Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan Family Study

Early life drought predicts components of adult body size in wild female baboons

OBJECTIVES

In many taxa, adverse early-life environments are associated with reduced growth and smaller body size in adulthood. However, in wild primates, we know very little about whether, where, and to what degree trajectories are influenced by early adversity, or which types of early adversity matter most. Here, we use parallel-laser photogrammetry to assess inter-individual predictors of three measures of body size (leg length, forearm length, and shoulder-rump length) in a population of wild female baboons studied since birth.

MATERIALS AND METHODS

Using >2000 photogrammetric measurements of 127 females, we present a cross-sectional growth curve of wild female baboons (Papio cynocephalus) from juvenescence through adulthood. We then test whether females exposed to several important sources of early-life adversity-drought, maternal loss, low maternal rank, or a cumulative measure of adversity-were smaller for their age than females who experienced less adversity. Using the "animal model," we also test whether body size is heritable in this study population.

RESULTS

Prolonged early-life drought predicted shorter limbs but not shorter torsos (i.e., shoulder-rump lengths). Our other measures of early-life adversity did not predict variation in body size. Heritability estimates for body size measures were 36%-67%. Maternal effects accounted for 13%-17% of the variance in leg and forearm length, but no variance in torso length.

DISCUSSION

Our results suggest that baboon limbs, but not torsos, grow plastically in response to maternal effects and energetic early-life stress. Our results also reveal considerable heritability for all three body size measures in this study population.

Tendencies Toward Supernormality/Subnormality in Generating Attractive and Unattractive Female and Male Avatars: Gender Differences

In the present study, we investigated the differences in the experience of attractiveness and unattractiveness of human bodies. A total of 101 participants (55 females) were asked to create the most attractive and the most unattractive female and male figures using a computer animation. They performed this task by adjusting the size of six body parts: shoulders, breasts/chest, waist, hips, buttocks, and legs. Analyses indicated that attractive body parts were distributed normally with the peak shifted to moderately supernormal sizes, while unattractive body parts had mostly U-shaped or skewed distributions with extremes in super-supernormal and/or subnormal sizes. Generally, both male and female attractive bodies had prominent "sporty" look: supernormally wide shoulders and long legs. Gender differences showed that men prefer more supernomal masculine and feminine sizes, while women show an ambivalence toward both groups of traits. Principal components analysis revealed gender differences on the multitrait level: males focus on prominent masculine and feminine traits, while women focus on traits that make both male and female bodies more elongated and slender. Gender differences were in line with specific male and female positions in the partner selection process, while a certain tendency toward masculinization of the female body required the inclusion of social factors, such as the influence of the culture of a sporty and fit look.

Secular trend of non-communicable chronic disease prevalence throughout the life span who endured Chinese Great Famine (1959-1961)

BACKGROUND

Famine is a risk factor for non-communicable chronic diseases (NCDs), which account for over 80% of deaths in China. The effect of famine on the prevalence of NCDs in terms of various age groups, time periods and cohorts is currently poorly understood.

OBJECTIVE

This study aims to explore long-term trends in the impact of China's Great Famine (1959-1961) on NCDs in China.

METHODS

This study used data from the 2010-2020 China Family Panel Longitudinal Survey across 25 provinces in China. The subjects were aged 18-85 years, and the total number of subjects was 174,894. The prevalence of NCDs was derived from the China Family Panel Studies database (CFPS). An age-period-cohort (APC) model was used to estimate the age, period and cohort effects of NCDs in 2010-2020 and the effect of famine on the risk of NCDs in terms of cohort effects.

RESULTS

The prevalence of NCDs increased with age. Additionally, the prevalence did not clearly decrease over the survey period. Regarding the cohort effect, people born in the years adjacent to the famine period had a higher risk of NCDs; additionally, females, those born in rural areas, and those who lived in provinces with severe famine and post-famine had a higher likelihood of NCDs.

CONCLUSIONS

Experiencing famine at an early age or the experience of famine in a close relative's generation (births after the onset of famine) are associated with an increased risk of NCDs. Additionally, more severe famine is associated with a higher risk of NCDs.

Lipid peroxidation biomarkers associated with height and obesity measures in the opposite direction in women

OBJECTIVE

This study aimed to investigate whether and how lipid peroxidation markers are associated with height and obesity measures.

METHODS

In two independent samples of women (Study 1: n = 1,005; Study 2: n = 1,158), systemic levels of lipid peroxidation were assessed by urinary markers F₂ -isoprostanes (F₂ -IsoPs) and its major metabolite (F₂ -IsoP-M), with gas chromatography/negative ion chemical ionization mass spectrometry assays. Anthropometric parameters were directly measured and genetically estimated, and they were used in the primary analysis and in a Mendelian randomization analysis in relation to lipid peroxidation, respectively, with general linear models.

RESULTS

After adjusting for potential confounders, it was found that measured adult height was inversely associated with levels of F₂ -IsoPs (β = -0.89, p < 0.001) and F₂ -IsoP-M (β = -0.71, p = 0.003), whereas obesity measures were positively associated with F₂ -IsoP-M (β = 1.81, p < 0.001 for BMI; and β = 0.77, p < 0.001 for waist circumference). Results were consistent between the two study samples. The opposite associations were further replicated when using genetically determined measures of height and obesity in the Mendelian randomization analysis. Moreover, analyses mutually adjusted for height and obesity measures suggested that these associations were independent of one another.

CONCLUSIONS

This study, for the first time, to our knowledge, reveals that a shared biological process (lipid peroxidation) is associated with both height and obesity measures but in the opposite direction.

Screening of hypertension, risks, knowledge/awareness in second-cycle schools in Ghana. A national cross-sectional study among students aged 12-22

In Ghana, the management of hypertension in primary health care is a cost-effective way of addressing premature deaths from vascular disorders that include hypertension. There is little or no evidence of large-scale studies on the prevalence, risk, and knowledge/awareness of hypertension in students aged 12-22 years in Ghana. In a cross-sectional study, blood pressure, anthropometric indices, and knowledge/awareness assessment of students at second-cycle schools were recorded from 2018 to 2020 in three regions of Ghana. Multistage cluster sampling was used in selecting regions and the schools. Prevalence of prehypertension and hypertension was categorized by the Joint National Committee 7, where appropriate, chi-square, scatter plots, and correlations were used in showing associations. A total of 3165 students comprising 1776 (56.1%) females and 1389 (43.9%) males participated in this study within three regions of Ghana. The minimum age was 12 years and the maximum age was 22 years. The mean age was 17.21 with standard deviation (SD: 1.59) years. A 95% confidence interval was set for estimations and a P value < 0.05 was set as significant. The prevalence rate of overall hypertension was 19.91% and elevated (prehypertension) was 26.07%. Risk indicators such as weight, BMI, waist circumference, physical activity, and form of the diet were positively correlated with hypertension. Among Ghanaian students currently in second-cycle educational institutions, 19.91% were hypertensive and 26.07% were prehypertensive. This may indicate a probable high prevalence of hypertension in the future adult population if measures are not taken to curb the associated risks.

Taller height and risk of coronary heart disease and cancer, a within-sibship Mendelian randomization study

Background:

Taller people have a lower risk of coronary heart disease but a higher risk of many cancers. Mendelian randomization (MR) studies in unrelated individuals (population MR) have suggested that these relationships are potentially causal. However, population MR studies are sensitive to demography (population stratification, assortative mating) and familial (indirect genetic) effects.

Methods:

In this study, we performed within-sibship MR analyses using 78,988 siblings, a design robust against demography and indirect genetic effects of parents. For comparison, we also applied population MR and estimated associations with measured height.

