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Huang J, Che J, Kee MZL, Tan AP, Law EC, Silveira PP, Pokhvisneva I, Patel S, Godfrey KM, Daniel LM, Tan KH, Chong YS, Chan SY, Eriksson JG, Wang D, Huang JY. Linking obesity-associated genotype to child language development: the role of early-life neurology-related proteomics and brain myelination. EBioMedicine 2025; 113:105579. [PMID: 39938231 PMCID: PMC11868953 DOI: 10.1016/j.ebiom.2025.105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 01/06/2025] [Accepted: 01/17/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND The association between childhood obesity and language development may be confounded by socio-environmental factors and attributed to comorbid pathways. METHODS In a longitudinal Singaporean mother-offspring cohort, we leveraged trans-ancestry polygenic predictions of body mass index (BMI) to interrogate the causal effects of early-life BMI on child language development and its effects on molecular and neuroimaging measures. Leveraging large genome-wide association studies, we examined whether the link between obesity and language development is causal or due to a shared genetic basis. FINDINGS We found an inverse association between polygenic risk for obesity, which is less susceptible to confounding, and language ability assessed at age 9. Our findings suggested a shared genetic basis between obesity and language development rather than a causal effect of obesity on language development. Interrogating early-life mechanisms including neurology-related proteomics and language-related white matter microstructure, we found that EFNA4 and VWC2 expressions were associated with language ability as well as fractional anisotropy of language-related white matter tracts, suggesting a role in brain myelination. Additionally, the expression of the EPH-Ephrin signalling pathway in the hippocampus might contribute to language development. Polygenic risk for obesity was nominally associated with EFNA4 and VWC2 expression. However, we did not find support for mediating mechanisms via these proteins. INTERPRETATION This study demonstrates the potential of examining early-life proteomics in conjunction with deep genotyping and phenotyping and provides biological insights into the shared genomic links between obesity and language development. FUNDING Singapore National Research Foundation and Agency for Science, Technology and Research.
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Affiliation(s)
- Jian Huang
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK.
| | - Jinyi Che
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore
| | - Michelle Z L Kee
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore
| | - Ai Peng Tan
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Department of Diagnostic Imaging, National University Hospital, Singapore, Republic of Singapore; Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, NUS, Singapore, Republic of Singapore
| | - Evelyn C Law
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Republic of Singapore
| | - Patricia Pelufo Silveira
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; Department of Psychiatry, Faculty of Medicine and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, McGill University, Montreal, Canada
| | - Irina Pokhvisneva
- Department of Psychiatry, Faculty of Medicine and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, McGill University, Montreal, Canada
| | - Sachin Patel
- Department of Psychiatry, Faculty of Medicine and Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Centre, McGill University, Montreal, Canada
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Lourdes Mary Daniel
- Department of Child Development, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Yap Seng Chong
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Shiao-Yng Chan
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Johan G Eriksson
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Dennis Wang
- Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science, Technology and Research (A∗STAR), Singapore, Republic of Singapore; Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore; National Heart and Lung Institute, Imperial College London, London, UK; Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Jonathan Yinhao Huang
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Republic of Singapore; Thompson School of Social Work & Public Health, Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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2
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Mahjubi K, Effatpanah M, Parsaei M, Mojtahedi SY, Izadi A, Tavakolizadeh R. Association of anthropometric parameters with intelligence quotient in early school-aged children: a cross-sectional study in Iran. BMC Pediatr 2024; 24:809. [PMID: 39696032 DOI: 10.1186/s12887-024-05303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 12/02/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND While the link between body growth indices in the first three years of life and neurodevelopment is well established, the relationship between these indicators and intelligence levels in later stages is not well understood. This study aimed to investigate the association between various anthropometric indices and Intelligence Quotient in early school-aged children. METHODS This cross-sectional study recruited healthy students aged 7 to 8 years from four primary schools in Tehran, Iran. Measurements included body weight, height, body mass index, arm circumference, waist circumference, and hip circumference. Intelligence Quotient was assessed using the Raven's Standard Progressive Matrices Test, with scores standardized by age according to the Raven's manual. Separate univariate linear regression analyses evaluated the association between each anthropometric index and children's Intelligence Quotient scores. Multivariate linear regression analyses were then performed to adjust for potential confounding factors, including the child's sex, age, and parental education levels. RESULTS A cohort of 160 children (80 females), with a mean age of 7.5 ± 0.6 years, was included in the study. The participants exhibited the following mean anthropometric values: weight 27.7 ± 6.5 kg, height 1.2 ± 0.1 m, body mass index 17.9 ± 3.4 kg/m2, arm circumference 20.7 ± 2.8 cm, waist circumference 56.4 ± 6.4 cm, and hip circumference 68.1 ± 6.6 cm. Their mean Intelligence Quotient score was 106 ± 16.6. In the univariate analysis, children's weight was not significantly associated with Intelligence Quotient score (P-value = 0.153, β = 0.288 [-0.108, 0.684]), while height was negatively associated (P-value = 0.048, β = -31.685 [-63.142, -0.228]) and body mass index showed a positive association (P-value = 0.001, β = 1.265 [0.524, 2.006]). Abdominal circumference was not significantly associated with Intelligence Quotient (P-value = 0.913, β = 0.051 [-0.870, 0.972]), but both waist circumference (P-value = 0.007, β = 0.542 [0.147, 0.937]) and hip circumference (P-value = 0.013, β = 0.484 [0.102, 0.866]) demonstrated significant positive associations with Intelligence Quotient. However, none of the anthropometric indices maintained statistically significant associations with Intelligence Quotient after adjusting for potential confounders (P-values > 0.05). CONCLUSIONS This study indicated no strong relationship between various body measurements and intelligence levels in school-aged children after adjusting the analyses for confounders. This suggests that intelligence in these children may be largely shaped by genetic and sociodemographic factors, with minimal influence from physical growth patterns.
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Affiliation(s)
- Kimia Mahjubi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- Department of Psychiatry, Zaieian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadamin Parsaei
- Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infectious Disease, Tehran University of Medical Science, Tehran, Iran
| | - Reza Tavakolizadeh
- Department of Pediatric Endocrinology and Metabolism, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Ong YY, Ng NBH, Michael N, Cai S, Thway Tint M, Ooi DSQ, Tan AP, Tan KH, Shek L, Yap F, Chong YS, Eriksson JG, Chan SY, Broekman BFP, Godfrey KM, Silveira PP, Tiemeier H, Law EC, Aris IM, Lee YS. Associations of fetal and postnatal growth trajectories with child cognition: the GUSTO cohort study. Int J Epidemiol 2024; 54:dyaf012. [PMID: 39947656 PMCID: PMC11825177 DOI: 10.1093/ije/dyaf012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 01/27/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Using longitudinal ultrasounds as an improved fetal growth marker, we aimed to investigate if increased postnatal growth following fetal abdominal circumference (AC) growth deceleration is associated with improved child cognition. METHODS Among 797 term-born singletons in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, we derived 2nd-3rd trimester fetal AC growth z-score, fetal AC growth deceleration, standardized height, weight, and body mass index (BMI) growth at early infancy (0-4 months), late infancy (4-15 months), toddlerhood (15-37 months), and early childhood (3-7 years), and investigated their associations with intelligence quotient (IQ) at ages 4.5 years (verbal, non-verbal) and 7 years (non-verbal-block design, matrix reasoning), adjusting for socio-demographic and biological confounders. RESULTS Among term-born newborns, 23.3% experienced fetal AC growth deceleration, which was associated with lower non-verbal IQ (4.5 years) [β (95% CI), -4.00 (-7.49, -0.51)]. Higher 0-7 years z-BMI gain was associated with lower non-verbal IQ (block design) (7 years) [-1.33 (-2.51, -0.14)]. Higher late infancy z-BMI gain was associated with higher verbal IQ (4.5 years) [3.36 (0.82,5.90)] but lower non-verbal IQ (matrix reasoning) (7 years) [-2.32 (-4.48, -0.17)]. Among those with fetal AC growth deceleration, higher 0-7 years z-weight gain was associated with lower non-verbal IQ (block design) (7 years) (P-interaction = .049); at z-weight gain of +2 standard deviation score (SDS), those with fetal AC growth deceleration had lower IQ [margins (95% CI), -2.6 (-7.1,1.9)]. On average, children with fetal AC growth deceleration caught up in z-height, z-weight, and z-BMI by 7 years. CONCLUSION Fetal AC growth deceleration was associated with lower cognition scores at preschool age. Increased weight or BMI growth from 0-7 years following fetal AC growth deceleration might not be favorable to cognition among generally well-nourished term-born children.
