Adult Cardiometabolic Disease Research Articles

Supplemental Material for Cumulative Childhood Adversity and Adult Cardiometabolic Disease: A Meta-Analysis

Supplemental Material for Cumulative Childhood Adversity and Adult Cardiometabolic Disease: A Meta-Analysis

Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood: associations and potential explanations

BackgroundEvidence of the association between childhood maltreatment and risk of adult cardiometabolic disease is sparse. We investigated associations of different forms of child maltreatment with adult cardiometabolic markers and potential explanations. MethodsIn the 1958 British birth cohort, we tested associations of childhood neglect (ascertained at age 7 years and 11 years) and abuse (physical, sexual, psychological, self-reported at 45 years) with adult (45 years) cardiometabolic markers (blood pressure, lipids, glycated haemoglobin [HbA1c]) using linear and logistic regressions. Models were adjusted, first for factors affecting measurements (eg, room temperature, postal delay of blood sample, and for women oral contraception and hormone replacement therapy) and early life factors (eg, birthweight, socioeconomic status) and second for explanatory factors (change in body-mass index from childhood to adulthood, adult socioeconomic status, lifestyles, mental health). We applied multiple imputation to missing data on neglect and covariates, and restricted analyses to individuals with observed cardiometabolic data. FindingsAmong 9349 participants (4650 men, 4699 women), 12% (1143) reported any form of abuse. Prevalence for sexual abuse was 1·6% (149), physical abuse 6·0% (565), and psychological abuse 10·0% (926), and 1627 (17·4%) had two or more indicators of childhood neglect. Childhood neglect was associated in adulthood with raised triglycerides by 3·9% (95% CI 0·4–7·4) and HbA1c by 1·2% (0·4–2·0), and for women lower HDL by 0·05 mmol/L (0·01–0·08), after adjusting for early life covariates. Physical abuse was associated with increased risk of high LDL (odds ratio [OR] 1·24, 95% CI 1·00–1·55) and raised HbA1c in men by 2·4% (0·6–4·2), and lower HDL in women by 0·06 mmol/L (0·01–0·12). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. Psychological abuse was associated with increased risk of high triglycerides (OR 1·23, 1·03–1·46) and low HDL by 0·04 mmol/L (0·01–0·07). Maltreatment was not associated with raised blood pressure. All associations disappeared after further adjustment: adult lifestyle was a key explanatory factor for most associations, adult socioeconomic status was important for associations with neglect but not abuse, body-mass index was important for neglect and physical abuse, and mental health was important for psychological abuse. InterpretationChildhood maltreatments were associated with poor lipid and HbA1c profiles decades later in adulthood in this population cohort. Explanations for associations varied by form of maltreatment. Further work is needed on the role of life-course explanatory factors and on effective strategies to reduce or prevent long-term health consequences of maltreatment. FundingThis work was funded by the Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health. Data collection for participants at age 45 years was funded by the Medical Research Council (grant G0000934).

Genome-wide associations for birth weight and correlations with adult disease.

Birth weight (BW) has been shown to be influenced by both fetal and maternal factors and in observational studies is reproducibly associated with future risk of adult metabolic diseases including type 2 diabetes (T2D) and cardiovascular disease. These life-course associations have often been attributed to the impact of an adverse early life environment. Here, we performed a multi-ancestry genome-wide association study (GWAS) meta-analysis of BW in 153,781 individuals, identifying 60 loci where fetal genotype was associated with BW (P < 5 × 10-8). Overall, approximately 15% of variance in BW was captured by assays of fetal genetic variation. Using genetic association alone, we found strong inverse genetic correlations between BW and systolic blood pressure (Rg = -0.22, P = 5.5 × 10-13), T2D (Rg = -0.27, P = 1.1 × 10-6) and coronary artery disease (Rg = -0.30, P = 6.5 × 10-9). In addition, using large -cohort datasets, we demonstrated that genetic factors were the major contributor to the negative covariance between BW and future cardiometabolic risk. Pathway analyses indicated that the protein products of genes within BW-associated regions were enriched for diverse processes including insulin signalling, glucose homeostasis, glycogen biosynthesis and chromatin remodelling. There was also enrichment of associations with BW in known imprinted regions (P = 1.9 × 10-4). We demonstrate that life-course associations between early growth phenotypes and adult cardiometabolic disease are in part the result of shared genetic effects and identify some of the pathways through which these causal genetic effects are mediated.

