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Rezaeizadeh G, Mansournia MA, Keshtkar A, Farahani Z, Zarepour F, Sharafkhah M, Kelishadi R, Poustchi H. Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102574. [PMID: 38596614 PMCID: PMC11001623 DOI: 10.1016/j.eclinm.2024.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/11/2024] Open
Abstract
Background The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies. Methods Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated. Findings The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD -0.028, 95% CI -0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD -0.045, 95% CI -0.079 to -0.011) but not in highly educated populations (MD 0.003, 95% CI -0.093 to 0.098). Interpretation Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better. Funding This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).
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Affiliation(s)
- Golnaz Rezaeizadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Keshtkar
- Department of Disaster and Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Farahani
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zarepour
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Paediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Layte R, Cronin FM, Nivakoski S, McEvoy O, Brannigan R, Stanistreet D. The relative roles of early life, physical activity, sedentarism and diet in social and economic inequalities in body mass index and obesity risk between 9 and 18. SSM Popul Health 2023; 24:101499. [PMID: 37731532 PMCID: PMC10507434 DOI: 10.1016/j.ssmph.2023.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
Background Studies in many middle and high-income countries describe an increasing prevalence of adiposity and obesity among children and adolescents. Prevalence is higher among families of low socioeconomic position (SEP) and systematic reviews have identified relevant factors, but have not quantified their relative importance to SEP differentials. This paper examines the relative importance of different factors to Body Mass Index (BMI) and obesity trajectories from age 9 to age 17/18. Methods Multi-level models of child BMI/obesity risk trajectory by maternal education were conducted using a nationally representative cohort of children born in Ireland in 1998 and aged 9 at baseline (N = 8568), with follow-up at 13 and 17/18 years (88% and 73% response rate respectively). Models were stratified by sex and both time-varying (e.g. child physical activity, diet, sedentary activity) and time-invariant (e.g. early life) factors were tested. Results Significant inverse gradients in BMI and obesity risk by level of maternal education were present across both sexes and at each age; unadjusted absolute differentials in obesity risk between highest/lowest education groups increased by 56% for males and 42% for females between age 9 and 17/18. Early life factors accounted for 22% of the differential in obesity risk between the lowest and highest education groups among males at age 9, falling to 13% at 17/18. Among females the proportion fell from 33 to 23%. Unadjusted absolute high/low maternal education group differentials in BMI were 7.5 times higher among males and 11 times higher among females at 17/18 than at age 9. Conclusions Given the importance of early life exposures to subsequent differentials in BMI and obesity risk our findings suggest that policy makers should focus resources on primary prevention during the prenatal and early life period if they wish to reduce the prevalence of child and adolescent obesity.
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Affiliation(s)
- Richard Layte
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Frances M. Cronin
- School of Population Health, Royal College of Surgeons University of Medicine and Health Sciences in Ireland, Dublin 2, Ireland
| | - Sanna Nivakoski
- European Foundation for Living and Working Conditions, Dublin, Ireland
| | - Olivia McEvoy
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Ross Brannigan
- School of Population Health, Royal College of Surgeons University of Medicine and Health Sciences in Ireland, Dublin 2, Ireland
| | - Debbi Stanistreet
- School of Population Health, Royal College of Surgeons University of Medicine and Health Sciences in Ireland, Dublin 2, Ireland
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Priest N, Guo S, Gondek D, O'Connor M, Moreno-Betancur M, Gray S, Lacey R, Burgner DP, Woolfenden S, Badland H, Redmond G, Juonala M, Lange K, Goldfeld S. The potential of intervening on childhood adversity to reduce socioeconomic inequities in body mass index and inflammation among Australian and UK children: A causal mediation analysis. J Epidemiol Community Health 2023; 77:632-640. [PMID: 37536921 PMCID: PMC10527996 DOI: 10.1136/jech-2022-219617] [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: 07/25/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Lower maternal education is associated with higher body mass index (BMI) and higher chronic inflammation in offspring. Childhood adversity potentially mediates these associations. We examined the extent to which addressing childhood adversity could reduce socioeconomic inequities in these outcomes. METHODS We analysed data from two early-life longitudinal cohorts: the Longitudinal Study of Australian Children (LSAC; n=1873) and the UK Avon Longitudinal Study of Parents and Children (ALSPAC; n=7085). EXPOSURE low/medium (below university degree) versus high maternal education, as a key indicator of family socioeconomic position (0-1 year). OUTCOMES BMI and log-transformed glycoprotein acetyls (GlycA) (LSAC: 11-12 years; ALSPAC: 15.5 years). Mediator: multiple adversities (≥2/<2) indicated by family violence, mental illness, substance abuse and harsh parenting (LSAC: 2-11 years; ALSPAC: 1-12 years). A causal mediation analysis was conducted. RESULTS Low/medium maternal education was associated with up to 1.03 kg/m2 higher BMI (95% CI: 0.95 to 1.10) and up to 1.69% higher GlycA (95% CI: 1.68 to 1.71) compared with high maternal education, adjusting for confounders. Causal mediation analysis estimated that decreasing the levels of multiple adversities in children with low/medium maternal education to be like their high maternal education peers could reduce BMI inequalities by up to 1.8% and up to 3.3% in GlycA. CONCLUSIONS Our findings in both cohorts suggest that slight reductions in socioeconomic inequities in children's BMI and inflammation could be achieved by addressing childhood adversities. Public health and social policy efforts should help those affected by childhood adversity, but also consider underlying socioeconomic conditions that drive health inequities.
