Groningen Expert Center For Kids With Obesity Drenthe Research Articles

Modelling individual infancy growth trajectories to predict excessive gain in BMI z-score: a comparison of growth measures in the ABCD and GECKO Drenthe cohorts

BackgroundExcessive weight gain during childhood is a strong predictor for adult overweight, but it remains unknown which growth measures in infancy (0–2 years of age), besides predictors known at birth, are the strongest predictors for excessive weight gain between 2 and 5–7 years of age.MethodsThe Amsterdam Born Children and their Development (ABCD) study formed the derivation cohort, and the Groningen Expert Center for Kids with Obesity (GECKO) Drenthe study formed the validation cohort. Change (Δ) in body mass index (BMI) z-score between 2 and 5–7 years was the outcome of interest. The growth measures considered were weight, weight-for-length (WfL), and body mass index (BMI). Formats considered for each growth measure were values at 1, 6, 12, and 24 months, at the BMI peak, the change between aforementioned ages, and prepeak velocity. 10 model structures combining different variable formats and including predictors at birth were derived for each growth measure, resulting in 30 linear regression models. A Parsimonious Model considering all growth measures and a Birth Model considering none were also derived.ResultsThe derivation cohort consisted of 3139 infants of which 373 (11.9%) had excessive gain in BMI z-score (> 0.67). The validation cohort contained 2201 infants of which 592 (26.9%) had excessive gain. Across the 3 growth measures, 5 model structures which included measures related to the BMI peak and prepeak velocity (derivation cohort area under the curve [AUC] range = 0.765–0.855) achieved more accurate estimates than 3 model structures which included growth measure change over time (0.706–0.795). All model structures which used BMI were superior to those using weight or WfL. The AUC across all models was on average 0.126 lower in the validation cohort. The Parsimonious Model’s AUCs in the derivation and validation cohorts were 0.856 and 0.766, respectively, compared to 0.690 and 0.491, respectively, for the Birth Model. The respective false positive rates were 28.2% and 20.1% for the Parsimonious Model and 70.0% and 74.6% for the Birth Model.ConclusionModels’ performances varied significantly across model structures and growth measures. Developing the optimal model requires extensive testing of the many possibilities.

Albuminuria and markers for cardiovascular risk in 12-year-olds from the general Dutch population: a cross-sectional study

In adults, albuminuria represents a risk factor for cardiovascular disease and is associated with hypertension and obesity. Pediatric data from the general population are inconsistent and largely based on randomly collected urine. A possible association between antenatal programming and albuminuria at school age has still to be investigated. The purpose of this study is to assess albuminuria in first morning void urine samples in a population-based pediatric cohort and to investigate cross-sectionally the association with factors related to cardiovascular risk. Moreover, we investigate the possible association of antenatal factors with albuminuria. A first morning void urine sample was collected in the population-based GECKO (Groningen Expert Center for Kids with Obesity) Drenthe cohort at the age of 12 years. We investigated cross-sectionally associations between albuminuria and body mass index (BMI), waist circumference (WC), blood pressure (BP) and antenatal factors. The prevalence of UACR (urinary albumin-creatinine ratio) ≥ 3 mg/mmol was 3.3% (95%CI 2.3–4.2). In a multivariate linear regression model, UAC was negatively associated with z-BMI (β-0.08, p = 0.013) and positively with z-systolic BP (β 0.09, p = 0.006), model significance p = 0.002. UACR was negatively associated with z-BMI (β − 0.13, p < 0.001) and positively with z-diastolic BP (β 0.09, p = 0.003), model significance p = 0.001. Albuminuria was not significantly associated with antenatal factors such as gestational age and standardized birth weight.Conclusions: Albuminuria in first morning void urine in 12-year-olds has a lower prevalence than previously reported by randomly collected samples. A negative association between albuminuria and BMI is confirmed. A positive association with blood pressure, but no association with antenatal factors was found.What is known:• While, in adults, albuminuria is a recognized risk factor for cardiovascular disease and is associated with hypertension and obesity, pediatric data are inconsistent and largely based on randomly collected urine.• A possible association between antenatal programming and albuminuria at school age has still to be investigated.What is new:• In this population study on first morning void urine samples from 12-year-olds of the general population, albuminuria is negatively associated with body mass index, and positively associated with blood pressure, while there is no association with antenatal factors.• The prevalence of albuminuria at 12 years is lower than previously reported in studies based on randomly collected urine samples, probably due to elimination of orthostatic proteinuria.

Adiposity and High Blood Pressure during Childhood: A Prospective Analysis of the Role of Physical Activity Intensity and Sedentary Time in the GECKO Drenthe Cohort.

