Publications by authors named "Wayne S Cutfield"

183 Publications

Bioelectrical impedance analysis for assessment of body composition in infants and young children-A systematic literature review.

Clin Obes 2021 Feb 9:e12441. Epub 2021 Feb 9.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Bioelectrical impedance analysis (BIA) is an easy to use, portable tool, but the accuracy of the technique in infants and young children (<24 months) remains unclear. A systematic literature review was conducted to identify studies that have developed and validated BIA equations in this age group. MEDLINE, Scopus, EMBASE, and CENTRAL were searched for relevant literature published up until June 30, 2020, using terms related to bioelectrical impedance, body composition, and paediatrics. Two reviewers independently screened studies for eligibility, resulting in 15 studies that had developed and/or validated equations. Forty-six equations were developed and 34 validations were conducted. Most equations were developed in young infants (≤6 months), whereas only seven were developed among older infants and children (6-24 months). Most studies were identified as having a high risk of bias, and only a few included predominantly healthy children born at term. Using the best available evidence, BIA appears to predict body composition at least as well as other body composition tools; however, among younger infants BIA may provide little benefit over anthropometry-based prediction equations. Currently, none of the available equations can be recommended for use in research or in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cob.12441DOI Listing
February 2021

The views of pregnant women in New Zealand on vaginal seeding: a mixed-methods study.

BMC Pregnancy Childbirth 2021 Jan 12;21(1):49. Epub 2021 Jan 12.

Liggins Institute, University of Auckland, Private Bag, Auckland, 92019, New Zealand.

Background: Vaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth. Appropriate development of the infant gut microbiome assists early immune development and might help reduce the risk of certain health conditions later in life, such as obesity and asthma. We aimed to explore the views of pregnant women on this practice.

Methods: We conducted a sequential mixed-methods study on the views of pregnant women in New Zealand (NZ) on vaginal seeding. Phase one: brief semi-structured interviews with pregnant women participating in a clinical trial of vaginal seeding (n = 15); and phase two: online questionnaire of pregnant women throughout NZ (not in the trial) (n = 264). Reflexive thematic analysis was applied to interview and open-ended questionnaire data. Closed-ended questionnaire responses were analysed using descriptive statistics.

Results: Six themes were produced through analysis of the open-ended data: "seeding replicates a natural process", "microbiome is in the media", "seeding may have potential benefits", "seeking validation by a maternity caregiver", "seeding could help reduce CS guilt", and "the unknowns of seeding". The idea that vaginal seeding replicates a natural process was suggested by some as an explanation to help overcome any initial negative perceptions of it. Many considered vaginal seeding to have potential benefit for the gut microbiome, while comparatively fewer considered it to be potentially beneficial for specific conditions such as obesity. Just under 30% of questionnaire respondents (n = 78; 29.5%) had prior knowledge of vaginal seeding, while most (n = 133; 82.6%) had an initially positive or neutral reaction to it. Few respondents changed their initial views on the practice after reading provided evidence-based information (n = 60; 22.7%), but of those who did, most became more positive (n = 51; 86.4%).

Conclusions: Given its apparent acceptability, and if shown to be safe and effective for the prevention of early childhood obesity, vaginal seeding could be a non-stigmatising approach to prevention of this condition among children born by CS. Our findings also highlight the importance of lead maternity carers in NZ remaining current in their knowledge of vaginal seeding research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-020-03500-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802193PMC
January 2021

Surrogate markers and predictors of endogenous insulin secretion in children and adolescents with type 1 diabetes.

World J Pediatr 2021 Feb 7;17(1):99-105. Epub 2021 Jan 7.

Department of Endocrinology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

Background: No studies have examined endogenous insulin secretion in pediatric patients with type 1 diabetes in China using the gold-standard mixed-meal tolerance test. Because the latter is labor-intensive, we examined simpler surrogate markers of endogenous insulin secretion in Chinese youth, as previously reported for a European population.

Methods: Participants were 57 children and adolescents with type 1 diabetes aged 4.4-16.8 years (56% females). We performed 120-minute mixed-meal tolerance tests with serum C-peptide (CP) measurements every 30 minutes. Severe insulin deficiency (SID) was defined as CP peak < 0.2 nmol/L. Urine CP and creatinine levels were measured at 0 and 120 minutes.

Results: Twenty-five (44%) patients had SID. Fasting CP levels missed one case (96% sensitivity) with no false positives (100% specificity). While the 120-minute urine CP/creatinine had 100% sensitivity, it yielded markedly lower specificity (63%). Every 1-year increase in diabetes duration and 1-year decrease in age at diagnosis were associated with 37% (P < 0.001) and 20% (P = 0.005) reductions in serum CP area-under-the-curve, respectively. Thus, 86% of children aged < 5 years had SID compared to none among patients aged ≥ 11 years.

Conclusions: Simple fasting CP measurements could be used to detect most SID cases in Chinese youth with type 1 diabetes. Fasting CP is a far more reliable measure of endogenous insulin secretion than the more commonly used insulin dose. Therefore, it could more precisely determine insulin secretory capacity to target those who could benefit, if treatments to preserve residual insulin secretion are developed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12519-020-00382-0DOI Listing
February 2021

Effects of Fecal Microbiome Transfer in Adolescents With Obesity: The Gut Bugs Randomized Controlled Trial.

JAMA Netw Open 2020 12 1;3(12):e2030415. Epub 2020 Dec 1.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Importance: Treatment of pediatric obesity is challenging. Preclinical studies in mice indicated that weight and metabolism can be altered by gut microbiome manipulation.

Objective: To assess efficacy of fecal microbiome transfer (FMT) to treat adolescent obesity and improve metabolism.

Design, Setting, And Participants: This randomized, double-masked, placebo-controlled trial (October 2017-March 2019) with a 26-week follow-up was conducted among adolescents aged 14 to 18 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or more in Auckland, New Zealand. A total of 87 individuals took part-565 individuals responded to advertisements, 328 were ineligible, and 150 declined participation. Clinical data were analyzed from September 2019 to May 2020.

Interventions: Single course of oral encapsulated fecal microbiome from 4 healthy lean donors of the same sex or saline placebo.

Main Outcomes And Measures: Primary outcome was BMI standard deviation score at 6 weeks using intention-to-treat analysis. Secondary outcomes included body composition, cardiometabolic parameters, well-being, and gut microbiome composition.

