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Bethlehem RAI, Seidlitz J, White SR, Vogel JW, Anderson KM, Adamson C, Adler S, Alexopoulos GS, Anagnostou E, Areces-Gonzalez A, Astle DE, Auyeung B, Ayub M, Bae J, Ball G, Baron-Cohen S, Beare R, Bedford SA, Benegal V, Beyer F, Blangero J, Blesa Cábez M, Boardman JP, Borzage M, Bosch-Bayard JF, Bourke N, Calhoun VD, Chakravarty MM, Chen C, Chertavian C, Chetelat G, Chong YS, Cole JH, Corvin A, Costantino M, Courchesne E, Crivello F, Cropley VL, Crosbie J, Crossley N, Delarue M, Delorme R, Desrivieres S, Devenyi GA, Di Biase MA, Dolan R, Donald KA, Donohoe G, Dunlop K, Edwards AD, Elison JT, Ellis CT, Elman JA, Eyler L, Fair DA, Feczko E, Fletcher PC, Fonagy P, Franz CE, Galan-Garcia L, Gholipour A, Giedd J, Gilmore JH, Glahn DC, Goodyer IM, Grant PE, Groenewold NA, Gunning FM, Gur RE, Gur RC, Hammill CF, Hansson O, Hedden T, Heinz A, Henson RN, Heuer K, Hoare J, Holla B, Holmes AJ, Holt R, Huang H, Im K, Ipser J, Jack CR, Jackowski AP, Jia T, Johnson KA, Jones PB, Jones DT, Kahn RS, Karlsson H, Karlsson L, Kawashima R, Kelley EA, Kern S, Kim KW, Kitzbichler MG, Kremen WS, Lalonde F, Landeau B, Lee S, Lerch J, Lewis JD, Li J, Liao W, Liston C, Lombardo MV, Lv J, Lynch C, Mallard TT, Marcelis M, Markello RD, Mathias SR, Mazoyer B, McGuire P, Meaney MJ, Mechelli A, Medic N, Misic B, Morgan SE, Mothersill D, Nigg J, Ong MQW, Ortinau C, Ossenkoppele R, Ouyang M, Palaniyappan L, Paly L, Pan PM, Pantelis C, Park MM, Paus T, Pausova Z, Paz-Linares D, Pichet Binette A, Pierce K, Qian X, Qiu J, Qiu A, Raznahan A, Rittman T, Rodrigue A, Rollins CK, Romero-Garcia R, Ronan L, Rosenberg MD, Rowitch DH, Salum GA, Satterthwaite TD, Schaare HL, Schachar RJ, Schultz AP, Schumann G, Schöll M, Sharp D, Shinohara RT, Skoog I, Smyser CD, Sperling RA, Stein DJ, Stolicyn A, Suckling J, Sullivan G, Taki Y, Thyreau B, Toro R, Traut N, Tsvetanov KA, Turk-Browne NB, Tuulari JJ, Tzourio C, Vachon-Presseau É, Valdes-Sosa MJ, Valdes-Sosa PA, Valk SL, van Amelsvoort T, Vandekar SN, Vasung L, Victoria LW, Villeneuve S, Villringer A, Vértes PE, Wagstyl K, Wang YS, Warfield SK, Warrier V, Westman E, Westwater ML, Whalley HC, Witte AV, Yang N, Yeo B, Yun H, Zalesky A, Zar HJ, Zettergren A, Zhou JH, Ziauddeen H, Zugman A, Zuo XN, Bullmore ET, Alexander-Bloch AF. Brain charts for the human lifespan. Nature 2022; 604:525-533. [PMID: 35388223 PMCID: PMC9021021 DOI: 10.1038/s41586-022-04554-y] [Citation(s) in RCA: 372] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
Over the past few decades, neuroimaging has become a ubiquitous tool in basic research and clinical studies of the human brain. However, no reference standards currently exist to quantify individual differences in neuroimaging metrics over time, in contrast to growth charts for anthropometric traits such as height and weight1. Here we assemble an interactive open resource to benchmark brain morphology derived from any current or future sample of MRI data ( http://www.brainchart.io/ ). With the goal of basing these reference charts on the largest and most inclusive dataset available, acknowledging limitations due to known biases of MRI studies relative to the diversity of the global population, we aggregated 123,984 MRI scans, across more than 100 primary studies, from 101,457 human participants between 115 days post-conception to 100 years of age. MRI metrics were quantified by centile scores, relative to non-linear trajectories2 of brain structural changes, and rates of change, over the lifespan. Brain charts identified previously unreported neurodevelopmental milestones3, showed high stability of individuals across longitudinal assessments, and demonstrated robustness to technical and methodological differences between primary studies. Centile scores showed increased heritability compared with non-centiled MRI phenotypes, and provided a standardized measure of atypical brain structure that revealed patterns of neuroanatomical variation across neurological and psychiatric disorders. In summary, brain charts are an essential step towards robust quantification of individual variation benchmarked to normative trajectories in multiple, commonly used neuroimaging phenotypes.
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Affiliation(s)
- R A I Bethlehem
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - J Seidlitz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Lifespan Brain Institute, The Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA.
| | - S R White
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - J W Vogel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Informatics & Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
| | - K M Anderson
- Department of Psychology, Yale University, New Haven, CT, USA
| | - C Adamson
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - S Adler
- UCL Great Ormond Street Institute for Child Health, London, UK
| | - G S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, New York, USA
| | - E Anagnostou
- Department of Pediatrics University of Toronto, Toronto, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - A Areces-Gonzalez
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
- University of Pinar del Río "Hermanos Saiz Montes de Oca", Pinar del Río, Cuba
| | - D E Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - B Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - M Ayub
- Queen's University, Department of Psychiatry, Centre for Neuroscience Studies, Kingston, Ontario, Canada
- University College London, Mental Health Neuroscience Research Department, Division of Psychiatry, London, UK
| | - J Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - G Ball
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - S Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge Lifetime Asperger Syndrome Service (CLASS), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - R Beare
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - S A Bedford
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - V Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - F Beyer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - J Blangero
- Department of Human Genetics, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - M Blesa Cábez
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - J P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M Borzage
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J F Bosch-Bayard
- McGill Centre for Integrative Neuroscience, Ludmer Centre for Neuroinformatics and Mental Health, Montreal Neurological Institute, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - N Bourke
- Department of Brain Sciences, Imperial College London, London, UK
- Care Research and Technology Centre, Dementia Research Institute, London, UK
| | - V D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
| | - M M Chakravarty
- McGill University, Montreal, Quebec, Canada
- Computational Brain Anatomy (CoBrA) Laboratory, Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - C Chen
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C Chertavian
- Lifespan Brain Institute, The Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - G Chetelat
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Y S 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
| | - J H Cole
- Centre for Medical Image Computing (CMIC), University College London, London, UK
- Dementia Research Centre (DRC), University College London, London, UK
| | - A Corvin
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - M Costantino
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Undergraduate program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - E Courchesne
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
- Autism Center of Excellence, University of California, San Diego, San Diego, CA, USA
| | - F Crivello
- Institute of Neurodegenerative Disorders, CNRS UMR5293, CEA, University of Bordeaux, Bordeaux, France
| | - V L Cropley
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - J Crosbie
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - N Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Instituto Milenio Intelligent Healthcare Engineering, Santiago, Chile
| | - M Delarue
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - R Delorme
- Child and Adolescent Psychiatry Department, Robert Debré University Hospital, AP-HP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - S Desrivieres
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G A Devenyi
- Cerebral Imaging Centre, McGill Department of Psychiatry, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - M A Di Biase
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Dolan
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, London, UK
| | - K A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - G Donohoe
- Center for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - K Dunlop
- Weil Family Brain and Mind Research Institute, Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - A D Edwards
- Centre for the Developing Brain, King's College London, London, UK
- Evelina London Children's Hospital, London, UK
- MRC Centre for Neurodevelopmental Disorders, London, UK
| | - J T Elison
- Institute of Child Development, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - C T Ellis
- Department of Psychology, Yale University, New Haven, CT, USA
- Haskins Laboratories, New Haven, CT, USA
| | - J A Elman
- Department of Psychiatry, Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - L Eyler
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, Los Angeles, CA, USA
| | - D A Fair
- Institute of Child Development, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - E Feczko
- Institute of Child Development, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - P C Fletcher
- Department of Psychiatry, University of Cambridge, and Wellcome Trust MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - P Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - C E Franz
- Department of Psychiatry, Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | | | - A Gholipour
- Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA, USA
| | - J Giedd
- Department of Child and Adolescent Psychiatry, University of California, San Diego, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - J H Gilmore
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - D C Glahn
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - I M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P E Grant
- Division of Newborn Medicine and Neuroradiology, Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - N A Groenewold
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - F M Gunning
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - R E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Brain Institute, The Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - R C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Brain Institute, The Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - C F Hammill
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Mouse Imaging Centre, Toronto, Ontario, Canada
| | - O Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - T Hedden
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Heinz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin, Germany
| | - R N Henson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - K Heuer
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Université de Paris, Paris, France
| | - J Hoare
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - B Holla
- Department of Integrative Medicine, NIMHANS, Bengaluru, India
- Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, NIMHANS, Bengaluru, India
| | - A J Holmes
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, USA
| | - R Holt
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - H Huang
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K Im
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Newborn Medicine and Neuroradiology, Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - J Ipser
- Department of Psychiatry and Mental Health, Clinical Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - C R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - A P Jackowski
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry, Beijing, China
| | - T Jia
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and BrainInspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology and Neuroscience, SGDP Centre, King's College London, London, UK
| | - K A Johnson
- Harvard Medical School, Boston, MA, USA
- Harvard Aging Brain Study, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - D T Jones
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - R S Kahn
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - H Karlsson
- Department of Clinical Medicine, Department of Psychiatry and Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - L Karlsson
- Department of Clinical Medicine, Department of Psychiatry and Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - R Kawashima
- Institute of Development, Aging and Cancer, Tohoku University, Seiryocho, Aobaku, Sendai, Japan
| | - E A Kelley
- Queen's University, Departments of Psychology and Psychiatry, Centre for Neuroscience Studies, Kingston, Ontario, Canada
| | - S Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - K W Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, South Korea
| | - M G Kitzbichler
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - W S Kremen
- Department of Psychiatry, Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA, USA
| | - F Lalonde
- Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - B Landeau
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - S Lee
- Department of Brain & Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - J Lerch
- Mouse Imaging Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - J D Lewis
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - J Li
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - W Liao
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - C Liston
- Department of Psychiatry and Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - M V Lombardo
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - J Lv
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
- School of Biomedical Engineering and Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - C Lynch
- Weil Family Brain and Mind Research Institute, Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - T T Mallard
- Department of Psychology, University of Texas, Austin, TX, USA
| | - M Marcelis
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - R D Markello
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - S R Mathias
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - B Mazoyer
- Institute of Neurodegenerative Disorders, CNRS UMR5293, CEA, University of Bordeaux, Bordeaux, France
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - P McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - A Mechelli
- Bordeaux University Hospital, Bordeaux, France
| | - N Medic
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - B Misic
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - S E Morgan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - D Mothersill
- Department of Psychology, School of Business, National College of Ireland, Dublin, Ireland
- School of Psychology and Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - J Nigg
- Department of Psychiatry, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - M Q W Ong
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C Ortinau
- Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA
| | - R Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - M Ouyang
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - L Palaniyappan
- Robarts Research Institute and The Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
| | - L Paly
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - P M Pan
- Department of Psychiatry, Federal University of Sao Poalo (UNIFESP), Sao Poalo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Sao Poalo, Brazil
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - M M Park
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - T Paus
- Department of Psychiatry, Faculty of Medicine and Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- Departments of Psychiatry and Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Z Pausova
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Physiology and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - D Paz-Linares
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
- Cuban Neuroscience Center, Havana, Cuba
| | - A Pichet Binette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - K Pierce
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
| | - X Qian
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J Qiu
- School of Psychology, Southwest University, Chongqing, China
| | - A Qiu
- Department of Biomedical Engineering, The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - A Raznahan
- Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - T Rittman
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - A Rodrigue
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - C K Rollins
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - R Romero-Garcia
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Instituto de Biomedicina de Sevilla (IBiS) HUVR/CSIC/Universidad de Sevilla, Dpto. de Fisiología Médica y Biofísica, Seville, Spain
| | - L Ronan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - M D Rosenberg
- Department of Psychology and Neuroscience Institute, University of Chicago, Chicago, IL, USA
| | - D H Rowitch
- Department of Paediatrics and Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - G A Salum
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry (INPD), São Paulo, Brazil
| | - T D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Informatics & Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
| | - H L Schaare
- Otto Hahn Group Cognitive Neurogenetics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Juelich, Juelich, Germany
| | - R J Schachar
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A P Schultz
- Harvard Medical School, Boston, MA, USA
- Harvard Aging Brain Study, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - G Schumann
- Centre for Population Neuroscience and Stratified Medicine (PONS), Institute for Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- PONS-Centre, Charite Mental Health, Dept of Psychiatry and Psychotherapy, Charite Campus Mitte, Berlin, Germany
| | - M Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
- Dementia Research Centre, Queen's Square Institute of Neurology, University College London, London, UK
| | - D Sharp
- Department of Brain Sciences, Imperial College London, London, UK
- Care Research and Technology Centre, UK Dementia Research Institute, London, UK
| | - R T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - I Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - C D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - R A Sperling
- Harvard Medical School, Boston, MA, USA
- Harvard Aging Brain Study, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - D J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Dept of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A Stolicyn
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - J Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - G Sullivan
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Y Taki
- Institute of Development, Aging and Cancer, Tohoku University, Seiryocho, Aobaku, Sendai, Japan
| | - B Thyreau
- Institute of Development, Aging and Cancer, Tohoku University, Seiryocho, Aobaku, Sendai, Japan
| | - R Toro
- Université de Paris, Paris, France
- Department of Neuroscience, Institut Pasteur, Paris, France
| | - N Traut
- Department of Neuroscience, Institut Pasteur, Paris, France
- Center for Research and Interdisciplinarity (CRI), Université Paris Descartes, Paris, France
| | - K A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - N B Turk-Browne
- Department of Psychology, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - J J Tuulari
- Department of Clinical Medicine, Department of Psychiatry and Turku Brain and Mind Center, FinnBrain Birth Cohort Study, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Turku Collegium for Science, Medicine and Technology, University of Turku, Turku, Finland
| | - C Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, CHU Bordeaux, Bordeaux, France
| | - É Vachon-Presseau
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | - P A Valdes-Sosa
- The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
- Alan Edwards Centre for Research on Pain (AECRP), McGill University, Montreal, Quebec, Canada
| | - S L Valk
- Institute for Neuroscience and Medicine 7, Forschungszentrum Jülich, Jülich, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - T van Amelsvoort
- Department of Psychiatry and Neurosychology, Maastricht University, Maastricht, The Netherlands
| | - S N Vandekar
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Vasung
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - L W Victoria
- Weill Cornell Institute of Geriatric Psychiatry, Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - S Villeneuve
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - A Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - P E Vértes
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - K Wagstyl
- Wellcome Centre for Human Neuroimaging, London, UK
| | - Y S Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Developmental Population Neuroscience Research Center, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- National Basic Science Data Center, Beijing, China
- Research Center for Lifespan Development of Brain and Mind, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - S K Warfield
- Computational Radiology Laboratory, Boston Children's Hospital, Boston, MA, USA
| | - V Warrier
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - E Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - M L Westwater
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - H C Whalley
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - A V Witte
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University of Leipzig Medical Center, Leipzig, Germany
- Faculty of Medicine, CRC 1052 'Obesity Mechanisms', University of Leipzig, Leipzig, Germany
| | - N Yang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Developmental Population Neuroscience Research Center, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- National Basic Science Data Center, Beijing, China
- Research Center for Lifespan Development of Brain and Mind, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - B Yeo
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
- Centre for Sleep and Cognition and Centre for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore, Singapore
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore
| | - H Yun
- Division of Newborn Medicine and Neuroradiology, Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - A Zettergren
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Gothenburg, Sweden
| | - J H Zhou
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
- Center for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - H Ziauddeen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Zugman
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Sao Poalo, Brazil
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Psychiatry, Escola Paulista de Medicina, São Paulo, Brazil
| | - X N Zuo
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Developmental Population Neuroscience Research Center, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- National Basic Science Data Center, Beijing, China
- Research Center for Lifespan Development of Brain and Mind, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Brain and Education, School of Education Science, Nanning Normal University, Nanning, China
| | - E T Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A F Alexander-Bloch
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Lifespan Brain Institute, The Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
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Sugianto R, Toh JY, Wong SF, Tint MT, Colega MT, Lee YS, Yap F, Shek LPC, Tan KH, Godfrey KM, Chong YS, Tai BC, Chong MFF. Dietary patterns of 5-year-old children and their correlates: findings from a multi-ethnic Asian cohort. Br J Nutr 2022; 127:763-772. [PMID: 33910654 PMCID: PMC7612427 DOI: 10.1017/s0007114521001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported 1-month quantitative FFQ of 777 children from the Growing Up in Singapore Towards healthy Outcomes cohort, cluster analysis identified two mutually exclusive clusters. Children in the 'Unhealthy' cluster (43·9 %) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared with those in the 'Healthy' cluster (56·1 %). Children with mothers of lower educational attainment had twice the odds of being assigned to the 'Unhealthy' cluster (adjusted OR (95 % CI) = 2·19 (95 % CI 1·49-3·24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the 'Unhealthy' cluster (adjusted OR = 25·46 (95 % CI 15·40, 42·10) and 4·03 (95 % CI 2·68-6·06), respectively), relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the 'Unhealthy' and 'Healthy' clusters. Mothers' educational attainment and ethnicity were two correlates that were associated with the children's assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children.
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Affiliation(s)
- R Sugianto
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - JY Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - SF Wong
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - MT Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - MT Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - YS Lee
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital and National University Health System, Singapore
| | - F Yap
- Duke-NUS Medical School, Singapore
- KK Women’s and Children’s Hospital, Singapore
| | - LPC Shek
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital and National University Health System, Singapore
| | - KH Tan
- Duke-NUS Medical School, Singapore
- KK Women’s and Children’s Hospital, Singapore
| | - KM Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - YS Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - BC Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - MFF Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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Lau TC, Chong YS, Loo BKG, Ganapathy S, Ho JMD, Lee SS, Yeo J, Samarasekera DD, Goh DLM. Adapting undergraduate paediatric medical education to the challenges of COVID-19 pandemic: perspective of NUS Medicine. Singapore Med J 2021. [DOI: 10.11622/smedj.2021075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
COVID-19 significantly impacted the teaching-learning-assessment activities in many medical schools. In this article, we discuss the impact of COVID-19 on the Yong Loo Lin School of Medicine, National University of Singapore, focusing on paediatric training and the adaptations of the system and the people. The school developed strategies to promptly disseminate information and safety measures to protect all its staff and students. By leveraging on the school’s infrastructure for technology-enabled learning, good-quality medical training and reliable assessments were able to be carried out swiftly. The paediatric curriculum was crafted based on these principles, and it provided distance-based learning with live and interactive sessions to teach core clinical skills. The faculty also tapped on standardised patients to provide consistent and life-like scenarios. Measures were implemented to minimise challenges with technology-enabled learning. Collectively, efforts from the staff, support from the leadership and students’ adaptations tremendously helped to ease the transition.
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Balan P, Brandt BW, Chong YS, Crielaard W, Wong ML, Lopez V, He HG, Seneviratne CJ. Subgingival Microbiota during Healthy Pregnancy and Pregnancy Gingivitis. JDR Clin Trans Res 2020; 6:343-351. [PMID: 32777190 DOI: 10.1177/2380084420948779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/17/2022] Open
Abstract
INTRODUCTION Previous studies have largely explored the microbial composition and pathogenesis of pregnancy gingivitis. However, the patterns of microbial colonization during pregnancy in the absence of pregnancy gingivitis have rarely been studied. Characterization of the oral microbiome in pregnant women with healthy gingiva is an important initial step in understanding the role of the microbiome in progression to pregnancy gingivitis. OBJECTIVES In this study, we compared the oral microbiome of pregnant women without gingivitis (healthy pregnancy) with pregnant women having gingivitis and nonpregnant healthy women to understand how pregnancy modifies the oral microbiome and induces progression to pregnancy gingivitis. METHODS Subgingival plaque samples were collected from Chinese pregnant women with gingivitis (n = 10), healthy pregnant women (n = 10), and nonpregnant healthy women (n = 10). The Illumina MiSeq platform was used to perform 16S rRNA gene sequencing targeting the V4 region. RESULTS The alpha and beta diversity was significantly different between pregnant and nonpregnant women, but minimal differences were observed between pregnant women with and without gingivitis. Interestingly, the oral bacterial community showed higher abundance of pathogenic taxa during healthy pregnancy as compared with nonpregnant women despite similar gingival and plaque index scores. However, when compared with overt pregnancy gingivitis, pathogenic taxa were less abundant during healthy pregnancy. PICRUSt analysis (phylogenetic investigation of communities by reconstruction of unobserved states) also suggested no difference in the functional capabilities of the microbiome during pregnancy, irrespective of gingival disease status. However, metabolic pathways related to amino acid metabolism were significantly increased in healthy pregnant women as compared with nonpregnant women. CONCLUSION The presence of pathogenic taxa in healthy pregnancy and pregnancy gingivitis suggests that bacteria may be necessary for initiating disease development but progression to gingivitis may be influenced by the host environmental factors. More efforts are required to plan interventions aimed at sustaining health before the appearance of overt gingivitis. KNOWLEDGE TRANSFER STATEMENT The results of this study draw attention to the importance of oral health maintenance during pregnancy, as women without any prenatal oral conditions are predisposed to the risk of developing pregnancy gingivitis. Hence, it is important to incorporate comprehensive assessment of oral health in the prenatal health care schedules. Pregnant woman should be screened for oral risks, counseled on proper oral hygiene and expected oral changes, and referred for dental treatment, when necessary.
