Britt W. Jensen

Change in Overweight from Childhood to Early Adulthood and Risk of Type 2 Diabetes

BACKGROUND Childhood overweight is associated with an increased risk of type 2 diabetes in adulthood. We investigated whether remission of overweight before early adulthood reduces this risk. METHODS We conducted a study involving 62,565 Danish men whose weights and heights had been measured at 7 and 13 years of age and in early adulthood (17 to 26 years of age). Overweight was defined in accordance with Centers for Disease Control and Prevention criteria. Data on type 2 diabetes status (at age ≥30 years, 6710 persons) were obtained from a national health registry. RESULTS Overweight at 7 years of age (3373 of 62,565 men; 5.4%), 13 years of age (3418 of 62,565; 5.5%), or early adulthood (5108 of 62,565; 8.2%) was positively associated with the risk of type 2 diabetes; associations were stronger at older ages at overweight and at younger ages at diagnosis of type 2 diabetes. Men who had had remission of overweight before the age of 13 years had a risk of having type 2 diabetes diagnosed at 30 to 60 years of age that was similar to that among men who had never been overweight (hazard ratio, 0.96; 95% confidence interval [CI], 0.75 to 1.21). As compared with men who had never been overweight, men who had been overweight at 7 and 13 years of age but not during early adulthood had a higher risk of type 2 diabetes (hazard ratio, 1.47; 95% CI, 1.10 to 1.98), but their risk was lower than that among men with persistent overweight (hazard ratio [persistently overweight vs. never overweight], 4.14; 95% CI, 3.57 to 4.79). An increase in body‐mass index between 7 years of age and early adulthood was associated with an increased risk of type 2 diabetes, even among men whose weight had been normal at 7 years of age. CONCLUSIONS Childhood overweight at 7 years of age was associated with increased risks of adult type 2 diabetes only if it continued until puberty or later ages. (Funded by the European Union.)

Associations between birth weight and colon and rectal cancer risk in adulthood

Highlights • High birth weight is associated with an increased risk of adult colon cancer.• High birth weight is associated with a decreased risk of adult rectal cancer.• Colon and rectal cancer should investigated as two separate entities in investigations of the early life origins of disease as they may arise through different biological mechanisms.

Intervention effects on dietary intake among children by maternal education level: results of the Copenhagen School Child Intervention Study (CoSCIS).

Dietary intake among Danish children, in general, does not comply with the official recommendations. The objectives of the present study were to evaluate the 3-year effect of a multi-component school-based intervention on nutrient intake in children, and to examine whether an intervention effect depended on maternal education level. A total of 307 children (intervention group: n 184; comparison group: n 123) were included in the present study. All had information on dietary intake pre- and post-intervention (mean age 6·8 and 9·5 years for intervention and comparison groups, respectively) assessed by a 7-d food record. Analyses were conducted based on the daily intake of macronutrients (energy percentage (E%)), fatty acids (E%), added sugar (E%) and dietary fibre (g/d and g/MJ). Analyses were stratified by maternal education level into three categories. Changes in nutrient intake were observed in the intervention group, mainly among children of mothers with a short education ( < 10 years). Here, intake of dietary fibre increased (β = 2·1 g/d, 95 % CI 0·5, 3·6, P= 0·01). Intake of protein tended to increase (β = 0·6 E%, 95 % CI -0·01, 1·2, P= 0·05), while intake of fat (β = -1·7 E%, 95 % CI -3·8, 0·3, P= 0·09) and SFA (β = -0·9, 95 % CI -2·0, 0·2, P= 0·10) tended to decrease. Also, a significant intervention effect was observed on the intake of SFA among children of mothers with a long education (β = -0·8, 95 % CI -1·5, -0·03, P= 0·04). This multi-component school-based intervention resulted in changes in the dietary intake, particularly among children of mothers with a short education. As the dietary intake of this subgroup generally differs most from the recommendations, the results of the present study are particularly encouraging.

Childhood body mass index and height in relation to site-specific risks of colorectal cancers in adult life

As colorectal cancers have a long latency period, their origins may lie early in life. Therefore childhood body mass index (BMI; kg/m2) and height may be associated with adult colorectal cancer. Using a cohort design, 257,623 children from The Copenhagen School Health Records Register born from 1930 to 1972 with measured heights and weights at ages 7 to 13xa0years were followed for adult colon and rectal adenocarcinomas by linkage to the Danish Cancer Registry. Hazard ratios (HRs) with 95% confidence intervals (CI) were estimated by Cox proportional hazard regressions. During follow-up, 2676 colon and 1681 rectal adenocarcinomas were diagnosed. No sex differences were observed in the associations between child BMI or height and adult colon or rectal cancers. Childhood BMI and height were positively associated with colon cancer; at age 13xa0years the HRs were 1.09 (95% CI 1.04–1.14) and 1.14 (95% CI 1.09–1.19) per z-score, respectively. Children who were persistently taller or heavier than average, had increased risk of colon cancer. Similarly, growing taller or gaining more weight than average was positively associated with colon cancer. No associations were observed between BMI or height and rectal cancer. Childhood BMI and height, along with above average change during childhood are significantly and positively associated with adult colon cancers, but not with rectal cancer, suggesting different etiologies.