Results:

Within-sibship MR estimated that 1 SD taller height lowers the odds of coronary heart disease by 14% (95% CI: 3–23%) but increases the odds of cancer by 18% (95% CI: 3–34%), highly consistent with population MR and height-disease association estimates. There was some evidence that taller height reduces systolic blood pressure and low-density lipoprotein cholesterol, which may mediate some of the protective effects of taller height on coronary heart disease risk.

Conclusions:

For the first time, we have demonstrated that the purported effects of height on adulthood disease risk are unlikely to be explained by demographic or familial factors, and so likely reflect an individual-level causal effect. Disentangling the mechanisms via which height affects disease risk may improve the understanding of the etiologies of atherosclerosis and carcinogenesis.

Funding:

This project was conducted by researchers at the MRC Integrative Epidemiology Unit (MC_UU_00011/1) and also supported by a Norwegian Research Council Grant number 295989.

The Relationship between Adult Height and Blood Pressure

BACKGROUND

Identification and modification of cardiovascular risk factors is paramount to reducing cardiovascular disease morbidity and mortality. Hypertension is a major risk factor for cardiovascular disease, but its association with height remains largely underrecognized.

OBJECTIVES

The objective of this manuscript is to review the evidence examining the association between blood pressure and human stature and to summarize the plausible pathophysiological mechanisms behind such an association.

METHODS

A systematic review of adult human height and its association with hypertension and coronary artery disease was undertaken. The literature evidence is summarized and tabulated, and an overview of the pathophysiological basis for this association is presented.

RESULTS

Shorter arterial lengths found in shorter individuals may predispose to hypertension in a complex hemodynamic interplay, which is explained predominantly by summated arterial wave reflections and an elevated augmentation index. Our systemic review suggests that an inverse relationship between adult height and blood pressure exists. However, differences in the studied populations and heterogeneity in the methods applied across the various studies limit the generalizability of these findings and their clinical application.

CONCLUSION

Physiological studies and epidemiological data suggest a potential inverse association between adult height and blood pressure. Further research is required to define the relationship more clearly between adult height and blood pressure and to assess whether antihypertensive therapeutic approaches and goals should be modified according to patients' heights.

Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: a systematic review

INTRODUCTION

Child malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs.

METHODS

Our peer-reviewed search strategy focused on 'severe childhood malnutrition', 'LMICs', 'famine', and 'cardiometabolic NCDs' to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist.

RESULTS

We identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome.

CONCLUSION

Severe malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors' long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.

The association of serum levels of zinc and vitamin D with wasting among Iranian pre-school children

PURPOSE

Wasting is a main indicator of Child's undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years.

METHODS

This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < - 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated.

RESULTS

The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27-0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34-0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31-0.91).

CONCLUSION

The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders.

LEVEL OF EVIDENCE

Level III, case-control analytic studies.

Influence of height on blood pressure and hypertension among Bangladeshi adults

Background

Recent studies have reported that height is inversely associated with blood pressure and hypertension. However, there is lack of comprehensive findings from Bangladesh in this regard.

Objective

The purpose of this study was to explore the association between height and blood pressure in a Bangladeshi population.

Setting

Rural and urban sites from seven divisions of Bangladesh.

Participants

Participants were 7932 males and females (aged ≥35 years) evaluated in the 2011 Bangladesh Demographic Health Survey. Participants (n = 7647) who had complete height, weight, systolic and diastolic blood pressure (SBP and DBP) measurements and non-missing medication history, were included in the analysis.

Methods

Hypertension was defined as an SBP over 140 mmHg or/and a DBP over 90 mmHg, or current use of antihypertensive medication. Difference between SBP and DBP was calculated to get pulse pressure (PP). Multivariate linear and logistic regression models were used.

Results

PP decreased linearly with increasing height among males (−0.11, P < 0.05) and females (−0.19, P < 0.05) after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. SBP decreased linearly with increasing height among only females (−0.14, P < 0.05), after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. No association was found between quartiles of height and prevalence of hypertension.

Conclusions

Height was found to be inversely associated with pulse pressure in both sexes. Studies with longitudinal design are needed to investigate the association between shortness with blood pressure and hypertension.

Height predict incident non-alcoholic fatty liver disease among general adult population in Tianjin, China, independent of body mass index, waist circumference, waist-to-height ratio, and metabolic syndrome

Background

Early-life hormonal and nutritional factors can greatly influence the risk of non-alcoholic fatty liver disease (NAFLD). Adult height is a simple marker for these factors. This study aimed to investigate the association between adult height and NAFLD.

Methods

We performed a prospective cohort study of 35,994 participants aged 25 years or over with measured height at baseline. NAFLD was diagnosed by abdominal ultrasound and self-reported history of alcohol intake. Multivariable Cox proportional hazards regression models were conducted to assess the gender-specific association between height and the risk of NAFLD.

Results

During a follow-up period of 5.5 years, 6245 of 35,994 subjects developed NAFLD. The adjusted hazard ratios (95% confidence interval) of NAFLD for increasing quintiles of height were 1.00 (reference), 0.82 (0.73, 0.92), 0.84 (0.73, 0.97), 0.72 (0.61, 0.85) and 0.63 (0.50, 0.79) (P for trend < 0.0001) in males, and 1.00 (reference), 1.00 (reference), 0.80 (0.69, 0.91), 0.72 (0.61, 0.85), 0.60 (0.49, 0.74) and 0.45 (0.35, 0.59) (P for trend < 0.0001) in females, respectively.

Conclusions

A higher adult height was associated with lower risk of NAFLD among males and females in Tianjin, China.

Plasticity in the growth of body segments in relation to height-for-age and maternal education in Guatemala

Objectives

Plasticity in the growth of body segments between populations has been researched in relation to migration, temporal change and high‐altitude studies. We study the within population variation in body segments, thus controlling for some of the environmental and genetic differences that could be at play in between populations studies. We test a version of the thrifty phenotype hypothesis, where the growth of head‐trunk and hand are prioritized due to their functional significance over height and leg growth.

Materials and methods

A total of 3913 Guatemalan, rural, semi‐urban and urban, Maya and Ladino children 6 to 15 years old were studied. Height, sitting height, leg length, and metacarpal length were studied in relation to three proxies for living conditions: height‐ and leg length‐for‐age, and maternal education. Estimation statistics and null hypothesis significance testing were used to analyze the data.

Results

Metatarsal length and sitting height values were higher than height and leg length respectively. Relative metacarpal length was conserved across height‐for‐age groups. Females were less affected than males for metacarpal length and sitting height, but more affected for leg length.

Conclusion

Our results agree with the thrifty phenotype hypothesis, where metacarpal and sitting height growth would be prioritized over height and leg length due to greater functional significance.

Adult height and risk of death from all-cause, cardiovascular, and cancer-specific disease: The Rural Chinese Cohort Study

BACKGROUND AND AIMS

We aimed to evaluate the sex-specific association of height and all-cause and cause-specific mortality in rural Chinese adults.

METHODS AND RESULTS

A total of 17,263 participants (10,448 women) ≥18 years old were randomly enrolled during 2007-2008 and followed up during 2013-2014. Sex-specific hazard ratios (HRs) for the height-mortality association, assessed in quintiles or 5 cm increments, were calculated by Cox proportional-hazards models. For both men and women, tall participants showed a baseline prevalence of high levels of socioeconomic factors including income and education but low systolic blood pressure and total cholesterol level. During a median of 6.01 years of follow-up, 620 men (in 39,993.45 person-years) and 490 women (in 61,590.10 person-years) died. With increasing height, the risk of all-cause mortality decreased in a curvilinear trend after adjustment for baseline age, socioeconomic and behavioral factors, and anthropometric and laboratory measurements. For men, height was inversely associated with all-cause mortality (HR per 5 cm increase: 0.89, 95% CI: 0.83-0.96) and cardiovascular mortality (HR per 5 cm increase: 0.81, 95% CI: 0.72-0.91). For women, height was inversely associated with all-cause mortality (HR per 5 cm increase: 0.88, 95% CI: 0.81-0.96) and other mortality (HR per 5 cm increase: 0.82, 95% CI: 0.71-0.96).