PP.29.19] VISFATIN SERUM LEVEL AND EXPRESSION IN SUBCUTANEOUS AND VISCERAL ADIPOSE TISSUE IN PREPUBERTERTAL BOYS

Objective: Childhood obesity presents a risk factor for adult atherosclerosis, hypertension and cardiometabolic diseases. Visfatin, an adipocytokine with inflammatory/enzymatic properties, is involved in atherogenesis and adipose tissue angiogenesis. Predominantly produced in visceral adipose tissue (VAT), less in subcoutaneous adipose tissue (SAT), muscles, liver, cardiac cells, peripheral blood neutrophils. In adolescents and adults is a part of metabolic syndrome and could present a marker of visceral adiposity. The aims of study were to determine the physiological values of serum visfatin concentrations, visfatin mRNA expression in SAT and VAT in childhood and its relation to anthropometric/metabolic/blood pressure (BP) level. Design and method: The study included 59 healthy boys, hospitalized for elective surgery, divided according to age into group I (1-3 years old), group II (3-7 years old) and group III (7-10 years old). Anthropometric, biochemical and BP measurements were done to all patients. The total visfatin serum were determined by ELISA immunoassay test, and mRNA level in SAT and VAT by real-time PCR. Results: Body weight and height were significantly different in all age groups, where body mass index was statistically higher in the third age group (p = 0.011). All groups statistically differ from each other in waist circumference (p < 0.001), but without difference in waist-to-hip ratio (p = 0.099). Group III had statistically higher systolic BP compared with groups I and II (p = 0.003), but the diastolic BP was statistically higher only in group III compared with group I (p = 0.009), all in the normal range values. Fasting morning glucose level, CRP, triglycerides, cholesterol, LDL and HDL levels did not significantly differ between groups, also as serum visfatin concentrations. Visfatin mRNA expression was higher in SAT compared with VAT in all three groups. Conclusions: The included subjects were metabolically healthy with normal glucose level, lipidogram and systolic/diastolic BP. Lack of correlation of visfatin serum level and mRNA expression in SAT and VAT with BP and metabolic parametars can be explained by the underdeveloped inflammation of adipose tissue, indicating that the maturation physiology and ageing process have an important part in the development of pathophysiological processes.

Childhood Infections, Socioeconomic Status, and Adult Cardiometabolic Risk.

Socioeconomic disadvantage throughout the life course is associated with increased risk of cardiometabolic diseases, but traditional risk factors do not fully account for the social gradient. We investigated the interactions between low socioeconomic status (SES) and infection in childhood and adverse cardiometabolic parameters in adulthood. Participants from the Cardiovascular Risk in Young Finns Study, a cohort well phenotyped for childhood and adulthood cardiometabolic risk factors and socioeconomic parameters, were linked to lifetime hospitalization data from birth onward available from the Finnish National Hospital Registry. In those with complete data, we investigated relationships between infection-related hospitalization in childhood, SES, and childhood and adult cardiometabolic parameters. The study cohort consisted of 1015 participants (age range 3-18 years at baseline and 30-45 years at follow-up). In adults who were raised in below-median income families, childhood infection-related hospitalizations (at age 0-5 years) were significantly associated with higher adult BMI (β ± SE comparing those with 0 vs ≥1 hospitalizations 2.4 ± 0.8 kg/m(2), P = .008), waist circumference (7.4 ± 2.3 cm, P = .004), and reduced brachial flow-mediated dilatation (-2.7 ± 0.9%, P = .002). No equivalent associations were observed in participants from higher-SES families. Infection was associated with worse cardiovascular risk factor profiles only in those from lower-SES families. Childhood infection may contribute to social gradients observed in adult cardiometabolic disease risk factors. These findings suggest reducing childhood infections, especially in socioeconomic disadvantaged children, may reduce the cardiometabolic disease burden in adults.

