Predictors of excess body weight concurrently affecting mother-child pairs: a 6 year follow-up.

BACKGROUND: We examined the predictors of excess body weight (EBW) concurrently affecting mother-child pairs after delivery during 6 years of follow-up. METHODS: Prospective cohort study conducted on 435 mother-child pairs. Data were collected at four time points: at birth in the maternity hospital; 1-2 years old, 4-5 years old and 6 years old at the participant's home. Poisson regression analysis was used to examine the predictors of maternal-child EBW: mothers with excessive gestational weight gain (GWG) and large-for-gestational age (LGA) baby (>90th percentile) at baseline and mothers with body mass index (BMI) ≥ 25 kg/m2 and a child > 85th percentile. RESULTS: The adjusted analysis showed that the risk of mother-child pairs concurrently having EBW increased with increasing pre-pregnancy BMI (RR = 2.4 and RR = 3.3 for pre-pregnancy BMI 25-30 and ≥30 kg/m2, respectively, P < 0.01). Excessive GWG and LGA infants were also significant predictors of EBW concurrently affecting mother-child pairs (RR = 2.2 and RR = 2.3, respectively, P < 0.01). CONCLUSION: Excessive pre-pregnancy BMI, excessive GWG and LGA status were strong predictors of EBW concurrently affecting mother-child pairs over 6 years of follow-up. Public policies must be established primarily before/during pregnancy to avoid an EBW cycle in the same family over the years.

The effect of pre-pregnancy weight and gestational weight gain on blood pressure in children at 6 years of age.

BACKGROUND: We evaluated the effect of maternal gestational weight gain (GWG) and pre-pregnancy weight on blood pressure (BP) of children 6 years after delivery. METHODS: Cross-sectional study that compared the anthropometric measurements of 181 mothers and their children's BP 6 years after delivery. The BP was measured by the auscultatory method. We used log-binomial regression to investigate the association of pre-pregnancy body mass index (BMI) and GWG categories with BP in mid-childhood. RESULTS: The prevalence of elevated BP in children was 26.5%. Maternal pre-pregnancy overweight and concurrent excessive GWG were positively associated with elevated BP at 6 years of age. Mothers with pre-pregnancy overweight and excessive GWG were more likely to have children with elevated BP at 6 years of age (OR = 2.05; P = 0.018) compared to mothers who were of normal weight pre-pregnancy and experienced appropriate GWG. We also found that mothers with pre-pregnancy BMI ≥25 kg/m2 and concurrent excessive GWG were more likely to have children with elevated diastolic blood pressure (OR = 2.72; P = 0.005). CONCLUSIONS: Pre-pregnancy overweight/obesity had impact on BP in mid-childhood. Interventions aimed at reducing cardiovascular diseases in children should promote weight loss in women of reproductive age rather than in pregnant women.

Effect of age at menarche on the mother's weight status two and four years after delivery: a cohort study.

We aimed to estimate the effect of age at menarche on the risk of excess body weight in Brazilian women two and four years after delivery. This was a cohort study that used data from adult women of the Predictors of Maternal and Child Excess Body Weight (PREDI) Study obtained at baseline (2012) and at 1st(2014) and 2nd(2016) follow-up. A total of 435 women attending a public maternity hospital in Joinville-Brazil were initially included in the study (baseline) and 215 of them continued to participate in the 2nd follow-up carried out in the homes of the participants. Regression analysis was used to estimate the association between age at menarche (<12; ≥12 years) and excess body weight (≥25 kg/m2) trajectory during the follow-ups. Unadjusted analysis showed that mothers with age at menarche <12 years were 1.29 times (p = .018) more likely to be overweight/obese than those with age at menarche ≥12 years. After adjustment, age at menarche continued to exert an independent effect on the mother's body mass index (RR = 1.23; p = .037) four years after delivery. Strategies designed to attenuate the rising prevalence of maternal overweight and obesity, especially after pregnancy, could help improve the mother's health status in the future.

Associations of ADIPOQ and LEP Gene Variants with Energy Intake: A Systematic Review.

