Abstract 41: The Effect Of Maternal Weight On Offspring Blood Pressure At 18 Years Of Age: A Causal Natural-effects Mediation Analysis

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nicole M Brunton ◽  
Allison Dart ◽  
Meghan Azad ◽  
Jonathan M McGavock
Keyword(s):  
Blood Pressure ◽  
Mediation Analysis ◽  
Latent Class ◽  
Maternal Obesity ◽  
Normal Weight ◽  
Childhood And Adolescence ◽  
Healthy Weight ◽  
Maternal Weight ◽  
Increased Risk ◽  
Shiny App

Objectives: Examine the relationship between maternal pre-pregnancy body mass index (BMI) and offspring systolic blood pressure (SBP) at 18 yrs old. Methods: We performed multivariate regression and causal mediation analysis within 3700 mother - offspring pairs from a prospective birth cohort. The main exposure was maternal pre-pregnancy BMI categorized as healthy weight, overweight, or obese according to international criteria. The main outcomes were high-normal BP and hypertension defined as SBP between the 90-95 th centile and >95 th centile for height and sex at 18 years, respectively, as per 2017 AAP guidelines. Analyses were adjusted for social class, pre-eclampsia, sex, and maternal tobacco use during pregnancy. The Canadian Pediatric Endocrine Group R Shiny app was used to obtain age-standardized BMI Z-scores and latent class analysis (LCA) was used to quantify the mediating factor of offspring BMIZ trajectories from 7 to 18 yrs. Results: Before pregnancy 14% of women were overweight and 5% were obese. At 18 yrs, SBP (122 ± 12 vs 118 ±11mmHg, p < 0.001), DBP (67 ± 7 vs 63 ± 6mmHg, p < 0.001) and the odds of elevated BP (aOR: 1.6; 95% CI: 1.1-2.3) and hypertension (aOR: 2.1; 95% CI: 1.4-3.1) were higher in offspring from women that were obese prior to pregnancy compared to those that were normal weight. LCA identified five distinct offspring BMIZ trajectories shown in the figure. SBP (125 ± 12 vs 117 ± 10 mmHg, p < 0.001) and the odds of hypertension (aOR: 3.8; 95% CI: 2.8-5.1) at 18 years were significantly higher in offspring with sustained high BMIZ (teal) compared to sustained low normal BMIZ (green). Casual mediation analysis revealed that maternal BMI directly (OR: 1.14; 95% CI: 1.03-1.25) and indirectly through offspring BMIZ trajectories (OR: 1.12; 95% CI: 1.08-1.15) increased offspring SBP at 18 years of age. Conclusion: Maternal obesity prior to pregnancy is associated with an increased risk of hypertension in offspring at 18 yrs of age, partly mediated by an elevated BMIZ score trajectory throughout childhood and adolescence.

scholarly journals Maternal obesity before pregnancy predicts offspring blood pressure at 18 years of age: A causal mediation analysis

2020 ◽  
Author(s):  
Nicole Brunton ◽  
Brenden Dufault ◽  
Allison Dart ◽  
Meghan B. Azad ◽  
Jonathan M McGavock
Keyword(s):  
Blood Pressure ◽  
Mediation Analysis ◽  
Elevated Blood Pressure ◽  
Childhood And Adolescence ◽  
Elevated Blood ◽  
Causal Mediation ◽  
Increased Risk ◽  
Causal Mediation Analysis ◽  
Maternal Bmi ◽  
Bmi Trajectory