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Affiliation(s)
- Yi Ying Ong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Health System, Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Delicia Shu Qin Ooi
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ai Peng Tan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Office of Academic Medicine, Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Lynette Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Fabian Yap
- Division of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Birit F P Broekman
- Department of Psychiatry, OLVG and Amsterdam UMC, Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia Pelufo Silveira
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ludmer Centre for Neuroinformatics and Mental Health, Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Research Centre, Montreal, QC, Canada
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Evelyn C Law
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Khoo Teck Puat—National University Children’s Medical Institute, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
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Cioffredi LA, Garner B, Maxwell JR, Merhar S, Peralta-Carcelen M, Scott LS, Sisodia M, DeMauro SB. Infant and early childhood physical health assessments in the HEALthy Brain and Child Development (HBCD) Study. Dev Cogn Neurosci 2024; 69:101414. [PMID: 39032415 PMCID: PMC11315127 DOI: 10.1016/j.dcn.2024.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child's routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.
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Affiliation(s)
- Leigh-Anne Cioffredi
- University of Vermont Larner College of Medicine, Vermont Children's Hospital, United States.
| | - Bailey Garner
- Department of Psychology, University of Florida, United States
| | - Jessie R Maxwell
- Division of Neonatology, Department of Pediatrics, University of New Mexico, United States
| | - Stephanie Merhar
- Perinatal Institute, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati, United States
| | | | - Lisa S Scott
- Department of Psychology, University of Florida, United States
| | | | - Sara B DeMauro
- Children's Hospital of Philadelphia, United States; University of Pennsylvania Perelman School of Medicine, United States
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Chen Y, Liu P, Yi S, Fan C, Zhao W, Liu J. Investigating the shared genetic architecture between attention-deficit/hyperactivity disorder and risk taking behavior: A large-scale genomewide cross-trait analysis. J Affect Disord 2024; 356:22-31. [PMID: 38565336 DOI: 10.1016/j.jad.2024.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/20/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND This study aims to explore the genetic architecture shared between Attention-Deficit/Hyperactivity Disorder (ADHD) and risk behavior. METHODS Based on the latest large-scale Genome-wide association studies (GWAS), we firstly employed Linkage disequilibrium score regression (LDSC) and Local Analysis of Variant Association (LAVA) to investigate the genetic correlation between risk behavior and ADHD. Then, we conducted cross-trait analysis to identified the Pleiotropic loci. Finally, bidirectional Mendelian randomization analysis (MR) was applied to examine the causal relationship. RESULTS We found a significant positive genetic correlation between ADHD and risk-taking behavior (rg = 0.351, p = 6.50E-37). The cross-trait meta-analysis identified 27 significant SNPs shared between ADHD and risk behavior. The most significant locus, located near the CADM2 gene on chromosome 3, had been identified associated with this two trait (pADHD = 3.07E-05 and prisk-taking behavior = 2.47E-30). The same situation can also be observed near the FOXP2 gene on chromosome 7 (rs8180817, pmeta = 5.72E-21). We found CCDC171 gene and other genes played a significant role in ADHD and risk behavior in mRNA level. Bidirectional MR analysis found a causal relationship between them. LIMITATION The majority of our data sources were of European origin, which may limit the generalizability of our findings to other ethnic populations. CONCLUSION This article reveals in depth the shared genetic structure between ADHD and risk-taking behavior, finding a significant positive genetic correlation between ADHD and risk-taking behavior. Providing insights for the future treatment and management of these two traits.
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Affiliation(s)
- Yanjing Chen
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province 410011, People's Republic of China.
| | - Ping Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province 410011, People's Republic of China.
| | - Sijie Yi
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province 410011, People's Republic of China
| | - Chunhua Fan
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province 410011, People's Republic of China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province 410011, People's Republic of China; Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan Province 410011, People's Republic of China.
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province 410011, People's Republic of China; Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan Province 410011, People's Republic of China.
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Cerda-Vega E, Pérez-Romero N, Sierralta SA, Hernández-Mendo A, Reigal RE, Ramirez-Campillo R, Martínez-Salazar C, Campos-Jara R, Arellano-Roco C, Campos-Jara C, Hernández-Cifuentes V, Contreras-Osorio F. Physical Exercise and Executive Function in the Pediatric Overweight and Obesity Population: A Systematic Review Protocol. Sports (Basel) 2024; 12:180. [PMID: 39058071 PMCID: PMC11280794 DOI: 10.3390/sports12070180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Executive function is often altered in overweight/obese children and adolescents, which has a negative impact on their learning and daily life. Furthermore, research has shown the benefits of physical exercise in improving cognitive performance. This protocol aims to define in a detailed and structured manner the procedures that will be conducted for the development of a systematic review of the literature aimed at evaluating the effects of physical exercise on the executive functions of children and adolescents (≤18 years) with overweight/obesity in comparison with peers in control groups. METHODS The Web of Science, PubMed, Scopus, and EBSCO databases will be searched for longitudinal studies that have at least one experimental and one control group using pre- and post-intervention measures of executive function, including working memory, inhibition, and cognitive flexibility in the pediatric population who are overweight or obese. The risk of bias and certainty of evidence will be assessed using Cochrane RoB2 and GRADE, respectively. Furthermore, Der Simonian-Laird's random effects model will be employed for meta-analyses. The effect sizes will be calculated with 95% confidence intervals, and p values < 0.05 indicate statistical significance for each dimension of executive function in the different groups before and after the intervention. DISCUSSION The results of this review may be useful for education and health professionals to design treatment plans for overweight/obese children and adolescents, offering potential benefits related to the learning and cognitive abilities of this population. PROSPERO registration number: CRD42023391420.
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Affiliation(s)
- Enrique Cerda-Vega
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.C.-V.); (C.C.-J.)
| | - Nuria Pérez-Romero
- Exercise and Rehabilitation Sciences Institute, Postgraduate, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile;
| | | | - Antonio Hernández-Mendo
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, Universidad de Málaga, 29071 Málaga, Spain; (A.H.-M.); (R.E.R.)
| | - Rafael E. Reigal
- Department of Social Psychology, Social Anthropology, Social Work and Social Services, Universidad de Málaga, 29071 Málaga, Spain; (A.H.-M.); (R.E.R.)