Results: Eighty-seven participants (59% female adolescents, mean [SD] age 17.2 [1.4] years) were randomized 1:1, in groups stratified by sex, to FMT (42 participants) or placebo (45 participants). There was no effect of FMT on BMI standard deviation score at 6 weeks (adjusted mean difference [aMD] -0.026; 95% CI -0.074, 0.022). Reductions in android-to-gynoid-fat ratio in the FMT vs placebo group were observed at 6, 12, and 26 weeks, with aMDs of -0.021 (95% CI, -0.041 to -0.001), -0.023 (95% CI, -0.043 to -0.003), and -0.029 (95% CI, -0.049 to -0.008), respectively. There were no observed effects on insulin sensitivity, liver function, lipid profile, inflammatory markers, blood pressure, total body fat percentage, gut health, and health-related quality of life. Gut microbiome profiling revealed a shift in community composition among the FMT group, maintained up to 12 weeks. In post-hoc exploratory analyses among participants with metabolic syndrome at baseline, FMT led to greater resolution of this condition (18 to 4) compared with placebo (13 to 10) by 26 weeks (adjusted odds ratio, 0.06; 95% CI, 0.01-0.45; P = .007). There were no serious adverse events recorded throughout the trial.

Conclusions And Relevance: In this randomized clinical trial of adolescents with obesite, there was no effect of FMT on weight loss in adolescents with obesity, although a reduction in abdominal adiposity was observed. Post-hoc analyses indicated a resolution of undiagnosed metabolic syndrome with FMT among those with this condition. Further trials are needed to confirm these results and identify organisms and mechanisms responsible for mediating the observed benefits.

Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001351505.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2020.30415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753902PMC
December 2020

Double-blind RCT of fish oil supplementation in pregnancy and lactation to improve the metabolic health in children of mothers with overweight or obesity during pregnancy: study protocol.

BMJ Open 2020 12 15;10(12):e041015. Epub 2020 Dec 15.

Liggins Institute, University of Auckland, Auckland, New Zealand

Introduction: Maternal obesity during pregnancy is associated with adverse changes in body composition and metabolism in the offspring. We hypothesise that supplementation during pregnancy of overweight and obese women may help prevent the development of greater adiposity and metabolic dysfunction in children. Previous clinical trials investigating fish oil supplementation in pregnancy on metabolic outcomes and body composition of the children have not focused on the pregnancies of overweight or obese women.

Methods And Analysis: A double-blind randomised controlled trial of fish oil (providing 3 g/day of n-3 polyunsaturated fatty acids) versus an equal volume of olive oil (control) taken daily from recruitment until birth, and in breastfeeding mothers, further continued for 3 months post partum. Eligible women will have a singleton pregnancy at 12-20 weeks' gestation and be aged 18-40 years with body mass index ≥25 kg/m at baseline. We aim to recruit a minimum of 128 participants to be randomised 1:1. Clinical assessments will be performed at baseline and 30 weeks of pregnancy, including anthropometric measurements, fasting metabolic markers, measures of anxiety, physical activity, quality of life and dietary intake. Subsequent assessments will be performed when the infant is 2 weeks, 3 months and 12 months of age for anthropometry, body composition (dual-energy X-ray absorptiometry (DXA)) and blood sampling. The primary outcome of the study is a between-group difference in infant percentage body fatness, assessed by DXA, at 2 weeks of age. Secondary outcomes will include differences in anthropometric measures at each time point, percentage body fat at 3 and 12 months and homeostatic model assessment of insulin resistance at 3 months. Statistical analysis will be carried out on the principle of intention to treat.

Ethics And Dissemination: This trial was approved by the Northern A Health and Disabilities Ethics Committee, New Zealand Ministry of Health (17/NTA/154). Results will be published in a peer-reviewed journal.

Trial Registration Number: ACTRN12617001078347p; Pre-results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-041015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745511PMC
December 2020

Prolonged transitional neonatal hypoglycaemia: characterisation of a clinical syndrome.

J Perinatol 2020 Dec 5. Epub 2020 Dec 5.

Kidz First, Counties Manukau Health, Auckland, New Zealand.

Background: We performed a case-control study to characterise infants with "prolonged transitional hypoglycaemia".

Methods: Cases were born ≥36 weeks' gestation; had ≥1 hypoglycaemic episode <72 h and ≥72 h; received ongoing treatment for hypoglycaemia ≥72 h; and were without congenital disorders or acute illness. Cases were compared to controls born ≥36 weeks' with brief transitional hypoglycaemia, resolving <72 h.

Results: 39/471 infants screened met case definition: 71.8% were male, 61.5% were small-for-gestational-age (SGA), and most were admitted <6 h. Compared to controls (N = 75), key risk factors for prolonged transitional hypoglycaemia were SGA (OR = 6.4, 95%CI 2.7-15.1), severe/recurrent hypoglycaemia <24 h (OR = 16.7, 95%CI 4.5-16.1), intravenous glucose bolus <24 h (OR = 26.6, 95%CI 9.4-75.1) and maximum glucose delivery rate <48 h of ≥8 mg/kg/min (OR = 25.5, 95%CI 7.7-84.1).

Conclusions: Infants with prolonged transitional hypoglycaemia are predominantly male, SGA and have early severe/recurrent hypoglycaemia requiring glucose boluses and high glucose delivery rates in the first 24-48 h.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41372-020-00891-wDOI Listing
December 2020

High prevalence of undiagnosed comorbidities among adolescents with obesity.