Early childhood social disadvantage is associated with poor health behaviours in adulthood

Background: Individual health behaviours are considered important risk factors for cardiometabolic diseases. These behaviours may be socially patterned by early exposure to social disadvantage, but few studies have prospectively tested this hypothesis empirically.Aim: This study investigated whether childhood social disadvantage was associated with likelihood of engaging in less healthy behaviours 40 years later.Subjects and methods: Prospective data were analysed from the New England Family Study, a 2005–2007 adult follow-up of a cohort initiated in 1959–1966 (n = 565). Childhood social environment (age 7 years) was assessed using a cumulative index of socioeconomic and family stability factors. Logistic regression models evaluated associations between social disadvantage and each health-related behaviour and obesity in adulthood.Results: Relative to low disadvantage, higher disadvantage was associated with 3.6-fold greater odds of smoking (95% CI = 1.9–7.0), 4.8-fold greater odds (in women only) of excess alcohol consumption (95% CI = 1.6–14.2) and 2.7-fold greater odds of obesity (95% CI = 1.3–5.5), but was not associated with unhealthy diet or physical inactivity.Conclusion: These findings suggest childhood social disadvantage may contribute to adult cardiometabolic disease by predisposing children to adopt certain unhealthy behaviours. If replicated, such findings may support intervention strategies that target social environmental factors and behavioural pathways that are established early in life.

The Health Impact of Upward Mobility: Does Socioeconomic Attainment Make Youth More Vulnerable to Stressful Circumstances?

Previous research has documented that adolescent stressful life experiences have a long-term detrimental influence on cardio-metabolic disease risk. While studies have focused on either the moderating or mediating effects of youth socioeconomic competence, drawing from a life course perspective, we estimate these mediating and moderating effects simultaneously within a single analytical framework. The study used a nationally representative sample of 11,271 adolescents (53% female) over 13years. The sample included 49% minority youth (21% Blacks, 16% Hispanics, 6% Asians, 4% multiracial youth, and 2% Native Americans). The analyses focused specifically on adolescents' stressful life experiences, their socioeconomic development (conceptualized as their future orientation in adolescence as well as their educational attainment and income in young adulthood), and cardio-metabolic disease risk in young adulthood (assessed by a measure of allostatic load consisting of nine regulatory bio-markers). The study findings indicated detrimental influences of stressful life experiences on both socioeconomic development and young adult cardio-metabolic disease risk and a beneficial additive influence of positive socioeconomic development on young adult cardio-metabolic health. However, there was also evidence that striving for socioeconomic attainment increased the detrimental influence of stressful life experiences on young adult cardio-metabolic health. These study findings have important implications for our understanding about youth resilience in relation to stressful life contexts and for the formulation of policies and programs for promoting youth health.

Do Childhood Infections Contribute to Adult Cardiometabolic Diseases?

Do Childhood Infections Contribute to Adult Cardiometabolic Diseases?

Overweight patterns throughout childhood and cardiometabolic markers in early adolescence.

