Bogalusa Heart Study Research Articles

Correlates of age onset of type 2 diabetes among relatively young black and white adults in a community: the Bogalusa Heart Study.

OBJECTIVEThe risk factors for middle-age onset of type 2 diabetes are well known. However, information is scant regarding the age onset of type 2 diabetes and its correlates in community-based black and white relatively young adults.RESEARCH DESIGN AND METHODSThis prospective cohort study consisted of normoglycemic (n = 2,459) and type 2 diabetic (n = 144) adults aged 18–50 years who were followed for an average of 16 years.RESULTSThe incidence rate of the onset of type 2 diabetes was 1.6, 4.3, 3.9, and 3.4 per 1,000 person-years for age-groups 18–29, 30–39, and 40–50 and total sample, respectively. Incidences of diabetes increased with age by race and sex groups (P for trend ≤0.01); higher in black females versus white females and blacks versus whites in total sample (P < 0.05). In a multivariable Cox model, baseline parental diabetes (hazard ratio [HR] 5.24) and plasma insulin were significantly associated with diabetes incidence at the youngest age (18–29 years); black race, BMI, and glucose at age 30–39 years; female sex, parental diabetes (HR 2.44), BMI, ratio of triglycerides and HDL cholesterol (TG/HDL-C ratio), and glucose at age 40–50 years; and black race, parental diabetes (HR 2.44), BMI, TG/HDL-C ratio, and glucose in whole cohort. Further, patients with diabetes, regardless of age onset, displayed a significantly higher prevalence of maternal history of diabetes at baseline (P < 0.01).CONCLUSIONSIn relatively young adults, predictability of baseline cardiometabolic risk factors along with race, sex, and parental history of diabetes for the onset of type 2 diabetes varied by age-group. These findings have implications for early prevention and intervention in relatively young adults.

Is the body adiposity index (hip circumference/height1·5) more strongly related to skinfold thicknesses and risk factor levels than is BMI? The Bogalusa Heart Study

Because of its strong association (r 0.85) with percentage of body fat determined by dual-energy X-ray absorptiometry, hip circumference divided by height(1.5) (the body adiposity index) has recently been proposed as an index of body fatness among adults. We examined whether this proposed index was more strongly associated with skinfold thicknesses and levels of CVD risk factors (lipids, fasting insulin and glucose, and blood pressure) than was BMI among 2369 18- to 49-year-olds in the Bogalusa Heart Study. All analyses indicated that the body adiposity index was less strongly associated with skinfold thicknesses and CVD risk factors than was either waist circumference or BMI. Correlations with the skinfold sum, for example, were r 0.81 (BMI) v. r 0.75 (body adiposity index) among men, and r 0.87 (BMI) v. r 0.80 among women; P< 0.001 for both differences. An overall index of seven CVD risk factors was also more strongly associated with BMI (r 0.58) and waist circumference (r 0.61) than with the body adiposity index (r 0.49). The weaker associations with the body adiposity index were observed in analyses stratified by sex, race, age and year of examination. Multivariable analyses indicated that if either BMI or waist circumference were known, the body adiposity index provided no additional information on skinfold thicknesses or risk factor levels. These findings indicate that the body adiposity index is likely to be an inferior index of adiposity than is either BMI or waist circumference.

Abstract MP085: Genotype Predicts Type 2 Diabetes in Adulthood in a Biracial Adolescent Population

