynecol Obstet 2024; 309:183-193. [PMID: 36708424 PMCID: PMC10770189 DOI: 10.1007/s00404-023-06916-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE Dietary micronutrient intakes of iron, folate and vitamin B12 are known to influence hemoglobin. Low maternal hemoglobin (maternal anemia) has been linked to low birthweight and other adverse health outcomes in the fetus and infant. Our primary aim was to explore relationships between maternal dietary micronutrient intakes, maternal full blood count (FBC) parameters and fetal abdominal circumference (AC) and estimated fetal weight (EFW) growth trajectories. Secondarily, we aimed to assess relationships between maternal dietary micronutrient intakes, maternal hemoglobin values and placental weight and birthweight. METHODS Mother-child pairs (n = 759) recruited for the ROLO study were included in this analysis. Maternal dietary micronutrient intakes were calculated from food diaries completed during each trimester of pregnancy. FBC samples were collected at 13- and 28-weeks' gestation. Fetal ultrasound measurements were recorded at 20- and 34-weeks' gestation. Growth trajectories for AC and EFW were estimated using latent class trajectory mixture models. RESULTS Dietary intakes of iron and folate were deficient for all trimesters. Mean maternal hemoglobin levels were replete at 13- and 28-weeks' gestation. Dietary iron, folate and vitamin B12 intakes showed no associations with fetal growth trajectories, placental weight or birthweight. Lower maternal hemoglobin concentrations at 28 weeks' gestation were associated with faster rates of fetal growth and larger placental weights and birthweights. CONCLUSION The negative association between maternal hemoglobin at 28 weeks' gestation and accelerated fetal and placental growth may be due to greater consumption of maternal iron and hemoglobin by fetuses' on faster growth trajectories in addition to placental biochemical responses to lower oxygen states.
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Affiliation(s)
- David J Rooney
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Marie Conway
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | | | - Ciara M McDonnell
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- Paediatric Endocrinology and Diabetes, Children's Health Ireland, Children's University Hospital, Dublin, Ireland
| | - Helena C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cara Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ricardo Segurado
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - John Mehegan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Yelverton CA, O'Keeffe LM, Bartels HC, McDonnell C, Geraghty AA, O'Brien EC, Killeen SL, Twomey P, Kilbane M, Crowley RK, McKenna M, McAuliffe FM. Association between maternal blood lipids during pregnancy and offspring growth trajectories in a predominantly macrosomic cohort: findings from the ROLO longitudinal birth cohort study. Eur J Pediatr 2023; 182:5625-5635. [PMID: 37819419 DOI: 10.1007/s00431-023-05251-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
The purpose of this study is to examine associations between maternal lipid profiles in pregnancy and offspring growth trajectories in a largely macrosomic cohort. This is a secondary analysis of the ROLO birth cohort (n = 293), which took place in the National Maternity Hospital, Dublin, Ireland. Infants were mostly macrosomic, with 55% having a birthweight > 4 kg. Maternal mean age was 32.4 years (SD 3.9 years), mean BMI was 26.1 kg/m2 (SD 4.4 kg/m2) and 48% of children born were males. Total cholesterol, high density lipoprotein cholesterol (HDL-cholesterol), low density lipoprotein cholesterol (LDL-cholesterol) and triglycerides were measured from fasting blood samples of mothers at 14 and 28 week gestation. The change in maternal lipid levels from early to late pregnancy was also examined. Offspring abdominal circumference and weight were measured at 20- and 34-week gestation, birth, 6 months, 2 years and 5 years postnatal. Linear spline multilevel models examined associations between maternal blood lipid profiles and offspring growth. We found some weak, significant associations between maternal blood lipids and trajectories of offspring growth. Significant findings were close to the null, providing limited evidence. For instance, 1 mmol/L increase in maternal triglycerides was associated with faster infant weight growth from 20- to 34-week gestation (0.01 kg/week, 95% CI - 0.02, - 0.001) and slower abdominal circumference from 2 to 5 years (0.01 cm/week, 95% CI - 0.02, - 0.001). These findings do not provide evidence of a clinically meaningful effect. Conclusion: These findings raise questions about the efficacy of interventions targeting maternal blood lipid profiles in pregnancies at risk of macrosomia. New studies on this topic are needed. What is Known: • Maternal fat accumulation during early pregnancy may potentially support fetal growth in the third trimester by providing a reserve of lipids that are broken down and transferred to the infant across the placental barrier. • There are limited studies exploring the impact of maternal lipid profiles on infant and child health using growth trajectories spanning prenatal to postnatal life. What is New: • Maternal blood lipid profiles were not associated with offspring growth trajectories of weight and abdominal circumference during pregnancy up to 5 years of age in a largely macrosomic cohort, as significant findings were close to the null, providing limited evidence for a clinically meaningful relationship. • Strengths of this work include the use of infant growth trajectories that span prenatal to postnatal life and inclusion of analyses of the change of maternal lipid levels from early to late pregnancy and their associations with offspring growth trajectories from 20-week gestation to 5 years of age.
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Affiliation(s)
- C A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - L M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - H C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland, Temple Street Hospital, Dublin, Ireland
| | - A A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - E C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - S L Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - P Twomey
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - M Kilbane
- Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland
| | - R K Crowley
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - M McKenna
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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O'Neill KN, Bell JA, Smith GD, Fraser A, Howe LD, Kearney PM, Robinson O, Tilling K, Willeit P, O'Keeffe LM. Childhood socioeconomic position and sex-specific trajectories of metabolic traits across early life: prospective cohort study. EBioMedicine 2023; 98:104884. [PMID: 37989036 PMCID: PMC10700592 DOI: 10.1016/j.ebiom.2023.104884] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Socioeconomic inequalities in cardiovascular disease risk begin early in life and are more pronounced in females than males later in life. Causal atherogenic traits explaining this are not well understood. We explored sex-specific associations between childhood socioeconomic position (SEP) and molecular measures of systemic metabolism across early life. METHODS Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in southwest England. Pregnant women with an expected delivery date between 1991 and 1992 were invited to participate. Maternal education was the primary indicator of SEP. Concentrations of 148 metabolic traits from targeted metabolomics (nuclear magnetic resonance spectroscopy) from research clinics at ages 7, 15, 18 and 25 years were analysed. The sex-specific slope index of inequality (SII) in trajectories of metabolic traits was estimated using multilevel models. FINDINGS Total number of participants included was 6537 (12,543 repeated measures). Lower maternal education was associated with more adverse levels of several atherogenic lipids and key metabolic traits among females at age 7 years, but not males. For instance, SII for very small very-low-density lipoprotein (VLDL) concentrations was 0.16SD (95% CI: 0.01, 0.30) among females and -0.02SD (95% CI: -0.16, 0.13) among males. Between 7 and 25 years, inequalities widened among females and emerged among males particularly for VLDL particle concentrations, apolipoprotein-B concentrations, and inflammatory glycoprotein acetyls. For instance, at 25 years, SII for very small VLDL concentrations was 0.36SD (95% CI: 0.20, 0.52) and 0.22SD (95% CI: 0.04, 0.40) among females and males respectively. INTERPRETATION Prevention of socioeconomic inequalities in cardiovascular disease risk requires a life course approach beginning at the earliest opportunity, especially among females. FUNDING The UK Medical Research Council and Wellcome (grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). KON is supported by a Health Research Board (HRB) of Ireland Investigator Led Award (ILP-PHR-2022-008). JB, GDS and KT work in a unit funded by the UK MRC (MC_UU_00011/1 and MC UU 00011/3) and the University of Bristol. OR is supported by a UKRI Future Leaders Fellowship (MR/S03532X/1). These funding sources had no role in the design and conduct of this study. This publication is the work of the authors and KON will serve as guarantor for the contents of this paper.
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Affiliation(s)
- Kate N O'Neill
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Patricia M Kearney
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Oliver Robinson
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Peter Willeit
- Clinical Epidemiology Team, Medical University of Innsbruck, Austria; Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Linda M O'Keeffe
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland; MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
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O'Keeffe LM, Tilling K, Bell JA, Walsh PT, Lee MA, Lawlor DA, Davey Smith G, Kearney PM. Sex-specific trajectories of molecular cardiometabolic traits from childhood to young adulthood. Heart 2023; 109:674-685. [PMID: 36914250 PMCID: PMC10176380 DOI: 10.1136/heartjnl-2022-321347] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The changes which typically occur in molecular causal risk factors and predictive biomarkers for cardiometabolic diseases across early life are not well characterised. METHODS We quantified sex-specific trajectories of 148 metabolic trait concentrations including various lipoprotein subclasses from age 7 years to 25 years. Data were from 7065 to 7626 offspring (11 702 to14 797 repeated measures) of the Avon Longitudinal Study of Parents and Children birth cohort study. Outcomes were quantified using nuclear magnetic resonance spectroscopy at 7, 15, 18 and 25 years. Sex-specific trajectories of each trait were modelled using linear spline multilevel models. RESULTS Females had higher very-low-density lipoprotein (VLDL) particle concentrations at 7 years. VLDL particle concentrations decreased from 7 years to 25 years with larger decreases in females, leading to lower VLDL particle concentrations at 25 years in females. For example, females had a 0.25 SD (95% CI 0.20 to 0.31) higher small VLDL particle concentration at 7 years; mean levels decreased by 0.06 SDs (95% CI -0.01 to 0.13) in males and 0.85 SDs (95% CI 0.79 to 0.90) in females from 7 years to 25 years, leading to 0.42 SDs (95% CI 0.35 to 0.48) lower small VLDL particle concentrations in females at 25 years. Females had lower high-density lipoprotein (HDL) particle concentrations at 7 years. HDL particle concentrations increased from 7 years to 25 years with larger increases among females leading to higher HDL particle concentrations in females at 25 years. CONCLUSION Childhood and adolescence are important periods for the emergence of sex differences in atherogenic lipids and predictive biomarkers for cardiometabolic disease, mostly to the detriment of males.
