Overweight at four years of age in a Swedish birth cohort: influence of neighbourhood-level purchasing power

Early life factors and oral microbial signatures define the risk of caries in a Swedish cohort of preschool children

The oral cavity harbors complex communities comprising bacteria, archaea, fungi, protozoa, and viruses. The oral microbiota is establish at birth and develops further during childhood, with early life factors such as birth mode, feeding practices, and oral hygiene, reported to influence this development and the susceptibility to caries. We here analyzed the oral bacterial composition in saliva of 260 Swedish children at two, three and five years of age using 16S rRNA gene profiling to examine its relation to environmental factors and caries development at five years of age. We were able to assign the salivary bacterial community in each child at each time point to one of seven distinct clusters. We observed an individual dynamic in the development of the oral microbiota related to early life factors, such as being first born, born by C-section, maternal perinatal antibiotics use, with a distinct transition between three and five years of age. Different bacterial signatures depending on age were related to increased caries risk, while Peptococcus consistently linked to reduced risk of caries development.

Socioeconomic Deprivation Is Not Associated with Outcomes after Esophagectomy at a German High-Volume Center

In Germany, socioeconomically deprived citizens more often develop esophageal carcinoma, since typical risk factors follow the social gradient. Therefore, we hypothesized that socioeconomic deprivation might also be associated with advanced tumor stages and comorbidities at the time of surgery. As a consequence, socioeconomic deprivation may be related to postoperative complications and reduced overall survival. Therefore, 310 patients who had undergone esophagectomy for cancer in curative intent between 2012 and 2020 at the University Medical Center Hamburg-Eppendorf (UKE) were included in this study. Socioeconomic status (SES) was estimated using the purchasing power of patients' postal codes as a surrogate parameter. No association was found between SES and tumor stage or comorbidities at the time of surgery. Moreover, SES was neither associated with postoperative complications nor overall survival. In conclusion, socioeconomic inequalities of patients treated at a high-volume center do not affect treatment outcomes.

Experiences of nurses and coordinators in a childhood obesity prevention trial based on motivational interviewing within Swedish child health services

Purpose

To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity.

Methods

Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis.

Results

Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses’ commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended.

Conclusions

Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints. .

Higher Socioeconomic Status is Associated with Improved Outcomes After Obesity Surgery Among Women in Germany

Background

Low socioeconomic status (SES) is associated with an increased prevalence of obesity. It is unknown whether SES influences the outcome after bariatric surgery in Germany. Therefore, the aim of our study was to investigate whether the SES is linked with an inferior outcome after bariatric surgery.

Methods

We included all patients who underwent bariatric surgery in our university hospital from 2012–2014. Net income was estimated by matching the zip codes of patient residency with the region-specific purchasing power index. We analyzed the relationship between SES, weight loss and remission of comorbidities.

Results

We included 559 patients in this study and detected a mean 5-year percentage excess weight loss (%EWL) of 52.3%. We detected a significantly lower initial body mass index (BMI) and weight in patients with a higher income. One year after surgery, we did not find a significant difference. Further analysis revealed that only women with a higher income had a significantly lower BMI and weight 3 and 5 years after surgery.

Conclusions

Bariatric surgery is beneficial for all patients regardless of income. Furthermore, we demonstrated that women with high SES have a better outcome after bariatric surgery.

Developmental trajectory of the healthy human gut microbiota during the first 5 years of life

The gut is inhabited by a densely populated ecosystem, the gut microbiota, that is established at birth. However, the succession by which different bacteria are incorporated into the gut microbiota is still relatively unknown. Here, we analyze the microbiota from 471 Swedish children followed from birth to 5 years of age, collecting samples after 4 and 12 months and at 3 and 5 years of age as well as from their mothers at birth using 16S rRNA gene profiling. We also compare their microbiota to an adult Swedish population. Genera follow 4 different colonization patterns during establishment where Methanobrevibacter and Christensenellaceae colonize late and do not reached adult levels at 5 years. These late colonizers correlate with increased alpha diversity in both children and adults. By following the children through age-specific community types, we observe that children have individual dynamics in the gut microbiota development trajectory.

A prospective study of perinatal and metabolic risk factors for early childhood caries

AIM

To study the relationship between early childhood caries and perinatal and metabolic risk factors in a cohort of preschool children.

METHODS

The study population consisted of 208 children followed from birth to 6.5 years. We extracted the perinatal factors from medical records and questionnaires and assessed the occurrence of caries at the age of 5 years. Indicators of the metabolic syndrome (waist circumference, blood pressure, fasting insulin, glucose and dyslipidaemia) were recorded at 6.5 years of age.

RESULTS

Infants born moderately to late preterm and infants born small for gestational age were more likely to have early childhood caries at 5 years of age (relative risk 4.2 and 2.3, respectively; P < .05). The presence of metabolic risk factors according to the IDEFICS monitoring levels did not differ between children with or without caries but a statistically significant correlation was found between the fasting glucose values and the number of decayed or filled teeth (r = 0.18; P < .05).

CONCLUSION

Being born preterm or small for gestational age increased the risk of early childhood caries. Preschool children with caries had higher fasting glucose levels but no other signs of the metabolic syndrome.