This systematic review aims to evaluate the association of adiponectin (ADIPOQ) and leptin (LEP) gene variants with energy intake. Cross-sectional, cohort, and case⁻control studies that reported an association of leptin and/or adiponectin gene variants with energy intake were included in this review. Human studies without any age restrictions were considered eligible. Detailed individual search strategies were developed for each of the following bibliographic databases: Cochrane, Latin American and Caribbean Center on Health Sciences Information (LILACS), PubMed/MEDLINE, Scopus, and Web of Science. Risk of bias assessment was adapted from the Downs and Black scale and was used to evaluate the methodology of the included studies. Seven studies with a pooled population of 2343 subjects were included. The LEP and ADIPOQ gene variants studied were LEP-rs2167270 (k = 1), LEP-rs7799039 (k = 5), ADIPOQ-rs2241766 (k = 2), ADIPOQ-rs17300539 (k = 1), and ADIPOQ marker D3S1262 (k = 1). Two of the seven studies reviewed demonstrated a positive association between the LEP-rs7799039 polymorphism and energy intake. Two other studies-one involving a marker of the ADIPOQ gene and one examining the ADIPOQ-rs17300539 polymorphism-also reported associations with energy intake. More research is needed to further elucidate the contributions of genetic variants to energy metabolism.

The association of serum 25-hydroxyvitamin D concentrations with elevated serum ferritin levels in normal weight, overweight and obese Canadians.

In light of the growing body of literature suggesting a beneficial effect of vitamin D on inflammatory response, we hypothesized that vitamin D affects serum ferritin (SF), a biomarker of inflammation. The objective of the present study is to examine the association of serum 25-hydroxyvitamin D [25(OH)D] with elevated SF concentrations indicative of inflammation as no earlier study has done so. Data from 5550 Canadian adults who participated in the 2012/2013 and the 2014/2015 Canadian Health Measures Surveys were analysed. We observed that 9.4% of Canadian adults have elevated SF concentrations and that 35.6% were vitamin D insufficient. Among Canadians with under/normal body weights, those with serum 25(OH)D ≥ 75 nmol/L relative to those with serum 25(OH)D < 50 nmol/L, were substantially less at risk for elevated SF concentrations (OR = 0.24; 95% CI = 0.06, 0.89; p = 0.034). We did not observe this association for overweight and obese Canadians. Canadians of older age, non-white ethnicity, males, those with income above $100,000, those who consumed alcohol, and those with high total cholesterol concentrations and elevated blood pressures were more likely to have elevated SF concentrations. Serum 25(OH)D ≥ 75 nmol/L is likely to provoke anti-inflammatory benefits, but intervention studies that achieve high 25(OH)D concentrations and with long follow up are needed to establish the role of vitamin D on SF.

The Effect of Serum 25-Hydroxyvitamin D on Serum Ferritin Concentrations: A Longitudinal Study of Participants of a Preventive Health Program.

Various studies have suggested a role of vitamin D in inflammation. However, its effect on ferritin, a biomarker of inflammation, has received relatively little attention. Therefore, we aimed to assess the association of serum 25-hydroxyvitamin D (25(OH)D) with serum ferritin (SF) concentrations, and to examine whether temporal increases in serum 25(OH)D concentrations are paralleled by a reduction in SF concentrations. Data from a community sample of Canadian adults who participated in a preventive health program (n = 6812) were analyzed. During the follow-up, serum 25(OH)D concentrations increased from 80.7 to 115.0 nmol/L whereas SF concentrations decreased from 122.0 to 92.0 µg/L (median follow-up time was 11.67 months). Cross-sectional analyses revealed that compared to participants with 25(OH)D concentrations of <50 nmol/L, those with 25(OH)D concentrations of 75 to <100, 100 to <125, and ≥125 nmol/L had SF concentrations that were 13.00, 23.15, and 27.59 µg/L lower respectively (p < 0.001). Compared to those without temporal improvements in 25(OH)D concentrations between baseline and follow-up, participants who improved their 25(OH)D concentrations with ≥50 nmol/L decreased their SF concentrations with 5.71 µg/L. For participants for whom the increase in 25(OH)D concentrations was less than 50 nmol/L, decreases in SF concentrations were less pronounced and not statistically significant. These observations suggest that despite strong associations between 25(OH)D and SF concentrations, interventions aiming to lower SF concentrations through sun-exposure and vitamin D supplementation should target substantial increases in 25(OH)D concentrations.