CONCLUSIONS

Our study demonstrated a sex-specific inverse effect of height on mortality from different major causes in rural Chinese adults.

Association between height and hypercholesterolemia in adults: a nationwide population-based study in Korea

Background

Previous studies reported that stature is inversely related to the risk of cardiovascular disease. However, there is limited evidence on the association between height and lipid profiles. We aimed to examine the association of height with total cholesterol and hypercholesterolemia based on the nationally representative dataset of Korean adults.

Methods

The data of 13,701 adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey (2013–2015) were used in this nationwide population-based cross-sectional study. Hypercholesterolemia was defined as a serum total cholesterol level ≥ 240 mg/dL or use of lipid-lowering medications. Multivariable linear regression and logistic regression analyses were used to examine the association of height with mean total cholesterol level and odds ratios (ORs) of hypercholesterolemia.

Results

Approximately 17% of participants had hypercholesterolemia. Mean total cholesterol levels decreased in the higher quartile (Q) groups of height after adjusting for confounding variables including age, sex, body mass index, smoking status, alcohol consumption, physical activity, income, educational level, hypertension, and diabetes mellitus (P for trend = 0.035). After adjusting for these potential confounding variables, the adjusted ORs of hypercholesterolemia were significantly lower in the Q3 and Q4 groups than in the Q1 group; ORs decreased in the higher quartile groups of height (OR: 0.83, 95% confidence interval: 0.71–0.99 in Q3; 0.81, 0.69–0.95 in Q4, P for trend = 0.007). The association between height (Q4 vs. Q1–Q3) and hypercholesterolemia was stronger in men or individuals without hypertension or diabetes than in women or individuals with such diseases.

Conclusions

Height is inversely associated with total cholesterol level and odds of hypercholesterolemia among Korean adults. Childhood environment related to short stature may be associated with hypercholesterolemia and cardiovascular health in adulthood.

Secular changes in limb lengths and proportions from 1952 to 2011 in children, adolescents, and young adults from Kolkata (India)

OBJECTIVES

The aim of the study was to investigate the intergenerational changes of upper and lower limb lengths as well as the values of the upper, lower limb, and intermembral indicators of children, adolescents, and young adults from Kolkata (India) between 1952 to 1966 and 2005 to 2011.

METHODS

The analysis was based on the results of anthropometric measurements of 7488 Bengali children, adolescents, and young adults. They were included in three cross-sectional surveys, carried out in 1955 to 1966, 1982 to 1983 (only males), and 2005 to 2011. The upper and lower limb lengths were obtained and the upper and lower limb indicators, as well as an intermembral index, were calculated. The differences between the cohorts were assessed using two-way ANOVA.

RESULTS

Positive, statistically significant, secular trends regarding the length of the lower and upper limbs as well as the value of the lower limb index were observed. Negative intergenerational changes were noted for the values of the upper limb indicator and intermembral index, suggesting that the secular increase of the length of the upper limbs was less pronounced than those of the body height and lower limbs length.

CONCLUSIONS

The secular increase regarding the lower limbs length was associated with the socioeconomic progress of the country, but the length of the upper limbs was less sensitive for those factors. It is also important to mention that there is still very little information on those characteristics in general, which further proves the need for similar studies.

Early-life exposures and cardiovascular disease risk among Ghanaian migrant and home populations: the RODAM study

Early-life environmental and nutritional exposures are considered to contribute to the differences in cardiovascular disease (CVD) burden. Among sub-Saharan African populations, the association between markers of early-life exposures such as leg length and sitting height and CVD risk is yet to be investigated. This study assessed the association between leg length, sitting height, and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Ghanaian-born populations in Europe and Ghana. We constructed sex-specific quintiles for sitting height and leg length for 3250 participants aged 40-70 years (mean age 52 years; men 39.6%; women 60.4%) in the cross-sectional multicenter Research on Diabetes and Obesity among African Migrants study. Ten-year risk of ASCVD was estimated using the Pooled Cohort Equations; risk ≥7.5% was defined as "elevated" CVD risk. Prevalence ratios (PR) were estimated to determine the associations between sitting height, leg length, and estimated 10-year ASCVD risk. For both men and women, mean sitting height and leg length were highest in Europe and lowest in rural Ghana. Sitting height was inversely associated with 10-year ASCVD risk among all women (PR for 1 standard deviation increase of sitting height: 0.75; 95% confidence interval: 0.67, 0.85). Among men, an inverse association between sitting height and 10-year ASCVD risk was significant on adjustment for study site, adult, and parental education but attenuated when further adjusted for height. No association was found between leg length and estimated 10-year ASCVD risk. Early-life and childhood exposures that influence sitting height could be the important determinants of ASCVD risk in this adult population.

Socioeconomic circumstances and respiratory function from childhood to early adulthood: a systematic review and meta-analysis

OBJECTIVE

Disadvantaged socioeconomic circumstances in early life have the potential to impact lung function. Thus, this study aimed to summarise evidence on the association between socioeconomic circumstances and respiratory function from childhood to young adulthood.

DESIGN

Systematic review and meta-analysis.

METHODS

Following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, Medline, ISI-Web of Science and Scopus were searched from inception up to January 2018. Original studies on the association between socioeconomic circumstances and respiratory function in early ages (ie, participants younger than 25 years of age) were investigated. Two investigators independently evaluated articles, applied the exclusion criteria, extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A meta-analysis of the standardised mean difference and 95% CI in respiratory function between participants from different socioeconomic circumstances was conducted, using a random-effects model.

RESULTS

Thirty-three papers were included in this review and 23 showed that disadvantaged socioeconomic circumstances were significantly associated with reduced respiratory function. The meta-analysis including seven papers showed a significant difference of -0.31 (95% CI -0.42 to -0.21) litres in forced expiratory volume in the first second between children, adolescents and young adults from disadvantaged versus advantaged socioeconomic circumstances. Specifically a difference of -0.31 (95% CI -0.51 to -0.10) litres in girls and -0.43 (95% CI -0.51 to -0.35) litres in boys was observed.

CONCLUSIONS

Children, adolescents and young adults from disadvantaged socioeconomic circumstances had lower respiratory function, and boys presented higher respiratory health inequalities. This information contributes to explain the social patterning of respiratory diseases, and might enable health policy makers to tackle respiratory health inequalities at early ages.

Mendelian randomisation analyses find pulmonary factors mediate the effect of height on coronary artery disease

There is evidence that lower height is associated with a higher risk of coronary artery disease (CAD) and increased risk of type 2 diabetes (T2D). It is not clear though whether these associations are causal, direct or mediated by other factors. Here we show that one standard deviation higher genetically determined height (~6.5 cm) is causally associated with a 16% decrease in CAD risk (OR = 0.84, 95% CI 0.80-0.87). This causal association remains after performing sensitivity analyses relaxing pleiotropy assumptions. The causal effect of height on CAD risk is reduced by 1-3% after adjustment for potential mediators (lipids, blood pressure, glycaemic traits, body mass index, socio-economic status). In contrast, our data suggest that lung function (measured by forced expiratory volume [FEV1] and forced vital capacity [FVC]) is a mediator of the effect of height on CAD. We observe no direct causal effect of height on the risk of T2D.

Eosinophil levels predict lung function deterioration in apparently healthy individuals

Background

While chronic respiratory diseases are among the leading causes of mortality and morbidity worldwide, little is known about the effect of blood eosinophil levels on lung function trajectories among healthy individuals.