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Affiliation(s)
- Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Patrick T Walsh
- School of Public Health, University College Cork, Cork, Ireland
| | - Matthew A Lee
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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O'Keeffe LM, Yelverton CA, Bartels HC, O'Neill KN, McDonnell C, McAuliffe FM. Application of multilevel linear spline models for analysis of growth trajectories in a cohort with repeat antenatal and postnatal measures of growth: a prospective cohort study. BMJ Open 2023; 13:e065701. [PMID: 36972957 PMCID: PMC10069489 DOI: 10.1136/bmjopen-2022-065701] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To model trajectories of antenatal and postnatal growth using linear spline multilevel models. DESIGN Prospective cohort study. SETTING Maternity hospital in Dublin, Ireland. PARTICIPANTS 720-759 mother-child pairs from the ROLO study (initially a randomised control trial of a low glycaemic index diet in pregnancy to prevent recurrence of macrosomia [birth weight >4 kg]). PRIMARY OUTCOMES Trajectories of growth from 20 weeks gestation (abdominal circumference [AC], head circumference [HC] and weight) or birth (length/height) to 5 years. RESULTS Over 50% of women had third-level education and 90% were of white ethnicity. Women were a mean (SD) age of 32 years (4.2) at recruitment. The best fitting model for AC, HC and weight included a model with 5 linear spline periods. The best fitting models for length/height included a model with 3 linear spline periods from birth to 6 months, 6 months to 2 years and 2 years to 5 years. Comparison of observed and predicted values for each model demonstrated good model fit. For all growth measures, growth rates were generally fastest in pregnancy or immediately post partum (for length/height), with rates of growth slowing after birth and becoming slower still as infancy and childhood progressed. CONCLUSION We demonstrate the application of multilevel linear spline models for examining growth trajectories when both antenatal and postnatal measures of growth are available. The approach may be useful for cohort studies or randomised control trials with repeat prospective assessments of growth.
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Affiliation(s)
- Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- MRC Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | - Cara A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Helena C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | - Kate N O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Ciara McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland at Temple Street, Dublin, Ireland
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
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9
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Bartels HC, O'Keeffe LM, Yelverton CA, O'Neill KN, Geraghty AA, O'Brien EC, Killeen SL, McDonnell C, McAuliffe FM. Associations between maternal metabolic parameters during pregnancy and fetal and child growth trajectories from 20 weeks' gestation to 5 years of age: Secondary analysis from the ROLO longitudinal birth cohort study. Pediatr Obes 2023; 18:e12976. [PMID: 36102219 PMCID: PMC10078394 DOI: 10.1111/ijpo.12976] [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: 05/14/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the association between maternal metabolic parameters in pregnancy and growth trajectories up to 5 years of age. METHODS Data from mother-child pairs who participated in the ROLO study, a randomized trial examining the impact of a low glycaemic index diet on the recurrence of macrosomia, were analysed. Fetal and child growth trajectories were developed from longitudinal measurements from 20 weeks gestation up to 5 years of age. We examined associations between maternal fasting glucose, insulin, HOMA-IR and leptin, taken in early pregnancy (14-16 weeks) and late pregnancy (28 weeks), and weight (kg) and abdominal circumference (cm) trajectories using linear spline multilevel models. RESULTS We found no strong evidence of associations between any maternal metabolic parameters and fetal to childhood weight and abdominal circumference trajectories from 20 weeks gestation to 5 years. CONCLUSION In a cohort of women with obesity with infants at risk of macrosomia, maternal metabolic markers were not strongly associated with trajectories of weight or abdominal circumference from 20 weeks gestation to 5 years of age.
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Affiliation(s)
- Helena C Bartels
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland.,MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cara A Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Kate N O'Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Ciara McDonnell
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,Department of Pediatric Endocrinology & Diabetes, Children's Health Ireland, Temple Street Hospital, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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10
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Bell JA, Richardson TG, Wang Q, Sanderson E, Palmer T, Walker V, O'Keeffe LM, Timpson NJ, Cichonska A, Julkunen H, Würtz P, Holmes MV, Davey Smith G. Effects of general and central adiposity on circulating lipoprotein, lipid, and metabolite levels in UK Biobank: A multivariable Mendelian randomization study. Lancet Reg Health Eur 2022; 21:100457. [PMID: 35832062 PMCID: PMC9272390 DOI: 10.1016/j.lanepe.2022.100457] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Background The direct effects of general adiposity (body mass index (BMI)) and central adiposity (waist-to-hip-ratio (WHR)) on circulating lipoproteins, lipids, and metabolites are unknown. Methods We used new metabolic data from UK Biobank (N=109,532, a five-fold higher N over previous studies). EDTA-plasma was used to quantify 249 traits with nuclear-magnetic-resonance spectroscopy including subclass-specific lipoprotein concentrations and lipid content, plus pre-glycemic and inflammatory metabolites. We used univariable and multivariable two-stage least-squares regression models with genetic risk scores for BMI and WHR as instruments to estimate total (unadjusted) and direct (mutually-adjusted) effects of BMI and WHR on metabolic traits; plus effects on statin use and interaction by sex, statin use, and age (proxy for medication use). Findings Higher BMI decreased apolipoprotein B and low-density lipoprotein cholesterol (LDL-C) before and after WHR-adjustment, whilst BMI increased triglycerides only before WHR-adjustment. These effects of WHR were larger and BMI-independent. Direct effects differed markedly by sex, e.g., triglycerides increased only with BMI among men, and only with WHR among women. Adiposity measures increased statin use and showed metabolic effects which differed by statin use and age. Among the youngest (38-53y, statins-5%), BMI and WHR (per-SD) increased LDL-C (total effects: 0.04-SD, 95%CI=-0.01,0.08 and 0.10-SD, 95%CI=0.02,0.17 respectively), but only WHR directly. Among the oldest (63-73y, statins-29%), BMI and WHR directly lowered LDL-C (-0.19-SD, 95%CI=-0.27,-0.11 and -0.05-SD, 95%CI=-0.16,0.06 respectively). Interpretation Excess adiposity likely raises atherogenic lipid and metabolite levels exclusively via adiposity stored centrally, particularly among women. Apparent effects of adiposity on lowering LDL-C are likely explained by an effect of adiposity on statin use. Funding UK Medical Research Council; British Heart Foundation; Novo Nordisk; National Institute for Health Research; Wellcome Trust; Cancer Research UK.
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Affiliation(s)
- Joshua A. Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom G. Richardson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford, UK
| | - Qin Wang
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eleanor Sanderson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom Palmer
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Venexia Walker
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Linda M. O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Public Health, Western Gateway Building, University College Cork, Ireland
| | - Nicholas J. Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - Michael V. Holmes
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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11
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O'Neill KN, Bell JA, Davey Smith G, Tilling K, Kearney PM, O'Keeffe LM. Puberty Timing and Sex-Specific Trajectories of Systolic Blood Pressure: a Prospective Cohort Study. Hypertension 2022; 79:1755-1764. [PMID: 35587023 PMCID: PMC9278704 DOI: 10.1161/hypertensionaha.121.18531] [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] [Indexed: 12/03/2022]
Abstract
BACKGROUND Sex differences in systolic blood pressure (SBP) emerge during adolescence but the role of puberty is not well understood. We examined sex-specific changes in SBP preceding and following puberty and examined the impact of puberty timing on SBP trajectories in females and males. METHODS Trajectories of SBP before and after puberty and by timing of puberty in females and males in a contemporary birth cohort study were analyzed. Repeated measures of height from age 5 to 20 years were used to identify puberty timing (age at peak height velocity). SBP was measured on ten occasions from 3 to 24 years (N participants, 4062; repeated SBP measures, 29 172). Analyses were performed using linear spline multilevel models based on time before and after puberty and were adjusted for parental factors and early childhood factors. RESULTS Mean age at peak height velocity was 11.7 years (SD, 0.8) for females and 13.6 years (SD, 0.9) for males. Males had faster rates of increase in SBP before puberty leading to 10.19 mm Hg (95% CI, 6.80-13.57) higher mean SBP at puberty which remained similar at 24 years (mean difference, 11.43 mm Hg [95% CI, 7.22-15.63]). Puberty timing was associated with small transient differences in SBP trajectories postpuberty in both sexes and small differences at 24 years in females only. CONCLUSIONS A large proportion of the higher SBP observed in males compared with females in early adulthood is accrued before puberty. Interventions targeting puberty timing are unlikely to influence SBP in early adulthood.
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Affiliation(s)
- Kate N O'Neill
- School of Public Health, University College Cork, Ireland (K.N.O.N., P.M.K., L.M.O.K.)
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
| | - Patricia M Kearney
- School of Public Health, University College Cork, Ireland (K.N.O.N., P.M.K., L.M.O.K.)
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Ireland (K.N.O.N., P.M.K., L.M.O.K.).,MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.).,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (J.A.B., G.D.S., K.T., L.M.O.K.)
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12
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Delahunt A, Conway MC, O'Brien EC, Geraghty AA, O'Keeffe LM, O'Reilly SL, McDonnell CM, Kearney PM, Mehegan J, McAuliffe FM. Ecological factors and childhood eating behaviours at 5 years of age: findings from the ROLO longitudinal birth cohort study. BMC Pediatr 2022; 22:366. [PMID: 35754036 PMCID: PMC9235107 DOI: 10.1186/s12887-022-03423-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Individual differences in children eating behaviours have been linked with childhood overweight and obesity. The determinants of childhood eating behaviours are influenced by a complex combination of hereditary and ecological factors. This study examines if key ecological predictors of childhood overweight; maternal socio-economic status (SES), children’s screen time, and childcare arrangements, are associated with eating behaviours in children aged 5-years-old. Methods This is secondary, cross-sectional analysis of the ROLO (Randomized COntrol Trial of LOw glycemic diet in pregnancy) study, using data from the 5-year follow-up (n = 306). Weight, height, and body mass index (BMI) were obtained from mothers and children at the 5-year follow-up. Children’s BMI z-scores were calculated. SES was determined using maternal education level and neighborhood deprivation score. Information on children’s screen time and childcare arrangements were collected using lifestyle questionnaires. Children’s eating behaviours were measured using the Children’s Eating Behaviour Questionnaire (CEBQ). Multiple linear regression, adjusted for potential confounders, assessed associations between maternal SES, screen time and children’s eating behaviours. One-way ANOVA, independent sample t-tests and Spearman’s correlation examined childcare exposure and children’s eating behaviour. Results Mothers in the lowest SES group had higher BMI and were younger than those in the highest SES group (p = < 0.001, p = 0.03 respectively). In adjusted analysis, the lowest SES group was associated with a 0.463-point higher mean score for ‘Desire to Drink’ (95% CI = 0.054,0.870, p = 0.027) and higher ‘Slowness to Eat’ (B = 0.388, 95% CI = 0.044,0.733, p = 0.027) when compared with the highest SES group. Screen time (hours) was associated with higher ‘Food Fussiness’ (B = 0.032, 95% CI = 0.014,0.051, p = 0.001). Those who attended childcare had higher scores for ‘Desire to Drink’(p = 0.046). No relationship was observed between longer duration (years) spent in childcare and eating behaviours. Conclusions In this cohort, the ecological factors examined had an influence on children’s eating behaviours aged 5-years-old. Our results illustrate the complexity of the relationship between the child’s environment, eating behaviour and children’s body composition. Being aware of the ecological factors that impact the development of eating behaviours, in the pre-school years is vital to promote optimal childhood appetitive traits, thus reducing the risk of issues with excess adiposity long-term. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03423-x.
