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Gardosi J, Hugh O. Stillbirth risk and smallness for gestational age according to Hadlock, INTERGROWTH-21st, WHO, and GROW fetal weight standards: analysis by maternal ethnicity and body mass index. Am J Obstet Gynecol 2023; 229:547.e1-547.e13. [PMID: 37247647 DOI: 10.1016/j.ajog.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Appropriate growth charts are essential for fetal surveillance, to confirm that growth is proceeding normally and to identify pregnancies that are at risk. Many stillbirths are avoidable through antenatal detection of the small-for-gestational-age fetus. In the absence of an international consensus on which growth chart to use, it is essential that clinical practice reflects outcome-based evidence. OBJECTIVE This study investigated the performance of 4 internationally used fetal weight standards and their ability to identify stillbirth risk in different ethnic and maternal size groups of a heterogeneous population. STUDY DESIGN We analyzed routinely collected maternity data from more than 2.2 million pregnancies. Three population-based fetal weight standards (Hadlock, Intergrowth-21st, and World Health Organization) were compared with the customized GROW standard that was adjusted for maternal height, weight, parity, and ethnic origin. Small-for-gestational-age birthweight and stillbirth risk were determined for the 2 largest ethnic groups in our population (British European and South Asian), in 5 body mass index categories, and in 4 maternal size groups with normal body mass index (18.5-25.0 kg/m2). The differences in trend between stillbirth and small-for-gestational-age rates were assessed using the Clogg z test, and differences between stillbirths and body mass index groups were assessed using the chi-square trend test. RESULTS Stillbirth rates (per 1000) were higher in South Asian pregnancies (5.51) than British-European pregnancies (3.89) (P<.01) and increased in both groups with increasing body mass index (P<.01). Small-for-gestational-age rates were 2 to 3-fold higher for South Asian babies than British European babies according to the population-average standards (Hadlock: 26.2% vs 12.2%; Intergrowth-21st: 12.1% vs 4.9%; World Health Organization: 32.2% vs 16.0%) but were similar by the customized GROW standard (14.0% vs 13.6%). Despite the wide variation, each standard's small-for-gestation-age cases had increased stillbirth risk compared with non-small-for-gestation-age cases, with the magnitude of risk inversely proportional to the rate of cases defined as small for gestational age. All standards had similar stillbirth risk when the small-for-gestation-age rate was fixed at 10% by varying their respective thresholds for defining small for gestational age. When analyzed across body mass index subgroups, the small-for-gestation-age rate according to the GROW standard increased with increasing stillbirth rate, whereas small-for-gestation-age rates according to Hadlock, Intergrowth-21st, and World Health Organization fetal weight standards declined with increasing body mass index, showing a difference in trend (P<.01) to stillbirth rates across body mass index groups. In the normal body mass index subgroup, stillbirth rates showed little variation across maternal size groups; this trend was followed by GROW-based small-for-gestation-age rates, whereas small-for-gestation-age rates defined by each population-average standard declined with increasing maternal size. CONCLUSION Comparisons between population-average and customized fetal growth charts require examination of how well each standard identifies pregnancies at risk of adverse outcomes within subgroups of any heterogeneous population. In both ethnic groups studied, increasing maternal body mass index was accompanied by increasing stillbirth risk, and this trend was reflected in more pregnancies being identified as small for gestational age only by the customized standard. In contrast, small-for-gestation-age rates fell according to each population-average standard, thereby hiding the increased stillbirth risk associated with high maternal body mass index.
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Affiliation(s)
| | - Oliver Hugh
- Perinatal Institute, Birmingham, United Kingdom
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Arntsen SH, Borch KB, Wilsgaard T, Njølstad I, Hansen AH. Time trends in body height according to educational level. A descriptive study from the Tromsø Study 1979-2016. PLoS One 2023; 18:e0279965. [PMID: 36696372 PMCID: PMC9876240 DOI: 10.1371/journal.pone.0279965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The objective of our study was to describe time trends in body height according to attained educational level in women and men in Norway. METHODS We used previously collected data from six repeated cross-sectional studies in the population based Tromsø Study 1979-2016. Measured body height in cm and self-reported educational level were the primary outcome measures. We included 31 466 women and men aged 30-49 years, born between 1930 and 1977. Participants were stratified by 10-year birth cohorts and allocated into four groups based on attained levels of education. Descriptive statistics was used to estimate mean body height and calculate height differences between groups with different educational levels. RESULTS Mean body height increased by 3.4 cm (95% confidence interval (CI) 3.0, 3.8) in women (162.5-165.9 cm) and men (175.9-179.3 cm) between 1930 and 1977. The height difference between groups with primary education compared to long tertiary education was 5.1 cm (95% CI 3.7, 6.5) in women (161.6-166.7 cm) and 4.3 cm (95% CI 3.3, 5.3) in men (175.0-179.3 cm) born in 1930-39. The height differences between these educational groups were reduced to 3.0 cm (95% CI 1.9, 4.1) in women (163.6-166.6 cm) and 2.0 cm (95% CI 0.9, 3.1) in men (178.3-180.3 cm) born in 1970-77. CONCLUSIONS Body height increased in women and men. Women and men with long tertiary education had the highest mean body height, which remained stable across all birth cohorts. Women and men in the three other groups had a gradual increase in height by birth cohort, reducing overall height differences between educational groups in our study population.
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Affiliation(s)
- Sondre Haakonson Arntsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- * E-mail:
| | - Kristin Benjaminsen Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Helen Hansen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- University Hospital of North Norway, Tromsø, Norway
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Candela-Martínez B, Cámara AD, López-Falcón D, Martínez-Carrión JM. Growing taller unequally? Adult height and socioeconomic status in Spain (Cohorts 1940–1994). SSM Popul Health 2022; 18:101126. [PMID: 35669890 PMCID: PMC9163098 DOI: 10.1016/j.ssmph.2022.101126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/05/2022] Open
Abstract
Socioeconomic inequalities and their evolution in different historical contexts have been widely studied. However, some of their dimensions remain relatively unexplored, such as the role played by socioeconomic status in the trajectory of biological living standards, especially net nutritional status. The main objective of this article is to analyze whether the power of socioeconomic status (SES) to explain differences in the biological dimensions of human well-being (in this case, adult height, a reliable metric for health and nutritional status) has increased or diminished over time. Educational attainment and occupational category have been used as two different proxies for the SES of Spanish men and women born between 1940 and 1994, thus covering a historical period in Spain characterized by remarkable socioeconomic development and a marked increase in mean adult height. Our data is drawn from nine waves of the Spanish National Health Survey and the Spanish sample of two waves of the European Health Interview Survey (ENSE) for the period 1987 to 2017 (N = 73,699 citizens aged 23–47). A multivariate regression analysis has been conducted, showing that, as a whole, height differentials by educational attainment have diminished over time, whereas differences by occupational category of household heads have largely persisted. These results indicate the need for further qualification when describing the process of convergence in biological well-being indicators across social groups. For instance, the progressive enrollment of a greater proportion of the population into higher educational levels may lead us to underestimate the real differences between socioeconomic groups, while other proxies of SES still point to the persistence of such differences. Different SES impact on nutritional status according to SES operationalization. Significant reduction in height differentials by educational attainment over time. Height differentials largely persist by social class over time. Evidence is provided on recent halt of upward intergenerational growth in Spain. Mean cohort height stagnation not due to increases in social groups' differentials.
