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Ye M, Robson PJ, Eurich DT, Vena JE, Xu JY, Johnson JA. Anthropometric changes and risk of diabetes: are there sex differences? A longitudinal study of Alberta's Tomorrow Project. BMJ Open 2019; 9:e023829. [PMID: 31326923 PMCID: PMC6661609 DOI: 10.1136/bmjopen-2018-023829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/19/2019] [Accepted: 06/21/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To characterise the sex-specific difference in the association between anthropometric changes and risk of diabetes in the general population in Canada. SETTING AND PARTICIPANTS From 2000 to 2008, Alberta's Tomorrow Project (ATP) invited Alberta's residents aged 35-69 years to a prospective cohort study. A total of 19 655 diabetes-free ATP participants having anthropometrics measured at the baseline and follow-ups were included. DESIGN AND OUTCOME MEASURES A longitudinal study design was used to examine the association between anthropometric changes and risk of diabetes and the sex difference in this association. Changes in weight, body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR) were calculated as the difference between baseline and follow-up measures. Diabetes cases were identified using the Canadian National Diabetes Surveillance System algorithm with administrative healthcare data (2000-2015) linked to the ATP cohort. The sex-specific association between anthropometric changes and incidence of diabetes were examined by multivariable Cox regression models. RESULTS Changes in weight, BMI, WC and WHR over time were positively associated with incidence of diabetes in both men and women. The sex difference in risk of diabetes associated with 1 standard deviation (SD) increase in anthropometrics was 0.07 (95% CI -0.02 to 0.14) for weight, 0.08 (95% CI -0.03 to 0.17) for BMI, 0.07 (95% CI -0.02 to 0.15) for WC and 0.09 (95% CI 0.03 to 0.13) for WHR. Similar results were found in sex difference in the associations with changes per 5% and changes per categories (5% loss, ±5%, 5% gain). CONCLUSIONS The positive association between anthropometric changes and risk of diabetes was generally stronger in men than in women. However, this sex-specific difference of approximately 10% of the total risk associated with anthropometric changes had limited significance. For population-based public health programmes aiming to control obesity and incidence of diabetes, it may not be necessary to set up sex-specific goals for anthropometric reduction.
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Affiliation(s)
- Ming Ye
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paula J Robson
- CancerControl Alberta, Alberta Health Services, Edmonton, Alberta, Canada
- Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jian-Yi Xu
- Alberta's Tomorrow Project, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Tran NTT, Blizzard CL, Luong KN, Truong NLV, Tran BQ, Otahal P, Nelson M, Magnussen C, Gall S, Bui TV, Srikanth V, Au TB, Ha ST, Phung HN, Tran MH, Callisaya M. The importance of waist circumference and body mass index in cross-sectional relationships with risk of cardiovascular disease in Vietnam. PLoS One 2018; 13:e0198202. [PMID: 29813112 PMCID: PMC5973604 DOI: 10.1371/journal.pone.0198202] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/15/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Waist circumference (WC) is an indicator of intra-abdominal adipose tissue, high levels of which confer an increased risk of cardiometabolic disease. Population data on WC should be more informative than data on body mass index (BMI), which is a general indicator of body size. This study aimed to evaluate the importance of WC relative to BMI in cross-sectional relationships with blood pressure (BP), glucose, and total cholesterol (TC) in the adult population of Vietnam. METHODS The data were collected in a population-based survey conducted during 2009-10 using the "WHO STEPwise approach to surveillance of risk factors for non-communicable disease" (STEPS) methodology. The survey participants (n = 14 706 aged 25 to 64 years) were selected by multi-stage stratified cluster sampling from eight provinces representative of the eight geographical regions of Vietnam. All measurements were performed in accordance with the STEPS protocols. All analyses were performed using complex survey methods. RESULTS The measurements of WC and BMI were highly correlated (men r = 0.80, women r = 0.77). For men, the strongest and predominant associations with BP, glucose, and TC were for WC or an index based on WC. For women, this was true for glucose but BMI was more important for BP and TC. WC or an index based on WC provided better discrimination than BMI of hypertension and elevated glucose, and of raised TC for men. Information on four new anthropometric indices did not improve model fit or subject discrimination. CONCLUSION For BP/hypertension, glucose/elevated glucose, and TC/raised TC, WC was more informative than BMI for Vietnamese men, but both WC and BMI were important for Vietnamese women. Both WC and BMI need to be assessed for estimation of CVD risk in Vietnam.
