Adolescent metabolic syndrome risk is increased with higher infancy weight gain and decreased with longer breast feeding

Effect of a care-coordinated responsive parenting intervention on obesogenic risk behaviours among mother-infant dyads enrolled in WIC

BACKGROUND

Integrating health care and social care presents opportunities to deliver responsive parenting (RP) interventions for childhood obesity prevention.

OBJECTIVES

This analysis examined the effect of an integrated RP intervention on infant obesogenic risk behaviours.

METHODS

This secondary analysis included 228 mother-infant dyads in the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study, a pragmatic randomized clinical trial that integrated care between paediatric clinicians and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutritionists to encourage RP. Mothers were randomized to a 6-month RP intervention or standard care. The Early Healthy Lifestyle risk assessment tool was completed at infant ages 2 and 6 months. Logistic regression examined study group effects on obesogenic risk behaviours, while t-tests assessed study group effects on a total obesogenic risk behaviour score. Models adjusted for milk type and parity.

RESULTS

RP mothers were less likely to report nighttime feedings at 2 (adjusted odds ratio [aOR] 0.21, 95% confidence interval [CI] 0.07-0.62) and 6 months (aOR 0.36, 95% CI 0.16-0.81); pressure to finish the bottle (aOR 0.53, 95% CI 0.30-0.93) and using screens when feeding/playing at 2 months (aOR 0.34, 95% CI 0.17-0.67); and putting their infant to bed after 8:00 PM at 6 months (aOR 0.46, 95% CI 0.21-0.97). RP mothers had significantly lower obesogenic risk behaviour scores at 2 months (p = 0.009) but not at 6 months (p = 0.06) compared to standard care.

CONCLUSIONS

The WEE Baby Care intervention decreased some obesogenic risk behaviours among WIC mother-infant dyads. Integrated care in health and social settings can be used to provide patient-centred RP guidance to improve early obesogenic risk behaviours in high-risk populations.

Association of Perinatal Factors and Family Sociodemographic Characteristics With Cardiometabolic Health in Pre-Adolescence: Cross-Sectional Results From Healthy Growth Study

AIM

Study the influence of a variety of perinatal factors on the presence of metabolic syndrome and its parameters in prepubertal age, considering socio-demographic factors, sex, Tanner stage and weight status of the preadolescent.

METHODS

Data collected from the cross-sectional Healthy Growth Study (2007) in students from four prefectures of Greece and their families. Cardiometabolic risk factors (waist circumference, blood pressure and blood indices) and perinatal data (from parents and health records) were collected. Single and a multiple logistic regression performed to assess the associations with cardiometabolic risk in preadolescence. Dependent variables included waist circumference, blood glucose, HDL-C, TG, blood pressure and metabolic syndrome presence, while independent variables encompassed perinatal factors categorised as pre-pregnancy, during and post-pregnancy.

RESULTS

2666 pre-adolescents (mean age 11.2 year) participated in the study. After adjustment for parental educational level, family income, sex, Tanner stage and weight category, maternal pre-pregnancy weight was positively associated with high waist circumference (OR, 95% CI 1.02 (1.00-1.04)), low HDL-C levels (OR, 95% CI 1.01 (1.00-1.03)) and metabolic syndrome (OR, 95% CI 1.02 (1.00-1.05)). Timing of solid foods' introduction was positively associated with high waist circumference (OR, 95% CI 1.09 (1.01-1.08)), gestational age with high glucose levels (OR, 95% CI 1.12 (1.04-1.19)), smoking (OR, 95% CI 1.07 (1.00-1.14)) and alcohol consumption (OR, 95% CI 2.35 (1.05-5.27)) during the first trimester of breastfeeding with high glucose levels and low HDL-C levels, respectively. Number of previous miscarriages was positively associated with low HDL-C levels (OR, 95% CI 1.28 (1.04-1.57)). Gestational age was negatively associated with high waist circumference (OR, 95% CI 0.87 (0.80-0.95)) and iron supplementation in the third pregnancy trimester negatively association with high TG levels (OR, 95% CI 0.34 (0.12-0.91)).

CONCLUSIONS

Maternal weight, perinatal behaviours, infant feeding and miscarriages influence pre-pubertal cardiometabolic health, independent of sociodemographics, sex, Tanner stage and weight.

Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis

OBJECTIVE

To investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents.

STUDY DESIGN

This study included 634 offsprings aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates.

RESULTS

Median breastfeeding duration was 7 months (minimum = 0, maximum = 36). Boys in the second quartile (median breastfeeding = 5 months) had lower total fat mass % (β (SE) -3.2 (1.5) P = .037), and higher lean mass % (3.1 (1.6) P = .049) and skeletal muscle mass % (1.8 (0.8) P = .031) compared with the reference group (median breastfeeding = 2 months). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) P = .035) was found among girls. No association was found with other cardiometabolic indicators.

CONCLUSION

Despite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.

Patterns of Early Life Weight Gain and Female Onset of Puberty

Context

Prepubertal obesity is a well-established predictor of earlier pubertal onset, which is itself a risk factor for poor health and well-being. Identifying specific patterns of weight gain in early life may help explain differential risk for earlier pubertal onset.

Objective

The objective of the study was to examine patterns of weight gain across infancy and early childhood in relation to pubertal onset outcomes.

Design, Setting, and Participants

Participants were 426 girls in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal birth cohort of children and their families followed between birth and adolescence.

Main Outcome Measures

Three pubertal onset outcomes were examined, including age at menarche and ages at Tanner stage II for dimensions of breast and pubic hair development.

Results

In infancy (birth to 15 months), greater percent weight gain and higher birthweight predicted earlier pubertal onset for all outcomes (Ps < 0.05). In early childhood (24 months to grade 1), body mass index (BMI) trajectories reflecting BMI values that were persistently high or changed from low to high over time (vs BMI values that were stable at median or low levels), predicted younger ages at menarche and the onset of breast (Ps < 0.05), but not pubic hair (Ps > 0.05), development. All associations were independent of breastfeeding, maternal menarcheal age, and race/ethnicity.