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Affiliation(s)
- Anna Delahunt
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
| | - Marie C Conway
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen C O'Brien
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Linda M O'Keeffe
- School of Public Health, College of Medicine and Health, University College Cork, Co Cork, Ireland
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Ciara M McDonnell
- Department of Paediatric Endocrinology and Diabetes, Children's Health Ireland Temple St and Tallaght, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, College of Medicine and Health, University College Cork, Co Cork, Ireland
| | - John Mehegan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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13
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Tschiderer L, Seekircher L, Kunutsor SK, Peters SAE, O'Keeffe LM, Willeit P. Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta-Analysis Involving Data From 8 Studies and 1 192 700 Parous Women. J Am Heart Assoc 2022; 11:e022746. [PMID: 35014854 PMCID: PMC9238515 DOI: 10.1161/jaha.121.022746] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Breastfeeding has been robustly linked to reduced maternal risk of breast cancer, ovarian cancer, and type 2 diabetes. We herein systematically reviewed the published evidence on the association of breastfeeding with maternal risk of cardiovascular disease (CVD) outcomes. Methods and Results Our systematic search of PubMed and Web of Science of articles published up to April 16, 2021, identified 8 relevant prospective studies involving 1 192 700 parous women (weighted mean age: 51.3 years at study entry, 24.6 years at first birth; weighted mean number of births: 2.3). A total of 982 566 women (82%) reported having ever breastfed (weighted mean lifetime duration of breastfeeding: 15.6 months). During a weighted median follow‐up of 10.3 years, 54 226 CVD, 26 913 coronary heart disease, 30 843 stroke, and 10 766 fatal CVD events were recorded. In a random‐effects meta‐analysis, the pooled multivariable‐adjusted hazard ratios comparing parous women who ever breastfed to those who never breastfed were 0.89 for CVD (95% CI, 0.83–0.95; I2=79.4%), 0.86 for coronary heart disease (95% CI, 0.78–0.95; I2=79.7%), 0.88 for stroke (95% CI, 0.79–0.99; I2=79.6%), and 0.83 for fatal CVD (95% CI, 0.76–0.92; I2=47.7%). The quality of the evidence assessed with the Grading of Recommendations Assessment, Development, and Evaluation tool ranged from very low to moderate, which was mainly driven by high between‐studies heterogeneity. Strengths of associations did not differ by mean age at study entry, median follow‐up duration, mean parity, level of adjustment, study quality, or geographical region. A progressive risk reduction of all CVD outcomes with lifetime durations of breastfeeding from 0 up to 12 months was found, with some uncertainty about shapes of associations for longer durations. Conclusions Breastfeeding was associated with reduced maternal risk of CVD outcomes.
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Affiliation(s)
- Lena Tschiderer
- Clinical Epidemiology Team Medical University of Innsbruck Innsbruck Austria
| | - Lisa Seekircher
- Clinical Epidemiology Team Medical University of Innsbruck Innsbruck Austria
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research CentreUniversity Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol Bristol United Kingdom.,Translational Health SciencesBristol Medical SchoolUniversity of BristolLearning & Research Building (Level 1)Southmead Hospital Bristol United Kingdom
| | - Sanne A E Peters
- The George Institute for Global HealthSchool of Public HealthImperial College London London United Kingdom.,Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands.,The George Institute for Global HealthUniversity of New South Wales Sydney New South Wales Australia
| | - Linda M O'Keeffe
- School of Public Health, Western Gateway Building University College Cork Cork Ireland.,MRC Integrative Epidemiology Unit University of Bristol United Kingdom.,Population Health Sciences Bristol Medical School University of Bristol United Kingdom
| | - Peter Willeit
- Clinical Epidemiology Team Medical University of Innsbruck Innsbruck Austria.,Department of Public Health and Primary Care University of Cambridge United Kingdom
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14
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Matvienko-Sikar K, O' Neill K, Fraser A, Hayes C, Howe L, Huizink AC, Kearney PM, Khashan A, Redsell SA, O'Keeffe LM. Maternal prenatal anxiety and depression and trajectories of cardiometabolic risk factors across childhood and adolescence: a prospective cohort study. BMJ Open 2021; 11:e051681. [PMID: 34911713 PMCID: PMC8679111 DOI: 10.1136/bmjopen-2021-051681] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Quantifying long-term offspring cardiometabolic health risks associated with maternal prenatal anxiety and depression can guide cardiometabolic risk prevention. This study examines associations between maternal prenatal anxiety and depression, and offspring cardiometabolic risk from birth to 18 years. DESIGN This study uses data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. PARTICIPANTS Participants were 526-8606 mother-offspring pairs from the ALSPAC cohort. SETTING British birth cohort set, Bristol, UK. PRIMARY AND SECONDARY OUTCOMES Exposures were anxiety (Crown-Crisp Inventory score) and depression (Edinburgh Postnatal Depression Scale score) measured at 18 and 32 weeks gestation. Outcomes were trajectories of offspring body mass index; fat mass; lean mass; pulse rate; glucose, diastolic and systolic blood pressure (SBP); triglycerides, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and insulin from birth/early childhood to 18 years. Exposures were analysed categorically using clinically relevant, cut-offs and continuously to examine associations across the distribution of prenatal anxiety and depression. RESULTS We found no strong evidence of associations between maternal anxiety and depression and offspring trajectories of cardiometabolic risk factors. Depression at 18 weeks was associated with higher SBP at age 18 (1.62 mm Hg (95% CI 0.17 to 3.07). Anxiety at 18 weeks was also associated with higher diastolic blood pressure at 7 years in unadjusted analyses (0.70 mm Hg (95% CI 0.02 to 1.38)); this difference persisted at age 18 years (difference at 18 years; 0.89 mm Hg (95% CI 0.05 to 1.73). No associations were observed for body mass index; fat mass; lean mass; pulse rate; glucose; triglycerides, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and insulin. CONCLUSIONS This is the first examination of maternal prenatal anxiety and depression and trajectories of offspring cardiometabolic risk. Our findings suggest that prevention of maternal prenatal anxiety and depression may have limited impact on offspring cardiometabolic health across the first two decades of life.
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Affiliation(s)
| | - Kate O' Neill
- School of Public Health, University College Cork, Cork, Ireland
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Laura Howe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | | | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT) Centre, Cork University Maternity Hospital, Cork, Ireland
| | - Sarah A Redsell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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15
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Maher GM, Ryan L, McCarthy FP, Hughes A, Park C, Fraser A, Howe LD, Kearney PM, O'Keeffe LM. Puberty timing and markers of cardiovascular structure and function at 25 years: a prospective cohort study. BMC Med 2021; 19:78. [PMID: 33761960 PMCID: PMC7992788 DOI: 10.1186/s12916-021-01949-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether earlier onset of puberty is associated with higher cardiovascular risk in early adulthood is not well understood. Our objective was to examine the association between puberty timing and markers of cardiovascular structure and function at age 25 years. METHODS We conducted a prospective birth cohort study using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants were born between April 1, 1991, and December 31, 1992. Exposure of interest was age at peak height velocity (aPHV), an objective and validated growth-based measure of puberty onset. Outcome measures included cardiovascular structure and function at age 25 years: carotid intima-media thickness (CIMT), left ventricular mass index (LVMI) and relative wall thickness (RWT), pulse wave velocity (PWV) and systolic blood pressure (SBP). Multiple imputation was used to impute missing data on covariates and outcomes. Linear regression was used to examine the association between aPHV and each measure of cardiac structure and function, adjusting for maternal age, gestational age, household social class, maternal education, mother's partner's education, breastfeeding, parity, birthweight, maternal body mass index, maternal marital status, maternal prenatal smoking status and height and fat mass at age 9. All analyses were stratified by sex. RESULTS A total of 2752-4571 participants were included in the imputed analyses. A 1-year older aPHV was not strongly associated with markers of cardiac structure and function in males and females at 25 years and most results spanned the null value. In adjusted analyses, a 1-year older aPHV was associated with 0.003 mm (95% confidence interval (CI) 0.00001, 0.006) and 0.0008 mm (95% CI - 0.002, 0.003) higher CIMT; 0.02 m/s (95% CI - 0.05, 0.09) and 0.02 m/s (95% CI - 0.04, 0.09) higher PWV; and 0.003 mmHg (95% CI - 0.60, 0.60) and 0.13 mmHg (95% CI - 0.44, 0.70) higher SBP, among males and females, respectively. A 1-year older aPHV was associated with - 0.55 g/m2.7 (95% CI - 0.03, - 1.08) and - 0.89 g/m2.7 (95% CI - 0.45, - 1.34) lower LVMI and - 0.001 (95% CI - 0.006, 0.002) and - 0.002 (95% CI - 0.006, 0.002) lower RWT among males and females. CONCLUSIONS Earlier puberty is unlikely to have a major impact on pre-clinical cardiovascular risk in early adulthood.