Methods

We analyzed data of apparently healthy individuals (n=18,089) recruited for the Tel Aviv Medical Center Inflammation Survey. Blood eosinophil levels were compared between participants with normal and those with abnormal lung function. Multivariate regression was used to assess the OR of forced expiratory volume in 1 second (FEV₁) deterioration according to baseline eosinophils in subjects with normal lung function (n=4,141) during a follow-up period of 4 years.

Results

Participants with an abnormal, as opposed to a normal, pulmonary function test (PFT) (n=1,832, 10.1%) had significantly higher eosinophil levels, expressed as a percentage or count (2.99%±2.00% compared to 2.67%±1.88% and 0.2210e3/µL±0.163/µL compared to 0.1810e3/µL±0.183/µL, respectively; P<0.001 for both). Among participants with a normal PFT at baseline, those with an eosinophil percentage higher than 4% showed a higher risk for FEV₁ decline above 60 mL/year (OR=1.199, 95% CI=1.005-1.431, P=0.044).

Conclusion

Our study suggests that higher blood eosinophil levels can predict PFT deterioration even in apparently healthy subjects, implying that these individuals could benefit from frequent lung function evaluation.

Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM): rationale and methods of a longitudinal observational study

INTRODUCTION

Mortality among children hospitalised for complicated severe acute malnutrition (SAM) remains high despite the implementation of WHO guidelines, particularly in settings of high HIV prevalence. Children continue to be at high risk of morbidity, mortality and relapse after discharge from hospital although long-term outcomes are not well documented. Better understanding the pathogenesis of SAM and the factors associated with poor outcomes may inform new therapeutic interventions.

METHODS AND ANALYSIS

The Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM) study is a longitudinal observational cohort that aims to evaluate the short-term and long-term clinical outcomes of HIV-positive and HIV-negative children with complicated SAM, and to identify the risk factors at admission and discharge from hospital that independently predict poor outcomes. Children aged 0-59 months hospitalised for SAM are being enrolled at three tertiary hospitals in Harare, Zimbabwe and Lusaka, Zambia. Longitudinal mortality, morbidity and nutritional data are being collected at admission, discharge and for 48 weeks post discharge. Nested laboratory substudies are exploring the role of enteropathy, gut microbiota, metabolomics and cellular immune function in the pathogenesis of SAM using stool, urine and blood collected from participants and from well-nourished controls.

ETHICS AND DISSEMINATION

The study is approved by the local and international institutional review boards in the participating countries (the Joint Research Ethics Committee of the University of Zimbabwe, Medical Research Council of Zimbabwe and University of Zambia Biomedical Research Ethics Committee) and the study sponsor (Queen Mary University of London). Caregivers provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and to caregivers at face-to-face meetings.

Early adulthood determinants of mid-life leisure-time physical inactivity stability and change: Findings from a prospective birth cohort

OBJECTIVES

Physical inactivity is highly prevalent. Knowledge is needed of influences on inactive lifestyles. We aimed to establish whether early adult factors predict subsequent inactivity patterns in mid-adulthood.

DESIGN

Leisure-time inactivity (activity frequency<1/week) was assessed at 33y and 50y in the 1958 British Birth cohort (N=12,271).

METHODS

We assessed associations of early adult (23-33y) physical status, mental function, social, family and neighbourhood circumstances with four 33-50y patterns (never inactive, persistently inactive, deteriorating or improving) using multinomial logistic regression with and without adjustment for childhood factors (e.g. social class).

RESULTS

Inactivity prevalence was similar at 33y and 50y (∼31%), but 17% deteriorated and 18% improved with age. Factors associated with persistent vs never inactive were: limiting illness (relative risk ratio (RRR):1.21(1.04,1.42) per number of ages exposed (0,1 or 2 times across ages 23y and 33y), obesity (1.33(1.16,1.54) per number of ages exposed), height (0.93(0.89,0.98) per 5cm), depression (1.32(1.19,1.47) per number of ages exposed); education (1.28(1.20,1.38) per decrease on 5-point scale) and neighbourhood (1.59(1.37,1.86) in 'industrial/local authority housing areas' and 1.33(1.12,1.58) in 'growth/metropolitan inner areas' vs 'suburbs, service, rural or seaside areas'). Associations were broadly similar for inactivity deterioration. Industrial/local authority housing areas (0.75(0.61,0.91)) and longer obesity exposure (0.78(0.64,0.95)) were associated with lower RRRs for improvement. Number of children was associated with improvement, although associations varied by age. Associations remained after adjustment for childhood factors.

CONCLUSIONS

Several early adult factors are associated with inactivity persistence and deterioration; fewer with improvement. Obesity duration and neighbourhood lived in during young adulthood had long-lasting associations with inactivity patterns in mid-life.

The influence of leg-to-body ratio, arm-to-body ratio and intra-limb ratio on male human attractiveness

Human mate choice is influenced by limb proportions. Previous work has focused on leg-to-body ratio (LBR) as a determinant of male attractiveness and found a preference for limbs that are close to, or slightly above, the average. We investigated the influence of two other key aspects of limb morphology: arm-to-body ratio (ABR) and intra-limb ratio (IR). In three studies of heterosexual women from the USA, we tested the attractiveness of male physiques that varied in LBR, ABR and IR, using figures that ranged from -3 to +3 standard deviations from the population mean. We replicated previous work by finding that the optimally attractive LBR is approximately 0.5 standard deviations above the baseline. We also found a weak effect of IR, with evidence of a weak preference for the baseline proportions. In contrast, there was no effect of ABR on attractiveness, and no interactions between the effects of LBR, ABR and IR. Our results indicate that ABR is not an important determinant of human mate choice for this population, and that IR may exert some influence but that this is much smaller than the effects of LBR. We discuss possible reasons for these results, including the limited variability in upper limb proportions and the potentially weak fitness-signal provided by this aspect of morphology.

Early-life nutritional status and metabolic syndrome: gender-specific associations from a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVE

In the present study we investigated gender-specific associations of low birth weight (LBW) and shorter relative leg length with metabolic syndrome (MetS) after adjusting for sociodemographic characteristics and health-related behaviours. We also investigated whether these associations are independent of age at menarche and BMI at 20 years old.

DESIGN

Cross-sectional analysis.

SUBJECTS

Baseline data from 12 602 participants (35-74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), 2008-2010.

SETTING

MetS was defined according to the revised National Cholesterol Education Program Adult Treatment Panel III guidelines. LBW (<2·5 kg) and age- and sex-standardized relative leg length (high, medium and low) were the explanatory variables studied. The strength of the associations between the explanatory variables and MetS was estimated by Poisson regression with robust variance.

RESULTS

MetS prevalence was 34·2 %; it was more prevalent in men (36·8 %) than in women (32·2 %). In multivariate analysis, LBW was associated (prevalence ratio; 95 % CI) with MetS only in women (1·28; 1·24, 1·45). Shorter leg length was associated with MetS in both men (1·21; 1·09, 1·35 and 1·46; 1·29, 1·65 for low and medium lengths, respectively) and women (1·12; 1·00, 1·25 and 1·40; 1·22, 1·59 for low and medium lengths, respectively). Additional adjustments for age at menarche and BMI at 20 years old did not change the associations.

CONCLUSIONS

Poor nutritional status as estimated by LBW and lower leg length in childhood was associated with a higher prevalence of MetS, although LBW was a significant factor only among women.