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Affiliation(s)
- Naomi Priest
- Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory, Australia
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Shuaijun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dawid Gondek
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Meredith O'Connor
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children's LifeCourse Initiative, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margarita Moreno-Betancur
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sarah Gray
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Lacey
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - David P Burgner
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
| | - Gerry Redmond
- College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, TYKS Turku University Hospital, Turku, Finland
| | - Katherine Lange
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Molecular Immunity Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders. J Adolesc Health 2022; 71:502-507. [PMID: 35739006 DOI: 10.1016/j.jadohealth.2022.05.004] [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: 12/05/2021] [Revised: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents. METHODS Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12-17 years using data from National Health Interview Survey 2016-2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions. RESULTS When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security. DISCUSSION This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.
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Vineis P, Barouki R. The exposome as the science of social-to-biological transitions. ENVIRONMENT INTERNATIONAL 2022; 165:107312. [PMID: 35635963 DOI: 10.1016/j.envint.2022.107312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
The understanding of disease etiology and pathogenesis has radically changed as a consequence of the new challenges posed by climate change, environmental degradation and emerging infectious diseases. The awareness of the influence of distal causes (e.g. planetary changes at the roots of new pandemics), of the social environment and of early life exposures calls for innovative models of disease onset. Here we propose a scheme for the practice of epidemiology and toxicology that incorporates new recent advancements in both disciplines, under the general umbrella of the "exposome". The exposome approach to disease encompasses a lifecourse perspective from conception onwards, and the investigation of the role played by all exposures individuals undergo in their lives. These include social inequalities and psychosocial influences, in addition to chemical, biological and physical exposures. We stress the role played by social differences and inequalities in the course of life as an overarching factor that influences downstream layers (including behaviours). We show that the idea of "lifecourse exposome" is compatible with the current interpretation of Adverse Outcome Pathways in toxicology, and in fact we propose an extension of the concept towards "lifecourse Adverse Outcome Pathways". We propose to merge different research perspectives and promote an encounter between the sociological perspective of "biography" (using Pierre Bourdieu's conceptual framework) and biology, according to the idea of accumulated biological capital of individuals. We also propose to treat social capital (including inequalities) no longer as a confounding factor but as an overarching determinant, perhaps the most important of all because it is the one that influences all other exposures downstream. The importance of early exposures in a lifecourse perspective leads to policy implications, i.e. investing more in the various forms of capital (social, economic, cultural) in early life.
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Affiliation(s)
- Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, United Kingdom.
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Almeida DQ, Barros H, Ribeiro AI. Residential and school green and blue spaces and intelligence in children: The Generation XXI birth cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 813:151859. [PMID: 34826494 DOI: 10.1016/j.scitotenv.2021.151859] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
Green and blue spaces have numerous health benefits. It has been hypothesized that contact with these spaces can have an important role in cognitive development, because it provides children with unique stimuli that can help develop curiosity, creativity, awareness, and control. This study aimed to estimate the association between exposure to green and blue spaces and the various measures of intelligence quotient (IQ) among children from Porto Metropolitan Area (Portugal). This investigation used data from the Generation XXI birth cohort. Exposure was assessed by Geographic Information Systems using vegetation indexes and measures of accessibility to urban green spaces and blue spaces in the surroundings of the residence and school, measured at 0, 4, 7 and 10 years. The outcome was the verbal, performance, and global IQ, measured using the Wechsler Intelligence Scale for Children (WISC-III), administered at age 10. Associations were estimated using crude and adjusted multilevel models. The mediation role of air pollution and physical activity was quantified. This study included 3827 children. The adjusted models showed that having green spaces up to 800 m of the residence was positively associated with performance IQ (1.30 95%CI [0.26; 2.35]) and global IQ (1.27 [0.18; 2.36]). No clear associations were observed regarding accessibility to blue spaces. Physical activity appeared to have a minor mediation role. Children with urban green spaces around their residences had higher performance and global IQ. Local actors in the sectors of public health and urban planning should promote the creation of green spaces close to residential areas.
