Lifelong Health Implications Research Articles

A Qualitative Study of Primary Care Physicians' Approaches to Caring for Adult Adopted Patients.

Adoption has lifelong health implications for 7.8 million adopted people and their families in the United States. The majority of adoptees have limited family medical history (LFMH). Primary care physicians (PCPs) rarely receive training about adoptees including their mental health needs and increased suicide risk. The growing availability and popularity of direct-to-consumer genetic testing kits amplifies the need for PCPs to be prepared to address genetic testing for adoptees with LFMH. This study explores PCP training and approaches to adult adopted patients with LFMH. We used critical adoption studies as a theoretical framework for this study to understand how adoptive identity might shape clinical experiences. We recruited PCPs from Minnesota and Rhode Island via purposive, criteria-based, reputational sampling. We conducted hour-long semistructured qualitative interviews incorporating hypothetical clinical vignettes. Transcripts were coded via template organizing method and analyzed via Immersion-Crystallization. We interviewed 23 PCPs. They reported receiving little training or resources on adult adoptees with LFMH and showed substantial knowledge gaps regarding mental health and genetic testing for this population. Many failed to adjust history-taking and primary care approaches, which they recognized as potentially resulting in inaccuracies, inappropriate clinical care, and microaggressions while inadvertently triggering anxiety, shame, and distrust among patients. A mismatch between adopted patients' and physicians' understandings of family medical history could strain the therapeutic relationship. Nearly all interviewees viewed additional training to care for adult adoptees with LFMH as beneficial. Future research should expand education and training for PCPs on adult adoptees with LFMH.

Breath Analysis Using Quartz Tuning Forks for Predicting Blood Glucose Levels Using Artificial Neural Networks.

Diabetes Mellitus (DM), a widespread metabolic disorder, poses lifelong health implications, demanding timely diagnosis and cautious monitoring for effective disease management. Traditional blood glucose tests are invasive and require medical expertise for intermittent checking, motivating the investigation of alternative, noninvasive methods. This study introduces an approach employing breath analysis through a set of 12 quartz tuning fork-based sensors enhanced using nanomaterials and dedicated artificial neural network (ANN) algorithms for data interpretation. The breath analysis methodology involves capturing unique breath signatures using the frequency-based sensor array. The accompanying neural network classification algorithm, customized for the sensor data, enables precise classification of data from 245 individuals as diabetic, prediabetic, or healthy. A neural network regression algorithm predicted blood glucose values and was compared with the actual values obtained from medical blood glucose measurement. The clinical relevance of the predicted blood glucose has been examined using error grids. The sensor array coupled with the ANN algorithm can identify diabetic, prediabetic, and control samples with 97% test accuracy. Blood glucose was predicted using neural network regression with a correlation coefficient of 0.89 and a mean square error of 0.13.

The ontogeny of human fetal trabecular bone architecture occurs in a limb-specific manner

Gestational growth and development of bone is an understudied process compared to soft tissues and has implications for lifelong health. This study investigated growth and development of human fetal limb bone trabecular architecture using 3D digital histomorphometry of microcomputed tomography data from the femora and humeri of 35 skeletons (17 female and 18 male) with gestational ages between 4 and 9 months. Ontogenetic data revealed: (i) fetal trabecular architecture is similar between sexes; (ii) the proximal femoral metaphysis is physically larger, with thicker trabeculae and greater bone volume fraction relative to the humerus, but other aspects of trabecular architecture are similar between the bones; (iii) between 4 and 9 months gestation there is no apparent sexual or limb dimorphism in patterns of growth, but the size of the humerus and femur diverges early in development. Additionally, both bones exhibit significant increases in mean trabecular thickness (and for the femur alone, bone volume fraction) but minimal trabecular reorganisation (i.e., no significant changes in degree of anisotropy, connectivity density, or fractal dimension). Overall, these data suggest that in contrast to data from the axial skeleton, prenatal growth of long bones in the limbs is characterised by size increase, without major reorganizational changes in trabecular architecture.

