Abdominal fat and birth size in healthy prepubertal children

BACKGROUND

Studies examining the foetal origins hypothesis suggest that small birth size may be a marker of foetal adaptations that programme future propensity to adult disease. We explore the hypothesis that birth size may relate to fat distribution in childhood and that fat distribution may be a link between birth size and adult disease.

OBJECTIVE

To investigate the relationship between birth size and abdominal fat, blood pressure, lipids, insulin and insulin:glucose ratio in prepubertal children.

DESIGN

Cross-sectional study, based on a birth cohort of consecutive full-term births.

SUBJECTS

Two hundred and fifty-five (137 females) healthy, 7- and 8-y-old children.

MEASUREMENTS

Body composition and abdominal fat was measured by dual energy X-ray absorptiometry. Lipid, glucose and insulin profiles were measured after an overnight fast and an automated BP monitor was used for blood pressure measurements.

RESULTS

There was a negative association between abdominal fat and birth weight s.d. score across a range of normal birth weights (beta=-0.18; 95% CI=-0.31 to -0.04, P=0.009) and a positive association with weight s.d. score at 7/8 y (beta=0.35; 95% CI=0.24 to 0.46, P<0.001). Children who were born with the lowest weight s.d. score and had the greatest weight s.d. score at 7/8 y had significantly more (P<0.001) abdominal fat, as a percentage of total fat (6.53+/-1.3%) than those who had the highest birth weight s.d. score and the lowest weight s.d. score at 7/8 y (4.14+/-0.5%). Similar results were seen if head circumference, but not ponderal index, was used as an indicator of birth size. Increased abdominal fat was associated with higher total cholesterol:HDL cholesterol, higher triglyceride concentration and increased diastolic blood pressure.

CONCLUSIONS

Birth weight independently predicted abdominal fat. Children with the highest amount of abdominal fat were those who tended to be born lighter and gained weight centiles. Increased abdominal fat was associated with precursor risk factors for ischaemic heart disease.

Identification of rat brainstem multisynaptic connections to the oral motor nuclei using pseudorabies virus. I. Masticatory muscle motor systems

Oromotor behavior results from the complex interaction between jaw, facial, and lingual muscles. The experiments in this and subsequent papers identify the sources of multisynaptic input to the trigeminal, facial, and hypoglossal motor nuclei. In the current experiments, pseudorabies virus (PRV-Ba) was injected into the jaw-opening (anterior digastric and mylohyoid) and jaw-closing muscles (masseter, medial pterygoid, and temporalis) in bilaterally sympathectomized rats. Injection volumes ranged from 2 to 21 microl with average titers of 2.8 x 10(8) pfu/ml and maximum survival times of 96 h. The labeling patterns and distributions were consistent between each of the individual muscles and muscle groups. A predictable myotopic labeling pattern was produced in the trigeminal motor nucleus (Mo 5). Transneuronally labeled neurons occurred in regions known to project directly to Mo 5 motoneurons including the principal trigeminal sensory and supratrigeminal areas, Kölliker-Fuse region, nucleus subcoeruleus, and the parvicellular reticular formation. Maximum survival times revealed polysynaptic connections from the periaqueductal gray, laterodorsal and pedunculopontine tegmental areas, and the substantia nigra in the midbrain, ventromedial pontine reticular regions including the gigantocellular region and pars alpha and ventralis in the pons and medulla, and the nucleus of the solitary tract, paratrigeminal region, and paramedian field in the medulla. Thus, the results define the structure of the multisynaptic brainstem neural circuits controlling mandibular movement in the rat.

Identification of rat brainstem multisynaptic connections to the oral motor nuclei in the rat using pseudorabies virus. II. Facial muscle motor systems

The present experiments continue our investigations of the higher order afferent systems controlling the orofacial musculature. Pseudorabies virus (PRV) was injected into the buccinator, platysma, posterior digastric, and zygomatic muscles in bilaterally sympathectomized rats. Injection volumes ranged from 6 to 12 microl with average titers of 7 x 10(8) pfu/ml and maximum survival times of 96 h. The labeling patterns and distributions were similar across the individual muscles and between muscle groups (perioral vs. posterior digastric), as well as in comparison to the results from previous masticatory muscle injections. Injections produced a predictable myotopic labeling pattern in the facial motor nucleus (Mo 7) and transneuronally in regions known to project directly to Mo 7 including the red nucleus, ventrolateral parabrachial region, principal trigeminal sensory nucleus, supratrigeminal area, and the parvicellular reticular formation. Maximum survival times revealed more distant connections from a variety of nuclear zones including the periaqueductal gray, laterodorsal and pedunculopontine tegmental areas, and the substantia nigra in the midbrain, ventromedial reticular regions including the gigantocellular region and pars alpha and ventralis in the pons and medulla, and the nucleus of the solitary tract, spinal trigeminal nucleus caudalis, paratrigeminal region, and paramedian field in the medulla. The similarity of the labeling patterns and distributions of the higher order afferents resulting from PRV facial and masticatory muscle injections identifies the neural circuits that may coordinate the activity of these muscle groups during oral motor behavior.