Change in weight status from childhood to early adulthood and late adulthood risk of colon cancer in men: a population-based cohort study

BackgroundAlthough weight gain in mid- to late adult life is associated with an increased risk of colon cancer, it is unclear if increases or losses in weight from childhood to early adulthood are differentially associated with risks of adult colon cancer.MethodsWeight and height were measured at 7 or 13 years and in early adulthood (17–26 years) in 64,675xa0boys in the Copenhagen School Health Records Register and the Danish Conscription Database. Cases of colon cancer (nu2009=u2009751) were identified in the Danish Cancer Registry. Boys and young men were categorized as normal weight or overweight. Associations between changes in weight and colon cancer were examined using Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsCompared with men with a normal weight at 7 years and in early adulthood, men with overweight at both ages had an increased risk of adult colon cancer (HR: 2.73, 95% CI 1.80–4.15). In contrast, men with overweight at 7 years, but not in early adulthood did not have an increased risk of colon cancer (HR: 0.73, 95% CI 0.35–1.54), nor did men with a normal weight at 7 years and overweight in early adulthood (HR: 1.28, 95% CI 0.96–1.70). Similar results were observed for weight status at age 13 years combined with early adulthood.ConclusionsChildhood overweight that persists into early adulthood is associated with an increased risk of colon cancer, whereas overweight that disappears before early adulthood or developed after childhood is not.

Height at Ages 7–13 Years in Relation to Developing Type 2 Diabetes Throughout Adult Life

BACKGROUNDnShort adults have an increased risk of type 2 diabetes. Although adult height results from childhood growth, the effects of height and growth trajectories during childhood are sparsely investigated. We investigated sex-specific associations between childhood height, growth and adult type 2 diabetes, including potential influences of birthweight and childhood body mass index (BMI).nnnMETHODSnWe followed 292xa0827 individuals, born 1930-83, from the Copenhagen School Health Records Register in national registers for type 2 diabetes (11xa0548 men; 7472 women). Weights and heights were measured at ages 7-13xa0years. Hazard ratios (HR) of type 2 diabetes (age ≥30xa0years) were estimated without and with adjustment for birthweight and BMI.nnnRESULTSnIn men, associations between height and type 2 diabetes changed from inverse for below-average heights at age 7xa0years to positive for above-average heights at 13xa0years. No consistent associations were observed among women. These associations were not affected by birthweight. After adjustment for BMI, below-average childhood heights were inversely associated with type 2 diabetes among men (HR range: 0.91-0.93 per z-score) but above-average heights were not. Among women, after adjustment for BMI, below- and above-average heights in childhood were inversely associated with type 2 diabetes (HR range: 0.91-0.95). Greater height growth from 7 to 13xa0years was positively associated with type 2 diabetes in men and women.nnnCONCLUSIONSnAfter adjustment for BMI, short childhood height at all ages and greater growth during childhood are associated with an increased risk of type 2 diabetes, suggesting that this period of life warrants mechanistic investigations.

Abstract LB-381: Childhood body size and the risk of colon or rectal cancer in adulthood

Background: Adult obesity and height are well-established risk factors for colorectal cancer, however, few studies have examined the possible association with childhood body size. It is therefore unknown if the association is due to the body size in adult life or may be influenced by body size already from childhood. In the present study, we examined if childhood body mass index (BMI: kg/m 2 ) and height from ages 7 to 13 years are associated with the risk of colon and rectal cancer in adulthood. Methods: We used the Copenhagen School Health Records Register to identify children who were born from 1930-1972 and had information on height and weight from their school health examinations. BMI and height were transformed into z-scores. Cases were identified by linkage to the Danish Cancer Registry using ICD-10 codes (colon: C18.0-18.9, rectal: C19.9, 20.9). Analyses were conducted using Cox proportional hazard regressions stratified by birth cohort and sex since no significant sex interactions were observed. Results: Among 257,623 individuals (49.7% women), 2,676 were diagnosed with colon cancer (47.5% women) and 1,681 with rectal cancer (38.9% women). Per z-score increase in BMI at age 13 years the hazard ratio (HR) for colon cancer in adulthood was 1.09 (95% confidence interval [CI]: 1.04 to 1.14) in sex-stratified analyses. Per z-score increase in height at age 13 years the HR for colon cancer in adulthood was 1.14 (95% CI: 1.09 to 1.19). In a model including BMI and height (thus comparing two children of the same height with different weights and vice versa), the effect of BMI was attenuated (HR per z-score of BMI: 1.05, 95% CI: 1.00 to 1.10) but the HR for height changed little (HR per z-score of height: 1.13, 95% CI: 1.08 to 1.17). Essentially similar results were observed at all other ages (7 to 12 years). Examining the associations by colon sub-sites showed that the results observed mainly were driven by the associations with sigmoid colon cancer (C18.7, 1100 cases). Per z-score unit increase in BMI at age 13 years the HR was 1.11 (95% CI: 1.04 to 1.19) for a cancer in sigmoid colon as adult, while the HR for height was 1.21 (95% CI: 1.14 to 1.29). Associations between BMI and rectal cancer were generally not significant, at age 13 years the HR was 0.97 (95% CI: 0.92 to 1.03). Overall similar results were observed at ages 7-10 years and at age 12 years. Only at age 11 years was a borderline significant association observed, with a HR of 0.95 (95% CI: 0.89 to 1.00) per unit of BMI z-score. For height no significant associations were observed with the later risk of rectal cancer, at age 13 years the HR was 1.03 (95% CI: 0.98 to 1.08) and essentially similar results were observed at ages 7 to 12 years. Conclusion: Body size in childhood was positively associated with the later risk of colon cancer, whereas no associations were observed for rectal cancer. However, the results indicate that among children the associations observed between body size and colon cancer were mainly but not exclusively explained by height. Citation Format: Britt W. Jensen, Michael Gamborg, Ismail Gogenur, Thorkild I.A. Sorensen, Jennifer L. Baker. Childhood body size and the risk of colon or rectal cancer in adulthood. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-381.