The Trauma of Separation: Lifelong Health Implications on Children.

In the United States, there are millions of globally displaced children who travel with family to seek immigration relief, many of whom have experienced family separation or live under the constant threat of separation. Family separation constitutes a significant trauma with lifelong impacts on a child's mental health, physical health, and development. This review provides a summary of the various contexts within which family separation occurs as well as the current literature on long-term health sequelae. These include mental illness, externalizing behaviors, developmental challenges, family stability, economic impacts, and educational attainment. Given the number of newcomer children in the US, it is paramount that pediatric clinicians develop a holistic understanding of their needs and the effects of separation to provide evidence-based care and to advocate for the prevention of this trauma for all future migrant families. [Pediatr Ann. 2024;53(5):e167-e170.].

Human Milk Oligosaccharides: Potential Upshot on Health at Early Life Stage Development

In the crucial early months of life, an infant's health, growth, and safeguarding are paramount. Breastfeeding stands out as the optimal and natural means of nourishment, offering profound benefits for their development and overall wellness. Within breast milk, a rich array of bioactive components, including hormones, oligosaccharides, and immunoglobulins, provide neonates with an ideal nutritional balance. Among these, Human Milk Oligosaccharides (HMOs) rank prominently, serving both as prebiotics and shields against various neonatal ailments. Particularly, compounds like 2′-Fucosyllactose (2′-FL) and Lacto-N-Neotetraose (LNnT) have been deemed safe for integration into infant formulas, amplifying their benefits. Extensive research underscores the manifold advantages of HMOs, from modulating gut microbiota to bolstering immune function and thwarting pathogenic invaders. HMOs also exhibit a nuanced interplay with maternal genetics, influencing their quantity and diversity. Infants nursed by secretor mothers tend to enjoy enhanced HMO benefits compared to non-secretor counterparts. Incorporating HMOs like Lacto-N-Neotetraose and 2′-Fucosyllactose into infant formulas represents a pivotal stride in optimizing child nutrition. This review offers a thorough exploration of recent research on HMOs, delving into their varied types, concentrations, and compositions, while emphasizing their profound impact on infant health and safety. By consolidating current research findings and recent progress, this study seeks to clarify the diverse effects of HMOs on different facets of human physiology, immune system maturation, modulation of gut microbiota, neurological functioning, and lifelong health implications. Emphasizing the pivotal role of HMOs in influencing human well-being from infancy to maturity, this review emphasize the necessity for continued research and potential utilization in clinical settings and nutritional science.

Conquering homocystinuria with engineered probiotics

Pyridoxine-unresponsive homocystinuria has lifelong implications for health. In this issue, Perreault and colleagues present evidence that orally delivered engineered probiotic Escherichia Coli Nissle SYNB1353 is a promising candidate in reducing homocysteine, with successful trials in mice, monkeys, and humans. However, further probiotic optimization and safety assessments are required.

Concentrations and health risks of selected elements in leafy vegetables: a comparison between roadside open-air markets and large stores in Johannesburg, South Africa

This study compared concentrations and health risks of selected elements (Al, As, Cd, Co, Cr, Cu, Hg, Ni, Pb, Zn) in leafy vegetables (coriander, lettuce, mint, spring onion, swiss chard) from roadside open-air markets (OM) and large stores (supermarkets: SM, vegetable markets: VM) in Johannesburg, South Africa. Along with washed leaves (OMW, SMW, VMW), unwashed OM leaves (OMUW) were assessed to investigate the contribution of deposition. The findings revealed that OMUW leaves had the highest concentrations of all elements. Furthermore, compared with washed leaves, OMUW leaves showed significantly higher (p < 0.05) mean concentrations of Cd, Hg, Ni and Pb, elements that typify the composition of polluted urban air. Bi- and multivariate analysis indicated anthropogenic origin of most elements in OM leaves and several in SMW and VMW leaves. Although only OMUW leaves exhibited hazard quotient above the safe threshold of 1 for Cd, Cr, As and Ni, hazard index exceeded this safe limit in all samples (OMUW (11.77) > OMW (1.83) > SMW (1.29) > VMW (1.01)). Determined cancer risk for Cd and As was greater than 1 × 10−6 in both washed and unwashed leaves, and the greatest cancer risk was estimated for OM leaves. Thorough washing of OM vegetables with water reduced non-carcinogenic risk (84%) and cancer risk (74‒87%) markedly. In conclusion, residents primarily relying on open-air markets for their regular leafy vegetable supplies might face far more severe lifelong health implications compared to customers of large stores in Johannesburg.