Risk of cardiovascular and metabolic disease is higher in adults who were relatively thin at birth and had subsequent accelerated weight gain. This specific pattern of weight gain may relate to unfavorable cardiometabolic markers already in childhood. We prospectively assessed whether children with different patterns of overweight development from age 3 months to 11 years had distinct levels of cardiometabolic markers at age 12 years. We used data of 1500 children participating in the PIAMA birth cohort that started in 1996/1997. Parents reported height and weight during 10 waves of follow-up from age 3 months to 11 years. Four distinct overweight development patterns were derived using longitudinal latent class analysis; 'never'; 'early transient'; 'gradually developing' and 'persistent' overweight. Cardiometabolic markers (total-to-high-density lipoprotein cholesterol (TC/HDLC) ratio, blood pressure (BP), glycated hemoglobin (HbA1c)) were assessed at age 12 years in 1500 children. Children who developed overweight gradually and children with persistent overweight throughout childhood, at age 12 years had a 2-3-fold higher risk of having high (>90th centile) TC/HDLC ratio, systolic and diastolic BP, compared with children who were never overweight. In children who gradually developed overweight, TC/HDLC ratio was 0.75 higher (95% confidence interval (CI) 0.54-0.96); systolic BP 4.90 mmHg higher (95% CI 2.45-7.36) and diastolic BP 1.78 mmHg higher (95% CI 0.07-3.49) than in children who never had overweight. Estimates for children with persistent overweight were similar. Children with gradually developing overweight, and those with persistent overweight had unfavorable cholesterol and blood pressure levels already at age 12 years, whereas children with early transient overweight avoided these unfavorable outcomes. Our results support the hypothesis that specific overweight patterns predispose to an adverse cardiometabolic profile, which is already apparent in early adolescence before progressing to adult cardiometabolic disease.

The Effect of Adenotonsillectomy for Childhood Sleep Apnea on Cardiometabolic Measures.

Obstructive sleep apnea syndrome (OSAS) has been associated with cardiometabolic disease in adults. In children, this association is unclear. We evaluated the effect of early adenotonsillectomy (eAT) for treatment of OSAS on blood pressure, heart rate, lipids, glucose, insulin, and C-reactive protein. We also analyzed whether these parameters at baseline and changes at follow-up correlated with polysomnographic indices. Data collected at baseline and 7-mo follow-up were analyzed from a randomized controlled trial, the Childhood Adenotonsillectomy Trial (CHAT). Clinical referral setting from multiple centers. There were 464 children, ages 5 to 9.9 y with OSAS without severe hypoxemia. Randomization to eAT or Watchful Waiting with Supportive Care (WWSC). There was no significant change of cardiometabolic parameters over the 7-mo interval in the eAT group compared to WWSC group. However, overnight heart rate was incrementally higher in association with baseline OSAS severity (average heart rate increase of 3 beats per minute [bpm] for apnea-hypopnea index [AHI] of 2 versus 10; [standard error = 0.60]). Each 5-unit improvement in AHI and 5 mmHg improvement in peak end-tidal CO2 were estimated to reduce heart rate by 1 and 1.5 bpm, respectively. An increase in N3 sleep also was associated with small reductions in systolic blood pressure percentile. There is little variation in standard cardiometabolic parameters in children with obstructive sleep apnea syndrome (OSAS) but without severe hypoxemia at baseline or after intervention. Of all measures, overnight heart rate emerged as the most sensitive parameter of pediatric OSAS severity. Clinicaltrials.gov (#NCT00560859).

Infection-Related Hospitalization in Childhood and Adult Metabolic Outcomes.

Identifying childhood determinants of adult cardiometabolic disease would facilitate early-life interventions. There are few longitudinal data on the contribution of childhood infections. Therefore, we investigated whether hospitalization with childhood infection is associated with adult anthropometric and metabolic outcomes in a large, well-phenotyped longitudinal cohort. A total of 1376 subjects from the Cardiovascular Risk in Young Finns Study, aged 3 to 9 years at baseline (1980), who had lifetime data from birth onward on infection-related hospitalization (IRH) had repeated assessments through childhood and adolescence and at least once in adulthood (age 30-45 years in 2001-2011). Early childhood (<5 years), childhood/adolescence (5-18 years), adult (>18 years), and total lifetime IRHs were related to adiposity, BMI, and metabolic syndrome in adulthood. Analyses were adjusted for childhood and adulthood risk factors and potential confounders. Early-childhood IRH correlated with adverse adult but not childhood metabolic variables: increased BMI (P = .02) and metabolic syndrome (risk ratio: 1.56; 95% confidence interval: 1.03-2.35; P = .03), adjusted for age, gender, birth weight, childhood BMI and other risk factors, and family income. The age at which differences in adult BMI became persistent was related to age of IRH in childhood. The greatest increase in adult BMI occurred in those with >1 childhood IRH. Childhood IRH was independently associated with adverse adult metabolic variables. This finding suggests that infections and/or their treatment in childhood may contribute to causal pathways leading to adult cardiometabolic diseases.