Whereas in adults, physical inactivity is strongly related to obesity and hypertension, in young children the evidence is inconsistent and scarce. We examined the association between physical activity (PA) behaviours at 5–6 years of age and adiposity and blood pressure (BP) at 10–11 years in 947 children (51% boys) from the Groningen Expert Center for Kids with Obesity (GECKO) Drenthe cohort. Sedentary time (ST) and light, moderate, and vigorous PA were assessed using accelerometry (ActiGraph GT3X, wear time > 600 min/day, ≥3 days). Body mass index (BMI), waist circumference (WC), and systolic and diastolic BP were measured at 5–6 and 10–11 years of age and standardized as age- and sex-adjusted (and height-adjusted, for BP) z-scores. Adjusted linear and logistic regression models showed that most PA behaviours were not related to standardized BMI or WC, overweightness/obesity, abdominal overweightness/obesity, standardized systolic or diastolic BP, pulse pressure, or prehypertension at 10–11 years of age. Only if children spent more time in vigorous PA was WC slightly lower (B (95% CI) = −0.08 (−0.16, −0.01) SD, stdβ = −0.068) and the increase in WC over the years was less (B (95% CI) = −0.10 (−0.18, −0.01) SD; stdβ = −0.083). To conclude, at this very young age, PA behaviours are not a strong predictor for overweightness/obesity or hypertension later in childhood.

Early Determinants of Childhood Blood Pressure at the Age of 6 Years: The GECKO Drenthe and ABCD Study Birth Cohorts.

BackgroundThere is still uncertainty about the nature and relative impact of early determinants on childhood blood pressure. This study explored determinants of blood pressure at the age of 6 years in 2 Dutch birth cohorts.Methods and ResultsResults of hierarchical multiple linear regression analyses in GECKO (Groningen Expert Center for Kids With Obesity) Drenthe study (n=1613) were replicated in ABCD (Amsterdam Born Children and Their Development) study (n=2052). All analyses were adjusted for child's age, sex, height, and body mass index (BMI), and maternal education and subsequently performed in the combined sample. No associations were found between maternal smoking during pregnancy and childhood blood pressure. In the total sample, maternal prepregnancy BMI was positively associated with systolic blood pressure (SBP) (β [95% CI], 0.09 [0.02–0.16] mm Hg) and diastolic blood pressure (β [95% CI], 0.11 [0.04–0.17] mm Hg). Children of women with hypertension had higher SBP (β [95% CI], 0.98 [0.17–1.79] mm Hg). Birth weight standardized for gestational age was inversely associated with SBP (β [95% CI], −6.93 [−9.25 to −4.61] mm Hg) and diastolic blood pressure (β [95% CI], −3.65 [−5.70 to −1.61] mm Hg). Longer gestational age was associated with lower SBP (β [95% CI] per week, −0.25 [−0.42 to −0.08] mm Hg). Breastfeeding for 1 to 3 months was associated with lower SBP (β [95% CI], −0.96 [−1.82 to −0.09] mm Hg) compared with no or <1 month of breastfeeding. Early BMI gain from the age of 2 to 6 years was positively associated with SBP (β [95% CI], 0.41 [0.08–0.74] mm Hg) and diastolic blood pressure (β [95% CI], 0.37 [0.07–0.66] mm Hg), but no effect modification by birth weight was found.ConclusionsHigher maternal prepregnancy BMI, maternal hypertension, a relatively lower birth weight for gestational age, shorter gestational age, limited duration of breastfeeding, and more rapid early BMI gain contribute to higher childhood blood pressure at the age of 6 years.

Young Children's Sugar-Sweetened Beverage Consumption and 5-Year Change in BMI: Lessons Learned from the Timing of Consumption.

Sugar-sweetened beverages (SSBs) are an already known risk factor for weight gain in childhood. To identify windows of opportunity for public health interventions, insight into the consumption behavior of SSBs is needed. We investigated whether total SSB consumption was related to body mass index (BMI) change and overweight and compared whether the timing of consumption over the day differed between low and high consumers. In the Dutch GECKO Drenthe birth cohort, a cohort embedded within the Groningen Expert Center for Kids with Obesity (GECKO), height and weight were measured by trained nurses at age 5/6 years (y) and 10/11 y (N = 1257). BMI was standardized for age and sex (BMI-z). In the food pattern questionnaire completed by parents at age 5/6 y, beverages were assessed for seven time segments (breakfast, morning, lunch at school, lunch at home, afternoon, dinner, and evening). Linear and logistic regression analyses were adjusted for potential confounders (sex, baseline BMI-z, parental BMI, parental education level, maternal age at birth, maternal smoking during pregnancy). The median daily SSB consumption frequency ranged from 1.9 times per day (1.5–2.0, 25th–75th percentile) in the lowest quartile to 4.9 times per day (4.6–5.5) in the highest quartile. In the highest compared to the lowest quartile of SSB consumption frequency, the confounder-adjusted odds ratio for overweight incidence was 3.12 (95% CI, 1.60–6.07). The difference in consumption between quartile 1 and quartile 4 occurred mainly during main meals and in the evening, e.g., at breakfast (31% vs. 98%, p < 0.001), lunch at home (32% vs. 98%, p < 0.001), and dinner (17% vs. 72%, p < 0.001). These drinking occasions characterizing high SSB consumers mostly occurred in the home environment, where parental influence on dietary behaviors is profound. Therefore, these results exposed a window of opportunity, leading to the advice for parents to offer their children sugar-free drinks to quench thirst with main meals.

