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Kumar M, Ang LT, Ho C, Soh SE, Tan KH, Chan JKY, Godfrey KM, Chan SY, Chong YS, Eriksson JG, Feng M, Karnani N. Machine Learning-Derived Prenatal Predictive Risk Model to Guide Intervention and Prevent the Progression of Gestational Diabetes Mellitus to Type 2 Diabetes: Prediction Model Development Study. JMIR Diabetes 2022; 7:e32366. [PMID: 35788016 PMCID: PMC9297138 DOI: 10.2196/32366] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/27/2021] [Accepted: 03/21/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The increasing prevalence of gestational diabetes mellitus (GDM) is concerning as women with GDM are at high risk of type 2 diabetes (T2D) later in life. The magnitude of this risk highlights the importance of early intervention to prevent the progression of GDM to T2D. Rates of postpartum screening are suboptimal, often as low as 13% in Asian countries. The lack of preventive care through structured postpartum screening in several health care systems and low public awareness are key barriers to postpartum diabetes screening. OBJECTIVE In this study, we developed a machine learning model for early prediction of postpartum T2D following routine antenatal GDM screening. The early prediction of postpartum T2D during prenatal care would enable the implementation of effective strategies for diabetes prevention interventions. To our best knowledge, this is the first study that uses machine learning for postpartum T2D risk assessment in antenatal populations of Asian origin. METHODS Prospective multiethnic data (Chinese, Malay, and Indian ethnicities) from 561 pregnancies in Singapore's most deeply phenotyped mother-offspring cohort study-Growing Up in Singapore Towards healthy Outcomes-were used for predictive modeling. The feature variables included were demographics, medical or obstetric history, physical measures, lifestyle information, and GDM diagnosis. Shapley values were combined with CatBoost tree ensembles to perform feature selection. Our game theoretical approach for predictive analytics enables population subtyping and pattern discovery for data-driven precision care. The predictive models were trained using 4 machine learning algorithms: logistic regression, support vector machine, CatBoost gradient boosting, and artificial neural network. We used 5-fold stratified cross-validation to preserve the same proportion of T2D cases in each fold. Grid search pipelines were built to evaluate the best performing hyperparameters. RESULTS A high performance prediction model for postpartum T2D comprising of 2 midgestation features-midpregnancy BMI after gestational weight gain and diagnosis of GDM-was developed (BMI_GDM CatBoost model: AUC=0.86, 95% CI 0.72-0.99). Prepregnancy BMI alone was inadequate in predicting postpartum T2D risk (ppBMI CatBoost model: AUC=0.62, 95% CI 0.39-0.86). A 2-hour postprandial glucose test (BMI_2hour CatBoost model: AUC=0.86, 95% CI 0.76-0.96) showed a stronger postpartum T2D risk prediction effect compared to fasting glucose test (BMI_Fasting CatBoost model: AUC=0.76, 95% CI 0.61-0.91). The BMI_GDM model was also robust when using a modified 2-point International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2018 criteria for GDM diagnosis (BMI_GDM2 CatBoost model: AUC=0.84, 95% CI 0.72-0.97). Total gestational weight gain was inversely associated with postpartum T2D outcome, independent of prepregnancy BMI and diagnosis of GDM (P=.02; OR 0.88, 95% CI 0.79-0.98). CONCLUSIONS Midgestation weight gain effects, combined with the metabolic derangements underlying GDM during pregnancy, signal future T2D risk in Singaporean women. Further studies will be required to examine the influence of metabolic adaptations in pregnancy on postpartum maternal metabolic health outcomes. The state-of-the-art machine learning model can be leveraged as a rapid risk stratification tool during prenatal care. TRIAL REGISTRATION ClinicalTrials.gov NCT01174875; https://clinicaltrials.gov/ct2/show/NCT01174875.
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Affiliation(s)
- Mukkesh Kumar
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Singapore
| | - Cindy Ho
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Singapore
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
- Obstetrics and Gynecology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Kumar M, Chen L, Tan K, Ang LT, Ho C, Wong G, Soh SE, Tan KH, Chan JKY, Godfrey KM, Chan SY, Chong MFF, Connolly JE, Chong YS, Eriksson JG, Feng M, Karnani N. Population-centric risk prediction modeling for gestational diabetes mellitus: A machine learning approach. Diabetes Res Clin Pract 2022; 185:109237. [PMID: 35124096 PMCID: PMC7612635 DOI: 10.1016/j.diabres.2022.109237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022]
Abstract
AIMS The heterogeneity in Gestational Diabetes Mellitus (GDM) risk factors among different populations impose challenges in developing a generic prediction model. This study evaluates the predictive ability of existing UK NICE guidelines for assessing GDM risk in Singaporean women, and used machine learning to develop a non-invasive predictive model. METHODS Data from 909 pregnancies in Singapore's most deeply phenotyped mother-offspring cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), was used for predictive modeling. We used a CatBoost gradient boosting algorithm, and the Shapley feature attribution framework for model building and interpretation of GDM risk attributes. RESULTS UK NICE guidelines showed poor predictability in Singaporean women [AUC:0.60 (95% CI 0.51, 0.70)]. The non-invasive predictive model comprising of 4 non-invasive factors: mean arterial blood pressure in first trimester, age, ethnicity and previous history of GDM, greatly outperformed [AUC:0.82 (95% CI 0.71, 0.93)] the UK NICE guidelines. CONCLUSIONS The UK NICE guidelines may be insufficient to assess GDM risk in Asian women. Our non-invasive predictive model outperforms the current state-of-the-art machine learning models to predict GDM, is easily accessible and can be an effective approach to minimize the economic burden of universal testing & GDM associated healthcare in Asian populations.
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Affiliation(s)
- Mukkesh Kumar
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Li Chen
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Karen Tan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Cindy Ho
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Gerard Wong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Republic of Singapore; Obstetrics and Gynecology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Republic of Singapore
| | - Jerry Kok Yen Chan
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Republic of Singapore; Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Mary Foong Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - John E Connolly
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore, Republic of Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Mengling Feng
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore and National University Health System, Singapore, Republic of Singapore.
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Republic of Singapore; Bioinformatics Institute, Agency for Science Technology and Research, Singapore, Republic of Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
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3
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Loo EXL, Zhang Y, Yap QV, Yu G, Soh SE, Loy SL, Lau HX, Chan SY, Shek LPC, Luo ZC, Yap FKP, Tan KH, Chong YS, Zhang J, Eriksson JG. Comparative epidemiology of gestational diabetes in ethnic Chinese from Shanghai birth cohort and growing up in Singapore towards healthy outcomes cohort. BMC Pregnancy Childbirth 2021; 21:566. [PMID: 34407778 PMCID: PMC8375167 DOI: 10.1186/s12884-021-04036-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has been associated with adverse health outcomes for mothers and offspring. Prevalence of GDM differs by country/region due to ethnicity, lifestyle and diagnostic criteria. We compared GDM rates and risk factors in two Asian cohorts using the 1999 WHO and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS The Shanghai Birth Cohort (SBC) and the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort are prospective birth cohorts. Information on sociodemographic characteristics and medical history were collected from interviewer-administered questionnaires. Participants underwent a 2-h 75-g oral glucose tolerance test at 24-28 weeks gestation. Logistic regressions were performed. RESULTS Using the 1999 WHO criteria, the prevalence of GDM was higher in GUSTO (20.8%) compared to SBC (16.6%) (p = 0.046). Family history of hypertension and alcohol consumption were associated with higher odds of GDM in SBC than in GUSTO cohort while obesity was associated with higher odds of GDM in GUSTO. Using the IADPSG criteria, the prevalence of GDM was 14.3% in SBC versus 12.0% in GUSTO. A history of GDM was associated with higher odds of GDM in GUSTO than in SBC, while being overweight, alcohol consumption and family history of diabetes were associated with higher odds of GDM in SBC. CONCLUSIONS We observed several differential risk factors of GDM among ethnic Chinese women living in Shanghai and Singapore. These findings might be due to heterogeneity of GDM reflected in diagnostic criteria as well as in unmeasured genetic, lifestyle and environmental factors.