ABSTRACTImportanceHypertension is the second most common pediatric chronic disease in Westernized countries. Understanding the natural history of hypertension is key to identifying prevention strategies.ObjectiveExamine the relationship between maternal pre-pregnancy body mass index (BMI) and offspring blood pressure at 18 years and the mediating role of growth throughout childhood and adolescence.Design, Setting, and ParticipantsWe performed multivariable regression and causal mediation analyses within 3217 mother - offspring pairs from the Avon Longitudinal Study of Parents and Children (ALSAPC) prospective birth cohort. Latent trajectory analysis (LTA) was used to quantify the mediating variable of offspring BMI from 7 to 18 years of age.ExposuresThe main exposure was maternal pre-pregnancy BMI. Analyses were adjusted for relevant confounders including maternal education, maternal blood pressure, and weeks gestation at delivery.Main Outcomes and MeasuresThe main outcome was offspring blood pressure at 18 years of age categorized as normal (SBP < 120 mmHg or DBP < 80mmHg) or elevated (SBP ≥ 120 mmHg or DBP ≥ 80 mmHg) as per the 2017 American Academy of Pediatrics guidelines.ResultsAt 18 years of age, among 3217 offspring, 676 (21%) were overweight or obese, 865 (27%) had elevated blood pressure, and 510 (16%) were hypertensive. LTA identified five distinct offspring BMI trajectories. Multivariate logistic regression revealed that for every 1 unit increase in maternal BMI the risk of elevated blood pressure at 18 years of age increased by 5% (aOR: 1.05, 95% CI: 1.03 – 1.07; p <0.001) and this effect was reduced after adjusting for offspring BMI trajectory (aOR: 1.03, 95% CI: 1.00 – 1.05; p = 0.017). Causal mediation analysis confirmed offspring BMI trajectory as a mediator accounting for 46% of the total effect of maternal BMI on elevated offspring blood pressure (aOR 1.22; 95% CI: 1.07-1.39).Conclusion and RelevanceMaternal BMI prior to pregnancy is associated with an increased risk of elevated blood pressure in offspring at 18 years of age and is mediated, in part, by offspring BMI trajectory throughout childhood and adolescence.

scholarly journals The Effect of Maternal Obesity on Breast Milk Fatty Acids and Its Association with Infant Growth and Cognition—The PREOBE Follow-Up

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2154 ◽  
Author(s):  
Andrea de la Garza Puentes ◽  
Adrià Martí Alemany ◽  
Aida Maribel Chisaguano ◽  
Rosa Montes Goyanes ◽  
Ana I. Castellote ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Breast Milk ◽  
Maternal Obesity ◽  
Infant Growth ◽  
Normal Weight ◽  
Healthy Weight ◽  
Infant Cognition ◽  
Maternal Weight ◽  
Mature Milk ◽  
Milk Fatty Acids

This study analyzed how maternal obesity affected fatty acids (FAs) in breast milk and their association with infant growth and cognition to raise awareness about the programming effect of maternal health and to promote a healthy prenatal weight. Mother–child pairs (n = 78) were grouped per maternal pre-pregnancy body mass index (BMI): normal-weight (BMI = 18.5–24.99), overweight (BMI = 25–29.99) and obese (BMI > 30). Colostrum and mature milk FAs were determined. Infant anthropometry at 6, 18 and 36 months of age and cognition at 18 were analyzed. Mature milk exhibited lower arachidonic acid (AA) and docosahexaenoic acid (DHA), among others, than colostrum. Breast milk of non-normal weight mothers presented increased saturated FAs and n6:n3 ratio and decreased α-linolenic acid (ALA), DHA and monounsaturated FAs. Infant BMI-for-age at 6 months of age was inversely associated with colostrum n6 (e.g., AA) and n3 (e.g., DHA) FAs and positively associated with n6:n3 ratio. Depending on the maternal weight, infant cognition was positively influenced by breast milk linoleic acid, n6 PUFAs, ALA, DHA and n3 LC-PUFAs, and negatively affected by n6:n3 ratio. In conclusion, this study shows that maternal pre-pregnancy BMI can influence breast milk FAs and infant growth and cognition, endorsing the importance of a healthy weight in future generations.

Multiple developmental pathways underlying conduct problems: A multitrajectory framework

2020 ◽  
pp. 1-10
Author(s):  
Jules R. Dugré ◽  
Stéphane Potvin
Keyword(s):  
Conduct Disorder ◽  
Conduct Problems ◽  
Latent Class ◽  
Population Based ◽  
Anxiety Symptoms ◽  
Behavioral Approach ◽  
Parameter Estimates ◽  
Childhood And Adolescence ◽  
Increased Risk ◽  
Psychological Features

Abstract In the past decades, there has been an overemphasis of a descriptive/behavioral approach to study conduct disorder. In an equifinal perspective, we aimed to examine the developmental multitrajectory groups of psychological features (irritability, interpersonal callousness, hyperactivity/impulsivity, and depressive–anxiety symptoms) and their associations with conduct problems. In a population-based cohort (n = 1,309 participants followed from 5 months to 17 years old), latent-class growth analysis was performed for each psychological feature to identify a two-trajectory model (from ages 6 to 12 years). Based on parameter estimates of the two-trajectory models for each of the four psychological features, a parallel process growth mixture model identified eight significant developmental patterns that were subsequently compared with typically developing children. Furthermore, we observed that while interpersonal callousness conferred an increased risk for childhood and adolescence conduct problems, its co-occurrence with hyperactivity/impulsivity, irritability, and/or depressive–anxiety symptoms heightened the general risk, but also predicted distinct subtypes of conduct problems (i.e., aggressive and rule-breaking behaviors). Thus, by studying complex developmental combinations of psychological features, we observed qualitatively distinct pathways towards conduct problems. A multitrajectory framework of psychological features should be considered as a significant step towards unveiling the multiple etiological pathways leading to conduct disorder and its substantial clinical heterogeneity.