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Lauringson V, Veldre G, Hõrak P. Adolescent Cranial Volume as a Sensitive Marker of Parental Investment: The Role of Non-material Resources? Front Psychol 2020; 11:602401. [PMID: 33384647 PMCID: PMC7769954 DOI: 10.3389/fpsyg.2020.602401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/25/2020] [Indexed: 12/18/2022] Open
Abstract
Growth of different body parts in humans is sensitive to different resource constraints that are mediated by parental investment. Parental investment can involve the expenditure of material, cognitive, and emotional resources on offspring. Cranial volume, an important predictor of cognitive ability, appears understudied in this context. We asked (1) whether there are associations between growth and family structure, self-reported estimates for resource availability, and sibling number; and (2) whether these constraints relate to head and body growth in a similar manner. We assessed the associations between parental investment, height, and cranial volume in a cross-sectional study of Estonian children (born 1980-87, aged 11-17). Height correlated negatively with the number of siblings but this association became negligible in a model controlling for birthweight, parental heights, and mother's age at birth. Unlike height, cranial volume was unrelated to sibling number, but it was negatively associated with self-reported meat and general resource shortage. Cranial volume was related to family structure and paternal education. Children living with both birth-parents had larger heads than those living in families containing a step-parent. Since these family types did not differ with respect to meat or general resource shortage, our findings suggest that families including both genetic parents provide non-material benefits that stimulate predominantly cranial growth. For the studied developmental period, cranial volume appeared a more sensitive marker of growth constraints than height. The potential of using cranial volume for quantifying physical impact of non-material parental investment deserves further attention.
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Affiliation(s)
| | - Gudrun Veldre
- Department of Anatomy, Centre for Physical Anthropology, University of Tartu, Tartu, Estonia
| | - Peeter Hõrak
- Department of Zoology, University of Tartu, Tartu, Estonia
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Agnihotri N, Øverby NC, Bere E, Wills AK, Brantsaeter AL, Hillesund ER. Childhood adherence to a potentially healthy and sustainable Nordic diet and later overweight: The Norwegian Mother, Father and Child Cohort Study (MoBa). MATERNAL AND CHILD NUTRITION 2020; 17:e13101. [PMID: 33103349 PMCID: PMC7988855 DOI: 10.1111/mcn.13101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/28/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022]
Abstract
The New Nordic Diet (NND) is a potentially healthy and sustainable dietary pattern represented by locally available and traditionally consumed foods in the Northern countries. The diet has been commonly examined in adult populations, but less is known regarding its potential associations with overweight/obesity in children. We have previously developed child diet scores measuring compliance to the NND at child age 6 and 18 months and 3 and 7 years. In this study, we aimed to describe child and maternal characteristics and assess potential associations between the age‐specific diet scores and child overweight at 8 years. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), including 14,989 mother–child pairs and uses data from the Medical Birth Registry of Norway (MBRN). The scores measured NND compliance as a total score and categorized into low, medium and high NND compliance at each age point. Using logistic regression models, we investigated the association between each age‐specific score and the odds of overweight at 8 years. In crude analyses, adherence to the NND at 6 months was inversely associated with odds of overweight at 8 years in the continuous score (odds ratio = 0.95, 95% CI [0.91, 0.98]) and when comparing high versus low NND adherence (odds ratio = 0.81, 95% CI [0.70, 0.94]). The association was almost entirely attenuated in the adjusted models. In conclusion, child NND adherence up to 7 years of age was not associated with odds of overweight at 8 years in adjusted analyses.
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Affiliation(s)
- Neha Agnihotri
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Elling Bere
- Department of Health and Inequalities and Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.,Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | | | - Anne Lise Brantsaeter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Genetic and environmental influences on human height from infancy through adulthood at different levels of parental education. Sci Rep 2020; 10:7974. [PMID: 32409744 PMCID: PMC7224277 DOI: 10.1038/s41598-020-64883-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/21/2020] [Indexed: 11/09/2022] Open
Abstract
Genetic factors explain a major proportion of human height variation, but differences in mean stature have also been found between socio-economic categories suggesting a possible effect of environment. By utilizing a classical twin design which allows decomposing the variation of height into genetic and environmental components, we tested the hypothesis that environmental variation in height is greater in offspring of lower educated parents. Twin data from 29 cohorts including 65,978 complete twin pairs with information on height at ages 1 to 69 years and on parental education were pooled allowing the analyses at different ages and in three geographic-cultural regions (Europe, North America and Australia, and East Asia). Parental education mostly showed a positive association with offspring height, with significant associations in mid-childhood and from adolescence onwards. In variance decomposition modeling, the genetic and environmental variance components of height did not show a consistent relation to parental education. A random-effects meta-regression analysis of the aggregate-level data showed a trend towards greater shared environmental variation of height in low parental education families. In conclusion, in our very large dataset from twin cohorts around the globe, these results provide only weak evidence for the study hypothesis.
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Lopuszanska-Dawid M, Kołodziej H, Lipowicz A, Szklarska A, Kopiczko A, Bielicki T. Social class-specific secular trends in height among 19-year old Polish men: 6th national surveys from 1965 till 2010. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100832. [PMID: 31924589 DOI: 10.1016/j.ehb.2019.100832] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
The results presented in this study concern the assessment of the secular trend of body height in 10 % a random national sample (N = 134,224) representing all regions of Poland in 8 homogeneous social groups over 45 years in Poland (1965-2010). Very significant political, social and economic changes in Poland occurred in the period studied. The political revolution that began in Poland at the turn of the 1980s and 1990s dramatically changed the picture of social inequalities in the country. It rapidly transformed (in different directions and to a different degree) the economic situation, working conditions, lifestyles and the prestige of particular social classes and professional groups. A positive secular trend was observed in 19-year-old participants in the period analysed in all homogeneous socio-professional groups, however, with different intensity in each group. The highest body height increases in 1965-2010 were observed in the sons of farmers with post-primary father's education (7.77 cm). The lowest were observed among the sons of professionals, only 5.45 cm. Although social distances between extreme socio-economic groups significantly decreased (from 4.89 cm in 1965 to 2.76 cm in 2010), social gradients of body height, despite the improvement in the standards of living of the entire society remained exceptionally stable and unchanged for nearly half a century.
