Olta Gishti

Fetal and infant growth patterns associated with total and abdominal fat distribution in school-age children

CONTEXT Higher infant growth rates are associated with an increased risk of obesity in later life. OBJECTIVE We examined the associations of longitudinally measured fetal and infant growth patterns with total and abdominal fat distribution in childhood. DESIGN, SETTING, AND PARTICIPANTS We performed a population-based prospective cohort study among 6464 children. We measured growth characteristics in the second and third trimesters of pregnancy, at birth, and at 6, 12, and 24 months. MAIN OUTCOME MEASURES Body mass index, fat mass index (body fat mass/height(2)), lean mass index (body lean mass/height(2)), android/gynoid fat ratio measured by dual-energy x-ray absorptiometry, and sc and preperitoneal abdominal fat measured by ultrasound at the median age of 6.0 years (90% range, 5.7-7.4). RESULTS We observed that weight gain in the second and third trimesters of fetal life and in early, mid, and late infancy were independently and positively associated with childhood body mass index (P < .05). Only infant weight gain was associated with higher fat mass index, android/gynoid fat ratio, and abdominal fat in childhood (P < .05). Children with both fetal and infant growth acceleration had the highest childhood body mass index, fat mass index, and sc abdominal fat, whereas children with fetal growth deceleration and infant growth acceleration had the highest value for android/gynoid fat ratio and the lowest value for lean mass index (P < .05). CONCLUSIONS Growth in both fetal life and infancy affects childhood body mass index, whereas only infant growth directly affects measured total body and abdominal fat. Fetal growth deceleration followed by infant growth acceleration may lead to an adverse body fat distribution in childhood.

BMI, total and abdominal fat distribution, and cardiovascular risk factors in school-age children.

Background:More specific total body and abdominal fat mass measures might be stronger associated with cardiovascular risk factors in childhood, than BMI. We examined the independent associations of total and abdominal fat measures with cardiovascular risk factors in school age children.Methods:We performed a population-based cohort study among 6,523 children. At the age of 6 y, we measured childhood BMI, and general and abdominal fat mass, using dual-energy X-ray absorptiometry, and ultrasound and cardiovascular risk factors.Results:Conditional on BMI, higher fat mass percentage and abdominal fat mass were associated with higher blood pressure, total- and low-density lipoprotein (LDL)-cholesterol, insulin and c-peptide levels, but with lower left ventricular mass and high-density lipoprotein (HDL)-cholesterol (P values < 0.05). These associations differed between underweight, normal weight, overweight, and obese children. Higher childhood adiposity measures were associated with increased odds of cardiovascular risk factors clustering, with the strongest effect for fat mass percentage (odds ratios: 3.01 (95% confidence interval: 2.67, 3.9).Conclusion:Our results suggest that general and abdominal fat measures are associated with cardiovascular risk factors in childhood, independent from BMI. These measures may provide additional information for identification of children with an adverse cardiovascular profile.

General and abdominal fat outcomes in school-age children associated with infant breastfeeding patterns

BACKGROUND Breastfeeding may have a protective effect on the development of obesity in later life. Not much is known about the effects of infant feeding on more-specific fat measures. OBJECTIVE We examined associations of breastfeeding duration and exclusiveness and age at the introduction of solid foods with general and abdominal fat outcomes in children. DESIGN We performed a population-based, prospective cohort study in 5063 children. Information about infant feeding was obtained by using questionnaires. At the median age of 6.0 y (95% range: 5.7 y, 6.8 y), we measured childhood anthropometric measures, total fat mass and the android:gynoid fat ratio by using dual-energy X-ray absorptiometry, and preperitoneal abdominal fat by using ultrasound. RESULTS We observed that, in the models adjusted for child age, sex, and height only, a shorter breastfeeding duration, nonexclusive breastfeeding, and younger age at the introduction of solid foods were associated with higher childhood general and abdominal fat measures (P-trend < 0.05) but not with higher childhood body mass index. The introduction of solid foods at a younger age but not breastfeeding duration or exclusivity was associated with higher risk of overweight or obesity (OR: 2.05; 95% CI: 1.41, 2.90). After adjustment for family-based sociodemographic, maternal lifestyle, and childhood factors, the introduction of solid food between 4 and 4.9 mo of age was associated with higher risks of overweight or obesity, but the overall trend was not significant. CONCLUSIONS Associations of infant breastfeeding and age at the introduction of solid foods with general and abdominal fat outcomes are explained by sociodemographic and lifestyle-related factors. Whether infant dietary composition affects specific fat outcomes at older ages should be further studied.