scholarly journals Body composition in childhood: effects of normal growth and disease

2003 ◽  
Vol 62 (2) ◽  
pp. 521-528 ◽  
Author(s):  
J. C. K. Wells
Keyword(s):  
Body Composition ◽  
Childhood Obesity ◽  
Fat Mass ◽  
Lean Mass ◽  
Normal Weight ◽  
Fat Free Mass ◽  
General Interest ◽  
Childhood And Adolescence ◽  
Adult Disease ◽  
Increased Risk

Body composition in children is of increasing interest within the contexts of childhood obesity, clinical management of patients and nutritional programming as a pathway to adult disease. Energy imbalance appears to be common in many disease states; however, body composition is not routinely measured in patients. Traditionally, clinical interest has focused on growth or nutritional status, whereas more recent studies have quantified fat mass and lean mass. The human body changes in proportions and chemical composition during childhood and adolescence. Most of the weight gain comprises lean mass rather than fat. In general, interest has focused on percentage fat, and less attention has been paid to the way in which lean mass varies within and between individuals. In the general population secular trends in BMI have been widely reported, indicating increasing levels of childhood obesity, which have been linked to reduced physical activity. However, lower activity levels may potentially lead not only to increased fatness, but also to reduced lean mass. This issue merits further investigation. Diseases have multiple effects on body composition and may influence fat-free mass and/or fat mass. In some diseases both components change in the same direction, whereas in other diseases, the changes are contradictory and may be concealed by relatively normal weight. Improved techniques are required for clinical evaluations. Both higher fatness and reduced lean mass may represent pathways to an increased risk of adult disease.

Abstract 14652: Systolic Blood Pressure Trajectories and Cardiovascular Outcomes in SPRINT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charles A German ◽  
Tali Elfassy ◽  
Matthew J Singleton ◽  
Carlos J Rodriguez ◽  
Walter T Ambrosius ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Latent Class ◽  
Stable Group ◽  
Coronary Syndrome ◽  
Average Blood Pressure ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Over Time

Introduction: Blood pressure trajectories have been associated with cardiovascular disease (CVD) in observational studies. It is unclear whether these associations are independent of average blood pressure over time. Methods: We used data from SPRINT to identify systolic blood pressure (SBP) trajectories among a cohort of 8901 participants by incorporating SBP measures during the first 12 months of the trial post randomization. Trajectories were identified using latent class based modeling. Study outcomes included incident CVD, defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death attributable to CVD, and all-cause mortality. Cox proportional hazards models were used to evaluate associations between SBP trajectories and our outcomes of interest. Results: Four distinct SBP trajectories were identified: ‘low decline’ (40%), ‘high decline’ (6%), ‘low stable’ (48%), and ‘high stable’ (5%) (Figure 1). Relative to the low decline group, the low stable group was associated with a 29% increased risk of CVD (HR: 1.29, 95%CI: 1.06-1.57) and the high stable group was associated with a 76% increased risk of all-cause mortality (HR: 1.76, 95%CI: 1.15-2.68) after baseline multivariable adjustment. Relative to the low stable group, the high stable group was associated with a 54% increased risk of all-cause mortality (HR: 1.54, 95%CI: 1.05-2.28). When adjusting for average blood pressure across the 12 month time period, there were no significant differences in outcomes. Conclusion: We identified 4 SBP trajectories using data from SPRINT and found differences in the risk of CVD and all-cause mortality after baseline adjustment. However, there were no differences in the risk of these outcomes after adjusting for average blood pressure over time. These results suggest that the pattern of blood pressure control may not be relevant as long as the target blood pressure is achieved.

scholarly journals Maternal Obesity and Developmental Programming of Metabolic Disorders in Offspring: Evidence from Animal Models

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
M. Li ◽  
D. M. Sloboda ◽  
M. H. Vickers
Keyword(s):  
Animal Models ◽  
Early Life ◽  
Metabolic Disorders ◽  
Maternal Obesity ◽  
Maternal Weight ◽  
Critical Window ◽  
Obesity Epidemic ◽  
Obesity And Overweight ◽  
Increased Risk ◽  
Maternal Overnutrition