Background Prediction of type 2 diabetes (T2D) early in the life course, before metabolic derangements occur, might facilitate prevention. In middle-aged adults, genotype risk scores (GRS) predict incident T2D but do not outperform prediction models consisting of clinical variables such as family history, body-mass index (BMI), and routine laboratory tests. Unlike clinical predictors and even family history, however, genotype does not change over the life course. We hypothesized that a diabetes GRS predicts incident adult T2D from adolescence and that the addition of this GRS improves T2D prediction models based on clinical adolescent risk factors alone. Methods The biracial Bogalusa Heart Study is a geographically based cohort study of children aged 4 to 18 years followed serially into adulthood. We limited the present analyses to participants seen in adolescence and followed into adulthood for whom genotype information was available. The baseline examination was the first assessment for each participant after age 12 years. Participants with childhood or type 1 diabetes were excluded. Incident T2D was defined as a fasting glucose ≥126 mg/dL or diabetes treatment after age 19 years. We used Cox regression to build nested T2D prediction models based on clinical risk factors assessed in adolescence (parental history of diabetes, BMI z -score, mean arterial pressure, fasting glucose, HDL cholesterol, and triglycerides) with and without a 38-variant GRS. We used likelihood ratios tests (LRT), differences in C statistics (ΔC), and net reclassification improvement indices (NRI) to assess whether GRS improved prediction in each model. Results Mean age at baseline was 14.4 years (range 12 to 19). Of the 1056 participants, 585 (55%) were girls, and 340 (32%) were black. Ninety (8.5%) developed T2D over a mean 26.3 years of follow-up. GRS significantly predicted incident T2D in all models, with hazard ratios of 1.09 per risk allele (95% CI 1.03, 1.15) in the basic demographic model and 1.06 (95% CI 1.00, 1.13) in the full model. The addition of GRS to all models improved model fit (all LRT p &lt;0.05) but not discrimination (all ΔC p &gt;0.05). The addition of GRS to the demographic model significantly improved the risk classification of the cohort (NRI 24.8%, 95% CI 8.3, 41.7%), but this reclassification was not significant when GRS was added to the full model (NRI 3.9%, 95% CI -5.0, 13.9%). Moreover, the GRS did not meaningfully improve prediction in a model which included only demographics and parental history of diabetes (NRI 0.8%, 95% CI -13.0, 16.0%). We found no interaction between race and GRS in any model (all p &gt;0.05). Conclusions Knowledge of genotype predicts adult T2D in white and black adolescents. Genotype does not meaningfully improve prediction over routinely collected clinical risk factors, including parental history.

An Evidence-Based Review of Exercise and Metabolic Syndrome

An Evidence-Based Review of Exercise and Metabolic Syndrome

Nonparametric Evaluation of Quantitative Traits in Population-Based Association Studies when the Genetic Model is Unknown

Statistical association between a single nucleotide polymorphism (SNP) genotype and a quantitative trait in genome-wide association studies is usually assessed using a linear regression model, or, in the case of non-normally distributed trait values, using the Kruskal-Wallis test. While linear regression models assume an additive mode of inheritance via equi-distant genotype scores, Kruskal-Wallis test merely tests global differences in trait values associated with the three genotype groups. Both approaches thus exhibit suboptimal power when the underlying inheritance mode is dominant or recessive. Furthermore, these tests do not perform well in the common situations when only a few trait values are available in a rare genotype category (disbalance), or when the values associated with the three genotype categories exhibit unequal variance (variance heterogeneity). We propose a maximum test based on Marcus-type multiple contrast test for relative effect sizes. This test allows model-specific testing of either dominant, additive or recessive mode of inheritance, and it is robust against variance heterogeneity. We show how to obtain mode-specific simultaneous confidence intervals for the relative effect sizes to aid in interpreting the biological relevance of the results. Further, we discuss the use of a related all-pairwise comparisons contrast test with range preserving confidence intervals as an alternative to Kruskal-Wallis heterogeneity test. We applied the proposed maximum test to the Bogalusa Heart Study dataset, and gained a remarkable increase in the power to detect association, particularly for rare genotypes. Our simulation study also demonstrated that the proposed non-parametric tests control family-wise error rate in the presence of non-normality and variance heterogeneity contrary to the standard parametric approaches. We provide a publicly available R library nparcomp that can be used to estimate simultaneous confidence intervals or compatible multiplicity-adjusted p-values associated with the proposed maximum test.

