Abstract
The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.
Highlights
While body fat is an important indicator of overweight-related diseases, the location of such fat seems to be of greater significance 1
It was possible to verify that the adolescents who returned to assess their body composition with dual X-ray energy absorptiometry (DXA) were mostly male, those with mothers who had 9 and 12 years of schooling in 1997/1998 (OR = 1.44; 95%CI: 1.07; 1.95) and those whose mother had performed prenatal care (OR = 1.69; 95%CI: 1.41; 2.50) (Table 1)
There were no significant differences in the central adiposity indicators evaluated by DXA: total fat mass ratio (T/T), android-to-gynoid fat mass ratio (A/G); to-limb fat mass ratio (T/Lb) and to-leg fat mass ratio (T/Lg)
Summary
While body fat is an important indicator of overweight-related diseases, the location of such fat seems to be of greater significance 1. The accumulation of adipose tissue in the central region of the body compared to peripheral fat is more closely associated with an increase in chronic noncommunicable diseases 2. This is because central fat, due to its visceral component, undergoes lipolysis more releasing greater amounts of inflammatory lipids and adipokines into the bloodstream 3. One of the possible mechanisms proposed for this association is that nonvaginal birth could cause unfavorable changes in the intestinal microbiota 7 This change would lead to intestinal dysbiosis, which could affect metabolism and energy storage and be considered a link between genetics and the environment in the development of excess weight 8
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