Deviation Increase In Score Research Articles

The association of highly processed food consumption with food choice values and food literacy in Japanese adults: a nationwide cross-sectional study

BackgroundHighly processed food (HPF) consumption is increasing globally and has become a prominent public health concern. However, the relationship between HPF consumption and food choice values and food literacy is unknown. This study aimed to examine the association of HPF consumption with food choice values and food literacy.MethodsThis cross-sectional study used data from a nationwide questionnaire survey conducted in 2018 among 2232 Japanese adults aged 18–80 years. We assessed eight food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort, and safety) using a 25-item scale, and food literacy characterised by nutrition knowledge (using a validated 143-item questionnaire), cooking and food skills (using 14- and 19-item scales, respectively), and eight eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, and slowness in eating, using the 35-item Adult Eating Behavior Questionnaire). HPF consumption was estimated using a validated brief diet history questionnaire. The associations between HPF consumption and age, body mass index, energy intake, and each score on food choice values and food literacy were evaluated by multiple linear regression.ResultsIn males, one standard deviation increase in scores for cooking skill and satiety responsiveness was associated with an increase in HPF consumption by 22.1 g/4184 kJ (95% confidence interval (CI): 6.6 to 37.5) and 15.4 g/4184 kJ (95% CI: 6.0 to 24.7), respectively. In females, one standard deviation increase in age and scores for safety and nutrition knowledge corresponded to a decrease in HPF consumption by − 16.4 g/4184 kJ (95% CI: − 23.4 to − 9.3), − 9.9 g/4184 kJ (95% CI: − 19.1 to − 0.7), and − 11.1 g/4184 kJ (95% CI: − 17.0 to − 5.3), whereas one standard deviation increase in the satiety responsiveness score corresponded to an increase in HPF consumption by 13.1 g/4184 kJ (95% CI: 6.8 to 19.4).ConclusionsThis cross-sectional study suggests that several aspects of food choice values and food literacy were associated with HPF consumption in Japanese adults. Further studies are needed to confirm our findings in a broader context.

Available Risk Scores Modestly Predict Hemorrhage in Patients with Atrial Fibrillation and Cance

Background: Patients with cancer have an increased risk of developing atrial fibrillation (AF). Patients with cancer who develop AF have an increased risk of cardiovascular-related death at 12-months. Use of anticoagulant therapy may benefit these patients. However, patients with cancer are at increased risk of anticoagulant-related bleeding. Several risk prediction models are available to estimate the risk of anticoagulant-related bleeding in patients with AF. However, these models were developed predominately in patients without cancer. Thus, the utility of these models in cancer is unknown. We aimed to evaluate the performance of existing bleeding risk models in a cohort of patients with active cancer and AF starting on anticoagulant therapy. Methods: Using a nationwide cohort of US Veterans, we identified patients with active cancer and AF with a new prescription for anticoagulant therapy between 2012 and 2018. Cancer was defined as active if the diagnosis of AF occurred within 3 months prior to up to 6 months after new cancer diagnosis or in the setting of incurable hematological cancers (e.g., multiple myeloma, chronic myelogenous leukemia) or metastatic solid tumors. We identified anticoagulant-related major bleeding (MB) within 6 months of anticoagulant start by the presence of inpatient ICD-9/10 codes in any position as previously validated. Patients were censored 30-days after last anticoagulant prescription. We evaluated the predictive performance of six models. The association per standard deviation increase in the score and MB within 6 months of anticoagulant start was estimated using Fine-Gray subdistribution survival analysis to account for the competing risk of death≥÷A sensitivity analysis limiting inpatient ICD-9/10 codes for MB to the first two positions was also performed. We evaluated model discrimination using Harrell's c-statistic. Results: 5716 patients met inclusion criteria into the cohort. The most common types of cancer included: hematological malignancies (24%), lung (20%), prostate (18%), non-prostate genitourinary (11%), and gastrointestinal (10%) cancer. Mean age at the start of anticoagulant therapy was 73.4 years and median overall survival 41.1 months. Of the cohort, anticoagulant therapy was as follows: 2040 warfarin, 179 LMWH, 5 fondaparinux, and 3495 DOAC. 328 (5.7%) patients had a MB within 6 months of anticoagulant start and 439 (7.7%) within 12 months. The most common type of bleeds within the first 6 months of anticoagulant therapy was gastrointestinal (47%), followed by hematuria (28%) and hemoptysis (13.7%). 2.4% of bleeding events (n=8) were intracranial hemorrhage. The increase in hazard of bleeding per each standard deviation increase in bleeding score is in Table 1. For model discrimination, Harrell's c-statistic for each score is also listed in Table 1. Conclusions: In this cohort of 5716 patients with active cancer and atrial fibrillation starting on anticoagulant therapy, available clinical risk models moderately predicted bleeding. The addition of cancer-specific risk factors might improve accuracy of the available models. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Prediction of clinical diagnosis of Alzheimer’s disease, vascular, mixed, and all‐cause dementia by a polygenic risk score and APOE status in a community‐based cohort prospectively followed over 17 years