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (R.R.-C.); (V.H.-C.)
| | - Cristian Martínez-Salazar
- Department of Physical Education, Sports, and Recreation, Pedagogy in Physical Education, School of Education and Social Sciences and Humanities, Universidad de La Frontera, Temuco 4811230, Chile;
| | | | - Cristián Arellano-Roco
- Laboratorio de Neuromecanica Aplicada, Escuela de Kinesiología, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170022, Chile;
| | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.C.-V.); (C.C.-J.)
| | - Victoria Hernández-Cifuentes
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (R.R.-C.); (V.H.-C.)
| | - Falonn Contreras-Osorio
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile; (E.C.-V.); (C.C.-J.)
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7
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Moussi C, Tahan L, Habchy P, Kattan O, Njeim A, Abou Habib L, El Bitar W, El Asmar B, Chahine MN. School-Based Pre- and Post-Intervention Tests Assessing Knowledge about Healthy Lifestyles: A National School Health Awareness Campaign on Children Aged between 3 and 12 Years Old. CHILDREN (BASEL, SWITZERLAND) 2024; 11:213. [PMID: 38397325 PMCID: PMC10887629 DOI: 10.3390/children11020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
In response to the diverse health challenges faced by today's youth and their extensive time spent in schools, we conducted a school health awareness campaign aimed at prioritizing well-being and academic performance. This analytical longitudinal study, spanning 27 schools in Lebanon, aimed to assess the impact of the awareness campaign on the health knowledge and practices of 5-, 8-, and 11-year-old students throughout pre- and post-intervention testing focused on general health and healthy habits, employing 11, 14, and 15 questions tailored to 5, 8, and 11 year olds, respectively. The questions covered various aspects, including sleep, personal and dental hygiene, nutrition, physical activity, addiction, security measures, and bullying. Out of the 7100 students who participated, 16.11% (1144 students) were evaluated before and after the campaign. The results indicated a significant increase in health awareness post-intervention across all age groups. For instance, in 5-year-olds, limited awareness decreased from 91.6% to 36.38%, while adequate awareness rose from 8.03% to 62.3%. Improvement varied across health knowledge topics, with security-related questions showing the highest enhancement. Factors such as governorate, normal-weight status, and close supervision influenced improvement. However, no significant correlations were found with school type, size, gender, age, nationality, parental factors, or comorbidities. The study concludes that the school health awareness campaign successfully heightened children's health awareness, advocating for the integration of regular health promotions into the standard educational curriculum.
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Affiliation(s)
- Charbel Moussi
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (C.M.); (L.T.); (P.H.); (O.K.); (A.N.)
| | - Léa Tahan
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (C.M.); (L.T.); (P.H.); (O.K.); (A.N.)
| | - Peter Habchy
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (C.M.); (L.T.); (P.H.); (O.K.); (A.N.)
| | - Ogarite Kattan
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (C.M.); (L.T.); (P.H.); (O.K.); (A.N.)
| | - Alain Njeim
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (C.M.); (L.T.); (P.H.); (O.K.); (A.N.)
| | - Leila Abou Habib
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
| | - Wassim El Bitar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Department of Pediatrics, Bellevue Medical Center University Hospital, Mansourieh P.O Box 295, Lebanon
| | - Béchara El Asmar
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Faculty of Medicine, Saint Joseph University, Beirut P.O. Box 17-5208, Lebanon
- Department of Cardiology, Hotel-Dieu de France Hospital, Achrafieh, Beirut P.O. Box 11-5190, Lebanon
| | - Mirna N. Chahine
- Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon; (C.M.); (L.T.); (P.H.); (O.K.); (A.N.)
- Lebanese Association of the Knights of Malta (Order of Malta Lebanon), Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon; (L.A.H.); (W.E.B.); (B.E.A.)
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon
- Foundation-Medical Research Institutes (F-MRI), Achrafieh, Beirut P.O. Box 64, Lebanon
- Foundation-Medical Research Institutes (F-MRI), 1211 Geneva, Switzerland
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8
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Ong YY, Rifas-Shiman SL, Perng W, Belfort MB, Law E, Hivert MF, Oken E, Tiemeier H, Aris IM. Growth Velocities Across Distinct Early Life Windows and Child Cognition: Insights from a Contemporary US Cohort. J Pediatr 2023; 263:113653. [PMID: 37541424 PMCID: PMC10837309 DOI: 10.1016/j.jpeds.2023.113653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/06/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE To evaluate the relative importance of overall and period-specific postnatal growth and their interaction with fetal growth on cognition in a generally well-nourished population. STUDY DESIGN We included 1052 children from Project Viva, a prospective cohort in Boston, Massachusetts. Using linear spline mixed-effects models, we modeled length/height and body mass index (BMI) trajectories from birth to 7 years and estimated standardized overall (0-7 years) and period-specific growth velocities ie, early infancy (0-4 months), late infancy (4-15 months), toddlerhood (15-37 months), and early childhood (37-84 months). We investigated associations of growth velocities as well as their interactions with birthweight-for-gestational age on mid-childhood (mean age: 7.9 years) IQ, visual memory and learning, and visual motor ability. RESULTS Greater overall height velocity was associated with modestly higher design memory score, (adjusted β [95% CI] 0.19 [-0.01,0.38] P = .057])points per SD increase but lower verbal IQ (-0.88 [-1.76,0.00] P = .051). Greater early infancy height velocity was associated with higher visual motor score (1.92 [0.67,3.18]). Greater overall BMI velocity was associated with lower verbal IQ (-0.71 [-1.52,0.11] P = .090). Greater late infancy BMI velocity was associated with lower verbal IQ (-1.21 [-2.07,-0.34]), design memory score (-0.22 [-0.42,-0.03)], but higher picture memory score (0.22 [0.01,0.43]). Greater early infancy height velocity (-1.5 SD vs 1.5 SD) was associated with higher nonverbal IQ (margins [95% CI] 102.6 [98.9106.3] vs 108.2 [104.9111.6]) among small-for-gestational age infants (P-interaction = 0.04). CONCLUSIONS Among generally well-nourished children, there might not be clear cognitive gains with faster linear growth except for those with lower birthweight-for-gestational age, revealing the potential importance of early infancy compensatory growth.
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Affiliation(s)
- Yi Ying Ong
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Evelyn Law
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA; Diabetes Unit, Massachusetts General Hospital, Boston, MA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA
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9
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Ribas-Prats T, Arenillas-Alcón S, Pérez-Cruz M, Costa-Faidella J, Gómez-Roig MD, Escera C. Speech-Encoding Deficits in Neonates Born Large-for-Gestational Age as Revealed With the Envelope Frequency-Following Response. Ear Hear 2023; 44:829-841. [PMID: 36759954 DOI: 10.1097/aud.0000000000001330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVES The present envelope frequency-following response (FFR ENV ) study aimed at characterizing the neural encoding of the fundamental frequency of speech sounds in neonates born at the higher end of the birth weight continuum (>90th percentile), known as large-for-gestational age (LGA). DESIGN Twenty-five LGA newborns were recruited from the maternity unit of Sant Joan de Déu Barcelona Children's Hospital and paired by age and sex with 25 babies born adequate-for-gestational age (AGA), all from healthy mothers and normal pregnancies. FFR ENV s were elicited to the/da/ syllable and recorded while the baby was sleeping in its cradle after a successful universal hearing screening. Neural encoding of the stimulus' envelope of the fundamental frequency (F 0ENV ) was characterized through the FFR ENV spectral amplitude. Relationships between electrophysiological parameters and maternal/neonatal variables that may condition neonatal neurodevelopment were assessed, including pregestational body mass index (BMI), maternal gestational weight gain and neonatal BMI. RESULTS LGA newborns showed smaller spectral amplitudes at the F 0ENV compared to the AGA group. Significant negative correlations were found between neonatal BMI and the spectral amplitude at the F 0ENV . CONCLUSIONS Our results indicate that in spite of having a healthy pregnancy, LGA neonates' central auditory system is impaired in encoding a fundamental aspect of the speech sounds, namely their fundamental frequency. The negative correlation between the neonates' BMI and FFR ENV indicates that this impaired encoding is independent of the pregnant woman BMI and weight gain during pregnancy, supporting the role of the neonatal BMI. We suggest that the higher adipose tissue observed in the LGA group may impair, via proinflammatory products, the fine-grained central auditory system microstructure required for the neural encoding of the fundamental frequency of speech sounds.