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Affiliation(s)
- Diogo Queiroz Almeida
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Unidade de Saúde Pública, Unidade Local de Saúde de Matosinhos, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal.
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Lassale C, Fitó M, Morales-Suárez-Varela M, Moya A, Gómez SF, Schröder H. Mediterranean diet and adiposity in children and adolescents: A systematic review. Obes Rev 2022; 23 Suppl 1:e13381. [PMID: 34816577 DOI: 10.1111/obr.13381] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023]
Abstract
Our aim was to summarize, through a systematic review, the current evidence from dietary intervention and observational studies on the impact of adherence to the Mediterranean diet on adiposity markers and obesity in children and adolescents. We searched Medline up to June 1, 2021 for the identification of intervention and observational studies meeting the inclusion criteria, following the PRISMA statement. We included 55 articles: 8 intervention studies and 47 observational studies. Three trials report a beneficial effect of the dietary intervention, whereas two did not, and three did not compare with a control. All observational studies were cross-sectional, and only five studies also included a longitudinal analysis. More than half of the cross-sectional studies found no significant association between adherence to Mediterranean diet and adiposity. Three out of the five longitudinal studies found a negative association. The majority of both observational and intervention studies was of low quality. Despite a large number of published studies, overall, there is only limited evidence of a beneficial effect of following a traditional Mediterranean diet to maintain a healthy body weight in childhood. More high-quality intervention and longitudinal data are needed to form the base of large-scale health programs to prevent childhood obesity.
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Affiliation(s)
- Camille Lassale
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Montserrat Fitó
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Andrés Moya
- CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,Institute of Integrative Systems Biology, Universitat de València and Spanish Research Council (CSIC), Valencia, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Santiago F Gómez
- Gasol Foundation, Sant Boi de Llobregat, Spain.,GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain
| | - Helmut Schröder
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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Socioeconomic inequalities in children's weight, height and BMI trajectories in Norway. Sci Rep 2021; 11:4979. [PMID: 33654136 PMCID: PMC7925535 DOI: 10.1038/s41598-021-84615-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/17/2021] [Indexed: 01/31/2023] Open
Abstract
Studies exploring when social inequalities in body mass index (BMI) and its composites emerge and how these evolve with age are limited. Thus, this study explored parental income and education related inequalities in children's weight, height, weight velocity and body mass index among Norwegian children from 1 month to 8 years. The study population included 59,927 family/children pairs participating in the Norwegian Mother, Father, and Child Cohort Study. Growth was modelled using the Jenss-Bayley model and linear mixed effects analyses were conducted. Maternal and paternal educational differences in children's weight and BMI trajectories emerged during infancy, continuing to age 8 years. Parental income-related inequalities in children's weight were observed from the age of 1 month to 4 years for maternal and up to 1 year for paternal income-related differences but then disappeared. Parental income-related inequalities in child's BMI were observed from 18 months to 8 years for maternal income, and from 9 months to 8 years for paternal income-related differences. These results suggest that social inequalities in children's BMI present early in infancy and continue to 8 years of age. The inequalities sometimes differed by indicator of socioeconomic position used. Interventions to combat these inequalities early in life are, thus needed.
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Variation in outcomes of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) according to maternal education and age 2 and 3·5 years post-intervention. Public Health Nutr 2021; 24:1460-1468. [PMID: 33427160 DOI: 10.1017/s1368980021000045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age. DESIGN Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children's BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years). SETTING Population based. PARTICIPANTS Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old. RESULTS At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively. CONCLUSIONS Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother's education level or age, which is important in community-based interventions.