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Affiliation(s)
- Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore. .,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yuqing Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Qai Ven Yap
- Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Guoqi Yu
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - See Ling Loy
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Hui Xing Lau
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhong-Cheng Luo
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, M5G 1X5, Canada
| | - Fabian Kok Peng Yap
- Duke-NUS Medical School, Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Public Health, Guilin Medical College, Guilin, Guangxi, China
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.,Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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4
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Chu AHY, Yuan WL, Loy SL, Soh SE, Bernard JY, Tint MT, Ho-Lim SST, Goh H, Ramasamy A, Kumar M, Goh C, Ang LT, Shek LPC, Chong YS, Tan KH, Su LL, Biswas A, Yap F, Lee YS, Chi C, Godfrey KM, Eriksson JG, Chan SY. Maternal height, gestational diabetes mellitus and pregnancy complications. Diabetes Res Clin Pract 2021; 178:108978. [PMID: 34303772 PMCID: PMC7611603 DOI: 10.1016/j.diabres.2021.108978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Abstract
AIMS To explore the glucose-overload hypothesis of artefactual gestational diabetes (GDM) diagnosis in shorter women during oral glucose tolerance testing (OGTT), by investigating associations between height and maternal glycemia; and GDM and pregnancy complications in height-groups. METHODS Women from GUSTO (n = 1100, 2009-2010) and NUH (n = 4068, 2017-2018) cohorts underwent a mid-gestation two and three time-point 75 g 2-hour OGTT, respectively. GDM-related complications (hypertensive disorders of pregnancy, preterm delivery, emergency cesarean section, neonatal intensive care unit admission, macrosomia, birthweight) were compared within shorter and taller groups, dichotomized by ethnic-specific median height. RESULTS Using WHO-1999 criteria, 18.8% (GUSTO) to 22.9% (NUH) of women were diagnosed with GDM-1999; and by WHO-2013 criteria, 21.9% (NUH) had GDM-2013. Each 5-cm height increment was inversely associated with GDM-1999 (adjusted odds ratio [aOR, 95% CI] = 0.81 [0.76-0.87], 2-h glycemia (adjusted β [aβ, 95% CI] = -0.171 mmol/L [-0.208, -0.135]) and 1-h glycemia (aβ = -0.160 mmol/L [-0.207, -0.112]). The inverse association between height and 2-h glycemia was most marked in "Other" ethnicities (Eurasians/Caucasians/mixed/other Asians) and Indians, followed by Chinese, then Malays. Compared with non-GDM, GDM-1999 was associated with preterm delivery (aOR = 1.76 [1.19-2.61]) and higher birthweight (aβ = 57.16 g [20.95, 93.38]) only among taller but not shorter women. CONCLUSIONS Only taller women had an increased odds of GDM-related pregnancy complications. An artefactual GDM diagnosis due to glucose-overload among shorter women is plausible.
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Affiliation(s)
- Anne H Y Chu
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Centre for Research in Epidemiology and StatisticS (CRESS), Université de Paris, Inserm, INRAE, Paris, France
| | - Mya-Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Huecin Goh
- Department of Nursing, National University Hospital, Singapore
| | - Adaikalavan Ramasamy
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Mukkesh Kumar
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Claire Goh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Fabian Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Claudia Chi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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5
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Loy SL, Cheung YB, Chan JKY, Soh SE, Godfrey KM, Tan KH, Shek LPC, Chong YS, Lek N, Yap F, Teoh OH, Yung CF, Thoon KC. Timeliness of Childhood Vaccination Coverage: the Growing Up in Singapore Towards Healthy Outcomes Study. Prev Sci 2021; 21:283-292. [PMID: 31960261 DOI: 10.1007/s11121-019-01078-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies investigating timeliness for childhood vaccination are limited especially in Asia. We examined the timeliness of vaccine administration and associated factors among infant and young children in Singapore. A total of 782 children born between November 2009 and July 2011 from a prospective cohort in Singapore were studied. Vaccination records from birth to 24 months of age were obtained from the National Immunization Registry of Singapore. Multivariable logistic regression models were performed. By 2 years of age, 92.8% of children in our cohort experienced a delay in receiving 1 or more vaccine doses according to the recommended national immunization schedule. When vaccinations were reviewed by series for each vaccine, 15.6% received all vaccine series outside the recommended age ranges. Factors associated with receiving vaccination series outside the recommended ages included maternal aged ≤ 35 years (OR 2.00; 95% CI 1.09, 3.66), Malay (1.71; 1.01, 2.89) or Indian ethnicity (2.06; 1.19, 3.59), low monthly household income (1.91; 1.14, 3.18), having at least four children (3.46; 1.62, 7.38) and private (3.42; 1.80, 6.48) and multiple vaccination providers (3.91; 1.23, 12.48). These findings show an unacceptably high proportion of children experienced a delay in the receipt of their vaccinations. The identification of several demographic, socioeconomic, health-seeking behavioural and vaccine provider factors provides opportunities for targeted interventions to enhance the timeliness of childhood vaccination in Singapore.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore.,Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, 33014, Tampere, Finland
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, 169857, Singapore.,Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Ngee Lek
- Duke-NUS Medical School, Singapore, 169857, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, 169857, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
| | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Chee Fu Yung
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, Singapore, 169857, Singapore. .,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
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6
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Chen LW, Soh SE, Tint MT, Loy SL, Yap F, Tan KH, Lee YS, Shek LPC, Godfrey KM, Gluckman PD, Eriksson JG, Chong YS, Chan SY. Combined analysis of gestational diabetes and maternal weight status from pre-pregnancy through post-delivery in future development of type 2 diabetes. Sci Rep 2021; 11:5021. [PMID: 33658531 PMCID: PMC7930020 DOI: 10.1038/s41598-021-82789-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023] Open
Abstract
We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery. Using Poisson regression with confounder adjustments, we assessed associations of standard categorisations of prospectively ascertained pre-pregnancy overweight and obesity (OWOB), gestational weight gain (GWG) and substantial post-delivery weight retention (PDWR) with post-delivery dysglycaemia (n = 692). Women with GDM had a higher risk of later T2D [relative risk (95% CI) 12.07 (4.55, 32.02)] and dysglycaemia [3.02 (2.19, 4.16)] compared with non-GDM women. Independent of GDM, women with pre-pregnancy OWOB also had a higher risk of post-delivery dysglycaemia. Women with GDM who were OWOB pre-pregnancy and had subsequent PDWR (≥ 5 kg) had 2.38 times (1.29, 4.41) the risk of post-delivery dysglycaemia compared with pre-pregnancy lean GDM women without PDWR. No consistent associations were observed between GWG and later dysglycaemia risk. In conclusion, women with GDM have a higher risk of T2D 4–6 years after the index pregnancy. Pre-pregnancy OWOB and PDWR exacerbate the risk of post-delivery dysglycaemia. Weight management during preconception and post-delivery represent early windows of opportunity for improving long-term health, especially in those with GDM.
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Affiliation(s)
- Ling-Wei Chen
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Mya-Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Fabian Yap
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Pediatric Endocrinology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Liggins Institute, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of General Practice and Primary Health Care, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.,Folkhälsan Research Center, Topeliusgatan 20, 00250, Helsinki, Finland
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 30 Medical Drive, Singapore, 117609, Singapore. .,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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7
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Loy SL, Cheung YB, Soh SE, Ng S, Tint MT, Aris IM, Bernard JY, Chong YS, Godfrey KM, Shek LP, Tan KH, Lee YS, Tan HH, Chern BSM, Lek N, Yap F, Chan SY, Chi C, Chan JKY. Female adiposity and time-to-pregnancy: a multiethnic prospective cohort. Hum Reprod 2019; 33:2141-2149. [PMID: 30285230 DOI: 10.1093/humrep/dey300] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/15/2018] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION Are higher overall and central adiposity associated with reduced fecundability, measured by time-to-pregnancy (TTP), in Asian women? SUMMARY ANSWER Higher overall adiposity, but not central adiposity, was associated with longer TTP in Asian women. WHAT IS KNOWN ALREADY High body mass index (BMI) has been associated with a longer TTP, although the associations of body composition and distribution with TTP are less clear. There are no previous studies of TTP in Asian women, who have a relatively higher percentage of body fat and abdominal fat at relatively lower BMI. STUDY DESIGN, SIZE, DURATION Prospective preconception cohort using data from 477 Asian (Chinese, Malay and Indian) women who were planning to conceive and enrolled in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) study, 2015-2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Women's mean age was 30.7 years. Overall adiposity was assessed by BMI, sum of 4-site skinfold thicknesses (SFT) and total body fat percentage (TBF%, measured using air displacement plethysmography); central adiposity was assessed by waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and A body Shape Index (ABSI). Pregnancy occurring within one year from recruitment was ascertained by ultrasonography. Those who did not conceive within one year of recruitment, were lost to follow-up, or initiated fertility treatment were censored. TTP was measured in cycles. Discrete-time proportional hazards models were used to estimate the fecundability ratio (FR) and 95% confidence interval (CI) for each anthropometric measure in association with fecundability, adjusting for confounders. MAIN RESULTS AND THE ROLE OF CHANCE Compared to women with a normal BMI of 18.5-22.9 kg/m2, women with higher BMI of 23-27.4 and ≥27.5 kg/m2 showed lower FR of 0.66 (95% CI 0.45, 0.97) and 0.53 (0.31, 0.89), respectively. Compared to women in the lowest quartile of SFT (25-52.9 mm), those in the highest quartile of ≥90.1 mm showed lower FR of 0.58 (95% CI 0.36, 0.95). Compared to women in the lowest quartile of TBF% (13.6-27.2%), those in the upper two quartiles of 33.0-39.7% and ≥39.8% showed lower FR of 0.56 (95% CI 0.32, 0.98) and 0.43 (0.24, 0.80), respectively. Association of high BMI with reduced fecundability was particularly evident among nulliparous women. Measures of central adiposity (WC, WHR, WHtR, ABSI) were not associated with fecundability. LIMITATIONS REASONS FOR CAUTION Small sample size could restrict power of analysis.The analysis was confined to planned pregnancies, which could limit generalizability of findings to non-planned pregnancies, estimated at around 44% in Singapore. Information on the date of last menstrual period for each month was not available, hence the accuracy of self-reported menstrual cycle length could not be validated, potentially introducing error into TTP estimation. Measures of exposures and covariates such as cycle length were not performed repeatedly over time; cycle length might have changed during the period before getting pregnant. WIDER IMPLICATIONS OF THE FINDINGS Other than using BMI as the surrogate measure of body fat, we provide additional evidence showing that higher amounts of subcutaneous fat that based on the measure of SFT at the sites of biceps, triceps, suprailiac and subscapular, and TBF% are associated with longer TTP. Achieving optimal weight and reducing total percentage body fat may be a potential intervention target to improve female fertility. The null results observed between central adiposity and TTP requires confirmation in further studies. STUDY FUNDING/COMPETING INTEREST(S) This research is supported by Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council, (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. Y.S.C., K.M.G., F.Y. and Y.S.L. have received reimbursement to speak at conferences sponsored by companies selling nutritional products. Y.S.C., K.M.G. and S.Y.C. are part of an academic consortium that has received research funding from Abbott, Nutrition, Nestle and Danone. Other authors declared no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S L Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Y B Cheung
