Sumaiya Patel

Associations of Gestational Diabetes, Existing Diabetes, and Glycosuria With Offspring Obesity and Cardiometabolic Outcomes

OBJECTIVE To assess associations of gestational diabetes, existing diabetes, and glycosuria with adiposity and cardiometabolic risk factors in offspring at adolescence. RESEARCH DESIGN AND METHODS Multivariable regression analyses were conducted in a prospective pregnancy cohort (n = 2,563–4,198 for different outcomes). Obstetric data were abstracted from clinical records. Offspring outcomes were assessed at mean age 15.5 years. Compared with those lost to follow-up, participants included in the analysis were of higher socioeconomic position. Outcomes included BMI, waist circumference, fat mass determined by dual-energy X-ray absorptiometry scan, systolic and diastolic blood pressure (sBP and dBP, respectively), fasting glucose, insulin, lipids, and C-reactive protein (CRP). RESULTS Maternal existing diabetes, gestational diabetes, and glycosuria were associated with higher offspring BMI and fat mass (z scores); however, this effect was attenuated in the confounder-adjusted model, and the CIs included the null value. Existing diabetes and gestational diabetes were associated with higher offspring fasting glucose levels (0.24 mmol/L [95% CI 0.03–0.45] and 0.20 mmol/L [0.02–0.39], respectively). Glycosuria was associated with higher fasting insulin (adjusted ratio of geometric means 1.12 [1.01–1.25]), but there were no clear associations of existing or gestational diabetes with offspring fasting insulin. There was little evidence of an association of maternal diabetes or glycosuria with offspring dBP, sBP, lipids, or CRP. CONCLUSIONS Maternal pregnancy glycosuria, gestational diabetes, and existing diabetes show some associations with higher offspring fasting glucose and insulin assessed in adolescence but are not clearly associated with a wider range of cardiometabolic risk factors.

Dietary antioxidant intake, allergic sensitization and allergic diseases in young children

Background:  Allergic diseases have risen in prevalence over recent decades. The aetiology remains unclear but is likely to be a result of changing lifestyle and/or environment. A reduction in antioxidant intake, consequent to reduced intake of fresh fruits and vegetables, has been suggested as a possible cause.

Cross-sectional association of dietary patterns with asthma and atopic sensitization in childhood - in a cohort study.

Many studies have investigated individual nutrients or foods as risk factors for allergic disease, but few have studied dietary patterns. We aimed to use principal component analysis (PCA) to determine dietary patterns in school age children and examine associations between these dietary patterns and wheeze, asthma and sensitization.

The Association Between Irregular Menstruations and Acne With Asthma and Atopy Phenotypes

Earlier menarche and irregular periods, among other markers of sex-hormone levels, have been associated with a higher risk of asthma and allergic diseases. This has suggested an etiologic role of sex hormones in the development of these conditions. The authors investigated the association of age at menarche, irregular periods, duration of menstruation, and acne with reported medical history of asthma and/or atopy (hay fever and/or eczema/urticaria) in a historical cohort of students born before the rise in asthma prevalence in the United Kingdom and attending university in 1948–1968. Finding consistent associations in a cohort that has experienced different life-course exposures and has different confounding structure can help to identify causal associations. In the Glasgow Alumni Cohort, irregular periods were associated with atopic asthma (multinomial odds ratio (MOR) = 2.79, 95% confidence interval (CI): 1.33, 5.83) and atopy alone (MOR = 1.40, 95% CI: 1.06, 1.84) but not with nonatopic asthma (MOR = 1.02, 95% CI: 0.45, 2.30), compared with students reporting no asthma and no atopy. The authors found no association with acne, a marker of high testosterone levels, that they hypothesized could point to polycystic ovary syndrome underpinning these associations. In summary, the authors found evidence for a potentially etiologic role of irregular menstruations with some specific asthma phenotypes, namely, atopic asthma and atopy, but not with nonatopic asthma.