Sci Rep 2020 11 18;10(1):20101. Epub 2020 Nov 18.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Metabolic diseases are increasing among adolescents with obesity. Although the reported prevalence of metabolic syndrome is approximately 30% worldwide, its prevalence is largely unknown among New Zealand adolescents. Therefore, we assessed the health of adolescents with obesity (BMI ≥ 30 kg/m) enrolled in a randomised clinical trial (Gut Bugs Trial), to identify the prevalence of undiagnosed comorbidities. Assessments included anthropometry, 24-h ambulatory blood pressure monitoring, and insulin sensitivity. We report on baseline data (pre-randomisation) on 87 participants (14-18 years; 59% females), with mean BMI 36.9 ± 5.3 kg/m (BMI SDS 3.33 ± 0.79). Approximately 40% of participants had undiagnosed metabolic syndrome, which was twice as common among males. Half (53%) had pre-diabetes and 92% a reduction in insulin sensitivity. Moreover, 31% had pre-hypertension/hypertension, 69% dyslipidaemia, and 25% abnormal liver function. Participants with class III obesity had a greater risk of metabolic syndrome than those with classes I/II [relative risk 1.99 (95% CI 1.19, 3.34)]. Risks for pre-hypertension/hypertension and inflammation were also greater among those with class III obesity. We identified a high prevalence of undiagnosed comorbidities among adolescents with obesity in New Zealand. As adolescent obesity tracks into adulthood, early interventions are needed to prevent progression to overt cardiometabolic diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-76921-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674474PMC
November 2020

Birth Size and Rapid Infant Weight Gain-Where Does the Obesity Risk Lie?

J Pediatr 2021 Mar 4;230:238-243. Epub 2020 Nov 4.

Liggins Institute, The University of Aucklan, Auckland, New Zealand; A Better Start - National Science Challenge, Auckland, New Zealand. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpeds.2020.10.078DOI Listing
March 2021

Do Human Milk Oligosaccharides Protect Against Infant Atopic Disorders and Food Allergy?

Nutrients 2020 Oct 21;12(10). Epub 2020 Oct 21.

Liggins Institute, The University of Auckland, Auckland 1023, New Zealand.

Atopic disorders (AD), often coexistent with food allergy (FA), start developing in early life and have lifelong health consequences. Breastfeeding is thought to be protective against AD and FA, but the data are controversial, and mechanisms are not well understood. Human milk oligosaccharides (HMOs) are complex carbohydrates that are abundant in human milk. These are thought to contribute to the development of the infant immune system by (i) promoting healthy microbiome, (ii) inhibiting pathogen binding to gut mucosa and (iii) modulating the immune system. Differences in microbiome composition between allergic and healthy infants have been observed, regardless of breastfeeding history. To date, limited studies have examined the preventive effects of HMOs on AD and FA in infants and current data relies on observation studies as trials of varying HMO intake through randomising individuals to breastfeeding are unethical. There is evidence for beneficial effects of breastfeeding on lowering the risks of FA, eczema and asthma but there are inconsistencies amongst studies in the duration of breastfeeding, diagnostic criteria for AD and the age at which the outcome was assessed. Furthermore, current analytical methods primarily used today only allow detection of 16-20 major HMOs while more than 100 types have been identified. More large-scale longitudinal studies are required to investigate the role of HMO composition and the impact of changes over the lactation period in preventing AD and FA later in life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu12103212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589050PMC
October 2020

Lower insulin sensitivity remains a feature of children born very preterm.

Pediatr Diabetes 2021 Mar 6;22(2):161-167. Epub 2020 Nov 6.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Background: The first report of children born very preterm (<32 weeks of gestation) having insulin resistance was made 16 years ago. However, neonatal care has improved since. Thus, we aimed to assess whether children born very preterm still have lower insulin sensitivity than term controls.

Methods: Participants were prepubertal children aged 5 to 11 years born very preterm (<32 weeks of gestation; n = 51; 61% boys) or at term (37-41 weeks; n = 50; 62% boys). Frequently sampled intravenous glucose tolerance tests were performed, and insulin sensitivity was calculated using Bergman's minimal model. Additional clinical assessments included anthropometry, body composition using whole-body dual-energy X-ray absorptiometry scans, clinic blood pressure, and 24-hour ambulatory blood pressure monitoring.

Results: Children born very preterm were 0.69 standard deviation score (SDS) lighter (P < .001), 0.53 SDS shorter (P = .003), and had body mass index 0.57 SDS lower (P = .003) than children born at term. Notably, children born very preterm had insulin sensitivity that was 25% lower than term controls (9.4 vs 12.6 × 10 minutes ·[mU/L]; P = .001). Other parameters of glucose metabolism, including fasting insulin levels, were similar in the two groups. The awake systolic blood pressure (from 24-hour monitoring) tended to be 3.1 mm Hg higher on average in children born very preterm (P = .054), while the clinic systolic blood pressure was 5.4 mm Hg higher (P = .002).

Conclusions: Lower insulin sensitivity remains a feature of children born very preterm, despite improvements in neonatal intensive care. As reported in our original study, our findings suggest the defect in insulin action in prepubertal children born very pretermis primarily peripheral and not hepatic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pedi.13140DOI Listing
March 2021

Abdominal Adiposity and Total Body Fat as Predictors of Cardiometabolic Health in Children and Adolescents With Obesity.

Front Endocrinol (Lausanne) 2020 4;11:579. Epub 2020 Sep 4.

Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

We aimed to assess the role of adipose tissue distribution in cardiometabolic risk (in particular insulin sensitivity) in a population of children and adolescents with obesity. In this cross-sectional study, participants were 479 children and adolescents with obesity (322 boys and 157 girls) aged 3 to 18 years attending the Children's Hospital at Zhejiang University School of Medicine (Hangzhou, China). Clinical assessments included anthropometry, body composition (DXA scans), carotid artery ultrasounds, and OGTT. Insulin sensitivity was assessed using the Matsuda index. Participants were stratified into groups by sex and pubertal stage. Key predictors were DXA-derived android-to-gynoid-fat ratio (A/G) and total body fat percentage (TBF%). Irrespective of sex and pubertal stage, there was a strong association between increasing A/G (i.e., greater abdominal adiposity) and lower insulin sensitivity. In multivariable models, every 0.1 increase in A/G was associated with a reduction in insulin sensitivity in prepubertal boys [-29% (95% CI -36%, -20%); < 0.0001], pubertal boys [-13% (95% CI -21%, -6%); = 0.001], and pubertal girls [-16% (95% CI -24%, -6%); = 0.002]. In contrast, TBF% was not associated with insulin sensitivity when A/G was adjusted for, irrespective of pubertal stage or sex. In addition, every 0.1 increase in A/G was associated with increased likelihood of dyslipidemia in prepubertal boys [adjusted odds ratio (aOR) 1.62 (95% CI 1.05, 2.49)], impaired glucose tolerance in pubertal boys [aOR 1.64 (95% CI 1.07, 2.51)] and pubertal girls [aOR 1.81 (95% CI 1.10, 2.98)], and odds of NAFLD in both prepubertal [aOR 2.57 (95% CI 1.56, 4.21)] and pubertal [aOR 1.69 (95% CI 1.18, 2.40)] boys. In contrast, higher TBF% was only associated with higher fasting insulin and ALT in pubertal boys, being also predictive of NAFLD in this group [aOR 1.15 per percentage point (95% CI 1.06, 1.26)], but was not associated with the likelihood of other cardiometabolic outcomes assessed in any group. A/G is a much stronger independent predictor of cardiometabolic risk factors in children and adolescents with obesity in China, particularly glucose metabolism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fendo.2020.00579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498567PMC
September 2020

Omega-3 fats in pregnancy: could a targeted approach lead to better metabolic health for children?