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Affiliation(s)
- M Lopuszanska-Dawid
- Józef Pilsudski University of Physical Education in Warsaw, Department of Biomedical Sciences, Marymoncka 34, 00-968 Warsaw 45, Poland.
| | - H Kołodziej
- Wroclaw University of Environmental and Life Sciences, The Faculty of Biology and Animal Science, Department of Anthropology, C. K. Norwida 25, 50-375 Wrocław, Poland
| | - A Lipowicz
- Wroclaw University of Environmental and Life Sciences, The Faculty of Biology and Animal Science, Department of Anthropology, C. K. Norwida 25, 50-375 Wrocław, Poland
| | - A Szklarska
- Polish Academy of Sciences, Palace of Culture and Science, Plac Defilad 1, 00-901 Warsaw, Poland
| | - A Kopiczko
- Józef Pilsudski University of Physical Education in Warsaw, Department of Biomedical Sciences, Marymoncka 34, 00-968 Warsaw 45, Poland
| | - T Bielicki
- Polish Academy of Sciences, Palace of Culture and Science, Plac Defilad 1, 00-901 Warsaw, Poland
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8
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Parsons CM, Carter SA, Ward K, Syddall HE, Clynes MA, Cooper C, Dennison EM. Intergenerational effect of early-life growth on offspring height: Evidence from the Hertfordshire Cohort Study. Paediatr Perinat Epidemiol 2020; 34:29-35. [PMID: 31960473 DOI: 10.1111/ppe.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous intergenerational (parent to child) and transgenerational (grandparent to grandchild) studies have shown there is a link between parental and offspring birthweight. OBJECTIVES The aim was to explore the association between the early-life weight gain of an individual and the adult height of their children and grandchildren. METHODS Study participants across three generations of the Hertfordshire Cohort Study (HCS) were included in this study. Health visitors recorded the birthweight (kg) and weight at 1 year (kg) of the original (F0 generation) HCS participants when they were born in Hertfordshire between 1931 and 1939. A conditional infant weight gain score for F0 participants was calculated using birthweight and weight at 1 year, and self-reported height (cm) of their children (F1 generation) and their grandchildren (F2 generation) was obtained from postal questionnaires. Due to the lack of clustering within family lines, linear regression analysis was used to compare intergenerational relationships. RESULTS Data were available from 139 F0, 148 F1, and 198 F2 participants. A positive association was found between parental birthweight (F0) and offspring adult height; on average, a 1 kg increase in F0 birthweight was associated with a 2.04 cm increase in F1 adult height (beta 2.04, 95% confidence interval [CI] -0.03, 4.10). A positive association was found between F0 conditional weight gain during the first year of life and offspring (beta 1.53, 95% CI 0.45, 2.62) and grandchild height (beta 1.06, 95% CI 0.03, 2.10). Positive associations were also found between F0 weight at 1 year and offspring (beta 1.83, 95% CI 0.79, 2.87) and grandchild height (beta 0.91, 95% CI -0.10, 1.91). CONCLUSION This study demonstrates an association between grandparental weight gain in early life and the heights of their children and grandchildren. The results of these analyses highlight the importance of early-life weight gain on the adult stature of subsequent offspring.
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Affiliation(s)
- Camille M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sarah A Carter
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Kate Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - Holly E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Michael A Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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Rocha V, Stringhini S, Henriques A, Falcão H, Barros H, Fraga S. Life-course socioeconomic status and lung function in adulthood: a study in the EPIPorto cohort. J Epidemiol Community Health 2019; 74:290-297. [PMID: 31822567 DOI: 10.1136/jech-2019-212871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/06/2019] [Accepted: 11/26/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aims to investigate the association of life-course socioeconomic status (SES) with lung function during adulthood, by exploring the influence of life-course social mobility and of cumulative exposure to low SES. METHODS Participants were 1458 individuals from EPIPorto study, a population-based cohort of Portuguese adults. The life-course SES was computed using participants' paternal occupation and own occupation, resulting in four patterns: stable high, upward, downward, stable low. A cumulative life-course SES index was also calculated using the participants' paternal occupation, own education and occupation. Lung function during adulthood was assessed with forced expiratory volume in first second (FEV1) and forced vital capacity (FVC) percentages predicted (higher percentages are associated with better lung function). Linear regression models were used to estimate beta coefficients and 95% CI for the association of socioeconomic indicators and lung function. RESULTS Disadvantaged SES from childhood to adulthood was associated with lower lung function (FEV1:-6.64%,-10.68;-2.60/FVC:-3.77%,-7.45;-0.08), and the greater the socioeconomic disadvantage, the lower the lung function (FEV1:-2.56%,-3.98;-1.15/FVC:-1.54%,-2.83;-0.24) among men, independently of marital status and behavioural factors. Among women, SES effects were only observed in those experiencing a stable low life-course SES at older ages (-5.15%,-10.20;-0.09). Men experiencing a downward social mobility presented the lowest lung function, but there was attenuation to the null after accounting for marital status and behavioural factors. CONCLUSION A life-course disadvantaged SES is an important predictor of lower lung function during adulthood. Downward social mobility was associated with the lowest lung function among men, although this association was mostly explained by behavioural factors.
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Affiliation(s)
- Vânia Rocha
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Population Epidemiology Unit, Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Ana Henriques
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Helena Falcão
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Sílvia Fraga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal .,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
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Bird PK, Pickett KE, Graham H, Faresjö T, Jaddoe VWV, Ludvigsson J, Raat H, Seguin L, Wijtzes AI, McGrath JJ. Income inequality and social gradients in children's height: a comparison of cohort studies from five high-income countries. BMJ Paediatr Open 2019; 3:e000568. [PMID: 31909223 PMCID: PMC6937032 DOI: 10.1136/bmjpo-2019-000568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/17/2019] [Accepted: 11/02/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health and well-being are better, on average, in countries that are more equal, but less is known about how this benefit is distributed across society. Height is a widely used, objective indicator of child health and predictor of lifelong well-being. We compared the level and slope of social gradients in children's height in high-income countries with different levels of income inequality, in order to investigate whether children growing up in all socioeconomic circumstances are healthier in more equal countries. METHODS We conducted a coordinated analysis of data from five cohort studies from countries selected to represent different levels of income inequality (the USA, UK, Australia, the Netherlands and Sweden). We used standardised methods to compare social gradients in children's height at age 4-6 years, by parent education status and household income. We used linear regression models and predicted height for children with the same age, sex and socioeconomic circumstances in each cohort. RESULTS The total analytic sample was 37 063 children aged 4-6 years. Gradients by parent education and household income varied between cohorts and outcomes. After adjusting for differences in age and sex, children in more equal countries (Sweden, the Netherlands) were taller at all levels of parent education and household income than children in less equal countries (USA, UK and Australia), with the greatest between-country differences among children with less educated parents and lowest household incomes. CONCLUSIONS The study provides preliminary evidence that children across society do better in more equal countries, with greatest benefit among children from the most disadvantaged socioeconomic groups.
