ADHD in childhood predicts BMI and body composition measurements over time in a population-based birth cohort.

BACKGROUND/OBJECTIVES: Obesity has been reported as an attention-deficit hyperactivity disorder (ADHD) comorbidity. So far, few studies have aimed to explore the potential causal relationship between ADHD and obesity, as well as used other measures of body composition like fat-free mass (FFM) and fat mass (FM) as measures of obesity. This study aimed to test the association between ADHD and body composition (body mass index [BMI] and others) and to evaluate the potential causal relationship with obesity. SUBJECTS/METHODS: Data from the 1993 Pelotas (Brazil) birth cohort at age 11-, 15-, 18-, and 22-year follow-up was used. We performed a cross-lagged panel model (CLPM) analysis between ADHD symptoms and BMI to explore the causal relationship between both traits. Finally, we tested whether ADHD, inattention, and hyperactivity symptom scales were associated with BMI, FM, and FFM at 22 years. RESULTS: In the CLPM, higher ADHD scores at age 11 predicted higher BMI at age 15 (ß = 0.055, 95% CI [0.037; 0.073]). ADHD symptoms at age 11 was also associated with a decrease in the FFM (ß = -0.16, 95% CI [-0.28; -0.05]), and an increase in the BMI (ß = 0.17, 95% CI [0.10; 0.23]) and FM (ß = 0.17, 95% CI [0.06; 0.29]) at 22 years. At 22 years of age, ADHD was associated with FFM and FM. Moreover, an increase in BMI was observed with an increase in several symptoms of ADHD in general (ß = 0.06, 95% CI [0.004; 0.12]), and hyperactivity symptoms (ß = 0.15, 95% CI [0.05; 0.25]). CONCLUSION: ADHD at 11 years predicted a higher BMI at 15 years, and body fat composition in adulthood, suggesting higher scores on ADHD symptoms in early life may be a critical point for body composition in early adulthood. The hyperactivity symptoms may play an important role in the BMI increase.

Age patterns in overweight and wasting prevalence of under 5-year-old children from low- and middle-income countries.

OBJECTIVES: To describe how overweight and wasting prevalence varies with age among children under 5 years in low- and middle-income countries (LMICs). METHODS: We used data from nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Overweight and wasting prevalence were defined as the proportions of children presenting mean weight for length/height (WHZ) more than 2 standard deviations above or below 2 standard deviations from the median value of the 2006 WHO standards, respectively. Descriptive analyses include national estimates of child overweight and wasting prevalence, mean, and standard deviations of WHZ stratified by age in years. National results were pooled using the population of children aged under 5 years in each country as weight. Fractional polynomials were used to compare mean WHZ with both overweight and wasting prevalence. RESULTS: Ninety national surveys from LMICs carried out between 2010 and 2019 were included. The overall prevalence of overweight declined with age from 6.3% for infants (aged 0-11 months) to 3.0% in 4 years olds (p = 0.03). In all age groups, lower prevalence was observed in low-income compared to upper-middle-income countries. Wasting was also more frequent among infants, with a slight decrease between the first and second year of life, and little variation thereafter. Lower-middle-income countries showed the highest wasting prevalence in all age groups. On the other hand, mean WHZ was stable over the first 5 years of life, but the median standard deviation for WHZ decreased from 1.39 in infants to 1.09 in 4-year-old children (p < 0.001). For any given value of WHZ, both overweight and wasting prevalence were higher in infants than in older children. CONCLUSION: The higher values of WHZ standard deviations in infants suggest that declining prevalence in overweight and wasting by age may be possibly due to measurement error or rapid crossing of growth channels by infants.

Consumption of ultra-processed foods at 11, 22 and 30 years at the 2004, 1993 and 1982 Pelotas Birth Cohorts.

