Cebu Longitudinal Health Research Articles

Dynamic effects of diet diversity and breastfeeding on weight in months 6‐24 of life (1024.9)

Nutrition is a primary contributor to infant growth. We estimated the association of diet diversity and weight in 6‐24 month old infants. Breastfeeding, dietary and weight data collected bimonthly in the Cebu Longitudinal Health and Nutrition Survey (n=3080) were analyzed using a random‐effects longitudinal regression model. Diet diversity (based on 7 food groups) was classified as low (<3 food groups) or high (3+ groups) for each survey. As time‐varying exposures, diet diversity and any breastfeeding (yes/no) captured the dynamic nature of the diet. Interactions between breastfeeding, age and diet diversity were also included in the model. Weight was measured in kg. We adjusted for fixed (sex, maternal SES, height & education) and time‐varying (diarrheal/respiratory illness) variables.Diet diversity (β=0.23, p<0.05) and breastfeeding (β=0.48, p<0.05) positively contributed to weight. When interactions between breastfeeding status, age and diet diversity were predicted, exclusively‐breastfed babies weighed the most at 6 months but were just as heavy as mixed fed babies by 10 months. Non‐breastfed babies fed a diverse diet weighed the least from 6‐16 months. Weights in the subgroups were indistinguishable after 16 months. The results illustrate the importance of exclusive breastfeeding in the earliest months of life and the need for time‐sensitive introduction of nutritious complementary foods.Grant Funding Source: Supported by an educational grant from Wyeth Nutrition

Lower hemoglobin levels in first time mothers from Cebu, Philippines

The association between parity and hemoglobin status in mothers is unclear. Closely spaced pregnancies may predict decreased hemoglobin in women, as these shorter intervals may limit the time available for iron repletion, or maternal age may be associated with general declines in hemoglobin. This study investigated the association between parity and hemoglobin status in a 1-year birth cohort of mothers from Cebu, Philippines, with variable parities. It was hypothesized that maternal parity would be inversely associated with hemoglobin status and that among multiparous mothers, interbirth interval, and prior breastfeeding duration would be positively associated with hemoglobin level. The study design was cross-section with participants (n = 125) recruited from the Cebu Longitudinal Health and Nutrition Survey; all mothers were 24-25 years of age at the time of the study and currently breastfeeding infants less than 3 years of age. Hemoglobin was measured using B-Hemocue Analyzer. Detailed dietary information, health recalls, anthropometrics, and reproductive histories were available on all mothers. Maternal parity ranged from 1 to 6 with an average of 2.2 (1.0) births. In this cross section of parity among similarly aged women, hemoglobin levels were significantly lower for primiparous (12.1 ± 1.8) compared to multiparous mothers (13.2 ± 1.5; P = 0.03), despite similar antianemic usage during gestation. There was no significant association between prior interbirth interval, prior, or current breastfeeding duration and hemoglobin in multiparas. Low hemoglobin levels of primiparous women in this sample might indicate increased nutritional stress associated with first pregnancy.

Gendered Differences in the Predictors of Sexual Initiation Among Young Adults in Cebu, Philippines

Social environment and family context exert substantial influence on adolescent sexual behaviors. These influences are especially important to examine in countries undergoing rapid demographic and social change. This study employs unique, intergenerational and longitudinal data (1998-2009) to examine the effects of parental, peer, and household influences on sexual initiation among young adults in Cebu, Philippines. Intergenerational and longitudinal cohort data from the 1998 Cebu Longitudinal Health and Nutrition Survey (CLHNS) are analyzed to examine the effects of household, peer, family, and young adults' sexual attitudes on age at first sex by 2009 among young men and women. Gender-stratified Cox proportional hazards models and Cox regression models are used to model time to first sex. Household, family, peer, and individual characteristics have disparate influences on sexual initiation among Filipino boys and girls. Boys' sexual initiation was positively associated with urbanicity, household wealth, and the presence of a family member working abroad, whereas for girls, these variables had no significant effects. Unique effects were also found for girls-mother's education was negatively associated, and girls' number of siblings was positively associated, with higher hazards of sex. Additionally, the effects of some variables on the occurrence of first sex differed across time, indicating that boys and girls may be differentially influenced by contextual characteristics across adolescence. Amid substantial sociodemographic changes and persistence of traditional gender norms, this study highlights the importance of examining the unique influences and intersections of gender and context on sexual initiation in the Philippines.