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Affiliation(s)
- Philippa K Bird
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Tomas Faresjö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johnny Ludvigsson
- Division of Pediatrics, Medical Faculty, Linköping University, Linköping, Sweden
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Louise Seguin
- Department of Social and Preventive Medicine, Universite de Montreal, Montreal, Québec, Canada
| | - Anne I Wijtzes
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer J McGrath
- Department of Psychology, Concordia University, Montreal, Québec, Canada
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11
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Fafard St-Germain AA, Siddiqi A. The Relation Between Household Food Insecurity and Children's Height in Canada and the United States: A Scoping Review. Adv Nutr 2019; 10:1126-1137. [PMID: 31075160 PMCID: PMC6855965 DOI: 10.1093/advances/nmz034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/08/2018] [Accepted: 03/18/2019] [Indexed: 01/14/2023] Open
Abstract
Household food insecurity is a determinant of health and marker of material deprivation. Although research has shown that food insecurity is associated with numerous adverse health, developmental and nutritional outcomes among children in high-income countries, little is known about its impact on children's height, an important marker of nutritional status and physical development. We reviewed evidence on the relation between experience-based measures of food insecurity and the height of children aged 0-18 y in Canada and the United States. The search, conducted in Embase, Medline, CINAHL, ProQuest, Web of Science, and EconLit from the inception of the databases to October 2017, identified 811 records that were screened for relevance. A total of 8 peer-reviewed studies, 2 from Canada and 6 from the United States, met the inclusion criteria and were summarized. Five studies found no association between food insecurity and children's height. One study found that having taller children in the household predicted more severe food insecurity, whereas 2 studies found that more severe experiences of food insecurity were associated with shorter height among children from ethnic minority populations. These results suggest that household food insecurity may not be associated with height inequalities among children in Canada and the United States, except perhaps in certain high-risk populations. However, the few studies identified for review provide insufficient evidence to determine whether food insecurity is or is not associated with children's height in these countries. Given the importance of optimal linear growth for current and future well-being, it is critical to understand how different modifiable environmental circumstances relate to children's height to help establish priorities for intervention. Families with children are disproportionately affected by food insecurity, and more research explicitly designed to examine the association between household food insecurity and children's height in high-income countries is needed.
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Affiliation(s)
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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12
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Ballon M, Botton J, Forhan A, de Lauzon-Guillain B, Melchior M, El Khoury F, Nakamura A, Charles MA, Lioret S, Heude B. Which modifiable prenatal factors mediate the relation between socio-economic position and a child's weight and length at birth? MATERNAL AND CHILD NUTRITION 2019; 15:e12878. [PMID: 31343839 DOI: 10.1111/mcn.12878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/27/2019] [Accepted: 07/22/2019] [Indexed: 01/08/2023]
Abstract
Although several studies have shown a positive association between socio-economic position and size at birth, not enough is known about the modifiable factors that may be involved. We aimed to investigate whether maternal prepregnancy body mass index (BMI), smoking, diet, and depression during pregnancy mediate the positive association between maternal education and birth size. Weight and length z-scores specific for gestational age and sex were calculated for 1,500 children from the EDEN mother-child cohort. A mediation analysis of the associations between maternal education and birth size was conducted with a counterfactual method, adjusted for recruitment centre, parity, maternal height, and age. In the comparison of children of mothers with low versus intermediate education levels, maternal smoking during pregnancy explained 52% of the total effect of education on birth weight. Similar findings were observed with birth length z-score (37%). The comparison of children of mothers with high versus intermediate education levels yielded a non-significant total effect, which masked opposite mediating effects by maternal BMI and smoking during pregnancy on both birth weight and length. Prepregnancy BMI and maternal smoking during pregnancy mediate the positive association between maternal education and birth weight and length z-scores. These mediators, however, act in opposite directions, thereby masking the extent to which healthy prenatal growth is socially differentiated.
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Affiliation(s)
- Morgane Ballon
- Université de Paris, CRESS, INSERM, INRA, F-75004, Paris
| | - Jérémie Botton
- Department of Epidemiology of Health Products, rench National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Anne Forhan
- Université de Paris, CRESS, INSERM, INRA, F-75004, Paris
| | | | - Maria Melchior
- Department of Social Epidemiology, INSERM, Sorbonne Université, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Fabienne El Khoury
- Department of Social Epidemiology, INSERM, Sorbonne Université, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Aurélie Nakamura
- Department of Social Epidemiology, INSERM, Sorbonne Université, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | - Barbara Heude
- Université de Paris, CRESS, INSERM, INRA, F-75004, Paris
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13
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Rosário R, Olsen NJ, Rohde JF, Händel MN, Santos R, Heitmann BL. Longitudinal associations between body composition and regional fat distribution and later attained height at school entry among preschool children predisposed to overweight. Eur J Clin Nutr 2019; 74:465-471. [PMID: 31444466 DOI: 10.1038/s41430-019-0494-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/19/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES To investigate the associations between indicators of obesity and fat distribution, such as body mass index (BMI), fat mass, and skinfold measures during preschool age, and attained height at school entry. SUBJECTS/METHODS The Healthy Start primary intervention study comprised 1100 obesity-prone preschool children from the greater Copenhagen area, with a mean [standard deviation (SD)] age of 4.0 (1.1) years at baseline. Anthropometry was measured by trained health professionals at baseline (preschool age) and follow-up height at school entry was gathered by school nurses. Prospective associations between body fat measures and later attained height were examined using generalized linear models with adjustments for potential confounders. RESULTS Greater adiposity at preschool age was directly associated with a higher attained height at follow-up at school-age, when adjusting for confounders. A baseline difference of one BMI unit was associated with a greater attained height of 0.8 cm [(95% confidence interval (CI) 0.5; 1.2]. Furthermore, a difference of 1 mm in the sum of four skinfolds measured at baseline was associated with a greater attained height of 0.1 cm (95% CI 0.03; 0.2) at follow-up. Children with overweight or obesity at baseline attained a significantly higher height of 2.9 (95% CI 1.6; 4.1) cm at follow-up after full adjustment than normal weight children. CONCLUSIONS Our results supports that greater adiposity at preschool age is associated with greater tallness. Although a greater height is assumed to be desirable, accelerated growth in childhood may in itself be a risk factor for obesity later in life.