Assessment of cardiometabolic risk in children in population studies: underpinning developmental origins of health and disease mother-offspring cohort studies.

Pregnancy and birth cohorts have been utilised extensively to investigate the developmental origins of health and disease, particularly in relation to understanding the aetiology of obesity and related cardiometabolic disorders. Birth and pregnancy cohorts have been utilised extensively to investigate this area of research. The aim of the present review was twofold: first to outline the necessity of measuring cardiometabolic risk in children; and second to outline how it can be assessed. The major outcomes thought to have an important developmental component are CVD, insulin resistance and related metabolic outcomes. Conditions such as the metabolic syndrome, type 2 diabetes and CHD all tend to have peak prevalence in middle-aged and older individuals but assessments of cardiometabolic risk in childhood and adolescence are important to define early causal factors and characterise preventive measures. Typically, researchers investigating prospective cohort studies have relied on the thesis that cardiovascular risk factors, such as dyslipidaemia, hypertension and obesity, track from childhood into adult life. The present review summarises some of the evidence that these factors, when measured in childhood, may be of value in assessing the risk of adult cardiometabolic disease, and as such proceeds to describe some of the methods for assessing cardiometabolic risk in children.

Effects of neonatal nutritional status on the risk for metabolic syndrome in Chilean obese children

Neonatal malnutrition defined by birth weight (BW) is a risk factor for obesity and cardio-metabolic diseases in adults. Neonatal ponderal index (NPI) may have better diagnostic value than BW to establish nutritional status. To determine the effect of neonatal nutritional status, established by the three NPI curves available in Chile, on the risk of Metabolic Syndrome (MS) in obese school children. A nested case/control study in a sample of 410 obese school children aged 10 to 16 years (57% males) was performed. The dichotomous response variable was the presence of MS defined as International Diabetes Federation (IDF) or Cook's criteria. The exposure variable was having NPI < percentile (p) 10. The frequency of MS was 36 and 39% according to the IDF and Cook criteria, respectively. The proportion of children with neonatal malnutrition exceeded 20%. A significantly increased risk for MS was only found when PNI was defined according to Lagos's Table and MS was defined using IDF criteria. Having a PNI > p90, however, showed a trend towards a reduced risk of MS, which only reached significance using Lagos's Table and Cook's Criteria. Neonatal malnutrition defined by NPI is common in obese school children. The condition of neonatal under nutrition defined as PNI < p10 may be a risk factor for developing MS. Instead, having a NPI > p90 could be protective.

The Typology of Metabolic Syndrome in the Transition to Adulthood

Metabolic syndrome (MetS) is a clustering of risks associated with cardiometabolic disease in adults. Obesity is considered the major etiologic factor. However, unlike obesity, the natural history of MetS as adolescents transition to adulthood is unknown. The purpose of this study was to characterize the typology of MetS as adolescents transition to young adulthood and to explore determinants of that typology. A total of 458 participants from a school-based longitudinal cohort study of baseline 5th to 12th graders were followed for 9 years. Based on the presence or absence of MetS at study visits (year [Y] 1, Y4, Y8, and Y10), a MetS typology was defined, and its characteristics were explored using multinomial regression modeling. Both obesity and MetS increased (obesity from 21.0% to 33.4% and MetS from 2.8% to 17.9%). MetS typology was as follows: never, 76.9%; incident, 16.4%; unstable/remitted, 5.7%; and persistent, 1.1%. Of Y1 MetS-positive cases, 61.5% remitted, as did 36.4% of Y4 MetS-positive cases and 25% of Y8 MetS-positive cases. Most incident cases (56.0%, n = 42) occurred in Y10; only 12% (n = 9) occurred in Y4. Obesity increased the odds of MetS (incident: odds ratio [OR] = 4.42, 95% confidence interval [CI] = 2.23-8.76; unstable/remitted: OR = 7.79, 95% CI = 3.12-19.41; persistent: OR = 31.36, 95% CI = 2.99-328.98). In addition, changes in body mass index over the study were associated with persistent (OR = 1.27, 95% CI = 1.03-1.56) and incident MetS (OR = 1.49, 95% CI = 1.31-1.71), but not unstable/remitted MetS (OR = 1.09, 95% CI = 0.99-1.19). Of note, body mass index increased for 77% of those with unstable/remitted MetS, including 90% (n = 9/10) of persistently obese youth with unstable/remitted MetS. During the transition to adulthood, the diagnosis of MetS is highly unstable and fluctuates even among those who are obese and gaining weight.