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Affiliation(s)
- Gillian M Maher
- INFANT Research Centre, University College Cork, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
| | - Lisa Ryan
- School of Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Alun Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Chloe Park
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Laura D Howe
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | | | - Linda M O'Keeffe
- School of Public Health, University College Cork, Cork, Ireland
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
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16
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Bell JA, Santos Ferreira DL, Fraser A, Soares ALG, Howe LD, Lawlor DA, Carslake D, Davey Smith G, O'Keeffe LM. Sex differences in systemic metabolites at four life stages: cohort study with repeated metabolomics. BMC Med 2021; 19:58. [PMID: 33622307 PMCID: PMC7903597 DOI: 10.1186/s12916-021-01929-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Males experience higher rates of coronary heart disease (CHD) than females, but the circulating traits underpinning this difference are poorly understood. We examined sex differences in systemic metabolites measured at four life stages, spanning childhood to middle adulthood. METHODS Data were from the Avon Longitudinal Study of Parents and Children (7727 offspring, 49% male; and 6500 parents, 29% male). Proton nuclear magnetic resonance (1H-NMR) spectroscopy from a targeted metabolomics platform was performed on EDTA-plasma or serum samples to quantify 229 systemic metabolites (including lipoprotein-subclass-specific lipids, pre-glycaemic factors, and inflammatory glycoprotein acetyls). Metabolites were measured in the same offspring once in childhood (mean age 8 years), twice in adolescence (16 years and 18 years) and once in early adulthood (25 years), and in their parents once in middle adulthood (50 years). Linear regression models estimated differences in metabolites for males versus females on each occasion (serial cross-sectional associations). RESULTS At 8 years, total lipids in very-low-density lipoproteins (VLDL) were lower in males; levels were higher in males at 16 years and higher still by 18 years and 50 years (among parents) for medium-or-larger subclasses. Larger sex differences at older ages were most pronounced for VLDL triglycerides-males had 0.19 standard deviations (SD) (95% CI = 0.12, 0.26) higher at 18 years, 0.50 SD (95% CI = 0.42, 0.57) higher at 25 years, and 0.62 SD (95% CI = 0.55, 0.68) higher at 50 years. Low-density lipoprotein (LDL) cholesterol, apolipoprotein-B, and glycoprotein acetyls were generally lower in males across ages. The direction and magnitude of effects were largely unchanged when adjusting for body mass index measured at the time of metabolite assessment on each occasion. CONCLUSIONS Our results suggest that males begin to have higher VLDL triglyceride levels in adolescence, with larger sex differences at older ages. Sex differences in other CHD-relevant metabolites, including LDL cholesterol, show the opposite pattern with age, with higher levels among females. Such life course trends may inform causal analyses with clinical endpoints in specifying traits which underpin higher age-adjusted CHD rates commonly seen among males.
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Affiliation(s)
- Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Diana L Santos Ferreira
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Luiza G Soares
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - David Carslake
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
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17
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Peters TM, Holmes MV, Richards JB, Palmer T, Forgetta V, Lindgren CM, Asselbergs FW, Nelson CP, Samani NJ, McCarthy MI, Mahajan A, Davey Smith G, Woodward M, O'Keeffe LM, Peters SAE. Sex Differences in the Risk of Coronary Heart Disease Associated With Type 2 Diabetes: A Mendelian Randomization Analysis. Diabetes Care 2021; 44:556-562. [PMID: 33277303 PMCID: PMC7818328 DOI: 10.2337/dc20-1137] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Observational studies have demonstrated that type 2 diabetes is a stronger risk factor for coronary heart disease (CHD) in women compared with men. However, it is not clear whether this reflects a sex differential in the causal effect of diabetes on CHD risk or results from sex-specific residual confounding. RESEARCH DESIGN AND METHODS Using 270 single nucleotide polymorphisms (SNPs) for type 2 diabetes identified in a type 2 diabetes genome-wide association study, we performed a sex-stratified Mendelian randomization (MR) study of type 2 diabetes and CHD using individual participant data in UK Biobank (251,420 women and 212,049 men). Weighted median, MR-Egger, MR-pleiotropy residual sum and outlier, and radial MR from summary-level analyses were used for pleiotropy assessment. RESULTS MR analyses showed that genetic risk of type 2 diabetes increased the odds of CHD for women (odds ratio 1.13 [95% CI 1.08-1.18] per 1-log unit increase in odds of type 2 diabetes) and men (1.21 [1.17-1.26] per 1-log unit increase in odds of type 2 diabetes). Sensitivity analyses showed some evidence of directional pleiotropy; however, results were similar after correction for outlier SNPs. CONCLUSIONS This MR analysis supports a causal effect of genetic liability to type 2 diabetes on risk of CHD that is not stronger for women than men. Assuming a lack of bias, these findings suggest that the prevention and management of type 2 diabetes for CHD risk reduction is of equal priority in both sexes.
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Affiliation(s)
- Tricia M Peters
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada .,Division of Endocrinology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, U.K.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, U.K.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K
| | - J Brent Richards
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.,Division of Endocrinology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tom Palmer
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Vincenzo Forgetta
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Cecilia M Lindgren
- Big Data Institute, Li Ka Shing Center for Health Information and Discovery, Oxford University, Oxford, U.K.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, U.K.,Program in Medical and Population Genetics, Broad Institute, Boston, MA
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, U.K.,Health Data Research UK and Institute of Health Informatics, University College London, London, U.K
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K.,National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K.,National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, U.K
| | - Mark I McCarthy
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, U.K.,Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill Hospital, University of Oxford, Oxford, U.K.,Oxford National Institute for Health Research Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, U.K
| | - Anubha Mahajan
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, U.K.,Oxford Centre for Diabetes, Endocrinology, and Metabolism, Churchill Hospital, University of Oxford, Oxford, U.K
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K.,School of Social and Community Medicine, University of Bristol, Bristol, U.K
| | - Mark Woodward
- George Institute for Global Health, University of Oxford, Oxford, U.K.,George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Linda M O'Keeffe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, U.K.,School of Public Health, University College Cork, Cork, Ireland
| | - Sanne A E Peters
- George Institute for Global Health, University of Oxford, Oxford, U.K.,George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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18
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Murphy M, McHugh S, O'Keeffe LM, Greene RA, Corcoran P, Kearney PM. Preventive health counselling during antenatal care using the pregnancy risk assessment monitoring system (PRAMS) in Ireland. BMC Pregnancy Childbirth 2020; 20:98. [PMID: 32046675 PMCID: PMC7014605 DOI: 10.1186/s12884-020-2756-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/21/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Maternal behaviours during pregnancy have short- and long-term consequences for maternal and infant health. Pregnancy is an ideal opportunity to encourage positive behaviour change. Despite this, limited information exists about the nature and content of lifestyle advice provided by healthcare professionals during antenatal care. Pregnancy Risk Assessment Monitoring System (PRAMS) Ireland is based on the Centers for Disease Control and Prevention (CDC) developed PRAMS that monitors maternal behaviours and experiences before, during and after pregnancy. The aim of the study was to assess the prevalence of preventive health counselling during pregnancy. METHODS Secondary data analysis of the PRAMS Ireland study. Using hospital discharge records, a sampling frame of 2424 mother-infant pairs was used to alternately sample 1212 women whom had recently given birth. Preventive health counselling was defined as advice during antenatal care on smoking, alcohol, infant feeding and weight gain. Self-reported maternal behaviours (smoking/alcohol cessation, gestational weight gain, infant feeding). Univariate and multivariable analyses were conducted, adjusting for maternal characteristics. RESULTS Among 718 women (61% response rate), the reported counselling rates were 84.8% for breastfeeding (n = 592), 48.4% for alcohol (n = 338), 47.6% for smoking (n = 333) and 31.5% for weight gain (n = 218). Women who smoked pre-pregnancy (23.7%, n = 170) were more likely to receive counselling on its effects compared to non-smokers (Adjusted Odds Ratio (AOR) 2.72 (95% Confidence Interval (CI), 1.84-4.02)). In contrast, women who did not breastfeed (AOR 0.74, 95%CI 0.44-1.26) and those who reported alcohol consumption pre-pregnancy (AOR 0.94, 95%CI 0.64-1.37) were not more likely to receive counselling on these topics. CONCLUSION Pregnancy is an ideal opportunity to encourage positive behaviour change. Preventive health counselling during pregnancy is not routinely provided and rates vary widely depending on the health behaviour. This study suggests that additional strategies are needed to promote positive behaviour before and during the unique opportunity provided by pregnancy.
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Affiliation(s)
- Marion Murphy
- School of Medicine, University College Cork, Cork, Ireland
| | - Sheena McHugh
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Linda M O'Keeffe
- Bristol Medical School, Oakfield House, MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Richard A Greene
- School of Medicine, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Cork, Ireland.
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19
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Bright HD, Howe LD, Khouja JN, Simpkin AJ, Suderman M, O'Keeffe LM. Epigenetic gestational age and trajectories of weight and height during childhood: a prospective cohort study. Clin Epigenetics 2019; 11:194. [PMID: 31842976 PMCID: PMC6916215 DOI: 10.1186/s13148-019-0761-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 05/18/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
Background Differences between an individual’s estimated epigenetic gestational age (EGA) and their actual gestational age (GA) are defined as gestational age acceleration (GAA). GAA is associated with increased birthweight and birth length. Whether these associations persist through childhood is yet to be investigated. Methods We examined the association between GAA and trajectories of height and weight from birth to 10 years (n = 785) in a British birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). EGA of participants was estimated using DNA methylation data from cord blood using a recently developed prediction model. GAA of participants, measured in weeks, was calculated as the residuals from a regression model of EGA on actual GA. Analyses were performed using linear spline multilevel models and adjusted for maternal age, maternal pre-pregnancy BMI, maternal smoking during pregnancy, and maternal education. Results In adjusted analyses, offspring with a one-week greater GAA were born on average 0.14 kg heavier (95% confidence interval (CI) 0.09, 0.19) and 0.55 cm taller (95% CI 0.33, 0.78) at birth. These differences in weight persisted up to approximately age 9 months but thereafter began to attenuate. From age 5 years onwards, the association between GAA and weight reversed such that GAA was associated with lower weight and this association strengthened with age (mean difference at age 10 years − 0.60 kg, 95% CI − 1.19, − 0.01). Differences in height persisted only up to age 9 months (mean difference at 9 months 0.15 cm, 95% CI − 0.09, 0.39). From age 9 months to age 10 years, offspring with a one-week greater GAA were of comparable height with those with no GAA (mean difference at age 10 years − 0.07 cm, 95% CI − 0.64, 0.50). Conclusions Gestational age acceleration is associated with increased birth weight and length and these differences persist to age 9 months. From age 5 years onwards, the association of GAA and weight reverses such that by age 10 years, greater GAA is associated with lower childhood weight. Further work is required to examine whether the weight effects of GAA strengthen through adolescence and into early adulthood.