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Affiliation(s)
- Rafaela Rosário
- School of Nursing, University of Minho, Minho, Portugal. .,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - Nanna Julie Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Jeanett Friis Rohde
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Mina Nicole Händel
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Early Start and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia.,Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
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Daoud A, Kim R, Subramanian SV. Predicting women's height from their socioeconomic status: A machine learning approach. Soc Sci Med 2019; 238:112486. [PMID: 31470245 DOI: 10.1016/j.socscimed.2019.112486] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 07/06/2019] [Accepted: 08/08/2019] [Indexed: 01/29/2023]
Abstract
The social determinants of health literature routinely deploy socio-economic status (SES) as a key factor in accounting for women's height-an established indicator of human welfare at the population level-using traditional regression. However, this literature lacks a systematic identification of the predictive power of SES as well as the possible non-linear relationships between the measures of SES (education, occupation, and material wealth) in predicting variation in women's height. This study aims to evaluate this predictive power. We used the Demographic and Health Surveys (DHS) from 66 low- and middle-income countries (women = 1,273,644), sampled between 1994 and 2016. The analysis consisted of training seven machine-learning algorithms of different function classes and assessing their predictive power out-of-sample, vis-à-vis OLS regression. In an OLS framework, SES accounts for 0.7%, R2, of the total variance in women's height (from σOLSFix2 = 31.82 to σOLSSES2 = 31.57), adjusting for country, community, and sampling year fixed effects. The country-specific variances range from as low as 25.10 units in Egypt to as high as 74.46 units in Sao Tome and Principe. With the same set of SES measures, the best performing learner, a Bayesian neural net, produces a predictive variance of σBnnSES2 = 31.52. This is a negligible improvement in variance explained by 0.3% (σBnnSES2-σOLSSES2). Given our selection of algorithms, our findings indicate no relevant non-linear relationships between SES and women's height, and also the predictive limits of SES. We recommend that scholars report both the average effect of SES on health outcomes as well as its contribution to the variance explained. This will improve our understanding of how key social and economic factors affect health, deepening our understanding of the social determinants of health.
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Affiliation(s)
- Adel Daoud
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, United States.
| | - Rockli Kim
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, United States
| | - S V Subramanian
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, United States
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Gunardi H, Soedjatmiko S, Sekartini R, Medise BE, Darmawan AC, Armeilia R, Nadya R. Association between parental socio-demographic factors and declined linear growth of young children in Jakarta. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v26i4.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: In Indonesia, approximately 35.5% of children under five years old were stunted. Stunting is related to shorter adult stature, poor cognition and educational performance, low adult wages, lost productivity, and higher risk of nutrition-related chronic disease. The aim of this study was to identify parental socio-demographic risk factors of declined linear growth in children younger than 2 years old.Methods: This was a cohort-prospective study between August 2012 and May 2014 at three primary community health care centers (Puskesmas) in Jakarta, Indonesia, namely Puskesmas Jatinegara, Mampang, and Tebet. Subjects were healthy children under 2 years old, in which their weight and height were measured serially (at 6–11 weeks old and 18–24 months old). The length-for-age based on those data was used to determine stature status. The serial measurement was done to detect growth pattern. Parental socio-demographic data were obtained from questionnairesResults: From the total of 160 subjects, 14 (8.7%) showed declined growth pattern from normal to stunted and 10 (6.2%) to severely stunted. As many as 134 (83.8%) subjects showed consistent normal growth pattern. Only 2 (1.2%) showed improvement in the linear growth. Maternal education duration less than 9 years (RR=2.60, 95% CI=1.23–5.46; p=0.02) showed statistically significant association with declined linear growth in children.Conclusion: Mother with education duration less than 9 years was the determining socio-demographic risk factor that contributed to the declined linear growth in children less than 2 years of age.
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Socioeconomic differences in children’s growth trajectories from infancy to early adulthood: evidence from four European countries. J Epidemiol Community Health 2017; 71:981-989. [DOI: 10.1136/jech-2016-208556] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/28/2017] [Accepted: 07/07/2017] [Indexed: 12/20/2022]
Abstract
BackgroundHeight is regarded as a marker of early-life illness, adversity, nutrition and psychosocial stress, but the extent to which differences in height are determined by early-life socioeconomic circumstances, particularly in contemporary populations, is unclear. This study examined socioeconomic differences in children’s height trajectories from birth through to 21 years of age in four European countries.MethodsData were from six prospective cohort studies—Generation XXI, Growing Up in Ireland (infant and child cohorts), Millennium Cohort Study, EPITeen and Cardiovascular Risk in Young Finns Study—comprising a total of 49 492 children with growth measured repeatedly from 1980 to 2014. We modelled differences in children’s growth trajectories over time by maternal educational level using hierarchical models with fixed and random components for each cohort study.ResultsAcross most cohorts at practically all ages, children from lower educated mothers were shorter on average. The gradient in height was consistently observed at 3 years of age with the difference in expected height between maternal education groups ranging between −0.55 and −1.53 cm for boys and −0.42 to −1.50 cm for girls across the different studies and widening across childhood. The height deficit persists into adolescence and early adulthood. By age 21, boys from primary educated maternal backgrounds lag the tertiary educated by −0.67 cm (Portugal) and −2.15 cm (Finland). The comparable figures for girls were −2.49 cm (Portugal) and −2.93 cm (Finland).ConclusionsSignificant differences in children’s height by maternal education persist in modern child populations in Europe.
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Muraro AP, Souza RAGD, Rodrigues PRM, Ferreira MG, Sichieri R. Effects of socioeconomic position and social mobility on linear growth from early childhood until adolescence. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 20:514-525. [PMID: 29160442 DOI: 10.1590/1980-5497201700030013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the effect of socioeconomic position (SEP) in childhood and social mobility on linear growth through adolescence in a population-based cohort. METHODS Children born in Cuiabá-MT, central-western Brazil, were evaluated during 1994 - 1999. They were first assessed during 1999 - 2000 (0 - 5 years) and again during 2009 - 2011 (10 - 17 years), and their height-for-age was evaluated during these two periods.Awealth index was used to classify the SEP of each child's family as low, medium, or high. Social mobility was categorized as upward mobility or no upward mobility. Linear mixed models were used. RESULTS We evaluated 1,716 children (71.4% of baseline) after 10 years, and 60.6% of the families showed upward mobility, with a higher percentage among the lowest economic classes. A higher height-for-age was also observed among those from families with a high SEP both in childhood (low SEP= -0.35 z-score; high SEP= 0.15 z-score, p < 0.01) and adolescence (low SEP= -0.01 z-score; high SEP= 0.45 z-score, p < 0.01), whereas upward mobility did not affect their linear growth. CONCLUSION Expressive social mobility was observed, but SEP in childhood and social mobility did not greatly influence linear growth through childhood in this central-western Brazilian cohort.