Economic burden of adverse perinatal outcomes from births to age 5 years in high-income settings: a protocol for a systematic review

BackgroundAdverse perinatal outcomes such as preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death have devastating impacts on individuals, families and societies, with significant lifelong...

166 Maternal Versus Environmental Contributions to the Piglet Pioneer Microbiome

Abstract The pioneer microbiome is the initial and foundational colonization of microbiological organisms within the neonatal animal and has lifelong implications for health and performance. The objective of this project was to quantify various maternal and environmental sources contributing to the pioneer microbiome of the piglet. Five pregnant gilts farrowed at the Texas A&amp;M University Swine Center in April 2022. Litters were a Duroc x Landrace x Yorkshire composite and averaged 13.4 total number born and 11.4 number weaned. At birth, all piglets were individually identified and weighed and 5 piglets per litter weighing ≥1,200 grams were selected for microbiome analysis. Sterile swabs were used to collect, in duplicate, samples from the farrowing crate before gilt introduction (EMPTYCRATE) and after gilts were moved in (FULLCRATE), from the birth canal during farrowing (BIRTHCANAL), and from the rectum of the piglet on days 0 (prior to suckling), 3, and 10 post-farrowing and at weaning (21.6 ±.0 days post-farrowing). Colostrum was collected from each gilt during farrowing from a representative sample of teats into a single sterile collection cup (COLOSTRUM). Swabs and colostrum were stored in sterile microcentrifuge tubes at -80°C until sequencing. Bacterial DNA was extracted, and sequencing targeted the V4 hypervariable region of the6S rRNA gene. Statistical analyses were conducted using PROC GLM and PROC REG in SAS 9.4. The phyla Firmicutes and Proteobacteria were not different between maternal (BIRTHCANAL, COLOSTRUM) and environmental (EMPTYCRATE, FULLCRATE) sources (Table 1). The piglet microbiome shifted from birth to weaning. The relative abundance of phylum Firmicutes was less on day 3 compared with day 0 and at weaning but did not differ from day0 (Table 1). Within the phylum Firmicutes, Lactobacillus and Clostridium genera were greater on day 3 compared with day 0, 10, and at weaning (Table 1). The relative abundance of phylum Proteobacteria, and the relative abundance of genus Escherichia within phylum Proteobacteria, were greater on day 3 compared with day 0, 10, and at weaning (Table 1). Multiple regression analyses indicated that BIRTHCANAL explained 51.6% of the variation observed in piglet day 0 microbiome (P &amp;lt; 0.0001), and 6.5% of the variation in the piglet day 10 microbiome (P = 0.01). The piglet day 0 (pre-suckle) microbiome explained 10.0% of the variation observed in day 3 microbiome and 15.6% of the day 10 microbiome (P &amp;lt; 0.05). Finally, day 10 microbiome explained 58.6% of the variation observed in the piglet microbiome at weaning (P &amp;lt; 0.0001). The microbiome of COLOSTRUM and the farrowing crate did not impact piglet microbiome (P &amp;gt; 0.10). Results indicate that the piglet pioneer microbiome is largely influenced by the microbiome of the birth canal and that the microbiome of the animal at weaning may be largely established by 10 days of age.

Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting

BackgroundBeing born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention.MethodsSecondary analysis was carried out on anonymised cross-sectional data from health visiting services in south and west Wales that had previously captured information on mothers’ ACEs during routine contacts. Demographic data and information on mothers’ health were extracted from the Healthy Child Wales Programme.ResultsHalf of all mothers sampled had experienced at least one ACE, with a history of ACEs more common among younger, white British mothers and those residing in deprived areas. Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83, 95% confidence interval [CI] = 1.19–12.32, p = 0.025), neglect (AOR = 7.60, 95%CI = 1.81–31.97, p = 0.006) and overall ACE exposure (AOR = 2.67, 95%CI = 1.14–6.23, p = 0.024), with one in ten mothers (10.0%) who experienced ≥4 ACEs having preterm birth. Sub-analyses revealed a more pronounced relationship among mothers with no known chronic health conditions, with those with ≥4 ACEs and no known chronic condition four times more likely to give birth preterm (AOR = 3.89, 95%CI = 1.40–10.80, p = 0.009).ConclusionsFindings highlight the importance of the entire maternal experience. The experience of childhood adversity can have a lasting impact into and beyond the prenatal period, potentially increasing the risk of preterm birth, even among otherwise healthy women. Increasing our understanding of the potential perinatal outcomes associated with ACEs can help to inform how maternity services and partners offer trauma-sensitive support to mitigate some of the risks of early parturition, as well as target intergenerational cycles of adversity and poor health.

Implications and Aspects of Lyme Neuroborreliosis

Lyme borreliosis or Lyme disease affects thousands of people globally each year, and, with nervous system involvement, this disease can lead to the development of Lyme neuroborreliosis (LNB). If not diagnosed and treated properly, LNB can lead to serious life-long health implications for affected patients. The clinical manifestations and treatment regimens are relatively well-studied, but much remains unknown about the disease’s pathogenesis and epidemiology. In this review, the authors elucidate the knowns and unknowns of LNB.

Socioeconomic inequalities in co-morbidity of overweight, obesity and mental ill-health from adolescence to mid-adulthood in two national birth cohort studies.

AimTo examine socioeconomic inequalities in comorbidity risk for overweight (including obesity) and mental ill-health in two national cohorts. We investigated independent effects of childhood and adulthood socioeconomic disadvantage on comorbidity from childhood to mid-adulthood, and differences by sex and cohort.MethodsData were from 1958 National Child Development Study (NCDS58) and 1970 British Cohort Study (BCS70) [total N=30,868, 51% males] assessed at ages 10, 16, 23/26, 34 and 42 years. Socioeconomic indicators included childhood and adulthood social class and educational level. Risk for i. having healthy BMI and mental ill-health, ii. overweight and good mental health, and iii. overweight and mental ill-health was analysed using multinomial logistic regression.FindingsSocioeconomic disadvantage was consistently associated with greater risk for overweight-mental ill-health comorbidity at all ages (RRR 1.43, 2.04, 2.38, 1.64 and 1.71 at ages 10, 16, 23, 34 and 42 respectively for unskilled/skilled vs. professional/managerial class). The observed inequalities in co-morbidity were greater than those observed for either condition alone (overweight; RRR 1.39 and 1.25, mental ill-health; 1.36 and 1.22 at ages 16 and 42 respectively, for unskilled/skilled vs. professional/managerial class). In adulthood, both childhood and adulthood socioeconomic disadvantage were independently associated with comorbid overweight-mental ill-health, with a clear inverse gradient between educational level and risk for comorbidity. For instance, for the no education group (compared to university education) the RRR is 6.11 (95% CI 4.31-8.65) at age 34 and 4.42 (3.28-5.96) at age 42. There were no differences observed in the extent of inequalities by sex and differences between cohorts were limited.InterpretationWhile socioeconomic disadvantage in childhood and adulthood are consistently and independently associated with greater risk for mental ill-health and being overweight separately, these associations are even larger for their comorbidity across the lifecourse. These findings are significant given the increasing global prevalence of obesity and mental ill-health, and their implications for lifelong health and mortality.FundingThis research was supported by grants from the Wellcome Trust (ISSF3/ H17RCO/NG1) and Medical Research Council (MRC) [MC_UU_00019/3].