Adult Height, Prevalent Coronary Artery Calcium Score, and Incident Cardiovascular Disease Outcomes in a Multiethnic Cohort

We assessed the relationships among adult height, coronary artery calcium (CAC) score, incident atherosclerotic cardiovascular disease (ASCVD) events, and atrial fibrillation (AFib) in a multiethnic cohort. We used race/ethnicity-specific height (dichotomized by median value and in quartiles) as the predictor variable within the 4 racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (n = 6,814). After a mean of 10.2 years of follow-up (2000-2012), 556 ASCVD events (8.2%) and 539 AFib events (7.9%) occurred. Adult height was not associated with prevalent CAC score (ln(CAC + 1) or categories). Tall stature (i.e., race/ethnicity-specific height ≥median) had a significant but opposite association with future ASCVD and AFib (hazard ratios were 0.72 (95% confidence interval: 0.56, 0.92) and 1.38 (95% confidence interval: 1.07, 1.79), respectively). We observed a gradient-response but opposite association between quartiles of race/ethnicity-specific height and ASCVD/AFib events in our multivariable models. A formal test of interaction between race/ethnicity-specific height and sex was not significant in the ASCVD model (P = 0.78) but was significant in the AFib model (P = 0.03). Tall stature was associated (in a gradient-response fashion) with reduced risk of ASCVD events and increased risk of AFib. Adult height may signal interactions between genetic and environmental factors and may provide risk information independent of current traditional risk factors and CAC score.

The effect of leg-to-body ratio on male attractiveness depends on the ecological validity of the figures

Leg-to-body ratio (LBR) predicts evolutionary fitness, and is therefore expected to influence bodily attractiveness. Previous investigations of LBR attractiveness have used a wide variety of stimuli, including line drawings, silhouettes, and computer-generated images based on anthropometric data. In two studies, community samples of heterosexual women from the USA rated the attractiveness of male figures presented as silhouettes and as detailed computer-generated images with three different skin tones (white, black, and an artificial grey). The effects of LBR depended on the image format. In particular, a curve-fitting analysis indicated that the optimally-attractive LBR for silhouettes was fractionally below the baseline, whereas the optima for more detailed computer-generated images was approximately 0.5 s.d. above the baseline and was similar for all three skin-tones. In addition, the participants' sensitivity to changes in the LBR was lowest for the silhouettes and highest for the grey figures. Our results add to evidence that the most attractive LBR is close to, but slightly above, the population mean, and caution that the effects of limb proportions on attractiveness depend on the ecological validity of the figures.

Leg Length Versus Torso Length in Pedophilia: Further Evidence of Atypical Physical Development Early in Life

Adult men's height results from an interaction among positive and negative influences, including genetic predisposition, conditions in utero, and influences during early development such as nutritional quality, pathogen exposure, and socioeconomic status. Decreased height, reflected specifically as a decreased leg length, is strongly associated with increased risk of poorer health outcomes. Although prior research has repeatedly shown that pedophiles are shorter than nonpedophiles, the largest study to date relied on self-reported height. In the present study, pedophiles demonstrated reduced measured height and reduced leg length as compared with teleiophiles. Given the prenatal and early childhood origins of height, these findings contribute additional evidence to a biological, developmental origin of pedophilia. In addition, the magnitude of this height difference was substantially larger than that found in children exposed to a variety of early environmental stressors, but similar to that seen in other biologically based neurodevelopmental disorders.

Height and prevalence of hypertension in a middle-aged and older Chinese population

Evidence from epidemiological studies reported that height was inversely associated with cardiovascular diseases, but the association between height and hypertension was unclear. The purpose of this study was to explore the association between height and blood pressure or prevalence of hypertension in a middle-aged and older Chinese population. A total of 33,197 participants aged 37 to 94 years were recruited from the Dongfeng-Tongji cohort study in Hubei province, China. All participants completed baseline questionnaires, medical examinations and provided blood samples. Hypertension was define as a systolic blood pressure (SBP) over 140 mmHg or/and a diastolic blood pressure (DBP) over 90 mmHg, or current use of antihypertensive medication, or participants with self-reported physician diagnosis of hypertension. Multivariate linear and logistic regression models were used. The prevalence of hypertension was 69.1% for men and 58.0% for women. Pulse pressure (PP) and SBP, but not DBP decreased linearly with increasing height among men and women. Comparing the highest with the shortest quartile of height, the multivariate-adjusted odds ratios were 0.80 (95% confidence interval, 0.71, 0.91) for men and 0.83 (0.74, 0.92) for women. In conclusion, height was associated with reduced SBP, PP and prevalence of hypertension in a middle-aged and older Chinese population.

Height correlates with dyslipidemia in non-overweight middle-aged Japanese men

Background

Our previous study showed that height is inversely associated with the risk of stroke in middle-aged Japanese men, particularly in those with a low body mass index (BMI). Since height is regarded as a surrogate maker of childhood social and physical condition, while BMI may reflect primarily on the current physical condition, a detailed analysis of those with a lower BMI may elucidate the effects of childhood conditions. On the other hand, dyslipidemia is recognized as a prominent risk factor for cardiovascular disease. However, no studies have reported on the association between height and dyslipidemia accounting for BMI status.

Methods

We conducted a hospital-based general population cross-sectional study of 3016 Japanese men aged 30–59 years. Dyslipidemia is defined by the Japan Atherosclerosis Society (JAS) Guidelines as follows: triglycerides (TG) ≥ 150 mg/dL and/or low-density lipoprotein-cholesterol (LDL) ≥ 140 mg/dL, and/or high-density lipoprotein-cholesterol (HDL) < 40 mg/dL, and/or lipid lowering medication use.

Results

Independent of classical cardiovascular risk factors, height was found to be inversely associated with dyslipidemia in subjects with a BMI <25 kg/m² but not in subjects with a BMI ≥25 kg/m². Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of dyslipidemia for an increment of one standard deviation (SD) in height (5.7 cm) were 0.90 (0.82–0.99) for subjects with a BMI < 25 kg/m² and 1.02 (0.89–1.17) for subjects with a BMI ≥ 25 kg/m².

Conclusion

Height is inversely associated with dyslipidemia in those with a BMI < 25 kg/m² but not with a BMI ≥ 25 kg/m².

Waist-to-Height Ratio Compared to Standard Obesity Measures as Predictor of Cardiometabolic Risk Factors in Asian Indians in North India

OBJECTIVE

The aim of this study was to compare the discriminatory ability of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) in identifying the presence of cardiometabolic risk factors in Asian Indians.

METHODS

This cross-sectional study involved 509 subjects (278 males and 231 females) aged 20-60 years from New Delhi, India. Measurements included complete clinical examination, blood pressure, weight, height, WC, BMI, WHR and WHtR, fasting blood glucose, lipid profile, and fasting insulin levels. Receiver operating characteristic curve analyses were performed to compare predictive validity of various adiposity measures against the cardiometabolic risk factors (dyslipidemia, hyperinsulinemia, impaired fasting glucose, hypertension, and metabolic syndrome). The odds ratio for the presence of individual cardiometabolic risk factors in the presence of overweight, abdominal obesity, and high WHtR were calculated using logistic regression analysis.

RESULTS

WC had the highest area under ROC for all other cardiometabolic risk factors except hyperinsulinemia in males and for dyslipidemia, metabolic syndrome and presence of at least one cardiometabolic risk factor in females. For metabolic syndrome, WC, followed by WHtR, was observed to be the better predictor than other measures of adiposity, and WHtR appeared to be the best predictor for hypertension in both genders, particularly in women.

CONCLUSIONS

In the northern Asian Indian population with high prevalence of cardiometabolic risk factors, a combination of WC and WHtR appeared to be having better clinical utility than BMI and WHR in identifying individuals with cardiometabolic risk factors.

Growth in Total Height and Its Components and Cardiometabolic Health in Childhood

BACKGROUND

Short stature or short legs is associated with cardiometabolic disease. Few studies have addressed this issue in children, incorporated repeated measures, or studied modern cohorts.