Genetic Profiling Using Genome-Wide Significant Coronary Artery Disease Risk Variants Does Not Improve the Prediction of Subclinical Atherosclerosis: The Cardiovascular Risk in Young Finns Study, the Bogalusa Heart Study and the Health 2000 Survey – A Meta-Analysis of Three Independent Studies

BackgroundGenome-wide association studies (GWASs) have identified a large number of variants (SNPs) associating with an increased risk of coronary artery disease (CAD). Recently, the CARDIoGRAM consortium published a GWAS based on the largest study population so far. They successfully replicated twelve already known associations and discovered thirteen new SNPs associating with CAD. We examined whether the genetic profiling of these variants improves prediction of subclinical atherosclerosis – i.e., carotid intima-media thickness (CIMT) and carotid artery elasticity (CAE) – beyond classical risk factors.Subjects and MethodsWe genotyped 24 variants found in a population of European ancestry and measured CIMT and CAE in 2001 and 2007 from 2,081, and 2,015 subjects (aged 30–45 years in 2007) respectively, participating in the Cardiovascular Risk in Young Finns Study (YFS). The Bogalusa Heart Study (BHS; n = 1179) was used as a replication cohort (mean age of 37.5). For additional replication, a sub-sample of 5 SNPs was genotyped for 1,291 individuals aged 46–76 years participating in the Health 2000 population survey. We tested the impact of genetic risk score (GRS24SNP/CAD) calculated as a weighted (by allelic odds ratios for CAD) sum of CAD risk alleles from the studied 24 variants on CIMT, CAE, the incidence of carotid atherosclerosis and the progression of CIMT and CAE during a 6-year follow-up.ResultsCIMT or CAE did not significantly associate with GRS24SNP/CAD before or after adjusting for classical CAD risk factors (p>0.05 for all) in YFS or in the BHS. CIMT and CAE associated with only one SNP each in the YFS. The findings were not replicated in the replication cohorts. In the meta-analysis CIMT or CAE did not associate with any of the SNPs.ConclusionGenetic profiling, by using known CAD risk variants, should not improve risk stratification for subclinical atherosclerosis beyond conventional risk factors among healthy young adults.

Obesity and implications for future generations

There is little debate that obesity has reached epidemic proportions. At last count, at least one-third of adults in the United States were obese, and all states, except Colorado, have experienced a doubling in obesity rates from 1980-2007. Should this upward spiral ontinue, projections for 2030 suggest 0% and 80% of the worldwide populaion will be obese or overweight, respecively. Several methods define obesity skin fold, % of ideal body weight, waist: ip ratios, body mass index [BMI]); owever, BMI (weight [kg]/height [m) s the most often used method, which denes a BMI of 24.6 kg/m as overweight and of 30 kg/m as obese. To lace this in perspective, a weight of 12454 lbs is a normal BMI for a woman ho is 5 feet 6 inches tall. Remarkably, 0% of adult women are unable to mainain their weight within the range of a ormal BMI. The prevalence of obesity during pregnancy has prompted the Institute of Medicine (IOM) to recommend new guidelines for gestational weight gain (GWG) during pregnancy. Nonetheless, obesity that is independent of GWG has been associated with adverse outcomes for both mother (miscarriage, thromboembolism, diabetes mellitus, preeclampsia, hemorrhage, cesarean section delivery, wound infection) and infant (congenital anomalies, stillbirth, neonatal death). Adherence to the IOM GWG guidelines, however, is difficult for many women. In a population-based study that assessed GWG, Chu et al demonstrated that approximately 40% of normal weight women and 60% of overweight women gained more weight during pregnancy than recommended. Obese women gained less weight as a group compared with the normal and overweight groups; however, approximately 25% still exceeded IOM recommendations. In addition, GWG was increased in women who were 19 years old, white, or 12 years of education. If pregnancy can be considered a window to future health, excessive GWG is a first glimpse at unhealthy trends that lead to adverse outcomes that are associated with obesity. An examination of the Danish National Birth Cohort by Nohr et al identified GWG as a determinant of long-term obesity. Obese women with GWG of 10 kg were below their prepregand were able to reduce their BMI; by contrast, 12% of overweight and 14% of obese women with excessive GWG, respectively, moved up a BMI category. Each successive pregnancy potentially allows for successive weight gain that perpetuates the obesity cycle and increases risks for cardiovascular disease, metabolic syndrome, and diabetes mellitus in later life. If the window during pregnancy provides a picture of adverse health consequences for mothers, what vision is revealed for the offspring? The increase in obesity of children mirrors the epidemic rise that is seen in adults. In adults, obesity is defined using a BMI cutoff of 30 kg/m; the more acceptable definition of obesity for children is a BMI of 95th percentile, specific for age and gender. Overweight is defined as a BMI between the 85th and 95th percentiles. Data suggest that 37.1% of infants are overweight and that 16.9% of children and adolescents are obese. In addition, evidence suggests that the trend toward obesity starts as early as 6 weeks. Using a nested case control design, McCormick et al demonstrated a 16% prevalence of infant obesity and also noted children who were obese at age 24 months were more likely to have been obese at age 6 months (odds ratio, 13.3; 95% confidence interval, 4.50– 39.53). Although additional evidence will be needed, this study suggests that interventions for obesity may need to be initiated early in infancy. The Bogalusa Heart Study included 12,000 children. EightyFrom the Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX. The author reports no conflict of interest. Presidential address presented at the 78th Annual Meeting of the Central Association of Obstetricians and Gynecologists, Nassau, Bahamas, Oct. 26-29, Reprints: Gayle Olson, MD, Department of Obstetrics & Gynecology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0587. golson@utmb.edu.