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.,Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - S E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - S Ng
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - M T Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - I M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - J Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Early Origins of the Child's Health and Development Unit, Centre for research in Epidemiology and Statistics Sorbonne Paris Cité, Inserm, Villejuif, France
| | - Y S Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - K M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - L P Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - K H Tan
- Duke-NUS Medical School, Singapore, Singapore.,Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - H H Tan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - B S M Chern
- Duke-NUS Medical School, Singapore, Singapore.,Department of Obstetrics & Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - N Lek
- Duke-NUS Medical School, Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - F Yap
- Duke-NUS Medical School, Singapore, Singapore.,Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - S Y Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - C Chi
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - J K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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8
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Balan P, He HG, Cao F, Wong ML, Chong YS, Lopez V, Soh SE, Seneviratne CJ. Oral Health in Pregnant Chinese Women in Singapore: A Call to Go beyond the Traditional Clinical Care. Healthcare (Basel) 2018; 6:healthcare6030077. [PMID: 29987265 PMCID: PMC6163358 DOI: 10.3390/healthcare6030077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the correlations among oral health knowledge, attitude, practices and oral disease among pregnant Chinese women in Singapore. Methods: A descriptive correlational study was conducted in pregnant Chinese women in Singapore. A questionnaire was used to collect data of oral health knowledge, attitude and practices. Plaque index scores were used to assess the oral health of subjects. Results: A total of 82 pregnant women participated in the study, out of whom 38% showed adequate oral health knowledge, nearly half of them achieved adequate and oral health attitude and practice scores while 34% had good Plaque index scores. The lower income group had higher experience of self-reported dental problems during pregnancy than those in the higher income group (p = 0.03). There were significant positive correlations between scores of oral health practice, attitude and oral health knowledge levels. The plaque index scores negatively correlated with the oral health practice scores (p = 0.02). Conclusions: Our findings provided evidence that oral health knowledge, attitude and practices among Chinese pregnant women were not optimal which implies the importance of promoting their oral health during pregnancy through the improvement of knowledge and attitudes. This would facilitate formulation and implementation of appropriate oral health promotion policies.
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Affiliation(s)
- Preethi Balan
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore 119083, Singapore.
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Fengchunzhi Cao
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Mun Loke Wong
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore 119083, Singapore.
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, Singapore 119228, Singapore.
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Shu E Soh
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, Singapore 119228, Singapore.
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9
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Aris IM, Bernard JY, Chen LW, Tint MT, Pang WW, Lim WY, Soh SE, Saw SM, Godfrey KM, Gluckman PD, Chong YS, Yap F, Kramer MS, Lee YS. Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort. Int J Epidemiol 2018; 46:513-525. [PMID: 27649801 DOI: 10.1093/ije/dyw232] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 12/14/2022] Open
Abstract
Background : Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. Methods : We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child's BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. Results : Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m 2 , 16.5 (5.3) mm and 3.8 (1.3) kg/m 2 , respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m 2 and pre-peak velocity of 0.7 (0.3) kg/m 2 /month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [-0.45 kg/m 2 (-0.69, -0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12-1.62) for age; 1.89 (1.60-2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. Conclusions : Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations.
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Affiliation(s)
- Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore
| | - Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wai Yee Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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10
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Chi C, Loy SL, Chan SY, Choong C, Cai S, Soh SE, Tan KH, Yap F, Gluckman PD, Godfrey KM, Shek LPC, Chan JKY, Kramer MS, Chong YS. Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study. BMC Pregnancy Childbirth 2018; 18:69. [PMID: 29562895 PMCID: PMC5863481 DOI: 10.1186/s12884-018-1707-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 03/15/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We assessed the impact of adopting the 2013 World Health Organization (WHO) diagnostic criteria on the rates of gestational diabetes (GDM), pregnancy outcomes and identification of women at future risk of type 2 diabetes. METHODS During a period when the 1999 WHO GDM criteria were in effect, pregnant women were universally screened using a one-step 75 g 2-h oral glucose tolerance test at 26-28 weeks' gestation. Women were retrospectively reclassified according to the 2013 criteria, but without the 1-h glycaemia measurement. Pregnancy outcomes and glucose tolerance at 4-5 years post-delivery were compared for women with GDM classified by the 1999 criteria alone, GDM by the 2013 criteria alone, GDM by both criteria and without GDM by both sets of criteria. RESULTS Of 1092 women, 204 (18.7%) and 142 (13.0%) were diagnosed with GDM by the 1999 and 2013 WHO criteria, respectively, with 27 (2.5%) reclassified to GDM and 89 (8.2%) reclassified to non-GDM when shifting from the 1999 to 2013 criteria. Compared to women without GDM by both criteria, cases reclassified to GDM by the 2013 criteria had an increased risk of neonatal jaundice requiring phototherapy (relative risk (RR) = 2.78, 95% confidence interval (CI) 1.32, 5.86); despite receiving treatment for GDM, cases reclassified to non-GDM by the 2013 criteria had higher risks of prematurity (RR = 2.17, 95% CI 1.12, 4.24), neonatal hypoglycaemia (RR = 3.42, 95% CI 1.04, 11.29), jaundice requiring phototherapy (RR = 1.71, 95% CI 1.04, 2.82), and a higher rate of abnormal glucose tolerance at 4-5 years post-delivery (RR = 3.39, 95% CI 2.30, 5.00). CONCLUSIONS Adoption of the 2013 WHO criteria, without the 1-h glycaemia measurement, reduced the GDM rate. Lowering the fasting glucose threshold identified women who might benefit from treatment, but raising the 2-h threshold may fail to identify women at increased risk of adverse pregnancy and future metabolic outcomes. TRIAL REGISTRATION NCT01174875 . Registered 1 July 2010 (retrospectively registered).
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Affiliation(s)
- Claudia Chi
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, 119074 Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, 229899 Singapore
- Duke-NUS Medical School, Singapore, 169857 Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, 119074 Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609 Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228 Singapore
| | - Cherie Choong
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, 119074 Singapore
| | - Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228 Singapore
| | - Shu E. Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609 Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228 Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, 229899 Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, 169857 Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, 229899 Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921 Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609 Singapore
- Liggins Institute, University of Auckland, Auckland, 1142 New Zealand
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD UK
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228 Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, 119074 Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, 229899 Singapore
- Duke-NUS Medical School, Singapore, 169857 Singapore
| | - Michael S. Kramer
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228 Singapore
- Department of Pediatrics, McGill University Faculty of Medicine, 845 Rue Sherbrooke Ouest, Montreal, QC, H3A 0G4 Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, 845 Rue Sherbrooke Ouest, Montreal, QC, H3A 0G4 Canada
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, 119074 Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609 Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228 Singapore
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11
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Aris IM, Chen LW, Tint MT, Pang WW, Soh SE, Saw SM, Shek LPC, Tan KH, Gluckman PD, Chong YS, Yap F, Godfrey KM, Kramer MS, Lee YS. Body mass index trajectories in the first two years and subsequent childhood cardio-metabolic outcomes: a prospective multi-ethnic Asian cohort study. Sci Rep 2017; 7:8424. [PMID: 28827610 PMCID: PMC5567284 DOI: 10.1038/s41598-017-09046-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/20/2017] [Indexed: 12/31/2022] Open
Abstract
We investigated body mass index (BMI) trajectories in the first 2 years of life in 1170 children from an Asian mother-offspring cohort in Singapore, and examined their predictors and associations with childhood cardio-metabolic risk measures at 5 years. Latent class growth mixture modelling analyses were performed to identify distinct BMI z-score (BMIz) trajectories. Four trajectories were identified: 73.2%(n = 857) of the children showed a normal BMIz trajectory, 13.2%(n = 155) a stable low-BMIz trajectory, 8.6%(n = 100) a stable high-BMIz trajectory and 5.0%(n = 58) a rapid BMIz gain after 3 months trajectory. Predictors of the stable high-BMIz and rapid BMIz gain trajectories were pre-pregnancy BMI, gestational weight gain, Malay and Indian ethnicity, while predictors of stable low-BMIz trajectory were preterm delivery and Indian ethnicity. At 5 years, children with stable high-BMIz or rapid BMIz gain trajectories had increased waist-to-height ratios [B(95%CI) 0.02(0.01,0.03) and 0.03(0.02,0.04)], sum of skinfolds [0.42(0.19,0.65) and 0.70(0.36,1.03)SD units], fat-mass index [0.97(0.32,1.63)SD units] and risk of obesity [relative risk 3.22(1.73,6.05) and 2.56 (1.19,5.53)], but not higher blood pressure. BMIz trajectories were more predictive of adiposity at 5 years than was BMIz at 2 years. Our findings on BMIz trajectories in the first 2 years suggest important ethnic-specific differences and impacts on later metabolic outcomes.