Genetic association with lipids in Filipinos: waist circumference modifies an APOA5 effect on triglyceride levels

Blood levels of lipoprotein cholesterol and triglycerides (TGs) are highly heritable and are major risk factors for cardiovascular disease (CVD). Approximately 100 lipid-associated loci have been identified in populations of European ancestry. We performed a genome-wide association study of lipid traits in 1,782 Filipino women from the Cebu Longitudinal Health and Nutrition Survey, and tested for evidence of interactions with waist circumference. We conducted additional association and interaction analyses in 1,719 of their young adult offspring. Genome-wide significant associations (P < 5 × 10⁻⁸) were detected at APOE for low density lipoprotein cholesterol and total cholesterol, and at APOA5 for TGs. Suggestive associations (P < 10⁻⁶) were detected at GCKR for TGs, and at CETP and TOM1 for high density lipoprotein cholesterol. Our data also supported the existence of allelic heterogeneity at APOA5, CETP, LIPC, and APOE. The secondary signal (Gly185Cys) at APOA5 exhibited a single nucleotide polymorphism (SNP)-by-waist circumference interaction affecting TGs (Pinteraction = 1.6 × 10⁻⁴), manifested by stronger SNP effects as waist circumference increased. These findings provide the first evidence that central obesity may accentuate the effect of the TG-increasing allele of the APOA5 signal, emphasizing that CVD risk could be reduced by central obesity control.

The Impact of Adequate Prenatal Care on Urban Birth Outcomes: An Analysis in a Developing Country Context

AbstractDeficient birth outcomes entail greater mortality risks and higher probabilities of poor future health. This study examines the effect of the World Health Organization’s prenatal care recommendations for developing countries. It accounts for the endogenous nature of prenatal care decisions by using an instrumental variables approach based on the opportunity cost and accessibility of prenatal services. Using the urban sample of the Cebu Longitudinal Health and Nutrition Survey, I construct a measure of prenatal care based on the WHO recommendations. This measure involves both timing and intensity. The instrumental variable used is shown to be strong and valid. The results show that adequate care has a positive impact on birth weight and decreases the probability of poor birth outcomes. The results are robust to seasonality and time effects and are not driven by the potential influence of rainfall shocks on maternal health. I also test the effectiveness of the WHO methodology by modifying the defini...

The spatial distribution of overweight and obesity among a birth cohort of young adult Filipinos (Cebu Philippines, 2005): an application of the Kulldorff spatial scan statistic.

Objectives:The objectives of the study were to test for spatial clustering of obesity in a cohort of young adults in the Philippines, to estimate the locations of any clusters, and to relate these to neighborhood-level urbanicity and individual-level socioeconomic status (SES).Subjects:Data are from a birth cohort of young adult (mean age 22 years) Filipino males (n=988) and females (n=820) enrolled in the Cebu Longitudinal Health and Nutrition Survey.Methods:We used the Kulldorff spatial scan statistic to detect clusters associated with unusually low or high prevalences of overweight or obesity (defined using body mass index, waist circumference and body fat percentage). Cluster locations were compared to neighborhood-level urbanicity, which was measured with a previously validated scale. Individual-level SES was adjusted for using a principal components analysis of household assets.Results:High-prevalence clusters were typically centered in urban areas, but often extended into peri-urban and even rural areas. There were also differences in clustering by both sex and the measure of obesity used. Evidence of clustering in males, but not females, was much weaker after adjustment for SES.