Maternal plasma PUFA concentrations during pregnancy and childhood adiposity: the Generation R Study

BACKGROUND Maternal polyunsaturated fatty acid (PUFA) concentrations during pregnancy may have persistent effects on growth and adiposity in the offspring. A suboptimal maternal diet during pregnancy might lead to fetal cardiometabolic adaptations with persistent consequences in the offspring. OBJECTIVE We examined the associations of maternal PUFA concentrations during pregnancy with childhood general and abdominal fat-distribution measures. DESIGN In a population-based, prospective cohort study of 4830 mothers and their children, we measured maternal second-trimester plasma n-3 (ω-3) and n-6 (ω-6) PUFA concentrations. At the median age of 6.0 y (95% range: 5.6, 7.9 y), we measured childhood body mass index (BMI), the fat mass percentage, and the android:gynoid fat ratio with the use of dual-energy X-ray absorptiometry and measured the preperitoneal abdominal fat area with the use of ultrasound. Analyses were adjusted for maternal and childhood sociodemographic- and lifestyle-related characteristics. RESULTS We observed that higher maternal total n-3 PUFA concentrations, and specifically those of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid, were associated with a lower childhood total-body fat percentage and a lower android:gynoid fat mass ratio (P< 0.05) but not with childhood BMI and the abdominal preperitoneal fat mass area. Higher maternal total n-6 PUFA concentrations, and specifically those of dihomo-γ-linolenic acid, were associated with a higher childhood total-body fat percentage, android:gynoid fat mass ratio, and abdominal preperitoneal fat mass area (P< 0.05) but not with childhood BMI. In line with these findings, a higher maternal n-6:n-3 PUFA ratio was associated with higher childhood total-body and abdominal fat mass. CONCLUSIONS Lower maternal n-3 PUFA concentrations and higher n-6 PUFA concentrations during pregnancy are associated with higher body fat and abdominal fat in childhood. Additional studies are needed to replicate these observations and to explore the causality, the underlying pathways, and the long-term cardiometabolic consequences.

Influence of Maternal Angiogenic Factors During Pregnancy on Microvascular Structure in School-Age Children

Reduced placental growth factor (PlGF) levels and higher soluble fms-like tyrosine kinase (sFlt-1) levels in mothers during pregnancy may have persistent effects on vascular structures in their offspring. We examined whether angiogenic factors during pregnancy also affect childhood retinal microvasculature in a population-based prospective cohort study among 3505 mothers and their children. We measured maternal PlGF and sFlt-1 in the first and second trimester of pregnancy. At the age of 6, we measured childhood retinal arteriolar and venular calibers from digitized retinal photographs. We performed multiple linear regression models, taking maternal and childhood sociodemographic and lifestyle-related characteristics, birth characteristics, and childhood current body mass index and blood pressure into account. We observed that first trimester maternal PlGF and sFlt-1 levels were not associated with childhood retinal arteriolar caliber. Lower second trimester maternal PlGF levels, but not sFlt-1 levels, were associated with narrower childhood retinal arteriolar caliber (difference: −0.09 SD score [95% confidence interval, −0.16 to 0.01], per SD score decrease in PlGF). This association was not explained by maternal and childhood sociodemographic and lifestyle-related characteristics, birth characteristics, or childhood current body mass index and blood pressure. Maternal PlGF and sFlt-1 levels in the first or second trimester were not associated with childhood retinal venular caliber. Our results suggest that lower maternal second trimester PlGF levels affect the microvascular development in the offspring, leading to narrower retinal arteriolar caliber in childhood. Further studies are needed to confirm these findings and to explore the underlying mechanisms and long-term cardiovascular consequences.

