Abstract
BackgroundCesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI.Objective: To assess the association between CS and indicators of peripheral and central adiposity in young adults.MethodsThe study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables.ResultsFollow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF.ConclusionSubjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.
Highlights
Over the last years, the prevalence of overweight and obesity has increased in the world population [1,2]
The accumulation of visceral or central fat has been shown to be a better predictor of adult morbidity than obesity alone measured by body mass index (BMI), justifying the use of indicators related to visceral fats such as waist circumference (WC) and waist/height ratio (WHtR) [5]
Subjects born by Cesarean section (CS) had greater proportions of increased indicators of adiposity than subjects born by vaginal delivery (p,0.05)
Summary
The prevalence of overweight and obesity has increased in the world population [1,2]. A systematic analysis of the worldwide trends in body mass index (BMI) for adults 20 years old and older in 199 countries and territories between 1980 and 2008 showed that, despite a substantial variation in BMI between nations, mean BMI has increased on average 0.4 kg/m2 per decade for men and 0.5 kg/m2 per decade for women over the period [3]. This increase is observed in the excessive accumulation of subcutaneous and visceral fat, which greatly contributes to metabolic complications and to adverse effects on health [4]. Objective: To assess the association between CS and indicators of peripheral and central adiposity in young adults
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