Nutr Rev 2020 Sep 24. Epub 2020 Sep 24.

Liggins Institute, University of Auckland, Auckland, New Zealand.

The prevalence of childhood obesity is increasing worldwide, and the children of women who are obese during pregnancy are at greatest risk. This risk may be mediated by exaggeration of the normal insulin resistance of pregnancy. Omega-3 (n-3) fats are insulin sensitizing. Supplementation during pregnancy may reduce metabolic risk and adiposity in the children. Though results from animal studies are encouraging, completed clinical trials have not demonstrated this benefit. However, to our knowledge, previous studies have not targeted women who are overweight or obese while pregnant-the group at greatest risk for insulin resistance and most likely to benefit from n-3. In this narrative review, the importance of performing clinical trials restricted to women who are overweight or obese is discussed, as is the potential importance of n-3 dose, oil source and quality, and the timing of the intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/nutrit/nuaa071DOI Listing
September 2020

Maternal bacteria to correct abnormal gut microbiota in babies born by C-section.

Medicine (Baltimore) 2020 Jul;99(30):e21315

A Better Start - National Science Challenge.

Introduction: There is evidence that caesarean section (CS) is associated with increased risk of childhood obesity, asthma, and coeliac disease. The gut microbiota of CS-born babies differs to those born vaginally, possibly due to reduced exposure to maternal vaginal bacteria during birth. Vaginal seeding is a currently unproven practice intended to reduce such differences, so that the gut microbiota of CS-born babies is similar to that of babies born vaginally. Our pilot study, which uses oral administration as a novel form of vaginal seeding, will assess the degree of maternal strain transfer and overall efficacy of the procedure for establishing normal gut microbiota development.

Methods And Analysis: Protocol for a single-blinded, randomized, placebo-controlled pilot study of a previously untested method of vaginal seeding (oral administration) in 30 CS-born babies. A sample of maternal vaginal bacteria is obtained prior to CS, and mixed with 5 ml sterile water to obtain a supernatant. Healthy babies are randomized at 1:1 to receive active treatment (3 ml supernatant) or placebo (3 ml sterile water). A reference group of 15 non-randomized vaginal-born babies are also being recruited. Babies' stool samples will undergo whole metagenomic shotgun sequencing to identify potential differences in community structure between CS babies receiving active treatment compared to those receiving placebo at age 1 month (primary outcome). Secondary outcomes include differences in overall gut community between CS groups (24 hours, 3 months); similarity of CS-seeded and placebo gut profiles to vaginally-born babies (24 hours, 1 and 3 months); degree of maternal vaginal strain transfer in CS-born babies (24 hours, 1 and 3 months); anthropometry (1 and 3 months) and body composition (3 months).

Ethics And Dissemination: Ethics approval by the Northern A Health and Disability Ethics Committee (18/NTA/49). Results will be published in peer-reviewed journals and presented at international conferences.

Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618000339257).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000021315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387037PMC
July 2020

Systematic review of randomised controlled trials to improve dietary intake for the prevention of obesity in infants aged 0-24 months.

Obes Rev 2021 Feb 10;22(2):e13110. Epub 2020 Aug 10.

A Better Start - National Science Challenge, New Zealand.

Improving dietary intake early in life is a common behavioural target in obesity prevention trials. We undertook a systematic review of randomised controlled trials aiming to improve dietary intake of complementary foods during infancy (0-24 months). PubMed, Cochrane Library, EMBASE, Medline, and PsycInfo were searched for trials focussed on obesity prevention conducted between January 2000 and August 2019 where dietary intake was an outcome. Two reviewers screened studies and extracted data from selected articles. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 tools. The protocol was registered on Open Science Framework (https://osf.io/6srg7/). Seventeen articles from 12 trials were selected for data extraction. Statistically significant group differences in outcomes were observed in 36 of 165 (21.8%) of dietary variables examined. Measurement and analysis of outcomes varied between studies. Overall risk of bias was rated as high, primarily due to missing outcome data. Improving dietary intake at this age appears challenging based on a relatively limited number of studies. Future research could consider dietary pattern analyses, which may provide more meaningful outcomes for this age group. Opportunities exist for further exploration of maternal-focussed interventions, responsive feeding interventions, and interventions delivered outside of homes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/obr.13110DOI Listing
February 2021

Differences in Compositions of Gut Bacterial Populations and Bacteriophages in 5-11 Year-Olds Born Preterm Compared to Full Term.

Front Cell Infect Microbiol 2020 16;10:276. Epub 2020 Jun 16.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Preterm infants are exposed to major perinatal, post-natal, and early infancy events that could impact on the gut microbiome. These events include infection, steroid and antibiotic exposure, parenteral nutrition, necrotizing enterocolitis, and stress. Studies have shown that there are differences in the gut microbiome during the early months of life in preterm infants. We hypothesized that differences in the gut microbial composition and metabolites in children born very preterm persist into mid-childhood. Participants were healthy prepubertal children aged 5-11 years who were born very preterm (≤32 weeks of gestation; = 51) or at term (37-41 weeks; = 50). We recorded the gestational age, birth weight, mode of feeding, mode of birth, age, sex, and the current height and weight of our cohort. We performed a multi'omics [i.e., 16S rRNA amplicon and shotgun metagenomic sequencing, SPME-GCMS (solid-phase microextraction followed by gas chromatography-mass spectrometry)] analysis to investigate the structure and function of the fecal microbiome (as a proxy of the gut microbiota) in our cross-sectional cohort. Children born very preterm were younger (7.8 vs. 8.3 years; = 0.034), shorter [height-standard deviation score (SDS) 0.31 vs. 0.92; = 0.0006) and leaner [BMI (body mass index) SDS -0.20 vs. 0.29; < 0.0001] than the term group. Children born very preterm had higher fecal calprotectin levels, decreased fecal phage richness, lower plasma arginine, lower fecal branched-chain amino acids and higher fecal volatile (i.e., 3-methyl-butanoic acid, butyrolactone, butanoic acid and pentanoic acid) profiles. The bacterial microbiomes did not differ between preterm and term groups. We speculate that the observed very preterm-specific changes were established in early infancy and may impact on the capacity of the very preterm children to respond to environmental changes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fcimb.2020.00276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309444PMC
June 2020