Replication of LIN28B SNP association with age of menarche in young Filipino women

Age of menarche, or the timing of first menses in girls, is a physiological trait that shows substantial genetic heritability. Earlier age of menarche is associated with increased childhood adiposity and with adult risk of obesity and cardiovascular disease. We sought to further characterize the single nucleotide polymorphism (SNP) rs7759938 from the menarche locus LIN28B in 827 young Filipino women from the Cebu Longitudinal Health and Nutrition Survey (CLHNS). We tested rs7759938 for additive association with age of menarche and also tested whether childhood adiposity, as measured by body mass index (BMI) at age 8, mediated this relationship. We observed nominal association of rs7759938 with age of menarche (β = -0.118 years, 95% confidence interval = (-0.216, -0.020), P = 0.019) with an effect direction consistent with the previous report. We also observed suggestive evidence that the effect of the SNP on age of menarche was independent of childhood BMI. These data confirm the strongest gene reported in Europeans (LIN28B) as a contributor to age of menarche in an Asian population.

From Family to Friends: Does Witnessing Interparental Violence Affect Young Adults' Relationships With Friends?

Childhood exposure to violence in one's family of origin has been closely linked to subsequent perpetration and victimization of intimate partner violence. There is, however, little research on the relationship between witnessing violence and subsequent peer violence. This study investigates the effects of witnessing interparental violence among Filipino young adults on their use and experience of psychological aggression with friends. The data source for this study was the Cebu Longitudinal Health and Nutrition Survey. Recent perpetration and victimization of friend psychological aggression among young adults ages 21-22 years was assessed through self-reports from the 2005 survey; witnessing interparental violence during childhood was assessed through self-reports from the 2002 survey. Multinomial logistic regression was used to examine the effects of witnessing interparental violence on subsequent use and experience of friend psychological aggression. Analyses were stratified by gender. About 13% of females and 4% of males perpetrated psychological aggression toward close friends, and about 4% of females and males were victims. Fourteen percent of females and 3% of males experienced bidirectional psychological aggression. About 44% of females and 47% of males had, during childhood, witnessed their parents physically hurt one another. Witnessing maternal and reciprocal interparental violence during childhood significantly predicted bidirectional friend psychological aggression among males. Among females, witnessing interparental violence did not significantly predict involvement with friend psychological aggression. Violence prevention programs should consider using family-centered interventions, and apply a gendered lens to their application. Further research on gender differences in friend aggression is recommended.

Associations between wealth and weight status in Filipinos from birth to early adulthood

Wealth predicts BMI and is especially relevant in the context of the nutrition transition in low‐and middle‐income countries.Sex‐stratified, longitudinal, random effects models were used to estimate how wealth (represented by factor scores of household assets) relates to BMI at birth, 2, 8.5, 11.5, 15.6, 18.7, and 21.5y in the Cebu Longitudinal Health and Nutrition Survey (n=1925). We performed a factor analysis on assets reported in 2005 using a varimax orthogonal rotation. Three factors with eigenvalues &gt;;1.5 were retained: F1 represents urban assets (e.g. car, appliances); F2 modernization (TV, videogames); F3 rural assets (animals, land). The 2005 factor structure was used to score prior years.In males, higher F1 and F2 scores were associated with significantly higher BMI (β=0.16, p&lt;0.001; β=0.044, p&lt;0.001, respectively). A higher F3 score was associated with lower BMI (β= −0.08, p&lt;0.001). In females, higher F1 and F2 scores were associated with lower BMI (β= −0.034, p=0.018; β= −0.018, p=0.023, respectively). However, in cross‐sectional analyses higher F1 score was associated with higher BMI at 8.5 and 11.5y (p&lt;0.01). F3 scores were unrelated to BMI.These sex differences in how wealth relates to BMI suggest that as wealth increases, females may be more susceptible to Western body image messages and exhibit an inverse relationship of wealth and BMI starting around menarche.Funding Source: Pfizer NutritionGrant Funding Source: Pfizer Nutrition