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Affiliation(s)
- Nga Thi Thu Tran
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Khue Ngoc Luong
- Medical Services Administration, Ministry of Health of the Socialist Republic of Vietnam, Ha Noi, Vietnam
| | - Ngoc Le Van Truong
- Medical Services Administration, Ministry of Health of the Socialist Republic of Vietnam, Ha Noi, Vietnam
| | - Bao Quoc Tran
- Medical Services Administration, Ministry of Health of the Socialist Republic of Vietnam, Ha Noi, Vietnam
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Costan Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tan Van Bui
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Velandai Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Thuy Bich Au
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Son Thai Ha
- Medical Services Administration, Ministry of Health of the Socialist Republic of Vietnam, Ha Noi, Vietnam
| | - Hai Ngoc Phung
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mai Hoang Tran
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Hui LL, Nelson EAS, Wong MY, Chung TWH, Lee KKY, Leung GM, Schooling CM. The Association of Intergenerational Mismatch With Adiposity and Blood Pressure in Childhood and Adolescence. J Adolesc Health 2018; 62:100-106. [PMID: 29056438 DOI: 10.1016/j.jadohealth.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE An intergenerational "mismatch," a transition from limited to plentiful living conditions over generations, may increase cardiovascular disease risks. In a migrant population within a homogenous culture, we tested the hypothesis that an intergenerational mismatch in childhood living condition is associated with higher body mass index (BMI) and blood pressure in childhood and adolescence. METHODS We used data from 6,965 native born Chinese in Hong Kong (participated in "Children of 1997" birth cohort) and migrant Chinese born elsewhere in China in 1997 (N = 9,845). We classified children into those with intergenerational mismatch (child migrants or first-generation migrants) or those without (second+-generation migrants). Generalized estimating equations were used to examine the associations of migration status (child migrants, first-generation migrants or second+-generation migrants) with age- and sex-specific BMI z-score at 8-15 years and age-, sex-, and height-specific blood pressure z-score at 11-13 years, adjusted for sex, month of birth, and age. RESULTS Compared with second+-generation migrants, first-generation migrants had higher diastolic blood pressure z-score (.04, 95% confidence interval (CI) .02, .06) and BMI z-score (.12, 95% CI .06, .18), whereas child migrants had higher diastolic blood pressure z-score (.03, 95% CI .01, .05) regardless of age at migration and higher BMI z-score if they had migrated in infancy (.17, 95% CI .11, .23). CONCLUSION Different relations for blood pressure and BMI suggest that intergenerational mismatch and proximal exposures may have different impacts on adiposity and blood pressure.
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Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hongkong; Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hongkong
| | - E Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hongkong
| | - M Y Wong
- Department of Mathematics, The Hong Kong University of Science & Technology, Hongkong
| | - Thomas W H Chung
- Department of Health, Student Health Service, Hong Kong Special Administrative Region
| | - Karen K Y Lee
- Department of Health, Student Health Service, Hong Kong Special Administrative Region
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hongkong
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hongkong; City University of New York Graduate School of Public Health and Health Policy, New York, New York.
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Hui LL, Leung GM, Schooling CM. Social Patterning in Adiposity in Adolescence: Prospective Observations from the Chinese Birth Cohort ''Children of 1997''. PLoS One 2016; 11:e0146198. [PMID: 26735134 PMCID: PMC4703380 DOI: 10.1371/journal.pone.0146198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/13/2015] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Low early life socio-economic position is more strongly associated with adiposity among women than men. We examined whether the sex difference of social patterning in general and central adiposity exists before adulthood. METHODS In Hong Kong's "Children of 1997" birth cohort, we used multivariable regression to examine the association of parental education, a marker of early life socio-economic position, with body mass index (BMI) (n = 7252, 88% follow-up) and waist-height ratio (n = 5636, 68% follow-up), at 14 years. RESULTS Parental education of Grade 9 or below, compared to Grade 12 or above, was associated with higher waist-height ratio z-score particularly in girls (0.30, 95% confidence interval (CI) 0.19, 0.41) compared to boys (0.12, 95% CI 0.02, 0.22) (p for sex interaction = 0.02). Lower parental education was associated with greater BMI z-score in adolescents of locally born mothers, but not adolescents of migrant mothers, with no difference by sex. CONCLUSIONS Different social patterning in different markers of adiposity may imply different sociological and biological mediating pathways. A stronger association between low early life socio-economic position and waist-height ratio in adolescent girls may indicate sex-specific influences of SEP related early life exposures on central adiposity.