Safety, feasibility and efficacy of side-alternating vibration therapy on bone and muscle health in children and adolescents with musculoskeletal disorders: A pilot trial.

J Paediatr Child Health 2020 Aug 21;56(8):1257-1262. Epub 2020 May 21.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Aims: A pilot study was performed to establish the safety, feasibility and efficacy of vibration therapy (VT) on bone and muscle health in children and adolescents with a range of musculoskeletal disorders.

Methods: Seventeen participants (15.7 years ± 2.9 years), with conditions that impacted on their musculoskeletal health, completed 20 weeks of side-alternating VT for 9 min/session, 4 times/week at 20 Hz. Data were collected at baseline and after 20 weeks of intervention. Assessments included whole-body dual-energyX-ray absorptiometry, muscle function (force plate) and 6-min walk test.

Results: Compliance with the prescribed VT training protocol was relatively high overall at 78% and there were no adverse events reported. After 20 weeks intervention, functional assessments showed time taken to perform the chair test was reduced by 15% (P = 0.018), leg balance improved with standard ellipse area decreasing by 88% (P = 0.006) and distance walked in the 6-min walk test improved by 9% (P = 0.002). Participants displayed increased total body mass (1.94 kg; P = 0.018) with increased lean mass (1.20 kg; P = 0.019) but not fat mass (P = 0.19). There was no change in total body bone mineral density (P = 0.44) or bone mineral content (P = 0.07).

Conclusions: Twenty weeks of side-alternating VT was a feasible protocol that was associated with improvements in physical function and no detrimental effects on lean mass, bone mass or density in children and adolescents with musculoskeletal disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpc.14913DOI Listing
August 2020

Why BMI should still be on the table.

N Z Med J 2020 04 24;133(1513):97-100. Epub 2020 Apr 24.

A Better Start National Science Challenge, Department of Women's and Children's Health, University of Otago, Dunedin.

Childhood obesity is common in New Zealand with one in three 4-5 year-old children identified as overweight or obese in the before school check (B4SC) programme. Recently, the use of BMI for assessing childhood obesity in the B4SC programme has been questioned. This article provides evidence in support of the assessment of BMI during the B4SC, including specific key points: 1. BMI is currently the only appropriate field tool for assessing overweight and obesity.2. Our New Zealand data show that BMI is reliable at measuring adiposity in all ethnic groups. 3. High childhood BMI often leads to adult obesity and is associated with increased adult morbidity and mortality. 4. We believe parents do want to know information regarding their child's obesity risk, based on recent findings in our New Zealand study.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2020

Gut microbiome transfer-Finding the perfect fit.

Clin Endocrinol (Oxf) 2020 07 15;93(1):3-10. Epub 2020 Apr 15.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Gut microbiome transfer (GMT; also referred to as faecal microbiota transplantation or FMT) has been propelled from fringe therapy to mainstream science as a highly effective treatment for recurrent Clostridioides difficile infection. As a result, there has been great interest in the potential efficacy and safety of GMT in treating other medical conditions, for example inflammatory bowel disease, and more recently as a novel therapy for obesity and metabolic diseases. For these chronic conditions, the results from clinical trials have been mixed. Further, specifically in obesity and metabolic diseases, there are limited available data, with only a few published studies with a small number of participants and short duration of follow-up. Therefore, this review aims to explore the human, microbial and formulation factors that may affect the success of GMT. This includes various aspects in the preparation and administration of GMT, such as stool processing, modes of delivery, pretreatment with antibiotics and/or bowel lavage, frequency of GMT and possible use of precision bacteriotherapy. In addition, we examine the potential use of GMT in obesity, type 2 diabetes and metabolic diseases based on current available literature, highlighting some recent advances in GMT research in this area, as well as potential adverse effects after GMT therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cen.14183DOI Listing
July 2020

Childhood dietary patterns and body composition at age 6 years: the Children of SCOPE study.

Br J Nutr 2020 Feb 26:1-21. Epub 2020 Feb 26.

Department of Women and Children's Health,School of Life Course Sciences, King's College London, UK.

Dietary patterns describe the quantity, variety, or combination of different foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6.0 (0.2) years) in Auckland, New Zealand whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by food frequency questionnaire (FFQ) and empirical dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified; 'Healthy', 'Traditional' and 'Junk'. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, body mass index (BMI), bioelectrical impedance analysis (BIA) derived body fat percentage, and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher 'Junk' dietary pattern scores had 0.24cm greater arm (0.08 SD (95%CI 0.04, 0.13)) and 0.44cm hip (0.05 SD (95% CI 0.01, 0.10)) circumferences, 1.13cm greater SST (0.07 SD (95%CI 0.03, 0.12)) and were more likely to be obese (OR=1.74 (95%CI 1.07, 2.82)); those with higher 'Healthy' pattern scores were less likely to be obese (OR=0.62 (95%CI 0.39, 1.00)). In a large mother-child cohort, a dietary pattern characterised by high sugar and fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a 'Healthy' dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0007114520000628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116586PMC
February 2020

Large-for-gestational-age phenotypes and obesity risk in adulthood: a study of 195,936 women.