OBJECTIVE: To describe the consumption of ultra-processed foods according to demographic and socioeconomic characteristics in three birth cohorts. DESIGN: Cross-sectional analysis. SETTING: Data from the 2004, 1993 and 1982 Pelotas Birth Cohorts were used at 11, 22 and 30 years, respectively, collected between 2012 and 2015. Outcome was the relative contribution of ultra-processed foods from the total daily energy intake. Maternal-independent variables were self-reported skin colour, schooling, age and family income (obtained in the perinatal study), and variables of the cohort member, sex, skin colour, schooling and current family income (the last two obtained at the 11-, 22- and 30-year follow-ups of the respective cohorts). We calculated crude and adjusted means of the outcome for the whole cohorts and according to the independent variables. PARTICIPANTS: 11-, 22- and 30-year-old individuals. RESULTS: Daily energetic contribution from ultra-processed foods was higher in the younger cohort (33·7, 29·8 and 25·1 % at 11, 22 and 30 years, respectively). Maternal schooling and family income at birth showed an inverse dose-response relationship at 11 and 22 years, but a positive dose-response at 30 years. Female sex, lower schooling and family income at 22 years and higher schooling at 30 years were associated to a higher contribution from ultra-processed foods in the daily energy intake. CONCLUSIONS: Information from food and nutrition policies needs a higher dissemination, mostly among women and population groups of lower income and schooling, including its promotion in media and health services, aiming for a decreased consumption of ultra-processed foods.

Prematurity and body composition at 6, 18, and 30 years of age: Pelotas (Brazil) 2004, 1993, and 1982 birth cohorts.

BACKGROUND: We aimed to investigate the association between preterm birth and body composition at 6, 18, and 30 years of age using data from three population-based birth cohort studies. METHODS: Gestational age (GA), defined by the date of the last menstrual period (categorized in ≤33, 34-36, and ≥ 37 weeks), was gathered in the first 24-h after delivery for all live births occurring in the city of Pelotas, Brazil, in 2004, 1993 and 1982. Body composition was assessed by air-displacement plethysmography. Outcomes included fat mass (FM, kg), percent FM (%FM), FM index (FMI, kg/m2), fat-free mass (FFM, kg); percent FFM (%FFM), FFM index (FFMI, kg/m2), body mass index (BMI, kg/m2 at 18 years in the 1993 cohort and 30 years in the 1982 cohort), and BMI Z-score (at 6 years in the 2004 cohort). We further explored the association of birth weight for GA with body composition indicators and BMI. Crude and adjusted linear regressions provided beta coefficients with 95% confidence intervals (95%CI). RESULTS: A total of 3036, 3027, and 3369 participants, respectively, from the 2004, 1993, and 1982 cohorts were analyzed. At 6 years, preterm boys (born at 34-36 weeks) presented lower adjusted mean of FM (ß = - 0.80 kg, - 1.45;-0.16, p = 0.046), %FM (ß = - 2.39%, - 3.90;-0.88, p = 0.008), FMI (ß = - 0.70 kg/m2, - 1.13;-0.27, p = 0.004) as well as lower FFM (ß = - 0.4 kg, - 0.77; - 0.12, p = 0.010) and FFMI (ß = - 0.3 kg/m2, - 0.46;-0.10, p < 0.001), and BMI Z-score (ß = - 0.69,; - 0.99;-0.40, p < 0.001); but higher %FFM (ß = 2.4%, 0.87;-3.90, p = 0.008), when compared to boys born at term (≥37). At 30 years, FM (15.7 kg, 0.25;31.1, p = 0.102) was higher among males born at ≤33 weeks. No association was observed for females from the three cohorts and for 18-year-old males. The association of birth weight for GA with body composition and BMI was not significant in any cohort. At 6 years, SGA boys had lower FFMI than boys AGA. CONCLUSIONS: Our results suggest that preterm birth is associated with decreased body fat and fat-free mass in childhood but higher fat mass in adulthood. Nevertheless, results were only significant for males. SGA boys also showed lower FFMI.

Associations between body mass index, body composition and bone density in young adults: findings from a southern Brazilian cohort.