Parental physical activity is associated with objectively measured physical activity in young children in a sex-specific manner: the GECKO Drenthe cohort

BackgroundPhysical activity (PA) is important in combating childhood obesity. Parents, and thus parental PA, could influence PA in young children. We examined whether the time spent at different intensities of PA and the type of parental PA are associated with the PA of children aged 4–7 years, and whether the associations between child-parent pairs were sex-specific.MethodsAll the participants were recruited from the Groningen Expert Center for Kids with Obesity (GECKO) birth cohort (babies born between 1 April 2006 and 1 April 2007 in Drenthe province, the Netherlands) and were aged 4–7 years during measurement. PA in children was measured using the ActiGraph GT3X (worn at least 3 days, ≥10 h per day). PA in parents was assessed using the validated SQUASH questionnaire.ResultsOf the N = 1146 children with valid ActiGraph data and 838 mothers and 814 fathers with valid questionnaire data, 623 child-parent pairs with complete data were analysed. More leisure time PA in mothers was associated with more time spent in moderate-to-vigorous PA (MVPA) in children (Spearman r = 0.079, P < .05). Maternal PA was significantly related to PA in girls, but not boys. More time spent in maternal vigorous PA, in sports activity, and leisure time PA, were all related to higher MVPA in girls (Spearman r = 0.159, r = 0.133 and r = 0.127 respectively, Pall < .05). In fathers, PA levels were predominantly related to PA in sons. High MVPA in fathers was also related to high MVPA in sons (r = 0.132, P < 0.5). Spending more time in light PA was related to more sedentary time and less time in MVPA in sons.ConclusionsHigher PA in mothers, for instance in leisure activities, is related to higher PA in daughters, and more active fathers are related to more active sons. To support PA in young children, interventions could focus on the PA of the parent of the same sex as the child. Special attention may be needed for families where the parents have sedentary jobs, as children from these families seem to adopt more sedentary behaviour.

Television, sleep, outdoor play and BMI in young children: the GECKO Drenthe cohort.

In this study, we investigated the interplay between screen time, sleep duration, outdoor play, having a television in the bedroom and the number of televisions at home and their association with body mass index (BMI) in preschool children. All participants, 3-4 years of age (n = 759), were part of the Groningen expert center for kids with obesity (GECKO) Drenthe birth cohort. Weight and height were measured. Total screen time, number of televisions at home, a television in the bedroom, sleep duration and time of outdoor play were self-reported by parents in a questionnaire. Ordinary least square (OLS) regression-based path analysis was used to estimate direct and indirect effects on BMI in mediation models. A television in the bedroom or more televisions at home gave a higher screen time, which were associated with decreased sleep duration and resulted in higher BMI (indirect effect = 0.0115, 95% bootstrap interval = 0.0016; 0.0368 and indirect effect = 0.0026, 95% bootstrap interval = 0.0004; 0.0078, respectively). In contrast to the direct effect of screen time, sleep duration and a television in the bedroom on BMI, no direct effect was found for outdoor play and number or televisions at home on BMI. Short sleep duration, long screen time and a television in the bedroom were associated with the presence of overweight in preschool children.

Effects of paternal and maternal lifestyle factors on pregnancy complications and perinatal outcome. A population-based birth-cohort study: the GECKO Drenthe cohort