Gender Divergence on the Impact of Multiple Cardiovascular Risk Factors on the Femoral Artery Intima-Media Thickness in Asymptomatic Young Adults: The Bogalusa Heart Study

IntroductionGender divergence on the impact of multiple cardiovascular risk factors on the femoral artery intima-media thickness (IMT) has not been studied in a biracial (black-white) community-based asymptomatic young adults. MethodsFemoral IMT was measured by B-mode ultrasonography in 1080 individuals (age, 24–43years; 71% white; 43% men) enrolled in the Bogalusa Heart Study. ResultsFemoral IMT showed a gender difference (men>women; P=0.001), but no racial difference. In a multivariate model, age, cigarette smoking, systolic blood pressure and total cholesterol to high-density lipoprotein cholesterol ratio related independently, in that order, to IMT in women, and age and low-density lipoprotein cholesterol in men. In women, mean IMT increased with increasing number of risk factors defined as values above the age-, race- and gender-specific 75th percentile of systolic blood pressure, waist circumference, total cholesterol to high-density lipoprotein cholesterol ratio and insulin along with positive smoking status (P for trend=0.001), with respective mean IMT (mm) values of 0.61, 0.65, 0.72 and 0.77, for 0, 1 to 2, 3 and 4 to 5 risk factors. There was no such significant trend in men. ConclusionsAlthough men versus women had thicker IMT, the observed increasing trend of femoral IMT with increasing number of risk factors in asymptomatic young women suggests that women may be relatively more susceptible to the burden of multiple risk factors.

Model-specific tests on variance heterogeneity for detection of potentially interacting genetic loci

BackgroundTrait variances among genotype groups at a locus are expected to differ in the presence of an interaction between this locus and another locus or environment. A simple maximum test on variance heterogeneity can thus be used to identify potentially interacting single nucleotide polymorphisms (SNPs).ResultsWe propose a multiple contrast test for variance heterogeneity that compares the mean of Levene residuals for each genotype group with their average as an alternative to a global Levene test. We applied this test to a Bogalusa Heart Study dataset to screen for potentially interacting SNPs across the whole genome that influence a number of quantitative traits. A user-friendly implementation of this method is available in the R statistical software package multcomp.ConclusionsWe show that the proposed multiple contrast test of model-specific variance heterogeneity can be used to test for potential interactions between SNPs and unknown alleles, loci or covariates and provide valuable additional information compared with traditional tests. Although the test is statistically valid for severely unbalanced designs, care is needed in interpreting the results at loci with low allele frequencies.

Is the Measurement of Epicardial Fat in Obese Adolescents Valuable?

Is the Measurement of Epicardial Fat in Obese Adolescents Valuable?

