Munim Mannan

Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis.

Gestational weight gain (GWG) is considered one of the risk factors for future obesity in the offspring. However, the direction and strength of this association at different periods of offspring life is relatively unknown. This study investigates whether excess or inadequate maternal GWG during pregnancy influences the risk of offspring obesity at different stages in life. A systematic review of published articles was undertaken after a comprehensive search of different databases, and extracted data were meta‐analysed. To quantify offspring obesity estimates in relation to GWG, we stratified obesity estimates within three life stages of the offspring age: <5 years, 5 to <18 years and 18+ years. Our meta‐analysis showed that, compared with offspring of women with adequate GWG, offspring of women who gained inadequate gestational weight were at a decreased risk of obesity (relative risk [RR]: 0.86; 95% confidence interval [CI]: 0.78–0.94), and offspring of women who gained excess weight were at an increased risk of obesity (RR: 1.40; 95% CI: 1.23–1.59). These relationships were similar after stratification by life stage. Findings of this study therefore suggest that excess GWG does influence offspring obesity over the short‐ and long‐term, and should therefore be avoided.

Association between gestational weight gain and postpartum diabetes: evidence from a community based large cohort study.

We have investigated the prospective association between excess gestational weight gain (GWG) and development of diabetes by 21 years post-partum using a community-based large prospective cohort study in Brisbane, Australia. There were 3386 mothers for whom complete data were available on GWG, pre-pregnancy BMI and self-reported diabetes 21 years post-partum. We used The Institute of Medicine (IOM) definition to categorize GWG as inadequate, adequate and excessive. We found 839 (25.78%) mothers gained inadequate weight, 1,353 (39.96%) had adequate weight gain and 1,194 (35.26%) had gained excessive weight during pregnancy. At 21 years post-partum, 8.40% of mothers self-reported a diagnosis of diabetes made by their doctor. In the age adjusted model, we found mothers who gained excess weight during pregnancy were 1.47(1.11,1.94) times more likely to experience diabetes at 21 years post-partum compared to the mothers who gained adequate weight. This association was not explained by the potential confounders including maternal age, parity, education, race, smoking, TV watching and exercise. However, this association was mediated by the current BMI. There was no association for the women who had normal BMI before pregnancy and gained excess weight during pregnancy. The findings of this study suggest that women who gain excess weight during pregnancy are at greater risk of being diagnosed with diabetes in later life. This relationship is likely mediated through the pathway of post-partum weight-retention and obesity. This study adds evidence to the argument that excessive GWG during pregnancy for overweight mothers has long term maternal health implications.

Is there a bi-directional relationship between depression and obesity among adult men and women? Systematic review and bias-adjusted meta analysis

The rapidly increasing prevalence of both obesity and depression represent two major public health concerns worldwide. But the evidence regarding the direction and strength of the association between these two disorders, for both adult men and women, are remain inconclusive. We systematically reviewed publications from five different databases: Pubmed, Embase, BIOSIS, CINAHL and PsychINFO. A total of 21 articles were included for the systematic review and 19 of them for the meta-analysis using a bias-adjusted (quality effect) model. This resulted in the inclusion of approximately 226,063 (33.7% men) participants. Those who were depressed had a 37% (RR: 1.37, 95% CI: 1.17, 1.48) increased risk of being obese, and who were obese had an 18% increased risk of being depressed (RR: 1.18, 95% CI: 1.04, 1.35). Those who were depressed had a 2% (RD: 0.02, 95% CI: 0.01, 0.03) excess risk of obesity, however, the reciprocal associations were not significant. The association between overweight and depression was not found significant in either direction. Both men and women were at risk of obesity and depression bi-directionally. In sensitivity analyses bi-directional associations were more pronounced among young and middle aged adults and in studies with longer follow-up. The findings of this study suggest that the strength of the association is greater for the direction leading from depression to obesity and this link was more pronounced for young and middle aged women.

Prospective associations between depression and obesity for adolescent males and females- a systematic review and meta-analysis of longitudinal studies

Adolescent obesity and depression are increasingly prevalent and are currently recognised as major public health concerns worldwide. The aim of this study is to evaluate the bi-directional associations between obesity and depression in adolescents using longitudinal studies. A systematic literature search was conducted using Pubmed (including Medline), PsycINFO, Embase, CINAHL, BIOSIS Preview and the Cochrane Library databases. According to the inclusion criteria, 13 studies were found where seven studies evaluated depression leading to obesity and six other studies examined obesity leading to depression. Using a bias-adjusted quality effects model for the meta-analysis, we found that adolescents who were depressed had a 70% (RR 1.70, 95% CI: 1.40, 2.07) increased risk of being obese, conversely obese adolescents had an increased risk of 40% (RR 1.40, 95% CI: 1.16, 1.70) of being depressed. The risk difference (RD) of early adolescent depression leading to obesity is 3% higher risk than it is for obesity leading to depression. In sensitivity analysis, the association between depression leading to obesity was greater than that of obesity leading to depression for females in early adulthood compared with females in late adolescence. Overall, the findings of this study suggest a bi-directional association between depression and obesity that was stronger for female adolescents. However, this finding also underscores the importance of early detection and treatment strategies to inhibit the development of reciprocal disorders.

Economic burden of underweight and overweight among adults in the Asia-Pacific region: a systematic review.

To assess the economic burden of underweight and overweight among adults in the Asia–Pacific region.