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Ribeiro AI, Fraga S, Correia-Costa L, McCrory C, Barros H. Socioeconomic disadvantage and health in early childhood: a population-based birth cohort study from Portugal. Pediatr Res 2020; 88:503-511. [PMID: 32005033 DOI: 10.1038/s41390-020-0786-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Measuring early socioeconomic inequalities in health provides evidence to understand the patterns of disease. Thus, our aim was to determine which children's health outcomes are patterned by socioeconomics and to what extent the magnitude/direction of the differences vary by socioeconomic measure and outcome. METHODS Data on early childhood (4 years) health was obtained from Generation XXI birth cohort (n = 8647). A total of 27 health outcomes and 13 socioeconomic indicators at the individual level and neighbourhood level were used to calculate the relative index of inequality (RII). RESULTS Socioeconomic inequalities were evident across 21 of the 27 health outcomes. Education, occupation and income more often captured inequalities, compared with neighbourhood deprivation or employment status. Using highest maternal education as reference category, we observed that seizures (RII = 8.64), obesity (2.94), abdominal obesity (2.66), urinary tract infection (2.26), language/speech problems (2.24), hypertension (2.08) and insulin resistance (1.33) were heavily socially patterned, much more common in disadvantaged children. Contrastingly, eczema (0.26) and rhinitis (0.26) were more common among more advantaged children. CONCLUSIONS Socioeconomic inequalities were evident for almost every health outcome assessed, although with varying magnitude/direction according to the socioeconomic indicator and outcome. Our results reinforce that the social gradient in health manifests early in childhood.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal. .,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Sílvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Liane Correia-Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Division of Pediatric Nephrology, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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11
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Madden D. BMI mobility and obesity transitions among children in Ireland. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100896. [PMID: 32526642 DOI: 10.1016/j.ehb.2020.100896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
This paper examines mobility and changes in Body Mass Index (BMI) for a sample of Irish children/adolescents across three waves of the longitudinal Growing Up in Ireland dataset. Particular attention is paid to transitions across the key BMI thresholds of overweight and obesity. Analysis is carried out by gender and by maternal education. In general, mobility is observed, with intra-generational rank-rank BMI coefficients of around 0.63 compared to coefficients of around 0.77 for the mothers of the children over the same time period. Across the distribution as a whole there is relatively little variation by gender and maternal education. However there a gender difference in terms of mobility out of obesity with the Shorrocks mobility index across categories of normal weight/overweight/obesity taking a value of 0.56 for females as opposed to 0.71 for males. This relative lack of mobility is more observed in later rather than earlier adolescence.
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Affiliation(s)
- David Madden
- School of Economics, University College Dublin, Belfield, Dublin 4, Ireland.
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12
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Evaluation of the Predictive Ability, Environmental Regulation and Pharmacogenetics Utility of a BMI-Predisposing Genetic Risk Score during Childhood and Puberty. J Clin Med 2020; 9:jcm9061705. [PMID: 32498346 PMCID: PMC7355743 DOI: 10.3390/jcm9061705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022] Open
Abstract
Polygenetic risk scores (pGRSs) consisting of adult body mass index (BMI) genetic variants have been widely associated with obesity in children populations. The implication of such obesity pGRSs in the development of cardio-metabolic alterations during childhood as well as their utility for the clinical prediction of pubertal obesity outcomes has been barely investigated otherwise. In the present study, we evaluated the utility of an adult BMI predisposing pGRS for the prediction and pharmacological management of obesity in Spanish children, further investigating its implication in the appearance of cardio-metabolic alterations. For that purpose, we counted on genetics data from three well-characterized children populations (composed of 574, 96 and 124 individuals), following both cross-sectional and longitudinal designs, expanding childhood and puberty. As a result, we demonstrated that the pGRS is strongly associated with childhood BMI Z-Score (B = 1.56, SE = 0.27 and p-value = 1.90 × 10−8), and that could be used as a good predictor of obesity longitudinal trajectories during puberty. On the other hand, we showed that the pGRS is not associated with cardio-metabolic comorbidities in children and that certain environmental factors interact with the genetic predisposition to the disease. Finally, according to the results derived from a weight-reduction metformin intervention in children with obesity, we discarded the utility of the pGRS as a pharmacogenetics marker of metformin response.