Carotid Intimal–Medial Thickness in Active Professional American Football Players Aged 23 to 35 Years

Risk of cardiovascular disease and death in retired professional American football players may be higher than that in the general population. Previously published data have demonstrated that American football players have less glucose intolerance, less smoking, similar lipid profiles, and higher blood pressure despite a much larger body compared to the general population, although the presence of subclinical atherosclerosis in these subjects has not been evaluated. This study compared the prevalence of subclinical atherosclerosis in active professional American football players to that in age-, gender-, and race-matched controls derived from the Bogalusa Heart Study. Carotid intimal-medial thickness (CIMT) was used as an indicator of subclinical atherosclerosis in 75 active American football players (23 to 35 years old, 31 white, 44 African-American) as measured by B-mode ultrasonography at Mayo Clinic, Scottsdale, Arizona, on September 13 and 14, 2009. CIMT measurements of 75 athletes were compared to those of 518 matched controls who had CIMT determinations in 1995 and 1996. Two-group t tests determined population similarities between groups. In a generalized linear model, players (overall and by race) had lower CIMT values than controls after age and race adjustment (p <0.001 for all comparisons). Nonlinemen and linemen had lower CIMT values than controls (p < 0.001 and p = 0.004, respectively). In conclusion, active professional American football players, regardless of position, had mean CIMT values similar to or lower than those in a matched general population cohort, suggesting that if the prevalence of subclinical atherosclerosis is increased in retired professional American football players, this occurs after retirement.

C-reactive protein is an independent predictor for carotid artery intima-media thickness progression in asymptomatic younger adults (from the Bogalusa Heart Study)

BackgroundConflicting information exists regarding the association between hsCRP and the progression of early stages of atherosclerosis. The purpose of the study was to investigate the association of high sensitiviy c-reactive protein (hsCRP) along with major cardiovascular (CV) risk factors on early carotid atherosclerosis progression in a large, population-based cohort study.MethodsThe study cohort included 839 young adults (aged 24 to 43 years, 70% white, 42% men) enrolled in Bogalusa Heart Study, who in 2001-2002 attended baseline examination with measurements of CV risk factors. Progression of carotid artery intima-media thickness (IMT) was assessed during a mean follow-up of 2.4 years.ResultsCarotid artery IMT progression rates were as follows: composite carotid artery = 9.2 ± 52 μm/y, common carotid artery = 0.0 ± 51 μm/y, carotid bulb = 8.8 ± 103 μm/y, and internal carotid artery = 18.9 ± 81 μm/y. Elevated baseline hsCRP, reflecting an inflammatory state, showed independent association with composite carotid artery IMT progression. Increased age, systolic blood pressure, fasting glucose, LDL cholesterol, and current smoking were other risk associates of carotid artery IMT progression in young adults, indicating an underlying burden on the CV system by multiple risk factors.ConclusionIn this population-based study, we observed independent categorical association of increased hsCRP with carotid artery IMT progression in young adults. This study underlines the importance of assesssing hsCRP levels along with smoking and traditional CV risk factor profiles in asymptomatic young adults.

Prevalence of atherosclerotic plaque in young and middle-aged asymptomatic individuals: the Bogalusa heart study.

To determine the prevalence of carotid and femoral artery atherosclerotic plaque in a community-based population of asymptomatic African American and white men and women, with an age range of 29 to 51 years, and the potential relations with cardiovascular risk factors. Between 2007 and 2010, 914 subjects, 58% women and 69% white, who were part of the Bogalusa Heart Study, an ongoing study of a southern biracial community in Bogalusa, Louisiana, were followed up from childhood through adulthood and assessed for plaque formation using ultrasound. Of the total number of subjects, those with a history of cardiovascular/cerebrovascular events were excluded. Plaque prevalence ranged from 8% to 14%, with greater frequency in white men. Plaque formation was also associated with smoking, hypertension, diabetes mellitus, age, and white race, in descending order. In this population, studied sequentially since 1973, the presence of plaque correlated with widely recognized cardiovascular risk factors, although we did not detect significant contributions from either obesity or elevated lipids, including low-density lipoprotein cholesterol. It is possible that interventions, such as diet alteration and statin therapy, may have a positive impact on these potential contributors to plaque formation, and hypertension, diabetes mellitus and smoking remain of great importance.

Health Consequences of Obesity

Epidemiologic studies have established that cardiovascular (CV) risk factors including obesity are identifiable in childhood. Childhood risk factors are predictive of adult cardiac risk and even premature death [Franks et al. (2010) N Engl J Med 362:485-493]. In the United States, CV diseases remains the leading causes of death. In fact, heart disease has become the major cause of death worldwide, surpassing undernutrition and infectious diseases, largely related to obesity in childhood [Wang and Lobstein (2006) Int J Pediatr Obes 1:11-25]. The concept that adult heart diseases begin in childhood is an outgrowth of extensive long-term epidemiologic studies in youth, that is, the Bogalusa Heart Study [Berenson et al. (1986) Causation of cardiovascular risk factors in children: Perspectives on cardiovascular risk in early life, Raven Press Books Ltd].