Existing Guidance on Feeding Infants and Children From Birth to 24 Months: Implications and Next Steps for Registered Dietitian Nutritionists

Increasingly, evidence exists that feeding practices for infants and young children can have lifelong health implications.1,2 The importance of this critical period was recognized in the Scientific Report of the 2020 Dietary Guidelines Advisory Committee,3 which will be used to develop the 2020-2025 Dietary Guidelines for Americans. For the first time, the 2020-2025 Dietary Guidelines for Americans will establish national guidance for diet from birth to 24 months of age.

Cord Blood Plasma Metabolome-wide Associations With Height From Birth to Adolescence.

Although the maternal intrauterine metabolic environment has been recognized to have a profound impact on fetal growth and development with lifelong health implications, to our knowledge, there have been few large-scale birth cohort studies linking the cord metabolome (reflecting both the maternal and fetal metabolic state) with postnatal height measurements across the pediatric age range. Using data from the Boston Birth Cohort, an ongoing prospective birth cohort, this study investigated the association of cord plasma metabolites with children's height from birth to adolescence. Height was analyzed as attained height and longitudinal trajectories. Distinctive cord metabolite types were associated with attained height at different developmental windows: triacylglycerols [TAGs], diacylglycerols [DAGs], cholesterol ester [CEs], phospholipids, amino acids [AAs], acylcarnitines [ACs], and nucleotides in early (age 0-4 years) and middle (age 6-12 years) childhood; various metabolite types other than TAGs in later childhood (after age 14 years). Functional principal component analysis on children's repeated height measurements summarized two typical height trajectory components: loadings on first eigenfunction [FPC1] representing overall height by age, and loadings on second eigenfunction [FPC2] representing speed of pubertal height growth. Although only one cord metabolite was correlated with FPC1 after accounting for multiple testing, the study found 27 metabolites with significant overall effect on FPC2 among females and 18 among males. These metabolites were mostly phospholipids (including phosphatidylethanolamines [PEs], phosphatidylethanolamine plasmalogens [PE_Ps], phosphatidylcholines [PCs], lysophosphatidylethanolamines [LPEs], and lysophosphatidylcholines [LPCs]), AAs, and nucleotides. Their associations with height differed between overweight/obesity (OWO) and non-OWO children, especially among females. In this prospective study of US understudied urban, low-income, racially diverse children, we demonstrated that cord plasma metabolites were significantly associated with postnatal attained height at different age windows as well as height trajectories from birth to adolescence. We also revealed how these associations differed by children's sex and OWO status. Our findings help elucidate metabolic pathways underlying fetal origins of height growth across developmental stages. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Maternal periconceptual nutrition, early pregnancy, and developmental outcomes in beef cattle.

The focus of this review is maternal nutrition during the periconceptual period and offspring developmental outcomes in beef cattle, with an emphasis on the first 50 d of gestation, which represents the embryonic period. Animal agriculture in general, and specifically the beef cattle industry, currently faces immense challenges. The world needs to significantly increase its output of animal food products by 2050 and beyond to meet the food security and agricultural sustainability needs of the rapidly growing human population. Consequently, efficient and sustainable approaches to livestock production are essential. Maternal nutritional status is a major factor that leads to developmental programming of offspring outcomes. Developmental programming refers to the influence of pre-and postnatal factors, such as inappropriate maternal nutrition, that affect growth and development and result in long-term consequences for health and productivity of the offspring. In this review, we discuss recent studies in which we and others have addressed the questions, "Is development programmed periconceptually?" and, if so, "Does it matter practically to the offspring in production settings?" The reviewed studies have demonstrated that the periconceptual period is important not only for pregnancy establishment but also may be a critical period during which fetal, placental, and potentially postnatal development and function are programmed. The evidence for fetal and placental programming during the periconceptual period is strong and implies that research efforts to mitigate the negative and foster the positive benefits of developmental programming need to include robust investigative efforts during the periconceptual period to better understand the implications for life-long health and productivity.