The incidence of obesity and overweight has reached epidemic proportions in the developed world as well as in those countries transitioning to first world economies, and this represents a major global health problem. Concern is rising over the rapid increases in childhood obesity and metabolic disease that will translate into later adult obesity. Although an obesogenic nutritional environment and increasingly sedentary lifestyle contribute to our risk of developing obesity, a growing body of evidence links early life nutritional adversity to the development of long-term metabolic disorders. In particular, the increasing prevalence of maternal obesity and excess maternal weight gain has been associated with a heightened risk of obesity development in offspring in addition to an increased risk of pregnancy-related complications. The mechanisms that link maternal obesity to obesity in offspring and the level of gene-environment interactions are not well understood, but the early life environment may represent a critical window for which intervention strategies could be developed to curb the current obesity epidemic. This paper will discuss the various animal models of maternal overnutrition and their importance in our understanding of the mechanisms underlying altered obesity risk in offspring.

scholarly journals Effects of a Lifestyle Intervention in Routine Care on Short- and Long-Term Maternal Weight Retention and Breastfeeding Behavior—12 Months Follow-up of the Cluster-Randomized GeliS Trial

2019 ◽  
Vol 8 (6) ◽  
pp. 876 ◽  
Author(s):  
Julia Hoffmann ◽  
Julia Günther ◽  
Lynne Stecher ◽  
Monika Spies ◽  
Dorothy Meyer ◽  
...  
Keyword(s):  
Lifestyle Intervention ◽  
Exclusive Breastfeeding ◽  
Maternal Obesity ◽  
Routine Care ◽  
Control Group ◽  
Weight Retention ◽  
Maternal Weight ◽  
Increased Risk ◽  
Postpartum Weight ◽  
Cluster Randomized

Postpartum weight retention (PPWR) is associated with an increased risk for maternal obesity and is discussed to be influenced by breastfeeding. The objective was to evaluate the effect of a lifestyle intervention delivered three times during pregnancy and once in the postpartum period on PPWR and on maternal breastfeeding behavior. In total, 1998 participants of the cluster-randomized “healthy living in pregnancy” (GeliS) trial were followed up until the 12th month postpartum (T2pp). Data were collected using maternity records and questionnaires. Data on breastfeeding behavior were collected at T2pp. At T2pp, mean PPWR was lower in women receiving counseling (IV) compared to the control group (C) (−0.2 ± 4.8 kg vs. 0.6 ± 5.2 kg), but there was no significant evidence of between-group differences (adjusted p = 0.123). In the IV, women lost more weight from delivery until T2pp compared to the C (adjusted p = 0.008) and showed a slightly higher rate of exclusive breastfeeding (IV: 87.4%; C: 84.4%; adjusted p < 0.001). In conclusion, we found evidence for slight improvements of maternal postpartum weight characteristics and the rate of exclusive breastfeeding in women receiving a lifestyle intervention embedded in routine care, although the clinical meaning of these findings is unclear.

The Blood Pressure Response to Exercise in Youth with Impaired Glucose Tolerance and Type 2 Diabetes

2015 ◽  
Vol 27 (1) ◽  
pp. 120-127 ◽  
Author(s):  
Jane E. Yardley ◽  
Jacqueline Hay ◽  
Freya MacMillan ◽  
Kristy Wittmeier ◽  
Brandy Wicklow ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Blood Pressure Response ◽  
Healthy Weight ◽  
Cross Sectional ◽  
Increased Risk ◽  
Graded Exercise ◽  
Consumption Rates ◽  
Response To Exercise

Type 2 diabetes is associated with hypertension and an increased risk of cardiovascular disease. In adults, blood pressure (BP) responses to exercise are predictive of these complications. To determine if the hemodynamic response to exercise is exaggerated in youth with dysglycemia (DG) compared with normoglycemic overweight/obese (OB) and healthy weight (HW) controls a cross-sectional comparison of BP and heart rate (HR) responses to graded exercise to exhaustion in participants was performed. DG and OB youth were matched for age, BMI z-score, height and sex. Systolic (SBP) and diastolic BP (DBP) were measured every 2 min, and HR was measured every 1 min. SBP was higher in OB and DG compared with HW youth at rest (p > .001). Despite working at lower relative workloads compared with HW, the BP response was elevated during exercise in OB and DG. For similar HR and oxygen consumption rates, BP responses to exercise were slightly higher in OB and DG compared with HW. OB and DG youth both display elevated resting and exercise BP relative to HW peers. Obesity may play a greater role than dysglycemia in the exaggerated BP response to exercise in youth.