Sci Rep 2020 02 7;10(1):2157. Epub 2020 Feb 7.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

While there is evidence that being born large-for-gestational-age (LGA) is associated with an increased risk of obesity later in life, the data are conflicting. Thus, we aimed to examine the associations between proportionality at birth and later obesity risk in adulthood. This was a retrospective study using data recorded in the Swedish Birth Register. Anthropometry in adulthood was assessed in 195,936 pregnant women at 10-12 weeks of gestation. All women were born at term (37-41 weeks of gestation). LGA was defined as birth weight and/or length ≥2.0 SDS. Women were separated into four groups: appropriate-for-gestational-age according to both weight and length (AGA - reference group; n = 183,662), LGA by weight only (n = 4,026), LGA by length only (n = 5,465), and LGA by both weight and length (n = 2,783). Women born LGA based on length, weight, or both had BMI 0.12, 1.16, and 1.08 kg/m greater than women born AGA, respectively. The adjusted relative risk (aRR) of obesity was 1.50 times higher for those born LGA by weight and 1.51 times for LGA by both weight and height. Length at birth was not associated with obesity risk. Similarly, women born LGA by ponderal index had BMI 1.0 kg/m greater and an aRR of obesity 1.39 times higher than those born AGA. Swedish women born LGA by weight or ponderal index had an increased risk of obesity in adulthood, irrespective of their birth length. Thus, increased risk of adult obesity seems to be identifiable from birth weight and ignoring proportionality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-58827-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005699PMC
February 2020

Associations of Prenatal and Childhood Antibiotic Exposure With Obesity at Age 4 Years.

JAMA Netw Open 2020 01 3;3(1):e1919681. Epub 2020 Jan 3.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Importance: Although antibiotics are associated with obesity in animal models, the evidence in humans is conflicting.

Objective: To assess whether antibiotic exposure during pregnancy and/or early childhood is associated with the development of childhood obesity, focusing particularly on siblings and twins.

Design, Setting, And Participants: This cross-sectional national study included 284 211 participants (132 852 mothers and 151 359 children) in New Zealand. Data analyses were performed for 150 699 children for whom data were available, 30 696 siblings, and 4188 twins using covariate-adjusted analyses, and for 6249 siblings and 522 twins with discordant outcomes using fixed-effects analyses. Data analysis was performed November 2017 to March 2019.

Exposure: Exposure to antibiotics during pregnancy and/or early childhood.

Main Outcomes And Measures: The main outcome is odds of obesity at age 4 years. Anthropometric data from children born between July 2008 and June 2011 were obtained from the B4 School Check, a national health screening program that records the height and weight of 4-year-old children in New Zealand. These data were linked to antibiotics (pharmaceutical records) dispensed to women before conception and during all 3 trimesters of pregnancy and to their children from birth until age 2 years.

Results: The overall study population consisted of 132 852 mothers and 151 359 children (77 610 [51.3%] boys) who were aged 4 to 5 years when their anthropometrical measurements were assessed. Antibiotic exposure was common, with at least 1 course dispensed to 35.7% of mothers during pregnancy and 82.3% of children during the first 2 years of life. Results from covariate-adjusted analyses showed that both prenatal and early childhood exposures to antibiotics were independently associated with obesity at age 4 years, in a dose-dependent manner. Every additional course of antibiotics dispensed to the mothers yielded an adjusted odds ratio (aOR) of obesity in their children (siblings) of 1.02 (95% CI, 0.99-1.06), which was similar to the odds across pregnancy for the whole population (aOR, 1.06; 95% CI, 1.04-1.07). For the child's exposure, the aOR for the association between antibiotic exposure and obesity was 1.04 (95% CI, 1.03-1.05) among siblings and 1.05 (95% CI, 1.02-1.09) among twins. However, fixed-effects analyses of siblings and twins showed no associations between antibiotic exposure and obesity, with aORs of 0.95 (95% CI, 0.90-1.00) for maternal exposure, 1.02 (95% CI, 0.99-1.04) for child's exposure, and 0.91 (95% CI, 0.81-1.02) for twins' exposure.

Conclusions And Relevance: Although covariate-adjusted analyses demonstrated an association between antibiotic exposure and odds of obesity, further analyses of siblings and twins with discordant outcomes showed no associations. Thus, these discordant results likely reflect unmeasured confounding factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamanetworkopen.2019.19681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991276PMC
January 2020

Lower insulin sensitivity in young adults born preterm in Thailand.

Pediatr Diabetes 2020 03 30;21(2):210-214. Epub 2019 Dec 30.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Background: Previous studies reported impaired glucose homeostasis among preterm survivors, but consisted almost exclusively of Caucasians. It is unknown whether Asians born preterm display similar impairments.

Aim: To assess glucose homeostasis and other cardiometabolic outcomes among young adults born preterm in Thailand.

Methods: Participants were 575 young adult offspring of mothers from the Chiang Mai Low Birth Weight Study, born in 1989 to 1990 and followed up in 2010: 54.1% females, median age 20.6 years, including 33 individuals (5.7%) born preterm. After an overnight fast, participants underwent clinical assessments, including blood sampling (glucose, insulin, and lipid profile). Insulin sensitivity was assessed using HOMA-IR and insulin secretion estimated using HOMA-β.

Results: In unadjusted analyses, young Thai adults born preterm were 3.2 cm shorter (P = .037), 6 kg lighter (P = .016), and had HOMA-β 34% higher (P = .026) than those born at term. Adjusted analyses accounting for important confounders showed marked impairments in glucose homeostasis among preterm survivors: fasting insulin levels were 32% greater (P = .011), with HOMA-IR and HOMA-β that were 31% (P = .020) and 43% higher (P = .005), respectively, compared to peers born at term. There were no other contrasting observations between groups, with anthropometric differences disappearing after adjustment for confounders.

Discussion: Young adults in Thailand born preterm were more insulin resistant than peers born at term. The observed impairments in glucose metabolism among young Thai adults born preterm corroborate findings reported mostly on Caucasians. The challenge for general practitioners and public health professionals is to encourage those born preterm to make healthier lifestyle choices early on.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pedi.12969DOI Listing
March 2020

Acceptability of early childhood obesity prediction models to New Zealand families.

PLoS One 2019 2;14(12):e0225212. Epub 2019 Dec 2.

A Better Start-National Science Challenge, Auckland, New Zealand.

Objective: While prediction models can estimate an infant's risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. We aimed to assess the acceptability of these models to New Zealand caregivers.

Methods: An anonymous questionnaire was distributed online. The questionnaire consisted of multiple choice and Likert scale questions. Respondents were parents, caregivers, and grandparents of children aged ≤5 years.