The association of nonalcoholic fatty liver disease with central and peripheral blood pressure in adolescence: findings from a cross-sectional study

Objectives: We aimed to determine the association of nonalcoholic fatty liver disease (NAFLD) with central and peripheral blood pressure (BP), in a general adolescent population and to examine whether associations are independent of adiposity. Methods: Using cross-sectional data from a subsample (N = 1904) of a UK birth cohort, we assessed markers of NAFLD including ultrasound scan (USS) determined fatty liver, shear velocity (marker of liver fibrosis), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) at a mean age of 17.8 years. These were related to BP [central and peripheral SBP and DBP and mean arterial pressure (MAP)]. Results: Fatty liver was positively associated with central and peripheral SBP, DBP and MAP in models adjusting for age, sex, social class, puberty and alcohol intake. These positive associations were attenuated to the null when fat mass was included. For example, in confounder-adjusted models, not including fat mass, mean central SBP was 3.74 mmHg [95% confidence interval (CI) 1.12 to 6.36] higher in adolescents with USS fatty liver than in those without; with additional adjustment for fat mass, the association attenuated to the null value (−0.37 mmHg; 95% CI –3.09 to 2.36). Similar patterns were found for associations of ALT and GGT with central and peripheral BP. There was no consistent evidence of associations of shear velocity or AST with BP measurements. Fatty liver was not consistently associated with central pulse pressure (PP), peripheral PP and Aix@75. Conclusion: NAFLD is not associated with higher central or peripheral BP in adolescents once confounding by adiposity is taken into account.

Estimated portion sizes in a school-aged population

OBJECTIVE To produce study-specific portion sizes for 11-year-old children in a population-based birth cohort and to compare these study-specific portion sizes with previously published childrens portion sizes, to assess their relevance today. DESIGN Two multiple-pass 24 h dietary recalls were taken. The Food Standard Agencys photographic food atlas was used to quantify intakes. Study-specific food portion sizes were calculated for each food group. Portion sizes were calculated for all children and separately for boys and girls. The nutrient intake from the 24 h dietary recalls was analysed using study-specific and published portion sizes for individual participants. Agreement was assessed using Pearsons correlation, intra-class correlation coefficients and the Bland-Altman method. SETTING Birth cohort study, UK. SUBJECTS Children (mean age 11.3 years, n 264) and parents/guardians. RESULTS A total of 124 food portion sizes were calculated. Differences in portion weights between boys and girls were seen only for seven food items. There was a significant positive relationship (P < 0.001) between intakes of each nutrient as determined by the two sets of portion sizes. Correlation coefficients ranged from 0.77 (protein) to 0.98 (β-carotene). The intra-class correlation coefficients showed good agreement between nutrient intakes determined by the study-specific and published portion sizes (P < 0.001). CONCLUSIONS Nutrient intakes calculated using portion sizes from our population were similar to those calculated from portion size data collected in a national survey, despite being collected over a decade later. The present study adds to the small amount of evidence regarding portion sizes in UK children and shows agreement with previously published paediatric portion sizes.

Public reaction to the UK government strategy on childhood obesity in England: A qualitative and quantitative summary of online reaction to media reports.

This work aimed to summarise public real-time reaction to the publication of the UK government childhood obesity strategy by applying a novel research design method. We used a netnographic technique to carry out thematic analysis of user-generated comments to online newspaper articles related to the strategy. We examined likes/dislikes associated with comments as a proxy of agreement of the wider community with identified themes. To examine media influence on the comments we carried out thematic analysis of online media headlines published about the strategy, and compared these themes with themes identified from comments. Three newspaper articles and 1704 associated comments were included. Three parent themes were identified: paternalism/libertarianism, lobbyist influence and, anecdotal solutions. The comments were largely negative (94%). Commenters were split as to individual responsibilities and the role of the government, some felt that lobbyist influence had won out over the nations health and others offered non-evidence based solutions. The ten most liked and disliked comments reflected themes identified in our main analysis. There was parity between themes that emerged from comments and from headlines. This summary of public reaction to the obesity strategy publication may aid translation of public views and receptiveness into practice and inform subsequent government action and policy. Furthermore, the process applied herein may provide a means of informal public engagement.

A qualitative analysis of the enforcement of the regulation of nutrition and health claims made for foods and its implications for health

In common with local government organisations across the world, local authorities in the UK have responsibility for promoting health. A key part of this function is the frontline enforcement activities of officers responsible for compliance with health and nutrition claims. This study identifies attitudes, values and practices of enforcers: namely trading standards and environmental health officers, when faced with the problem of non-compliance with the Regulation. Semi-structured interviews with frontline enforcers from local authority regulatory services to investigate challenges with the enforcement of Regulation (EC) 1924/2006. Twenty participants were interviewed; sixteen were based in North West England and two in the North and two in the South of England. The participants were selected for their specialist knowledge and experience of enforcement of nutrition and health claims. Regulation (EC) No. 1924/2006 on nutrition and health claims presents particular challenges for enforcers seeking to apply an optimal strategy to flawed regulatory design. As with other regulations, when faced with non-compliance, enforcers, specifically trading standards and environmental health officers have a wide discretion to determine their response: ranging from the deterrent or accommodative styles of enforcement. The participants reported using advice rather than action and by doing so confronting their bifurcating identity of prosecutor and advisor. Enforcers used advice as a regulatory tool in enforcing the law relating to nutrition and health claims.