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Affiliation(s)
- Teresa Ribas-Prats
- Brainlab-Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- Institute of Neurosciences, University of Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Sonia Arenillas-Alcón
- Brainlab-Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- Institute of Neurosciences, University of Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Míriam Pérez-Cruz
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Costa-Faidella
- Brainlab-Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- Institute of Neurosciences, University of Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - Maria Dolores Gómez-Roig
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
- BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic), University of Barcelona, Barcelona, Catalonia, Spain
| | - Carles Escera
- Brainlab-Cognitive Neuroscience Research Group. Department of Clinical Psychology and Psychobiology, University of Barcelona, Catalonia, Spain
- Institute of Neurosciences, University of Barcelona, Catalonia, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
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Hawani A, Chikha AB, Zoghlami W, Souissi MA, Trabelsi O, Mrayeh M, Muscella A. Working Memory in Overweight Boys during Physical Education Classes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050805. [PMID: 37238353 DOI: 10.3390/children10050805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
This study examined the effect of small-sided football games (SSFG) and small-sided Ultimate Frisbee games (SSUFG) on working memory, response times, and feeling mood of boys with overweight. Twenty-eight boys (age 12.23 ± 1.58 years) participated in two trials during physical education lessons (20-min SSFG and 20-min SSUFG) in a counterbalanced, randomized crossover design. The response times and feeling mood were measured for all participants post-exercise through the Sternberg paradigm and feeling scale. For the response times, the paired samples t-test revealed a significantly better reaction time after SSUFG at the "One item level" of the Sternberg paradigm (p = 0.014, Hedges' g = 0.27, small effect) and (p = 0.010, Hedges' g = 0.74, medium effect), at "Three item level" (p = 0.000106, Hedges' g = 1.88, very large effect). The SSFG also showed vigor at the "Five item level" (p = 0.047, Hedges' g = 0.61, medium effect). For the feeling mood, the feeling score was significantly higher after the SSUFG session than the SSFG session and the increase in feeling scores observed after switching from SSFG to SSUFG was significantly different (p < 0.001) from the decrease observed in feeling scores after switching from SSUFG to SSFG. Therefore, the results of the study allow the teacher to introduce new sports and reflect on the motor tasks he or she proposes for boys with overweight during physical education classes.
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Affiliation(s)
- Aymen Hawani
- The Higher Institute of Sport and Physical Education (Ksar Saïd), University of Manouba, Manouba 2010, Tunisia
- Physical Activity, Sport and Health, Research Unit (UR18JS01), National Observatory of Sport, Tunis 1003, Tunisia
| | - Anis Ben Chikha
- The Higher Institute of Sport and Physical Education (Ksar Saïd), University of Manouba, Manouba 2010, Tunisia
| | - Wael Zoghlami
- High Institute of Sport and Physical Education, Sfax University, Sfax 3000, Tunisia
| | - Mohamed Abdelkader Souissi
- Physical Activity, Sport and Health, Research Unit (UR18JS01), National Observatory of Sport, Tunis 1003, Tunisia
| | - Omar Trabelsi
- Physical Activity, Sport and Health, Research Unit (UR18JS01), National Observatory of Sport, Tunis 1003, Tunisia
- High Institute of Sport and Physical Education, Sfax University, Sfax 3000, Tunisia
| | - Maher Mrayeh
- The Higher Institute of Sport and Physical Education (Ksar Saïd), University of Manouba, Manouba 2010, Tunisia
- Physical Activity, Sport and Health, Research Unit (UR18JS01), National Observatory of Sport, Tunis 1003, Tunisia
| | - Antonella Muscella
- Department of Biological and Environmental Science and Technologies (DiSTeBA), University of Salento, 73100 Lecce, Italy
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11
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Cáceres A, Carreras-Gallo N, Andrusaityte S, Bustamante M, Carracedo Á, Chatzi L, Dwaraka VB, Grazuleviciene R, Gutzkow KB, Lepeule J, Maitre L, Mendez TL, Nieuwenhuijsen M, Slama R, Smith R, Stratakis N, Thomsen C, Urquiza J, Went H, Wright J, Yang T, Casas M, Vrijheid M, González JR. Prenatal environmental exposures associated with sex differences in childhood obesity and neurodevelopment. BMC Med 2023; 21:142. [PMID: 37046291 PMCID: PMC10099694 DOI: 10.1186/s12916-023-02815-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Obesity and neurodevelopmental delay are complex traits that often co-occur and differ between boys and girls. Prenatal exposures are believed to influence children's obesity, but it is unknown whether exposures of pregnant mothers can confer a different risk of obesity between sexes, and whether they can affect neurodevelopment. METHODS We analyzed data from 1044 children from the HELIX project, comprising 93 exposures during pregnancy, and clinical, neuropsychological, and methylation data during childhood (5-11 years). Using exposome-wide interaction analyses, we identified prenatal exposures with the highest sexual dimorphism in obesity risk, which were used to create a multiexposure profile. We applied causal random forest to classify individuals into two environments: E1 and E0. E1 consists of a combination of exposure levels where girls have significantly less risk of obesity than boys, as compared to E0, which consists of the remaining combination of exposure levels. We investigated whether the association between sex and neurodevelopmental delay also differed between E0 and E1. We used methylation data to perform an epigenome-wide association study between the environments to see the effect of belonging to E1 or E0 at the molecular level. RESULTS We observed that E1 was defined by the combination of low dairy consumption, non-smokers' cotinine levels in blood, low facility richness, and the presence of green spaces during pregnancy (ORinteraction = 0.070, P = 2.59 × 10-5). E1 was also associated with a lower risk of neurodevelopmental delay in girls, based on neuropsychological tests of non-verbal intelligence (ORinteraction = 0.42, P = 0.047) and working memory (ORinteraction = 0.31, P = 0.02). In line with this, several neurodevelopmental functions were enriched in significant differentially methylated probes between E1 and E0. CONCLUSIONS The risk of obesity can be different for boys and girls in certain prenatal environments. We identified an environment combining four exposure levels that protect girls from obesity and neurodevelopment delay. The combination of single exposures into multiexposure profiles using causal inference can help determine populations at risk.
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Affiliation(s)
- Alejandro Cáceres
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain.
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
- Department of Mathematics, Escola d'Enginyeria de Barcelona Est (EEBE), Universitat Politècnica de Catalunya, 08019, Barcelona, Spain.
| | | | - Sandra Andrusaityte
- Department of Environmental Science, Vytautas Magnus University, 44248, Kaunas, Lithuania
| | - Mariona Bustamante
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Center for Genomic Regulation (CRG), Barcelona, Institute of Science and Technology (BIST), Barcelona, Spain
| | - Ángel Carracedo
- Medicine Genomics Group, Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), CIMUS, University of Santiago de Compostela, Santiago de Compostela, Spain
- Galician Foundation of Genomic Medicine, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servicio Gallego de Salud (SERGAS), Galicia, Santiago de Compostela, Spain
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | | | - Regina Grazuleviciene
- Department of Environmental Science, Vytautas Magnus University, 44248, Kaunas, Lithuania
| | - Kristine Bjerve Gutzkow
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0456, Oslo, Norway
| | - Johanna Lepeule
- Institut National de La Santé Et de La Recherche Médicale (Inserm) and Université Grenoble-Alpes, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France
| | - Léa Maitre
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Mark Nieuwenhuijsen
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Remy Slama
- Institut National de La Santé Et de La Recherche Médicale (Inserm) and Université Grenoble-Alpes, Institute for Advanced Biosciences (IAB), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France
| | | | - Nikos Stratakis
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
| | - Cathrine Thomsen
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0456, Oslo, Norway
| | - Jose Urquiza
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Maribel Casas
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Martine Vrijheid
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Experimental Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Juan R González
- Instituto de Salud Global de Barcelona (ISGlobal), 08003, Barcelona, Spain.