Iron and diabetes risk among Filipino women

Some studies suggest that increased iron intake may lead to diabetes risk possibly thru oxidative stress, inflammation, free fatty acid oxidation, insulin extraction and secretion. But, this has not yet been established in less developed countries where iron deficiency is likely to occur. We examined the association of iron intake with impaired fasting glucose/diabetes mellitus (IFG/DM: FG&gt;;=110 mg/dL) using data from 1,871 women (ages 35–68 yr) from the Cebu Longitudinal Health and Nutrition Survey in 2005. About 9% of women had IFG/DM. On average, women consumed 11.25±7.04 mg of iron daily. Logistic regression analyses adjusted for current BMI, age, total energy intake and other confounders showed that the odds of having IFG/DM increased with iron intake. Compared to the lowest quartile of iron intake, those in the highest quartile were 78% more likely to have IFG/DM [OR(95% CI): 1.78 (1.01–3.12)]. Results of this study suggest the need to further examine the link between iron intake and diabetes risk in less developed countries like the Philippines where iron deficiency anemia is still prevalent but diabetes has also become one of the major causes of mortality and morbidity. R01TW008288

Energy implications of eating out and other diet behaviors in Filipino adults

Energy and other nutrient intakes have been linked with obesity and cardiovascular disease (CVD) development. Intervention messages are best expressed as modifications in food consumption and diet behaviors rather than in nutrient levels. We examined diet behaviors and associated nutrient intakes (using 24‐hour food recall data) in 1909 Filipino young adults aged 21–22 (53% males) and their mothers (2018; aged 35–68) from the Cebu Longitudinal Health and Nutrition Survey. The majority ate 3 meals/day (16% young adults and 22% mothers usually skip breakfast), and 77% usually ate snacks (mean 1.4/day). Buying ready‐cooked foods (RCF; 71% mothers, 83% young adults) and eating in fast food restaurants (FFR; 20% mothers, 50% young adults) are emerging trends in the country. Multivariable models show that compared to home cooked foods, the number of RCF in the diet was positively associated with mean calories/day and negatively associated with vitamin intakes. Most RCF are bought from neighborhood eateries and ambulant vendors which raises food safety issues. Fat intakes were positively associated with eating in FFR which merits concern given the increase in FFR in Cebu. Skipping breakfast was also positively associated with fat intakes congruent with studies showing that prolonged overnight fast promotes unhealthy eating later in the day. R01AG039443, R01HD054501 R01TW008288

Genetic risk scores across multiple cardiometabolic traits predict patterns of cardiometabolic risk in Filipino women

We aimed to identify how genetic risk scores predicted patterns of cardiometabolic (CM) risk factors in women from the 2005 Cebu Longitudinal Health and Nutrition Survey (n = 1,492, age =36–68 y).Previous work identified clusters of women with similar CM features: healthy, high blood pressure (BP), low HDL‐c, insulin resistant (IR), and high inflammation. Genetic risk scores for BP, LDL‐c, HDL‐c, triglycerides, glucose, and C‐reactive protein (CRP) summed the number of effect alleles known to relate to each trait. Using multinomial logistic regression, we predicted CM clusters with genetic risk scores, adjusting for population substructure, age, menopause, parity, waist circumference, BMI, and energy intake.Compared to the healthy cluster: a higher HDL‐c genetic risk score (OR 1.12, 95% CI= 1.03–1.02) increased odds of being in the elevated BP cluster; a lower LDL‐c score (0.90, 0.82–1.00) and higher HDL‐c score (1.15, 1.08–1.23) increased the odds of being in the low HDL‐c cluster; a higher CRP score (1.28, 1.05–1.55) and higher glucose score (1.23, 1.09–1.39) increased the odds of being in the IR cluster; a higher CRP score (1.32, 1.15–1.50) and higher BP score (1.11, 1.01–1.23) increased the odds of being in the high inflammation cluster.For most CM clusters, genetic risk across multiple traits predicted cluster membership, emphasizing the notion that many synergistic genetic effects likely influence CM risk.Grant Funding Source: The University of North Carolina at Chapel Hill and National Institutes of Health: DK078150, HL0851445144