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Affiliation(s)
- Harold D Bright
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Jasmine N Khouja
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,School of Psychological Science at the University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, University Road, Galway, H91 TK33, Ireland
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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20
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Abstract
Correlations of body composition with height vary by age and sex during childhood. Standard approaches to accounting for height in measures of body composition (dividing by height (in meters)2) do not take this into account. Using measures of total body mass (TBM), fat mass (FM) and fat free mass (FFM) at ages nine, 11, 13, 15 and 18 years from a longitudinal UK cohort study (ALSPAC), we calculated indices of body composition at each age by dividing measures by height (in meters)2. We then produced age-and sex-specific powers of height using allometric regressions and calculated body composition indices by dividing measures by height raised to these powers. TBM, FM and FFM divided by height2 were correlated with height up-to age 11 in females. In males, TBM and FM divided by height2 were correlated with height up-to age 15 years while FM divided by height2 was correlated with height up-to age 11 years. Indices of body composition using age-and sex-specific powers were not correlated with height at any age. In early life, age-and sex-specific powers of height, rather than height in meters2, should be used to adjust body composition for height when measures of adiposity/mass independent of height are required.
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21
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O'Keeffe LM, Simpkin AJ, Tilling K, Anderson EL, Hughes AD, Lawlor DA, Fraser A, Howe LD. Data on trajectories of measures of cardiovascular health in the Avon Longitudinal Study of Parents and Children (ALSPAC). Data Brief 2019; 23:103687. [PMID: 30847378 PMCID: PMC6389726 DOI: 10.1016/j.dib.2019.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/09/2019] [Accepted: 01/18/2019] [Indexed: 01/06/2023] Open
Abstract
Cardiometabolic disease risk begins in early life and tracks through the life course. As described in "Sex-specific trajectories of measures of cardiovascular health during childhood and adolescence: a prospective cohort study" (O'Keeffe et al., 2018), we modelled sex-specific change in 11 key measures of cardiovascular health from birth/early childhood to age 18 years in a British birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). In this article, we describe the data used in these analyses. Risk factors measured included BMI, fat and lean mass, blood pressure and blood-based biomarkers. Data are from several sources including cord blood at birth, clinic assessments, routine health records, questionnaires and nuclear magnetic resonance spectroscopy. Outcomes were measured over varying time spans from birth or mid-childhood to age 18 and with different numbers of repeated measures per outcome. Analyses were performed using fractional polynomial and linear spline multilevel models. Further information can be found in O'Keeffe et al. (2018).
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Affiliation(s)
- Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
| | - Andrew J Simpkin
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
| | - Emma L Anderson
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
| | - Alun D Hughes
- Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, UK
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland, UK
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22
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Bell JA, Carslake D, O'Keeffe LM, Frysz M, Howe LD, Hamer M, Wade KH, Timpson NJ, Davey Smith G. Associations of Body Mass and Fat Indexes With Cardiometabolic Traits. J Am Coll Cardiol 2018; 72:3142-3154. [PMID: 30545453 PMCID: PMC6290112 DOI: 10.1016/j.jacc.2018.09.066] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/15/2018] [Accepted: 09/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Body mass index (BMI) is criticized for not distinguishing fat from lean mass and ignoring fat distribution, leaving its ability to detect health effects unclear. OBJECTIVES The aim of this study was to compare BMI with total and regional fat indexes from dual-energy x-ray absorptiometry in their associations with cardiometabolic traits. Duration of exposure to and change in each index across adolescence were examined in relation to detailed traits in young adulthood. METHODS BMI was examined alongside total, trunk, arm, and leg fat indexes (each in kilograms per square meter) from dual-energy x-ray absorptiometry at ages 10 and 18 years in relation to 230 traits from targeted metabolomics at age 18 years in 2,840 offspring from the Avon Longitudinal Study of Parents and Children. RESULTS Higher total fat mass index and BMI at age 10 years were similarly associated with cardiometabolic traits at age 18 years, including higher systolic and diastolic blood pressure, higher very low-density lipoprotein and low-density lipoprotein cholesterol, lower high-density lipoprotein cholesterol, higher triglycerides, and higher insulin and glycoprotein acetyls. Associations were stronger for both indexes measured at age 18 years and for gains in each index from age 10 to 18 years (e.g., 0.45 SDs [95% confidence interval: 0.38 to 0.53] in glycoprotein acetyls per SD unit gain in fat mass index vs. 0.38 SDs [95% confidence interval: 0.27 to 0.48] per SD unit gain in BMI). Associations resembled those for trunk fat index. Higher lean mass index was weakly associated with traits and was not protective against higher fat mass index. CONCLUSIONS The results of this study support abdominal fatness as a primary driver of cardiometabolic dysfunction and BMI as a useful tool for detecting its effects.
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Affiliation(s)
- Joshua A Bell
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - David Carslake
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Monika Frysz
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Mark Hamer
- School of Sport, Exercise & Health Sciences, Loughborough University, Leicestershire, United Kingdom
| | - Kaitlin H Wade
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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23
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O'Keeffe LM, Simpkin AJ, Tilling K, Anderson EL, Hughes AD, Lawlor DA, Fraser A, Howe LD. Sex-specific trajectories of measures of cardiovascular health during childhood and adolescence: A prospective cohort study. Atherosclerosis 2018; 278:190-196. [PMID: 30296724 DOI: 10.1016/j.atherosclerosis.2018.09.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Sex differences in measures of cardiovascular health in adults are well documented. However, the sex-specific aetiology of cardiovascular health across childhood and adolescence is poorly understood. METHODS We examined sex differences in trajectories of 11 measures of cardiovascular health from birth to 18 years, in a contemporary birth cohort study in England (N participants per outcomes: 662-13,985, N repeated measures per outcome: 1,831-112,768). Outcomes were measured over varying time spans from birth or mid-childhood to age 18 and with different numbers of repeated measures per outcome. Analyses were performed using fractional polynomial and linear spline multilevel models. RESULTS Females had higher mean BMI, height-adjusted fat mass, pulse rate, insulin, triglycerides, and non-high-density lipoprotein cholesterol (HDL-c) and lower mean height-adjusted lean mass from birth or from mid-childhood to age 18. For example, mean non-HDL-c was 0.07 mmol/l (95% confidence interval (CI), 0.04, 0.10) higher in females compared with males at birth. By age 18, this difference persisted and widened to 0.19 mmol/l (95% CI, 0.16, 0.23) higher non-HDL-c in females compared with males. Females had lower levels of glucose from mid-childhood and developed lower systolic blood pressure and higher HDL-c from mid-adolescence onward. For example, females had 0.08 mmol/l (95% CI, 0.05, 0.10) lower mean glucose compared with males at age seven which widened to a difference of 0.22 mmol/l (95% CI, 0.25, 0.19) at age 18. CONCLUSIONS Sex differences in measures of cardiovascular health are apparent from birth or mid-childhood and change during early life. These differences may have implications for sex-specific disease risk in future adult populations.
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Affiliation(s)
- Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK.
| | - Andrew J Simpkin
- Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Emma L Anderson
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Alun D Hughes
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK; MRC Unit for Lifelong Health and Ageing at University College London, London, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
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O'Keeffe LM, Taylor G, Huxley RR, Mitchell P, Woodward M, Peters SAE. Smoking as a risk factor for lung cancer in women and men: a systematic review and meta-analysis. BMJ Open 2018; 8:e021611. [PMID: 30287668 PMCID: PMC6194454 DOI: 10.1136/bmjopen-2018-021611] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/13/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To investigate the sex-specific association between smoking and lung cancer. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed and EMBASE from 1 January 1999 to 15 April 2016 for cohort studies. Cohort studies before 1 January 1999 were retrieved from a previous meta-analysis. Individual participant data from three sources were also available to supplement analyses of published literature. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Cohort studies reporting the sex-specific relative risk (RR) of lung cancer associated with smoking. RESULTS Data from 29 studies representing 99 cohort studies, 7 million individuals and >50 000 incident lung cancer cases were included. The sex-specific RRs and their ratio comparing women with men were pooled using random-effects meta-analysis with inverse-variance weighting. The pooled multiple-adjusted lung cancer RR was 6.99 (95% Confidence Interval (CI) 5.09 to 9.59) in women and 7.33 (95% CI 4.90 to 10.96) in men. The pooled ratio of the RRs was 0.92 (95% CI 0.72 to 1.16; I2=89%; p<0.001), with no evidence of publication bias or differences across major pre-defined participant and study subtypes. The women-to-men ratio of RRs was 0.99 (95% CI 0.65 to 1.52), 1.11 (95% CI 0.75 to 1.64) and 0.94 (95% CI 0.69 to 1.30), for light, moderate and heavy smoking, respectively. CONCLUSIONS Smoking yields similar risks of lung cancer in women compared with men. However, these data may underestimate the true risks of lung cancer among women, as the smoking epidemic has not yet reached full maturity in women. Continued efforts to measure the sex-specific association of smoking and lung cancer are required.
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Affiliation(s)
- Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma Taylor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel R Huxley
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Health and Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, John Hopkins University, Baltimore, Maryland, USA
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
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Chowdhury R, Ramond A, O'Keeffe LM, Shahzad S, Kunutsor SK, Muka T, Gregson J, Willeit P, Warnakula S, Khan H, Chowdhury S, Gobin R, Franco OH, Di Angelantonio E. Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2018; 362:k3310. [PMID: 30158148 PMCID: PMC6113772 DOI: 10.1136/bmj.k3310] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of epidemiological studies investigating the association of arsenic, lead, cadmium, mercury, and copper with cardiovascular disease. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, and Web of Science searched up to December 2017. REVIEW METHODS Studies reporting risk estimates for total cardiovascular disease, coronary heart disease, and stroke for levels of arsenic, lead, cadmium, mercury, or copper were included. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks were standardised to a common scale and pooled across studies for each marker using random effects meta-analyses. RESULTS The review identified 37 unique studies comprising 348 259 non-overlapping participants, with 13 033 coronary heart disease, 4205 stroke, and 15 274 cardiovascular disease outcomes in aggregate. Comparing top versus bottom thirds of baseline levels, pooled relative risks for arsenic and lead were 1.30 (95% confidence interval 1.04 to 1.63) and 1.43 (1.16 to 1.76) for cardiovascular disease, 1.23 (1.04 to 1.45) and 1.85 (1.27 to 2.69) for coronary heart disease, and 1.15 (0.92 to 1.43) and 1.63 (1.14 to 2.34) for stroke. Relative risks for cadmium and copper were 1.33 (1.09 to 1.64) and 1.81 (1.05 to 3.11) for cardiovascular disease, 1.29 (0.98 to 1.71) and 2.22 (1.31 to 3.74) for coronary heart disease, and 1.72 (1.29 to 2.28) and 1.29 (0.77 to 2.17) for stroke. Mercury had no distinctive association with cardiovascular outcomes. There was a linear dose-response relation for arsenic, lead, and cadmium with cardiovascular disease outcomes. CONCLUSION Exposure to arsenic, lead, cadmium, and copper is associated with an increased risk of cardiovascular disease and coronary heart disease. Mercury is not associated with cardiovascular risk. These findings reinforce the importance of environmental toxic metals in cardiovascular risk, beyond the roles of conventional behavioural risk factors.