Conclusions

Distinct patterns of early life weight gain predict differential risk for earlier onset puberty. Focusing on these patterns for earlier and more targeted intervention may help lessen life course linkages between prepubertal obesity, accelerated pubertal development, and negative postpubertal outcomes.

Vitamin D status in infancy and cardiometabolic health in adolescence

BACKGROUND

Vitamin D deficiency is associated with obesity-related conditions, but the role of early life vitamin D status on the development of obesity is poorly understood.

OBJECTIVES

We assessed whether serum 25-hydroxyvitamin D [25(OH)D] at age 1 y was related to metabolic health through adolescence.

METHODS

We quantified serum 25(OH)D in samples obtained at age 1 y from 306 participants in a cohort study in Santiago, Chile. Anthropometry was performed at ages 5, 10, and 16/17 y. At 16/17 y, we determined body composition using DXA and quantified metabolic parameters in a blood sample. We examined the associations of infancy 25(OH)D with BMI-for-age z-score (BMIZ) at ages 5, 10, and 16/17 y; with percentage fat and percentage lean body mass at age 16/17 y; and with a metabolic syndrome (MetS) score and its components at age 16/17 y.

RESULTS

Infancy 25(OH)D was inversely associated with BMIZ in childhood. Every 25-nmol/L difference in 25(OH)D was related to an adjusted 0.11 units lower BMIZ at age 5 y (95% CI: -0.20, -0.03; P = 0.01) and a 0.09 unit lower BMIZ change from ages 1 to 5 y (95% CI: -0.17, -0.01; P = 0.02). Also, every 25-nmol/L 25(OH)D in infancy was associated with an adjusted 1.3 points lower percentage body fat mass (95% CI: -2.2, -0.4; P = 0.005) and an adjusted 0.03 units lower MetS score (95% CI: -0.05, -0.01; P = 0.01) at age 16/17 y, through inverse associations with waist circumference and the HOMA-IR.

CONCLUSIONS

Serum 25(OH)D at age 1 y is inversely associated with childhood BMIZ, percentage body fat at age 16/17 y, and a MetS score at age 16/17 y. Intervention studies are warranted to examine the effects of vitamin D supplementation in early life on long-term cardiometabolic outcomes.

Sociodemographic predictors of early postnatal growth: evidence from a Chilean infancy cohort

OBJECTIVES

Infant anthropometric growth varies across socioeconomic factors, including maternal education and income, and may serve as an indicator of environmental influences in early life with long-term health consequences. Previous research has identified sociodemographic gradients in growth with a focus on the first year and beyond, but estimates are sparse for growth before 6 months. Thus, our objective was to examine the relationship between sociodemographic factors and infant growth patterns between birth and 5 months of age.

DESIGN

Prospective cohort study.

SETTINGS

Low-income to middle-income neighbourhoods in Santiago, Chile (1991-1996).

PARTICIPANTS

1412 participants from a randomised iron-deficiency anaemia preventive trial in healthy infants.

MAIN OUTCOME MEASURES

Longitudinal anthropometrics including monthly weight (kg), length (cm) and weight-for-length (WFL) values. For each measure, we estimated three individual-level growth parameters (size, timing and velocity) from SuperImposition by Translation and Rotation models. Size and timing changes represent vertical and horizontal growth curve shifts, respectively, and velocity change represents growth rate shifts. We estimated the linear association between growth parameters and gestational age, maternal age, education and socioeconomic position (SEP).

RESULTS

Lower SEP was associated with a slower linear (length) velocity growth parameter (-0.22, 95% CI -0.31 to -0.13)-outcome units are per cent change in velocity from the average growth curve. Lower SEP was associated with later WFL growth timing as demonstrated through the tempo growth parameter for females (0.25, 95% CI 0.05 to 0.42)-outcome units are shifts in days from the average growth curve. We found no evidence of associations between SEP and the weight size, timing or velocity growth rate parameters.

CONCLUSION

Previous research on growth in older infants and children shows associations between lower SEP with slower length velocity. We found evidence supporting this association in the first 5 months of life, which may inform age-specific prevention efforts aimed at infant length growth.

Increased blood pressure and impaired endothelial function after accelerated growth in IVF/ICSI children

STUDY QUESTION

What is the effect of growth velocity (height and weight) in early infancy on metabolic end-points and endothelial function in children born after ART?

SUMMARY ANSWER

Neonatal, infant and childhood growth is positively related to blood pressure in 9-year-old IVF/ICSI offspring, while growth in childhood was negatively associated with endothelial function.

WHAT IS KNOWN ALREADY

Offspring of pregnancies conceived after ART are at risk for later cardiometabolic risk factors. It is well established that early growth is related to numerous later cardiometabolic risk factors such as high blood pressure. This concept is known as the Developmental Origin of Health and Disease theory.

STUDY DESIGN SIZE DURATION

The relation between early growth and later cardiometabolic risk profile was studied in the MEDIUM-KIDS study, a prospective observational cohort study in children born after an IVF/ICSI treatment. In 131 children (48.1% males) at the average age of 9.4 years, cardiometabolic outcomes were assessed and growth data from birth until age 9 years were collected from child welfare centers.

PARTICIPANTS/MATERIALS SETTINGS METHODS

The following cardiometabolic outcomes were assessed: blood pressure, skinfolds, lipid spectrum, hair cortisone and glucose and insulin levels. Data on maximum skin perfusion after transdermal delivery of acetylcholine as a measure of endothelial function were collected.Growth charts were obtained electronically from child welfare centers, which offer free consultations and vaccinations to all Dutch children. At these centers, height and weight are recorded at predefined ages. Growth was defined as z-score difference in weight between two time points. Multivariable linear regression analysis was used to model the relation between growth and cardiometabolic outcomes. The following growth windows were -studied simultaneously in each model: 0-1 month, 1-3 months, 3-6 months, 6-11 months, 11-24 months and 2-6 years. The model was adjusted for height growth in all intervals except for 0-1 month.