Do paternal and maternal lifestyle factors influence the risk of hypertensive pregnancy complications, gestational diabetes mellitus (GDM), spontaneous preterm birth and small-for-gestational-age (SGA)? Paternal lifestyle factors do not exert an independent effect on the investigated outcomes while maternal prepregnancy BMI and maternal smoking during pregnancy influence the risk of hypertensive pregnancy complications, GDM and SGA. Maternal lifestyle factors are associated with perinatal complications, but the impact of paternal lifestyle factors is unclear. Data from the GECKO (Groningen Expert Center for Kids with Obesity) Drenthe cohort, a prospective population-based birth-cohort of children born between April 2006 and April 2007 in a northern province of The Netherlands, were analysed. The parents of 2958 children (62% of those approached) gave their consent to participate in the study and the data of 2264 (77%) couples were available for analysis. All pregnant women in the Dutch province of Drenthe with an expected date of delivery between April 2006 and April 2007 were invited to participate and included during the third trimester of their pregnancy or within 6 months after delivery. All consenting couples received extensive questionnaires including lifestyle, biological and socio-demographic-related questions covering the period of 6 months prior to conception. Outcome data were obtained from midwives and hospital registries. Univariable and multivariable logistic regression analyses were used to determine the impact of the lifestyle factors on the primary outcome measures. Of all 2264 women, 241 women (10.6%) developed a hypertensive pregnancy complication, 50 women (2.2%) developed GDM, 79 (3.5%) children were spontaneously delivered preterm and 155 children (6.8%) were SGA. All paternal and maternal lifestyle factors were positively correlated. Multivariable analysis showed that paternal lifestyle factors did not have an independent influence on the investigated outcomes. Of the maternal factors, prepregnancy BMI was independently associated with an increased risk of a hypertensive disorder during pregnancy (odds ratio (OR): 1.12, 95% CI 1.09-1.16), a higher risk of GDM (OR BMI >23 kg/m(2), per BMI unit: 1.13, 95% CI 1.08-1.18) and with a decreased risk of SGA (OR per BMI point 0.94, 95% CI 0.90-0.99). Maternal smoking during pregnancy was significantly associated with SGA (OR 3.00, 95% CI 1.80-4.99) in multivariable analysis. The retrospective nature of the questionnaire may have induced recall bias. Selection bias might have occurred, as ethnic minorities were less willing to co-operate in the GECKO Drenthe study. The possibility of misclassification bias regarding the primary outcome measures cannot be ruled out. Inclusion bias might have occurred as not all questionnaires of the parents of the children participating in the GECKO Drenthe cohort were completed. Paternal lifestyle factors do not have an independent effect on the investigated adverse pregnancy outcomes. However, as paternal and maternal lifestyles are positively correlated, both partners should be involved in preconception counselling regarding the investigated outcome measures.

The influence of maternal and paternal factors on time to pregnancy--a Dutch population-based birth-cohort study: the GECKO Drenthe study

Both maternal and paternal factors have been suggested to influence a couple's fecundity. To investigate this, we examined the role of several maternal and paternal lifestyle and socio-demographic factors as determinants of time to pregnancy (TTP) in a Dutch birth-cohort. Groningen Expert Center for Kids with Obesity (GECKO) Drenthe is a population-based birth-cohort study of children born between April 2006 and April 2007 in Drenthe, a province of The Netherlands. Both partners received extensive questionnaires during pregnancy. Univariable and multivariable Cox regression analyses were used to determine the impact of the investigated factors on TTP. A total of 4778 children were born, and the parents of 2997 children (63%) gave their consent to participate. After excluding unintended pregnancies and pregnancies as a result of fertility treatment, the data of 1924 couples were available for analysis. Hazards ratios and 95% confidence intervals of factors influencing TTP in multivariable Cox regression analysis were: maternal age 1.23 (0.98-1.54) for age <25 years, 1.17 (1.03-1.32) for age 25-30 years and 0.72 (0.61-0.85) for age >35 years (reference category: 30-35 years); paternal age: 1.31 (0.94-1.82) for age <25 years, 1.11 (0.97-1.28) for age 25-30 years and 0.91 (0.80-1.04 for age >35 years (reference category: 30-35 years); nulliparity: 0.76 (0.68-0.85) versus multiparity; menstrual cycle length: 1.12 (0.95-1.30) for 3 weeks, 0.72 (0.62-0.83) for 4-6 weeks, 0.68 (0.40-1.16) for >6 weeks and 0.66 (0.54-0.81) for irregular cycle (reference category: 4 weeks); prior contraceptive use: 0.78 (0.67-0.91) for no contraception, 1.68 (1.45-1.95) for condom use, 1.08 (0.89-1.33) for condom use combined with oral contraception, 1.40 (1.16-1.70) for intrauterine device and 0.50 (0.25-1.01) for contraceptive injection (reference category: oral contraception); and maternal educational level 0.75 (0.62-0.92) for low education level and 0.81 (0.73-0.90) for medium educational level (reference category: high educational level). This population-based birth-cohort study performed in fertile couples who had conceived revealed neither maternal nor paternal modifiable lifestyle factors were significantly associated with TTP after adjustment for confounding by socio-demographic factors. In contrast, several non-modifiable maternal socio-demographic factors are significant predictors of a couple's fecundity.