AbstractBackgroundThe strongest genetic risk factor for Alzheimer’s disease (AD) is the ε4 allele of Apolipoprotein E (APOE4) and recent genome‐wide association (GWA) meta‐analyses have confirmed additional associated genetic loci with smaller effects. The aim of this study was to investigate the ability of an AD polygenic risk score (PRS) and APOE status to predict clinical diagnosis of AD, vascular (VD), mixed (MD), and all‐cause dementia in a community‐based cohort prospectively followed over 17 years and secondarily across age, sex and education strata.MethodA PRS encompassing genetic variants reaching genome‐wide significant associations to AD (excluding APOE) from the most recent genome‐wide association meta‐analysis data was calculated and APOE status was determined in 5 351 participants. During follow‐up, 109, 113, 59, and 366 participants were diagnosed with AD, VD, MD, and all‐cause dementia, respectively. Prediction ability of AD, VD, MD, and all‐cause dementia by the PRS and APOE was assessed by multiple logistic regression and receiver operating characteristic curve analyses.ResultThe PRS per standard deviation increase in score and APOE4 (≥ 1 e4 allele) positivity were significantly associated with greater odds of AD (PRS OR, 95% CI: 1.70, 1.45‐2.03; APOE4 OR, 95% CI: 3.21, 2.14‐4.80) and AD prediction accuracy was significantly improved when adding the PRS to a base model of age, sex and education (ASE) (c‐statistics: ASE, 0.772; ASE+PRS, 0.809).ConclusionThe PRS enriched the ability of APOE4 to discern AD with stronger associations than to VD, MD, or all‐cause dementia in a prospective community‐based cohort.

Fetal exposure to phthalates and bisphenols and childhood general and organ fat. A population-based prospective cohort study.

Fetal exposure to phthalates and bisphenols might have long-lasting effects on growth and fat development. Not much is known about the effects on general and organ fat development in childhood. We assessed the associations of fetal exposure to phthalates and bisphenols with general and organ fat measures in school-aged children. In a population-based, prospective cohort study among 1128 mother-child pairs, we measured maternal urinary phthalate metabolites and bisphenol concentrations in first, second, and third trimester. Offspring body mass index, fat mass index by dual-energy X-ray absorptiometry, and visceral and pericardial fat indices and liver fat fraction were measured by magnetic resonance imaging at 10 years. After adjustment for confounders and correction for multiple testing, an interquartile range increase in first trimester phthalic acid concentrations remained associated with a 0.14 (95% confidence interval: 0.05, 0.22) standard deviation score increase in pericardial fat index. We also observed tendencies for associations of higher maternal low molecular weight phthalate urinary concentrations in second trimester with childhood pericardial fat index, but these were not significant after adjustment for multiple testing. High molecular weight phthalate, di-2-ethylhexyl phthalate, and di-n-octyl phthalate concentrations were not associated with childhood outcomes. Maternal urinary bisphenol concentrations were not associated with childhood adiposity. Maternal first trimester phthalic acid concentrations are associated with increased childhood pericardial fat index at 10 years of age, whereas maternal bisphenol concentrations are not associated with childhood adiposity. We did not find significant sex-specific effects. These findings should be considered as hypothesis generating and need further replication and identification of underlying mechanisms.

Evaluating shared genetic influences on nonsyndromic cleft lip/palate and oropharyngeal neoplasms.

It has been hypothesised that nonsyndromic cleft lip/palate (nsCL/P) and cancer may share aetiological risk factors. Population studies have found inconsistent evidence for increased incidence of cancer in nsCL/P cases, but several genes (e.g., CDH1, AXIN2) have been implicated in the aetiologies of both phenotypes. We aimed to evaluate shared genetic aetiology between nsCL/P and oral cavity/oropharyngeal cancers (OC/OPC), which affect similar anatomical regions. Using a primary sample of 5,048 OC/OPC cases and 5,450 controls of European ancestry and a replication sample of 750 cases and 336,319 controls from UK Biobank, we estimate genetic overlap using nsCL/P polygenic risk scores (PRS) with Mendelian randomization analyses performed to evaluate potential causal mechanisms. In the primary sample, we found strong evidence for an association between a nsCL/P PRS and increased odds of OC/OPC (per standard deviation increase in score, odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.04, 1.13; p = .000053). Although confidence intervals overlapped with the primary estimate, we did not find confirmatory evidence of an association between the PRS and OC/OPC in UK Biobank (OR 1.02; 95% CI: 0.95, 1.10; p = .55). Mendelian randomization analyses provided evidence that major nsCL/P risk variants are unlikely to influence OC/OPC. Our findings suggest possible shared genetic influences on nsCL/P and OC/OPC.