MAIN RESULTS AND THE ROLE OF CHANCE

In multivariable linear regression analyses, multiple growth windows were positively associated with blood pressure, for example growth from 2-6 years was significantly related to systolic blood pressure: B = 4.13, P = 0.005. Maximum skin perfusion after acetylcholine was negatively associated with height-adjusted weight gain from 2 to 6 years: B = -0.09 (log scale), P = 0.03. Several growth windows (weight 1-3 months, 3-6 months, 6-11 months, 11-24 months, 2-6 years) were positively linked with total adiposity. Lipids, glucose tolerance indices and cortisone were not related to growth.

LIMITATIONS REASONS FOR CAUTION

This study is of modest size and of observational nature, and we did not include a control group. Therefore, we cannot assess whether the observed associations are causal. It is also not possible to analyze if our observations are specific for, or exacerbated in, the ART population. Ideally, a control group of naturally conceived siblings of IVF/ICSI children should simultaneously be studied to address this limitation and to assess the impact of the ART procedure without the influence of parental (subfertility) characteristics.

WIDER IMPLICATIONS OF THE FINDINGS

The results of this study contribute to our understanding of the reported increased risk for hypertension in ART offspring. We speculate that early, accelerated growth may be involved in the reported increased risk for hypertension in ART offspring, with endothelial dysfunction as a possible underlying mechanism. However, additional research into the mechanisms involved is required.

STUDY FUNDING/COMPETING INTERESTS

The study was financially supported by the March of Dimes, grant number #6-FY13-153. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation or writing of the paper. The authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

NTR4220.

Long-term vs. recent-onset obesity: their contribution to cardiometabolic risk in adolescence

BACKGROUND

The contribution of long-term vs. recent-onset obesity to cardiometabolic risk in adolescence remains controversial. Here, we aimed to investigate the association of time of onset and length of obesity with the cardiometabolic profile of adolescence.

METHODS

Prospective study in 678 16-year-olds. BMI was measured at birth-1-5-10-16 years and BMI trajectories were interpolated using cubic splines. BMI > 2 SD at <6 years was defined as early obesity. Waist circumference (WC), blood pressure, lipid and glucose profiles were measured at 16 years. A cardiometabolic risk score was computed (MetS_score). According to the BMI trajectory, four groups were defined: participants who were never obese (NOB), participants with obesity during adolescence (recent-onset obese (ROB)), participants who were obese in early childhood but transitioned to normal/overweight as preadolescents (formerly obese (FOB)), and participants who were obese in early childhood and remained obese (persistently obese (POB)).

RESULTS

ROBs and POBs had significantly unhealthier cardiometabolic profile than NOBs. No differences were observed in the cardiometabolic profile of ROBs compared to POBs. Although FOBs had higher WC and MetS_score than NOBs, no differences were found in other biomarkers. FOBs were in healthier cardiometabolic condition than ROBs and POBs.

CONCLUSIONS

Both long-term and recent-onset obesity increase the cardiometabolic risk in adolescents.

Infant Psychosocial Environment Predicts Adolescent Cardiometabolic Risk: A Prospective Study

OBJECTIVE

To prospectively assess whether the infant psychosocial environment was associated with cardiometabolic risk as early as adolescence.

STUDY DESIGN

Participants were recruited in Santiago, Chile, and have been followed from infancy. Inclusion criteria included healthy infants with birth weight ≥3 kg and a stable caregiver. The psychosocial environment, including depressive symptoms, stressful life events, poor support for child development, father absence, and socioeconomic status, was reported by mothers at 6-12 months. Body mass index (BMI) z score was assessed at 5 and 10 years. BMI z score, waist-to-hip ratio, systolic and diastolic blood pressure, fat mass and body fat percentage, fasting glucose, total and high-density lipoprotein cholesterol, and homeostatic model of insulin resistance were tested in adolescence.

RESULTS

Adolescents ranged from 16 to 18 years of age (n = 588; 48.1% female). A poorer infant psychosocial environment was associated with BMI z score at 10 years (β = 0.10, 95% CI = 0.00-0.19) and in adolescence (β = 0.15, 95% CI = 0.06-0.24) but not at 5 years. A poorer infant psychosocial environment was associated with higher blood pressure (β = 0.15, 95% CI = 0.05-0.24), greater anthropometric risk (β = 0.13, 95% CI = 0.03-0.22), greater biomarker (triglycerides, homeostatic model assessment of insulin resistance, total cholesterol) risk (β = 0.12, 95% CI = 0.02-0.22), and a higher likelihood of metabolic syndrome in adolescence (aOR = 1.50; 95% CI = 1.06-2.12).

CONCLUSIONS

These findings demonstrate that a poorer infant psychosocial environment was associated with greater adolescent cardiometabolic risk. The results support screening for infants' psychosocial environments and further research into causality, mechanisms, prevention, and intervention.

Association of infant growth with emergence of permanent dentition among 12 year-aged southern Chinese school children

BACKGROUND

There is a need to comprehensively investigate the relationship between tooth eruption and infant growth to explain the theory of tooth emergence. This study aimed to investigate the association between infant growth during the first year of life and the emergence of the permanent teeth.

METHODS

A random sample of 668, 12-year-old students was recruited from a birth cohort. Erupted permanent tooth number was recorded. The association of infant growth (growth trajectories and growth rates) and permanent tooth emergence was examined through logistic regression analyses. The regression model was adjusted by potential confounders including gender, gestational age, mode of delivery, type of feeding, parental education, and health status.