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13
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Vineis P, Avendano-Pabon M, Barros H, Bartley M, Carmeli C, Carra L, Chadeau-Hyam M, Costa G, Delpierre C, D'Errico A, Fraga S, Giles G, Goldberg M, Kelly-Irving M, Kivimaki M, Lepage B, Lang T, Layte R, MacGuire F, Mackenbach JP, Marmot M, McCrory C, Milne RL, Muennig P, Nusselder W, Petrovic D, Polidoro S, Ricceri F, Robinson O, Stringhini S, Zins M. Special Report: The Biology of Inequalities in Health: The Lifepath Consortium. Front Public Health 2020; 8:118. [PMID: 32478023 PMCID: PMC7235337 DOI: 10.3389/fpubh.2020.00118] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset—i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.
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Affiliation(s)
- Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mauricio Avendano-Pabon
- Department of Social Sciences, Health and Medicine, King's College London, London, United Kingdom
| | - Henrique Barros
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Mel Bartley
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Cristian Carmeli
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | | | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Giuseppe Costa
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Silvia Fraga
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Marcel Goldberg
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Benoit Lepage
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Thierry Lang
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Richard Layte
- Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Frances MacGuire
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dusan Petrovic
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | - Silvia Polidoro
- Molecular Epidemiology and Exposomics Unit, Italian Institute for Genomic Medicine, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy.,Department of Epidemiology, ASL TO3, Turin, Italy
| | - Oliver Robinson
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Zins
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
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14
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Vineis P, Avendano-Pabon M, Barros H, Bartley M, Carmeli C, Carra L, Chadeau-Hyam M, Costa G, Delpierre C, D'Errico A, Fraga S, Giles G, Goldberg M, Kelly-Irving M, Kivimaki M, Lepage B, Lang T, Layte R, MacGuire F, Mackenbach JP, Marmot M, McCrory C, Milne RL, Muennig P, Nusselder W, Petrovic D, Polidoro S, Ricceri F, Robinson O, Stringhini S, Zins M. Special Report: The Biology of Inequalities in Health: The Lifepath Consortium. Front Public Health 2020. [PMID: 32478023 DOI: 10.3389/fpubh.2020.00118/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset-i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.
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Affiliation(s)
- Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mauricio Avendano-Pabon
- Department of Social Sciences, Health and Medicine, King's College London, London, United Kingdom
| | - Henrique Barros
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Mel Bartley
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Cristian Carmeli
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | | | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Giuseppe Costa
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Silvia Fraga
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Marcel Goldberg
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Benoit Lepage
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Thierry Lang
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Richard Layte
- Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Frances MacGuire
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dusan Petrovic
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | - Silvia Polidoro
- Molecular Epidemiology and Exposomics Unit, Italian Institute for Genomic Medicine, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
- Department of Epidemiology, ASL TO3, Turin, Italy
| | - Oliver Robinson
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Zins
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
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15
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Promoting education is preventive medicine at its best. Pediatr Res 2020; 87:185-187. [PMID: 31683275 DOI: 10.1038/s41390-019-0656-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022]
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16
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Vineis P, Delpierre C, Castagné R, Fiorito G, McCrory C, Kivimaki M, Stringhini S, Carmeli C, Kelly-Irving M. Health inequalities: Embodied evidence across biological layers. Soc Sci Med 2019; 246:112781. [PMID: 31986347 DOI: 10.1016/j.socscimed.2019.112781] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
RATIONALE Socioeconomic disparities have been documented in major non-communicable diseases and in their risk factors, such as obesity, hypertension, diabetes, smoking, physical inactivity, unhealthful diet and heavy drinking. However, a key research question has remained unanswered: is there a separate biological embodiment of socio-economic conditions underlying health disparities, additional and independent of those risk factors? As lifelong socioeconomic circumstances cannot be randomised, one way forward is the examination of different biological layers of evidence, including molecular changes. METHOD In this methodological paper we report the association of socio-economic disadvantage with (a) long-term health outcomes, before and after taking risk factors into account; (b) biological intermediaries that increase susceptibility to disease, such as childhood obesity; (c) intermediate circulating biomarkers and omic measurements (transcriptomics, DNA methylation, inflammatory proteins, allostatic load); and (d) immunity. In our Lifepath consortium, these analyses have been performed in several cohort studies, countries and contexts, and at different stages of the life course in up to 1.7 million subjects. The main goal is to test the assumption that each layer (death, functional outcomes, DNA, RNA, proteins, infections) is characterized by different types of bias and confounding, and that consistency across layers reinforces causality assessment. RESULTS The findings show consistent associations of social disparities with unfavourable health outcomes spanning inflammatory biomarkers, DNA or RNA-based markers, infection, indicators of physical functioning and mortality. Although each of these associations has a different set of confounders, a dose-response relationship is nevertheless consistently observed, thus showing the power of our multi-layered approach. CONCLUSIONS This new evidence supports biological embodiment of social disadvantage, in addition to the impact of known (mainly behavioural) risk factors for disease.