Low calcium intake is associated with increased blood pressure among Filipino women

The role of dietary calcium (Ca) as a determinant of blood pressure (BP) has not been firmly established, especially in developing countries like the Philippines where Ca intake is low and hypertension (Htn) prevalence is high. We examined how Ca intake relates to BP among Filipino women using data from 1,997 women (ages 35–68y) in the 2005 Cebu Longitudinal Health and Nutrition Survey. Dietary Ca intake was measured using two 24‐hr recalls (mean: 309 mg/d). Major dietary sources of Ca were fish (37%), creamers/milk/milk products (23%), and vegetables (11%). About 27% of women had Htn (BP&gt;;=140/90 mmHg). Regression analyses adjusted for age, smoking, energy intake, and other confounders showed that low Ca intake (lowest quartile) is associated with higher BP and odds of having Htn. Women with low Ca intake had 3.8 mmHg (95% CI: 1.6–6.1) higher systolic BP and 46% higher odds of having Htn [OR 1.46 (1.11–1.92)]. For diastolic BP, the effect of low Ca intake increased as WC increased (p for interaction &lt;0.1). For example, for women with 75cm WC, the effect of low Ca intake was 1.6 (.1–3.1) while for those with 95cm WC, the effect is 3.8 (1.5–6.0) mmHg. Although Ca intake has been associated with fat metabolism and deposition, the biological mechanism of this interaction is yet to be elucidated. Results suggest that increasing Ca intake may help decrease BP in this population and preventing high WC may enhance this benefit. R01TW008288

Low meats and sweets diet attenuates the effect of overweight duration on glucose levels among Filipino women

Overweight (OW) duration and diet affect glucose levels. We examined whether diet modified the effect of OW duration on fasting glucose and having impaired fasting glucose or type 2 diabetes (IFG/DM: FG&gt;;=110mg/dL) in 1,887 women (ages 35–68y) in the 2005 Cebu Longitudinal Health and Nutrition Survey. OW (BMI&gt;;=25kg/m2) duration was categorized as &gt;;=10 y (25%), &lt; 10 y (17%), had a history but not currently OW (10%) and never OW (48%). Using factor analysis, we identified 3 diet patterns: meats/sweets, vegetables/grains, and processed seafoods. Mean FG was 99.6 mg/dL; 14% had IFG/DM. For FG, linear regression results showed significant interaction between OW duration and the meats/sweets pattern (LR test p&lt;0.04). OW duration was not significantly associated with FG among women who consumed low meats/sweets (lowest quartile): 1.6 (−10.1, 13.2) [COEFF (95% CI)] for women OW &lt;10 yrs and 2.6 (−10.8,15.9) for women OW &gt;;10yrs. For women who consumed higher amounts of meats/sweets, compared to never OW women, FG was 4.5 (− 2.0,11.4) and 18.8 (11.0, 26.5) mg/dL higher for women OW &lt; 10y and OW &gt;;=10y, respectively. Similarly, we found increased effect of OW duration on having IFG/DM among women who consumed greater meats/sweets. Results underscore the benefit of controlling meats and sweets consumption, especially among those who have been chronically OW. R01TW008288

Are gestational age, birth weight, and birth length indicators of favorable fetal growth conditions? A structural equation analysis of Filipino infants