RESULTS

The response rate was 76.9% (n = 514). Two hundred and forty-five (47.7%) children had all 28 permanent teeth erupted. Infants who had higher birth weight z-scores and those who had grown slowly during the first three months of life were more likely to have complete permanent teeth emergence at their 12-year-old in both unadjusted (p <  0.01) and adjusted model (adjusted for gender, gestational age, mode of delivery, type of feeding, parental education, and health status, p <  0.01). However, no significant association was found between the growth trajectories and permanent tooth emergence in either unadjusted or adjusted models (p > 0.05).

CONCLUSION

Birth weight and infant growth during the first three months of life might be associated with permanent tooth emergence at their 12 years of age. This association may be applied in the assessment of risk for dental caries or malocclusion.

Pathways Linking Birth Weight and Insulin Sensitivity in Early Adolescence: A Double Mediation Analysis

PURPOSE

We examined pathways linking birth weight, weight gain from 0 to 2 years, and adiposity during childhood with insulin sensitivity in early adolescence.

METHODS

Data were from a longitudinal cohort of 630 Quebec white children with a parental history of obesity (Quebec Adipose and Lifestyle Investigation in Youth study). In a subsample of children born at term (n = 395), weight-for-length z score (zWFL) from 0 to 2 years were computed. At 8 to 10 years, the percentage of body fat was assessed using dual energy X-ray absorptiometry. At 10 to 12 years, the Matsuda insulin sensitivity index (ISI) and the homeostasis model assessment for insulin resistance were determined. A linear regression-based approach for mediation analysis was used to estimate the distinct pathways linking zWFL at 0 to 2 years to insulin sensitivity.

RESULTS

Every additional unit in zWFL at birth was associated with a 10% (95% CI, 5.26% to 14.85%) increase in the Matsuda ISI in early adolescence, independently of the weight at 0 to 2 years and in childhood. An indirect effect of zWFL at birth on the Matsuda ISI was also observed but in the opposite direction (-4.44; 95% CI, -7.91 to -1.05). This relation was mediated by childhood adiposity but not by weight gain from 0 to 2 years. The indirect effect of weight gain from 0 to 2 years, via childhood adiposity, also led to lower insulin sensitivity (-4.83%, 95% CI, -7.34 to -2.53). The findings were similar for the homeostasis model assessment for insulin resistance or when restricted to children with appropriate-for-gestational-age birth weights.

CONCLUSIONS

A greater birth weight-for-length resulted in improved insulin sensitivity in early adolescence. However, in the presence of excess childhood adiposity, both a greater birth weight and a faster rate of weight gain from 0 to 2 years resulted in lower insulin sensitivity.

Complex lipid globules in early-life nutrition improve long-term metabolic phenotype in intra-uterine growth-restricted rats

Intra-uterine growth restriction (IUGR) is associated with adverse metabolic outcome later in life. Healthy mice challenged with a Western-style diet (WSD) accumulated less body fat when previously fed a diet containing large lipid globules (complex lipid matrix (CLM)). This study was designed to clarify whether an early-life CLM diet mitigates 'programmed' visceral adiposity and associated metabolic sequelae after IUGR. In rats, IUGR was induced either by bilateral uterine vessel ligation (LIG) or sham operation (i.e. intra-uterine stress) of the dam on gestational day 19. Offspring from non-operated (NOP) dams served as controls. Male offspring of all groups were either fed CLM or 'normal matrix' control diet (CTRL) from postnatal days (PND) 15 to 42. Thereafter, animals were challenged with a mild WSD until dissection (PND 98). Fat mass (micro computer-tomograph scan; weight of fat compartments), circulating metabolic markers and expression of 'metabolic' genes (quantitative real-time PCR) were assessed. CLM diet significantly reduced visceral fat mass in LIG at PND 40. At dissection, visceral fat mass, fasted blood glucose, TAG and leptin concentrations were significantly increased in LIG-CTRL v. NOP-CTRL, and significantly decreased in LIG-CLM v. LIG-CTRL. Gene expression levels of leptin (mesenteric fat) and insulin-like growth factor 1 (liver) were significantly reduced in LIG-CLM v. LIG-CTRL. In conclusion, early-life CLM diet mitigated the adverse metabolic phenotype after utero-placental insufficiency. The supramolecular structure of dietary lipids may be a novel aspect of nutrient quality that has to be considered in the context of primary prevention of obesity and metabolic disease in at-risk populations.

Protective effect of breastfeeding on recurrent cough in adulthood

RATIONALE

Breastfeeding protects from respiratory infections in early life but its relationship to recurrent cough and other respiratory outcomes in adult life is not well established.

METHODS

Infant feeding practices were assessed prospectively in the Tucson Children's Respiratory Study, a non-selected birth cohort and categorised into formula from birth or introduced <1 month, formula introduced ≥1 to <4 months and exclusive breastfeeding for ≥4 months. Infant feeding was assessed as an ordinal variable representing an increasing dose of breastmilk across the three categories. Recurrent cough was defined at 22, 26 and 32 years as ≥2 episodes of cough without a cold lasting 1 week during the past year. Covariates included participant sex, race/ethnicity and smoking as well as parental smoking, education, age and asthma. Covariates were evaluated as potential confounders for the relation between infant feeding and adult outcomes.

RESULTS

Of the 786 participants, 19% breastfed <1 month, 50% breastfed ≥1 to <4 months and 31% breastfed ≥4 months. The prevalence of recurrent cough at 22, 26 and 32 years was 17%, 15% and 16%, respectively. Each ordinal increase in breastfeeding duration was associated with a decreased risk of recurrent cough in adult life: adjusted OR=0.71, (95% CI: 0.56 to 0.89), p=0.004. Additional adjustment for concurrent adult asthma, wheeze, smoking and lung volume did not change these results.