Effect of birth weight on adulthood renal function: A bias‐adjusted meta‐analytic approach

While the association between low birth weight (LBW; <2500 g) and development of adult chronic renal disease (CKD) is inconsistently reported, less information is available regarding association of high birth weight (HBW; ≥4000 g) with CKD. We undertook a systematic review and meta‐analysis on studies published before 30 September 2015 and report associations between birth weight and renal function. Blood (glomerular filtration rate (GFR)) and urine (microalbuminuria/albumin excreation rate (AER)/urinary albumin creatinine ratio (ACR)) parameters were used to define CKD. Three different effect size estimates were used (odds ratio, regression coefficient and mean difference). The odds of developing CKD in the life course among those born LBW was 1.77 (95% CI: 1.42, 2.20) times and 1.68 (1.27, 2.33) times, assessed by blood and urine parameters respectively. Higher risk was also observed among Asian and Australian populations (blood: OR 2.68; urine: OR 2.28), individuals aged ≤30 years (blood: OR 2.30; urine: OR 1.26), and ≥50 years (blood: OR 3.66; urine: OR 3.10), people with diabetes (blood: OR 2.51), and aborigines (urine: OR 2.32). There was no significant association between HBW and CKD. For every 1 kg increase in BW, the estimated GFR increased by 2.09 mL/min per 1.73 m2 (1.33–2.85), and it was negatively associated with LogACR (ß −0.07, 95% CI: −0.14, 0.00). LBW inborn had lower mean GFR −4.62 (−7.10, −2.14) compared with normal BW. Findings of this study suggest that LBW increased the risk of developing CKD, and HBW did not show any significant impact.

Caesarean delivery and the risk of offspring overweight and obesity over the life course: a systematic review and bias‐adjusted meta‐analysis

A causal role of Caesarean delivery (CD) on developing overweight and obesity in the life course of offspring has been postulated. However, the true strength of this association is not clear and the potential for confounding has not been adequately addressed. A systematic review and meta‐analysis were conducted to evaluate the strength of this association, this time using a bias‐adjusted model in addition to conventional methods. Our search yielded 32 estimates from 14 publications (n = 261 000) for meta‐analysis. The pooled analysis of seven estimates (n = 194 463) demonstrated a trend only towards a risk increase (RR = 1.15; 95% CI:0.94, 1.40) in overweight and obesity combined (ow+ob) due to CD in early childhood (0–5 years) and a similar trend was observed for mid‐childhood and adolescence (5–18 years). In adulthood, a moderate increase in risk for ow+ob due to CD was observed (n = 30 200) (RR = 1.28; 95% CI 1.02, 1.34). Results for obesity and overweight separately were stronger for obesity and demonstrated a decreasing effect across the three life stages. Conventional methods of analysis suggested less uncertainty than we report and publication bias assessment was strongly suggestive of a bias in favour of positive studies. The current analysis therefore suggests that the small effects seen with CD in this and previous meta‐analyses are probably a cumulative consequence of several biases we have outlined, including confounding effect and publication bias.

Prevalence of overweight and obesity among children and adolescents of the Indian subcontinent: a meta-analysis.

In order to examine the prevalence of overweight and obesity in childhood within the Indian subcontinent, a meta-analysis of studies was conducted. Within the data sets analyzed, six homogeneous statistical subgroups were observed and three levels of prevalence were discernible (low, intermediate, and high). The pooled estimates of the prevalence of overweight and obesity in children were 2% (95% confidence interval [CI], 2-3%) to 6% (95% CI, 6-7%) for the low-prevalence group, 11% (95% CI, 11-12%) to 18% (95% CI, 17-18%) for the intermediate-prevalence group, and 23% (95% CI, 22-24%) to 36% (95% CI, 34-37%) for the high-prevalence group. Data on subjects in the low-prevalence group were obtained from national-level data and from data sets in which urban and rural subjects were combined. Neither the intermediate- nor the high-prevalence category contained any data from the rural or national level. The intermediate group largely included urban children, whereas the high-prevalence group generally included affluent children within major urban centers. Most of the data sets reported the prevalence of overweight and obesity among children in the 10-18-year age range. The prevalence of overweight and obesity was higher among boys than girls, and had increased among urban dwellers during the last decade.

Predictors of maternal perceptions of their offspring's weight status during adolescence: evidence from the Mater-University of Queensland Study of Pregnancy Cohort

We examined the predictors of maternal perceptions on their adolescent offspring’s weight status. A mother-child linked analysis was carried out using 14 years follow-up data from a population-based prospective birth cohort of 3721 children (52% males) who born in Brisbane, Australia, between 1981 and 1983. Maternal perception of offspring weight was reported when the offspring were 14 years old and predictors were prospectively. We found that mothers perceived their adolescents’ sons were more underweight and less overweight than their daughters. The independent predictors of maternal perceptions of child overweight status were gender, maternal perceived child dissatisfaction of appearance, shape, size and weight, adolescent dieting to lose weight, their general health status, sports and maternal BMI. Mainly two factors- child health and dieting predict maternal perception of offspring underweight. This study found more child factors than family or maternal factors predict maternal perceptions of their offspring weight status. The finding that child factors are related to maternal perception should be helpful to clinicians as it suggests understanding adolescent and maternal perceptions of weight will best be achieved by a focus on current adolescent body image, dieting, behavioural problems, and parental weight status.