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Affiliation(s)
- Rajiv Chowdhury
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Anna Ramond
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Linda M O'Keeffe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Population Health Science Institute, Bristol Medical School, Bristol, UK
| | - Sara Shahzad
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Taulant Muka
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Susmita Chowdhury
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Oscar H Franco
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
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26
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O'Keeffe LM, Ramond A, Di Angelantonio E. Mid- and Long-Term Health Risks in Living Kidney Donors. Ann Intern Med 2018; 169:265-266. [PMID: 30128524 DOI: 10.7326/l18-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Anna Ramond
- University of Cambridge and National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom (A.R.)
| | - Emanuele Di Angelantonio
- University of Cambridge, National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, and National Health Service Blood and Transplant, Cambridge, United Kingdom (E.D.)
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Khouja JN, Simpkin AJ, O'Keeffe LM, Wade KH, Houtepen LC, Relton CL, Suderman M, Howe LD. Epigenetic gestational age acceleration: a prospective cohort study investigating associations with familial, sociodemographic and birth characteristics. Clin Epigenetics 2018; 10:86. [PMID: 29983833 PMCID: PMC6020346 DOI: 10.1186/s13148-018-0520-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 01/18/2018] [Accepted: 06/14/2018] [Indexed: 11/20/2022] Open
Abstract
Background Gestational age at delivery is associated with health and social outcomes. Recently, cord blood DNA methylation data has been used to predict gestational age. The discrepancy between gestational age predicted from DNA methylation and determined by ultrasound or last menstrual period is known as gestational age acceleration. This study investigated associations of sex, socioeconomic status, parental behaviours and characteristics and birth outcomes with gestational age acceleration. Results Using data from the Avon Longitudinal Study of Parents and Children (n = 863), we found that pre-pregnancy maternal overweight and obesity were associated with greater gestational age acceleration (mean difference = 1.6 days, 95% CI 0.7 to 2.6, and 2.9 days, 95% CI 1.3 to 4.4, respectively, compared with a body mass index < 25 kg/m2, p < .001). There was evidence of an association between male sex and greater gestational age acceleration. Greater gestational age acceleration was associated with higher birthweight, birth length and head circumference of the child (mean differences per week higher gestational age acceleration: birthweight 0.1 kg, 95% CI 0.1 to 0.2, p < .001; birth length 0.4 cm, 95% CI 0.2 to 0.7, p < .001; head circumference 0.2 cm, 95% CI 0.1 to − 0.4, p < .001). There was evidence of an association between gestational age acceleration and mode of delivery (assisted versus unassisted delivery, odds ratio = 0.9 per week higher gestational age acceleration, 95% CI 0.7, 1.3 (p = .05); caesarean section versus unassisted delivery, odds ratio = 0.6, 95% CI 0.4 to 0.9 per week higher gestational age acceleration (p = .05)). There was no evidence of association for other parental and perinatal characteristics. Conclusions The associations of higher maternal body mass index and larger birth size with greater gestational age acceleration may imply that maternal overweight and obesity is associated with more rapid development of the fetus in utero. The implications of gestational age acceleration for postnatal health warrant further investigation. Electronic supplementary material The online version of this article (10.1186/s13148-018-0520-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasmine N Khouja
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.,3School of Experimental Psychology at the University of Bristol, Bristol, England
| | - Andrew J Simpkin
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Linda M O'Keeffe
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Kaitlin H Wade
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Lotte C Houtepen
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Caroline L Relton
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Matthew Suderman
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
| | - Laura D Howe
- 1MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, England.,2Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England
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O'Keeffe LM, Howe LD, Fraser A, Hughes AD, Wade KH, Anderson EL, Lawlor DA, Erzurumluoglu AM, Davey-Smith G, Rodriguez S, Stergiakouli E. Associations of Y chromosomal haplogroups with cardiometabolic risk factors and subclinical vascular measures in males during childhood and adolescence. Atherosclerosis 2018; 274:94-103. [PMID: 29753233 PMCID: PMC6013646 DOI: 10.1016/j.atherosclerosis.2018.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/11/2018] [Accepted: 04/24/2018] [Indexed: 12/12/2022]
Abstract
Background and aims Males have greater cardiometabolic risk than females, though the reasons for this are poorly understood. The aim of this study was to examine the association between common Y chromosomal haplogroups and cardiometabolic risk during early life. Methods In a British birth cohort, we examined the association of Y chromosomal haplogroups with trajectories of cardiometabolic risk factors from birth to 18 years and with carotid-femoral pulse wave velocity, carotid intima media thickness and left ventricular mass index at age 18. Haplogroups were grouped according to their phylogenetic relatedness into categories of R, I, E, J, G and all other haplogroups combined (T, Q, H, L, C, N and O). Risk factors included BMI, fat and lean mass, systolic blood pressure (SBP), diastolic blood pressure, pulse rate, triglycerides, high density lipoprotein cholesterol (HDL-c), non-HDL-c and c-reactive protein. Analyses were performed using multilevel models and linear regression, as appropriate. Results Y chromosomal haplogroups were not associated with any cardiometabolic risk factors from birth to 18 years. For example, at age 18, the difference in SBP comparing each haplogroup with haplogroup R was −0.39 mmHg (95% Confidence Interval (CI): −0.75, 1.54) for haplogroup I, 2.56 mmHg (95% CI: −0.76, 5.89) for haplogroup E, −0.02 mmHg (95% CI: −2.87, 2.83) for haplogroup J, 1.28 mmHg (95% CI: −4.70, 2.13) for haplogroup G and −2.75 mmHg (95% CI: −6.38, 0.88) for all other haplogroups combined. Conclusions Common Y chromosomal haplogroups are not associated with cardiometabolic risk factors during childhood and adolescence or with subclinical cardiovascular measures at age 18. Common Y chromosomal haplogroups are not associated with cardiometabolic risk factors from birth to age 18. Common Y chromosomal haplogroups are not associated with cardiovascular structure and function at age 18. Common Y chromosomal haplogroups are not associated with cardiometabolic risk in males during early life.
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Affiliation(s)
- Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK.
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Alun D Hughes
- MRC Unit of Lifelong Health & Aging at UCL, Institute of Cardiovascular Science, University College London, London, WC1E6BT, UK
| | - Kaitlin H Wade
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Emma L Anderson
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - A Mesut Erzurumluoglu
- Genetic Epidemiology Group, Department of Health Sciences, Centre for Medicine, University Road, University of Leicester, LE1 7RH, UK
| | - George Davey-Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Santiago Rodriguez
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; Population Health Sciences, Bristol Medical School, Oakfield House, Oakfield Grove, Bristol, BS82BN, UK; School of Oral and Dental Sciences, University of Bristol, UK
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O'Keeffe LM, Ramond A, Oliver-Williams C, Willeit P, Paige E, Trotter P, Evans J, Wadström J, Nicholson M, Collett D, Di Angelantonio E. Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis. Ann Intern Med 2018; 168:276-284. [PMID: 29379948 DOI: 10.7326/m17-1235] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Long-term health risks for adults who donate kidneys are unclear. PURPOSE To summarize evidence about mid- and long-term health risks associated with living kidney donation in adults. DATA SOURCES PubMed, Embase, Scopus, and PsycINFO without language restriction from April 1964 to July 2017. STUDY SELECTION Observational studies with at least 1 year of follow-up that compared health outcomes in adult living kidney donors versus nondonor populations. DATA EXTRACTION Two investigators independently extracted study data and assessed study quality. DATA SYNTHESIS 52 studies, comprising 118 426 living kidney donors and 117 656 nondonors, were included. Average follow-up was 1 to 24 years. No evidence suggested higher risk for all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, or adverse psychosocial health outcomes in living kidney donors than in nondonor populations. Donors had higher diastolic blood pressure, lower estimated glomerular filtration rates, and higher risk for end-stage renal disease (ESRD) (relative risk [RR], 8.83 [95% CI, 1.02 to 20.93]) and preeclampsia in female donors (RR, 2.12 [CI, 1.06 to 4.27]). Despite the increased RR, donors had low absolute risk for ESRD (incidence rate, 0.5 event [CI, 0.1 to 4.9 events] per 1000 person-years) and preeclampsia (incidence rate, 5.9 events [CI, 2.9 to 8.9 events] per 100 pregnancies). LIMITATION Generalizability was limited by selected control populations, few studies reported pregnancy-related outcomes, and few studies were from low- and middle-income countries. CONCLUSION Although living kidney donation is associated with higher RRs for ESRD and preeclampsia, the absolute risk for these outcomes remains low. Compared with nondonor populations, living kidney donors have no increased risk for other major chronic diseases, such as type 2 diabetes, or for adverse psychosocial outcomes. PRIMARY FUNDING SOURCE National Health Service Blood and Transplant and National Institute for Health Research. (PROSPERO: CRD42017072284).
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Affiliation(s)
| | - Anna Ramond
- University of Cambridge and National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom (A.R.)
| | | | - Peter Willeit
- University of Cambridge, Cambridge, United Kingdom, and Medical University of Innsbruck, Innsbruck, Austria (P.W.)
| | - Ellie Paige
- University of Cambridge, Cambridge, United Kingdom, and Australian National University, Canberra, Australia (E.P.)
| | - Patrick Trotter
- National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation and University of Cambridge, Cambridge, United Kingdom (P.T., M.N.)
| | - Jonathan Evans
- University of Cambridge, Cambridge, United Kingdom (C.O., J.E.)
| | - Jonas Wadström
- Karolinska University Hospital, Stockholm, Sweden (J.W.)
| | - Michael Nicholson
- National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation and University of Cambridge, Cambridge, United Kingdom (P.T., M.N.)
| | - Dave Collett
- National Health Service Blood and Transplant, Bristol, United Kingdom (D.C.)
| | - Emanuele Di Angelantonio
- University of Cambridge, National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, and National Health Service Blood and Transplant, Cambridge, United Kingdom (E.D.)