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Affiliation(s)
- P Balan
- Singapore Oral Microbiomics Inititative, National Dental Research Institute Singapore, SingHealth, Singapore.,Oral Health ACP, Duke NUS Medical School, Singapore
| | - B W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry, Amsterdam, the Netherlands
| | - Y S Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University Hospital, Singapore
| | - W Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry, Amsterdam, the Netherlands
| | - M L Wong
- Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore
| | - V Lopez
- School of Nursing, Hubei University of Medicine, Shiyan City, China
| | - H G He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C J Seneviratne
- Singapore Oral Microbiomics Inititative, National Dental Research Institute Singapore, SingHealth, Singapore.,Oral Health ACP, Duke NUS Medical School, Singapore
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Kalhan TA, Un Lam C, Karunakaran B, Chay PL, Chng CK, Nair R, Lee YS, Fong MCF, Chong YS, Kwek K, Saw SM, Shek L, Yap F, Tan KH, Godfrey KM, Huang J, Hsu CYS. Caries Risk Prediction Models in a Medical Health Care Setting. J Dent Res 2020; 99:787-796. [PMID: 32311276 DOI: 10.1177/0022034520913476] [Citation(s) in RCA: 4] [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: 12/11/2022] Open
Abstract
Despite development of new technologies for caries control, tooth decay in primary teeth remains a major global health problem. Caries risk assessment (CRA) models for toddlers and preschoolers are rare. Among them, almost all models use dental factors (e.g., past caries experience) to predict future caries risk, with limited clinical/community applicability owing to relatively uncommon dental visits compared to frequent medical visits during the first year of life. The objective of this study was to construct and evaluate risk prediction models using information easily accessible to medical practitioners to forecast caries at 2 and 3 y of age. Data were obtained from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother-offspring cohort. Caries was diagnosed using modified International Caries Detection and Assessment System criteria. Risk prediction models were constructed using multivariable logistic regression coupled with receiver operating characteristic analyses. Imputation was performed using multiple imputation by chained equations to assess effect of missing data. Caries rates at ages 2 y (n = 535) and 3 y (n = 721) were 17.8% and 42.9%, respectively. Risk prediction models predicting overall caries risk at 2 and 3 y demonstrated area under the curve (AUC) (95% confidence interval) of 0.81 (0.75-0.87) and 0.79 (0.74-0.84), respectively, while those predicting moderate to extensive lesions showed 0.91 (0.85-0.97) and 0.79 (0.73-0.85), respectively. Postimputation results showed reduced AUC of 0.75 (0.74-0.81) and 0.71 (0.67-0.75) at years 2 and 3, respectively, for overall caries risk, while AUC was 0.84 (0.76-0.92) and 0.75 (0.70-0.80), respectively, for moderate to extensive caries. Addition of anterior caries significantly increased AUC in all year 3 models with or without imputation (all P < 0.05). Significant predictors/protectors were identified, including ethnicity, prenatal tobacco smoke exposure, history of allergies before 12 mo, history of chronic maternal illness, maternal brushing frequency, childbearing age, and so on. Integrating oral-general health care using medical CRA models may be promising in screening caries-susceptible infants/toddlers, especially when medical professionals are trained to "lift the lip" to identify anterior caries lesions.
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Affiliation(s)
- T A Kalhan
- Faculty of Dentistry, National University of Singapore, Singapore
| | - C Un Lam
- Chief Dental Officer's Office, Ministry of Health, College of Medicine Building, Singapore
| | - B Karunakaran
- Faculty of Dentistry, National University of Singapore, Singapore
| | - P L Chay
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - C K Chng
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - R Nair
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Dentistry-Quality and Safety of Oral Healthcare, Nijmegen, the Netherlands.,Dr. D. Y. Patil Dental College & Hospital, Pune, Maharashtra, India
| | - Y S Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - M C F Fong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Y S Chong
- Chief Dental Officer's Office, Ministry of Health, College of Medicine Building, Singapore.,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - K Kwek
- Dental Service, KK Women's and Children's Hospital, Singapore
| | - S M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - L Shek
- Division of Paediatric Allergy, Immunology & Rheumatology, National University Hospital, Singapore
| | - F Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Department of Paediatrics, Duke-National University of Singapore Graduate Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - K H Tan
- Dental Service, KK Women's and Children's Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore
| | - C-Y S Hsu
- Faculty of Dentistry, National University of Singapore, Singapore
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6
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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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7
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Yee KH, Tan KH, Aris IM, Lamoureux EL, Chong YS, Wang JJ, Wong TY, Li LJ. History of gestational diabetes mellitus and postpartum maternal retinal microvascular structure and function. Diabet Med 2019; 36:784-786. [PMID: 30729567 DOI: 10.1111/dme.13928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- K H Yee
- College of Medicine, Nursing& Health Sciences, National University of Ireland (Galway), Galway, Ireland
| | - K H Tan
- Health Services Systems Research Programme, Duke-NUS Medical School, Singapore
- Division of O&G, KK Women's and Children's Hospital, Singapore
| | - I M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E L Lamoureux
- Health Services Systems Research Programme, Duke-NUS Medical School, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Y S Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J J Wang
- Centre for Clinician-Scientist Development, Singapore
| | - T Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - L-J Li
- Division of O&G, KK Women's and Children's Hospital, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- O&G ACP, Duke-NUS Medical School, Singapore
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8
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Cai S, Natarajan P, Chan JKY, Wong PC, Tan KH, Godfrey KM, Gluckman PD, Shek LPC, Yap F, Kramer MS, Chan SY, Chong YS. Maternal hyperglycemia in singleton pregnancies conceived by IVF may be modified by first-trimester BMI. Hum Reprod 2018; 32:1941-1947. [PMID: 28854717 PMCID: PMC5638004 DOI: 10.1093/humrep/dex243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/09/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Does IVF independently increase the risk of gestational diabetes mellitus (GDM) and is this increase in risk modified by maternal body mass index? SUMMARY ANSWER IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women (BMI > 25 kg/m2). WHAT IS KNOWN ALREADY IVF has been associated with increased risk of GDM, but most previous studies did not adequately assess confounding or effect modification by other risk factors. STUDY DESIGN, SIZE, DURATION Cross-sectional study using data from 1089 women with singleton pregnancies who participated in a Singaporean birth cohort study (GUSTO) and received a 75 g oral glucose tolerance test (OGTT) at 26-28 weeks gestation. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1089 women (n = 1013 conceived spontaneously, n = 76 conceived through IVF) with singleton pregnancies received a 75 g OGTT at 26-28 weeks gestation. Fasting and 2 h postprandial blood glucose levels were assayed. World Health Organization criteria (1999) standard criteria were used to classify GDM: ≥7.0 mmol/L for fasting and/or ≥7.8 mmol/L for 2-h postprandial plasma glucose levels, which was the clinical guideline in use during the study. MAIN RESULTS AND THE ROLE OF CHANCE IVF pregnancies had nearly double the odds of GDM (OR = 1.83, 95% CI: 1.03-3.26) and elevated fasting (mean difference = 0.12 mmol/L, 95% CI: 0.00-0.24) and OGTT 2-h blood glucose levels (mean difference = 0.64 mmol/L, 95% CI: 0.27-1.01), after adjusting for commonly recognized risk factors for GDM. After stratification by first-trimester BMI, these increased risks of GDM (OR = 3.54, 95% CI: 1.44-8.72) and elevated fasting (mean difference = 0.39 mmol/L, 95% CI: 0.13-0.65) and 2-h blood (mean difference = 1.24 mmol/L, 95% CI: 0.56-1.91) glucose levels were significant only in the IVF group who is also overweight or obese (BMI > 25 kg/m2). LIMITATIONS REASONS FOR CAUTION One limitation of our study is the absence of a 1 h post-OGTT plasma glucose sample, as we were using the 1999 WHO diagnostic criteria (the clinical guideline in Singapore) at the time of our study, instead of the revised 2013 WHO diagnostic criteria. Our cohort may not be representative of the general Singapore obstetric population, although participants were recruited from the two largest maternity hospitals in the country and include both private and subsidized patients. WIDER IMPLICATIONS OF THE FINDINGS IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women. Our findings reinforce the need to advise overweight or obese women contemplating IVF to lose weight before the procedure to reduce their risk of GDM and hyperglycemia-related adverse outcomes arising therefrom. In settings where universal GDM screening is not routine, overweight or obese women who conceive by IVF should be screened. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Program and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding was provided by the Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR). K.M.G. and Y.S.C. have received lecture fees from Nestle Nutrition Institute and Danone, respectively. K.M.G., Y.S.C. and S.Y.C. are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. The other authors have nothing to disclose. The other authors have nothing to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - P Natarajan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - J K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.,Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - P C Wong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore
| | - K H Tan
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore.,Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - P 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
| | - L P C 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 Health System, Singapore 119074, Singapore
| | - F Yap
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore
| | - M S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada QC H3A 1A2.,Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada QC H3G 2M1
| | - S Y Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
| | - Y S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
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9
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Low JSY, Soh SE, Lee YK, Kwek KYC, Holbrook JD, Van der Beek EM, Shek LP, Goh AEN, Teoh OH, Godfrey KM, Chong YS, Knol J, Lay C. Ratio of Klebsiella/Bifidobacterium in early life correlates with later development of paediatric allergy. Benef Microbes 2017; 8:681-695. [PMID: 29022383 DOI: 10.3920/bm2017.0020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Several studies have reported that intestinal microbial colonisation patterns differ between non-allergic and allergic infants. However, the microbial signature underlying the pathogenesis of allergies remains unclear. We aim to gain insight into the development of the intestinal microbiota of healthy infants and infants who develop allergy in early life, and identify potential microbiota biomarkers of later allergic disease. Using a case-control design in a Chinese sub-cohort of a Singaporean birth cohort (GUSTO), we utilised 16S rRNA gene sequencing to assess intestinal microbial composition and diversity of 21 allergic and 18 healthy infants at 3 weeks, 3 months and 6 months of age, and correlated the microbiota with allergy at ages 18 and 36 months. Pronounced differences in intestinal microbiota composition between allergic and healthy infants were observed at 3 months of age. The intestine of healthy infants was colonised with higher abundance of commensal Bifidobacterium. Conversely, Klebsiella, an opportunistic pathogen, was significantly enriched in the allergic infants. Interestingly, infants with a high Klebsiella/Bifidobacterium (K/B) ratio (above the population median K/B ratio) at age 3 months had an odds ratio of developing allergy by 3 years of age of 9.00 (95% confidence interval 1.46-55.50) compared to those with low K/B ratio. This study demonstrated a relationship between the ratio of genera Klebsiella and Bifidobacterium during early infancy and development of paediatric allergy in childhood. Our study postulates that an elevated K/B ratio in early infancy could be a potential indicator of an increased risk of allergy development. This line of research might enable future intervention strategies in early life to prevent or treat allergy. Our study provides new insights into microbial signatures associated with childhood allergy, in particular, suggests that an elevated K/B ratio could be a potential early-life microbiota biomarker of allergic disease.