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Affiliation(s)
- Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
| | - Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kok-Hian Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Singapore, Singapore
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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12
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Aris IM, Bernard JY, Chen LW, Tint MT, Pang WW, Soh SE, Saw SM, Shek LPC, Godfrey KM, Gluckman PD, Chong YS, Yap F, Kramer MS, Lee YS. Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status. Int J Obes (Lond) 2017; 42:44-51. [PMID: 28751763 DOI: 10.1038/ijo.2017.178] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/12/2017] [Accepted: 07/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort. METHODS Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m-2), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l-1), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models. RESULTS Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41-1.15) for BMI, 0.79 (0.41-1.16) for WHtR, 0.46 (0.06-0.83) for SSF and 0.67 (0.07-1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5-49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8-13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity. CONCLUSIONS Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.
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Affiliation(s)
- I M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - J Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - L-W Chen
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M T Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - W W Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - S-M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - L P-C Shek
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Y-S Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - F Yap
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Faculty of Medicine, Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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13
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Lin X, Lim IY, Wu Y, Teh AL, Chen L, Aris IM, Soh SE, Tint MT, MacIsaac JL, Morin AM, Yap F, Tan KH, Saw SM, Kobor MS, Meaney MJ, Godfrey KM, Chong YS, Holbrook JD, Lee YS, Gluckman PD, Karnani N. Developmental pathways to adiposity begin before birth and are influenced by genotype, prenatal environment and epigenome. BMC Med 2017; 15:50. [PMID: 28264723 PMCID: PMC5340003 DOI: 10.1186/s12916-017-0800-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/21/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity is an escalating health problem worldwide, and hence the causes underlying its development are of primary importance to public health. There is growing evidence that suboptimal intrauterine environment can perturb the metabolic programing of the growing fetus, thereby increasing the risk of developing obesity in later life. However, the link between early exposures in the womb, genetic susceptibility, and perturbed epigenome on metabolic health is not well understood. In this study, we shed more light on this aspect by performing a comprehensive analysis on the effects of variation in prenatal environment, neonatal methylome, and genotype on birth weight and adiposity in early childhood. METHODS In a prospective mother-offspring cohort (N = 987), we interrogated the effects of 30 variables that influence the prenatal environment, umbilical cord DNA methylation, and genotype on offspring weight and adiposity, over the period from birth to 48 months. This is an interim analysis on an ongoing cohort study. RESULTS Eleven of 30 prenatal environments, including maternal adiposity, smoking, blood glucose and plasma unsaturated fatty acid levels, were associated with birth weight. Polygenic risk scores derived from genetic association studies on adult adiposity were also associated with birth weight and child adiposity, indicating an overlap between the genetic pathways influencing metabolic health in early and later life. Neonatal methylation markers from seven gene loci (ANK3, CDKN2B, CACNA1G, IGDCC4, P4HA3, ZNF423 and MIRLET7BHG) were significantly associated with birth weight, with a subset of these in genes previously implicated in metabolic pathways in humans and in animal models. Methylation levels at three of seven birth weight-linked loci showed significant association with prenatal environment, but none were affected by polygenic risk score. Six of these birth weight-linked loci continued to show a longitudinal association with offspring size and/or adiposity in early childhood. CONCLUSIONS This study provides further evidence that developmental pathways to adiposity begin before birth and are influenced by environmental, genetic and epigenetic factors. These pathways can have a lasting effect on offspring size, adiposity and future metabolic outcomes, and offer new opportunities for risk stratification and prevention of obesity. CLINICAL TRIAL REGISTRATION This birth cohort is a prospective observational study, designed to study the developmental origins of health and disease, and was retrospectively registered on 1 July 2010 under the identifier NCT01174875 .
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Affiliation(s)
- Xinyi Lin
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore
| | - Ives Yubin Lim
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Yonghui Wu
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore
| | - Ai Ling Teh
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore
| | - Li Chen
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Julia L MacIsaac
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Alexander M Morin
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117597, Singapore.,Singapore Eye Research Institute, Singapore, 169856, Singapore.,Duke NUS Medical School, Singapore, 169857, Singapore
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, BC, V5Z 4H4, Canada
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore.,Ludmer Centre for Neuroinformatics and Mental Health, Douglas University Mental Health Institute, McGill University, Montreal, Quebec, H4H 1R3, Canada
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Joanna D Holbrook
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.,Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, 119228, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore.,Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland, 1142, New Zealand
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences, A*STAR, 30 Medical Drive, Singapore, 117609, Singapore. .,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.
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14
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Loy SL, Lek N, Yap F, Soh SE, Padmapriya N, Tan KH, Biswas A, Yeo GSH, Kwek K, Gluckman PD, Godfrey KM, Saw SM, Müller-Riemenschneider F, Chong YS, Chong MFF, Chan JKY. Association of Maternal Vitamin D Status with Glucose Tolerance and Caesarean Section in a Multi-Ethnic Asian Cohort: The Growing Up in Singapore Towards Healthy Outcomes Study. PLoS One 2015; 10:e0142239. [PMID: 26571128 PMCID: PMC4646602 DOI: 10.1371/journal.pone.0142239] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/18/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Epidemiological studies relating maternal 25-hydroxyvitamin D (25OHD) with gestational diabetes mellitus (GDM) and mode of delivery have shown controversial results. We examined if maternal 25OHD status was associated with plasma glucose concentrations, risks of GDM and caesarean section in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. METHODS Plasma 25OHD concentrations, fasting glucose (FG) and 2-hour postprandial glucose (2HPPG) concentrations were measured in 940 women from a Singapore mother-offspring cohort study at 26-28 weeks' gestation. 25OHD inadequacy and adequacy were defined based on concentrations of 25OHD ≤75nmol/l and >75nmol/l respectively. Mode of delivery was obtained from hospital records. Multiple linear regression was performed to examine the association between 25OHD status and glucose concentrations, while multiple logistic regression was performed to examine the association of 25OHD status with risks of GDM and caesarean section. RESULTS In total, 388 (41.3%) women had 25OHD inadequacy. Of these, 131 (33.8%), 155 (39.9%) and 102 (26.3%) were Chinese, Malay and Indian respectively. After adjustment for confounders, maternal 25OHD inadequacy was associated with higher FG concentrations (β = 0.08mmol/l, 95% Confidence Interval (CI) = 0.01, 0.14), but not 2HPPG concentrations and risk of GDM. A trend between 25OHD inadequacy and higher likelihood of emergency caesarean section (Odds Ratio (OR) = 1.39, 95% CI = 0.95, 2.05) was observed. On stratification by ethnicity, the association with higher FG concentrations was significant in Malay women (β = 0.19mmol/l, 95% CI = 0.04, 0.33), while risk of emergency caesarean section was greater in Chinese (OR = 1.90, 95% CI = 1.06, 3.43) and Indian women (OR = 2.41, 95% CI = 1.01, 5.73). CONCLUSIONS 25OHD inadequacy is prevalent in pregnant Singaporean women, particularly among the Malay and Indian women. This is associated with higher FG concentrations in Malay women, and increased risk of emergency caesarean section in Chinese and Indian women.
