Hilkka Ylihärsilä

Birth size, adult body composition and muscle strength in later life.

Objective:Low birth weight has been linked to lower lean body mass and abdominal obesity later in life, whereas high birth weight has been suggested to predict later obesity as indicated by high body mass index (BMI). We examined how birth weight was related to adult body size, body composition and grip strength.Design/subjects:Cross-sectional study on 928 men and 1075 women born in 1934–1944, with measurements at birth recorded.Measurements:Height, weight, waist and hip circumference and isometric grip strength were measured. Lean and fat body mass were estimated by bioelectrical impedance with an eight-polar tactile electrode system.Results:A 1 kg increase in birth weight corresponded in men to a 4.1 kg (95% CI: 3.1, 5.1) and in women to a 2.9 kg (2.1, 3.6) increase in adult lean mass. This association remained significant after adjustment for age, adult body size, physical activity, smoking status, social class and maternal size. Grip strength was positively related to birth weight through its association with lean mass. The positive association of birth weight with adult BMI was explained by its association with lean mass. Low birth weight was related to higher body fat percentage only after adjustment for adult BMI. Abdominal obesity was not predicted by low birth weight.Conclusions:Low birth weight is associated with lower lean mass in adult life and thus contributes to the risk of relative sarcopenia and the related functional inability at the other end of the lifespan. At a given level of adult BMI, low birth weight predicts higher body fat percentage.

Self-Perpetuating Effects of Birth Size on Blood Pressure Levels in Elderly People

Abstract—It has been suggested that essential hypertension is determined by 2 separate mechanisms: a growth-promoting process in childhood and a self-perpetuating mechanism in adult life. We report a clinical study of 500 people taken from a cohort of 7086 men and women who were born in Helsinki from 1924 to 1933, and whose body size at birth was recorded. As expected, blood pressure levels were inversely related to birthweight and birth length. These associations, however, were confined to the 213 people who had previously been diagnosed as having hypertension. In them, a 1-kg increase in birthweight was associated with a 6.4-mm Hg (95% confidence interval, 1.0 to 11.9) decrease in systolic blood pressure recorded at the clinic, and with a 9.3-mm Hg (95% confidence interval, 2.1 to 16.5) decrease recorded by ambulatory measurement. We conclude that pathological processes initiated in utero become self-perpetuating in adult life and lead to hypertension. Among elderly people with established hypertension, these processes have a strong effect on blood pressure levels, because they are processes that do not respond well to treatment.

Prevalence of diabetes and impaired glucose regulation in 45- to 64-year-old individuals in three areas of Finland

Aims  To determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) and possible regional differences in Finnish adults aged between 45 and 64 years.

Role of Socioeconomic Indicators on Development of Obesity from a Life Course Perspective

Aims. Development of obesity is modified by several factors, including socioeconomic ones. We studied the importance of socioeconomic indicators on the development of obesity from a life course perspective. Methods. 2003 people born 1934–1944 in Helsinki, Finland, participated in clinical examinations in 2001–2004. Obesity was defined as body mass index (BMI) >30 kg/m2. Results. Prevalence of obesity was 22.3% in men and 27.2% in women. Lower educational attainment and lower adult social class were associated with higher BMI in both men (P = .03 and P < .01) and women (P < .001 and P = .01). Childhood social class was inversely associated with BMI only in men (P < .001); lower household income was associated with higher BMI in women only (P < .001). Those men belonging to the lowest childhood social class had higher risk of being obese than those of the highest childhood social class (OR 1.8 (95% CI: 1.0–3.1)). Household income was the strongest predictor of obesity among women. Conclusion. Overweight and obesity are inversely associated with socioeconomic status. Men seem to be more susceptible to adverse childhood socioeconomic circumstances than women, while adult socioeconomic indicators were more strongly associated with obesity in women.

Depression and its association with diabetes, cardiovascular disease, and birth weight.

Background. Diabetes increases the risk for depression. Aim. To study the independent effects of diabetes mellitus (DM) and cardiovascular disease (CVD) on the prevalence of depression and to examine low birth weight as a possible common explanatory factor. Methods. 2003 subjects from the Helsinki Birth Cohort Study underwent a 75‐g oral glucose tolerance test and filled out the Beck Depression Inventory. Results. Depressive symptoms were more prevalent among subjects with diabetes (23.5%) than among those with normal glucose tolerance (16.6%) (P<0.001). A history of CVD also markedly increased the odds of having depressive symptoms (odds ratio (OR) = 2.38, 95% confidence interval (CI) = 1.70–3.32, P<0.001). The association between DM and depressive symptoms was, however, rendered non‐significant when adjusting for the presence of CVD. Being born with a low birth weight doubled the risk for having depressive symptoms (OR = 2.64, 95% CI = 1.42–4.91, P = 0.002) and magnified the association between CVD/DM and depression. Conclusion. Diabetes has only a minor independent effect on concurrent occurrence of depressive symptoms, while cardiovascular disease seems to be a more important underlying factor. The association between disease and depression is in particular characteristic to individuals born with a low birth weight.