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Affiliation(s)
- J S Y Low
- 1 Nutricia Research, Danone Nutricia Early Life Nutrition, Matrix Building #05-01B, 30 Biopolis Street, 138671 Singapore, Singapore
| | - S-E Soh
- 2 Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 5 Science drive 2, 117597, Singapore, Singapore
| | - Y K Lee
- 4 Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 5 Science drive 2, 117597, Singapore, Singapore
| | - K Y C Kwek
- 5 KK Women's and Children's Hospital, Singapore, Singapore
| | - J D Holbrook
- 2 Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore.,6 Human Development & Health Academic Unit, University of Southampton & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - E M Van der Beek
- 7 Nutricia Research, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands.,8 Department of Pediatrics, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - L P Shek
- 2 Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 5 Science drive 2, 117597, Singapore, Singapore
| | - A E N Goh
- 5 KK Women's and Children's Hospital, Singapore, Singapore
| | - O H Teoh
- 5 KK Women's and Children's Hospital, Singapore, Singapore
| | - K M Godfrey
- 9 MRC Lifecourse Epidemiology Unit, and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Tremona Road, SO16 6YD Southampton, United Kingdom
| | - Y-S Chong
- 2 Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609, Singapore, Singapore.,10 Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 5 Science drive 2, 117597 Singapore, Singapore
| | - J Knol
- 7 Nutricia Research, Uppsalalaan 12, 3584 CT, Utrecht, the Netherlands.,11 Laboratory of Microbiology, Wageningen University, P.O. Box 7005, 6700 CA, Wageningen, the Netherlands
| | - C Lay
- 1 Nutricia Research, Danone Nutricia Early Life Nutrition, Matrix Building #05-01B, 30 Biopolis Street, 138671 Singapore, Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 5 Science drive 2, 117597, Singapore, Singapore
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10
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Sakwinska O, Foata F, Berger B, Brüssow H, Combremont S, Mercenier A, Dogra S, Soh SE, Yen JCK, Heong GYS, Lee YS, Yap F, Meaney MJ, Chong YS, Godfrey KM, Holbrook JD. Does the maternal vaginal microbiota play a role in seeding the microbiota of neonatal gut and nose? Benef Microbes 2017; 8:763-778. [PMID: 29022384 DOI: 10.3920/bm2017.0064] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 12/24/2022]
Abstract
The acquisition and early maturation of infant microbiota is not well understood despite its likely influence on later health. We investigated the contribution of the maternal microbiota to the microbiota of infant gut and nose in the context of mode of delivery and feeding. Using 16S rRNA sequencing and specific qPCR, we profiled microbiota of 42 mother-infant pairs from the GUSTO birth cohort, at body sites including maternal vagina, rectum and skin; and infant stool and nose. In our study, overlap between maternal vaginal microbiota and infant faecal microbiota was minimal, while the similarity between maternal rectal microbiota and infant microbiota was more pronounced. However, an infant's nasal and gut microbiota were no more similar to that of its own mother, than to that of unrelated mothers. These findings were independent of delivery mode. We conclude that the transfer of maternal vaginal microbes play a minor role in seeding infant stool microbiota. Transfer of maternal rectal microbiota could play a larger role in seeding infant stool microbiota, but approaches other than the generally used analyses of community similarity measures are likely to be needed to quantify bacterial transmission. We confirmed the clear difference between microbiota of infants born by Caesarean section compared to vaginally delivered infants and the impact of feeding mode on infant gut microbiota. Only vaginally delivered, fully breastfed infants had gut microbiota dominated by Bifidobacteria. Our data suggest that reduced transfer of maternal vaginal microbial is not the main mechanism underlying the differential infant microbiota composition associated with Caesarean delivery. The sources of a large proportion of infant microbiota could not be identified in maternal microbiota, and the sources of seeding of infant gut and nasal microbiota remain to be elucidated.
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Affiliation(s)
- O Sakwinska
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - F Foata
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - B Berger
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - H Brüssow
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - S Combremont
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - A Mercenier
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - S Dogra
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, 119228 Singapore
| | - S-E Soh
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,4 Vishuo BioMedical Pte Ltd, 03-33/35A, Teletech Park, 2O Science Park Road, Singapore
| | - J C K Yen
- 5 Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore
| | - G Y S Heong
- 6 Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore.,7 Duke-NUS Medical School, 8 College Road, 169857 Singapore.,8 Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, 119228 Singapore
| | - Y S Lee
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, 119228 Singapore.,9 Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat - National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, 119228 Singapore
| | - F Yap
- 10 Department of Paediatric Endocrinology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore
| | - M J Meaney
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,11 Ludmer Centre for Neuroinformatics and Mental Health, Douglas University Mental Health Institute, McGill University, 3755 Côte-Ste-Catherine Montreal, QC H3T 1E2 Canada
| | - Y-S Chong
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,8 Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, 119228 Singapore
| | - K M Godfrey
- 12 MRC Lifecourse Epidemiology Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.,13 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, MP 218 Tremona Road, SO16 6YD Southampton, United Kingdom
| | - J D Holbrook
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,13 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, MP 218 Tremona Road, SO16 6YD Southampton, United Kingdom
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11
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Chen LW, Tint MT, Fortier MV, Aris IM, Shek LPC, Tan KH, Chan SY, Gluckman PD, Chong YS, Godfrey KM, Rajadurai VS, Yap F, Kramer MS, Lee YS. Which anthropometric measures best reflect neonatal adiposity? Int J Obes (Lond) 2017; 42:501-506. [PMID: 28990589 DOI: 10.1038/ijo.2017.250] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/05/2017] [Accepted: 09/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studying the determinants and the long-term consequences of fetal adipose accretion requires accurate assessment of neonatal body composition. In large epidemiological studies, in-depth body composition measurement methods are usually not feasible for cost and logistical reasons, and there is a need to identify anthropometric measures that adequately reflect neonatal adiposity. METHODS In a multiethnic Asian mother-offspring cohort in Singapore, anthropometric measures (weight, length, abdominal circumference, skinfold thicknesses) were measured using standardized protocols in newborn infants, and anthropometric indices (weight/length, weight/length2 (body mass index, BMI), weight/length3 (ponderal index, PI)) derived. Neonatal total adiposity was measured using air displacement plethysmography (ADP) and abdominal adiposity using magnetic resonance imaging (MRI). Correlations of the anthropometric measures with ADP- and MRI-based adiposity were assessed using Pearson's correlation coefficients (rp), including in subsamples stratified by sex and ethnicity. RESULTS Study neonates (n=251) had a mean (s.d.) age of 10.2 (2.5) days. Correlations between ADP-based fat mass (ADPFM) and anthropometric measures were moderate (rp range: 0.44-0.67), with the strongest being with weight/length, weight, BMI and sum of skinfolds (rp=0.67, 0.66, 0.62, 0.62, respectively, all P<0.01). All anthropometric measures except skinfold thicknesses correlated more strongly with ADP-based fat-free mass than ADPFM, indicating that skinfold measures may have more discriminative power in terms of neonatal total body adiposity. For MRI-based measures, weight and weight/length consistently showed strong positive correlations (rp⩾0.7) with abdominal adipose tissue compartments. These correlations were consistent in boys and girls, across different ethnic groups, and when conventional determinants of neonatal adiposity were adjusted for potential confounding. Abdominal circumference was not strongly associated with ADPFM or abdominal fat mass. CONCLUSIONS Simple anthropometric measures (weight and weight/length) correlated strongly with neonatal adiposity, with some evidence for greater discriminative power for skinfold measures. These simple measures could be of value in large epidemiological studies.
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Affiliation(s)
- L-W Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M-T Tint
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - I M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - L P-C Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K H Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - S-Y Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Y-S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - V S Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - F Yap
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.,Department of Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Y S Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, 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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Lee YS, Biddle S, Chan MF, Cheng A, Cheong M, Chong YS, Foo LL, Lee CH, Lim SC, Ong WS, Pang J, Pasupathy S, Sloan R, Seow M, Soon G, Tan B, Tan TC, Teo SL, Tham KW, van Dam RM, Wang J. Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity. Singapore Med J 2017; 57:472. [PMID: 27550044 DOI: 10.11622/smedj.2016141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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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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14
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Wen DJ, Poh JS, Ni SN, Chong YS, Chen H, Kwek K, Shek LP, Gluckman PD, Fortier MV, Meaney MJ, Qiu A. Influences of prenatal and postnatal maternal depression on amygdala volume and microstructure in young children. Transl Psychiatry 2017; 7:e1103. [PMID: 28440816 PMCID: PMC5416711 DOI: 10.1038/tp.2017.74] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
Maternal depressive symptoms influence neurodevelopment in the offspring. Such effects may appear to be gender-dependent. The present study examined contributions of prenatal and postnatal maternal depressive symptoms to the volume and microstructure of the amygdala in 4.5-year-old boys and girls. Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) at 26 weeks of gestation. Postnatal maternal depression was assessed at 3 months using the EPDS and at 1, 2, 3 and 4.5 years using the Beck's Depression Inventory-II. Structural magnetic resonance imaging and diffusion tensor imaging were performed with 4.5-year-old children to extract the volume and fractional anisotropy (FA) values of the amygdala. Our results showed that greater prenatal maternal depressive symptoms were associated with larger right amygdala volume in girls, but not in boys. Increased postnatal maternal depressive symptoms were associated with higher right amygdala FA in the overall sample and girls, but not in boys. These results support the role of variation in right amygdala structure in transmission of maternal depression to the offspring, particularly to girls. The differential effects of prenatal and postnatal maternal depressive symptoms on the volume and FA of the right amygdala suggest the importance of the timing of exposure to maternal depressive symptoms in brain development of girls. This further underscores the need for intervention targeting both prenatal and postnatal maternal depression to girls in preventing adverse child outcomes.