Genetic Variants and Blood Pressure in a Population-Based Cohort

Clinical relevance of a genetic predisposition to elevated blood pressure was quantified during the transition from childhood to adulthood in a population-based Finnish cohort (N=2357). Blood pressure was measured at baseline in 1980 (age 3-18 years) and in follow-ups in 1983, 1986, 2001, and 2007. Thirteen single nucleotide polymorphisms associated with blood pressure were genotyped, and 3 genetic risk scores associated with systolic and diastolic blood pressures and their combination were derived for all of the participants. Effects of the genetic risk score were 0.47 mm Hg for systolic and 0.53 mm Hg for diastolic blood pressures (both P<0.01). The combination genetic risk score was associated with diastolic blood pressure from age 9 years onward (β=0.68 mm Hg; P=0.015). Replications in 1194 participants of the Bogalusa Heart Study showed essentially similar results. The participants in the highest quintile of the combination genetic risk score had a 1.82-fold risk of hypertension in adulthood (P<0.0001) compared with the lowest quintile, independent of a family history of premature hypertension. These findings show that genetic variants are associated with preclinical blood pressure traits in childhood; individuals with several susceptibility alleles have, on average, a 0.5-mm Hg higher blood pressure, and this trajectory continues from childhood to adulthood.

Dietary, Lifestyle, and Health Correlates of Overweight and Obesity in Adults 19 to 39 Years of Age

Diet and lifestyle factors of young adults and their relationship to health risk factors are understudied. Data from the Bogalusa Heart Study population (n = 1214; 19-39 years; 74.1% white; 60.8% female) were used to study associations of lifestyle, health risk factors, and reported health problems with the National Institutes of Health body mass index (BMI) categories of normal, overweight, and obese. Data from self-reported questionnaires and laboratory measures were evaluated using covariate-adjusted multinomial logistic regression and analysis of covariance, linear trend test, and the Cochran–Armitage trend test. Obese individuals had lower odds of consuming high-fat dairy products (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.62-0.96) and fruit/fruit juice/vegetables (OR = 0.83; CI = 0.75-0.93) and had higher odds of consuming hamburgers/sandwiches (OR = 2.81; CI = 1.52-5.20); processed meats (OR = 6.95; CI = 2.20-21.96); and sweetened (OR = 1.20; CI = 1.01-1.43) or diet beverages (OR = 1.27; CI = 1.02-1.58) than those of normal weight. Obese participants also had higher odds of being physically inactive versus being very active (OR = 2.65; CI = 1.64-4.29). Mean serum total and low-density lipoprotein cholesterol, triglycerides, apolipoprotein-B, and insulin resistance were higher ( P &lt; .05 for all) in the overweight/obese when compared with normal weight individuals. Values were higher in those with higher weight status (linear trend P &lt; .0001 for all). Self-reported health problems also increased with BMI. Interventions to improve diet and physical activity patterns among overweight/obese adults in this age group are needed.

The association of variants in the FTO gene with longitudinal body mass index profiles in non-Hispanic white children and adolescents