Identification of rat brainstem multisynaptic connections to the oral motor nuclei using pseudorabies virus. III. Lingual muscle motor systems

The present experiments complete our investigations of higher order afferent control of the orofacial muscles by examining the premotor systems controlling the lingual musculature. Pseudorabies virus (PRV) was injected into the extrinsic (protruders: genioglossus and geniohyoid; retractors: hyoglossus and styloglossus) and intrinsic tongue muscles in bilaterally sympathectomized rats. Injection volumes ranged from 1 to 12 microl with average titers of 4 x 10(8) pfu/ml and maximum survival times of 90 h. Consistent labeling patterns and distributions occurred across each of the individual muscles and between extrinsic and intrinsic muscle groups, as well as in comparison to the results from the previous masticatory and facial muscle experiments. Virus injections produced a predictable myotopic labeling pattern in the hypoglossal nucleus (Mo 12). Transneuronally labeled neurons occurred in regions known to project directly to Mo 12 motoneurons including the nucleus subcoeruleus, trigeminal sensory areas, parvicellular reticular formation, and the dorsal medullary reticular fields. Maximum survival times revealed more distant connections from medial and lateral reticular zones including the periaqueductal gray, dorsal raphe, laterodorsal and pedunculopontine tegmental areas, and substantia nigra in the midbrain, the gigantocellular region, pontine nucleus caudalis and ventralis, and lateral paragigantocellular region in the pons, and the nucleus of the solitary tract, paratrigeminal region, and paramedian field in the medulla. Thus, injections of PRV into the orofacial muscles revealed a complex, but remarkably uniform network of multisynaptic connections in the brainstem that control and coordinate the activity of the masticatory, facial, and lingual muscles.

Determining consumer preferences for a cash option: Arkansas survey results

As long-term care (LTC) expenditures have risen, policymakers have sought ways to control costs while maintaining consumer satisfaction. Concurrently, there is increasing interest within the aging and disability communities in consumer-directed care. The Cash and Counseling Demonstration and Evaluation (CCDE) seeks to increase consumer direction and control costs by offering a cash allowance and information services to persons with disabilities, enabling them to purchase needed assistance. The authors present results from a telephone survey conducted to assess consumer preferences for a cash option in Arkansas and describe how findings from the four-State CCDE can inform consumer information efforts and policymakers.

A randomized controlled trial of aspirin in patients with abnormal uterine artery blood flow

OBJECTIVE

To evaluate color Doppler imaging of the uterine arteries as a screening test in nulliparous women, and to examine the role of low-dose aspirin therapy in pregnancies with abnormal uteroplacental resistance.

METHODS

At the routine 18-week fetal morphology ultrasound scan, 955 nulliparous women underwent color Doppler imaging of the uterine arteries. Abnormal uteroplacental vascular resistance was defined with respect to both the systolic-diastolic ratio of the flow velocity waveform and the presence of an ipsilateral early diastolic notch. Those with abnormal uterine artery waveforms were asked to participate in a randomized controlled trial of aspirin therapy. Pregnancy outcomes were compared in women with normal or abnormal flow velocity waveforms, as well as in the two arms of the intervention study.

RESULTS

Of 186 women with abnormal uteroplacental resistance according to criteria defined previously, 102 agreed to randomization to either low-dose aspirin (100 mg/day) or placebo for the remainder of the pregnancy. Abnormal uterine artery flow velocity waveforms were associated with statistically significant increases in preeclampsia (11 versus 4%), birth weight below the tenth percentile (28 versus 11%), and adverse pregnancy outcome (45 versus 28%). Prophylactic aspirin therapy did not result in a significant reduction in pregnancy complications.

CONCLUSION

Abnormal uteroplacental resistance at 18 weeks' gestation was associated with a significant increase in adverse pregnancy outcome. Low-dose aspirin did not reduce pregnancy complications in women with uteroplacental insufficiency.