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Affiliation(s)
- D J Wen
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - J S Poh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - S N Ni
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - Y-S Chong
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - H Chen
- KK Women's and Children's Hospital, Singapore, Singapore
| | - K Kwek
- KK Women's and Children's Hospital, Singapore, Singapore
| | - L P Shek
- Department of Pediatrics, Khoo Teck Puat – National University Children's Medical Institute, National University of Singapore, Singapore, Singapore
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Sackler Program for Epigenetics and Psychobiology at McGill University, Montreal, QC, Canada
| | - A Qiu
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Singapore, Singapore
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15
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Wen DJ, Soe NN, Sim LW, Sanmugam S, Kwek K, Chong YS, Gluckman PD, Meaney MJ, Rifkin-Graboi A, Qiu A. Infant frontal EEG asymmetry in relation with postnatal maternal depression and parenting behavior. Transl Psychiatry 2017; 7:e1057. [PMID: 28291259 PMCID: PMC5416671 DOI: 10.1038/tp.2017.28] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 12/18/2022] Open
Abstract
Right frontal electroencephalogram (EEG) asymmetry associates with negative affect and depressed mood, which, among children, are predicted by maternal depression and poor parenting. This study examined associations of maternal depression and maternal sensitivity with infant frontal EEG asymmetry based on 111 mother-6-month-infant dyads. There were no significant effects of postnatal maternal depression or maternal sensitivity, or their interaction, on infant EEG frontal asymmetry. However, in a subsample for which the infant spent at least 50% of his/her day time hours with his/her mother, both lower maternal sensitivity and higher maternal depression predicted greater relative right frontal EEG asymmetry. Our study further showed that greater relative right frontal EEG asymmetry of 6-month-old infants predicted their greater negative emotionality at 12 months of age. Our study suggested that among infants with sufficient postnatal maternal exposure, both maternal sensitivity and mental health are important influences on early brain development.
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Affiliation(s)
- D J Wen
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - N N Soe
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - L W Sim
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - S Sanmugam
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - K Kwek
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Y-S Chong
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Sackler Program for Epigenetics & Psychobiology, McGill University, Montréal, QC, Canada
| | - A Rifkin-Graboi
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - A Qiu
- Department of Biomedical Engineering, Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Singapore, Singapore
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16
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Song LLT, Venkataraman K, Gluckman P, Chong YS, Chee MWL, Khoo CM, Leow MK, Lee YS, Tai ES, Khoo EYH. Smaller size of high metabolic rate organs explains lower resting energy expenditure in Asian-Indian Than Chinese men. Int J Obes (Lond) 2015; 40:633-8. [PMID: 26568151 DOI: 10.1038/ijo.2015.233] [Citation(s) in RCA: 10] [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] [Received: 02/11/2015] [Revised: 07/28/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND In Singapore, the obesity prevalence is disproportionately higher in the Asian-Indians and Malays than the Chinese. Lower resting energy expenditure (REE) may be a contributory factor. OBJECTIVE We explored the association between ethnicity and REE in Chinese, Asian-Indian and Malay men living in Singapore and determined the influence of body composition, mass/volume of high metabolic rate organs, represented by brain volume and trunk fat-free mass (FFM), and physical activity on ethnic differences. DESIGN Two hundred and forty-four men from Singapore (n=100 Chinese, 70 Asian-Indians and 74 Malays), aged 21-40 years and body mass index of 18.5-30.0 kg m(-2), were recruited in this cross-sectional study. REE was assessed by indirect calorimetry and body composition by dual-energy X-ray absorptiometry. Brain volume was measured by magnetic resonance imaging. Physical activity was assessed by the Singapore Prospective Study Program Physical Activity Questionnaire. RESULTS REE was significantly lower in Asian-Indians compared with that in Chinese after adjusting for body weight. FFM (total, trunk and limb) and total fat mass were important predictors of REE across all ethnic groups. Brain volume was positively associated with REE only in Malays. Moderate and vigorous physical activity was positively associated with REE only in Asian-Indians and Malays. The difference in REE between Asian-Indians and Chinese was attenuated but remained statistically significant after adjustment for total FFM (59±20 kcal per day), fat mass (67±20 kcal per day) and brain volume (54±22 kcal per day). The association between REE and ethnicity was no longer statistically significant after total FFM was replaced by trunk FFM (which includes heart, liver, kidney and spleen) but not when it was replaced by limb FFM (skeletal muscle). CONCLUSIONS We have demonstrated a lower REE in Asian-Indians compared with Chinese who may contribute to the higher rates of obesity in the former. This difference could be accounted for by differences in metabolically active organs.
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Affiliation(s)
- L L T Song
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - K Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - P Gluckman
- Singapore Institute for Clinical Sciences, Singapore
| | - Y S Chong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | - M-W L Chee
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - C M Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore.,Division of Endocrinology, National University Health System, Singapore
| | - M-Ks Leow
- Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - E S Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore.,Division of Endocrinology, National University Health System, Singapore
| | - E Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Endocrinology, National University Health System, Singapore
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17
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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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18
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Rifkin-Graboi A, Kong L, Sim LW, Sanmugam S, Broekman BFP, Chen H, Wong E, Kwek K, Saw SM, Chong YS, Gluckman PD, Fortier MV, Pederson D, Meaney MJ, Qiu A. Maternal sensitivity, infant limbic structure volume and functional connectivity: a preliminary study. Transl Psychiatry 2015; 5:e668. [PMID: 26506054 PMCID: PMC4930120 DOI: 10.1038/tp.2015.133] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/02/2015] [Accepted: 07/22/2015] [Indexed: 11/30/2022] Open
Abstract
Mechanisms underlying the profound parental effects on cognitive, emotional and social development in humans remain poorly understood. Studies with nonhuman models suggest variations in parental care affect the limbic system, influential to learning, autobiography and emotional regulation. In some research, nonoptimal care relates to decreases in neurogenesis, although other work suggests early-postnatal social adversity accelerates the maturation of limbic structures associated with emotional learning. We explored whether maternal sensitivity predicts human limbic system development and functional connectivity patterns in a small sample of human infants. When infants were 6 months of age, 20 mother-infant dyads attended a laboratory-based observational session and the infants underwent neuroimaging at the same age. After considering age at imaging, household income and postnatal maternal anxiety, regression analyses demonstrated significant indirect associations between maternal sensitivity and bilateral hippocampal volume at six months, with the majority of associations between sensitivity and the amygdala demonstrating similar indirect, but not significant results. Moreover, functional analyses revealed direct associations between maternal sensitivity and connectivity between the hippocampus and areas important for emotional regulation and socio-emotional functioning. Sensitivity additionally predicted indirect associations between limbic structures and regions related to autobiographical memory. Our volumetric results are consistent with research indicating accelerated limbic development in response to early social adversity, and in combination with our functional results, if replicated in a larger sample, may suggest that subtle, but important, variations in maternal care influence neuroanatomical trajectories important to future cognitive and emotional functioning.
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Affiliation(s)
- A Rifkin-Graboi
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore,Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Brenner Centre for Molecular Medicine 30 Medical Drive, Singapore 117609, Singapore. E-mail:
| | - L Kong
- Department of Biomedical Engineering and Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - L W Sim
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - S Sanmugam
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - B F P Broekman
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - H Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - E Wong
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - K Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - S-M Saw
- Department of Epidemiology, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Y-S Chong
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore,Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - P D Gluckman
- Human Development, Singapore Institute for Clinical Sciences, Singapore, Singapore,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - D Pederson
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - M J Meaney
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore,Department of Neurosciences, Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada,Sackler Program for Epigenetics and Psychobiology, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - A Qiu
- Integrative Neuroscience Program, Singapore Institute for Clinical Sciences, Singapore, Singapore,Department of Biomedical Engineering and Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore,Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA #03-12, Singapore 117576, Singapore. E-mail:
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19
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Tan VMH, Lee YS, Venkataraman K, Khoo EYH, Tai ES, Chong YS, Gluckman P, Leow MKS, Khoo CM. Ethnic differences in insulin sensitivity and beta-cell function among Asian men. Nutr Diabetes 2015; 5:e173. [PMID: 26192451 PMCID: PMC4521178 DOI: 10.1038/nutd.2015.24] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/17/2015] [Accepted: 06/21/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lean Asian Indians are less insulin sensitive compared with Chinese and Malays, but the pancreatic beta-cell function among these ethnic groups has yet to be studied in depth. We aimed to study beta-cell function in relation to insulin sensitivity among individuals of Chinese, Malay and Asian-Indian ethnicity living in Singapore. SUBJECTS AND METHODS This is a sub-group analysis of 59 normoglycemic lean (body mass index (BMI) <23 kg m(-)(2)) adult males (14 Chinese, 21 Malays and 24 Asian Indians) from the Singapore Adults Metabolism Study. Insulin sensitivity was determined using fasting state indices (homeostatic model assessment-insulin resistance), the euglycemic-hyperinsulinemic clamp (ISI-clamp) and a liquid mixed-meal tolerance test (LMMTT) (Matsuda insulin sensitivity index (ISI-Mat)). Beta-cell function was assessed using fasting state indices (homeostatic model assessment-beta-cell function) and from the LMMTT (insulinogenic index and insulin secretion index). The oral disposition index (DI), a measure of beta-cell function relative to insulin sensitivity during the LMMTT, was calculated as a product of ISI-Mat and insulin secretion index. RESULTS Asian Indians had higher waist circumference and percent body fat than Chinese and Malays despite similar BMI. Overall, Asian Indians were the least insulin sensitive whereas the Chinese were most insulin sensitive. Asian Indians had higher beta-cell function compared with Chinese or Malays but these were not statistically different. Malays had the highest incremental area under the curve for glucose during LMMTT compared with Asian Indians and Chinese. However, there were no significant ethnic differences in the incremental insulin area under the curve. The oral DI was the lowest in Malays, followed by Asian Indians and Chinese. CONCLUSION Among lean Asians, Chinese are the most insulin sensitive whereas Asian Indians are the least insulin sensitive. However, Malays demonstrate higher postprandial glucose excursion with lower beta-cell response compare with Chinese or Asian Indians. The paths leading to type 2 diabetes mellitus might differ between these Asian ethnic groups.