- Centro de Investigación Biomédica en Red en Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
- Department of Mathematics, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona , Spain.
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12
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McMath AL, Iwinski S, Shen S, Bost KF, Donovan SM, Khan NA. Adherence to Screen Time and Physical Activity Guidelines is Associated with Executive Function in US Toddlers Participating in the STRONG Kids 2 Birth Cohort Study. J Pediatr 2023; 252:22-30.e6. [PMID: 36027980 PMCID: PMC10918530 DOI: 10.1016/j.jpeds.2022.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test the hypothesis that healthy weight status and adherence to American Academy of Pediatrics (AAP) guidelines for diet and physical activity would extend to greater executive function (EF) at age 24 months. STUDY DESIGN Parents of 24-month-old children from the STRONG Kids 2 cohort study (n = 352) completed the Behavioral Rating Inventory of Executive Function for Preschoolers (BRIEF-P) and reported physical activities, diet, and screen time. Toddlers met AAP guidelines if they consumed at least 5 servings of fruits and vegetables, were physically active, refrained from sugar-sweetened beverages, and limited daily screen time to <60 minutes. Relationships between EF, 24-month weight status, and meeting AAP guidelines were tested independent of child sex, ethnicity, socioeconomic status, weight status at birth, and maternal pregnancy weight status. RESULTS Weight-for-length z-score had no effect on EF. Toddlers meeting the screen time guideline had greater EF (β, -0.125; 95% CI, 0.234 to -0.008), inhibitory self-control (β, -0.142; 95% CI, -0.248 to -0.029), and emergent metacognition (β, -0.111; 95% CI, -0.221 to 0.002), indicated by lower BRIEF-P scores. Those with more minutes of screen time had poorer overall EF (β, 0.257; 95% CI, 0.118-0.384), inhibitory self-control (β, 0.231; 95% CI, 0.099-0.354), cognitive flexibility (β, 0.217; 95% CI, 0.082-0.342), and emergent metacognition (β, 0.257; 95% CI, 0.120-0.381). Daily physical activity was associated with greater emergent metacognition (β, -0.116; 95% CI, -0.225 to -0.005). CONCLUSIONS Meeting AAP guidelines for physical activity and screen time was related to greater EF in a demographically homogenous sample of toddlers. Future randomized control trials and more diverse samples are needed to confirm the directionality of this relationship. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03341858.
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Affiliation(s)
- Arden L McMath
- Division of Nutritional Sciences, University of Illinois Urbana-Champaign, Champaign, IL
| | - Samantha Iwinski
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Champaign, IL
| | - Sa Shen
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL
| | - Kelly F Bost
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Champaign, IL; Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL
| | - Sharon M Donovan
- Division of Nutritional Sciences, University of Illinois Urbana-Champaign, Champaign, IL; Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, Champaign, IL
| | - Naiman A Khan
- Division of Nutritional Sciences, University of Illinois Urbana-Champaign, Champaign, IL; Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL.
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13
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Dzhambov AM, Lercher P, Rüdisser J, Browning MH, Markevych I. Home gardens and distances to nature associated with behavior problems in alpine schoolchildren: Role of secondhand smoke exposure and biomarkers. Int J Hyg Environ Health 2022; 243:113975. [DOI: 10.1016/j.ijheh.2022.113975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 01/13/2023]
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El Wakeel MA, El-Kassas G, Elsheikh E, ElKhatib AA, Hashem S, Elzayat SR, Sibaii H, Fadl N, Rabah T. Gut–brain Axis: Impact of Intestinal Inflammation and Micronutrient Deficiency on Psychomotor Development and Cognitive Functions in Egyptian Children with UndernutritionGut–brain Axis: Impact of Intestinal Inflammation and Micronutrient Deficiency on Psychomotor Development and Cognitive Functions in Egyptian Children with Undernutrition. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cognitive impairment, growth faltering and stunting are pervasive in many countries. mostly causes are unknown. Role of intestinal inflammation in such cases should be minded especially in low- and middle-income countries. We assessed serum markers of inflammation, fecal markers of intestinal inflammation and serum micronutrients in cases with aged 1 to 10 years who suffer from moderate or severe malnutrition “weight-for-age z-score and height-for-age z- Score (WAZ or HAZ) less than -2 SD”. Cognitive abilities were assessed using Wechsler intelligence scale for preschool and school children, Bayley scale III. 55.6% of preschool cases were below average or had mild or moderate intelligence retardation while 24.5% of school cases and 5% of children below 2 years were below average regarding cognitive functions. Cases showed statistically significant reduction of vitamin D, zinc and iron as compared to control. Serum markers of inflammation (alpha 1- glycoprotein (a1-AGP), endotoxin core protein (EndoCAB)) and fecal markers of intestinal inflammation (alpha 1 antitrypsin (AAT) and neopterin (NEOP)) were significant higher in cases than controls. School children showed negative correlation between processing functions and( a1-AGP), positive correlation between perceptual reasoning and serum vitamin A. Children below 2 years, showed negative correlations between motor function and (AAT), (a1-AGP), tumor necrosis factor- alpha (TNF-a) and (EndoCAB), positive correlation between language and serum zinc. In conclusion, our study showed impaired neurocognitive and psychomotor functions in malnourished stunted children. Also, vitamins and minerals deficiency and increased markers of intestinal inflammation were observed in cases compared to healthy control.
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Contreras-Osorio F, Guzmán-Guzmán IP, Cerda-Vega E, Chirosa-Ríos L, Ramírez-Campillo R, Campos-Jara C. Anthropometric Parameters, Physical Activity, Physical Fitness, and Executive Functions among Primary School Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053045. [PMID: 35270736 PMCID: PMC8910200 DOI: 10.3390/ijerph19053045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023]
Abstract
Physical activity during childhood and adolescence favors brain development and cognitive functioning, particularly the executive functions. This study aimed to assess potential associations between anthropometric parameters, physical activity, physical fitness, and executive functions among elementary school children returning to school after the COVID-19 lockdown in Chile. School-age male and female participants (n = 90; age, 10−12 years) participated in the study. To determine the association between variables, a multivariable linear regression analysis was performed. Higher fat-related anthropometric indexes were associated with lower working memory, cognitive flexibility, planning, and attention (r = −0.55 to −0.22; p = 0.031 to <0.001). In contrast, higher physical activity levels, better sprint performance, higher lower-body muscular power, and greater upper-body muscular strength were associated with better working memory, cognitive flexibility, inhibition, planning, and/or attention (r = 0.19 to −0.54; p = 0.04 to <0.001). Current results consistently suggest the need for adequate levels of physical activity, physical fitness, and anthropometric parameters among the school-age population to promote healthy and adequate executive functions.
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Affiliation(s)
- Falonn Contreras-Osorio
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (F.C.-O.); (L.C.-R.)