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Affiliation(s)
- Ana Paula Muraro
- Public Health Institute, Universidade Federal do Mato Grosso - Cuiabá (MT), Brazil
| | | | - Paulo Rogério Melo Rodrigues
- School of Nutrition, Department of Food and Nutrition, Universidade Federal do Mato Grosso - Cuiabá (MT), Brazil
| | - Márcia Gonçalves Ferreira
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Rosely Sichieri
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
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18
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Intergenerational change in anthropometric indices and their predictors among children in New Delhi birth cohort. Indian Pediatr 2016; 54:185-192. [DOI: 10.1007/s13312-017-1028-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pathways between Socioeconomic Disadvantage and Childhood Growth in the Scottish Longitudinal Study, 1991-2001. PLoS One 2016; 11:e0164853. [PMID: 27736963 PMCID: PMC5063393 DOI: 10.1371/journal.pone.0164853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 10/03/2016] [Indexed: 01/08/2023] Open
Abstract
Socioeconomically disadvantaged children are more likely to be of shorter stature and overweight, leading to greater risk of obesity in adulthood. Disentangling the mediatory pathways between socioeconomic disadvantage and childhood size may help in the development of appropriate policies aimed at reducing these health inequalities. We aimed to elucidate the putative mediatory role of birth weight using a representative sample of the Scottish population born 1991-2001 (n = 16,628). Estimated height and overweight/obesity at age 4.5 years were related to three measures of socioeconomic disadvantage (mother's education, Scottish Index of Multiple Deprivation, synthetic weekly income). Mediation was examined using two approaches: a 'traditional' mediation analysis and a counterfactual-based mediation analysis. Both analyses identified a negative effect of each measure of socioeconomic disadvantage on height, mediated to some extent by birth weight, and a positive 'direct effect' of mother's education and Scottish Index of Multiple Deprivation on overweight/obesity, which was partly counterbalanced by a negative 'indirect effect'. The extent of mediation estimated when adopting the traditional approach was greater than when adopting the counterfactual-based approach because of inappropriate handling of intermediate confounding in the former. Our findings suggest that higher birth weight in more disadvantaged groups is associated with reduced social inequalities in height but also with increased inequalities in overweight/obesity.
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20
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Horan MK, Donnelly JM, McGowan CA, Gibney ER, McAuliffe FM. The association between maternal nutrition and lifestyle during pregnancy and 2-year-old offspring adiposity: analysis from the ROLO study. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2016; 24:427-436. [PMID: 27695668 PMCID: PMC5025498 DOI: 10.1007/s10389-016-0740-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
Aim To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet. Subject and methods Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum. Results Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B = 0.105, p = 0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B = 0.018, p = 0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B = 0.009, p = 0.029). Conclusions Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity. Electronic supplementary material The online version of this article (doi:10.1007/s10389-016-0740-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary K. Horan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Jean M. Donnelly
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Ciara A. McGowan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen R. Gibney
- Science Centre – South, University College Dublin School Of Agriculture & Food Science, Belfield, Dublin 4 Ireland
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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Hancock C, Bettiol S, Smith L. Socioeconomic variation in height: analysis of National Child Measurement Programme data for England. Arch Dis Child 2016; 101:422-6. [PMID: 26342096 DOI: 10.1136/archdischild-2015-308431] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/17/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Short stature is associated with increased risk of ill health and mortality and can negatively impact on an individual's economic opportunity and psychological well-being. The aim of this study was to investigate the association between height and area-level deprivation by ethnic group in children in England. DESIGN Cross-sectional analysis of data gathered from the National Child Measurement Programme 2008/2009 to 2012/2013. PARTICIPANTS/METHODS Children (n=1 213 230) aged 4-5 and 10-11 years attending state-maintained primary schools in England. Mean height SD score (SDS) (based on the British 1990 growth reference) was calculated for children by Income Deprivation Affecting Children Index as a measure of area-level deprivation. Analyses were performed by sex and age group for white British, Asian and black ethnicities. RESULTS For white British children mean height decreased 0.2 SDS between the least and the most deprived quintile. For Asian children the relationship was weaker and varied between 0.08 and 0.18 SDS. For white British boys the magnitude of association was similar across age groups; for Asian boys the magnitude was higher in the age group of 10-11 years and in white British girls aged 10-11 years the association decreased. Height SDS was similar across all levels of deprivation for black children. CONCLUSIONS Social inequalities were shown in the height of children from white British and Asian ethnic groups. Further evaluation of height in black children is warranted. Action is needed to reduce inequalities in height by addressing the modifiable negative environmental factors that prevent healthy growth and development of children.
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Affiliation(s)
| | - Silvana Bettiol
- School of Medicine, University of Tasmania, Medical Sciences Precinct, Hobart, Tasmania, Australia
| | - Lesley Smith
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, UK
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22
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Li L, Pearce A. Inequalities in childhood height persist and may vary by ethnicity in England. Arch Dis Child 2016; 101:413-4. [PMID: 26755537 DOI: 10.1136/archdischild-2015-309360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/05/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Leah Li
- Population, Policy and Practice Programme, University College London Institute of Child Health, London, UK
| | - Anna Pearce
- Population, Policy and Practice Programme, University College London Institute of Child Health, London, UK
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Abstract
In this review, the potential causes and consequences of adult height, a measure of cumulative net nutrition, in modern populations are summarized. The mechanisms linking adult height and health are examined, with a focus on the role of potential confounders. Evidence across studies indicates that short adult height (reflecting growth retardation) in low- and middle-income countries is driven by environmental conditions, especially net nutrition during early years. Some of the associations of height with health and social outcomes potentially reflect the association between these environmental factors and such outcomes. These conditions are manifested in the substantial differences in adult height that exist between and within countries and over time. This review suggests that adult height is a useful marker of variation in cumulative net nutrition, biological deprivation, and standard of living between and within populations and should be routinely measured. Linkages between adult height and health, within and across generations, suggest that adult height may be a potential tool for monitoring health conditions and that programs focused on offspring outcomes may consider maternal height as a potentially important influence.
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Affiliation(s)
- Jessica M Perkins
- J.M. Perkins is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; and the Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA. S.V. Subramanian is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. G. Davey Smith is with the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom. E. Özaltin is with the Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA.
| | - S V Subramanian
- J.M. Perkins is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; and the Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA. S.V. Subramanian is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. G. Davey Smith is with the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom. E. Özaltin is with the Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA.
| | - George Davey Smith
- J.M. Perkins is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; and the Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA. S.V. Subramanian is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. G. Davey Smith is with the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom. E. Özaltin is with the Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Emre Özaltin
- J.M. Perkins is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; and the Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA. S.V. Subramanian is with the Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA; and the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. G. Davey Smith is with the MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom. E. Özaltin is with the Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA.
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Boone-Heinonen J, Messer L, Andrade K, Takemoto E. Connecting the Dots in Childhood Obesity Disparities: A Review of Growth Patterns from Birth to Pre-Adolescence. CURR EPIDEMIOL REP 2016; 3:113-124. [PMID: 27172171 DOI: 10.1007/s40471-016-0065-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this review, we considered how disparities in obesity emerge between birth, when socially disadvantaged infants tend to be small, and later in childhood, when socially disadvantaged groups have high risk of obesity. We reviewed epidemiologic evidence of socioeconomic and racial/ethnic differences in growth from infancy to pre-adolescence. Minority race/ethnicity and lower socioeconomic status was associated with rapid weight gain in infancy but not in older age groups, and social differences in linear growth and relative weight were unclear. Infant feeding practices was the most consistent mediator of social disparities in growth, but mediation analysis was uncommon and other factors have only begun to be explored. Complex life course processes challenge the field of social epidemiology to develop innovative study designs and analytic techniques with which to pose and test challenging yet impactful research questions about how obesity disparities evolve throughout childhood.