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Abstract
OBJECTIVES To examine the prevalence of positive lifestyle behaviours before and during pregnancy in Ireland. DESIGN Cross-sectional study. SETTING Population-based study in Ireland. PARTICIPANTS A total of 718 women of predominantly Caucasian origin from the Pregnancy Risk Assessment Monitoring System (PRAMS), Ireland, were included. PRIMARY AND SECONDARY OUTCOME MEASURES Positive lifestyle behaviour changes before and during pregnancy in Ireland on alcohol consumption, smoking, folate use and nutrition. RESULTS Of 1212 women surveyed, 718 (59%) responded. 26% were adherent to all three recommendations on alcohol consumption, smoking and folate use before pregnancy. This increased to 39% for the same three behaviours during pregnancy, with greater increases in adherence observed among women with the lowest adherence before pregnancy. Age, education and ethnicity gaps in adherence before pregnancy appeared to narrow during pregnancy. Adherence to all seven food pyramid guidelines was less than 1% overall, and less than 1% of participants met all four micronutrient guidelines on vitamin D, folate, calcium and iron intake around the time of pregnancy. CONCLUSIONS Low levels of healthy lifestyle behaviours before pregnancy and low levels of positive lifestyle behaviours during pregnancy demonstrate an urgent need for increased clinical and public health efforts to target deleterious health behaviours before, during and after pregnancy.
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Affiliation(s)
- Linda M O'Keeffe
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, Bristol, UK
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Darren L Dahly
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- HRB Clinical Research Facility Cork, Mercy University Hospital, Cork, Ireland
| | - Marion Murphy
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- School of Medicine, University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Cork, Ireland
| | - Janas M Harrington
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Paul Corcoran
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
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Abstract
To describe response rates and characteristics associated with response to the Pregnancy Risk Assessment Monitoring System study in Ireland (PRAMS Ireland). Using hospital discharge records of live births at a large, urban, obstetric hospital, a sampling frame of approximately 2,400 mother-infant pairs were used to alternately sample 1,200 women. Mothers' information including name, address, parity, age and infant characteristics such as sex and gestational age at delivery were extracted from records. Modes of contact included an invitation letter with option to opt out of the study, three mail surveys, a reminder letter and text message reminder for remaining non-respondents. Sixty-one per cent of women responded to the PRAMS Ireland survey over a 133 day response period. Women aged <30, single women, multiparous women and women with a preterm delivery were less likely to respond. Women participating in PRAMS Ireland were similar to the national birth profile in 2011 which had a mean age of 32, were 40 % primiparous, 33 % single or never married and had a 28 % caesarean section rate. Survey and protocol changes are required to increase response rates above recommended Centers for Disease Control and Prevention (CDC) thresholds of 65 % within the recommended 90 day data collection cycle. Additional efforts such as stratification and over-sampling are required to increase representativeness among hard to reach groups such as younger, single and multiparous women before expanding the project to an ongoing, national surveillance system in Ireland.
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Affiliation(s)
- Linda M O'Keeffe
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland,
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O'Keeffe LM, Kearney PM, Greene RA, Zuccolo L, Tilling K, Lawlor DA, Howe LD. Maternal alcohol use during pregnancy and offspring trajectories of height and weight: A prospective cohort study. Drug Alcohol Depend 2015; 153:323-9. [PMID: 26073790 DOI: 10.1016/j.drugalcdep.2015.02.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/21/2014] [Revised: 02/06/2015] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have examined associations between alcohol use in pregnancy and offspring birth size but evidence on whether associations persist during childhood is limited. METHODS We examined the association between maternal drinking during pregnancy and trajectories of offspring weight and height from 0 to 10 years in 7597 mother-child pairs in the Avon Longitudinal Study of Parents and Children. To strengthen the inference, we compared the maternal alcohol-offspring growth association with the partner alcohol-offspring growth association, to partially control for unmeasured confounding. We also performed sensitivity analyses restricting our analysis to women of white ethnicity and participants with three or more growth measures. RESULTS Maternal occasional or light daily drinking during pregnancy was not associated with reduced birth weight, birth length or offspring growth trajectories up to age 10 years. The infants of heavy drinking mothers were born 0.78cm shorter (95% CI -1.34, -0.22) and 0.22kg lighter (95% CI -0.34, -0.09) than infants of pregnancy abstainers but by age 10, offspring of heavy drinking mothers were of comparable height (mean difference 0.59cm, 95% CI -0.93, 2.11) and weight (mean difference 0.41kg, 95% CI -0.70, 1.52). These associations were not observed for heavy partner drinking and were not altered in sensitivity analyses. CONCLUSION Maternal occasional or light daily drinking is not associated with birth weight, birth length or postnatal growth, but residual confounding may persist. Maternal heavy drinking may have an intrauterine association with reduced birth weight and length but this association is overcome during childhood.
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Affiliation(s)
- Linda M O'Keeffe
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland; Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Luisa Zuccolo
- UK Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK; School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Debbie A Lawlor
- UK Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK; School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Laura D Howe
- UK Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK; School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
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Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, Bansal N, O'Keeffe LM, Gao P, Wood AM, Burgess S, Freitag DF, Pennells L, Peters SA, Hart CL, Håheim LL, Gillum RF, Nordestgaard BG, Psaty BM, Yeap BB, Knuiman MW, Nietert PJ, Kauhanen J, Salonen JT, Kuller LH, Simons LA, van der Schouw YT, Barrett-Connor E, Selmer R, Crespo CJ, Rodriguez B, Verschuren WMM, Salomaa V, Svärdsudd K, van der Harst P, Björkelund C, Wilhelmsen L, Wallace RB, Brenner H, Amouyel P, Barr ELM, Iso H, Onat A, Trevisan M, D'Agostino RB, Cooper C, Kavousi M, Welin L, Roussel R, Hu FB, Sato S, Davidson KW, Howard BV, Leening MJG, Leening M, Rosengren A, Dörr M, Deeg DJH, Kiechl S, Stehouwer CDA, Nissinen A, Giampaoli S, Donfrancesco C, Kromhout D, Price JF, Peters A, Meade TW, Casiglia E, Lawlor DA, Gallacher J, Nagel D, Franco OH, Assmann G, Dagenais GR, Jukema JW, Sundström J, Woodward M, Brunner EJ, Khaw KT, Wareham NJ, Whitsel EA, Njølstad I, Hedblad B, Wassertheil-Smoller S, Engström G, Rosamond WD, Selvin E, Sattar N, Thompson SG, Danesh J. Association of Cardiometabolic Multimorbidity With Mortality. JAMA 2015; 314:52-60. [PMID: 26151266 PMCID: PMC4664176 DOI: 10.1001/jama.2015.7008] [Citation(s) in RCA: 521] [Impact Index Per Article: 57.9] [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] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAIN OUTCOMES AND MEASURES All-cause mortality and estimated reductions in life expectancy. RESULTS In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pei Gao
- University of Cambridge, Cambridge, England
| | | | | | | | | | - Sanne A Peters
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Bu B Yeap
- University of Western Australia, Perth
| | | | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | | | | | | | - Leon A Simons
- University of New South Wales, New South Wales, Australia
| | | | | | - Randi Selmer
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | | | | | - Cyrus Cooper
- University of Southampton, Southampton, England32University of Oxford, Oxford, England
| | | | | | - Ronan Roussel
- INSERM, Centre de Recherche des Cordeliers, Paris, France36Université Paris Diderot, Paris, France37Diabétologie, AP-HP, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France
| | - Frank B Hu
- Harvard School of Public Health, Boston, Massachusetts
| | - Shinichi Sato
- Osaka Medical Center for Health Science and Promotion/Chiba Prefectural Institute of Public Health, Suita, Japan
| | | | | | | | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Dörr
- University Medicine Greifswald, Greifswald, Germany44DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Dorly J H Deeg
- Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany52German Research Center for Cardiovascular Research (DZHK eV), Partner-Site Munich, Munich, Germany
| | - Tom W Meade
- London School of Hygiene and Tropical Medicine, London, England
| | | | | | | | | | | | - Gerd Assmann
- Assmann-Stiftung für Prävention, Munster, Germany
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec, Canada
| | | | | | | | | | | | | | - Eric A Whitsel
- Department of Medicine, University of North Carolina, Chapel Hill65Department of Epidemiology, University of North Carolina, Chapel Hill
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O'Keeffe LM, Kearney PM, McCarthy FP, Khashan AS, Greene RA, North RA, Poston L, McCowan LME, Baker PN, Dekker GA, Walker JJ, Taylor R, Kenny LC. Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies. BMJ Open 2015; 5:e006323. [PMID: 26152324 PMCID: PMC4499685 DOI: 10.1136/bmjopen-2014-006323] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the prevalence and predictors of alcohol use in multiple cohorts. DESIGN Cross-cohort comparison of retrospective and prospective studies. SETTING Population-based studies in Ireland, the UK, Australia and New Zealand. PARTICIPANTS 17,244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up in Ireland (GUI) and Pregnancy Risk Assessment Monitoring System Ireland (PRAMS Ireland)), and one multicentre prospective international cohort, Screening for Pregnancy Endpoints (SCOPE) study. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of alcohol use pre-pregnancy and during pregnancy across cohorts. Sociodemographic factors associated with alcohol consumption in each cohort. RESULTS Alcohol consumption during pregnancy in Ireland ranged from 20% in GUI to 80% in SCOPE, and from 40% to 80% in Australia, New Zealand and the UK. Levels of exposure also varied substantially among drinkers in each cohort ranging from 70% consuming more than 1-2 units/week in the first trimester in SCOPE Ireland, to 46% and 15% in the retrospective studies. Smoking during pregnancy was the most consistent predictor of gestational alcohol use in all three cohorts, and smokers were 17% more likely to drink during pregnancy in SCOPE, relative risk (RR)=1.17 (95% CI 1.12 to 1.22), 50% more likely to drink during pregnancy in GUI, RR=1.50 (95% CI 1.36 to 1.65), and 42% more likely to drink in PRAMS, RR=1.42 (95% CI 1.18 to 1.70). CONCLUSIONS Our data suggest that alcohol use during pregnancy is prevalent and socially pervasive in the UK, Ireland, New Zealand and Australia. New policy and interventions are required to reduce alcohol prevalence both prior to and during pregnancy. Further research on biological markers and conventions for measuring alcohol use in pregnancy is required to improve the validity and reliability of prevalence estimates.