CONCLUSION

Longer duration of breastfeeding reduces the risk of recurrent cough in adult life, regardless of smoking and other respiratory symptoms, suggesting long-term protective effects on respiratory health.

Childhood Health Outcomes in Term, Large-for-Gestational-Age Babies With Different Postnatal Growth Patterns

Large-for-gestational-age (LGA) babies have a higher risk of metabolic disease later in life, and their postnatal growth in early childhood may be associated with long-term adverse outcomes. This study aimed to determine childhood health outcomes of term LGA babies with different growth patterns. Data were obtained from the US Collaborative Perinatal Project for the years between 1959 and 1976. The growth trajectories of 3,316 term LGA babies were identified and odds ratios of obesity, growth restriction, low intelligence quotient (IQ), and high blood pressure (HBP) were calculated by logistic regression. Compared with term appropriate-for-gestational-age infants, term LGA babies without catch-down growth had increased risks of obesity (adjusted odds ratio (aOR) = 6.37, 95% confidence interval (CI): 5.24, 7.73) and HBP (aOR = 1.67, 95% CI: 1.37, 2.03). Those with high catch-down growth had higher risks of growth restriction (aOR = 2.21, 95% CI: 1.66, 2.95) and low IQ (aOR = 1.61, 95% CI: 1.04, 2.49). Nevertheless, infants with small catch-down growth had lower risks of obesity (aOR = 0.78, 95% CI: 0.63, 0.95), growth restriction (aOR = 0.28, 95% CI: 0.17, 0.46), low IQ (aOR = 0.66, 95% CI: 0.41, 1.06), and HBP (aOR = 0.89, 95% CI: 0.77, 1.04). According to our data, term LGA infants with small catch-down growth had no increased risks of adverse outcomes.

Determinants of Cardiometabolic Risk Factors in the First Decade of Life: A Longitudinal Study Starting at Birth

The present prospective study assessed the association of birth weight (BW) and growth pattern on cardiometabolic risk factors in a cohort followed from birth to 10 years of age. One hundred and forty-five subjects (73 girls) who fulfilled the inclusion criteria and had all their data recorded at birth and at 5 years were enrolled. Of these, 100 (52 girls) also recorded data at 10 years. Anthropometric measurements, office and 24-hour blood pressure, and metabolic parameters were obtained. At 5 years, both BW and current weight were determinants of blood pressure and metabolic parameters; however, as the subjects got older, the impact of body size increased. Higher BW and maternal obesity increased the risk of becoming obese at 5 years while this was reduced if breastfeeding. Maternal obesity was the only factor associated with becoming obese at 10 years. Twenty-two children at 10 years had insulin values ≥15 U/L, some of whom were persistent from 5 years while in others it increased afterward. Subjects with insulin values ≥15 U/L showed significant higher values of office systolic blood pressure, triglycerides, and uric acid and lower values of high-density lipoprotein than did those with normal insulin values. Highest weight gain from 5 to 10 years and lowest BW were the main determinants of high insulin levels. In conclusion, although BW was a proxy of the events during fetal life and projected its influence later, the influence of gaining weight was a key determinant in the risk to develop obesity and metabolic abnormalities.

Low muscle mass is associated with cardiometabolic risk regardless of nutritional status in adolescents: A cross-sectional study in a Chilean birth cohort

BACKGROUND

Increased cardiometabolic risk (CMR) is documented in obese and non-obese adolescents with low muscular fitness. However, the association of low muscle mass (LMM) with CMR, independent of weight status, has not been examined. We analyzed the relationship of LMM with CMR in adolescents, regardless of their weight status.

MATERIALS AND METHODS

Observational study in 660 adolescents. BMI, waist circumference (WC), arterial blood pressures (ABP) were measured. Total fat mass (TFM), total lean tissue (TLT), and appendicular skeletal muscle mass (ASM) were estimated (DXA). Fasting lipid profile, glucose, and insulin were measured. HOMA-IR was estimated. Metabolic Syndrome (MetS) was diagnosed (AHA/NHLBI/IDF). ROC analysis was performed to find the optimal cutoffs of TLT percentage for MetS diagnosis. Values below these cutoffs defined LMM. ANCOVA examined the association of LMM with selected cardiometabolic biomarkers.

RESULTS

In both sexes, TLT showed better sensitivity and specificity than ASM for MetS diagnosis. In males and females, TLT of 66.1% and 56.3%, respectively, were the optimal cutoff for MetS diagnosis. In the sample, 17.3% of males and 23.7% of females had LMM. In both sexes, adolescents with LMM had significantly higher values of WC, ABP, TG, TC/HDL, HOMA-IR, and MetS z-score than non-LMM participants. Adolescents with LMM, regardless nutritional status, had significantly increased values of MetS z-score, ABP, TG, TC/HDL-chol, and HOMA-IR than non-obese non-LMM adolescents. Adolescents having both obesity and LMM had the unhealthiest CMR profile.

CONCLUSION

In adolescents, LMM was associated with higher CMR, regardless of nutritional status. In obese adolescents, LMM increased obesity-associated CMR.

Associations between bottle-feeding intensity and maternal encouragement of bottle-emptying

Objective

To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.

Design

Mothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying.

Setting

The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.

Subjects

Mothers (n 1776).

Results

Repeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001).

Conclusions

More frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed.

Birth Weight, Postnatal Weight Gain, and Childhood Adiposity in Relation to Lipid Profile and Blood Pressure During Early Adolescence

Background

Different pathways likely underlie the association between early weight gain and cardiovascular disease risk. We examined whether birth weight for length relationship and weight gain up to 2 years of age are associated with lipid profiles and blood pressure (BP) in early adolescence and determined whether childhood adiposity mediates these associations.