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Affiliation(s)
- Janne Boone-Heinonen
- Oregon Health & Science University, OHSU-PSU School of Public Health 3181 SW Sam Jackson Park Road, CB669 Portland, OR 97239-3098
| | - Lynne Messer
- Portland State University; OHSU-PSU School of Public Health 470H Urban Center; 506 SW Mill St. Portland, OR 37201 (P) 503.725.5182 (F) 503.725.5100
| | - Kate Andrade
- University of Minnesota, Division of Epidemiology & Community Health 1300 S 2 St, Ste 300 Minneapolis, MN 55454
| | - Erin Takemoto
- Oregon Health & Science University, OHSU-PSU School of Public Health 3181 SW Sam Jackson Park Road, CB669 Portland, OR 97239-3098 (P) 503-418-9810
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Patel R, Tilling K, Lawlor DA, Howe LD, Bogdanovich N, Matush L, Nicoli E, Kramer MS, Martin RM. Socioeconomic differences in childhood length/height trajectories in a middle-income country: a cohort study. BMC Public Health 2014; 14:932. [PMID: 25200513 PMCID: PMC4181044 DOI: 10.1186/1471-2458-14-932] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/29/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Socioeconomic disadvantage is associated with shorter adult stature. Few studies have examined socioeconomic differences in stature from birth to childhood and the mechanisms involved, particularly in middle-income former Soviet settings. METHODS The sample included 12,463 Belarusian children (73% of the original cohort) born in 1996-1997, with up to 14 stature measurements from birth to 7 years. Linear spline multi-level models with 3 knots at 3, 12 and 34 months were used to analyse birth length and growth velocity during four age-periods by parental educational achievement (up to secondary school, advanced secondary/partial university, completed university) and occupation (manual, non-manual). RESULTS Girls born to the most (versus least) educated mothers were 0.43 cm (95% confidence interval (CI): 0.28, 0.58) longer at birth; for boys, the corresponding difference was 0.30 cm (95% CI: 0.15, 0.46). Similarly, children of the most educated mothers grew faster from birth-3 months and 12-34 months (p-values for trend ≤ 0.08), such that, by age 7 years, girls with the most (versus least) educated mothers were 1.92 cm (95% CI: 1.47, 2.36) taller; after controlling for urban/rural and East/West area of residence, this difference remained at 1.86 cm (95% CI: 1.42, 2.31), but after additionally controlling for mid-parental height, attenuated to 1.10 cm (95% CI: 0.69, 1.52). Among boys, these differences were 1.95 cm (95% CI: 1.53, 2.37), 1.89 cm (95% CI: 1.47, 2.31) and 1.16 cm (95% CI: 0.77, 1.55), respectively. Additionally controlling for breastfeeding, maternal smoking and older siblings did not substantively alter these findings. There was no evidence that the association of maternal educational attainment with growth differed in girls compared to boys (p for interaction = 0.45). Results were similar for those born to the most (versus least) educated fathers, or who had a parent with a non-manual (versus manual) occupation. CONCLUSIONS In Belarus, a middle-income former Soviet country, socioeconomic differences in offspring growth commence in the pre-natal period and generate up to approximately 2 cm difference in height at age 7 years. These associations are partly explained by genetic or other factors influencing parental stature. TRIAL REGISTRATION Current Controlled Trials: NCT01352247 assigned 9 Sept 2005; ClinicalTrials.gov. Identifier: NCT01561612 received 20 Mar 2012.
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Affiliation(s)
- Rita Patel
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Kate Tilling
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Debbie A Lawlor
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Laura D Howe
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- />The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Lidia Matush
- />The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Emily Nicoli
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Michael S Kramer
- />Department of Pediatrics, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
- />Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Richard M Martin
- />School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- />National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, UK
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Fenger RV, Vidal C, Gonzalez-Quintela A, Husemoen LLN, Skaaby T, Aadahl M, Linneberg A. The association of the 'additional height index' with atopic diseases, non-atopic asthma, ischaemic heart disease and mortality: a population-based study. BMJ Open 2014; 4:e003933. [PMID: 24583759 PMCID: PMC3939652 DOI: 10.1136/bmjopen-2013-003933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Intrauterine growth has been associated with atopic conditions. Growth and adult height have been associated with cardiovascular disease, cancers and mortality but are highly genetic traits. The objectives of the study were as follows: first, to define a height measure indicating an individual's height below or above that which could be expected based on parental height (genetic inheritance) and growth charts. It was named 'the additional height index' (AHI), defined as (attained-expected) height; second, to investigate possible associations of AHI with atopic versus non-atopic health outcomes and with ischaemic heart disease (IHD) and IHD mortality. DESIGN General population-based study. SETTING Research centre. PARTICIPANTS A random sample of 2656 men and women living in greater Copenhagen took part in the MONICA10 study (the Danish monitoring trends and determinants of cardiovascular disease). In total, 1900 participants with information of parental height were selected. OUTCOME MEASURES Atopic sensitisation (serum IgE), questionnaire information of atopic dermatitis, rhinoconjunctivitis, asthma or wheezing, and registry-based diagnoses of IHD/IHD mortality from National Registries. RESULTS Increasing levels of AHI were inversely associated with non-atopic asthma, non-atopic wheezing, IHD and IHD mortality (IHD-all). For one SD increase of AHI, the OR or HR with CI in adjusted analyses was non-atopic asthma OR=0.52 (0.36 to 0.74), non-atopic wheezing OR=0.67 (0.51 to 0.89), and IHD-all HR=0.89 (0.78 to 1.01). The level of AHI was higher among individuals with atopic dermatitis, allergic rhinoconjunctivitis and atopic sensitisation (all p values <0.001) compared with individuals without those conditions; however, the associations were not confirmed in adjusted analyses. CONCLUSIONS Individuals with childhood conditions that led them to attain tallness higher than expected from their parents' height may be at lower risk of non-atopic asthma/wheeze and IHD/IHD mortality but possibly at higher risk of atopic conditions. The measure of tallness below or above the expected height could be a sensitive alternative to normal height in epidemiological analyses.