scholarly journals Normal-Weight Obesity Is Associated with Increased Cardiometabolic Risk in Young Adults

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1106 ◽  
Author(s):  
María Correa-Rodríguez ◽  
Katherine González-Ruíz ◽  
David Rincón-Pabón ◽  
Mikel Izquierdo ◽  
Antonio García-Hermoso ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Young Adults ◽  
Body Mass ◽  
Abdominal Obesity ◽  
Cardiometabolic Risk ◽  
Large Population ◽  
Normal Weight ◽  
Increased Risk ◽  
Low Hdl ◽  
Normal Weight Obesity

Normal-weight obesity (NWO) has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in early adulthood. The aim of this study was to investigate the associations between NWO and cardiometabolic risk factors in a large population of Colombian young adults. A cross-sectional study was conducted on 1354 subjects (61% women), aged from 18 to 30. Anthropometric data, including body mass index (BMI) and waist circumference (WC), were estimated, and the percentage of fat mass was measured through bioelectrical impedance analysis (BIA). Muscular fitness was determined by using a handgrip strength test and normalized grip strength (NGS = handgrip (kg)/body mass (kg)). A cardiometabolic risk Z-score was derived by assessing WC, triglycerides, high-density lipoprotein cholesterol (HDL-C) cholesterol, fasting glucose, and systolic blood pressure. NWO was defined by the combination of excess %BF (over 25.5% for men and 38.9% for women) and a BMI < 25 kg/m2. The overall prevalence of NWO was 29.1%. Subjects with NWO have an increased risk of cardiometabolic risk compared to the normal-weight lean group (OR = 3.10). Moreover, NWO was associated with an increased risk of presenting low HDL-C (OR = 2.34), high abdominal obesity (OR = 7.27), and low NGS (OR = 3.30), p < 0.001. There is a high prevalence of NWO in American Latin young adults and this condition is associated with an increased cardiovascular risk, high blood pressure, low HDL-C, high abdominal obesity, and low muscular strength early in life. Screening for adiposity in subjects with a normal BMI could help to identify young adults at a high risk of cardiometabolic abnormalities.

Metabolic syndrome, leptin-insulin resistance and uric acid: a trinomial foe for Algerian city-dweller adolescents’ health

2018 ◽  
Vol 31 (6) ◽  
Author(s):  
Hamida Bouhenni ◽  
Hadjer Daoudi ◽  
Haidar Djemai ◽  
Abdelkader Rouabah ◽  
Damien Vitiello ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Uric Acid ◽  
Serum Levels ◽  
Normal Weight ◽  
Excess Weight ◽  
Health Concern ◽  
Critical Periods ◽  
Weight Group ◽  
Increased Risk

Abstract Background Adolescence is one of the critical periods where increased risk for long-term obesity-related complications is an important health concern. This highlights the need to perform early diagnostics based on precise biomarkers to decrease the risk of complications in adolescents with obesity. Objective To determine the relationships between serum levels of uric acid (UA), leptin and insulin with metabolic syndrome (MS) components in Algerian adolescents. Subjects Nondiabetic adolescents (n = 204). Methods Blood pressure (BP) and anthropometric measurements were performed using standardized techniques. Blood samples were taken for determination of glycemia, triglyceridemia, uricemia, cholesterolemia, leptinemia and insulinemia. Results The rate of MS among an excess weight group was 17.4% [95% confidence interval (CI)]. Serum levels of UA, leptin and insulin were significantly higher in the excess weight group compared to a normal weight group (279.4 ± 86.05 vs. 204.9 ± 50.34 μmol/L and 25.65 ± 14.01 vs. 4.09 ± 2.60 μg/L, p < 0.001; 24.58 ± 13.85 vs. 13.34 ± 6.41 μIU/L, p < 0.05). Serum levels of UA, leptin and insulin were significantly higher in adolescents with MS compared to those without MS (304.86 ± 111.41 vs. 224.72 ± 77.81 μmol/L, 30.26 ± 12.46 vs. 16.93 ± 14.97 μg/L and 30.91 ± 17.30 vs. 18.71 ± 10.14 μIU/L, p < 0.05, respectively). Significant correlations were found between UA and leptin with waist circumference (r = 0.50 and 0.76), diastolic blood pressure (r = 0.58 and 0.43), triglycerides (r = 0.42 and 0.35) and high-density lipoprotein-cholesterol (r = −0.36 and −0.35). Conclusion Serum levels of UA and leptin may be useful biomarkers for early diagnosis of the risk of MS in our Algerian adolescent population.

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