Methods and Results

Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), a cohort of white children with parental history of obesity, were analyzed (n=395). Sex‐specific weight for length z scores from birth to 2 years were computed. Rate of postnatal weight gain was estimated using individual slopes of weight for length z‐score measurements. Percentage of body fat was measured at 8 to 10 years. Fasting lipids and BP were measured at 10 to 12 years. Using path analysis, we found indirect effects of postnatal weight gain, through childhood adiposity, on all outcomes: Rate of postnatal weight for length gain was positively associated with childhood adiposity, which in turn was associated with unfavorable lipid and BP levels in early adolescence. In contrast, small beneficial direct effects on diastolic BP z scores, independent of weight at other time points, were found for birth weight for length (β=−0.05, 95% CI, −0.09 to −0.002) and for postnatal weight gain (β=−0.02, 95% CI, −0.03 to −0.002).

Conclusions

Among children with at least 1 obese parent, faster postnatal weight gain leads to cardiovascular risk factors in early adolescence through its effect on childhood adiposity. Although heavier newborns may have lower BP in early adolescence, this protective direct effect could be offset by a deleterious indirect effect linking birth weight to later adiposity.

Differences in Postprandial Lipid Response to Breast- or Formula-feeding in 8-Week-Old Infants

OBJECTIVE

Lipids play important roles in infant growth and development. In this exploratory observational single-center study, we investigated postmeal responses of infants to dietary lipids and differences between breast-feeding (BF) and formula-feeding (FF).

METHODS

Two capillary blood samples were collected from each subject, before and randomly assigned at either 30, 60, 90, 120, 180, or 240 minutes after their respective feeding, followed by measurement of lipid-related plasma parameter concentrations using enzyme-linked immunosorbent assay-based or combined enzymatic and colorimetric methods.

RESULTS

The intermeal interval before testing was shorter in the BF (182.91 ± 22.85 minutes, n = 33) versus FF group (214.1 ± 30.76 minutes, n = 34); BF subjects fed 5 minutes longer (BF 20.27 ± 7.7 minutes; FF 14.82 ± 3.57 minutes). Composite postmeal concentration profiles were generated from 59 plasma sample pairs with sufficient volume (BF = 30): triglyceride (TG) baselines were not different. A TG difference was indicated for BF over FF subjects at 30 minutes, for FF over BF subjects at 60 minutes when corrected for baseline. TG responses in both groups appeared and seemed to clear much faster than those reported for adults. The TG:apolipoprotein B48 (ApoB48) ratio suggests that chylomicrons in BF subjects may carry a higher fat load (P < 0.05), compensated by a higher chylomicron number in FF subjects (P < 0.05). Cholesterol in BF subjects was higher and showed an increase after feeding when corrected for baseline.

CONCLUSIONS

Our results indicate that lipids from either BF or FF may be handled differently in young healthy infants.

Exposure to Tobacco Metabolites via Breast Milk and Infant Weight Gain: A Population-Based Study

BACKGROUND

Although the immutable benefits of breastfeeding are well documented, information on the potential consequences of exposure to tobacco metabolites specifically via breastfeeding is sparse.

OBJECTIVE

The aim was to conduct the first study of the association between exposure to tobacco metabolites specifically through breastfeeding and infant weight gain.

METHODS

We used historical data from the US Collaborative Perinatal Project. Mothers were classified as nonsmokers, light smokers (1-19 cigarettes/day), and heavy (20+ cigarettes/day) smokers. In-hospital feeding type was observed during a nursery stay after delivery. We conducted stratified analyses among average-for-gestational-age (AGA; N = 23 571) and small-for-gestational-age (SGA; N = 2552) infants. We isolated the effect of exposure to tobacco metabolites specifically through breastfeeding.

RESULTS

Overall, maternal smoking was associated with change in weight-for-length z-score in a dose-response manner. Change in weight z-score was most pronounced among SGA infants of heavy smokers (breastfed: 0.53; 95% confidence interval [CI], 0.12-0.94; formula fed: 0.17; 95% CI, 0.03-0.30). Exposure to tobacco metabolites specifically through breastfeeding was not associated with additional weight gain among AGA infants. Among the much smaller sample of SGA infants, exposure specifically through breastfeeding was associated with marginally significant additional weight gain (0.46; 95% CI, 0.00-0.91) among infants of heavy smokers.

CONCLUSION

Our findings are in accord with recommendations by health agencies for smokers to breastfeed. However, SGA infants exposed to tobacco metabolites via breastfeeding by heavy smokers appear to gain weight more rapidly than other infants. Practical implications of our findings are discussed.

Metabolic syndrome and its associated early-life factors in children and adolescents: a cross-sectional study in Guangzhou, China

Objective

The present study aimed to investigate the prevalence of metabolic syndrome (MetS) in 7- to 17-year-old children and adolescents in China and to examine the relationship between MetS and its associated early-life factors.

Design

Data were collected using a standard parent/guardian questionnaire in a face-to-face interview. Each participant underwent a complete anthropometric evaluation. MetS was defined according to the criteria of the International Diabetes Federation (IDF; 2007) for children and adolescents.

Setting

Guangzhou, a large city in South China, September 2013.

Subjects

A total of 1770 children and adolescents were enrolled in the study, including 913 girls (51·6 %) and 857 boys (48·4 %).

Results

The overall prevalence of MetS in children and adolescents was 1·1 % (n 19), which was higher in boys (1·4 %) than in girls (0·8 %). Multivariate analysis indicated that high birth weight was significantly associated with abdominal obesity (OR=2·86; 95 % CI 1·62, 5·06) and MetS (OR=3·61; 95 % CI 1·33, 9·82). Furthermore, >6 months of maternal breast-feeding was inversely associated with MetS (OR=0·39; 95 % CI 0·16, 0·98).

Conclusion

Based on IDF criteria, the prevalence of MetS among southern Chinese children was significantly lower than that in other populations. High birth weight was significantly associated with abdominal obesity and MetS, and breast-feeding for longer than 6 months was inversely associated with MetS in South China.