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Affiliation(s)
- R V Fenger
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
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Kwok MK, Leung GM, Lam TH, Leung SSL, Schooling CM. Grandparental education, parental education and child height: evidence from Hong Kong's "Children of 1997" birth cohort. Ann Epidemiol 2013; 23:475-84. [PMID: 23889857 DOI: 10.1016/j.annepidem.2013.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/24/2013] [Accepted: 05/29/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Adult height is the sum of growth during fetal, infancy, childhood, and puberty, controlled by different biological factors. In long-term developed Western populations, height is positively associated with socioeconomic position, but less clearly so in recently developing populations. We aimed to elucidate socioeconomic influences on height at different growth phases. METHODS We examined the associations of parents' education and grandparents' education with birth weight and height gain z-scores during infancy (birth to <2 years), childhood (2 to <8 years), and puberty (8 to <14 years) adjusted for parents' height using generalized estimating equations in Hong Kong's "Children of 1997" birth cohort (n = 8264). RESULTS Parents' education, but not grandparents', was positively associated with birth weight (z-score, 0.07; 95% confidence interval [CI] 0.01-0.12 for grade ≥12 compared with grade ≤9) and height gain during infancy (0.11; 95% CI, 0.05-0.18), adjusted for gender, gestational age, initial size, parity, parents' age, parents' birthplace, and parents' height. Conversely, similarly adjusted, grandparents' education, but not parents', was associated with height gain during childhood (0.11; 95% CI, 0.04-0.18). CONCLUSIONS Parental education was associated with fetal and infant, but not childhood, linear growth, suggesting the mechanism underlying socioeconomic influences on height at different growth phases may be contextually specific.
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Affiliation(s)
- Man Ki Kwok
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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28
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Howe LD, Tilling K, Matijasevich A, Petherick ES, Santos AC, Fairley L, Wright J, Santos IS, Barros AJ, Martin RM, Kramer MS, Bogdanovich N, Matush L, Barros H, Lawlor DA. Linear spline multilevel models for summarising childhood growth trajectories: A guide to their application using examples from five birth cohorts. Stat Methods Med Res 2013; 25:1854-1874. [PMID: 24108269 PMCID: PMC4074455 DOI: 10.1177/0962280213503925] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Childhood growth is of interest in medical research concerned with determinants and consequences of variation from healthy growth and development. Linear spline multilevel modelling is a useful approach for deriving individual summary measures of growth, which overcomes several data issues (co-linearity of repeat measures, the requirement for all individuals to be measured at the same ages and bias due to missing data). Here, we outline the application of this methodology to model individual trajectories of length/height and weight, drawing on examples from five cohorts from different generations and different geographical regions with varying levels of economic development. We describe the unique features of the data within each cohort that have implications for the application of linear spline multilevel models, for example, differences in the density and inter-individual variation in measurement occasions, and multiple sources of measurement with varying measurement error. After providing example Stata syntax and a suggested workflow for the implementation of linear spline multilevel models, we conclude with a discussion of the advantages and disadvantages of the linear spline approach compared with other growth modelling methods such as fractional polynomials, more complex spline functions and other non-linear models.
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Affiliation(s)
- Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, University of Bristol, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, UK
| | - Alicia Matijasevich
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Ana Cristina Santos
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, University of Porto Institute of Public Health, Porto, Portugal
| | - Lesley Fairley
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Wright
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Iná S Santos
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio Jd Barros
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, UK National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol / University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael S Kramer
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Canada
| | - Natalia Bogdanovich
- Belarusian Ministry of Health and Belarussian Maternal and Child Health Research Institute, Minsk, Belarus
| | - Lidia Matush
- Belarusian Ministry of Health and Belarussian Maternal and Child Health Research Institute, Minsk, Belarus
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, University of Porto Institute of Public Health, Porto, Portugal
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, University of Bristol, UK
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Mandy W, Skuse D, Steer C, St Pourcain B, Oliver BR. Oppositionality and socioemotional competence: interacting risk factors in the development of childhood conduct disorder symptoms. J Am Acad Child Adolesc Psychiatry 2013; 52:718-27. [PMID: 23800485 DOI: 10.1016/j.jaac.2013.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/07/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Oppositional behavior in childhood is a probabilistic risk factor for the subsequent development of more serious conduct problems characteristic of conduct disorder (CD). The capacity to understand the subjective states of others (socioemotional competence) helps regulate antisocial behavior in typical development. We hypothesized that socioemotional competence moderates the developmental relationship between oppositionality and CD symptoms, such that oppositional defiant disorder (ODD) symptoms pose the greatest risk for subsequent CD symptoms in children with poor socioemotional competence. METHOD Parent-report data were collected for 6,218 children at 7 and 10 years of age. Bootstrap multiple regression predicting CD symptoms at age 10 was used to test for an interaction between socioemotional competence and ODD symptoms, while also accounting for direct effects and controlling for sex, maternal education, attention-deficit/hyperactivity disorder symptoms, and CD symptoms at 7 years. We further tested whether the interaction applied to both males and females, and to both aggressive and rule-breaking CD symptoms. RESULTS A significant interaction was found between ODD and socioemotional competence: the association between oppositionality at 7 years and CD traits at 10 years was strongest for children with poor socioemotional capacities. As predicted, this moderation effect was significant in a model predicting aggression, but it was not significant for rule-breaking CD symptoms. CONCLUSION Socioemotional competence moderates the developmental relationship between mid-childhood oppositionality and more serious conduct problems in later childhood. A capacity to understand the subjective states of others may buffer the risk posed by oppositionality for later CD symptoms, including aggression.
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Affiliation(s)
- William Mandy
- Department of Clinical, Education and Health Psychology, University College London, UK.
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Bouthoorn SH, van Lenthe FJ, Hokken-Koelega ACS, Moll HA, Tiemeier H, Hofman A, Mackenbach JP, Jaddoe VWV, Raat H. Head circumference of infants born to mothers with different educational levels; the Generation R Study. PLoS One 2012; 7:e39798. [PMID: 22768125 PMCID: PMC3387269 DOI: 10.1371/journal.pone.0039798] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 05/28/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Head circumference (HC) reflect growth and development of the brain in early childhood. It is unknown whether socioeconomic differences in HC are present in early childhood. Therefore, we investigated the association between socioeconomic position (SEP) and HC in early childhood, and potential underlying factors. METHODS The study focused on Dutch children born between April 2002 and January 2006 who participated in The Generation R Study, a population-based prospective cohort study in Rotterdam, The Netherlands. Maternal educational level was used as indicator of SEP. HC measures were concentrated around 1, 3, 6 and 11 months. Associations and explanatory factors were investigated using linear regression analysis, adjusted for potential mediators. RESULTS The study included 3383 children. At 1, 3 and 6 months of age, children of mothers with a low education had a smaller HC than those with a high education (difference at 1 month: -0.42 SD; 95% CI: -0.54,-0.30; at 3 months: -0.27 SD; 95% CI -0.40,-0.15; and at 6 months: -0.13 SD; 95% CI -0.24,-0.02). Child's length and weight could only partially explain the smaller HC at 1 and 3 months of age. At 6 months, birth weight, gestational age and parental height explained the HC differences. At 11 months, no HC differences were found. CONCLUSION Educational inequalities in HC in the first 6 months of life can be mainly explained by pregnancy-related factors, such as birth weight and gestational age. These findings further support public health policies to prevent negative birth outcomes in lower socioeconomic groups.
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Affiliation(s)
- Selma H. Bouthoorn
- The Generation R Study Group, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Henriëtte A. Moll
- Department of Pediatrics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Albert Hofman
- The Generation R Study Group, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study Group, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
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