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Affiliation(s)
- See Ling Loy
- KK Research Centre, KK Women’s and Children’s Hospital, Singapore
| | - Ngee Lek
- Duke-NUS Graduate Medical School, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | - Fabian Yap
- Duke-NUS Graduate Medical School, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | - Shu E. Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), Singapore
| | - Natarajan Padmapriya
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - George Seow Heong Yeo
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Kenneth Kwek
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, (A*STAR), Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
- * E-mail: (JKYC); (MFFC)
| | - Jerry Kok Yen Chan
- KK Research Centre, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore
- * E-mail: (JKYC); (MFFC)
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15
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Aris IM, Soh SE, Tint MT, Saw SM, Rajadurai VS, Godfrey KM, Gluckman PD, Yap F, Chong YS, Lee YS. Associations of gestational glycemia and prepregnancy adiposity with offspring growth and adiposity in an Asian population. Am J Clin Nutr 2015; 102:1104-12. [PMID: 26423388 DOI: 10.3945/ajcn.115.117614] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/03/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal obesity and hyperglycemia increase risk of obesity and diabetes in offspring later in life. OBJECTIVE We examined the relation between gestational glycemia and prepregnancy body mass index (ppBMI) with offspring growth in an Asian mother-offspring cohort. DESIGN Pregnant mothers undertook a 75-g 2-h oral-glucose-tolerance test at 26-28 wk of gestation. In 937 singleton offspring, ≤9 serial measurements of weight and length were obtained from birth until 36 mo of age. RESULTS Gestational fasting plasma glucose (FPG) was positively associated with birth weight (B: 0.17; 95% CI: 0.10, 0.24; P < 0.001) and birth BMI (B: 0.15; 95% CI: 0.06, 0.40; P = 0.001) but not at ≥3 mo of age. In contrast, maternal ppBMI was positively associated with birth variables and conditional growth in weight and BMI in the first 36 mo of life. However, gestational FPG and prepregnancy obesity status interacted significantly for the association with offspring growth and overweight status in the first 36 mo of life (P-interaction < 0.01). In nonobese mothers, each unit increase in gestational FPG was associated with increased offspring weight (B: 0.08; 95% CI: 0.008, 0.16; P = 0.03) and BMI (B: 0.08; 95% CI: 0.003, 0.15; P = 0.04) as well as increased risk of overweight in the first 36 mo of life (OR: 1.36; 95% CI: 1.10, 1.68). However, in obese mothers, each unit increase in gestational FPG was associated with decreased offspring weight (B: -0.01; 95% CI: -0.02, -0.003) and BMI (B: -0.008; 95% CI: -0.01, -0.002) velocity (P < 0.01 for both) and decreased risk of overweight (OR: 0.59; 95% CI: 0.41, 0.86) in the first 36 mo of life. CONCLUSIONS Prepregnancy adiposity was associated with offspring growth in early childhood. Although pooled analyses showed no demonstrable difference by 3 mo of age, there were contrasting and opposite associations of gestational glycemia with weight and BMI in the first 36 mo of life in offspring of nonobese and obese mothers separately. This study was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
- Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Departments of Paediatrics and
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Departments of
| | - Mya Thway Tint
- Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, and
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Departments of
| | | | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Departments of Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- Paediatrics, KK Women's and Children's Hospital, Singapore; Duke-National University of Singapore Graduate Medical School, Lee Kong Chian School of Medicine, Singapore; and
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Departments of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, and
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Departments of Paediatrics and Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
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16
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Snodgrass AM, Tan PT, Soh SE, Goh A, Shek LP, van Bever HP, Gluckman PD, Godfrey KM, Chong YS, Saw SM, Kwek K, Teoh OH. Tobacco smoke exposure and respiratory morbidity in young children. Tob Control 2015; 25:e75-e82. [DOI: 10.1136/tobaccocontrol-2015-052383] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/07/2015] [Indexed: 11/04/2022]
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17
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Lin X, Aris IM, Tint MT, Soh SE, Godfrey KM, Yeo GSH, Kwek K, Chan JKY, Gluckman PD, Chong YS, Yap F, Holbrook JD, Lee YS. Ethnic Differences in Effects of Maternal Pre-Pregnancy and Pregnancy Adiposity on Offspring Size and Adiposity. J Clin Endocrinol Metab 2015; 100. [PMID: 26200236 PMCID: PMC4628100 DOI: 10.1210/jc.2015-1728] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Maternal adiposity and overnutrition, both before and during pregnancy, plays a key role in the subsequent development of obesity and metabolic outcomes in offspring. OBJECTIVE We explored the hypothesis that maternal adiposity (pre-pregnancy and at 26-28 weeks' gestation) and mid-pregnancy gestational weight gain (GWG) are independently associated with offspring size and adiposity in early childhood, and determined whether these effects are ethnicity dependent. DESIGN In a prospective mother-offspring cohort study (N = 976, 56% Chinese, 26% Malay, and 18% Indian), we assessed the associations of offspring size (weight, length) and adiposity (subscapular and triceps skinfolds), measured at birth and age 6, 12, 18, and 24 mo, with maternal pre-pregnancy body mass index (ppBMI), mid-pregnancy GWG, and mid-pregnancy four-site skinfold thicknesses (triceps, biceps, subscapular, suprailiac). RESULTS ppBMI and mid-pregnancy GWG were independently associated with postnatal weight up to 2 y and skinfold thickness at birth. Weight and subscapular and triceps skinfolds at birth increased by 2.56% (95% confidence interval, 1.68-3.45%), 3.85% (2.16-5.57%), and 2.14% (0.54-3.75%), respectively for every SD increase in ppBMI. Similarly, a one-SD increase in GWG increased weight and subscapular and triceps skinfolds at birth by 2.44% (1.66-3.23%), 3.28% (1.75-4.84%), and 3.23% (1.65-4.84%), respectively. ppBMI and mid-pregnancy suprailiac skinfold independently predicted postnatal skinfold adiposity up to 2 years of age, whereas only GWG predicted postnatal length. The associations of GWG with postnatal weight and length were present only among Chinese and Indians, but not Malays (P < .05 for interaction). CONCLUSIONS ppBMI and GWG are independent modifiable factors for child size and adiposity up to 2 years of age. The associations are ethnic-dependent, and underscore the importance of ethnic specific studies before generalizing the applicability of risk factors reported in other populations.
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Affiliation(s)
- Xinyi Lin
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Keith M Godfrey
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - George Seow-Heong Yeo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Kenneth Kwek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Jerry Kok-Yen Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Fabian Yap
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Joanna D Holbrook
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
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Pan H, Lin X, Wu Y, Chen L, Teh AL, Soh SE, Lee YS, Tint MT, MacIsaac JL, Morin AM, Tan KH, Yap F, Saw SM, Kobor MS, Meaney MJ, Godfrey KM, Chong YS, Gluckman PD, Karnani N, Holbrook JD. HIF3A association with adiposity: the story begins before birth. Epigenomics 2015; 7:937-50. [PMID: 26011824 PMCID: PMC4863876 DOI: 10.2217/epi.15.45] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: Determine if the association of HIF3A DNA methylation with weight and adiposity is detectable early in life. Material & methods: We determined HIF3A genotype and DNA methylation patterns (on hybridization arrays) in DNA extracted from umbilical cords of 991 infants. Methylation levels at three CpGs in the HIF3A first intron were related to neonatal and infant anthropometry and to genotype at nearby polymorphic sites. Results & conclusion: Higher methylation levels at three previously described HIF3A CpGs were associated with greater infant weight and adiposity. The effect sizes were slightly smaller than those reported for adult BMI. There was also an interaction within cis-genotype. The association between higher DNA methylation at HIF3A and increased adiposity is present in neonates. In this study, no particular prenatal factor strongly influenced HIF3A hypermethylation. Our data nonetheless suggest shared prenatal influences on HIF3A methylation and adiposity.
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Affiliation(s)
- Hong Pan
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore.,School of Computer Engineering, Nanyang Technological University (NTU), 639798, Singapore
| | - Xinyi Lin
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore
| | - Yonghui Wu
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore
| | - Li Chen
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore
| | - Ai Ling Teh
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore
| | - Shu E Soh
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 117597, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), 119228, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), 119228, Singapore.,Division of Paediatric Endocrinology & Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 119228, Singapore
| | - Mya Thway Tint
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), 119228, Singapore
| | - Julia L MacIsaac
- Department of Medical Genetics, Centre for Molecular Medicine & Therapeutics, Child & Family Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4 Canada
| | - Alexander M Morin
- Department of Medical Genetics, Centre for Molecular Medicine & Therapeutics, Child & Family Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4 Canada
| | - Kok Hian Tan
- KK Women's and Children's Hospital, 229899, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, 229899, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), 117597, Singapore
| | - Michael S Kobor
- Department of Medical Genetics, Centre for Molecular Medicine & Therapeutics, Child & Family Research Institute, University of British Columbia, Vancouver, BC, V5Z 4H4 Canada
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore.,Ludmer Centre for Neuroinformatics & Mental Health, Douglas University Mental Health Institute, McGill University, Montreal, (Quebec) H4H 1R3, Canada
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), 119228, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore.,Centre for Human Evolution, Adaptation & Disease, Liggins Institute, University of Auckland, Auckland, 1142, New Zealand
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), 119228, Singapore
| | - Joanna D Holbrook
- Singapore Institute for Clinical Sciences (SICS), A*STAR, Brenner Centre for Molecular Medicine, 117609, Singapore
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Loo EXL, Shek LPC, Goh A, Teoh OH, Chan YH, Soh SE, Saw SM, Kwek K, Gluckman PD, Godfrey KM, Chong YS, Lee BW, Van Bever HP. Atopic Dermatitis in Early Life: Evidence for at Least Three Phenotypes? Results from the GUSTO Study. Int Arch Allergy Immunol 2015; 166:273-9. [PMID: 25925088 DOI: 10.1159/000381342] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/27/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) has been highlighted as a likely first step in the 'atopic march', emphasizing the need to define predisposing factors. METHODS We evaluated AD risk factors and phenotypes in an Asian mother-offspring cohort . We defined three phenotypes of doctor-diagnosed AD based on the time of onset of the disease: early AD occurring within the first 6 months of life, AD occurring between 6 and 12 months and late-onset AD starting after the age of 12 months. RESULTS Maternal allergic history was associated with an increased risk of developing early-onset AD (adjusted odds ratio (aOR) 20.46, 95% confidence interval (CI) 2.73-153.15, p < 0.01). Maternal allergic history and attendance at a daycare centre increased the odds of the development of AD between 6 and 12 months (aOR 4.19, 95% CI 1.01-17.45, p = 0.049 and aOR 11.42, 95% CI 1.49-87.50, p = 0.02, respectively). Risk factors associated with increased odds of late-onset AD from 12 months were the consumption of probiotics between the age of 9 and 12 months and antibiotic treatment in the first 6 months of life (aOR 4.32, 95% CI 1.07-17.45, p = 0.04 and aOR 3.11, 95% CI 1.10-8.76, p = 0.03, respectively). Early-onset AD was associated with an increased risk of developing allergic sensitization (aOR 46.51, 95% CI 3.44-628.81, p < 0.01). CONCLUSION We found that early-onset AD was mainly associated with familial factors, while late-onset AD was associated with the consumption of antibiotics or probiotics. The findings support the concept that different phenotypes of AD exist in young children.