The fetal origins hypothesis emphasizes the life-long health impacts of prenatal conditions. Birth weight, birth length, and gestational age are indicators of the fetal environment. However, these variables often have missing data and are subject to random and systematic errors caused by delays in measurement, differences in measurement instruments, and human error. With data from the Cebu (Philippines) Longitudinal Health and Nutrition Survey, we use structural equation models, to explore random and systematic errors in these birth outcome measures, to analyze how maternal characteristics relate to birth outcomes, and to take account of missing data. We assess whether birth weight, birth length, and gestational age are influenced by a single latent variable that we call favorable fetal growth conditions (FFGC) and if so, which variable is most closely related to FFGC. We find that a model with FFGC as a latent variable fits as well as a less parsimonious model that has birth weight, birth length, and gestational age as distinct individual variables. We also demonstrate that birth weight is more reliably measured than is gestational age. FFGCs were significantly influenced by taller maternal stature, better nutritional stores indexed by maternal arm fat and muscle area during pregnancy, higher birth order, avoidance of smoking, and maternal age 20-35 years. Effects of maternal characteristics on newborn weight, length, and gestational age were largely indirect, operating through FFGC.

A comprehensive SNP and indel imputability database

Genotype imputation has become an indispensible step in genome-wide association studies (GWAS). Imputation accuracy, directly influencing downstream analysis, has shown to be improved using re-sequencing-based reference panels; however, this comes at the cost of high computational burden due to the huge number of potentially imputable markers (tens of millions) discovered through sequencing a large number of individuals. Therefore, there is an increasing need for access to imputation quality information without actually conducting imputation. To facilitate this process, we have established a publicly available SNP and indel imputability database, aiming to provide direct access to imputation accuracy information for markers identified by the 1000 Genomes Project across four major populations and covering multiple GWAS genotyping platforms. SNP and indel imputability information can be retrieved through a user-friendly interface by providing the ID(s) of the desired variant(s) or by specifying the desired genomic region. The query results can be refined by selecting relevant GWAS genotyping platform(s). This is the first database providing variant imputability information specific to each continental group and to each genotyping platform. In Filipino individuals from the Cebu Longitudinal Health and Nutrition Survey, our database can achieve an area under the receiver-operating characteristic curve of 0.97, 0.91, 0.88 and 0.79 for markers with minor allele frequency >5%, 3-5%, 1-3% and 0.5-1%, respectively. Specifically, by filtering out 48.6% of markers (corresponding to a reduction of up to 48.6% in computational costs for actual imputation) based on the imputability information in our database, we can remove 77%, 58%, 51% and 42% of the poorly imputed markers at the cost of only 0.3%, 0.8%, 1.5% and 4.6% of the well-imputed markers with minor allele frequency >5%, 3-5%, 1-3% and 0.5-1%, respectively. http://www.unc.edu/∼yunmli/imputability.html

C‐reactive protein by pregnancy and lactational status among Filipino young adult women

Pregnancy and lactation involve adaptations in immune regulation, but little is known about cross-cultural variation in inflammatory changes during pregnancy or lactation. Here we report concentrations of C-reactive protein (CRP) in a large cross-sectional sample of healthy Filipino women who vary in parity, gestational, and lactational status, and who come from a population previously described as having low CRP. Fasting plasma CRP was measured among female participants (ages 20.8-22.4 years) in the Cebu Longitudinal Health and Nutrition Survey (n = 822). Median CRP was 0.2 mg/l in nulliparous women and peaked at 2.0 mg/l in women in their 3rd trimester of pregnancy. Parous but post-partum women had higher CRP compared to nulliparous women, which was largely explained by body composition differences as reflected in waist circumference and skinfold measures. Among post-partum women with infants, CRP was similar in women who were currently breastfeeding compared to those who were not. At Cebu, women late in gestation have 10-fold higher C-reactive protein compared to nulliparous women, with no evidence that lactation is inflammatory. These population-based findings are similar with findings from prior clinic-based studies and are consistent with the maternal immunological adaptations initiated during pregnancy. The tendency of human females to spend more time than females of other great apes in gestation rather than lactation suggests that the human life history strategy involved increased time spent by reproductively aged females in a pro-inflammatory state.

Do environments in infancy moderate the association between stress and inflammation in adulthood? Initial evidence from a birth cohort in the Philippines.