Prediction of clinical diagnosis of Alzheimer\u2019s disease, vascular, mixed, and all-cause dementia by a polygenic risk score and APOE status in a community-based cohort\xa0prospectively followed over 17 years

The strongest genetic risk factor for Alzheimer’s disease (AD) is the ε4 allele of Apolipoprotein E (APOE) and recent genome-wide association meta-analyses have confirmed additional associated genetic loci with smaller effects. The aim of this study was to investigate the ability of an AD polygenic risk score (PRS) and APOE status to predict clinical diagnosis of AD, vascular (VD), mixed (MD), and all-cause dementia in a community-based cohort prospectively followed over 17 years and secondarily across age, sex, and education strata. A PRS encompassing genetic variants reaching genome-wide significant associations to AD (excluding APOE) from the most recent genome-wide association meta-analysis data was calculated and APOE status was determined in 5203 participants. During follow-up, 103, 111, 58, and 359 participants were diagnosed with AD, VD, MD, and all-cause dementia, respectively. Prediction ability of AD, VD, MD, and all-cause dementia by the PRS and APOE was assessed by multiple logistic regression and receiver operating characteristic curve analyses. The PRS per standard deviation increase in score and APOE4 positivity (≥1 ε4 allele) were significantly associated with greater odds of AD (OR, 95% CI: PRS: 1.70, 1.45–1.99; APOE4: 3.34, 2.24–4.99) and AD prediction accuracy was significantly improved when adding the PRS to a base model of age, sex, and education (ASE) (c-statistics: ASE, 0.772; ASE + PRS, 0.810). The PRS enriched the ability of APOE to discern AD with stronger associations than to VD, MD, or all-cause dementia in a prospective community-based cohort.

Perceived Discrimination and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis.

Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults.

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort

BackgroundGlobal and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke. MethodsA prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20–70years recruited into the EPIC-NL study during 1993–1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk. ResultsAfter an average follow-up of 12.2years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk. ConclusionThe HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke.

Abstract P214: Adherence to Dietary Patterns after Gestational Diabetes Mellitus and Risk of Subsequent Type 2 Diabetes

Background: Adherence to healthful dietary patterns is associated with lower risk of type 2 diabetes (T2DM) in the general population. Women with a history of gestational diabetes mellitus (GDM) are at particularly high risk for future type 2 diabetes (T2DM), though relations of dietary patterns with incident T2DM in this population are unknown. Hypothesis: We hypothesize that adherence to healthful dietary patterns among women with prior GDM is inversely associated with incident T2DM. Methods: We evaluated 4,413 participants from the Nurses' Health Study II longitudinal cohort with a history of GDM in one or more pregnancies. GDM was ascertained by self-report of a physician's diagnosis and has been previously validated in a subsample with confirmation of over 90% by medical record review. Participants were free of chronic disease at baseline and followed from 1991 through 2007. Dietary pattern adherence scores were derived for the alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and the alternate Healthy Eating Index (aHEI) based on validated food frequency questionnaires assessed after GDM and updated every 4 years thereafter. Incident T2DM was assessed every 2 years through previously validated questionnaire responses. Multivariable Cox proportional hazards models estimated the relationship of each dietary pattern with incident T2DM, adjusting for age, total energy intake, parity, age at first birth, race/ethnicity, parental history of T2DM, oral contraceptive use, menopausal status, and smoking status. Body mass index (BMI) was included in a subsequent model. Results: There were 491 cases of incident T2DM over 52,743 person-years of observation. In multivariable analyses, the aMED, DASH, and aHEI dietary patterns were each inversely associated with incident T2DM. For each 1 standard deviation increase in score, the aMED pattern was associated with a 24% lower risk (HR=0.76 [95% CI: 0.67, 0.86] p<0.0001), DASH with an 18% lower risk (HR=0.86 [95% CI: 0.73, 0.92] p=0.0005), and aHEI with a 30% lower risk (HR=0.70 [95% CI: 0.61, 0.79] p<0.0001). Further adjustment for BMI moderately but not completely attenuated these findings: (aMED: HR=0.85 [95% CI: 0.75, 0.97] p=0.014; DASH: HR=0.91 [95% CI: 0.80, 1.02] p=0.11; aHEI: HR=0.84 [95% CI: 0.73, 0.96] p=0.009). Conclusions: Adherence to healthful dietary patterns is associated with a lower incidence of T2DM among women following a diagnosis of GDM, and may be partially mediated by BMI. These findings have implications for prevention efforts in this high-risk population.