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Affiliation(s)
- Evelyn Xiu Ling Loo
- Department of Paediatrics, National University of Singapore, Singapore, Singapore
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Aris IM, Gandhi M, Cheung YB, Soh SE, Tint MT, Gluckman PD, Lee YS, Yap FKP, Chong YS. A new population-based reference for gestational age-specific size-at-birth of Singapore infants. Ann Acad Med Singap 2014; 43:439-447. [PMID: 25341628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION There is currently a lack of representative data for local gestational age-specific size-at- birth percentile charts. Existing charts also suffer from limitations relating to the measurement of gestational age (GA) and an outdated population. We aim to construct reference values and charts for size-at-birth from 35 to 41 weeks, based on the healthy local population. MATERIALS AND METHODS Prospective observational birth cohort study which recruited pregnant mothers from the 2 major public hospitals with obstetric service in Singapore, at <14 weeks gestation and data was collected for birth weight, length and head circumference of infants born from November 2009 to May 2011. Percentile curves were created separately for male and female infants using the lambda-mu-sigma (LMS) method. The new percentile curves were then compared with other internationally published growth charts. RESULTS Smoothened curves for birth weight, length and head circumference centiles were created from 863 infants (460 males, 403 females). Male infants consistently exceeded female infants in all 3 variables at each GA. For a male and female Singapore infant at 38 weeks gestation, the 10-50-90th centile values for weight would be 2663-3096-3597 vs. 2571-2966-3417 grams, for length 46.4-48.6-51.1 vs. 45.6-48.0-50.4 cm, and for head circumference 32.0-33.5-35.2 vs. 31.4-32.9-34.6 cm. There was no statistically significant difference between ethnic groups. On comparing our birth weight curves with data from Finland across all gestations, birth weights in our term infants (GA ≥37 weeks) were found to be lower across the 10-50-90th percentiles. CONCLUSION The new centile charts in this study may be used as reference charts for size-at-birth for a subgroup of near-term and term infants. The use of foreign charts may lead to misclassification of small for gestational age (SGA) or large for gestational age (LGA) infants.
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Affiliation(s)
- Izzuddin M Aris
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Aris IM, Soh SE, Tint MT, Liang S, Chinnadurai A, Saw SM, Rajadurai VS, Kwek K, Meaney MJ, Godfrey KM, Gluckman PD, Yap FKP, Chong YS, Lee YS. Effect of maternal glycemia on neonatal adiposity in a multiethnic Asian birth cohort. J Clin Endocrinol Metab 2014; 99:240-7. [PMID: 24243635 DOI: 10.1210/jc.2013-2738] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Gestational hyperglycemia increases the risk of obesity and diabetes in offspring later in life. OBJECTIVE We examined the relationship between gestational glycemia and neonatal adiposity in a multiethnic cohort of Singaporean neonates. DESIGN A prospective mother-offspring cohort study recruited 1247 pregnant mothers (57.2% Chinese, 25.5% Malay, 17.3% Indian) and performed 75-g, 2-hour oral glucose tolerance tests at 26-28 weeks' gestation; glucose levels were available for 1081 participants. Neonatal anthropometry (birth weight, length, triceps, and subscapular skinfolds) was measured, and percentage body fat (%BF) was derived using our published equation. Associations of maternal glucose with excessive neonatal adiposity [large for gestational age; %BF; and sum of skinfolds (∑SFT)>90th centile] were assessed using multiple logistic regression analyses. RESULTS Adjusting for potential confounders we observed strong positive continuous associations across the range of maternal fasting and 2-hour glucose in relation to excessive neonatal adiposity; each 1 SD increase in fasting glucose was associated with 1.31 [95% confidence interval (CI) 1.10-1.55], 1.72 (95% CI 1.31-2.27) and 1.64 (95% CI 1.32-2.03) increases in odds ratios for large for gestational age and %BF and ∑SFT greater than the 90th centile, respectively. Corresponding odds ratios for 2-hour glucose were 1.11 (95% CI 0.92-1.33), 1.55 (95% CI 1.10-2.20), and 1.40 (95% CI 1.10-1.79), respectively. The influence of high maternal fasting glucose on neonatal ∑SFT was less pronounced in Indians compared with Chinese (interaction P=.005). CONCLUSIONS A continuous relationship between maternal glycemia and excessive neonatal adiposity extends across the range of maternal glycemia. Compared with Chinese infants, Indian infants may be less susceptible to excessive adiposity from high maternal glucose levels.
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Affiliation(s)
- Izzuddin M Aris
- Departments of Paediatrics (I.M.A., S.E.S., Y.S.L.), Obstetrics and Gynaecology (M.T.T., Y.S.C.), and Biostatistics (S.L.), Yong Loo Lin School of Medicine, and Saw Swee Hock School of Public Health (S.E.S., S.M.S.), National University of Singapore, Singapore 119228; Department of Neonatology (A.C.), National University Hospital, National University Health System, Singapore 119074; Departments of Neonatology (V.S.R.) Maternal-Fetal Medicine (K.K.), and Paediatric Endocrinology (F.K.P.Y.), KK Women's and Children's Hospital, Singapore 229899; Department of Psychiatry, Neurology, and Neurosurgery (M.J.M.), McGill University, Montréal, Québec, Canada H4H 1R3; Singapore Institute for Clinical Sciences (M.J.M., P.D.G., Y.S.L.), Agency for Science, Technology, and Research, Singapore 117609; MRC Lifecourse Epidemiology Unit and National Institute of Health Research Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton SO16 6YD, United Kingdom; and Liggins Institute (P.D.G.), University of Auckland, 1142 Auckland, New Zealand
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Aris IM, Soh SE, Tint MT, Liang S, Chinnadurai A, Saw SM, Kwek K, Godfrey KM, Gluckman PD, Chong YS, Yap FKP, Lee YS. Body fat in Singaporean infants: development of body fat prediction equations in Asian newborns. Eur J Clin Nutr 2013; 67:922-7. [PMID: 23549200 DOI: 10.1038/ejcn.2013.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Prediction equations are commonly used to estimate body fat from anthropometric measurements, but are population specific. We aimed to establish and validate a body composition prediction formula for Asian newborns, and compared the performance of this formula with that of a published equation. SUBJECTS/METHODS Among 262 neonates (174 from day 0, 88 from days 1-3 post delivery) from a prospective cohort study, body composition was measured using air-displacement plethysmography (PEA POD), with standard anthropometric measurements, including triceps and subscapular skinfolds. Using fat mass measurement by PEA POD as a reference, stepwise linear regression was utilized to develop a prediction equation in a randomly selected subgroup of 62 infants measured on days 1-3, which was then validated in another subgroup of 200 infants measured on days 0-3. RESULTS Regression analyses revealed subscapular skinfolds, weight, gender and gestational age were significant predictors of neonatal fat mass, explaining 81.1% of the variance, but not triceps skinfold or ethnicity. By Bland-Altman analyses, our prediction equation revealed a non-significant bias with limits of agreement (LOA) similar to those of a published equation for infants measured on days 1-3 (95% LOA: (-0.25, 0.26) kg vs (-0.23, 0.21) kg) and on day 0 (95% LOA: (-0.19, 0.17) kg vs (-0.17, 0.18) kg). The published equation, however, exhibited a systematic bias in our sample. CONCLUSIONS Our equation requires only one skinfold site measurement, which can significantly reduce time and effort. It does not require the input of ethnicity and, thus, aid its application to other Asian neonatal populations.