RURAL LOCALE PROTECTIVE FOR ETHNICALLY AND RACIALLY DIVERSE WOMEN AT RISK FOR GESTATIONAL DIABETES MELLITUS IN THE PACIFIC NORTHWEST

Pregnancy-related complications like gestational diabetes mellitus (GDM) lead to adverse outcomes and increased chronic disease risk for both mother and fetus. Women living in rural and medically underserved communities are at especially high risk due to the inverse association of health outcomes with the social determinants of health and high rates of obesity. Prevalence of GDM in rural and non-rural areas has not been not been previously evaluated, and with co-morbidities leading to lifelong health implications, it is imperative to identify disparities to mitigate them.

Early Nutrition eAcademy Southeast Asia e-Learning for Enhancing Knowledge on Nutrition during the First 1000 Days of Life.

Background: The double burden of both under- and overnutrition during the first 1000 days is highly prevalent in Southeast Asia (SEA), with major implications for lifelong health. Tackling this burden requires healthcare professionals (HCPs) to acquire evidence-based current knowledge and counselling skills. We assessed the needs of HCPs in SEA and developed a continuing medical education/professional development (CME/CPD) program using an e-learning platform to reduce existing gaps. Methods: European, Thai and Malaysian universities collaborated with SEA national nutrition associations in the Early Nutrition eAcademy Southeast Asia (ENeA SEA) project. We assessed HCPs’ needs using questionnaires and mapped CME/CPD programmes and regulations through stakeholder questionnaires. Using a co-creation approach, we established an e-learning platform. Evaluation in users was undertaken using questionnaires. Results: HCPs in SEA reported major training gaps relating to the first 1000 days of nutrition and limited impact of existing face-to-face training. Existing pre/postgraduate, residency and CME/CPD programmes did not adequately address the topic. To address these gaps, we produced a targeted e-learning platform with six modules and CME-tests. National ministries, Thai and Malaysian universities, and professional associations endorsed the training platform. To date, over 2600 HCPs have registered. Evaluation shows high acceptance and a very positive assessment. Conclusions: Dedicated e-learning can reduce major gaps in HCP training in SEA regarding nutrition during the first 1000 days of life at scale and is highly valued by both users and key stakeholders.

Can a probiotic supplement in pregnancy result in transfer to the neonatal gut: A systematic review.

The establishment of the neonatal gut microbiome is a crucial step that may have lifelong health implications. We aimed to systematically review evidence on maternal probiotic supplementation during pregnancy and vertical transfer of the corresponding strain to the infant gut. Medline, CINAHL, Embase, Web of Science, and OVID were searched from inception to September 2018. Studies of maternal probiotic supplementation for a minimum duration of 2weeks and analyses of neonatal stool samples were included. The primary outcome was presence of the specific probiotic strain in the infant stool. Electronic databases were searched for relevant studies and references were cross-checked. Risk of bias among included studies was assessed and data were extracted independently by two authors. Three studies were included in the review. Only one study was identified involving prenatal maternal probiotic supplementation alone. Neonatal colonization with the maternally administered probiotic was not demonstrated but supplementation with the probiotic influenced levels of a bacterial strain other than that found in the probiotic product. The other two studies identified included both prenatal and postnatal supplementation of either mother or infant. All three studies reported employing strain-specific isolation methodology to isolate the supplemented bacterial strain in infant stool but none used whole metagenome shotgun sequencing. Few studies investigating transfer of a specific probiotic bacterial strain from mother to infant were identified, showing inconclusive evidence of vertical transfer.

Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health.