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Affiliation(s)
- V M H Tan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Paediatric, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Paediatric, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - K Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - E Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
| | - E S Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Y S Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Liggins Institute, Auckland, New Zealand
| | - M K S Leow
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - C M Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
- Duke-NUS Graduate Medical School, Singapore
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20
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Magiati I, Goh DA, Lim SJ, Gan DZQ, Leong JCL, Allison C, Baron-Cohen S, Rifkin-Graboi A, Broekman BFP, Saw SM, Chong YS, Kwek K, Gluckman PD, Lim SB, Meaney MJ. The psychometric properties of the Quantitative-Checklist for Autism in Toddlers (Q-CHAT) as a measure of autistic traits in a community sample of Singaporean infants and toddlers. Mol Autism 2015; 6:40. [PMID: 26124950 PMCID: PMC4484636 DOI: 10.1186/s13229-015-0032-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 11/05/2014] [Accepted: 06/03/2015] [Indexed: 12/27/2022] Open
Abstract
Background There is growing research evidence that subclinical autistic traits are elevated in relatives of individuals with autism spectrum disorder (ASD), continuously distributed in the general population and likely to share common etiology with ASD. A number of measures have been developed to assess autistic traits quantitatively in unselected samples. So far, the Quantitative-Checklist for Autism in Toddlers (Q-CHAT) is one of very few measures developed for use with toddlers as young as 18 months, but little is known about its measurement properties and factor structure. Methods The present study examined internal consistency, factor structure, test-retest stability, and convergent validity of the Q-CHAT in a sample of toddlers in Singapore whose caregivers completed the Q-CHAT at 18 (n = 368) and 24 months (n = 396). Results Three factors were derived accounting for 38.1 % of the variance: social/communication traits, non-social/behavioral traits, and a speech/language factor. Internal consistency was suboptimal for the total and speech/language scores, but acceptable for the social/communication and non-social/behavioral factor scores. Scores were generally stable between 18 and 24 months. Convergent validity was found with the Pervasive Developmental Disorders subscale of the Child Behavior Checklist (CBCL) completed by caregivers when their children were 24 months. Q-CHAT total scores in this sample were higher than those reported in other unselected samples from the UK. Conclusions The Q-CHAT was found to have a three-factor structure, acceptable internal consistency for its two main factor scores (social/communication and non-social/behavioral), normally distributed scores in an unselected sample, and similar structure and measurement properties as those reported in other published studies. Findings are discussed in relation to existing literature and future directions for the validation of the Q-CHAT.
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Affiliation(s)
- I Magiati
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - D A Goh
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - S J Lim
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - D Z Q Gan
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - J C L Leong
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - C Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A Rifkin-Graboi
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore
| | - B F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore ; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - S-M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - 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, National University Health System, Singapore, Singapore
| | - K Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - 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
| | - S B Lim
- Department of Child Development, KK Women's and Children's Hospital, Singapore, Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore ; Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Verdun, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
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Qiu A, Anh TT, Li Y, Chen H, Rifkin-Graboi A, Broekman BFP, Kwek K, Saw SM, Chong YS, Gluckman PD, Fortier MV, Meaney MJ. Prenatal maternal depression alters amygdala functional connectivity in 6-month-old infants. Transl Psychiatry 2015; 5:e508. [PMID: 25689569 PMCID: PMC4445753 DOI: 10.1038/tp.2015.3] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/25/2014] [Accepted: 12/19/2014] [Indexed: 12/12/2022] Open
Abstract
Prenatal maternal depression is associated with alterations in the neonatal amygdala microstructure, shedding light on the timing for the influence of prenatal maternal depression on the brain structure of the offspring. This study aimed to examine the association between prenatal maternal depressive symptomatology and infant amygdala functional connectivity and to thus establish the neural functional basis for the transgenerational transmission of vulnerability for affective disorders during prenatal development. Twenty-four infants were included in this study with both structural magnetic resonance imaging (MRI) and resting-state functional MRI (fMRI) at 6 months of age. Maternal depression was assessed at 26 weeks of gestation and 3 months after delivery using the Edinburgh Postnatal Depression Scale. Linear regression was used to identify the amygdala functional networks and to examine the associations between prenatal maternal depressive symptoms and amygdala functional connectivity. Our results showed that at 6 months of age, the amygdala is functionally connected to widespread brain regions, forming the emotional regulation, sensory and perceptual, and emotional memory networks. After controlling for postnatal maternal depressive symptoms, infants born to mothers with higher prenatal maternal depressive symptoms showed greater functional connectivity of the amygdala with the left temporal cortex and insula, as well as the bilateral anterior cingulate, medial orbitofrontal and ventromedial prefrontal cortices, which are largely consistent with patterns of connectivity observed in adolescents and adults with major depressive disorder. Our study provides novel evidence that prenatal maternal depressive symptomatology alters the amygdala's functional connectivity in early postnatal life, which reveals that the neuroimaging correlates of the familial transmission of phenotypes associated with maternal mood are apparent in infants at 6 months of age.
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Affiliation(s)
- A Qiu
- Department of Biomedical Engineering and Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore,Singapore Institute for Clinical Sciences, Singapore, Singapore,Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA #03-12, Singapore 117576, Singapore. E-mail:
| | - T T Anh
- Department of Biomedical Engineering and Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - Y Li
- Department of Biomedical Engineering and Clinical Imaging Research Center, National University of Singapore, Singapore, Singapore
| | - H Chen
- KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - A Rifkin-Graboi
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - B F P Broekman
- Singapore Institute for Clinical Sciences, Singapore, Singapore,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - K Kwek
- KK Women's and Children's Hospital, Duke-National University of Singapore, Singapore, Singapore
| | - S-M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Y-S Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, Singapore, Singapore,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada,Sackler Program for Epigenetics and Psychobiology, McGill University, Montreal, QC, Canada
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Chen M, Zhang Y, Yu VC, Chong YS, Yoshioka T, Ge R. Isthmin targets cell-surface GRP78 and triggers apoptosis via induction of mitochondrial dysfunction. Cell Death Differ 2014; 21:797-810. [PMID: 24464222 PMCID: PMC3978310 DOI: 10.1038/cdd.2014.3] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 12/15/2013] [Accepted: 12/23/2013] [Indexed: 12/31/2022] Open
Abstract
Isthmin (ISM) is a secreted 60-kDa protein that potently induces endothelial cell (EC) apoptosis. It suppresses tumor growth and angiogenesis in mice when stably overexpressed in cancer cells. Although αvβ5 integrin serves as a low-affinity receptor for ISM, the mechanism by which ISM mediates antiangiogenesis and apoptosis in ECs remain to be fully resolved. In this work, we report the identification of cell-surface glucose-regulated protein 78 kDa (GRP78) as a high-affinity receptor for ISM (Kd=8.6 nM). We demonstrated that ISM-GRP78 interaction triggers apoptosis not only in activated ECs but also in cancer cells expressing high level of cell-surface GRP78. Normal cells and benign tumor cells tend to express low level of cell-surface GRP78 and are resistant to ISM-induced apoptosis. Upon binding to GRP78, ISM is internalized into ECs through clathrin-dependent endocytosis that is essential for its proapoptotic activity. Once inside the cell, ISM co-targets with GRP78 to mitochondria where it interacts with ADP/ATP carriers on the inner membrane and blocks ATP transport from mitochondria to cytosol, thereby causing apoptosis. Hence, ISM is a novel proapoptotic ligand that targets cell-surface GRP78 to trigger apoptosis by inducing mitochondrial dysfunction. The restricted and high-level expression of cell-surface GRP78 on cancer cells and cancer ECs make them uniquely susceptible to ISM-targeted apoptosis. Indeed, systemic delivery of recombinant ISM potently suppressed subcutaneous 4T1 breast carcinoma and B16 melanoma growth in mice by eliciting apoptosis selectively in the cancer cells and cancer ECs. Together, this work reveals a novel ISM-GRP78 apoptosis pathway and demonstrates the potential of ISM as a cancer-specific and dual-targeting anticancer agent.
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Affiliation(s)
- M Chen
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Y Zhang
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - V C Yu
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Y-S Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - T Yoshioka
- Department of Molecular Pathology and Tumor Pathology, Akita University Graduate School of Medicine, Akita, Japan
| | - R Ge
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
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Yang PLS, Lu Y, Khoo CM, Leow MKS, Khoo EYH, Teo A, Lee YS, Das De S, Chong YS, Gluckman PD, Tai ES, Venkataraman K, Ng CMA. Associations between ethnicity, body composition, and bone mineral density in a Southeast Asian population. J Clin Endocrinol Metab 2013; 98:4516-23. [PMID: 24037892 DOI: 10.1210/jc.2013-2454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVE Chinese men in Singapore have a higher incidence of hip fractures than Malay and Indian men. We investigated whether there were corresponding ethnic differences in peak bone mineral density (BMD) in young men and whether differences in body composition influenced peak BMD. DESIGN AND SETTING This was a cross-sectional study of healthy volunteers in a tertiary medical center. PARTICIPANTS A total of 100 Chinese, 82 Malay, and 80 Indian men aged 21 to 40 years, with body mass index between 18 and 30 kg/m(2) underwent dual-energy x-ray absorptiometry to assess BMD, lean mass (LM) and fat mass (FM), and magnetic resonance imaging to quantify abdominal subcutaneous and visceral adipose tissue. Multiple linear regression models, with adjustment for age and height (as a proxy for skeletal size), were used. RESULTS Malay and Indian men had significantly higher BMD than Chinese men at the lumbar spine (Malay: B, 0.06 ± 0.02, P = .001; Indian: B, 0.03 ± 0.02, P = .049), femoral neck (Malay: B 0.04 ± 0.02, P = .034; Indian: B, 0.04 ± 0.02, P = .041), hip (Malay: B, 0.05 ± 0.02, P = .016; Indian: B, 0.06 ± 0.02, P = .001), and ultradistal radius (Malay: B, 0.03 ± 0.01, P < .001; Indian: B, 0.02 ± 0.01, P = .029), and this difference was retained after adjustment for LM and FM, except in Malay men at the femoral neck and in Indian men at the ultradistal radius. LM was an important independent determinant of BMD at all sites, whereas FM, subcutaneous adipose tissue, and visceral adipose tissue were not significantly associated with BMD at any site. CONCLUSIONS Lower peak BMD in Chinese men may partly explain the higher fracture incidence in this ethnic group. Further studies are needed to elucidate the reasons for these ethnic differences in bone accumulation.
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Affiliation(s)
- P L S Yang
- The Endocrine Clinic, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, No. 17-08, Singapore 228510.
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Qiu A, Rifkin-Graboi A, Chen H, Chong YS, Kwek K, Gluckman PD, Fortier MV, Meaney MJ. Maternal anxiety and infants' hippocampal development: timing matters. Transl Psychiatry 2013; 3:e306. [PMID: 24064710 PMCID: PMC3784768 DOI: 10.1038/tp.2013.79] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/06/2013] [Accepted: 08/12/2013] [Indexed: 01/28/2023] Open
Abstract
Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety.