A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburb of Mumbai 2001-2002 and 2013-2014

Introduction: Change in lifestyle patterns associated with genetic factors is causing increasing prevalence of childhood and adolescent obesity in India. Obesity during childhood and adolescence puts these children at a high risk for adult cardio-metabolic disorders and other chronic diseases. It is important that this avalanche is prevented in time by comprehensive school health education programmes and other timely interventions. An observational cross-sectional study, as a part of the School Health Education and Enlightened Living (SHEEL) project, was conducted to assess the prevalence in childhood overweight and obesity during the academic years 2000-2001 and 2013-2014 at a private school. Materials and Methods: As a part of the SHEEL project, a total of 2421 children consists of 1346 boys and 1075 girls (age ranged, 4 -15 years) were evaluated for their height (stadiometer), weight (electronic weighing scale) and body mass index (BMI) during the academic year 2000-2001 (stage 1 study). We approached the same school again in the academic year 2013-14 (stage 2 study). In this stage, a total of 2056 children (1067 boys and 989 girls; age range 5-15 years) were measured for the same parameters to evaluate in childhood and adolescent obesity when compared with that observed in 2000-2001.The measurements were plotted on gender specific BMI charts (Center for Disease Control and Prevention [CDC] charts) for obtaining percentiles. Identification of overweight and obesity was arrived at by CDC centile charts. Results: The stage 1 study done during the academic year 2000-2001 in school children from an affluent class of society showed a prevalence of overweight, in girls as 16.7% (180/1075) and in boys, 13.7% (185/1346). The prevalence of obesity for the total number of children was 15.3% (14.2% in 1075 girls and 16.1% in 1346 boys). In stage 2 study done during the academic year 2013-2014 in the same school, prevalence of overweight in girls was 16% (158/989) and in boys, 15.3% (163/1067) and the prevalence of obesity was 11.1% (9.1% in 989 girls and 12.9% in 1067 boys). If children at risk for obesity (overweight) and obese were clubbed together, nearly 1/3 of the children, 30.4% in 2001 and 26.7% in 2013, had above-normal BMI percentiles. In this study, the percentage of children showing overweight/obesity increased from the age groups 7 to 8 years and above as compared to the younger age groups. Conclusions: The current cross-sectional study shows that the prevalence of childhood and adolescent overweight and obesity amongst children from a upper-socio-economic stratum of society has remained high at 25-30% during both the periods of the school-based study. However, the trend for the prevalence of overweight and obesity in this >10 years has shown a definite decline of 5.8% in girls, while the decline of 1.6% in boys was not as remarkable.

Sedentary behaviour and risk of mortality from all-causes and cardiometabolic diseases in adults: evidence from the HUNT3 population cohort

BackgroundSedentary behaviour is a potential risk factor for chronic-ill health and mortality, that is, independent of health-enhancing physical activity. Few studies have investigated the risk of mortality associated with multiple...

Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies

SummaryBackgroundFast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development, but might increase risk of obesity and related adult cardiometabolic diseases. We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults.MethodsWe used data from five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa. We investigated body-mass index, systolic and diastolic blood pressure, plasma glucose concentration, height, years of attained schooling, and related categorical indicators of adverse outcomes in young adults. With linear and logistic regression models, we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth (relative weight gain) in three age periods: 0–2 years, 2 years to mid-childhood, and mid-childhood to adulthood.FindingsWe obtained data for 8362 participants who had at least one adult outcome of interest. A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 (odds ratio 1·28, 95% CI 1·21–1·35) and a reduced likelihood of short adult stature (0·49, 0·44–0·54) and of not completing secondary school (0·82, 0·78–0·87). Faster linear growth was strongly associated with a reduced risk of short adult stature (age 2 years: 0·23, 0·20–0·52; mid-childhood: 0·39, 0·36–0·43) and of not completing secondary school (age 2 years: 0·74, 0·67–0·78; mid-childhood: 0·87, 0·83–0·92), but did raise the likelihood of overweight (age 2 years: 1·24, 1·17–1·31; mid-childhood: 1·12, 1·06–1·18) and elevated blood pressure (age 2 years: 1·12, 1·06–1·19; mid-childhood: 1·07, 1·01–1·13). Faster relative weight gain was associated with an increased risk of adult overweight (age 2 years: 1·51, 1·43–1·60; mid-childhood: 1·76, 1·69–1·91) and elevated blood pressure (age 2 years: 1·07, 1·01–1·13; mid-childhood: 1·22, 1·15–1·30). Linear growth and relative weight gain were not associated with dysglycaemia, but a higher birthweight was associated with decreased risk of the disorder (0·89, 0·81–0·98).InterpretationInterventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors, with few adverse trade-offs.FundingWellcome Trust and Bill & Melinda Gates Foundation.

Improving Prediction Algorithms for Cardiometabolic Risk in Children and Adolescents

Clustering of abnormal metabolic traits, the Metabolic Syndrome (MetS), has been associated with an increased cardiovascular disease (CVD) risk. Several algorithms including the MetS and other risk factors exist for adults to predict the risk of CVD. We discuss the use of MetS scores and algorithms in an attempt to predict later cardiometabolic risk in children and adolescents and offer suggestions for developing clinically useful algorithms in this population. There is little consensus in how to define the MetS or to predict future CVD risk using the MetS and other risk factors in children and adolescents. The MetS scores and prediction algorithms we identified had usually not been tested against a clinical outcome, such as CVD, and they had not been validated in other populations. This makes comparisons of algorithms impossible. We suggest a simple two-step approach for predicting the risk of adult cardiometabolic disease in overweight children. It may have advantages in terms of cost-effectiveness since it uses simple measurements in the first step and more complex, costly measurements in the second step. It also takes advantage of the continuous distributions of the metabolic features. We suggest piloting and validating any new algorithms.

Diet and Primordial Prevention of Cardiovascular Disease in Children and Adolescents

It is now clear that the process of atherosclerosis begins in childhood. A series of pathology studies, starting with autopsy examination of young soldiers killed in combat in the Korean War1 and the war in Vietnam2 to more recent studies such as the Pathobiologic Determinants of Atherosclerosis in Youth (PDAY) study3 and the Bogalusa study,4,5 have demonstrated that fatty streaks in the aorta and coronary arteries develop early in life and that even the more advanced and more concerning fibrous plaques are present in a proportion of adolescents and young adults. The PDAY and Bogalusa studies also have demonstrated that the traditional risk factors such as high body mass index, high blood pressure, and dyslipidemia are strongly associated with the presence and extent of arterial lesions.3,4 The Bogalusa cohort also has demonstrated that the presence of multiple risk factors is associated with an even higher risk for atherosclerotic lesions.5 Article p 1032 It is also well known that atherosclerotic cardiovascular disease is the most common cause of death in developed countries.6 Not uncommonly, the first clinical episode related to atherosclerosis is sudden cardiac death.7 Taken together, these data argue very strongly for the prevention of atherosclerosis and for prevention efforts to begin early in life. This might best be labeled primordial prevention because it is aimed at the prevention of development of risk factors in the first place. However, pediatric prevention of cardiovascular …