Results: 1,934 questionnaires were analysed. Responses were received from caregivers of various ethnicities and levels of education. Nearly two-thirds (62.1%) of respondents would "definitely" or "probably" want to hear if their infant was at risk of early childhood obesity, although "worried" (77.0%) and "upset" (53.0%) were the most frequently anticipated responses to such information. With lower mean scores reflecting higher levels of acceptance, grandparents (mean score = 1.67) were more receptive than parents (2.10; p = 0.0002) and other caregivers (2.13; p = 0.021); males (1.83) were more receptive than females (2.11; p = 0.005); and Asian respondents (1.68) were more receptive than those of European (2.05; p = 0.003), Māori (2.11; p = 0.002), or Pacific (2.03; p = 0.042) ethnicities. There were no differences in acceptance according to socioeconomic status, levels of education, or other ethnicities.

Conclusions: Almost two-thirds of respondents were receptive to communication regarding their infant's risk of childhood obesity. While our results must be interpreted with some caution due to their hypothetical nature, findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225212PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886750PMC
April 2020

Perspective: Human Milk Oligosaccharides: Fuel for Childhood Obesity Prevention?

Adv Nutr 2020 01;11(1):35-40

Liggins Institute, University of Auckland, Auckland, New Zealand.

Obesity begins early but has lifelong consequences for health and well-being. Breastfeeding is thought to be preventive against obesity, but the extent and cause of this association are not well understood. Human milk oligosaccharides (HMOs) are abundant in human milk and not present in commercially available infant formula. These complex sugars are thought to contribute to the development of the infant gut microbiome and immune system. Recently, they have been investigated as a potential link between breastfeeding and lower obesity risk. So far, only a few human studies have examined HMO composition of human milk in association with the infant's concurrent anthropometry or subsequent growth in infancy, with conflicting results. However, HMOs have been shown to modulate the gut microbiome profile by selectively promoting the growth of specific bacteria, such as bifidobacteria. Moreover, there are differences in the gut microbiome of lean and obese humans, and there is some evidence that the early composition of the gut microbiome can predict later obesity. Although it seems that HMOs might have a role in infant growth and adiposity, there is not enough consistent evidence to understand their potential role in obesity prevention. More data, particularly from large or longitudinal studies, are needed to clarify the functions of HMOs and other breast-milk components in determining long-term health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/advances/nmz093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442366PMC
January 2020

Ranked Importance of Childhood Obesity Determinants: Parents' Views across Ethnicities in New Zealand.

Nutrients 2019 Sep 7;11(9). Epub 2019 Sep 7.

A Better Start-National Science Challenge, Auckland 1142, New Zealand.

Māori, Pacific, Indian, and New Zealand European pre-school children's caregivers' views on determinants of childhood obesity are needed to inform strategies that will reduce disparities in prevalence. Nineteen focus groups were conducted to explore the relative influence of factors contributing to body weight in children. Predetermined and participant-suggested factors were ranked. Discussion data were inductively analysed. The cost of healthy foods was the highest ranked factor across all groups. Ranked similarly were ease of access to takeaways and lack of time for food preparation. Cultural factors followed by screen time induced sedentariness in children and lack of time to ensure children exercised was next. Participant-raised factors included lack of familial, social, and health promotion support, and others' behaviour and attitudes negatively impacting what children ate. All groups rejected stereotyping that blamed culture for higher obesity rates. Compared to the Māori and NZ European groups, the Pacific Island and Indian participants spoke of losing culture, missing extended family support, and not having access to culturally appropriate nutrition education or social support and services. Public health policies need to mitigate the negative effects of economic deprivation on food insecurity. Complementary interventions that increase access to healthier meal choices more often are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu11092145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769712PMC
September 2019

Parental Perceptions of Obesity in School Children and Subsequent Action.

Child Obes 2019 10 13;15(7):459-467. Epub 2019 Aug 13.

Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Despite perceiving their child as being above a healthy weight, many parents do not intervene. Little is known about the factors influencing parental action. We assessed parental perception of child's weight status, the prevalence of mitigating parental action, and the underlying factors. We studied 20,242 children and adolescents from 6 centers across China. Anthropometry was measured by research nurses. Parents answered questionnaires, including their perception of their child's weight status, and any subsequent weight treatment. A total of 3254 children had obesity (16.1%), with 63.0% correctly perceived as overweight by their parents. These children were more likely to be older (≥8 years;  < 0.0001), have severe obesity [adjusted relative risk (aRR) 1.41;  < 0.0001], and have mothers with overweight/obesity (aRR 1.15;  < 0.0001). In particular, parents of children aged <8 years were over five times more likely to perceive their child with overweight/obesity as "thin" than parents of teenagers. Conversely, girls, older children/adolescents, and urban youth were more likely to be wrongly perceived by parents as having an overweight issue. Only one in four children (27.8%) with available information received treatment for their perceived weight problem. Children with severe obesity were more likely to be treated (aRR 1.34;  < 0.0001), as were children of mothers with overweight/obesity (aRR 1.18;  = 0.002). Only one in four Chinese children perceived as overweight by their parents received treatment for their weight problem. Given that overweight/obesity in childhood tracks into adulthood and many parents did not intervene despite perceiving an overweight problem in their child, interventions for childhood obesity need to extend beyond parental perception of children's weight status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/chi.2018.0338DOI Listing
October 2019

Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose-adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand.

Pediatr Diabetes 2019 11 4;20(7):892-900. Epub 2019 Jul 4.

Liggins Institute, University of Auckland, Auckland, New Zealand.

Background: Partial remission (PREM) by the insulin dose-adjusted HbA1c (IDAA1c) method has not been evaluated for the combined associations of ethnicity and socioeconomic status in children and adolescents with type 1 diabetes (T1D).

Objective: To investigate prevalence and predictors of PREM defined by IDAA1c.

Methods: Six hundred fourteen of 678 children (aged <15 years) with new-onset T1D (2000-2013) from a regional pediatric diabetes service (Auckland, New Zealand).