Computer analysis of the early diastolic notch in Doppler sonograms of the uterine arteries

This article describes a set of processing and analysis techniques for automated identification and quantification of the early diastolic notch (EDN), a feature of Doppler sonograms from the uterine arteries which has been associated with adverse pregnancy outcomes such as preeclampsia and intrauterine growth retardation. Examples covering different sonogram types are provided to illustrate the effectiveness and reproducibility of the processing/analysis tools. Also, a receiver-operating characteristic-based evaluation of the EDN quantification and pulsatility indexes is presented, which examines the ability to predict hypertension and/or intrauterine growth retardation, using a set of uterine Doppler sonograms from 92 patients acquired at 18 weeks of gestation. In summary, the ROC results confirm the link between the EDN and abnormal pregnancy outcomes, and suggest that EDN quantification has a higher diagnostic accuracy than the pulsatility index, which characterises the flow waveform in a global manner and therefore does not take explicitly into account the localised nature of the EDN. Quantification of the EDN at 18 weeks of gestation appears to best predict the most severely abnormal pregnancy outcomes.

Color Doppler imaging of the uteroplacental circulation in the middle trimester: observations on the development of a low-resistance circulation

We aimed to study the changes in the flow dynamics of the uteroplacental and umbilical circulations in the middle trimester of normal pregnancy, and establish normal ranges for indices of the Doppler flow velocity waveforms (FVWs) from both circulations at 14, 18 and 24 weeks. A longitudinal study was conducted with the use of color Doppler imaging to localize both uterine arteries and umbilical arteries and obtain FVWs from 106 healthy nulliparous women with a singleton pregnancy. Of these, 70 did not have a complicated pregnancy outcome, defined as hypertension, growth retardation, preterm delivery or perinatal death. We measured the resistance index (RI), pulsatility index (PI), systolic/diastolic (S/D) ratio and presence of early diastolic notching in both uterine arteries, and RI, PI and S/D in one umbilical artery. The results showed a fall in all measured indices of blood flow impedance in the uteroplacental and umbilical circulations and a marked reduction in the incidence of the early diastolic notch in the uterine artery FVWs during the mid-trimester. Our conclusion was that color Doppler imaging allows for the accurate localization of both uterine and umbilical arteries. Doppler FVWs then obtained confirm the development of the low-resistance uteroplacental and umbilical circulations in the mid-trimester. Diastolic notching is common at 14 weeks in normal pregnancy but uncommon at 24 weeks.

Ponderal index: a better definition of the 'at risk' group with intrauterine growth problems than birth-weight for gestational age in term infants

A study was undertaken at Nepean Hospital, Penrith to compare the outcome of pregnancies with growth retarded infants; 2,508 consecutive births were analyzed between August 1, 1989 and April 30, 1990. A comparison of outcome was made between infants whose birth-weight for gestational age was below the tenth percentile and infants who had a low ponderal index from 37 weeks' gestation. The Caesarean section delivery and fetal distress rates were significantly higher for infants with a low ponderal index than for infants with a low birth-weight. Ponderal index appears to be a better measure of infants with intrauterine growth problems than birth-weight percentiles.

The value of the monoclonal antibody (cancer antigen 125) in serial monitoring of ovarian cancer: a comparison with circulating immune complexes

The use of circulating immune complexes and a commercial monoclonal antibody to ovarian cancer (CA 125 kit) in monitoring progress in patients with ovarian cancer has been assessed. While changes in immune complexes were apparent in some patients with active progression of disease, the marked change in values and linear trend make the use of CA 125 a useful clinical marker.

Platelets and uric acid in the prediction of preeclampsia

Fifty-four pregnancies that were subsequently complicated by preeclampsia had platelet parameters and uric acid levels measured during pregnancy. The expected fall in platelet count and rise in platelet volume parameters and uric acid levels beyond those that occur in normal pregnancy were seen only in the week before delivery.

Feto-maternal haemorrhage as a cause of fetal morbidity and mortality

Massive feto-maternal haemorrhage is a cause of significant fetal morbidity and mortality, but is often overlooked because screening for fetal erythrocytes in the maternal circulation has not been a routine procedure in stillbirths, fetal distress or neonatal anaemia; there are few recognized clinical symptoms or signs, or histopathological features. This report covers three cases. A screening blood test in the last month of pregnancy could be of value in detecting feto-maternal haemorrhage before irreversible damage to the fetus occurs.

Platelets in pregnancy: hyperdestruction in pregnancy

Platelet count, mean platelet volume, and platelet volume distribution width were measured with the Coulter counter in 2813 blood samples from 2066 women with an uncomplicated pregnancy. There was a significant fall in the platelet count in the last 8 weeks of gestation, and a significant rise in the mean platelet volume in the last 4 weeks. The platelet volume distribution width rose constantly and significantly throughout pregnancy. These findings indicate an increased platelet consumption (hyperdestruction) throughout normal pregnancy. Platelet volume distribution width appears to be the more sensitive measure of macrothrombocytosis in pregnancy.