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Affiliation(s)
- I M Aris
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Soh SE, Cook AR, Chen MIC, Lee VJ, Cutter JL, Chow VTK, Tee NWS, Lin RTP, Lim WY, Barr IG, Lin C, Phoon MC, Ang LW, Sethi SK, Chong CY, Goh LG, Goh DLM, Tambyah PA, Thoon KC, Leo YS, Saw SM. Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore. BMC Infect Dis 2012; 12:336. [PMID: 23206689 PMCID: PMC3544582 DOI: 10.1186/1471-2334-12-336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schools are important foci of influenza transmission and potential targets for surveillance and interventions. We compared several school-based influenza monitoring systems with clinic-based influenza-like illness (ILI) surveillance, and assessed the variation in illness rates between and within schools. METHODS During the initial wave of pandemic H1N1 (pdmH1N1) infections from June to Sept 2009 in Singapore, we collected data on nation-wide laboratory confirmed cases (Sch-LCC) and daily temperature monitoring (Sch-DTM), and teacher-led febrile respiratory illness reporting in 6 sentinel schools (Sch-FRI). Comparisons were made against age-stratified clinic-based influenza-like illness (ILI) data from 23 primary care clinics (GP-ILI) and proportions of ILI testing positive for pdmH1N1 (Lab-ILI) by computing the fraction of cumulative incidence occurring by epidemiological week 30 (when GP-ILI incidence peaked); and cumulative incidence rates between school-based indicators and sero-epidemiological pdmH1N1 incidence (estimated from changes in prevalence of A/California/7/2009 H1N1 hemagglutination inhibition titers ≥ 40 between pre-epidemic and post-epidemic sera). Variation in Sch-FRI rates in the 6 schools was also investigated through a Bayesian hierarchical model. RESULTS By week 30, for primary and secondary school children respectively, 63% and 79% of incidence for Sch-LCC had occurred, compared with 50% and 52% for GP-ILI data, and 48% and 53% for Sch-FRI. There were 1,187 notified cases and 7,588 episodes in the Sch-LCC and Sch-DTM systems; given school enrollment of 485,723 children, this represented 0.24 cases and 1.6 episodes per 100 children respectively. Mean Sch-FRI rate was 28.8 per 100 children (95% CI: 27.7 to 29.9) in the 6 schools. We estimate from serology that 41.8% (95% CI: 30.2% to 55.9%) of primary and 43.2% (95% CI: 28.2% to 60.8%) of secondary school-aged children were infected. Sch-FRI rates were similar across the 6 schools (23 to 34 episodes per 100 children), but there was widespread variation by classrooms; in the hierarchical model, omitting age and school effects was inconsequential but neglecting classroom level effects led to highly significant reductions in goodness of fit. CONCLUSIONS Epidemic curves from Sch-FRI were comparable to GP-ILI data, and Sch-FRI detected substantially more infections than Sch-LCC and Sch-DTM. Variability in classroom attack rates suggests localized class-room transmission.
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Affiliation(s)
- Shu E Soh
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Alex R Cook
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Mark IC Chen
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
- Communicable Disease Centre, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Vernon J Lee
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
- Ministry of Defence, Gombak Drive, Singapore, 669645, Singapore
| | - Jeffery L Cutter
- Ministry of Health, College of Medicine Building, 16 College Road, Singapore, 169854, Singapore
| | - Vincent TK Chow
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Nancy WS Tee
- KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Raymond TP Lin
- Ministry of Health, College of Medicine Building, 16 College Road, Singapore, 169854, Singapore
| | - Wei-Yen Lim
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Ian G Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, 10 Wreckyn Street, North Melbourne, VIC, 3051, Australia
| | - Cui Lin
- Ministry of Health, College of Medicine Building, 16 College Road, Singapore, 169854, Singapore
| | - Meng Chee Phoon
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Li Wei Ang
- Ministry of Health, College of Medicine Building, 16 College Road, Singapore, 169854, Singapore
| | - Sunil K Sethi
- National University Health Systems, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chia Yin Chong
- KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Lee Gan Goh
- National University Health Systems, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Denise LM Goh
- National University Health Systems, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Paul A Tambyah
- National University Health Systems, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Koh Cheng Thoon
- KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yee Sin Leo
- Communicable Disease Centre, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Seang Mei Saw
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
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Soh SE, Lee SSM, Hoon SW, Tan MY, Goh A, Lee BW, Shek LPC, Teoh OH, Kwek K, Saw SM, Godfrey K, Chong YS, Gluckman P, van Bever HP. The methodology of the GUSTO cohort study: a novel approach in studying pediatric allergy. Asia Pac Allergy 2012; 2:144-8. [PMID: 22701865 PMCID: PMC3345328 DOI: 10.5415/apallergy.2012.2.2.144] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/20/2012] [Indexed: 12/20/2022] Open
Abstract
Growing Up in Singapore Towards healthy Outcomes (GUSTO) is Singapore's largest birth cohort study to date. The main aim of GUSTO is to evaluate the role of developmental factors in the early pathways to metabolic compromise. Detailed data is collected for a range of environmental exposures in the parents and offspring, and allergic disorders are among a number of outcomes assessed in infancy and childhood. Under the Allergy domain of GUSTO, this integrated study will describe the epidemiology of allergic manifestations and different phenotypes in the Asian context and help shed light on the association of metabolic disease to allergy. Epigenetic mechanisms and associations with other childhood disorders will also be explored. The aim of this report is to focus on methodology of GUSTO, and to suggest similar approaches (i.e., integrated cohort studies on pediatric allergy) worldwide. Recruitment commenced in 2009 with a cohort of 1,163 pregnant mothers in their first trimester. The mothers and children were followed throughout pregnancy and follow-up will continue until the child reaches 3 years of age. Preliminary results showed that 39.8% of the mothers had a personal history of having at least one allergic disease, which included asthma, eczema and allergic rhinitis. Further data collection and analyses are still ongoing. Allergy is a complex spectrum of disorders with numerous poorly-understood aspects. The ongoing GUSTO cohort study, with its longitudinal design and multi-disciplinary nature, may provide new insights into developmental influences on allergy. As a Singapore-based study, it will be the first integrated allergy cohort in Southeast Asia, of which recruitment started during pregnancy.
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Affiliation(s)
- Shu E Soh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597, Singapore
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Wong IYZ, Soh SE, Chng SY, Shek LPC, Goh DYT, Van Bever HPS, Lee BW. Compliance with topical nasal medication--an evaluation in children with rhinitis. Pediatr Allergy Immunol 2010; 21:1146-50. [PMID: 20718924 DOI: 10.1111/j.1399-3038.2010.01015.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is our impression that children with rhinitis often dislike or struggle with the administration of topical nasal sprays and drops. This study aims to investigate children's acceptance of topical nasal sprays/drops, and to identify patient factors that may affect their acceptance. An interview (by WYZI) questionnaire survey was carried out on parents/guardians of children aged 1-15 with rhinitis, where information on the diagnosis and treatment, patients' use and responses to these medications, and their preferred treatment routes were collected. Two hundred questionnaires were completed, of which 194 were valid for analysis. The mean age of patients was 7.54 yr; male to female ratio was 1:1.6, and Chinese made up the majority (62.4%). About one quarter (24.7%) of children disliked the use of topical nasal sprays/drops sufficiently to affect compliance with the medication. Furthermore, of those who could indicate their preferred route of drug administration (n = 75), 73% indicated a preference for oral medication, while only 11% preferred the nasal route. Topical nasal sprays/drops were more acceptable in older children (7-15 yr) compared to the younger ones (1-6 yr) (OR = 2.383, CI 1.223-4.644). The acceptance of nasal sprays/drops was not associated with gender, ethnic group, concurrent use by other family members, length and amount of usage, and the response to therapy. A substantial proportion of children prescribed topical nasal sprays/drops did not find it acceptable. Age played a significant factor to the acceptance of the use of topical nasal sprays/drops.
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Affiliation(s)
- Ivy Y Z Wong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University Health System, Singapore
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Shek LPC, Cabrera-Morales EA, Soh SE, Gerez I, Ng PZ, Yi FC, Ma S, Lee BW. A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol 2010; 126:324-31, 331.e1-7. [PMID: 20624649 DOI: 10.1016/j.jaci.2010.06.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 05/31/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND There has been a substantial increase in the prevalence of peanut and tree nut allergy in Western populations in the last 2 decades. However, there is an impression that peanut and tree nut allergy is relatively uncommon in Asia. OBJECTIVE To evaluate the prevalence of peanut, tree nut, and shellfish allergy in schoolchildren in 2 Asian countries (Singapore and Philippines). METHODS A structured written questionnaire was administered to local and expatriate Singapore (4-6 and 14-16 years old) and Philippine (14-16 years old) schoolchildren. RESULTS A total of 25,692 schoolchildren responded to the survey (response rate, 74.2%). Of these, 23,425 responses fell within the study protocol's 4 to 6 and 14 to 16 year age groups and were included in the analysis. The prevalence of convincing peanut and tree nut allergy were similar in both local Singapore (4-6 years, 0.64%, 0.28%; 14-16 years, 0.47%, 0.3%, respectively) and Philippine (14-16, 0.43%, 0.33%, respectively) schoolchildren, but was higher in the Singapore expatriates (4-6 years, 1.29%, 1.12%; 14-16 years, both 1.21%, respectively; 4-6 years, expatriates vs local Singaporeans: peanut, P = .019; tree nut, P = .0017; 14-16 years, P > .05). Conversely, shellfish allergy was more common in the local Singapore (4-6 years, 1.19%; 14-16 years, 5.23%) and Philippine (14-16 years, 5.12%) schoolchildren compared with expatriate children (4-6 years, 0.55%; 14-16 years, 0.96%; P < .001). When data were pooled, respondents born in Western countries were at higher risk of peanut (adjusted odds ratios [95% CIs]: 4-6 years, 3.47 [1.35-8.93]; 14-16 years, 5.56 [1.74-17.76]) and tree nut allergy (adjusted odds ratios [95% CIs]: 4-6 years, 10.40 [1.61-67.36]; 14-16 years, 3.53 [1.00-12.43]) compared with those born in Asia. CONCLUSION This study substantiates the notion that peanut and tree nut allergy is relatively low in Asian children, and instead shellfish allergy predominates. Environmental factors that are yet to be defined are likely to contribute to these differences.