The accuracy of neck circumference for assessing overweight and obesity: a systematic review and meta-analysis.

CONTEXT: Neck circumference (NC) has been suggested as an alternative measure to screen for excess body weight. OBJECTIVE: The aim of this study was to demonstrate the accuracy of neck circumference (NC) as a measure for assessing overweight and obesity in both sexes in different age groups. METHODS: Detailed individual search strategies were developed for each of the following bibliographic databases: Cochrane, LILACS, PubMed/MEDLINE, Science Direct, Scopus and Web of Science. The QUADAS-2 checklist was used to assess the methodology of the studies included. RESULTS: Thirty-eight assessments were performed in 11 articles according to age, sex and weight status. Using sensitivity and specificity, 27 assessments (71.0%) considered NC an accurate measure to diagnose overweight and obesity. The best sensitivity and specificity were found for the age >19 years (82.0%, 82.0%), female (80.0%, 73.0%), and obese (80.0%, 85.0%) categories. CONCLUSION: NC is an accurate tool for assessing overweight and obesity in males and females of different age groups and could be used to screen for excess body weight in routine medical practice or epidemiological studies. It is also believed that more studies will permit the creation of a reference dataset of NC cut-off values for world populations.

The Association of Serum 25-Hydroxyvitamin D Concentrations and Elevated Glycated Hemoglobin Values: A Longitudinal Study of Non-Diabetic Participants of a Preventive Health Program.

The prevalence of Type 2 Diabetes (T2D) is sharply on the rise, both in Canada and worldwide. As addressing its root causes, i.e., promotion of healthy lifestyles and weight management, has been largely unsuccessful, new clues for primary prevention seem essential to curbing the increasing public health burden of T2D. In the present study, we examined whether improvements in vitamin D status, i.e., serum 25-hydroxyvitamin D [25(OH)D] concentrations, are paralleled by a reduction in the risk for reaching adverse glycated hemoglobin (HbA1c) levels in a community sample of non-diabetic volunteers participating in a preventive health program that encourages the use of vitamin D. Repeated observations on 6565 participants revealed that serum 25(OH)D concentrations increased from 90.8 to 121.3 nmol/L, HbA1c values decreased from 5.6% to 5.5%, and the prevalence of having HbA1c values ≥ 5.8% decreased from 29.5% to 17.4% while in the program. Compared to participants who did not increase their 25(OH)D concentrations during follow-up, those who increased their 25(OH)D concentrations with 50 nmol/L or more were 0.74 times as likely to achieve elevated HbA1c values at follow-up (p = 0.03). These findings suggest that public health initiatives that promote vitamin D status along with healthy lifestyles in the population at large may alleviate the future public health burden associated with T2D.

Association of ADIPOQ, LEP, and FTO gene polymorphisms with large for gestational age infants.

OBJECTIVE: The main objective of this study was to evaluate the effect of the ADIPOQ rs2241766, LEP rs7799039, and FTO rs9939609 polymorphisms on the birth weight status of Brazilian infants. METHODS: This cross-sectional study was conducted in southern Brazil. Large for gestational age (LGA) newborns (n = 105), and the same number of small for gestational age/adequate for gestational age newborns, were included. Genotyping of the rs2241766, rs7799039, and rs9939609 polymorphisms was done by PCR-RFLP analysis. Logistic regression was used to investigate the association between LGA newborns and the presence of the polymorphisms. RESULTS: Infants carrying the GG genotype of the rs7799039 polymorphism were 2.12 times more likely to be born LGA than those carrying the GA + AA genotypes (95% CI: 1.17-3.83). These results did not change substantially after adjusting for potential confounding variables (OR = 1.98; 95% CI 1.05-3.73) and adjustment for the three polymorphisms (OR = 1.98; 95% CI 1.05-3.74). Regarding the ADIPOQ polymorphism, newborns carrying the TG or GG genotype were 1.88 times more likely to be born LGA than those carrying the TT genotype, although this difference was not statistically significant (p = 0.082). No association was found between the FTO gene polymorphism and newborn weight status. CONCLUSIONS: This study showed that the GG genotype of the LEP polymorphism rs7799039 is a risk factor for LGA infants. The exact role and mechanism of action of the GG genotype of this polymorphism in weight status control remain to be elucidated, and more studies are needed.