Suicide and history of childhood trauma among street youth

Street youth represent a marginalized population marked by early mortality and elevated risk for suicide. It is not known to what extent childhood abuse and neglect predispose to suicide in this difficult-to-study population. This study is among the first to examine the relationship between childhood trauma and subsequent attempted suicide during adolescence and young adulthood among street youth. From October 2005 to November 2007, data were collected for the At Risk Youth Study (ARYS), a cohort of 495 street-recruited youth aged 14-26 in Vancouver, Canada. Self-reported attempted suicide in the preceding six months was examined in relation to childhood abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), using logistic regression. Overall, 46 (9.3%) youth reported a suicide attempt during the preceding six months. Childhood physical and sexual abuse were highly prevalent, with 201 (40.6%) and 131 (26.5%) of youth reporting history of each, respectively. Increasing CTQ score was related to risk for suicide attempt despite adjustment for confounders (adjusted odds ratio [AOR], 1.45 per standard deviation increase in score; 95% confidence interval [CI], 1.08-1.91). Use of snowball sampling may not have produced a truly random sample, and reliance on self-report may have resulted in underreporting of risk behaviors among participants. Moreover, use of cross-sectional data limits the degree to which temporality can be concluded from the results of this study alone. There exists a strong and graded association between childhood trauma and subsequent attempted suicide among street youth, an otherwise 'hidden' population. There is a need for effective interventions that not only prevent maltreatment of children but also aid youth at increased risk for suicide given prior history of trauma.

Growth in foetal life and infancy is associated with abdominal adiposity at the age of 2 years: The Generation R Study

Early weight gain is associated with an increased risk of obesity. It is not known whether rapid weight gain in foetal life and infancy is also associated with increased abdominal adiposity. We examined the associations of foetal and postnatal growth characteristics with abdominal fat mass at the age of 2 years. This study was performed in 481 children participating in a prospective cohort study from early foetal life onward. Foetal and postnatal growth characteristics in second and third trimester, at birth and at the age of 2 years were related to abdominal fat mass (subcutaneous distance and area, preperitoneal distance and area) measured by ultrasound at the age of 2 years. Foetal and birth weight were not associated with abdominal subcutaneous fat mass. Estimated foetal weight in second trimester of pregnancy was inversely associated with preperitoneal fat area [-3.73% (95% confidence interval -7.23, -0.10)] per standard deviation score increase in weight. Weight gain from birth to the age of 2 years was positively associated with preperitoneal fat mass measures. These associations remained significant after adjustment for age, sex, breastfeeding and body mass index. Positive associations were found between catch-up growth in weight and abdominal fat mass measures. Our results suggest that rapid growth rates during foetal life and infancy are associated with increased abdominal subcutaneous and preperitoneal fat mass in healthy children. Further studies need to explore whether these associations persist in later life and are related to metabolic syndrome outcomes.

Risk Factors and Outcomes Associated With First-Trimester Fetal Growth Restriction