BACKGROUND: This study aimed to evaluate the association of body composition components and obesity with bone density. METHODS: Prospective study with data on 2968 members of the 1993 Pelotas Birth Cohort from follow-ups at 18 and 22 years of age. Areal bone mineral density (aBMD, g/cm2) was evaluated for whole body, lumbar spine, and femoral neck at 22 years using dual-energy X-ray absorptiometry. Simple and multiple linear regression, stratified by sex, were used to assess the effect of BMI, fat mass (FMI) and lean mass index (LMI), evaluated at 18 and 22 years, and obesity trajectories classified by FMI and categorized as "never", "only at 18 years", "only at 22 years" or "always" on aBMD. RESULTS: Among men, the largest coefficients were observed for BMI, followed by lean mass and fat mass. Compared to fat mass, lean mass presented the largest coefficients for all sites, with the strongest associations observed for the femoral neck (ß: 0.035 g/cm2; 95% CI: 0.031; 0.039 for both follow-ups), while the largest effect for FMI was observed for whole-body aBMD at 18 years (ß: 0.019 g/cm2; 95% CI: 0.014; 0.024). Among women, the strongest associations were observed for LMI. The largest coefficients for LMI and FMI were observed for femoral neck at age 18, presented ß: 0.030 g/cm2, 95% CI: 0.026, 0.034 for LMI and ß: 0.012 g/cm2; 95% CI: 0.009; 0.015) for FMI. Men who were "always obese" according to FMI had smallest aBMD for spine (ß: -0.014; 95%CI: - 0.029; - 0.001). Women who were obese "only at 18 years" had smallest aBMD for the whole-body (ß: -0.013; 95%CI: - 0.023; - 0.002), whereas those who were obese "only at 22 years" had larger whole-body and femoral neck aBMD (ß: 0.013; 95%CI: 0.009; 0.017 and ß: 0.027; 95%CI: 0.016; 0.038, respectively) and those "always obese" for whole-body aBMD (ß: 0.005; 95%CI: 0.001; 0.011) compared to the reference category. CONCLUSIONS: The indexes were positively associated with aBMD in this sample. Fat mass had smaller positive influence on these outcomes than lean mass, suggesting the most important body composition component for bone density is the lean mass.

Early pregnancy body mass index modifies the association of pre-pregnancy dietary patterns with serum polyunsaturated fatty acid concentrations throughout pregnancy in Brazilian women.

Dietary patterns (DPs) have been described as an important factor that may influence polyunsaturated fatty acid (PUFA) concentrations and body mass index (BMI) during pregnancy. We aim to evaluate the association between pre-pregnancy DPs and serum PUFA percentages throughout pregnancy considering early pregnancy BMI as a possible effect modifier. A prospective cohort of 154 pregnant women was followed (5th-13th, 20th-26th, and 30th-36th gestational weeks). Serum PUFA concentrations (total n-3 and total n-6, eicosapentaenoic + docosahexaenoic acids) were measured in each trimester and expressed as percentages. The n-6/n-3 ratio was calculated. Longitudinal linear mixed-effects models including interaction terms between DPs and early pregnancy BMI were employed. Serum PUFA percentages declined, whereas the n-6/n-3 ratio, monounsaturated, and saturated percentages increased throughout pregnancy for all BMI categories. Three pre-pregnancy DPs were identified by principal component analysis (common Brazilian, healthy, and processed). Overweight women with higher adherence to the common-Brazilian and to the healthy DPs presented reduced n-3 PUFA percentage and increased n-6 percentages and n-6/n-3 ratio compared to under or normal weight women. Obese women with higher adherence to the processed DP presented a more pronounced decrease of total n-3 percentage compared to under or normal weight women. Early pregnancy BMI modified the effect of pre-pregnancy DPs on PUFA profile throughout gestation. Higher adherence to the healthy pattern was associated with increased n-3 percentage, except for overweight women. Only for processed DP was the behaviour of PUFA the same for all BMI categories, showing a worse evolution profile, that is, increased n-6 and reduced n-3 fractions.

High Consumption of Sugar-Sweetened Beverages Is Associated with Low Bone Mineral Density in Young People: The Brazilian Birth Cohort Consortium.