The Independent Importance of Pre-pregnancy Weight and Gestational Weight Gain for the Prevention of Large-for Gestational Age Brazilian Newborns.

Objectives To study the independent effect of pre-pregnancy weight, gestational weight gain (GWG), and other important risk factors on newborn birth weight. Methods Baseline data of 435 adult women and their singletons born between January and February 2012 at a public hospital in Brazil were used. Logistic regression was applied to determine the independent importance of pre-pregnancy weight and GWG for large for gestational age (LGA) newborns. Results Among all mothers, 37.9 % were overweight and obese before pregnancy and 45.3 % experienced excessive GWG. Among the newborns, 24.4 % were classified as LGA. Univariate analysis showed an association of family income, GWG, pre-pregnancy BMI and excessive GWG with LGA newborns. Smoking before and during pregnancy was associated with a decreased likelihood of giving birth to an LGA newborn compared to mothers who did not smoke. After adjustment for confounding variables, age at birth of first child, GWG, HbA1c and pre-pregnancy weight-GWG were significant and independent determinants of giving birth to an LGA newborn. Mothers with pre-pregnancy overweight and excessive GWG were more likely to deliver an LGA newborn (OR 2.54, P < 0.05) compared to mothers who were normal weight and experienced adequate GWG. Conclusions for Practice Age at first birth of child, GWG, HbA1c and pre-pregnancy overweight combined with excessive GWG are independent determinants of LGA newborns. The results of this study suggest that both primary prevention of overweight in women of childbearing age and management of GWG may be important strategies to reduce the number of LGA newborns and, consequently, the long-term public health burden of obesity.

The Effect of Serum 25-Hydroxyvitamin D Concentrations on Elevated Serum C-Reactive Protein Concentrations in Normal Weight, Overweight and Obese Participants of a Preventive Health Program.

The hypothesized effect of vitamin D on C-reactive protein (CRP) has received substantial attention as a potential means to alleviate the risk for cardiovascular disease. However, observational studies have been inconsistent in their reporting of associations between serum 25-hydroxyvitamin D (25(OH)D) and CRP concentrations, and trials and meta analyses have been inconsistent in their conclusions regarding the effect of vitamin D supplementation on CRP concentrations. These supplementation trials were mostly conducted among patients with more or less inflammatory complications and did not consider potential distinctive effects by weight status. To further our understanding of the potential influences of vitamin D on CRP, we analyzed longitudinal observations of 6755 participants of a preventative health program. On average, serum 25(OH)D concentrations increased from 88.3 to 121.0 nmol/L and those of CRP decreased from 1.7 to 1.6 mg/L between baseline and follow up. Relative to obese participants without temporal increases in 25(OH)D, those who showed improvements of <25, 25-50, 50-75, and more than 75 nmol/L at follow up were 0.57 (95% confidence interval: 0.37-0.88), 0.54 (0.34-0.85), 0.49 (0.30-0.80), and 0.48 (0.29-0.78) times as likely to have elevated CRP concentrations (≥1 mg/L), respectively. These associations were less pronounced and not statistically significant for normal weight and overweight participants. Herewith, the findings suggest that promotion of adequate serum 25(OH)D concentrations among obese individuals along with healthy lifestyles may alleviate the public health burden associated with cardiovascular disease.

Influence of altered maternal lipid profile on the lipid profile of the newborn.

OBJECTIVE: To evaluate whether there is an association between altered maternal lipid profile and the lipid profile of the newborn in a maternity hospital. SUBJECTS AND METHOD: Cross-sectional study with 435 parturients and their respective newborns. Blood samples from the newborns were collected during delivery by venipuncture of the umbilical cord close to the placenta. Blood samples from the parturients were collected in the pre-delivery room or right after delivery. The concentrations of total cholesterol, triglycerides and HDL-c were determined by an enzymatic colorimetric method and LDL-c was calculated by the Friedewald formula. RESULTS: There was no significant difference in mean concentrations of total cholesterol, LDL-c, HDL-c and triglycerides in neonates according to altered or non-altered maternal total cholesterol, LDL-c, HDL-c and triglycerides. CONCLUSIONS: Change in maternal lipid profile is not significantly associated with the mean concentrations of total cholesterol, LDL-c, HDL-c and triglycerides in newborns.