METHODS

We examined if change in total height, leg length and trunk length between two time points from early (median: 3.2 years) to mid-childhood (median: 7.7 years), with and without adjustment for concurrent change in adiposity (subscapular plus triceps skinfold thickness), was associated with mid-childhood cardiometabolic risk in 315 boys and 295 girls from Project Viva. The main outcome was a cardiometabolic risk score based on sex-specific internal z-scores for systolic blood pressure, waist circumference, homeostatic model assessment of insulin resistance, triglycerides and high-density lipoprotein-cholesterol.

RESULTS

Mean (SD) total height was 97.9 (4.5) cm in boys and 97.1 (4.7) cm in girls in early childhood and 129.1 (7.2) cm in boys and 128.3 (7.9) cm in girls in mid-childhood. Trunk length constituted about half of total height. In linear regression models adjusted for parental anthropometry and socio-demographics, faster growth in total height, leg length and particularly trunk length, were associated with higher cardiometabolic risk in mid-childhood. Per 1 cm annual increase in trunk length, the cardiometabolic risk score was 0.23 z-score (95% confidence interval [CI] 0.08, 0.39) higher among boys and 0.47 z-score (95% CI 0.33, 0.60) higher among girls. Estimates were attenuated after adjusting for adiposity (boys: 0.03 z-score, 95% CI -0.11, 0.18; girls: 0.32 z-score, 95% CI 0.19, 0.45).

CONCLUSION

Rapid linear growth, particularly in trunk length, was associated with higher cardiometabolic risk in childhood, which was explained by relationships of linear growth with adiposity in boys, but only partly in girls.

Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): a cohort study

BACKGROUND

Tackling severe acute malnutrition (SAM) is a global health priority. Heightened risk of non-communicable diseases (NCD) in children exposed to SAM at around 2 years of age is plausible in view of previously described consequences of other early nutritional insults. By applying developmental origins of health and disease (DOHaD) theory to this group, we aimed to explore the long-term effects of SAM.

METHODS

We followed up 352 Malawian children (median age 9·3 years) who were still alive following SAM inpatient treatment between July 12, 2006, and March 7, 2007, (median age 24 months) and compared them with 217 sibling controls and 184 age-and-sex matched community controls. Our outcomes of interest were anthropometry, body composition, lung function, physical capacity (hand grip, step test, and physical activity), and blood markers of NCD risk. For comparisons of all outcomes, we used multivariable linear regression, adjusted for age, sex, HIV status, and socioeconomic status. We also adjusted for puberty in the body composition regression model.

FINDINGS

Compared with controls, children who had survived SAM had lower height-for-age Z scores (adjusted difference vs community controls 0·4, 95% CI 0·6 to 0·2, p=0·001; adjusted difference vs sibling controls 0·2, 0·0 to 0·4, p=0·04), although they showed evidence of catch-up growth. These children also had shorter leg length (adjusted difference vs community controls 2·0 cm, 1·0 to 3·0, p<0·0001; adjusted difference vs sibling controls 1·4 cm, 0·5 to 2·3, p=0·002), smaller mid-upper arm circumference (adjusted difference vs community controls 5·6 mm, 1·9 to 9·4, p=0·001; adjusted difference vs sibling controls 5·7 mm, 2·3 to 9·1, p=0·02), calf circumference (adjusted difference vs community controls 0·49 cm, 0·1 to 0·9, p=0·01; adjusted difference vs sibling controls 0·62 cm, 0·2 to 1·0, p=0·001), and hip circumference (adjusted difference vs community controls 1·56 cm, 0·5 to 2·7, p=0·01; adjusted difference vs sibling controls 1·83 cm, 0·8 to 2·8, p<0·0001), and less lean mass (adjusted difference vs community controls -24·5, -43 to -5·5, p=0·01; adjusted difference vs sibling controls -11·5, -29 to -6, p=0·19) than did either sibling or community controls. Survivors of SAM had functional deficits consisting of weaker hand grip (adjusted difference vs community controls -1·7 kg, 95% CI -2·4 to -0·9, p<0·0001; adjusted difference vs sibling controls 1·01 kg, 0·3 to 1·7, p=0·005,)) and fewer minutes completed of an exercise test (sibling odds ratio [OR] 1·59, 95% CI 1·0 to 2·5, p=0·04; community OR 1·59, 95% CI 1·0 to 2·5, p=0·05). We did not detect significant differences between cases and controls in terms of lung function, lipid profile, glucose tolerance, glycated haemoglobin A1c, salivary cortisol, sitting height, and head circumference.

INTERPRETATION

Our results suggest that SAM has long-term adverse effects. Survivors show patterns of so-called thrifty growth, which is associated with future cardiovascular and metabolic disease. The evidence of catch-up growth and largely preserved cardiometabolic and pulmonary functions suggest the potential for near-full rehabilitation. Future follow-up should try to establish the effects of puberty and later dietary or social transitions on these parameters, as well as explore how best to optimise recovery and quality of life for survivors.

FUNDING

The Wellcome Trust.

Sexual dimorphism in growth in the relative length of the forearm and relative knee height during adolescence

There are numerous studies concerning sexual dimorphism in body proportions, but only a few have investigated growth in the relative length of particular segments of the upper and lower limbs during adolescence. The aim of the study is an assessment of sex differences of longitudinal growth in the relative length of the forearm and knee height among adolescents. Sample involved 121 boys and 111 girls, participants of the Wroclaw Growth Study, examined annually between 8 and 18 years of age. Sexual dimorphism in six ratios: forearm length and knee height relatively to: trunk, height, and limb length were analyzed using a two-way analysis of variance with repeated measurements. The sex and age relative to an estimate of maturity timing (3 years before, and after age class at peak height velocity [PHV]) were independent variables. All of the ratios showed significant sex differences in interaction with age relative to age at PHV. The relative length of the forearm, in boys, did not change significantly with the years relative to age at PHV, whereas in girls, was the lowest in the two first age classes and afterward significantly increased just 1 year before and during the adolescent growth spurt, remaining unchanged in further age classes. For relative knee height no clear pattern for sex differences was noticed. It is proposed that relatively longer forearms, particularly in relation to the trunk in girls, could have evolved as an adaptation to more efficient infant carrying and protection during breastfeeding.

Early Life Factors and Adult Leisure Time Physical Inactivity Stability and Change

PURPOSE

Physical inactivity has a high prevalence and associated disease burden. A better understanding of influences on sustaining and changing inactive lifestyles is needed. We aimed to establish whether leisure time inactivity was stable in midadulthood and whether early life factors were associated with inactivity patterns.

METHODS

In the 1958 British birth cohort (n = 12,271), leisure time inactivity (frequency, less than once a week) assessed at 33 and 50 yr was categorized as "never inactive," "persistently inactive," "deteriorating," or "improving." Early life factors (birth to 16 yr) were categorized into three (physical, social, and behavioral) domains. Using multinomial logistic regression, we assessed associations with inactivity persistence and change of factors within each early life domain and the three domains combined with and without adjustment for adult factors.

RESULTS

Inactivity prevalence was similar at 33 and 50 yr (approximately 31%), but 17% deteriorated and 18% improved with age. In models adjusted for all domains simultaneously, factors associated with inactivity persistence versus never inactive were prepubertal stature (8% lower risk/height SD), poor hand control/coordination (17% higher risk/increase on four-point scale), cognition (16% lower/SD in ability) (physical); parental divorce (25% higher), class at birth (7% higher/reduction on four-point scale), minimal parental education (16% higher), household amenities (2% higher/increase in 19-point score (high = poor)) (social); and inactivity (22% higher/reduction in activity on four-point scale), low sports aptitude (47% higher), smoking (30% higher) (behavioral). All except stature, parental education, sports aptitude, and smoking were associated also with inactivity deterioration. Poor hand control/coordination was the only factor associated with improved status (13% lower/increase on four-point scale) versus persistently inactive.