Results: Overall rate of PREM at 3 months was 42.4%, and lower in Māori/Pacific children (28.6%; P = .006) and those of other ethnicities (28.8%; P = .030) compared with New Zealand Europeans (50.4%). Comparing the most and least deprived socioeconomic quintiles, the odds of PREM were lower among the most deprived (adjusted odds ratio [aOR] 0.44; P = .019). Lower rates of PREM were seen in children aged 0 to 4.9 years (23.8%) and 10 to 14 years (40.9%) than in children aged 5 to 9.9 years (57.4%; P < .05). Further predictors of lower rates of PREM were ketoacidosis at diagnosis (aOR 0.54 with DKA; P = .002) and diabetes duration (aOR 0.84 per month; P < .0001). Patient's sex, body mass index standard deviation score, or autoantibodies were not associated with PREM. PREM at 3 months was associated with lower HbA1c over 18 months compared with children not in PREM (65.0 vs 71.3 mmol/mol; P < .0001), independent of ketoacidosis.

Conclusions: This study on a regional cohort of youth with T1D showed social and ethnic disparities in rates of PREM defined by IDAA1c. Further research into reducing ketoacidosis rates at diagnosis and addressing factors associated with lower rates of PREM in non-European children are important health priorities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pedi.12881DOI Listing
November 2019

Relationships of maternal body mass index and plasma biomarkers with childhood body mass index and adiposity at 6 years: The Children of SCOPE study.

Pediatr Obes 2019 10 24;14(10):e12537. Epub 2019 Jun 24.

Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.

Background: Maternal obesity has been implicated in the origins of childhood obesity through a suboptimal environment in-utero.

Objective: We examined relationships of maternal early pregnancy body mass index (BMI), overweight/obesity, and plasma biomarkers of obesity, inflammation, insulin resistance, and placental function with measures of childhood BMI and adiposity.

Methods: BMI z-score, sum of skinfold thicknesses (SST), body fat percentage (BFP, by bioelectrical impedance), and waist, arm, and hip circumferences were measured in 1173 6-year-old children of nulliparous pregnant women in the Screening for Pregnancy Endpoints (SCOPE) study, New Zealand. Relationships of maternal early pregnancy (15 weeks' gestation) BMI and biomarkers with these childhood anthropometric measures were assessed by linear regression, with appropriate adjustment.

Results: 28.1% of mothers were classified as overweight and 10.1% with obesity; compared with normal weight mothers, the BFP of their children were 5.3% higher (0.16 SD [95% CI, 0.04-0.29] p = .01) and 7.8% higher (0.27 [0.08-0.47] p = .006) with comparable values for BMI z-score and arm, waist, and hip circumferences. Early pregnancy maternal BMI and plasma placental growth factor (PlGF) were associated with higher child's SST, BMI z-score, hip circumference, and BFP. None of the metabolic or inflammatory maternal biomarkers were associated with childhood obesity.

Conclusion: In this contemporary large prospective cohort study with extensive maternal/childhood phenotyping and a high prevalence of maternal overweight/obesity, we found independent relationships of maternal early pregnancy BMI with childhood BMI and adiposity; similar associations were observed with PlGF, which may imply a role for placenta function in the developmental programming of childhood obesity risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijpo.12537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731120PMC
October 2019

Decomposing ethnic differences in body mass index and obesity rates among New Zealand pre-schoolers.

Int J Obes (Lond) 2019 10 13;43(10):1951-1960. Epub 2019 Jun 13.

A Better Start-National Science Challenge, Auckland, New Zealand.

Objective: To determine the extent to which ethnic differences in BMI Z-scores and obesity rates could be explained by the differential distribution of demographic (e.g. age), familial (e.g. family income), area (e.g. area deprivation), parental (e.g. immigration status), and birth (e.g. gestational age) characteristics across ethnic groups.

Methods: We used data on 4-year-old children born in New Zealand who attended the B4 School Check between the fiscal years of 2010/2011 to 2015/2016, who were resident in the country when the 2013 census was completed (n = 253,260). We implemented an Oaxaca-Blinder decomposition to explain differences in BMI Z-score and obesity between Māori (n = 63,061) and European (n = 139,546) children, and Pacific (n = 21,527) and European children.

Results: Overall, 15.2% of the children were obese and mean BMI Z-score was 0.66 (SD = 1.04). The Oaxaca-Blinder decomposition demonstrated that the difference in obesity rates between Māori and European children would halve if Māori children experienced the same familial and area level conditions as Europeans. If Pacific children had the same characteristics as European children, differences in obesity rates would reduce by approximately one third, but differences in mean BMI Z-scores would only reduce by 16.1%.

Conclusion: The differential distribution of familial, parental, area, and birth characteristics across ethnic groups explain a substantial percentage of the ethnic differences in obesity, especially for Māori compared to European children. However, marked disparities remain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41366-019-0390-4DOI Listing
October 2019

Preterm Birth is Associated With Increased Blood Pressure in Young Adult Women.

J Am Heart Assoc 2019 06 5;8(12):e012274. Epub 2019 Jun 5.

2 Department of Women's and Children's Health Uppsala University Uppsala Sweden.

Background While there is some evidence of elevated blood pressure later in life in preterm survivors, data on adult women are still lacking. Thus, we assessed the associations between preterm birth and blood pressure in young adult women. Methods and Results We studied 5232 young adult women who volunteered for military service in Sweden between 1990 and 2007. Anthropometric and clinic blood pressure data were collected during the medical examination at the time of conscription. There was a progressive decline in systolic and diastolic blood pressures, as well as in mean arterial pressure, with increasing gestational age. Women born preterm had an adjusted increase in systolic blood pressure of 3.8 mm Hg (95% CI , 2.5-5.1; P<0.0001) and mean arterial pressure of 1.9 mm Hg (95% CI , 0.9-2.8; P=0.0001) compared with young women born at term. Rates of systolic hypertension were also considerably higher in young women born preterm (14.0% versus 8.1%, P<0.0001), as were rates of isolated systolic hypertension. The adjusted relative risk of systolic hypertension in women born preterm was 1.72 (95% CI , 1.26-2.34; P<0.001) that of women born at term or post-term, but there was no significant difference in the risk of diastolic hypertension (adjusted relative risk, 1.60; 95% CI , 0.49-5.20). Conclusions Young adult women born preterm display elevated systolic blood pressure and an increased risk of hypertension compared with peers born at term or post-term.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.119.012274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645636PMC
June 2019