- Exercise and Rehabilitation Sciences Laboratory, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile 7591538, Chile
| | - Iris Paola Guzmán-Guzmán
- Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39087, Mexico;
| | - Enrique Cerda-Vega
- Pedagogy in Physical Education and Health Career, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile 7820436, Chile;
| | - Luis Chirosa-Ríos
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain; (F.C.-O.); (L.C.-R.)
| | - Rodrigo Ramírez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile 7591538, Chile;
| | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Laboratory, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile 7591538, Chile
- Correspondence: ; Tel.: +56-9-42057069
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16
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Climie RE, Tafflet M, van Sloten T, de Lauzon-Guillain B, Bernard JY, Dargent-Molina P, Plancoulaine S, Lioret S, Jouven X, Charles MA, Heude B, Empana JP. Cardiovascular Health at Age 5 Years: Distribution, Determinants, and Association With Neurodevelopment. Front Pediatr 2022; 10:827525. [PMID: 35479759 PMCID: PMC9035843 DOI: 10.3389/fped.2022.827525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Early childhood may represent an opportune time to commence primordial prevention of cardiovascular disease (CVD, i.e., prevention of risk factors onset), but epidemiological evidence is scarce. We aimed to examine the distribution and parental and early life determinants of ideal cardiovascular health (CVH) in children up to 5 years and to compare the level of cognitive development between children with and without ideal CVH at age 5 years. METHODS Using data from the Etude sur les déterminants pré et post natals précoces du Développement psychomoteur et de la santé de l'Enfant (EDEN) study, a French population-based mother-child cohort study, CVH was examined in children at 5 years of age based on the American Heart Association CVH metrics (ideal body mass index, physical activity, diet, blood pressure, cholesterol and glucose levels, and passive smoking, considered in sensitivity analysis only). Children were categorized as having ideal (five to six ideal metrics) or non-ideal CVH (<5 ideal metrics). Intelligence quotient (IQ) at age 5 years was assessed using the French version of the Wechsler Preschool and Primary Scale of Intelligence. RESULTS Among the 566 children (55% boys), only 34% had ideal CVH. In fully adjusted logistic regression, boys compared to girls (OR = 1.77, 95% CI 1.13-2.78), children with intermediate (1.77, 1.05-2.98) or ideal (2.58, 1.38-4.82) behavioral CVH at age 3 years and children who spent < 30 min/day watching television (1.91, 1.09-3.34) at age 3 years were more likely to have ideal CVH at age 5 years. At age 5 years, there was a significant 2.98-point difference (95% CI 0.64-5.32) in IQ between children with and without ideal biological CVH after adjusting for confounders. CONCLUSION This study highlights that only a third of children aged 5 years had ideal CVH and identified modifiable determinants of ideal CVH and is suggestive of an association between CVH and neurodevelopment at a young age.
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Affiliation(s)
- Rachel E Climie
- Université de Paris, Inserm, U970, Paris Cardiovascular Research Center (PARCC), Integrative Epidemiology of Cardiovascular Disease, Paris, France.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia.,Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Muriel Tafflet
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Thomas van Sloten
- Université de Paris, Inserm, U970, Paris Cardiovascular Research Center (PARCC), Integrative Epidemiology of Cardiovascular Disease, Paris, France.,Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Blandine de Lauzon-Guillain
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Jonathan Y Bernard
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Patricia Dargent-Molina
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Sabine Plancoulaine
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Sandrine Lioret
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Xavier Jouven
- Université de Paris, Inserm, U970, Paris Cardiovascular Research Center (PARCC), Integrative Epidemiology of Cardiovascular Disease, Paris, France
| | - Marie-Alines Charles
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Barbara Heude
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Jean-Philippe Empana
- Université de Paris, Inserm, U970, Paris Cardiovascular Research Center (PARCC), Integrative Epidemiology of Cardiovascular Disease, Paris, France
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Lu MS, Lu JH, Zhang LF, Liu X, Zhao X, Nagraj S, Shen SY, Xiao WQ, He JR, Qiu X. Infancy weight gain and neurodevelopmental outcomes among term-born infants at age one year: A large prospective cohort study in China. Child Neuropsychol 2021; 28:554-567. [PMID: 34846268 DOI: 10.1080/09297049.2021.1999402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To investigate the association between infancy weight gain and neurodevelopment among term-born infants. Singleton term-born infants (n = 5837) were included from the Born in Guangzhou Cohort Study. Absolute weight gain was obtained by calculating the weight difference from birth to exactly 12 months. The primary outcome was neurodevelopment at age one year, which included five developmental domains. Global developmental delay was defined as delays in ≥3 domains. Multivariable logistic regression was used to examine the associations between infancy weight gain and neurodevelopment. Compared with infants gaining 6001-7000 g (reference group), infants gaining ≤5000 g had higher odds of delay in adaptive, gross motor, fine motor, social, and global developmental delay, infants gaining 5001-6000 g had higher odds of gross motor delay and social delay. A sex-stratified analysis showed that compared with the reference group, gaining ≤5000 g was associated with higher odds of fine motor delay in male infants, while gaining >7000 g was associated with higher odds of fine motor delay in females. Inadequate infancy weight gain is associated with higher odds of poor neurodevelopment at age one year among term-born infants.
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Affiliation(s)
- Min-Shan Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jin-Hua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Li-Fang Zhang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xian Liu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xuan Zhao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shobhana Nagraj
- The George Institute for Global Health, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Song-Ying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wan-Qing Xiao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,The George Institute for Global Health, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Women Health Care, Provincial Key Clinical Specialty of Woman and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.,Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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18
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Clouard C, Reimert I, Fleming SA, Koopmans SJ, Schuurman T, Hauser J. Dietary sialylated oligosaccharides in early-life may promote cognitive flexibility during development in context of obesogenic dietary intake. Nutr Neurosci 2021; 25:2461-2478. [PMID: 34565309 DOI: 10.1080/1028415x.2021.1975877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Oligosaccharides found in mammalian milk have shown the potential to alter brain development across multiple species. The diversity and concentration of these oligosaccharides is species-specific and varies greatly between individuals, thus understanding their role in cognitive development is warranted. We investigated the impact of early life dietary fucosylated/neutral or sialylated human milk oligosaccharides (HMO) on behaviours in tasks assessing anxiety, motivation, appetite, learning, and memory.Methods: Sixty-four female Göttingen minipigs were artificially reared from 2 weeks postnatal and provided milk replacers. The study used four groups: no additional oligosaccharides (Con), fucosylated and neutral oligosaccharides (FN, 4 g/L), sialylated oligosaccharides (SL, 0.68 g/L), or both FN and SL (FN + SL, 4 g/L) from 2 to 11 weeks postnatal. One reference group was sow-reared. Weaning occurred between 10 and 11 weeks postnatal, and thereafter an obesogenic diet was provided. Behavioral tasks were conducted over three periods: 1) 0-11 weeks; 2) 16-29 weeks; 3) 39-45 weeks. Tasks included a spatial holeboard task, open field task, exposure to a novel object, runway task, single-feed task, and home pen behaviour observation.Results: In the holeboard, the SL group demonstrated improved reference memory during reversal trials between 16-29 weeks. All groups demonstrated equivalent behavior in open field, novel object, runway, and single-feed tasks, as well as in their home pens (Ps > 0.05).Discussion: These results suggest that early life dietary intake of sialylated oligosaccharides may provide an improvement to cognition during the equivalent developmental stage of adolescence.