ObjectiveTo investigate possible age-related changes in associations between polymorphisms in the fat mass and obesity-associated (FTO) gene and higher body mass index (BMI).Design and SubjectsMultilevel mixed regression models were used to examine associations between four FTO variants and longitudinal BMI profiles in non-Hispanic white and African American children and adolescents 8 - 17 years of age from two different longitudinal cohort studies, the Bogalusa Heart Study (BHS) and Project HeartBeat! (PHB). In the BHS, there were 1551 examinations of 478 African Americans and 3210 examinations of 1081 non-Hispanic whites; in PHB, there were 971 examinations of 131 African Americans and 4458 examinations of 505 non-Hispanic whites.ResultsIn African Americans, no significant FTO associations with BMI were found. In non-Hispanic whites, linkage disequilibrium among all four variants made haplotype analysis superfluous, so we focused on the single-nucleotide polymorphism (SNP), rs9939609. In longitudinal multilevel models, the A/A genotype of rs9939609 was associated with higher BMI in non-Hispanic whites in both cohorts at all ages. A significant age-by-genotype interaction found only in the BHS cohort predicted that in those with the A/A genotype, BMI would be approximately 0.7 kg/m2 higher at age 8, and approximately 1.6 kg/m2 higher at age 17 than in those with A/T or T/T genotypes. The design of Project HeartBeat! limited follow-up of any single individual to four years, and may have reduced the ability to detect any age-by-genotype interaction in this cohort.ConclusionsThe A/A genotype of rs9939609 in the FTO gene is associated with higher longitudinal BMI profiles in non-Hispanic whites from two different cohorts. The association may change with age, with the A/A genotype being associated with a larger BMI difference in late adolescence than in childhood, though this was observed only in the Bogalusa Heart Study cohort and requires verification.

Reduction of risk for cardiovascular disease in children and adolescents.

Atherosclerotic cardiovascular disease (CVD) is the number 1 cause of death in the United States and other developed nations.1 After decades of study, risk factors for the development of atherosclerotic CVD have been identified. These risk factors include older age, male sex, a positive family history, hypertension, dyslipidemia, diabetes mellitus, cigarette smoking, and obesity.2 As these risk factors have been studied, it has become clear that both genetics and lifestyle are important contributors to increased risk. The primary lifestyle components are diet, physical activity, and smoking. A fundamental issue has been the timing of the development of atherosclerosis. Timing is critical because it determines, at least in part, when interventions should occur. Both the prevention of risk factor development (primordial prevention) and modification of risk factors once they are established (primary prevention) are important. An impediment to understanding the development of atherosclerosis has been the lack of simple, noninvasive methods to follow the atherosclerotic process longitudinally. This problem led to the Bogalusa Heart Study and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY).3–6 These pathology studies investigated the aorta and coronary arteries in autopsies of young individuals who died of accidental causes. The investigators were able to evaluate the extent of atherosclerosis and the presence of risk factors. They found that even relatively advanced levels of atherosclerosis, including fibrous plaques, can be present in adolescents and young adults. They also found that increased body mass index (BMI), systolic and diastolic blood pressures, and low-density lipoprotein cholesterol (LDL-C); low levels of high-density lipoprotein cholesterol (HDL-C); diabetes mellitus; and the presence of cigarette smoking were all associated with greater atherosclerotic plaque coverage and more advanced atherosclerotic lesions.3–6 Subsequent studies using noninvasive measures of atherosclerosis, including carotid intima-medial thickness (CIMT) and arterial distensibility, have resulted …

The Relationship Between Obesity and Complications After Neonatal Circumcision

Penile adhesions with hidden penis and penile skin bridges are complications after neonatal circumcision that seem to develop more often in overweight children. They could possibly be avoided if there were neonatal parameters predicting circumcision complications. We hypothesized that penile adhesions with hidden penis and skin bridges may be predicted by the height and weight of a newborn. We performed an institutional review board approved case-control study. Boys younger than 5 years who presented for evaluation of penile adhesions with hidden penis and/or penile skin bridges after newborn circumcision were compared to boys of the same age who were circumcised at birth and did not have penile adhesions with hidden penis and/or skin bridges when evaluated for cryptorchidism or hernia/hydrocele. Weight for length percentiles were compared at birth and at urological evaluation. We evaluated 51 patients with penile adhesions and hidden penis after newborn circumcision, and compared them to 33 age matched controls. Boys with hidden penis had a statistically higher weight for length percentile at birth and at urological evaluation. However, in boys with penile skin bridges there was no statistical difference in the weight for length percentile at either time. An increased weight for length percentile in male infants before and after circumcision may be associated with penile adhesions with hidden penis but not penile skin bridges. These parameters should be considered before newborn circumcision when counseling parents, and after circumcision since early recognition of obesity might indicate the need for diligent genital hygiene to try to prevent post-circumcision complications.

Obesity Prevention and Treatment

Obesity Prevention and Treatment