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Affiliation(s)
- L. L. Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gabriel M. Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C. Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- CUNY School of Public Health and Hunter College, New York City, New York, United States of America
- * E-mail:
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Schooling CM, Kelvin EA, Jones HE. Alanine transaminase has opposite associations with death from diabetes and ischemic heart disease in NHANES III. Ann Epidemiol 2012; 22:789-98. [DOI: 10.1016/j.annepidem.2012.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 08/04/2012] [Accepted: 08/06/2012] [Indexed: 12/21/2022]
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Lin SL, Lee SL, Hui LL, Au Yeung SL, Tse MA, Leung GM, Schooling CM. Pubertal muscle mass and diabetes markers in Chinese adolescents. Am J Hum Biol 2012; 24:183-5. [PMID: 22287498 DOI: 10.1002/ajhb.22210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 09/30/2011] [Accepted: 11/16/2011] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Diabetes is common in China despite a relatively nonobese population. We hypothesized that testosterone driven muscle mass acquisition at puberty may be relevant. We examined the associations of testosterone with muscle mass and of muscle mass with fasting glucose in Chinese adolescents. METHODS In 40 adolescents (20 boys and 20 girls, age 12.9 ± 0.1 years) from Hong Kong's "Children of 1997" birth cohort, we used multivariable linear regression to assess adjusted associations of testosterone and fasting glucose (from a morning blood sample) with muscle and fat mass from a dual-energy X-ray absorptiometry scan. RESULTS Testosterone was positively associated with muscle mass (0.05 kg, 95% confidence interval (CI) 0.01 to 0.09, per pg/ml testosterone). Muscle mass was associated with lower glucose (-0.04 mmol/l, 95% CI -0.08 to -0.01 per kg muscle mass) adjusted for sex and fat mass. CONCLUSIONS Environmentally driven muscle mass acquisition at puberty could influence diabetes.
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Affiliation(s)
- Shi Lin Lin
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Kavikondala S, Jiang CQ, Zhang WS, Cheng KK, Lam TH, Leung GM, Schooling CM. Intergenerational influences on diabetes in a developing population: the Guangzhou Biobank Cohort Study. Am J Hum Biol 2011; 23:747-54. [PMID: 21987430 DOI: 10.1002/ajhb.21206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 06/07/2011] [Accepted: 06/13/2011] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Intergenerational "mismatch" and/or growth conditions may be relevant to the epidemic of diabetes in developing populations. In a rapidly developing southern Chinese population, we tested whether maternal environment, proxied by maternal literacy, or family socio-economic position (SEP), proxied by paternal literacy, were associated with fasting glucose and diabetes. To assess if intergenerational mismatch contributed, we tested whether the associations varied by life course SEP. METHODS In 19,818 older (≥50 years) adults from the Guangzhou Biobank Cohort Study (phases 2 and 3), we used censored and logistic regression to assess the associations of maternal and paternal literacy with fasting glucose, elevated fasting glucose and diabetes and whether these associations varied by sex, age or life course SEP. RESULTS Maternal, but not paternal, literacy was negatively associated with fasting plasma glucose (β-coefficient -0.06 mmol/l, 95% confidence interval (CI) -0.11 to -0.01) and elevated fasting glucose (odds ratio (OR) 0.92, 95% CI 0.86-0.99) adjusted for age, sex, study phase, life course SEP, childhood growth, adiposity, number of offspring, and birth order. Associations of maternal and paternal literacy with fasting glucose, elevated fasting glucose and diabetes did not vary by sex, age or life course SEP. CONCLUSION Offspring of literate mothers had lower risk for impaired glucose tolerance than offspring of illiterate mothers. Being raised by literate mothers may increase the likelihood of children with higher SEP and lower long-term disease risk, or better maternal conditions over generations may be associated with lower fasting glucose.