CONCLUSIONS

Adult leisure time inactivity is moderately stable. Early life factors are associated with persistent and deteriorating inactivity over decades in midadulthood but rarely with improvement.

Divergent associations of height with cardiometabolic disease and cancer: epidemiology, pathophysiology, and global implications

Among chronic non-communicable diseases, cardiometabolic diseases and cancer are the most important causes of morbidity and mortality worldwide. Although high BMI and waist circumference, as estimates of total and abdominal fat mass, are now accepted as predictors of the increasing incidence of these diseases, adult height, which also predicts mortality, has been neglected. Interestingly, increasing evidence suggests that height is associated with lower cardiometabolic risk, but higher cancer risk, associations supported by mendelian randomisation studies. Understanding the complex epidemiology, biology, and pathophysiology related to height, and its association with cardiometabolic diseases and cancer, is becoming even more important because average adult height has increased substantially in many countries during recent generations. Among the mechanisms driving the increase in height and linking height with cardiometabolic diseases and cancer are insulin and insulin-like growth factor signalling pathways. These pathways are thought to be activated by overnutrition, especially increased intake of milk, dairy products, and other animal proteins during different stages of child development. Limiting overnutrition during pregnancy, early childhood, and puberty would avoid not only obesity, but also accelerated growth in children-and thus might reduce risk of cancer in adulthood.

Relationship between early growth and CVD risk factors in adolescents

Low birth weight and a rapid weight gain in early childhood may lead to an increased risk for developing cardiovascular disease later in life, such as hypertension and dyslipidaemia. In this study, we examined the associations between size at birth, relative weight gain in infancy and childhood with specific cardiovascular disease risk factors in early adulthood. Adolescents (n=1935) from the Birth to Twenty plus (BT20+) cohort were included in the analysis. The following were treated as exposure variables: weight at birth, and relative conditional weight gain (CW), independent of height, between ages 0-24 months and 24-48 months. Outcomes were serum lipids and body composition variables at age 18 years. After adjusting for sex and other confounders, early life exposures were not associated with adolescent lipid profile. Following adjustment for sex and height (body size), birth weight [β=0.704 (0.40, 1.01)], CW 0-24 [β=1.918 (1.56, 2.28)] and CW24-48 [β=1.485 (1.14, 1.82)] accounted for 48% of the variance in fat mass. However, birth weight [β=0.773 (0.54, 1.01)], CW 0-24 [β=1.523 (1.24, 1.80)] and CW24-48 [β=1.226 (0.97, 1.49)] were also positively predicted and accounted for 71% of the variance in fat mass in adolescence (P<0.05). Our data suggests that birth weight and weight gain during infancy and early childhood independent of linear growth are related to adolescent body composition but not blood lipid profiles in an urban African population.

Contributions of maternal and paternal adiposity and smoking to adult offspring adiposity and cardiovascular risk: the Midspan Family Study

OBJECTIVE

Obesity has some genetic basis but requires interaction with environmental factors for phenotypic expression. We examined contributions of gender-specific parental adiposity and smoking to adiposity and related cardiovascular risk in adult offspring.

DESIGN

Cross-sectional general population survey.

SETTING

Scotland.

PARTICIPANTS

1456 of the 1477 first generation families in the Midspan Family Study: 2912 parents (aged 45-64 years surveyed between 1972 and 1976) who had 1025 sons and 1283 daughters, aged 30-59 years surveyed in 1996.

MAIN MEASURES

Offspring body mass index (BMI), waist circumference (WC), cardiometabolic risk (lipids, blood pressure and glucose) and cardiovascular disease as outcome measures, and parental BMI and smoking as determinants. All analyses adjusted for age, socioeconomic status and family clustering and offspring birth weight.

RESULTS

Regression coefficients for BMI associations between father-son (0.30) and mother-daughter (0.33) were greater than father-daughter (0.23) or mother-son (0.22). Regression coefficient for the non-genetic, shared-environment or assortative-mating relationship between BMIs of fathers and mothers was 0.19. Heritability estimates for BMI were greatest among women with mothers who had BMI either <25 or ≥30 kg/m(2). Compared with offspring without obese parents, offspring with two obese parents had adjusted OR of 10.25 (95% CI 6.56 to 13.93) for having WC ≥102 cm for men, ≥88 cm women, 2.46 (95% CI 1.33 to 4.57) for metabolic syndrome and 3.03 (95% CI 1.55 to 5.91) for angina and/or myocardial infarct (p<0.001). Neither parental adiposity nor smoking history determined adjusted offspring individual cardiometabolic risk factors, diabetes or stroke. Maternal, but not paternal, smoking had significant effects on WC in sons (OR=1.50; 95% CI 1.13 to 2.01) and daughters (OR=1.42; 95% CI 1.10 to 1.84) and metabolic syndrome OR=1.68; 95% CI 1.17 to 2.40) in sons.

CONCLUSIONS

There are modest genetic/epigenetic influences on the environmental factors behind adverse adiposity. Maternal smoking appears a specific hazard on obesity and metabolic syndrome. A possible epigenetic mechanism linking maternal smoking to obesity and metabolic syndrome in offspring is proposed. Individuals with family histories of obesity should be targeted from an early age to prevent obesity and complications.

Higher Lipoprotein (a) Levels Are Associated with Better Pulmonary Function in Community-Dwelling Older People - Data from the Berlin Aging Study II

Reduced pulmonary function and elevated serum cholesterol levels are recognized risk factors for cardiovascular disease. Currently, there is some controversy concerning relationships between cholesterol, LDL-cholesterol, HDL-cholesterol, serum triglycerides and lung function. However, most previous studies compared patients suffering from chronic obstructive pulmonary disease (COPD) with healthy controls, and only a small number examined this relationship in population-based cohorts. Moreover, lipoprotein a [Lp(a)], another lipid parameter independently associated with cardiovascular diseases, appears not to have been addressed at all in studies of lung function at the population level. Here, we determined relationships between lung function and several lipid parameters including Lp(a) in 606 older community-dwelling participants (55.1% women, 68±4 years old) from the Berlin Aging Study II (BASE-II). We found a significantly lower forced expiration volume in 1 second (FEV1) in men with low Lp(a) concentrations (t-test). This finding was further substantiated by linear regression models adjusting for known covariates, showing that these associations are statistically significant in both men and women. According to the highest adjusted model, men and women with Lp(a) levels below the 20^th percentile had 217.3ml and 124.2ml less FEV1 and 239.0ml and 135.2ml less FVC, respectively, compared to participants with higher Lp(a) levels. The adjusted models also suggest that the known strong correlation between pro-inflammatory parameters and lung function has only a marginal impact on the Lp(a)-pulmonary function association. Our results do not support the hypothesis that higher Lp(a) levels are responsible for the increased CVD risk in people with reduced lung function, at least not in the group of community-dwelling older people studied here.

A life course approach to cardiovascular aging

A life course approach in epidemiology investigates the biological, behavioral and social pathways that link physical and social exposures and experiences during gestation, childhood, adolescence and adult life, and across generations, to later-life health and disease risk. We illustrate how a life course approach has been applied to cardiovascular disease, highlighting the evidence in support of the early origins of disease risk. We summarize how trajectories of cardiometabolic risk factors change over the life course and suggest that understanding underlying 'normal' or 'healthy' trajectories and the characteristics that drive deviations from such trajectories offer the potential for early prevention and for identifying means of preventing future disease.

Association of maternal menarcheal age with anthropometric dimensions and blood pressure in children from Greater Bilbao

BACKGROUND

Earlier menarche has been related to shorter height and greater obesity-related anthropometric dimensions and blood pressure in women. Boys and girls with earlier maternal menarcheal age (MMA) have shown greater height and body mass index (BMI) in childhood.