Consistency in infants' behavioural signalling of satiation during bottle-feeding

BACKGROUND

Understanding the dynamics of feeding is essential for preventing accelerated weight gain during infancy, a risk factor for obesity.

OBJECTIVES

Because infants satiate on larger volumes of cow milk formula (CMF) than CMF enriched with the free amino acid glutamate (CMF + glu), we used this model system to determine whether infants displayed consistent behaviours despite satiating on lower volumes.

METHODS

In this laboratory-based, within-subject experimental study of ≤4-month-old infants (n = 41) and their mothers, infants were videotaped while feeding to satiation CMF on one test day and CMF + glu on the other, in counterbalanced order. Each video-recording was analysed frame-by-frame for frequency and timing of behaviours.

RESULTS

Infants' behaviours were consistent in types and frequency but were displayed sooner when feeding CMF + glu compared with CMF. The less responsive the mother's feeding style, the less consistent the infant displayed behaviours across the two formula meals (P = 0.05). Infants who spat up (a possible sign of overfeeding) consumed more formula (P = 0.01) and had less responsive mothers (P = 0.04) compared with the other infants.

CONCLUSIONS

Infants are consistent in their behavioural displays during feeding at this developmental age. Regulation of intake and signalling of satiation during bottle-feeding are associated with formula composition and maternal feeding style.

Growth and endothelial function in the first 2 years of life

OBJECTIVE

To test the hypothesis that the inverse association between infant growth and endothelial function at 6 months would persist to 24 months and that accelerated growth would lead to an increased percent body fat, which would, in turn, impact negatively on endothelial function.

STUDY DESIGN

In a prospective observational study, 104 healthy term newborns underwent anthropometry and measurements of vascular vasodilation at 0, 6, 12, and 24 months. We recorded maximum vasodilation in response to acetylcholine (endothelium-dependent) and nitroprusside (endothelium-independent) by use of laser-Doppler vascular perfusion monitoring of the forearm skin vasculature. Additional anthropometry at 1 and 3 months was collected from child welfare centers. The data were analyzed by multilevel linear regression.

RESULTS

Weight gain from 0-1 month was associated inversely with maximum perfusion in response to acetylcholine at the age of 2 years (b = -8.28 perfusion units [PU] per Δ z-score, P = .03). Weight gain from 0-1 month was related positively to maximum perfusion in response to nitroprusside (b = 10.12 PU per Δ z-score, P = .04), as was birth weight (b = 8.02 PU per z-score, P = .02). Body fat percentage did not have a significant effect in any of the perfusion models and was not related to maximum perfusion at 2 years.

CONCLUSION

Infant weight gain from 0-1 month is inversely related to endothelial function in healthy term infants, at least to the age of 2 years. This relationship was not explained by an increased percentage body fat.

Obesity is associated with acute inflammation in a sample of adolescents

BACKGROUND

Obesity is associated with a mild chronic inflammatory response, which has been suggested to be pivotal in the development of cardiometabolic alterations of obesity. However, little is known about the involvement of acute inflammation.

OBJECTIVE

To evaluate whether circulating neutrophils, markers of acute inflammation, are associated (quantitatively and qualitatively) with adolescent obesity and whether leptin modulates these associations.

SUBJECTS AND METHODS

We assessed 528 adolescents (16.8 yr old, 47% females), without chronic/acute illness. We measured anthropometry and dual energy X-ray absorptiometry and calculated fat mass percentage (FM%). Fasting serum glucose, high-density lipoprotein (HDL)-cholesterol, and triglycerides were used with blood pressure and waist circumference to compute a metabolic z-score. Leukocyte and neutrophil counts were obtained, together with levels of serum leptin. In a subsample of 23 males, flow cytometry was used to assess degranulation (CD66b expression) of neutrophils.

RESULTS

Female sex and obesity were positively related to mean neutrophil counts (p < 0.05). When accounting for sex and weight status, leptin was associated with neutrophil counts (p < 0.05), partially explaining the association between obesity and neutrophil counts. Neutrophil counts were related to metabolic risk z-scores, controlling for fat mass. Participants with elevated FM% showed more neutrophil degranulation than controls (p < 0.05).

CONCLUSIONS

Participants with increased adiposity had higher circulating neutrophil counts, suggesting acute inflammation. Furthermore, the neutrophils showed more degranulation, indicating inflammation. Obesity-induced alteration of the adipose secretory pattern (i.e., changes in leptin levels) could be involved in acute inflammation.

Menstrual cycle alterations during adolescence: early expression of metabolic syndrome and polycystic ovary syndrome

STUDY OBJECTIVE

To assess the importance of the menstrual pattern as a marker for clinical and laboratory alterations related to metabolic syndrome (MS) and polycystic ovary syndrome (PCOS) among Brazilian adolescents.

DESIGN

A cross-sectional study.

SETTING

Endocrine Gynecology Outpatient Clinic of the Adolescent Health Studies Center (NESA) at the Pedro Ernesto University Hospital.

PARTICIPANTS

59 girls (12-19 years old) were classified by their menstrual cycles as regular (n = 23) and irregular (n = 36).

INTERVENTION

None.

MAIN OUTCOME MEASURES

Biochemical collections were made of peripheral blood after fasting for 12 hours, and the oral glucose tolerance test with 75 g of anhydrous glucose.

RESULTS

PCOS, MS, and the criteria for MS were significantly more frequent (P < .05) in the subgroup with irregular menstruation. Adolescents with irregular cycles presented a significant increase in waist circumference, glycemia 2 hours after oral glucose overload (2 h), fasting and 2-h insulin, HOMA-IR, and triglycerides. In contrast, the glucose/insulin ratio, quantitative insulin-sensitivity check index, and HDL serum levels were significantly lower among patients with irregular menstruation, compared to those with regular cycles. In the logistic regression, we noted that insulin 2 h ≥ 75 μIU/mL (r = 1.90; P = .018), waist circumference > 95 cm (r = 2.21; P = .006) and diagnosis of PCOS (r = 1.93; P = .023) were significantly correlated to irregular cycles.