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Affiliation(s)
- Shu E Soh
- Department of Epidemiology and Public Health, National University of Singapore, Republic of Singapore
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Shek LPC, Chong AR, Soh SE, Cheong N, Teo ASM, Yi FC, Giam YC, Chua KY, Van Bever HP. Specific profiles of house dust mite sensitization in children with asthma and in children with eczema. Pediatr Allergy Immunol 2010; 21:e718-22. [PMID: 20337963 DOI: 10.1111/j.1399-3038.2010.01019.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sensitization to house dust mites (HDM) is highly prevalent among the young atopic population in Singapore. Previously published data suggest that individuals with skin allergies show preferred sensitization to Dermatophagoides pteronyssinus while individuals with pure respiratory allergies show preferred sensitization to Blomia tropicalis. The aim of our study was to compare the sensitization profiles between children with asthma and those with eczema to D. pteronyssinus and B. tropicalis and their specific allergens. A total of 60 children, 30 with asthma and 30 with eczema were recruited. IgE levels specific for a panel of HDM allergens from the two mite species were measured using enzyme-linked immunosorbent assay. The asthma group showed highest sensitization to Blo t5 while the eczema group showed highest sensitization to Der p5. Comparison between the two disease groups showed that the eczema group had significantly higher IgE levels for Der p (p = 0.042) and its allergens Der p1 (p = 0.019) and Der p5 (p = 0.001). Generally, the eczema group was more sensitized to the panel of allergens compared to the asthma group. Individuals with asthma and those with eczema showed different sensitization profiles to HDM. These findings highlighted possible mechanisms for different manifestation of allergy.
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Wang XS, Shek LP, Ma S, Soh SE, Lee BW, Goh DYT. Time trends of co-existing atopic conditions in Singapore school children: prevalence and related factors. Pediatr Allergy Immunol 2010; 21:e137-41. [PMID: 19397754 DOI: 10.1111/j.1399-3038.2009.00877.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atopic diseases are known to co-exist and are interrelated. Their co-existence in a patient increases disease burden and morbidity. We sought to study the prevalence of co-existing atopic conditions over time and its associated risk factors among Singapore children. Data was collected from two respective The International Study of Asthma and Allergies in Childhood surveys conducted in 1994 and 2001. Data on asthma, rhinitis and eczema were obtained from the responses to questions about wheezing, exercise-induced wheezing, nocturnal cough, rhinitis symptoms, rash, and diagnoses of asthma, rhinitis and eczema in the last 12 months. Data on demographic and known risk factors were also obtained. The prevalence of children who have had more than one atopic disorder increased significantly from 6.0% in 1994 to 10.2% in 2001 (p < 0.001). Parental history of atopic disease, maternal educational level, male gender and smoke exposure were significantly associated with co-existent atopic symptoms in the child. Among Singapore schoolchildren, there was a significant prevalence of co-existent atopic disease and this prevalence was rising. The influences of both genetic and environmental factors were likely to have contributed to these observations.
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Affiliation(s)
- Xiao Shan Wang
- Department of Paediatrics, National University of Singapore, Singapore
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Soh SE, Ong DQR, Gerez I, Zhang X, Chollate P, Shek LPC, Lee BW, Aw M. Effect of probiotic supplementation in the first 6 months of life on specific antibody responses to infant Hepatitis B vaccination. Vaccine 2010; 28:2577-9. [PMID: 20105426 DOI: 10.1016/j.vaccine.2010.01.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 01/04/2010] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
Probiotics have been shown to enhance specific immune responses to vaccines. We aim to assess the effect of probiotic supplementation on specific IgG antibody responses to Hepatitis B (HepB) vaccination in infants. Compared to controls, probiotic supplementation improved HepB surface antibody responses in subjects receiving monovalent doses of HepB vaccine at 0, 1 month and a DTPa-HepB combination vaccine at 6 months [placebo (n=28): 187.97 (180.70-195.24), probiotic (n=29): 345.70 (339.41-351.99)mIU/ml] (p=0.069), but not those who received 3 monovalent doses [placebo (n=68): 302.34 (296.31-308.37), probiotic (n=77): 302.06 (296.31-307.81)mIU/ml] (p=0.996). Probiotics may enhance specific antibody responses in infants receiving certain Hepatitis B vaccine schedules.
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Affiliation(s)
- Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University Health System, Singapore 119074, Singapore
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Soh SE, Aw M, Gerez I, Chong YS, Rauff M, Ng YPM, Wong HB, Pai N, Lee BW, Shek LPC. Probiotic supplementation in the first 6 months of life in at risk Asian infants--effects on eczema and atopic sensitization at the age of 1 year. Clin Exp Allergy 2008; 39:571-8. [PMID: 19134020 DOI: 10.1111/j.1365-2222.2008.03133.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The role of probiotics in allergy prevention remains uncertain but has been shown in some studies to have a possible protective effect on eczema. OBJECTIVE We aimed to assess the effect of probiotic supplementation in the first 6 months of life on eczema and allergic sensitization at 1 year of age in Asian infants at risk of allergic disease. METHODS A double-blind, placebo-controlled randomized clinical trial involving 253 infants with a family history of allergic disease was carried out. Infants received at least 60 mL of commercially available cow's milk formula with or without probiotic supplementation [Bifidobacterium longum (BL999) 1 x 10(7) colony forming unit (CFU)/g and Lactobacillus rhamnosus (LPR) 2 x 10(7) CFU/g] daily for the first 6 months. Clinical evaluation was performed at 1, 3, 6 and 12 months of age, with serum total IgE measurement and skin prick tests conducted at the 12-month visit. The primary and secondary end-points were eczema and allergen sensitization, respectively. RESULTS The incidence of eczema in the probiotic (22%) group was similar to that in the placebo group (25%) (P=0.53). The median Scoring Atopic Dermatitis score at 12 months was 17.10 (9.74) in the probiotic group and 11.60 (8.40) in the placebo group (P=0.17). The prevalence of allergen sensitization showed no difference (probiotic=24% vs. placebo=19%, P=0.26). The total IgE geometric mean (95% confidence interval) was 18.76 (12.54-24.98) kU/L in the probiotic group and 23.13 (16.01-30.24) kU/L in the placebo group (P=0.15). Atopic eczema (with sensitization) in the probiotic (7.3%) group was comparable to the placebo group (5.8%) (P=0.86). CONCLUSION Early life administration of a cow's milk formula supplemented with probiotics showed no effect on prevention of eczema or allergen sensitization in the first year of life in Asian infants at risk of allergic disease. Further work is needed to determine whether timing of supplementation, dose and probiotic strain are important considerations.
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Affiliation(s)
- S E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Hospital, Singapore
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Abstract
OBJECTIVE : This is a review on published data available on food allergy in East Asia and a discussion on the insights that it offers. METHODS : PubMed searches were made for terms food allergy and anaphylaxis, in combination with Asia. RESULTS : There is a paucity of population-based prevalence studies on food allergy in Asia. Certain unique food allergens, such as buckwheat, chestnuts, chickpeas, bird's nest, and royal jelly, which are consumed extensively by certain Asian populations have resulted in clinical food allergy of little importance in other populations. Crustacean shellfish is of importance in this region relative to other common food allergens. The high consumption of these foods and possibly coupled with cross-reactive tropomyosins from dominant inhalant dust mite and cockroach allergens in this region may explain this phenomenon. In contrast, the prevalence of peanut allergy is relatively low in this region. The reasons for this difference are not apparent. However, this may be a reflection of the general reduced propensity in this region to allergic diseases as seen with asthma. CONCLUSIONS : Further research on food allergy in Asia is warranted because it offers unique opportunities to further our understanding on the influence of population and environment.
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Affiliation(s)
- Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Children's Medical Institute, National University Hospital, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Children's Medical Institute, National University Hospital, Singapore
| | | | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hugo P Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Children's Medical Institute, National University Hospital, Singapore
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