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Affiliation(s)
- A Qiu
- Department of Bioengineering, National University of Singapore, Singapore,Clinical Imaging Research Centre, National University of Singapore, Singapore,Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore,Department of Bioengineering, National University of Singapore, 9 Engineering Drive 1, Block EA #03-12, Singapore 117576, Singapore. E-mail:
| | - A Rifkin-Graboi
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore
| | - H Chen
- KK Women's and Children's Hospital (KKH), Singapore
| | - Y-S Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - K Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - P D Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - M V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital (KKH), Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research, Singapore,Departments of Psychiatry and Neurology & Neurosurgery, McGill University, Montreal, Canada
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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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Raj JM, K K, M NM, A R MZ, B B, Chong YS, Sachithanandan A. Coronary artery bypass surgery in a patient with asymptomatic brugada syndrome. Med J Malaysia 2013; 68:171-172. [PMID: 23629569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- J M Raj
- Hospital Serdang, Cardiothoracic Surgery, Jalan Puchong, Kajang , Selangor 43000, Malaysia.
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Teo AE, Ng AC, Venkataraman K, Tai ES, Lee YS, Khoo EY, Khoo CM, Sadananthan SA, Velan SS, Zagorodnov V, Chong YS, Gluckman P, Leow MK. Ethnic differences in the association of fat and lean mass with bone mineral density in the Singapore population. BMC Proc 2012. [PMCID: PMC3426076 DOI: 10.1186/1753-6561-6-s4-p43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Tan TC, Yan SY, Chua TM, Biswas A, Chong YS. A randomised controlled trial of low-dose misoprostol and dinoprostone vaginal pessaries for cervical priming. BJOG 2010; 117:1270-7. [PMID: 20722643 DOI: 10.1111/j.1471-0528.2010.02602.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We studied the efficacy of 25-microg misoprostol pessaries as either single or double dose compared with a 3-mg dinoprostone pessary for cervical priming. DESIGN AND SETTING A randomised controlled trial in Singapore. POPULATION One hundred and seventy-one women with term pregnancies and modified Bishop scores (mBS) < or =6 from 2003 to 2004. METHOD Patients were randomised to single misoprostol dose, double misoprostol dose or the current dinoprostone regimen. MAIN OUTCOME MEASURES Primary outcome was number of women who achieved favourable mBS >6 or active labour by day 2. Secondary outcomes were time interval from insertion to delivery, cardiotocographic abnormalities, delivery and neonatal outcome. RESULTS More women in the misoprostol double-dose group (96.6%) and dinoprostone group (93%) achieved the primary outcome compared with the single-dose group (77.8%) (P = 0.003 and P = 0.03, respectively). There was no difference in secondary outcomes. More multiparous women achieve primary outcome compared with nulliparous women (odds ratio 0.21, 95% confidence interval 0.06-0.77). CONCLUSION Double-dose misoprostol 25 microg is as effective as dinoprostone 3 mg inserts for cervical priming; both are more efficacious than a single-dose misoprostol pessary. Parity prognosticates the success of induction.
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Affiliation(s)
- T-C Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, University Hospital, Singapore
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Su LL, Rauff M, Chan YH, Mohamad Suphan N, Lau TP, Biswas A, Chong YS. Carbetocin versus syntometrine for the third stage of labour following vaginal delivery-a double-blind randomised controlled trial. BJOG 2009; 116:1461-6. [DOI: 10.1111/j.1471-0528.2009.02226.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhou YY, Lee LY, Ng SY, Hia CPP, Low KT, Chong YS, Goh DLM. UGT1A1 haplotype mutation among Asians in Singapore. Neonatology 2009; 96:150-5. [PMID: 19325249 DOI: 10.1159/000209851] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [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: 02/04/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND The uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) enzyme is responsible for conjugation of the bilirubin in the liver as well as for drug metabolism. Some of the polymorphisms have been associated with an increased risk of neonatal hyperbilirubinemia which may explain the increased incidence of jaundice in an Asian population as well as exaggerated irinotecan-induced leukopenia. OBJECTIVE The local Asian incidence of hypomorphic haplotypes, defined as gene mutations known to have a reduced function, has not been described. Clinical correlation between the mutations and the need for phototherapy for hyperbilirubinemia was carried out. METHODS A cohort of 241 consecutive term infants delivered in the National University Hospital, Singapore, was recruited with parental consent. Cord blood was collected, and the promoter and coding regions of the UGT1A1 gene were sequenced. RESULTS Six known haplotypes and 2 novel haplotypes were identified: 1 wild type, 5 with reduced function, while the 2 novel ones were predicted to have decreased function. The frequency of these hypomorphic haplotypes was high. Among the 241 infants screened, 35% had 1 hypomorphic haplotype and 12% had 2 hypomorphic haplotypes. The frequency was also different among ethnic groups, with 48% Chinese, 64% Indian and 31% Malay infants having at least 1 hypomorphic haplotype (chi(2) test, p < 0.05). There was a trend seen between the number of G71R mutations and the need for phototherapy (chi2 test for trend, p < 0.05). CONCLUSIONS The local Asian incidence of hypomorphic haplotypes was high and there was a trend between the number of G71R mutations and the need for phototherapy. The G71R mutation may account for the increased incidence of neonatal jaundice seen in Asian populations.
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Affiliation(s)
- Y Y Zhou
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University, Singapore, 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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Mattar CN, Fok D, Chong YS. Common concerns regarding breastfeeding in a family practice setting. Singapore Med J 2008; 49:272-279. [PMID: 18418517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- C N Mattar
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Abstract
BACKGROUND Postpartum haemorrhage (PPH) is one of the major contributors to maternal mortality and morbidity worldwide. Active management of the third stage of labour has been proven to be effective in the prevention of PPH. Syntometrine is more effective than oxytocin but is associated with more side-effects. Carbetocin, a long-acting oxytocin agonist appears to be a promising agent for the prevention of PPH. OBJECTIVES To determine if the use of oxytocin agonist is as effective as conventional uterotonic agents for the prevention of PPH, and assess the best routes of administration and optimal doses of oxytocin agonist. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 2), MEDLINE (1966 to June 2006) and EMBASE (1974 to June 2006). We checked references of articles and communicated with authors and pharmaceutical industry. SELECTION CRITERIA Randomised controlled trials which compared oxytocin agonist (carbetocin) with other uterotonic agents or with placebo or no treatment for the prevention of PPH. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality. MAIN RESULTS Four studies (1037 women) were included in the review (three studies on caesarean delivery and one on vaginal delivery). The risk of PPH was similar in both oxytocin and carbetocin arms for participants who underwent caesarean delivery as well as participants, with risk factor(s) for PPH, who underwent vaginal delivery. Use of carbetocin resulted in a statistically significant reduction in the need for therapeutic uterotonic agent (relative risk (RR) 0.44, 95% confidence interval (CI) 0.25 to 0.78) compared to oxytocin for those who underwent caesarean section, but not for vaginal delivery. Carbetocin is also associated with a reduced need for uterine massage in both caesarean and vaginal deliveries (RR 0.38, 95% CI 0.18 to 0.80; RR 0.70, 95% CI 0.51 to 0.94) respectively. However, this outcome measure was only documented in one study on caesarean delivery and in the only study on vaginal delivery. Pooled data from the trials did not reveal any statistically significant differences in terms of the adverse effects between carbetocin and oxytocin. AUTHORS' CONCLUSIONS There is insufficient evidence that 100 micrograms of intravenous carbetocin is as effective as oxytocin to prevent PPH. In comparison to oxytocin, carbetocin was associated with reduced need for additional uterotonic agents, and uterine massage. There was limited comparative evidence on adverse events.
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Affiliation(s)
- L L Su
- National University Hospital, Department of Obstetrics and Gynaecology, 5 Lower Kent Ridge Road, Singapore, Singapore, 119074.
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Srilatha B, Adaikan PG, Chong YS. Relevance of oestradiol-testosterone balance in erectile dysfunction patients' prognosis. Singapore Med J 2007; 48:114-8. [PMID: 17304389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The ageing process in man is accompanied by a number of endocrine changes including decline in testosterone (T), physiological imbalance between androgen and oestradiol (E2) and changes in the E2-T ratio. In this study, hormone profile data from a group of erectile dysfunction (ED) patients were reviewed to evaluate its impact on ED, with emphasis on oestradiol derangement. METHODS 30 ED patient case notes with a record of hormone profiles were retrospectively reviewed. Laboratory investigation included levels of total testosterone, total oestradiol, prolactin, luteinising and follicle stimulating hormones, in addition to lipid profile and glucose, based on specific history. These patients were divided into two groups based on the history of presence (Group A) or absence (Group B) of adequate sexual desire. RESULTS In Group B patients, the E2-T derangement with increasing age was statistically significant with lower serum T level (2.6 ng/ml; range, 1.6-3.7 ng/ml) and elevated E2 level (60 pg/ml; range, 40-120 pg/ml). CONCLUSION In this preliminary report, although low total testosterone level is seen together with impaired libido and erectile impairment, the accompanying significant increase in E2 indicates the possible role for oestrogen in causation and/or persistence of ED in this group of patients.
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Affiliation(s)
- B Srilatha
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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Su LL, Chong YS. Common modalities for routine antepartum foetal monitoring: are they evidence-based? Singapore Med J 2006; 47:830-5; quiz 836. [PMID: 16990956] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Antepartum foetal monitoring is crucial for the detection of foetuses at risk so that timely intervention can improve the perinatal outcome. The evidence underlying the most common modalities of antepartum foetal monitoring used are appraised and presented in this article. Foetal movement chart should be used in high-risk pregnancies but not recommended routinely in low-risk pregnancies. Symphysis-fundal height measurement, being associated with low cost and ease of use, is a reasonable screening tool for foetal well-being. Third trimester ultrasonography is, thus far, the best modality available for the assessment of foetal growth, and can be used until a better modality for foetal growth assessment becomes available. Antepartum cardiotocography can be used to monitor foetal well-being in normal pregnancies beyond the estimated date of delivery but it probably serves little purpose prior to that. Well-designed controlled studies evaluating modalities for antepartum foetal monitoring are generally lacking. With the advance of medical science, more research should be focused on this aspect of obstetric care so that our practice can become more evidence-based.