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Affiliation(s)
- Linda M O'Keeffe
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- The Irish Centre for Foetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Foetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Robyn A North
- Division of Women's Health, Women's Health Academic Centre, King's College London, and King's Health Partners, London, UK
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London, and King's Health Partners, London, UK
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Philip N Baker
- National Centre for Growth & Development and Maternal and Fetal Health, Liggins Institute, University of Auckland, Auckland District Health Board and Counties Manukau District Health Board, Auckland, New Zealand
| | - Gus A Dekker
- Women's and Children's Division Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia
| | | | - Rennae Taylor
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Louise C Kenny
- The Irish Centre for Foetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
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O'Keeffe LM, Greene RA, Kearney PM. The effect of moderate gestational alcohol consumption during pregnancy on speech and language outcomes in children: a systematic review. Syst Rev 2014; 3:1. [PMID: 24383422 PMCID: PMC3892059 DOI: 10.1186/2046-4053-3-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/05/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Consensus has not been reached on safe alcohol consumption recommendations during pregnancy. The National Institutes for Care and Health Excellence (NICE) in the UK suggest that one to two drinks not more than twice per week is safe. However, the speech and language effects of even low levels of alcohol use among offspring are unknown. The aim of this study was to review systematically the evidence on studies of the effect of low to moderate levels of alcohol consumption during pregnancy (up to 70 grams of alcohol per week) compared to abstinence on speech and language outcomes in children. METHODS Using medical subject headings, PubMed, Web of knowledge, Scopus, Embase, Cinahl and the Cochrane Library were searched from their inception up to March 2012. Case control and cohort studies were included. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality. RESULTS A total of 1,397 titles and abstracts were reviewed of which 51 full texts were retrieved. Three cohort studies totaling 10,642 women met the inclusion criteria. All three studies, (United States (2) and Australia (1)) indicated that language was not impaired as a result of low to moderate alcohol consumption during pregnancy. Two studies were judged to be of low quality based on a six-item bias classification tool. Due to heterogeneity, results could not be meta-analyzed. CONCLUSION Studies included in this review do not provide sufficient evidence to confirm or refute an association between low to moderate alcohol use during pregnancy and speech and language outcomes in children. High quality, population based studies are required to establish the safety of low to moderate levels of alcohol use such as those set out by the NICE guidelines in the UK.
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Affiliation(s)
- Linda M O'Keeffe
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland.
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Southby J, O'Keeffe LM, Martin TJ, Gillespie MT. Alternative promoter usage and mRNA splicing pathways for parathyroid hormone-related protein in normal tissues and tumours. Br J Cancer 1995; 72:702-7. [PMID: 7669584 PMCID: PMC2033910 DOI: 10.1038/bjc.1995.397] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [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] [Indexed: 01/26/2023] Open
Abstract
The parathyroid hormone-related protein (PTHrP) gene consists of nine exons and allows the production of multiple PTHrP mRNA species via the use of three promoters and 5' and 3' alternative splicing; as a result of 3' alternative splicing one of three protein isoforms may be produced. This organisation has potential for tissue-specific splicing patterns. We examined PTHrP mRNA expression and splicing patterns in a series of tumours and normal tissues, using the sensitive reverse transcription-polymerase chain reaction (RT-PCR) technique. Use of promoter 3 and mRNA specifying the 141 amino acid PTHrP isoform were detected in all samples. Transcripts encoding the 139 amino acid isoform were detected in all but two samples. Use of promoters 1 and 2 was less widespread as was detection of mRNA encoding the 173 amino acid isoform. While different PTHrP splicing patterns were observed between tumours, no tissue- or tumour-specific transcripts were detected. In comparing normal and tumour tissue from the same patient, an increase in the number of promoters utilised was observed in the tumour tissue. Furthermore, mRNA for the PTH/PTHrP receptor was detected in all samples, thus the PTHrP produced by these tumours may potentially act in an autocrine or paracrine fashion.
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Affiliation(s)
- J Southby
- St. Vincent's Institute of Medical Research, St. Vincent's Hospital, Victoria, Australia
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Heath JK, Southby J, Fukumoto S, O'Keeffe LM, Martin TJ, Gillespie MT. Epidermal growth factor-stimulated parathyroid hormone-related protein expression involves increased gene transcription and mRNA stability. Biochem J 1995; 307 ( Pt 1):159-67. [PMID: 7717970 PMCID: PMC1136758 DOI: 10.1042/bj3070159] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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: 01/26/2023]
Abstract
Epidermal growth factor (EGF) produced rapid and striking effects on parathyroid hormone-related protein (PTHrP) gene expression in the immortalized human keratinocyte cell line, HaCaT. Steady-state levels of PTHrP mRNA and secreted PTHrP were increased 10-fold by maximally effective concentrations of EGF. EGF increased both PTHrP gene transcription and PTHrP mRNA stability. Nuclear run-on assays demonstrated a 4-fold increase in transcriptional rate in EGF-stimulated cells while transient transfection analysis indicated that the action of EGF on transcription involved both the GC-rich promoter, P2, and the downstream TATA promoter, P3, but apparently not the upstream TATA promoter, P1. In experiments where EGF treatment produced more stable PTHrP transcripts, the half-life of c-fos mRNA was unaltered, suggesting a relatively specific effect of EGF. Moreover, only those species of PTHrP mRNA containing two of the alternative 3' exons (exons VII and VIII) were stable, those containing exon IX were not. Reverse-transcription PCR demonstrated that EGF produced differential increases in the abundance of PTHrP mRNA species initiated by the three PTHrP promoters. The major effect was seen on the abundance of transcripts initiated by P1 and P2, with less marked regulation of P3-initiated transcripts. Thus EGF regulation of PTHrP gene expression in HaCaT cells is multifactorial and the combination of its actions at the 5' and 3' ends of the gene favours the accumulation of subpopulations of PTHrP mRNA containing exons I, VII and VIII.
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Affiliation(s)
- J K Heath
- St. Vincent's Institute of Medical Research, University of Melbourne, Victoria, Australia
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Glatz JA, Heath JK, Southby J, O'Keeffe LM, Kiriyama T, Moseley JM, Martin TJ, Gillespie MT. Dexamethasone regulation of parathyroid hormone-related protein (PTHrP) expression in a squamous cancer cell line. Mol Cell Endocrinol 1994; 101:295-306. [PMID: 9397964 DOI: 10.1016/0303-7207(94)90246-1] [Citation(s) in RCA: 32] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Dexamethasone regulation of PTHrP expression has been studied in an epidermal squamous cancer cell line COLO 16, which secretes immunoreactive PTHrP into conditioned medium. Dexamethasone was found to suppress PTHrP expression in a time- and dose-dependent manner, which was reversible upon removal of dexamethasone. The half-maximal effective concentration of dexamethasone was 1 nM and an effect of dexamethasone on PTHrP mRNA was first observed after 2 h of treatment, with maximal inhibition by 6 h. Dexamethasone action on PTHrP expression was steroid specific since progestin, 5alpha-dihydroxytestosterone and oestrogen did not regulate PTHrP expression in COLO 16 cells. The gluocorticoid/progesterone receptor antagonist RU486 inhibited the dexamethasone effect, indicating glucocorticoid receptor-mediated regulation of PTHrP expression. The half-life of PTHrP mRNA in COLO 16 cells was approximately 120 min and was not altered by treatment of cells with dexamethasone. Nuclear run-on assays revealed that dexamethasone reduced PTHrP gene transcription in COLO 16 cells. Transient transfection assays with a series of reporter gene constructs encompassing 3.5 kb of the 5' end of the PTHrP gene failed to identify a region of the gene responsible for glucocorticoid down-regulation. PCR of reverse-transcribed RNA from COLO 16 cells revealed that dexamethasone down-regulated transcripts driven from all three promoters (i.e., the TATA promoters 5' to exons I and IV and the GC-rich promoter 5' to exon III) of the human PTHrP gene.
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Affiliation(s)
- J A Glatz
- The University of Melbourne Department of Medicine, St. Vincent's Hospital and St. Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
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Sexton PM, Houssami S, Hilton JM, O'Keeffe LM, Center RJ, Gillespie MT, Darcy P, Findlay DM. Identification of brain isoforms of the rat calcitonin receptor. Mol Endocrinol 1993; 7:815-21. [PMID: 8395656 DOI: 10.1210/mend.7.6.8395656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/30/2023] Open
Abstract
Two rat calcitonin receptor isoforms have been identified by cDNA cloning from a hypothalamic library. The clones, C1a and C1b, specified proteins of 478 and 515 amino acids, respectively. The clones were identical, except that the C1b sequence encoded a 37-amino acid insert in the second extracellular domain, which conferred altered ligand recognition. Compared to the C1a receptor, expressed C1b receptors exhibited decreased affinity for porcine CT, relative to salmon CT, and negligible affinity for human CT. Clone C1b mRNA was predominately expressed in the brain, whereas mRNA for the C1a clone was present in both brain and peripheral tissues. Both receptors were able to couple functionally to adenylate cyclase. Thus, clone C1b represents a novel brain isoform of the CT receptor with different affinity for CT analogs resulting from an altered second extracellular domain.
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Affiliation(s)
- P M Sexton
- St. Vincent's Institute of Medical Research Fitzroy, Victoria, Australia
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Galanis M, Law RH, O'Keeffe LM, Devenish RJ, Nagley P. Aberrant mitochondrial processing of chimaeric import precursors containing subunits 8 and 9 of yeast mitochondrial ATP synthase. Biochem Int 1990; 22:1059-66. [PMID: 2151020] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A set of chimaeric precursors which contain the same leader sequences but different passenger proteins has been analyzed for the site of protease cleavage following import into yeast mitochondria. Each precursor comprises the leader of Neurospora crassa subunit 9 of mitochondrial ATP synthase fused to subunit 8 or 9 of the corresponding yeast enzyme. Precursors containing the first five residues of mature N. crassa subunit 9 interposed between the leader and the yeast passenger protein were cleaved at the natural site of the N. crassa subunit 9 precursor. Direct fusions without interposed sequences were cleaved at novel sites. Cleavage occurred between the 3rd and 4th residues of yeast subunit 8, but for yeast subunit 9, cleavage occurred within the leader, 8 residues upstream of the passenger protein.
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Affiliation(s)
- M Galanis
- Department of Biochemistry, Monash University, Clayton, Victoria, Australia
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