Sugar-sweetened beverages (SSB) consumption may be associated with a reduction in bone mineral density (BMD). The aim of this study was to evaluate the association between the consumption of SSB and BMD among young people. We performed a cross-sectional study that evaluated 6620 young people (18-23 years of age) from three Brazilian birth cohorts (Ribeirão Preto, Pelotas, and São Luís). We analyzed the daily frequency and the amount and energy contribution of the SSB, which were obtained through a food frequency questionnaire. Total body and lumbar spine BMD (g/cm2), measured by dual-energy X-ray absorptiometry, were the outcomes. Unadjusted linear regression models, adjusted for sex, socioeconomic class, physical activity, smoking, alcohol consumption, and body mass index were used. The highest tertile of SSB consumption frequency (2.1-16.7 times/day) was associated with a lower lumbar spine BMD (ß = -0.009; 95% CI: -0.017; -0.001; standardized ß = -0.03). This association persisted after adjustment for confounders (ß = -0.008; 95% CI: -0.016; -0.001; standardized ß = -0.03). No association was observed between SSB consumption frequency and total body BMD or between the amount and energy contribution of SSB and total body or lumbar spine BMD. A high frequency of SSB consumption was associated with a low lumbar spine BMD.

Do inflammation and adiposity mediate the association of diet quality with depression and anxiety in young adults?

BACKGROUND & AIMS: Diet quality has been inversely associated with depression, but less is known about its association with anxiety and about the mechanisms involved in the association between diet and mental health. This study aimed to assess the associations of diet quality with major depressive disorder (MDD) and generalized anxiety disorder (GAD) in young adults, and to explore whether inflammation, indexed by interleukin-6 (IL-6) and C-reactive protein (CRP), and body mass index (BMI) mediate this association. METHODS: We used data of 3331 participants from the 1993 Pelotas Birth Cohort (Brazil). Data on dietary intake and inflammatory markers were assessed at 18 years, and information on mental disorders was obtained at both 18 and 22 years. A food frequency questionnaire was used to assess dietary intake, and diet quality was estimated using the Brazilian Healthy Eating Index - Revised (BHEI-R). The occurrence of MDD and GAD was assessed using the Mini International Neuropsychiatric Interview (MINI), conducted by psychologists. The associations of diet quality, BMI and inflammatory markers with mental disorders were explored using logistic regression. The mediation analysis was performed using structural equation modelling. RESULTS: A one standard deviation increase in the diet quality score at age 18 years was associated with both lower levels of CRP (-0.06 mg/L; 95% CI: -0.10; -0.008) at 18 years and 23% lower odds of MDD at 22 years (OR: 0.77; 95% CI: 0.61; 0.97). No association was found between diet quality score and both BMI and GAD. Obesity was associated with higher odds of MDD, but CRP and IL-6 were not associated with MDD or GAD. Our results provide no evidence that inflammatory markers and BMI mediate the association between diet quality and MDD in young adults. CONCLUSIONS: A better diet quality is associated with lower occurrence of MDD among young adults, but we did not find evidence that inflammatory markers and BMI mediate this association.

Serum fatty acids are positively associated with changes in systemic blood pressure throughout pregnancy.

OBJECTIVES: To assess whether serum concentrations of saturated (SFAs), polyunsaturated (PUFAs), and monounsaturated (MUFAs) fatty acids are associated with changes in blood pressure (BP) throughout pregnancy. STUDY DESIGN: Prospective cohort. MAIN OUTCOME MEASURES: Longitudinal measurements of systolic (SBP) and diastolic (DBP) BP. METHODS: Two hundred twenty-three healthy pregnant women were recruited in a public health center in Rio de Janeiro, Brazil between 2009 and 2011. Fasting blood samples and BP measurements were obtained at the 1st (5th-13th weeks), 2nd (20th-26th) and 3rd trimester (30th-36th). Crude and adjusted (maternal age, education, energy intake, gestational body weight change, leptin concentrations, early pre-pregnancy BMI, leisure time physical activity prior to pregnancy and linear and quadratic gestational weeks) longitudinal linear mixed-effects models were employed. RESULTS: SBP and DBP decreased from the 1st to the 2nd trimester and slightly increased from the 2nd to the 3rd trimester (P < 0.001). In the adjusted model (ß and 95% CI), total SFAs [0.005 (0.001-0.008); P = 0.008], total MUFAs [0.005 (0.001-0.009); P = 0.019] and total n-6 PUFAs [0.005 (0.001-0.009); P = 0.025] were positively associated with SBP throughout pregnancy. CONCLUSIONS: Maternal serum concentrations of total SFAs, MUFAs and n-6 PUFAs were positively associated with BP levels in normotensive pregnant women.