Developmental Origins of Physical Fitness: The Helsinki Birth Cohort Study

Background Cardiorespiratory fitness (CRF) is a major factor influencing health and disease outcomes including all-cause mortality and cardiovascular disease. Importantly CRF is also modifiable and could therefore have a major public health impact. Early life exposures play a major role in chronic disease development. Our aim was to explore the potential prenatal and childhood origins of CRF in later life. Methods/Principal Findings This sub-study of the HBCS (Helsinki Birth Cohort Study) includes 606 men and women who underwent a thorough clinical examination and participated in the UKK 2-km walk test, which has been validated against a maximal exercise stress test as a measure of CRF in population studies. Data on body size at birth and growth during infancy and childhood were obtained from hospital, child welfare and school health records. Body size at birth was not associated with adult CRF. A 1 cm increase in height at 2 and 7 years was associated with 0.21 ml/kg/min (95% CI 0.02 to 0.40) and 0.16 ml/kg/min (95% CI 0.03 to 0.28) higher VO2max, respectively. Adjustment for adult lean body mass strengthened these findings. Weight at 2 and 7 years and height at 11 years became positively associated with CRF after adult lean body mass adjustment. However, a 1 kg/m2 higher BMI at 11 years was associated with −0.57 ml/kg/min (95% CI −0.91 to −0.24) lower adult VO2max, and remained so after adjustment for adult lean body mass. Conclusion/Significance We did not observe any significant associations between body size at birth and CRF in later life. However, childhood growth was associated with CRF in adulthood. These findings suggest, importantly from a public point of view, that early growth may play a role in predicting adult CRF.

Childhood growth and future risk of the metabolic syndrome in normal-weight men and women.

AIM The aim of this study was to examine the effects of early growth on the risk of developing the metabolic syndrome in normal-weight individuals. METHODS We examined 2003 subjects born in Helsinki, Finland, between 1934 and 1944, focusing on 588 individuals who were normal weight (body mass index [BMI] less than or equal to 25 kg/m(2)). These subjects had a median of seven measurements of height and weight from birth to 2 years, and eight measurements from 2 to 11 years of age. The metabolic syndrome was defined according to the 2005 criteria of the International Diabetes Federation. RESULTS Individuals with the metabolic syndrome were heavier, had higher mean BMI and higher body fat percentages than those without the syndrome. No differences were seen in body size at birth and at 2 years but, by the age of 7 years, those men who later developed the metabolic syndrome were thinner (P=0.01). Changes in BMI during infancy were predictive of the syndrome, with an OR of 0.57 (95% CI: 0.36-0.90) per one S.D. increase in BMI from birth to 2 years. In women, these associations paralleled those in men, but did not reach statistical significance. CONCLUSION Among normal-weight men, those who developed the metabolic syndrome in adulthood had smaller gains in BMI during infancy and were thinner at age 7 years. These results support findings that early growth may play an important role in the development of the metabolic syndrome.

Impact of glucose metabolism and birth size on cognitive performance in elderly subjects.

AIMS We aimed to investigate the impact of diabetes and impaired glucose tolerance on cognitive performance and to explore the association between birth weight and cognitive performance among diabetic subjects. METHODS We performed a standard oral glucose tolerance test and a computerised test for assessment of cognitive performance (CogState) in 1243 subjects; 173 of them had type 2 diabetes. At the time of cognitive testing the mean age of the subjects was 64 years. Subjects with type 1 diabetes or a history of stroke were excluded. RESULTS Subjects with known diabetes performed significantly poorer in cognitive tasks measuring visual attention, working memory and episodic learning than subjects with normal glucose tolerance. Subjects with newly diagnosed diabetes or milder impairments in glucose regulation did not differ from the normoglycaemic group. A low birth weight enhanced the association between diabetes and poor performance in the working memory and episodic learning tasks. CONCLUSIONS Poorer cognitive performance was associated with known type 2 diabetes but not with newly diagnosed diabetes or milder impairments in glucose regulation. Low birth weight was found to be an additional vulnerability factor enhancing cognitive decline in diabetic subjects.

Childhood growth and future risk of the metabolic syndrome in normal-weight men and women

AIM The aim of this study was to examine the effects of early growth on the risk of developing the metabolic syndrome in normal-weight individuals. METHODS We examined 2003 subjects born in Helsinki, Finland, between 1934 and 1944, focusing on 588 individuals who were normal weight (body mass index [BMI] less than or equal to 25 kg/m(2)). These subjects had a median of seven measurements of height and weight from birth to 2 years, and eight measurements from 2 to 11 years of age. The metabolic syndrome was defined according to the 2005 criteria of the International Diabetes Federation. RESULTS Individuals with the metabolic syndrome were heavier, had higher mean BMI and higher body fat percentages than those without the syndrome. No differences were seen in body size at birth and at 2 years but, by the age of 7 years, those men who later developed the metabolic syndrome were thinner (P=0.01). Changes in BMI during infancy were predictive of the syndrome, with an OR of 0.57 (95% CI: 0.36-0.90) per one S.D. increase in BMI from birth to 2 years. In women, these associations paralleled those in men, but did not reach statistical significance. CONCLUSION Among normal-weight men, those who developed the metabolic syndrome in adulthood had smaller gains in BMI during infancy and were thinner at age 7 years. These results support findings that early growth may play an important role in the development of the metabolic syndrome.