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Affiliation(s)
- Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, W2 1 PG, UK; Italian Institute for Genomic Medicine, Torino, Italy.
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Raphaële Castagné
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Ireland
| | - Mika Kivimaki
- Department of Epidemiology, University College London, UK
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Cristian Carmeli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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17
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Ribeiro AI, Fraga S, Kelly-Irving M, Delpierre C, Stringhini S, Kivimaki M, Joost S, Guessous I, Gandini M, Vineis P, Barros H. Neighbourhood socioeconomic deprivation and allostatic load: a multi-cohort study. Sci Rep 2019; 9:8790. [PMID: 31217447 PMCID: PMC6584573 DOI: 10.1038/s41598-019-45432-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/06/2019] [Indexed: 11/09/2022] Open
Abstract
Living in deprived neighbourhoods may have biological consequences, but few studies have assessed this empirically. We examined the association between neighbourhood deprivation and allostatic load, a biological marker of wear and tear, taking into account individual's socioeconomic position. We analysed data from three cohort studies (CoLaus-Switzerland; EPIPorto-Portugal; Whitehall II-UK) comprising 16,364 participants. We defined allostatic load using ten biomarkers of dysregulated metabolic, cardiovascular, and inflammatory systems (body mass index; waist circumference; total, high and low density lipoprotein cholesterol; triglycerides; glucose; systolic and diastolic blood pressure; C-reactive protein). Mixed Poisson regression models were fitted to examine associations with neighbourhood deprivation (in quintiles, Q1-least deprived as reference). After adjustment for confounding variables, participants living in the most deprived quintile had 1.13 times higher allostatic load than those living in the least deprived quintile (Relative Risk, RR, for Q2 RR = 1.06, 95% CI 1.03-1.09; Q3 = 1.06, 1.03-1.10; Q4 = 1.09, 1.06-1.12; Q5 = 1.13, 1.09-1.16). This association was partially modified by individual's socioeconomic position, such that the relative risk was higher in participants with low socioeconomic position (Q5 vs Q1 1.16, 1.11-1.22) than those with high socioeconomic position (Q5 vs Q1 1.07, 1.01-1.13). Neighbourhood deprivation is associated with biological wear and tear, suggesting that neighbourhood-level interventions may yield health gains.
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Grants
- MR/L01341X/1 Medical Research Council
- MR/R024227/1 Medical Research Council
- MR/S011676/1 Medical Research Council
- K013351 Medical Research Council
- This study was supported by the European Commission (Horizon 2020 grant number 633666) and by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology &#x2013; FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investiga&#x00E7;&#x00E3;o em Epidemiologia - Instituto de Sa&#x00FA;de P&#x00FA;blica da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). This article is a result of the project DOCnet (NORTE-01-0145-FEDER-000003),supported by Norte Portugal Regional Operational Programme (NORTE 2020),under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).
- This study was supported by the European Commission (Horizon 2020 grant number 633666) and by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology &#x2013; FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investiga&#x00E7;&#x00E3;o em Epidemiologia - Instituto de Sa&#x00FA;de P&#x00FA;blica da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013); and the Postdoc grant SFRH/BPD/97015/2013 (Silvia Fraga), co-funded by the FCT and the POPH/FSE Program. This article is a result of the project DOCnet (NORTE-01-0145-FEDER-000003), supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF).
- MK is supported by the UK Medical Research Council (K013351, MR/R024227), NordForsk, the Nordic Programme on Health and Welfare, the Academy of Finland (311492), and a Helsinki Institute of Life Science fellowship This study was supported by the European Commission (Horizon 2020 grant number 633666)
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600, Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Silvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Michelle Kelly-Irving
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Cyrille Delpierre
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Mika Kivimaki
- University College London, Department of Epidemiology and Public Health, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Stéphane Joost
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010, Lausanne, Switzerland
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- GIRAPH Lab (Geographic information for research and analysis in public health), Geneva, Switzerland
- La Source, School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- GIRAPH Lab (Geographic information for research and analysis in public health), Geneva, Switzerland
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, (TO), Italy
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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