Osteoporosis is a significant cause of morbidity and mortality in contemporary populations. This common disease of aging results from a state of bone fragility that occurs with low bone mass and loss of bone quality. Osteoporosis is thought to have origins in childhood. During growth and development, there are rapid gains in bone dimensions, mass, and strength. Peak bone mass is attained in young adulthood, well after the cessation of linear growth, and is a major determinant of osteoporosis later in life. Here we discuss the evolutionary implications of osteoporosis as a disease with developmental origins that is shaped by the interaction among genes, behavior, health status, and the environment during the attainment of peak bone mass. Studies of contemporary populations show that growth, body composition, sexual maturation, physical activity, nutritional status, and dietary intake are determinants of childhood bone accretion, and provide context for interpreting bone strength and osteoporosis in skeletal populations. Studies of skeletal populations demonstrate the role of subsistence strategies, social context, and occupation in the development of skeletal strength. Comparisons of contemporary living populations and archeological skeletal populations suggest declines in bone density and strength that have been occurring since the Pleistocene. Aspects of western lifestyles carry implications for optimal peak bone mass attainment and lifelong skeletal health, from increased longevity to circumstances during development such as obesity and sedentism. In light of these considerations, osteoporosis is a disease of contemporary human evolution and evolutionary perspectives provide a key lens for interpreting the changing global patterns of osteoporosis in human health.

Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study

Sexual minority adolescents are more likely to have mental health problems, adverse social environments, and negative health outcomes compared with their heterosexual counterparts. There is a paucity of up-to-date population-level estimates of the extent of risk across these domains in the UK. We analysed outcomes across mental health, social environment, and health-related domains in sexual minority adolescents compared with their heterosexual counterparts in a large, contemporary national cohort. The Millennium Cohort Study (MCS) is a birth cohort study in the UK following up children born between Sept 1, 2000, and Jan 11, 2002 across England, Wales, Scotland, and Northern Ireland. Children recruited from the MCS have been followed up over six recruitment sweeps to date at ages 9 months, 3 years, 5 years, 7 years, 11 years, and 14 years. We analysed mental health, social, and health-related outcomes in sexual minority versus heterosexual adolescents at age 14 years. Additionally, we estimated the accumulation of multiple adverse outcomes in both groups. The primary aim of the study was to assess whether sexual minority adolescents experienced more adverse outcomes than heterosexual adolescents. Between January, 2015, and April, 2016, 9885 adolescents provided a response about their sexual attraction. 629 (6%) of 9885 adolescents (481 female participants and 148 male participants) were identified as sexual minorities. 9256 (94%) of 9885 participants (4431 female and 4825 male) were attracted to the opposite sex or not attracted to the same sex and identified as heterosexual. Sexual minority adolescents were more likely to experience high depressive symptoms (odds ratio [OR] 5·43, 95% CI 4·32-6·83; p<0·0001), self-harm (5·80, 4·55-7·41; p<0·0001), lower life satisfaction (3·66, 2·92-4·58; p<0·0001), lower self-esteem (β 1·83, 95% CI 1·47-2·19; p<0·0001), and all forms of bullying and victimisation. Sexual minorities were more likely to have tried alcohol (OR 1·85, 95% CI 1·47-2·33; p<0·0001), smoking (2·41, 1·92 -3·03; p<0·0001), and cannabis (3·22, 2·24-4·61; p<0·0001), and also had increased odds of being less physically active (β 0·36, 95% CI 0·25-0·46; p<0·0001), perceiving themselves as overweight (OR 1·73, 95% CI 1·40-2·14; p<0·0001), and dieting to lose weight (1·98, 1·58-2·48; p<0·0001). Sexual minority adolescents had more co-occurring mental health outcomes (mean 1·43 of 3 outcomes, 95% CI 1·34-1·52) compared with heterosexual adolescents (0·40 of 3 outcomes, 0·38-0·41), and more total cumulative difficulties (mean 9·43 of 28 outcomes, 95% CI 9·09-9·76 in sexual minority adolescents vs 6·16 of 28 outcomes, 6·08-6·23 in heterosexual adolescents). Sexual minority adolescents in the UK experience disparities in mental health, social, and health-related outcomes despite living in a time of substantial progress in rights for sexual minorities. These adverse outcomes co-occur, with implications for lifelong health and social outcomes. Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents. None.