OP11 The Association of Childhood Adiposity, and its Distribution, with Cardiometabolic Outcomes: Results from 13 European Cohorts

Background Adiposity in childhood has been associated with increased cardiovascular risk which may be established in childhood and adolescence. Also centrally distributed fat (waist circumference) has been suggested to be a better marker of cardiometabolic risk compared to body mass index (BMI). We aimed to assess the association of adiposity measures with cardiometabolic outcomes in children and consider if the magnitude of these associations differ by adiposity measurement. Methods European cohorts with data available on BMI and waist circumference and cardiometabolic outcomes (at least blood pressure) were invited to participate in the collaborative project. Cross-sectional associations between adiposity measures (age- and gender-standardised z scores) and cardiometabolic outcomes and prospective associations (cardiometabolic outcomes measured at least 12 months after adiposity measurement) were examined. Results from individual cohorts were pooled using a random-effect meta-analysis and heterogeneity between them explored. Results A total of 13 cohorts (n=3644–17186 for different outcomes) were included in the cross-sectional analysis. BMI and waist circumference were both positively associated with diastolic and systolic blood pressure (DBP, SBP) and with total cholesterol, LDLc, triglycerides, insulin and CRP, with the magnitudes of association with each outcome being similar for BMI and waist. For example, the mean difference in DBP per standard deviation (SD) increase in BMI was 0.90 mmHg (95% confidence intervals (CI) 0.55, 1.24) and per SD waist was 0.73 mmHg (95%CI 0.33, 1.12); similar results for SBP were 1.73 mmHg (95%CI 1.28, 2.18) and 1.33 mmHg (95%CI 0.83, 1.81). In prospective analysis (6 cohorts, n=3708–7073 for different outcomes) BMI and waist circumference were positively associated with SBP and total cholesterol and inversely with HDLc associations were similar for the two adiposity measurements or were stronger for BMI. For example a 1SD greater BMI was associated with 1.36 mmHg higher SBP (95%CI 0.67, 2.05) compared with 0.96 mmHg (95% CI 0.35, 1.57) for waist. Direct measurements of fat mass, such as DXA or bioelectrical impedance, did not exhibit stronger associations with risk factors than did BMI. Age at adiposity measurement did not consistently influence the heterogeneity of association between studies. Conclusion Adiposity in childhood and adolescence is associated with adverse cardiometabolic outcomes. This suggests that interventions should be considered earlier before adverse effects become established. The magnitude of the association is similar between BMI, waist circumference and direct measures of adipostiy. Therefore BMI alone could be considered an adequate measure in public health and health surveillance systems.

P1-278 Associations between socioeconomic position and asthma- findings from a historical cohort

Introduction The association between asthma and socioeconomic position (SEP) is not well understood. This study aims to assess the variation in asthma across SEP in a historical cohort before the rise in asthma prevalence. Methods Students participating in a health survey at Glasgow University from 1948 to 1968 (11 274 men; 3502 women) completed a medical history of bronchitis, asthma, hay fever, eczema/urticaria, and reported early life SEP. A subsample responded to a postal follow-up in adulthood (4101 men; 1411 women) including respiratory diseases and early life and adult SEP. Results Among men, lower early life SEP was associated with higher risk of non-atopic asthma (asthma without eczema/urticaria or hay fever) (trend aOR=1.25 95% CI 1.05 to 1.48). Lower early life SEP was associated with a lower risk of hay fever (trend aOR=0.76 95% CI 0.68 to 0.85) and atopic asthma (asthma with eczema/urticaria or hay fever) (trend aOR=0.63 95% CI 0.50 to 0.78). No associations were seen for women. Early life SEP, adult household crowding, adult occupation, income and car ownership were not associated with adult onset asthma (onset >30 years) for men or women. Household amenities (<3) in early life was associated with higher risk of adult onset asthma for men (OR=1.48 95% CI 1.07 to 2.05). Conclusion Lower SEP in early life was associated with a higher risk of non-atopic asthma but a lower risk of hay fever and atopic asthma among men in a cohort that preceded the 1960s rise in asthma prevalence in the UK. Adult onset asthma was associated with early life household amenities but not adult SEP.