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Affiliation(s)
- S Kavikondala
- Department of Community Medicine and School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
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Berentzen TL, Jakobsen MU, Halkjaer J, Tjønneland A, Sørensen TIA, Overvad K. Changes in waist circumference and the incidence of diabetes in middle-aged men and women. PLoS One 2011; 6:e23104. [PMID: 21829698 PMCID: PMC3150401 DOI: 10.1371/journal.pone.0023104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 07/08/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Waist circumference (WC) is positively associated with diabetes, but the association with changes in WC (DWC) is less clear. We investigated the association between DWC and the subsequent risk of diabetes in middle-aged men and women, and evaluated the influence from concurrent changes in body mass index (DBMI). METHODOLOGY/PRINCIPAL FINDINGS Data on 15,577 men and 20,066 women from the Danish Diet, Cancer and Health study were analyzed. Anthropometry was assessed in 1993-97 and 1999-02. Information on diabetes was obtained from The Danish National Diabetes Register. Hazard ratios (HR) were calculated from Cox' proportional hazard models with individuals considered at risk from 1999-02 until December 31 2006. During 5.4 years of follow-up, 1,027 and 876 new cases of diabetes occurred among men and women, respectively. WC was positively associated with diabetes in both sexes also with adjustment for covariates and BMI. DWC was positively associated with diabetes in women, but not in men (HR per 5 cm change = 1.09 (1.04:1.15) in women, and 1.00 (0.94, 1.07) in men with adjustment for covariates, baseline WC, BMI and DBMI). Associations with DWC were not notably different in sub-groups stratified according to baseline WC or DBMI, or when individuals with diseases or diabetes occurring within the first years of follow-up were excluded. CONCLUSIONS/SIGNIFICANCE While this study confirmed that WC is positively associated with the risk of diabetes in middle-aged men and women, it surprisingly showed that changes in WC were not associated with the subsequent risk of diabetes in men, and only weakly positively associated with the risk of diabetes in women. Accordingly, these findings suggest that a reduction in WC may be a weak or insufficient or target for prevention of diabetes in middle-aged men and women.
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Schooling CM, Hui LL, Ho LM, Lam TH, Leung GM. Cohort profile: 'children of 1997': a Hong Kong Chinese birth cohort. Int J Epidemiol 2011; 41:611-20. [PMID: 21224275 DOI: 10.1093/ije/dyq243] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- C Mary Schooling
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Schooling CM, Jiang C, Zhang W, Lam TH, Cheng KK, Leung GM. Adolescent Build and Diabetes: The Guangzhou Biobank Cohort Study. Ann Epidemiol 2011; 21:61-6. [DOI: 10.1016/j.annepidem.2010.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/11/2010] [Accepted: 08/26/2010] [Indexed: 10/18/2022]
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Schooling CM, Jiang C, Zhang W, Lam TH, Cheng KK, Leung GM. Size Does Matter: Adolescent Build and Male Reproductive Success in the Guangzhou Biobank Cohort Study. Ann Epidemiol 2011; 21:56-60. [DOI: 10.1016/j.annepidem.2010.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/17/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
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Schooling CM, Jiang CQ, Lam TH, Cowling BJ, Au Yeung SL, Zhang WS, Cheng KK, Leung GM. Estimated birth weight and adult cardiovascular risk factors in a developing southern Chinese population: a cross sectional study. BMC Public Health 2010; 10:270. [PMID: 20492733 PMCID: PMC2887395 DOI: 10.1186/1471-2458-10-270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/24/2010] [Indexed: 02/02/2023] Open
Abstract
Background Birth weight is negatively associated with cardiovascular diseases and diabetes, but the associations are less well-established in developing populations where birth weight is often unavailable. We studied the association of birth weight and cardiovascular risk, using birth rank as an instrumental variable, in Southern China. Methods We used published data on birth weight by birth rank from an appropriate population and baseline data from the Guangzhou Biobank Cohort Study phases 2 & 3 (2005-8) to examine the adjusted associations, using instrumental variable analysis, of birth weight with clinically measured cardiovascular risk factors and the metabolic syndrome in older (≥ 50 years) men (n = 5,051) and women (n = 13,907). Results Estimated birth weight was associated with lower blood pressure (systolic -0.25 mm Hg 95% confidence interval (CI), -0.53 to 0.03 and diastolic -0.33 mm Hg 95% CI -0.48 to -0.18 per standard deviation higher birth weight), but had little association with glucose, lipids, waist-hip ratio, body mass index or the metabolic syndrome, adjusted for age, sex, early environment and number of offspring. Conclusion Birth weight may impact blood pressure; however associations of birth weight with other cardiovascular risk factors may not be related to foetal exposures, but speculatively could be an historical co-incidence, with corresponding implications for prevention.
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Affiliation(s)
- C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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