Chronic inflammation is a potentially important pathway through which psychosocial stressors increase risk for cardiovascular disease. However, prior research on stress and inflammation has been conducted almost exclusively in high income, industrialized populations with low levels of infectious disease. In this study we test the hypothesis that psychosocial stressors are associated with elevated concentrations of C-reactive protein (CRP) among young adults in the Philippines (n=1622), who have grown up in an ecological and epidemiological setting that differs substantially from that of the US. In addition, we apply a developmental, ecological perspective to consider whether microbial and nutritional environments in infancy alter patterns of association between stressors and CRP. Data come from the Cebu Longitudinal Health and Nutrition Survey, a prospective cohort study that began collecting data in 1983-1984 when participants were in utero. A series of regression models indicate trends toward significant interactions between perceived stress and environmental factors in infancy, including exposure to animal feces, season of birth, and birth weight. Parental absence in childhood was a significant predictor of CRP in adulthood in interaction with exposure to animal feces in infancy. Positive associations between stressors and CRP were only evident for individuals with lower levels of microbial exposure in infancy, or lower birth weight. These results suggest that early environments influence the development of inflammatory phenotypes in ways that moderate sensitivity to psychosocial stressors in adulthood, and they underscore the value of a comparative, developmental approach to research on social environments, inflammation, and disease.

Age at menarche and parity are independently associated with Anti‐Müllerian hormone, a marker of ovarian reserve, in filipino young adult women

Despite ample evidence of variation in timing of menopause, little is known about the extent or underlying causes of individual variation in ovarian reserve and age-related follicular decline. Anti-Müllerian hormone (AMH), a hormonal marker of ovarian reserve, may be a useful tool to clarify these questions. We describe AMH in a cohort of Filipino young adult women, and evaluate whether ovarian reserve in early adulthood relates to measures of life history scheduling (menarcheal age) and reproductive effort (parity). Data and samples are obtained from 294 nonpregnant participants (21.5 years ± 0.3) in the Cebu Longitudinal Health and Nutrition Survey. Plasma AMH was assayed using an enzyme immunoassay and relationships between AMH, menarcheal age, and parity were examined. Mean AMH was 4.3 ng/mL. In multiple regression models, women who experienced menarche earlier had significantly higher AMH as young adults (P < 0.05). Women with two (P < 0.05) and three or more (P < 0.01) children had significantly lower AMH than those with no children. These associations were independent of age, smoking, and body mass index. These findings suggest that individual variation in life history scheduling and reproductive history could contribute to variation in ovarian reserve. Moreover, they demonstrate the utility of AMH as a tool for human reproductive ecology, and highlight the need for further research clarifying the extent of human population variation in ovarian reserve and the behavioral and ecological influences underlying this variation.

Infant BMI trajectories are associated with young adult body composition.

The dynamic aspect of early life growth is not fully captured by typical analyses, which focus on one specific time period. To better understand how infant and young child growth relate to the development of adult body composition, the authors characterized body mass index (BMI) trajectories using latent class growth analysis (LCGA) and evaluated their association with adult body composition. Data are from the Cebu Longitudinal Health and Nutrition Survey, which followed a birth cohort to age 22 years (n = 1749). In both males and females, LCGA identified seven subgroups of respondents with similar BMI trajectories from 0 to 24 months (assessed with bimonthly anthropometrics). Trajectory groups were compared with conventional approaches: (1) accelerated growth between two time points (0-4 months), (2) continuous BMI gain between two points (0-4 months and 0-24 months) and (3) BMI measured at one time point (24 months) as predictors of young adult body composition measures. The seven trajectory groups were distinguished by age-specific differences in tempo and timing of BMI gain in infancy. Infant BMI trajectories were better than accelerated BMI gain between 0 and 4 months at predicting young adult body composition. After controlling for BMI at age 2 years, infant BMI trajectories still explained variation in adult body composition. Using unique longitudinal data and methods, we find that distinct infant BMI trajectories have long-term implications for the development of body composition.