Influence of altered maternal lipid profile on the lipid profile of the newborn

Objective To evaluate whether there is an association between altered maternal lipid profile and the lipid profile of the newborn in a maternity hospital. Subjects and method Cross-sectional study with 435 parturients and their respective newborns. Blood samples from the newborns were collected during delivery by venipuncture of the umbilical cord close to the placenta. Blood samples from the parturients were collected in the pre-delivery room or right after delivery. The concentrations of total cholesterol, triglycerides and HDL-c were determined by an enzymatic colorimetric method and LDL-c was calculated by the Friedewald formula. Results There was no significant difference in mean concentrations of total cholesterol, LDL-c, HDL-c and triglycerides in neonates according to altered or non-altered maternal total cholesterol, LDL-c, HDL-c and triglycerides. Conclusions Change in maternal lipid profile is not significantly associated with the mean concentrations of total cholesterol, LDL-c, HDL-c and triglycerides in newborns. .

Concentrations of Fe, K, Na, Ca, P, Zn and Mg in maternal colostrum and mature milk.

The objective of this study was to determine the concentrations of Fe, K, Na, Ca, P, Zn and Mg in colostrum and mature milk (2 months) from nursing mothers, and the correlation between the concentration of these micronutrients and newborn weight, maternal age, gestational age GA, inter-pregnancy interval, and gestational weight gain. Thirty one women donated milk on the 2nd postpartum day and on the 2nd month of lactation. Micronutrients were analysed by atomic emission spectrophotometry. The concentrations (mean+/-SD) of Fe (0.12+/-0.08; 0.09+/-0.5 mg/100 ml), Zn (0.93+/-0.36; 0.15+/-0.06 mg/100 ml), K (62.8+/-11.5; 46.2+/-0.84 mg/100 ml) and Na (33.3+/-12.3; 20.5+/-15.6 mg/100 ml) decreased from colostrum to mature milk, whereas Ca (21.4+/-5.8; 25.0+/-3.1 mg/100 ml) and P (11.12+/-2.8; 13.7+/-2.0 mg/100 ml) increased. Correlations were observed between Zn and Ca concentrations and GA (r=-0.41, p=0.042; r=0.48, p=0.014, respectively), between Ca and K and inter-pregnancy interval (r=0.56, p=0.001; r=0.38, p=0.033, respectively), and between Mg and P and maternal age (r=0.49, p=0.005; r=0.37, p=0.042, respectively). The Zn concentration in colostrum showed a negative correlation with gestational weight gain (r=-0.49, p=0.006), and Na concentration showed a negative correlation with newborn weight (r=-0.38, p=0.036). The concentration of micronutrients in colostrum and mature milk (2 months) suffers alterations, including a decrease in Fe, Zn, K and Na and an increase in Ca and P, probably in order to satisfy the requirements of the nursing infant. Micronutrients are influenced by birth weight, maternal age, gestational weight gain, GA and inter-pregnancy interval.

Lead contamination and anthropometry of the newborn baby.

The objective of the present study was to determine the lead (Pb) concentration in umbilical cord blood and its relationship with anthropometric measurements of 55 newborns. Umbilical cord blood was collected immediately after delivery for the determination of Pb and hemoglobin (Hb) concentrations. Hb was measured with the HemoCue system and blood Pb concentration was determined by graphite furnace atomic absorption spectrophotometry. We observed an inversely proportional correlation of cord blood Pb concentrations with newborn weight (beta=-0.275; p=0.048) and length (beta=-0.460; p=0.003). The mechanisms whereby Pb reduces newborn size are unknown. One possible explanation would be a reduction in fetal thyroid hormones caused by the presence of Pb. However, further studies are necessary to confirm this hypothesis.