Body fat distribution, metabolic and inflammatory markers and retinal microvasculature in school-age children. The Generation R Study

Objective:To examine the associations of body fatness, metabolic and inflammatory markers with retinal vessel calibers among children.Design:We performed a population-based cohort study among 4145 school-age children. At the median age of 6.0 years (95% range 5.8, 8.0 years), we measured body mass index, total and abdominal fat mass, metabolic and inflammatory markers (blood levels of lipids, insulin and C-peptide and C-reactive protein) and retinal vascular calibers from retinal photographs.Results:We observed that compared with normal weight children, obese children had narrower retinal arteriolar caliber (difference −0.21 s.d. score (SDS; 95% confidence interval (CI) −0.35, −0.06)), but not venular caliber. Continuous analyses showed that higher body mass index and total body fat mass, but not android/gynoid fat mass ratio and pre-peritoneal fat mass, were associated with narrower retinal arteriolar caliber (P<0.05 for body mass index and total body fat mass), but not with retinal venular caliber. Lipid and insulin levels were not associated with retinal vessel calibers. Higher C-reactive protein was associated with only wider retinal venular caliber (difference 0.10 SDS (95% CI 0.06, 0.14) per SDS increase in C-reactive protein). This latter association was not influenced by body mass index.Conclusions:Higher body fatness is associated with narrower retinal arteriolar caliber, whereas increased C-reactive protein levels are associated with wider retinal venular caliber. Increased fat mass and inflammation correlate with microvascular development from school-age onwards.

Impact of birth parameters and early life growth patterns on retinal microvascular structure in children: The Generation R Study.

Objective: The aim of the study was to examine the associations of birth outcomes and longitudinally measured fetal and infant growth patterns with retinal vessel calibers in childhood. Methods: In a population-based prospective cohort study among 4122 children, we measured growth characteristics in second and third trimester of pregnancy, at birth, and at 6, 12, 24, 36, 48, and 72 months. At the age of 6 years, we measured retinal arteriolar and venular calibers from digitized retinal photographs. Results: We observed that compared with term-born children, those born preterm had narrower retinal arteriolar caliber [differences −0.46 standard deviation score (95% confidence interval −0.77 to −0.15) and −0.24 standard deviation score (95% confidence interval −0.42 to −0.05) for children born <34 and 34–37 weeks of gestation, respectively]. Children born with a low birth weight (<2500 g) had narrower retinal arteriolar caliber than children with a normal birth weight, but this association was fully explained by gestational age at birth. Accelerated infant growth until 24 months was associated with narrow retinal arteriolar caliber, especially among preterm-born children (P < 0.05). Early growth measures were not associated with retinal venular caliber. Conclusion: Preterm birth and accelerated infant growth are associated with narrower retinal arteriolar caliber in childhood. Whether these microvascular adaptations explain the well known associations of fetal and infant characteristics with cardiovascular disease in later life should be further studied.

Retinal Microvasculature and Cardiovascular Health in Childhood

BACKGROUND AND OBJECTIVE: Alterations in retinal microvasculature are associated with increased risk of cardiovascular disease. We examined the associations of retinal vessel caliber with cardiovascular markers in school-age children. METHODS: Among 4007 school-age children (median age of 6.0 years), we measured cardiovascular markers and retinal vessel calibers from digitized retinal photographs. RESULTS: Narrower retinal arteriolar caliber was associated with higher systolic and diastolic blood pressure (−0.20 SD score [SDS] [95% confidence interval (CI) −0.24 to −0.18] and −0.14 SDS [−0.17 to −0.11], respectively, per SDS increase in retinal arteriolar caliber), mean arterial pressure, and pulse pressure, but not with carotid-femoral pulse wave velocity, heart rate, cardiac output, or left ventricular mass. A wider retinal venular caliber was associated with lower systolic blood pressure, mean arterial pressure, and pulse pressure and higher carotid-femoral pulse wave velocity (carotid-femoral pulse wave velocity difference = 0.04 SDS [95% CI 0.01 to 0.07] per SDS increase in retinal venular caliber). Both narrower retinal arteriolar and venular calibers were associated with higher risk of hypertension at the age of 6 years, with the strongest association for retinal arteriolar caliber (odds ratio 1.35 [95% CI 1.21 to 1.45] per SDS decrease in arteriolar caliber). Adjustment for parental and infant sociodemographic factors did not influence the observed associations. CONCLUSIONS: Both retinal arteriolar and venular calibers are associated with blood pressure in school-age children, whereas retinal venular caliber is associated with carotid-femoral pulse wave velocity. Microvascular adaptations in childhood might influence cardiovascular health and disease from childhood onward.