AIM

To analyse associations of menarcheal age with their own and their children's anthropometric dimensions and blood pressure.

SUBJECTS AND METHODS

The sample consisted of 493 women and their children (aged 2-19 years) from Greater Bilbao (Basque Country, Spain). For both generations there is information on 19 anthropometric dimensions, blood pressure and socio-demographic characteristics. Linear regressions adjusted for different covariates were used to analyse the associations.

RESULTS

Menarcheal age in women showed the greatest positive associations with iliospinal height and ectomorphy and negative associations with BMI, sum of six skin-folds, endomorphy and mesomorphy. Boys with earlier MMA had greater body heights and breadths, particularly iliospinal height and biacromial breadth (0.10 z-score/year; p < 0.05). In girls, earlier MMA predicted greater sitting height, biepicondylar humerus breadth, weight and sum of four circumferences (0.07-0.09 z-score/year; p < 0.05). However, there was some evidence that MMA was positively associated with body heights, ectomorphy and blood pressure in girls aged ≥12.

CONCLUSION

Children with earlier MMA tend to have greater anthropometric dimensions. Adolescent growth spurt might affect these relationships, at least in girls.

Comparing the impact of personal and parental risk factors, and parental lifespan on all-cause mortality and cardiovascular disease: findings from the Midspan Family cohort study

BACKGROUND

We aimed to identify which personal and parental factors best explained all-cause mortality and cardiovascular disease (CVD).

METHODS

In 1996, data were collected on 2338 adult offspring of the participants in the 1972-1976 Renfrew and Paisley prospective cohort study. Recorded risk factors were assigned to 5 groups: mid-life biological and behavioural (BB), mid-life socioeconomic, parental BB, early-life socioeconomic and parental lifespan. Participants were followed up for mortality and hospital admissions to the end of 2011. Cox proportional hazards models were used to analyse how well each group explained all-cause mortality or CVD. Akaike's Information Criterion (AIC), a measure of goodness-of-fit, identified the most important groups.

RESULTS

For all-cause mortality (1997 participants with complete data, 111 deaths), decreases in AIC from the null model (adjusting for age and sex) to models including mid-life BB, mid-life socioeconomic, parental BB, early-life socioeconomic and parental lifespan were 55.8, 21.6, 10.3, 7.3 and 5.9, respectively. For the CVD models (1736 participants, 276 with CVD), decreases were 37.8, 3.7, 6.7, 17.3 and 0.4. Mid-life BB factors were the most important for both all-cause mortality and CVD; mid-life socioeconomic factors were important for all-cause mortality, and early-life socioeconomic factors were important for CVD. Parental lifespan was the weakest factor.

CONCLUSIONS

As mid-life BB risk factors best explained all-cause mortality and CVD, continued action to reduce these is warranted. Targeting adverse socioeconomic factors in mid-life and early life may contribute to reducing all-cause mortality and CVD risk, respectively.

Genome-wide Analysis of Body Proportion Classifies Height-Associated Variants by Mechanism of Action and Implicates Genes Important for Skeletal Development

Human height is a composite measurement, reflecting the sum of leg, spine, and head lengths. Many common variants influence total height, but the effects of these or other variants on the components of height (body proportion) remain largely unknown. We studied sitting height ratio (SHR), the ratio of sitting height to total height, to identify such effects in 3,545 African Americans and 21,590 individuals of European ancestry. We found that SHR is heritable: 26% and 39% of the total variance of SHR can be explained by common variants in European and African Americans, respectively, and global European admixture is negatively correlated with SHR in African Americans (r(2) ≈ 0.03). Six regions reached genome-wide significance (p < 5 × 10(-8)) for association with SHR and overlapped biological candidate genes, including TBX2 and IGFBP3. We found that 130 of 670 height-associated variants are nominally associated (p < 0.05) with SHR, more than expected by chance (p = 5 × 10(-40)). At these 130 loci, the height-increasing alleles are associated with either a decrease (71 loci) or increase (59 loci) in SHR, suggesting that different height loci disproportionally affect either leg length or spine/head length. Pathway analyses via DEPICT revealed that height loci affecting SHR, and especially those affecting leg length, show enrichment of different biological pathways (e.g., bone/cartilage/growth plate pathways) than do loci with no effect on SHR (e.g., embryonic development). These results highlight the value of using a pair of related but orthogonal phenotypes, in this case SHR with height, as a prism to dissect the biology underlying genetic associations in polygenic traits and diseases.

Genetically determined height and coronary artery disease

BACKGROUND

The nature and underlying mechanisms of an inverse association between adult height and the risk of coronary artery disease (CAD) are unclear.

METHODS

We used a genetic approach to investigate the association between height and CAD, using 180 height-associated genetic variants. We tested the association between a change in genetically determined height of 1 SD (6.5 cm) with the risk of CAD in 65,066 cases and 128,383 controls. Using individual-level genotype data from 18,249 persons, we also examined the risk of CAD associated with the presence of various numbers of height-associated alleles. To identify putative mechanisms, we analyzed whether genetically determined height was associated with known cardiovascular risk factors and performed a pathway analysis of the height-associated genes.

RESULTS

We observed a relative increase of 13.5% (95% confidence interval [CI], 5.4 to 22.1; P<0.001) in the risk of CAD per 1-SD decrease in genetically determined height. There was a graded relationship between the presence of an increased number of height-raising variants and a reduced risk of CAD (odds ratio for height quartile 4 versus quartile 1, 0.74; 95% CI, 0.68 to 0.84; P<0.001). Of the 12 risk factors that we studied, we observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides (accounting for approximately 30% of the association). We identified several overlapping pathways involving genes associated with both development and atherosclerosis.

CONCLUSIONS

There is a primary association between a genetically determined shorter height and an increased risk of CAD, a link that is partly explained by the association between shorter height and an adverse lipid profile. Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association. (Funded by the British Heart Foundation and others.).

Association of restrictive ventilatory dysfunction with the development of prediabetes and type 2 diabetes in Koreans

AIMS

This study was performed to investigate whether ventilatory dysfunction is a predictor for the development of prediabetes and type 2 diabetes in Koreans.

METHODS

We analyzed the clinical and laboratory data of 16,195 Korean adults (age 20-79 years) who underwent routine medical checkups with a mean 4.7-years (range 3.0-5.9 years) interval. Spirometry results were categorized into three patterns: normal, obstructive ventilatory dysfunction [OVD; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.70], and restrictive ventilatory dysfunction (RVD; FVC < 80 % predicted, FEV1/FVC ≥ 0.70).

RESULTS

Compared with subjects with normal ventilatory function, subjects with RVD had a higher incidence of type 2 diabetes (3.7 vs. 6.3 %; P < 0.001), whereas subjects with OVD did not (3.7 vs. 4.8 %; P = 0.119). On multivariate logistic regression analysis, the odds ratio (OR) of RVD for type 2 diabetes was significantly increased after adjusting for age, sex, and lifestyle factors (1.40; 95 % CI 1.10-1.78). However, further adjustment for body mass index (BMI), waist circumference, and baseline glucose level attenuated the OR to become insignificant (1.12; 95 % CI 0.86-1.47). Among the 9,461 participants who had normal fasting glucose and HbA1c levels at baseline, the OR for progression to prediabetes or diabetes in the RVD group was significantly increased (1.30; 95 % CI 1.12-1.51). The increased OR remained significant after adjusting for BMI, waist circumference, and baseline glucose level (1.26; 95 % CI 1.07-1.47).

CONCLUSIONS

Our results indicate that restrictive, but not obstructive ventilatory dysfunction, is independently associated with development of prediabetes and precedes the development of type 2 diabetes.