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Affiliation(s)
- Caroline Clouard
- Department of Animal Sciences, Adaptation Physiology Group, Wageningen University & Research, Wageningen, Netherlands.,PEGASE, INRAE, Institut Agro, Saint-Gilles, France
| | - Inonge Reimert
- Department of Animal Sciences, Adaptation Physiology Group, Wageningen University & Research, Wageningen, Netherlands
| | | | - Sietse-Jan Koopmans
- Wageningen Livestock Research, Wageningen University & Research, Netherlands
| | - Teun Schuurman
- Department of Animal Sciences, Wageningen University & Research, Wageningen, Netherlands
| | - Jonas Hauser
- Brain Health, Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., 1005 Lausanne, Switzerland
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19
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Smith L, Toussaint L, Micoli A, Lynch B. Obesity, putative biological mediators, and cognitive function in a national sample of children and adolescents. Prev Med 2021; 150:106659. [PMID: 34097950 DOI: 10.1016/j.ypmed.2021.106659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 01/20/2023]
Abstract
Childhood obesity has reached epidemic rates nationwide and may be associated with impaired cognitive function. A growing body of evidence suggests that poorer academic performance for children with obesity and overweight is related to declines in executive function skills. This study aimed to identify biological mediators between obesity and overweight and cognitive function among children and adolescents. A total of 3323 children aged 6-16 years from the Third National Health and Nutrition Examination Survey between 1988 and 1994 (NHANES III) was used to measure associations between measures of obesity and overweight, cognitive function (IQ test batteries), iron deficiency, inflammation (c-reactive protein), and glucose metabolism (glycosylated hemoglobin) using multiple mediation models. Approximately 15% of the children were overweight and 11% were obese. Results showed lower scores for children who were obese or overweight than children of normal weight on several IQ subtest batteries. Obesity and overweight were also associated with biological mediators such as iron deficiency, elevated c-reactive protein and glycosylated hemoglobin. Several biomarkers of iron status were also related to measures of cognitive function. Early declines in cognitive function are associated with biomarkers of iron deficiency and inflammation in children and adolescents, and while some biological linkages between obesity and overweight and cognitive function are identified herein, further study is needed to identify additional biological mediators between obesity and overweight and cognitive function in pediatric populations.
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Affiliation(s)
- Latasha Smith
- 1501 College Avenue, Central Baptist College, Conway, AR 72032, United States of America.
| | - Loren Toussaint
- Luther College, 700 College Dr. Decorah, IA 52101, United States of America
| | - Antonela Micoli
- Mayo Clinic, 200 First Street SW, Rochster, MN 55901, United States of America
| | - Brian Lynch
- Mayo Clinic, 200 First Street SW, Rochster, MN 55901, United States of America
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20
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Ronan L, Alexander-Bloch A, Fletcher PC. Childhood Obesity, Cortical Structure, and Executive Function in Healthy Children. Cereb Cortex 2021; 30:2519-2528. [PMID: 31646343 PMCID: PMC7175011 DOI: 10.1093/cercor/bhz257] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The development of executive function is linked to maturation of prefrontal cortex (PFC) in childhood. Childhood obesity has been associated with changes in brain structure, particularly in PFC, as well as deficits in executive functions. We aimed to determine whether differences in cortical structure mediate the relationship between executive function and childhood obesity. We analyzed MR-derived measures of cortical thickness for 2700 children between the ages of 9 and 11 years, recruited as part of the NIH Adolescent Brain and Cognitive Development (ABCD) study. We related our findings to measures of executive function and body mass index (BMI). In our analysis, increased BMI was associated with significantly reduced mean cortical thickness, as well as specific bilateral reduced cortical thickness in prefrontal cortical regions. This relationship remained after accounting for age, sex, race, parental education, household income, birth-weight, and in-scanner motion. Increased BMI was also associated with lower executive function. Reduced thickness in the rostral medial and superior frontal cortex, the inferior frontal gyrus, and the lateral orbitofrontal cortex partially accounted for reductions in executive function. These results suggest that childhood obesity is associated with compromised executive function. This relationship may be partly explained by BMI-associated reduced cortical thickness in the PFC.
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Affiliation(s)
- Lisa Ronan
- Department of Psychiatry, University of Cambridge, Cambridge CB2 8HA UK
| | - Aaron Alexander-Bloch
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, PA 19104, USA
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge CB2 8HA UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK.,The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories (IMS-MRL), University of Cambridge, Cambridge CB2 0QQ, UK
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21
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Mora-Gonzalez J, Esteban-Cornejo I, Migueles JH, Rodriguez-Ayllon M, Molina-Garcia P, Cadenas-Sanchez C, Solis-Urra P, Plaza-Florido A, Kramer AF, Erickson KI, Hillman CH, Catena A, Ortega FB. Physical fitness and brain source localization during a working memory task in children with overweight/obesity: The ActiveBrains project. Dev Sci 2020; 24:e13048. [PMID: 33037758 DOI: 10.1111/desc.13048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/02/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
The present study aims (i) to examine the association of physical fitness components (i.e., cardiorespiratory fitness, speed-agility, and muscular fitness) with brain current source density during working memory; and (ii) to examine whether fitness-related current density was associated to working memory performance and academic achievement. Eighty-five children with overweight/obesity aged 8-11 years participated in this cross-sectional study. Physical fitness components were assessed using the ALPHA test battery. Electroencephalography recordings were performed during a Delayed Non-Match-to-Sample task that assessed working memory. Brain source analysis was carried out using sLORETA to estimate regional current source density differences between high and low (H-L) working memory loads. Academic achievement was measured by the Spanish version of the Woodcock-Johnson III test battery. The main results showed that higher cardiorespiratory fitness was associated with higher H-L current density differences in frontal, limbic, and occipital regions during encoding and maintenance task's phases (β≥0.412, p ≤ 0.019). A limbic area was further related to better working memory performance (β=0.267, p = 0.005). During retrieval, higher cardiorespiratory fitness was also associated with higher current density in temporal regions (β=0.265, p = 0.013), whereas lower muscular fitness was associated with higher current density in frontal regions (β=-0.261, p = 0.016). Our results suggest that cardiorespiratory fitness, but not speed-agility nor muscular fitness, is positively associated with brain current source density during working memory processes in children with overweight/obesity. Fitness-related current density differences in limbic regions were associated with better working memory.
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Affiliation(s)
- Jose Mora-Gonzalez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain.,College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Irene Esteban-Cornejo
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Jairo H Migueles
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - María Rodriguez-Ayllon
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Pablo Molina-Garcia
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Cristina Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain.,Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, Pamplona, Spain
| | - Patricio Solis-Urra
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain.,IRyS Research Group, School of Physical Education, Pontificia Universidad Católica de Valparaiso, Valparaiso, Chile
| | - Abel Plaza-Florido
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
| | - Arthur F Kramer
- Department of Psychology, Northeastern University, Boston, MA, USA.,Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Sennott Square, Pittsburgh, PA, USA
| | - Charles H Hillman
- Department of Psychology, Northeastern University, Boston, MA, USA.,Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Andrés Catena
- Department of Experimental Psychology, Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sports Science, University of Granada, Granada, Spain
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22
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Soch A, Spencer SJ. Consequences of early life overfeeding for microglia - Perspectives from rodent models. Brain Behav Immun 2020; 88:256-261. [PMID: 32088312 DOI: 10.1016/j.bbi.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 12/24/2022] Open
Abstract
The early life period is crucially important to how the individual develops, and environmental and lifestyle challenges during this time can lead to lasting programming effects on the brain and immune system. In particular, poor diet in early development can lead to long-term negative metabolic and cognitive outcomes, with those who over-eat in early development being at risk of obesity and poor learning and memory throughout their adult lives. Current research has identified a neuroinflammatory component to this metabolic and cognitive programming that can potentially be manipulated to restore a healthy phenotype. Thus, early life over-feeding in a rat model leads to microglial priming and an exacerbated microglial response to immune challenge when the rats reach adulthood. Microglial responses to a learning task are also impaired. To specifically investigate the role of microglia in these programming effects our group has developed a novel transgenic rat with a diphtheria toxin receptor insertion in the promoter region for the Cx3cr1 gene, expressed on microglia and monocytes; allowing us to conditionally ablate microglia throughout the brain. With this model we reveal that microglia have a direct role in regulating feeding behavior and modifying cognition, but are not likely to be the sole mechanism by which early life overfeeding confers lasting neuroimmune and cognitive effects. Additional work implicates changes to the hypothalamic-pituitary-adrenal axis in this. Together these data highlight the importance of dietary choices in early life and the potential for positive interventions targeting the neuroimmune and neuroendocrine stress systems to reverse such programming damage.