Prevention of Childhood Obesity in Child Health Services: Follow-Up of the PRIMROSE Trial

BACKGROUND

Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI).

METHODS

A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect.

RESULTS

There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons.

CONCLUSIONS

A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.

Social Norms Influencing the Local Food Environment as Perceived by Residents and Food Traders: The Heart Healthy Hoods Project

Exploring subjective elements of the food environment remains key to understand why and how residents purchase food. Our aim was to explore and describe the social norms relating to the local food environment and food purchasing behaviors, as perceived by residents and food traders in Madrid, Spain. This qualitative study took place in a middle socioeconomic status neighborhood of Madrid between January 2015 and May 2016. We conducted 35 semi-structured interviews. We used stratified purposive sampling to recruit residents, neighborhood workers (N = 20) and food traders (N = 15) representing different levels of involvement with food purchasing behaviors. We analyzed these data using an interpretative phenomenological analysis approach. Participants highlighted social aspects of the food environment in relation to food purchasing behaviors. First, interpersonal and relational food environment elements were emphasized, including trust and tradition. Participants also identified generational demographic trends in relation to changes in the way residents purchased food: the new pace of life and the lack of time to buy fresh food and to cook at home. All these elements were influenced by the economic crisis. Food environment interventions aiming to improve food purchasing behaviors and residents' diets should consider intermediate social aspects of the food environment like trust and tradition and the fast pace of life of younger generations.

Influence of mode of delivery, family and nursing determinants on early childhood caries development: a prospective cohort study

INTRODUCTION

Conflicting results exist regarding mode of delivery and caries. We investigated the influence of the mode of delivery and selected family- and nursing factors during the first 2 years of life on the prevalence of dental caries at 5 years.

MATERIALS AND METHODS

551 infants were invited to a prospective medical study with focus on growth and overweight prevention. The parents of 346 infants (179 boys and 167 girls) accepted this invitation and at the age of 2-years, 336 of them agreed to dental check-ups and salivary samplings. At the ages of three and five years, 302 (90%) and 292 children (87%) could be re-examined with respect to caries by one of two calibrated examiners. All stages of caries lesions were scored on tooth and surface level. Background maternal and nursing data were collected semiannually through validated questionnaires and interviews.

RESULTS

The caries prevalence (initial + cavitated lesions) was 5.6% at 3 years of age and 18.9% at 5 years. The 5-year-olds delivered with caesarian section displayed a significantly elevated risk of having caries (relative risk [RR] 2.2; 95% confidence interval (CI) 1.4-3.6; p < .05). Parental smoking and siblings with caries were the most influential family determinants (p < .05) while drinking juice to meals at 2 years of age (p < .05) was most outstanding among the nursing factors (p < .05).

CONCLUSIONS

In this cohort, the mode of delivery (caesarian section) had a significant impact on the risk of early childhood caries (ECC) but also other family and infant nursing determinants were related to the development of the disease.

Contrasting patterns of overweight and thinness among preschool children of different ethnic groups in Norway, and relations with maternal and early life factors

Background

Childhood obesity is a worldwide health challenge and risk factor for adult life obesity, which predisposes to development of type 2 diabetes and cardiovascular diseases. However, also thinness in early life has been related to these diseases, especially if followed by fat gain. In European countries, susceptibility to cardio-metabolic diseases varies considerably between ethnic groups. We investigated ethnic differences in overweight and thinness in a multi-ethnic, population-based cohort of preschool children in Norway, and associations with maternal and early postnatal factors.

Methods

Participants were children aged 4–5 years (n = 570) drawn from the population-based STORK Groruddalen cohort of healthy women and offspring followed from early pregnancy. Ethnic groups were: European (n = 298), South Asian (n = 154), and Middle East/North African (n = 118). Children’s growth data were provided from routine visits at local Child Health Clinics. Weight status was defined by the International Obesity Task Force. Using multinomial logistic regression analysis, we explored ethnic differences in overweight and thinness, and associations with maternal-, pre, − and postnatal factors.

Results

Children of Middle East/North African origin had higher prevalence of overweight (22.0%) compared to European (12.8%) children, and in adjusted logistic regression analysis almost the double risk (OR 1.98; 95%CI: 1.08–3.63). Prevalence was lower in children of South Asian origin (5.2%). Children with South Asian background had higher prevalence of thinness (26.0%) compared to ethnic Europeans (10.4%), and the double risk (OR 2.20; 95%CI: 1.25–3.87) in adjusted models. Applying newly suggested BMI adjustments in South Asian children, taking into account their relatively increased adiposity, markedly increased the prevalence of overweight, and decreased the prevalence of thinness in this subgroup. Birthweight and maternal prepregnant overweight were strongly, positively associated with overweight, and inversely associated with thinness. Lower maternal age was associated with overweight only.

Conclusions

In a multi-ethnic cohort we found strikingly different patterns of overweight and thinness among children of different ethnic groups at age 4–5 years, and a strong association between maternal BMI and their children’s weight status. More knowledge is needed on what characterizes and what promotes healthy growth patterns in multi-ethnic populations.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5952-1) contains supplementary material, which is available to authorized users.