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Affiliation(s)
- L L Su
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074. su_lin_lin@ hotmail.com
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Chee CYI, Lee DTS, Chong YS, Tan LK, Ng TP, Fones CSL. Confinement and other psychosocial factors in perinatal depression: a transcultural study in Singapore. J Affect Disord 2005; 89:157-66. [PMID: 16257451 DOI: 10.1016/j.jad.2005.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 09/16/2005] [Accepted: 09/16/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND To investigate the prevalence, socio-cultural and psychosocial risk factors for perinatal depression in Singaporean women. METHOD A prospective cohort of 559 women was interviewed antenatally and at six weeks' postpartum at a tertiary hospital. Women were interviewed for diagnosis of depression using a two-stage design, with a screening questionnaire and diagnostic interview. RESULTS Postnatally, a negative confinement experience was associated with depression. Other independent factors included poor emotional support, a past history of depression, unplanned pregnancy and perceived potential conflicts with relatives over childcare antenatally and dissatisfaction, poor instrumental support postnatally. The prevalence of depression antenatally and postnatally was 12.2% and 6.8%, respectively. LIMITATIONS Measures of satisfaction with social support were based on self-report; there were high dropout rates at six weeks' postpartum; and other modulating social factors such as pre-existing interpersonal conflicts were not studied. CONCLUSIONS Perinatal depression in Singaporean women is common. Contrary to expectations, a negative 'confinement' experience is a significant risk factor for postnatal depression, and is not universally welcomed by women. Depression is modulated by dissimilar sets of psychosocial factors antenatally and postnatally.
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Affiliation(s)
- Cornelia Y I Chee
- Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
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Amin Z, Chong YS, Khoo HE. Towards better practices in medical student assessment. Ann Acad Med Singap 2005; 34:471-2. [PMID: 16205822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Z Amin
- Medical Education Unit, Yong Loo Lin School of Medicine, National University of Singapore, #01-08 Clinical Research Centre, 10 Medical Drive, Singapore 117597.
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Su LL, Chong YS, Chan ESY, Samuel M. Oxytocin agonists for preventing postpartum haemorrhage. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tan G, Chong YS, Biswas A. Caesarean scar pregnancy: a diagnosis to consider carefully in patients with risk factors. Ann Acad Med Singap 2005; 34:216-9. [PMID: 15827671] [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: 05/02/2023]
Abstract
INTRODUCTION Caesarean scar pregnancy is rare. A high index of suspicion is necessary to make the right diagnosis early. CLINICAL PICTURE Two women, each with a history of 1 previous caesarean delivery, were initially diagnosed with spontaneous abortion in progress when ultrasonography scan revealed the gestational sac to be in the lower uterine cavity. Subsequent ultrasound scans showed that the gestational sac was actually in the anterior uterine wall at the level of the uterine isthmus. TREATMENT Both women were managed successfully with intrasac methotrexate injection. OUTCOME We report 2 cases of caesarean scar pregnancies mistaken for spontaneous abortions by experienced ultrasonographers. CONCLUSION This highlights the difficulty in differentiating between these 2 diagnoses and the importance of having a high index of suspicion in women with risk factors.
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Affiliation(s)
- G Tan
- Department of Obstetrics and Gynaecology, National University of Hospital, Singapore.
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Chee CY, Chong YS, Lee DTS, Ng TP, Tan JLK, Fones CSL. Perinatal depressive disorders in Singaporean women and their partners. Ann Acad Med Singap 2004; 33:S38-9. [PMID: 15651199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- C Y Chee
- Department of Psychological Medicine, National UniversitY Hospital, Singapore
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Ng SCY, Chong YS, Rauff M, Myo ZM, Nurfarah C, Deurenberg PRM. The influence of breast feeding compared to formula feeding on infant adiposity. Ann Acad Med Singap 2004; 33:S75. [PMID: 15651220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- S C Y Ng
- Department of Neonatology, Children's Medical Institute, National University Hospital, Singapore
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Abstract
[reaction--see text] Diimide 1 and octaimide 2 both adopt two stable conformations at room temperature as a result of restricted rotation about two C(aryl)-N(imide) single bonds, a compact "folded" and an open "unfolded" structure. Predictable ratios of folded and unfolded rotamers can be achieved by heating in solvents of appropriate polarity as measured by the Reichardt's parameter (E(T30)). On cooling to room temperature, the resulting conformational changes are "locked in" as restricted rotation is reestablished.
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Affiliation(s)
- D S Choi
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina 29208, USA
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Affiliation(s)
- Y S Chong
- University of South Carolina Department of Chemistry and Biochemistry Columbia, South Carolina 29208, USA
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Chong YS, Chua S, El-Refaey H, Choo WL, Chanrachakul B, Tai BC, Rodeck C, Arulkumaran S. Postpartum intrauterine pressure studies of the uterotonic effect of oral misoprostol and intramuscular syntometrine. BJOG 2001; 108:41-7. [PMID: 11213003 DOI: 10.1111/j.1471-0528.2001.00014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the effect of oral misoprostol in dosages varying from 200 microg to 800 microg on postpartum uterine contractility and to establish their side effects. DESIGN A prospective descriptive study. PARTICIPANTS Fifty-seven women who delivered vaginally after spontaneous labours not requiring augmentation. METHODS Within 5 minutes of delivery of the placenta, a calibrated Gaeltec catheter with an intrauterine pressure transducer at its tip was inserted transcervically into the uterine cavity. Cumulative uterine activity was recorded for 30 minutes in each woman before administering the oral misoprostol tablets and continued for a further 90 minutes after its administration. Thus each woman acted as her own control regarding changes in uterine contractility. Uterine activity was recorded on a Sonicaid Meridian fetal monitor, which measures active contraction area automatically. The incidence of side effects was also recorded. RESULTS There was no statistical difference (P = 0.887) in the adjusted mean difference in cumulative uterine activity following all the doses of oral misoprostol, compared with intramuscular syntometrine, the largest difference being seen in oral misoprostol 200 microg (adjusted mean difference -2282 kPas s, 95% CI -7954 to 3390 kPas s). The mean onset of action of oral misoprostol (6.1, SD 2.1 min) was significantly slower than that of intramuscular syntometrine (3.2, SD 1.5 min; P = 0.002), but their durations of action were similar (P = 0.637). In the misoprostol group the commonest side effects were shivering (36%) and a rise in body temperature above 38 degrees C (40%). In the syntometrine group, the most commonly observed side effect was moderate uterine pain (nine out of ten women) and a rise in diastolic blood pressure of 20 mmHg (two out of ten women). CONCLUSION The results of this study show that oral misoprostol has a definite uterotonic effect on the postpartum uterus. At doses of 200 microg to 400 microg, oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with significantly more side effects.
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Affiliation(s)
- Y S Chong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
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Choo WL, Chua S, Chong YS, Vanaja K, Oei PL, Ho LM, Roy AC, Arulkumaran S. Correlation of change in uterine activity to blood loss in the third stage of labour. Gynecol Obstet Invest 2000; 46:178-80. [PMID: 9736799 DOI: 10.1159/000010028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In 47 women, the change in the uterine activity after the administration of a uterotonic agent was correlated with the amount of blood loss during the same period of time. Uterine activity was measured by a Gaeltec catheter-tipped pressure transducer inserted transcervically within 5 min of delivery of the placenta. A uterotonic agent (either intravenous syntocinon, intramuscular syntometrine or oral misoprostol) was given after the insertion of the intrauterine pressure catheter and pressure recorded for another 90 min. Blood loss over the same 2-hour period was collected with absorbent paper which was then assessed by colorimetric measurement of the haemoglobin content in the sample. Our results show that the change in uterine activity is associated with the total blood loss. However, there is a poor linear correlation between the two variables probably because of the biological variation in myometrial activity and differences in coagulation mechanisms in normal women.
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Affiliation(s)
- W L Choo
- Department of Obstetrics and Gynaecology, National University of Singapore National University Hospital, Singapore
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Abstract
OBJECTIVE To determine whether there is a difference in peripheral vascular reactivity between normal women and those with pregnancy-induced hypertension. METHODS Capillary blood flow (flux) was recorded in the skin over the ankle in 26 pregnant women with pregnancy-induced hypertension at term. Twelve of these women had proteinuria, and 14 were nonproteinuric. Leg lowering was used to activate the venoarteriolar reflex, and the resultant change in flux, expressed as a percentage change from the baseline, was used as an index of vascular reactivity. The results were compared with those of a control group comprising 23 matched normotensive women. The study was repeated on all of the women after delivery. RESULTS Women with hypertension showed a median (range) increase in flux of +24.4% (-15.5% to +151.1%), significantly different from controls: -39.3% (-80.9% to -4.3%, P <.001). This difference persisted regardless of the presence or absence of proteinuria. Responses in women with pregnancy-induced hypertension were significantly different after delivery (median -60.7%; range -158.5% to -19.5%, P <.001) when compared with predelivery responses. Similar changes as a result of delivery were seen in women with proteinuric (medians +25.9% and -57. 9%, P <.002) and nonproteinuric (medians +7.8% and -62.8%, P <.001) hypertension but not in controls. Postdelivery responses in women with hypertension were no different from those of controls. CONCLUSION Women with pregnancy-induced hypertension have abnormal cutaneous vascular reactivity that returns to normal after delivery.
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Affiliation(s)
- L C Foong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.
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Affiliation(s)
- Y S Chong
- Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital, Singapore
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Abstract
Sulprostone, a synthetic prostaglandin with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case in which a bolus intravenous injection of sulprostone 30 micrograms was administered to treat postpartum haemorrhage during caesarean section. The 38-year-old patient with no previous cardiac or smoking history developed complete heart block, ventricular fibrillation and subsequent asystole. Cardiopulmonary resuscitation was successful after 45 minutes. Post resuscitation there was no myocardial infarction and she had complete neurological recovery. We postulate that the bolus of sulprostone resulted in possible coronary spasm that resulted in cardiac arrest.
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Affiliation(s)
- F G Chen
- Department of Anaesthesia, National University of Singapore
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Chua S, Lee M, Vanaja K, Chong YS, Nordstrom L, Arulkumaran S. The reliability of catheter-tip transducers for the measurement of intrauterine pressure in the third stage of labour. Br J Obstet Gynaecol 1998; 105:352-6. [PMID: 9532999 DOI: 10.1111/j.1471-0528.1998.tb10099.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to assess the reliability of intrauterine pressure measurements in the third stage of labour, catheter-tip transducers were used in 20 women randomly allocated into two groups of 10. In each case in the first group two catheters were tied together and introduced transcervically into the uterine cavity after delivery of the placenta. In each case in the second group two catheters were inserted independently into the same uterine cavity. The active and cumulative active pressures recorded from the pairs of catheters within each uterine cavity were compared. Comparison of individual active pressure readings from separate transducers revealed good agreement whether the catheters were tied together or were separate. Cumulative active pressure was very similar when assessed by each catheter in the same uterus. Intrauterine catheter-tip transducers can be used reliably to measure uterine activity in the third stage of labour although there may be minor contraction by contraction differences in recordings of individual active pressures.
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Affiliation(s)
- S Chua
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
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Affiliation(s)
- Y S Chong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
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