Adverse environmental exposures lead to developmental adaptations in fetal life. The influences of maternal physical characteristics and lifestyle habits on first-trimester fetal adaptations and the postnatal consequences are not known. To determine the risk factors and outcomes associated with first-trimester growth restriction. Prospective evaluation of the associations of maternal physical characteristics and lifestyle habits with first-trimester fetal crown to rump length in 1631 mothers with a known and reliable first day of their last menstrual period and a regular menstrual cycle. Subsequently, we assessed the associations of first-trimester fetal growth restriction with the risks of adverse birth outcomes and postnatal growth acceleration until the age of 2 years. The study was based in Rotterdam, The Netherlands. Mothers were enrolled between 2001 and 2005. First-trimester fetal growth was measured as fetal crown to rump length by ultrasound between the gestational age of 10 weeks 0 days and 13 weeks 6 days. Main birth outcomes were preterm birth (gestational age <37 weeks), low birth weight (<2500 g), and small size for gestational age (lowest fifth birth centile). Postnatal growth was measured until the age of 2 years. In the multivariate analysis, maternal age was positively associated with first-trimester fetal crown to rump length (difference per maternal year of age, 0.79 mm; 95% confidence interval [CI], 0.41 to 1.18 per standard deviation score increase). Higher diastolic blood pressure and higher hematocrit levels were associated with a shorter crown to rump length (differences, -0.40 mm; 95% CI, -0.74 to -0.06 and -0.52 mm; 95% CI, -0.90 to -0.14 per standard deviation increase, respectively). Compared with mothers who were nonsmokers and optimal users of folic acid supplements, those who both smoked and did not use folic acid supplements had shorter fetal crown to rump lengths (difference, -3.84 mm; 95% CI, -5.71 to -1.98). Compared with normal first-trimester fetal growth, first-trimester growth restriction was associated with increased risks of preterm birth (4.0% vs 7.2%; adjusted odds ratio [OR], 2.12; 95% CI, 1.24 to 3.61), low birth weight (3.5% vs 7.5%; adjusted OR, 2.42; 95% CI, 1.41 to 4.16), and small size for gestational age at birth (4.0% vs 10.6%; adjusted OR, 2.64; 95% CI, 1.64 to 4.25). Each standard deviation decrease in first-trimester fetal crown to rump length was associated with a postnatal growth acceleration until the age of 2 years (standard deviation score increase, 0.139 per 2 years; 95% CI, 0.097 to 0.181). Maternal physical characteristics and lifestyle habits were independently associated with early fetal growth. First-trimester fetal growth restriction was associated with an increased risk of adverse birth outcomes and growth acceleration in early childhood.

Milk as a food for growth? The insulin-like growth factors link

The mechanisms underlying the association of insulin-like growth factor-I (IGF-I) and leg length (a marker of prepubertal growth) with cancer risk are uncertain. One hypothesis is that diet in early childhood might provide the link. The aim of the present study was to examine the association between early diet - in particular, the intakes of cows' milk and dairy products - and height, leg length and IGF-I levels at age 7-8 years. Children participating in the Avon Longitudinal Study of Parents and Children. Diet was assessed using a 3-day unweighed food record. Anthropometry, IGF-I and insulin-like growth factor-binding protein-3 (IGFBP-3) were measured by standard methods. Data on both diet and height were available for 744 children (404 boys) and on diet and IGF for 538 (295 boys). After adjusting for energy, both cows' milk and dairy product intakes were positively associated with IGF-I (P=0.040 and 0.027, respectively) and IGFBP-3 levels (P=0.082 and 0.067, respectively). These associations persisted on adjustment for potential confounders, but were abolished on controlling for protein intake. In energy-adjusted models there was only weak evidence of associations of milk and dairy product intakes with anthropometry. In boys only, dairy product intake was positively associated with leg length (equivalent to a 0.058 (0.002, 0.114) standard deviation score increase in leg length per 100 g increase in daily intake). These data provide some evidence that variation in childhood milk and dairy product intakes underlies associations of leg length, IGF-I and cancer risk. The association appears to be due to the protein content of milk.

Basic Skills and the Earnings of Dropouts

This paper quantifies the extent to which basic skills matter for young dropouts entering today's labor market. Estimates indicate that for dropouts who were age 16-18 when they took a high stakes test in the late 1990s, a standard deviation increase in scores is associated with earnings that are 9 percent higher in the first three years in the labor market. These results are the first direct evidence that young dropouts in today's economy are not relegated to jobs where cognitive skills are not rewarded, and they stress the importance of skill acquisition for students who may eventually drop out.

Fetal, infant, and childhood growth and adult blood pressure: a longitudinal study from birth to 22 years of age.

People who are small at birth tend to have higher blood pressure in later life. However, it is not clear whether it is fetal growth restriction or the accelerated postnatal growth that often follows it that leads to higher blood pressure. We studied blood pressure in 346 British men and women aged 22 years whose size had been measured at birth and for the first 10 years of life. Their childhood growth was characterized using a conditional method that, free from the effect of regression to the mean, estimated catch-up growth. People who had been small at birth but who gained weight rapidly during early childhood (1 to 5 years) had the highest adult blood pressures. Systolic pressure increased by 1.3 mm Hg (95% CI, 0.3 to 2.3) for every standard deviation score decrease in birth weight and, independently, increased by 1.6 mm Hg (95% CI, 0.6 to 2.7) for every standard deviation score increase in early childhood weight gain. Adjustment for adult body mass index attenuated the effect of early childhood weight gain but not of birth weight. Relationships were smaller for diastolic pressure. Weight gain in the first year of life did not influence adult blood pressure. Part of the risk of adult hypertension is set in fetal life. Accelerated weight gain in early childhood adds to this risk, which is partly mediated through the prediction of adult fatness. The primary prevention of hypertension may depend on strategies that promote fetal growth and reduce childhood obesity.