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Affiliation(s)
- Alita Soch
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic., Australia
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic., Australia; ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Melbourne, Vic., Australia.
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23
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Kirkegaard H, Möller S, Wu C, Häggström J, Olsen SF, Olsen J, Nohr EA. Associations of birth size, infancy, and childhood growth with intelligence quotient at 5 years of age: a Danish cohort study. Am J Clin Nutr 2020; 112:96-105. [PMID: 32232408 PMCID: PMC7326594 DOI: 10.1093/ajcn/nqaa051] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/24/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The correlates of prenatal and postnatal growth on Intelligence Quotient (IQ) in childhood in term-born children living in high-income countries are not well known. OBJECTIVES We examined how birth size and growth in infancy and childhood were associated with IQ at age 5 y in term-born children using path analysis. METHODS The study sample comprised 1719 children from the Danish National Birth Cohort who participated in a substudy in which psychologists assessed IQ using the Wechsler Primary and Preschool Scales of Intelligence-Revised. Measured weight, length/height, and head circumference at birth, 5 mo, 12 mo, and 5 y were included in a path model to estimate their total, indirect, and direct effects on IQ. All growth measures were included in the model as sex- and age-standardized z-scores. RESULTS After adjusting for potential confounders, a positive association between birth weight and IQ was observed, and 88% of the association was direct. Weight gain in infancy was associated with IQ [per z-score increase from 5 to 12 mo, IQ increased by 1.53 (95% CI: 0.14; 2.92) points] whereas weight gain from 12 mo to 5 y was not associated with IQ. Height and head circumference growth in childhood was associated with IQ [per z-score increase from 12 mo to 5 y, IQ increased by 0.98 (95% CI: 0.17; 1.79) and 2.09 (95% CI: 0.78; 3.41) points, respectively]. CONCLUSIONS In children born at term in an affluent country with free access to health care, higher IQ was seen with greater size at birth and greater weight gain in infancy. Also, greater growth in height and head circumference throughout the first 5 y of life was associated with higher childhood IQ whereas greater weight gain after the first year of life was not.
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Affiliation(s)
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Chunsen Wu
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Sjurdur Frodi Olsen
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Aagaard Nohr
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Mora‐Gonzalez J, Esteban‐Cornejo I, Cadenas‐Sanchez C, Migueles JH, Rodriguez‐Ayllon M, Molina‐García P, Hillman CH, Catena A, Pontifex MB, Ortega FB. Fitness, physical activity, working memory, and neuroelectric activity in children with overweight/obesity. Scand J Med Sci Sports 2019; 29:1352-1363. [DOI: 10.1111/sms.13456] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/06/2019] [Accepted: 04/25/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Jose Mora‐Gonzalez
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
- Department of Kinesiology Michigan State University East Lansing Michigan
| | - Irene Esteban‐Cornejo
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
- Department of Psychology Northeastern University Boston Massachusetts
| | - Cristina Cadenas‐Sanchez
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
| | - Jairo H. Migueles
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
| | - Maria Rodriguez‐Ayllon
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
| | - Pablo Molina‐García
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
| | - Charles H. Hillman
- Department of Psychology Northeastern University Boston Massachusetts
- Department of Physical Therapy, Movement & Rehabilitation Sciences Northeastern University Boston Massachusetts
| | - Andrés Catena
- Department of Experimental Psychology, Mind, Brain and Behaviour Research Centre (CIMCYC) University of Granada Granada Spain
| | | | - Francisco B. Ortega
- PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical and Sports Education, Faculty of Sports Sciences University of Granada Granada Spain
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Li N, Arbuckle TE, Muckle G, Lanphear BP, Boivin M, Chen A, Dodds L, Fraser WD, Ouellet E, Séguin JR, Velez MP, Yolton K, Braun JM. Associations of cord blood leptin and adiponectin with children's cognitive abilities. Psychoneuroendocrinology 2019; 99:257-264. [PMID: 30390444 PMCID: PMC6239208 DOI: 10.1016/j.psyneuen.2018.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022]
Abstract
Background Adipocytokines may play a role in fetal programming of neurodevelopment. We aimed to investigate the associations between cord blood adipocytokine concentrations and children's intelligence test scores. Methods We used data from two ongoing pregnancy cohorts in North America: the Maternal-Infant Research on Environmental Chemicals (MIREC, n = 429) and Health Outcomes and Measures of the Environment (HOME, n = 183) Studies. Umbilical cord blood adipocytokine concentrations were measured using enzyme-linked immunosorbent assays. We assessed children's Intelligence Quotient (IQ) and its components using the Wechsler Preschool and Primary Scales of Intelligence-III or Wechsler Intelligence Scale for Children-IV. We used linear regression and linear mixed models to estimate associations between log2-transformed adipocytokine concentrations and children's IQ after adjusting for sociodemographic, perinatal, and child factors. Results After adjusting for covariates, cord blood adiponectin was positively associated with children's full-scale IQ scores at age 3 years in the MIREC Study (β = 1.4, 95% confidence interval [CI]: 0.2, 2.5) and at ages 5 and 8 years in the HOME Study (β = 1.7, CI: -0.1, 3.5). Adiponectin was positively associated with performance IQ in both studies (MIREC: β = 2.0, CI: 0.7, 3.3; HOME: β = 2.2, CI: 0.5, 3.9). Adiponectin was positively associated with working memory composite scores at age 8 in the HOME Study (β = 3.1, CI: 1.0, 5.2). Leptin was not associated with children's IQ in either study. Conclusions Cord blood adiponectin was associated with higher full-scale and performance IQ and working memory composite scores in children. Future studies are needed to explore the mechanisms underlying these associations.
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Affiliation(s)
- Nan Li
- Department of Epidemiology, Brown University, Providence, RI, United States.
| | - Tye E Arbuckle
- Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Gina Muckle
- School of Psychology, Laval University, Ville de Québec, Québec, Canada
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada; Child and Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Michel Boivin
- School of Psychology, Laval University, Ville de Québec, Québec, Canada
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Linda Dodds
- Perinatal Epidemiology Research Unit, IWK Health Center, Halifax, Canada
| | - William D Fraser
- Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Mother and Child University Hospital Center, Montreal, Québec, Canada; Centre de recherche du CHUS (CHU de Sherbrooke), University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Emmanuel Ouellet
- CHU de Québec-Université Laval Research Center, Ville de Québec, Québec, Canada
| | - Jean R Séguin
- Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Mother and Child University Hospital Center, Montreal, Québec, Canada; Department of Psychiatry, University of Montréal, Montréal, Québec, Canada
| | - Maria P Velez
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Kimberly Yolton
- Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, United States
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