CONCLUSIONS

We concluded that close observation of menstrual cycle patterns is an important tool for identifying adolescents at higher risk of developing PCOS and MS.

Metabolic syndrome in Spanish adolescents and its association with birth weight, breastfeeding duration, maternal smoking, and maternal obesity: a cross-sectional study

PURPOSE

The metabolic syndrome (MetS) in adolescents is a growing problem. The objectives were to verify the association among early predictors such as birth weight, breastfeeding, maternal weight status, smoking during pregnancy, and the development of MetS.

METHODS

A cross-sectional study was performed of 976 children and adolescents, 10-15 years of age, at schools in the provinces of Granada and Almeria (Spain). For this purpose, we analyzed the physical characteristics as well as the biochemical markers of the participants with a view to ascertaining the prevalence of the MetS. Relevant data were also extracted from the clinical histories of their mothers.

RESULTS

It was found that 3.85% of the female subjects and 5.38% of the male subjects in the sample population suffered from MetS. In both sexes, there was an association between birth weight and positive MetS diagnosis (OR 1.27). For both males and females, there was an inverse association between the length of time that they had been breastfed and positive MetS diagnosis (OR1-3 months 3.16; OR4-6 months 1.70; OR(>6 months) 0.13). There was also a significant association between maternal weight (OR(overweight )30.79; OR(obesity) 49.36) and cigarette consumption during pregnancy (OR 1.47) and the subsequent development of MetS in the children of these mothers.

CONCLUSIONS

Those subjects born with a higher than average birth weight had a greater risk of developing MetS in childhood and adolescence. Breastfeeding children for longer than 6 months protected them from MetS in their early years as well as in their teens. Other risk factors for MetS were maternal smoking during pregnancy as well as maternal overweight and obesity.

High plasma homocysteine increases risk of metabolic syndrome in 6 to 8 year old children in rural Nepal

Little attention has been given to the association of plasma homocysteine (Hcy) and metabolic syndrome (MetS) in children. We have evaluated the risk of MetS with plasma Hcy in a cohort of 6 to 8 year old rural Nepalese children, born to mothers who had participated in an antenatal micronutrient supplementation trial. We assessed Hcy in plasma from a random selection of n = 1000 children and determined the relationship of elevated Hcy (>12.0 μmol/L) to MetS (defined as the presence of any three of the following: abdominal adiposity (waist circumference ≥ 85th percentile of the study population), high plasma glucose (≥85th percentile), high systolic or diastolic blood pressure (≥90th percentile of reference population), triglyceride ≥ 1.7 mmol/L and high density lipoprotein < 0.9 mmol/L.) and its components. There was an increased risk of low high-density lipoproteins (HDL), [odds ratios (OR) = 1.77, 95% confidence intervals (CI) = 1.08–2.88; p = 0.020], high blood pressure [OR = 1.60, 95% CI = 1.10–2.46; p = 0.015] and high body mass index (BMI) [OR = 1.98, 95% CI = 1.33–2.96; p = 0.001] with elevated Hcy. We observed an increased risk of MetS (OR = 1.75, 95% CI = 1.06–2.90; p = 0.029) with elevated Hcy in age and gender-adjusted logistic regression models. High plasma Hcy is associated with increased risk of MetS and may have implications for chronic disease later in life.

Associations of birth weight and postnatal weight gain with cardiometabolic risk parameters at 5 years of age

The present prospective study assessed the impact of birth weight (BW) and postnatal weight gain on blood pressure and metabolic profile during the first 5 years of life. One hundred thirty-nine newborns (63 women) born at term after uncomplicated pregnancies and in the absence of perinatal illness were included. Subjects were divided according to size at birth in small, appropriate, and large for gestational age. After the initial evaluation on the second day of life, infants were followed up at 6 months and 2 and 5 years. Anthropometric parameters and blood pressure were measured at each visit and metabolic assessment was performed at 5 years of age. Among the BW groups, mothers did not differ in terms of age, smoking, and weight gain during pregnancy. BW was a positive determinant of systolic blood pressure at birth. Afterward, current weight was the strongest determinant, becoming significant at 2 years of age and progressively increasing in influence. At 5 years insulin, the homeostasis model assessment index and triglycerides were dependent on BW, current weight, and postnatal weight gain. In addition, BW was positively associated with high-density lipoprotein-cholesterol and inversely so to uric acid. A positive relationship among insulin, blood pressure values, and uric acid was observed even early in life. In conclusion, the acceleration of early infant weight gain may aggravate the effects of low BW. Multiple interactions between hemodynamic and metabolic parameters foreshadow the clustering of cardiometabolic risk factors later in life.

Preimplantation stress and development

The developmental origins of health and disease hypothesis holds that inappropriate environmental cues in utero, a period marked by tremendous developmental sensitivity, facilitate cellular reprogramming to ultimately predispose disease in adulthood. In this review, we analyze if stress during early stages of development can affect future health. This has wide clinical importance, given that 5 million children have been conceived with assisted reproductive technologies (ART). Because the primary outcome of assisted reproduction procedures is delivery at term of a live, healthy baby, the postnatal effects occurring outside ofthe neonatal period are often overlooked. To this end, the long-term outcome of ART is appropriately the most relevant concern of the field today. Evidence of adverse consequences is controversial. The majority of studies have concluded no obvious problems in IVF-conceived children, although a number of isolated cases of imprinted diseases, cancers, or malformations have been reported. Given that animal studies suggest alteration of metabolic pathways following preimplantation stress, it will be of great importance to follow-up ART individuals as they enter later stages of adult life.