Higher Maternal Plasma n–3 PUFA and Lower n–6 PUFA Concentrations in Pregnancy Are Associated with Lower Childhood Systolic Blood Pressure

BACKGROUND Suboptimal maternal diet during pregnancy might lead to fetal cardiovascular adaptations with persistent consequences in the offspring. OBJECTIVE We assessed the associations of maternal polyunsaturated fatty acid (PUFA) concentrations during pregnancy with childhood blood pressure. METHODS In a population-based prospective cohort study among 4455 mothers and their children, we measured maternal second-trimester n-3 (ω-3) and n-6 (ω-6) PUFA concentrations in plasma glycerophospholipids and expressed n-3 and n-6 PUFAs as proportions of total PUFAs (wt%). Childhood blood pressure was measured at the median age of 6.0 y (95% range: 5.7-7.9 y). We used linear regression models to assess the associations of maternal PUFA wt% with childhood blood pressure at 6 y. RESULTS Higher total maternal n-3 PUFA wt% and, specifically, docosahexaenoic acid (DHA; 22:6n-3) wt% were associated with lower childhood systolic blood pressure [differences: -0.28 (95% CI: -0.54, -0.03) and -0.29 mm Hg (95% CI: -0.54, -0.03) per SD increase of total n-3 PUFAs and DHA wt%, respectively], but not with childhood diastolic blood pressure. Total maternal n-6 PUFA wt% was positively associated with childhood systolic blood pressure [differences: 0.36 mm Hg (95% CI: 0.09, 0.62) per SD increase of total n-6 PUFA wt%], but not with childhood diastolic blood pressure. A higher n-6:n-3 PUFA ratio was associated with higher childhood systolic blood pressure (P < 0.05). Pregnancy and childhood characteristics only partly explained the observed associations. CONCLUSIONS Higher maternal plasma n-3 PUFA and lower n-6 PUFA concentrations during pregnancy are associated with a lower systolic blood pressure in childhood. Further studies are needed to replicate these findings, explore the underlying mechanisms, and examine the long-term cardiovascular consequences.

Ethnic Disparities in General and Abdominal Adiposity at School Age: A Multiethnic Population-Based Cohort Study in The Netherlands

Background/Aims: Ethnic differences in obesity prevalence have been reported. We examined ethnic differences in general and abdominal fat distribution in school-age children and the influence of parental prepregnancy, pregnancy, and childhood factors on these differences. Methods: We performed a multiethnic population-based prospective cohort study among 5,244 children with information about prepregnancy factors, pregnancy, and childhood factors. At the age of 6 years, the BMI, total fat mass, android/gynoid fat mass ratio, and preperitoneal fat mass were assessed via dual-energy X-ray absorptiometry and abdominal ultrasound. Results: The overweight and obesity prevalences among Dutch children were 10.0 and 2.1%, respectively. Higher prevalences were observed among Cape Verdean (21.0 and 10.3%), Dutch Antillean (18.4 and 13.8%), Moroccan (20.6 and 7.7%), Surinamese-Creole (13.4 and 7.7%), Surinamese-Hindustani (12.3 and 6.2%), and Turkish (23.8 and 12.0%) children. In the models adjusted for age and sex only, Moroccan, Surinamese-Hindustani, and Turkish children had a higher total fat mass than Dutch children, whereas Surinamese-Creole children had a lower total fat mass. Compared to Dutch children, the android/gynoid fat mass ratio was higher in Moroccan, Surinamese-Hindustani, and Turkish children, whereas the preperitoneal fat mass was higher among Dutch Antillean, Moroccan, Surinamese-Hindustani, and Turkish children (all p < 0.05). Prepregnancy factors explained up to 73% of these differences. In addition to prepregnancy factors, pregnancy factors explained up to 34% of the differences. Childhood factors did not significantly explain these associations. Conclusions: All ethnic minority groups had higher risks of overweight and obesity than Dutch children. Moroccan, Surinamese-Hindustani, and Turkish children also had an adverse body fat profile. Prepregnancy and pregnancy might be critical periods for preventive strategies focused on the reduction of ethnic disparities in childhood adiposity.