Socioeconomic inequalities in childhood-to-adulthood BMI tracking in three British birth cohorts

Background: Body mass index (BMI) tracks from childhood to adulthood, but the extent to which this relationship varies across the distribution and according to socio-economic position (SEP) is unknown. We aimed to address this using data from three British cohort studies. Methods: We used data from: 1946 National Survey of Health and Development (NSHD, n=2,470); 1958 National Child Development Study (NCDS, n=7,747); 1970 British Cohort Study (BCS, n=5,323). BMI tracking between 11 and 42 years was estimated using quantile regression, with estimates reflecting correlation coefficients. SEP disparities in tracking were investigated using a derived SEP variable based on parental education reported in childhood. This SEP variable was then interacted with the 11-year BMI z-score. Results: In each cohort and sex, tracking was stronger at the upper end of the distribution of BMI at 42 years. For example, for men in the 1946 NSHD, the tracking estimate at the 10th quantile was 0.31 (0.20, 0.41), increasing to 0.71 (0.61, 0.82) at the 90th quantile. We observed no strong evidence of SEP inequalities in tracking in men in the 1946 and 1958 cohorts. In the 1970 cohort, however, we observed tentative evidence of stronger tracking in low SEP groups, particularly in women and at the higher end of the BMI distribution. For example, women in the 1970 cohort from low SEP backgrounds had tracking coefficients at the 50th, 70th, and 90th quantiles which were 0.05 (-0.04; 0.15), 0.19 (0.06; 0.31), and 0.22 (0.02; 0.43) units higher, respectively, than children from high SEP groups. Conclusion: Tracking was consistently stronger at the higher quantiles of the BMI distribution. We observed suggestive evidence for a pattern of greater BMI tracking in lower (compared to higher) SEP groups in the more recently born cohort, particularly in women and at the higher end of the BMI distribution

Birth weight charts for a Chinese population: an observational study of routine newborn weight data from Chongqing

Background: To construct birth weight charts for the Chongqing municipality, China and to identify whether differences in birth weight exist across urban/rural populations, thereby warranting separate charts.Methods: Secondary analysis of routinely collected data from 338,454 live infants between 2014 and 2017 in Chongqing municipality. Sex-specific birth weight-for-gestational age centiles were constructed by the lambda-mu-sigma method via the GAMLSS R-based package. This method remodels the skewed birth weight distribution to estimate a normal distribution, allowing any birth weight centile to be generated. A separate set of centiles were created, accounting for urban/rural differences in birth weight.Results: The centiles performed well across all gestational ages. For example, 2.37% (n = 4176) of males and 2.26% (n = 3656) of females were classified as below the 2nd centile (expected percentage = 2.28%), 49.75% of males (n = 87,756) and 50.73% of females (n = 82,203) were classified as below the 50th centile (expected proportion = 50%) and 97.52% of males (n = 172,021) and 97.48% of females (n = 157,967) were classified as below the 98th centile (expected proportion = 97.72%). The overall estimated centiles of birth weight for rural infants were higher than the centiles for urban infants at the earlier gestational ages (Conclusion: We have constructed a readily utilizable set of birth weight references from a large representative sample of births in Chongqing. The method used to construct the references allows for the calculation of the exact centile for any infant delivered between 28 and 42 completed weeks, which was not possible with previous charts.</div

Depressive symptoms at age 9–13 and chronic disabling fatigue at age 16: A longitudinal study

IntroductionWe investigated whether depressive symptoms at ages 9–13 years were associated with chronic disabling fatigue (CDF) at age 16 among children in the Avon Longitudinal Study of Parents & Children (ALSPAC) birth cohort.MethodsDepressive symptoms at ages 9, 10, 11, 12, and 13 years were defined as a child- or parent-completed Short Mood and Feelings Questionnaire (SMFQ) score ≥11 (range 0–26). SMFQ score was also analysed as a continuous exposure. Chronic disabling fatigue at 16 was defined as fatigue of ≥6 months' but ResultsIn fully adjusted models using imputed data (N = 13,978), depressive symptoms at ages 9, 11, and 13 years were associated with 2- to 3-fold higher odds of CDF at age 16. Each one-point increase in SMFQ score at ages 9, 10, 11, 12, and 13 years was associated with 6–11% higher odds of CDF at age 16. Depressive symptoms and continuous SMFQ scores at each age were not associated with CDF if the outcome was reclassified to exclude children with comorbid depressive symptoms at age 16.ConclusionsDepressive symptoms at ages 9–13 were associated with chronic disabling fatigue at age 16, but causality is not certain.</div

Secular changes in mid-adulthood body mass index, waist circumference, and low HDL cholesterol between 1990, 2003, and 2018 in Great Britain

ObjectiveTo investigate the extent to which (1) secular changes in mid-adulthood WC are independent of BMI and (2) secular changes in low HDL-C are dependent on WC in each sex.MethodsThe sample comprised 19,406 adults (aged 43–47 years) from three birth cohort studies with BMI and WC measured in 1990, 2003, or 2018; 13,239 participants additionally had HDL-C measured in 2003 or 2018. Quantile regression was used to model differences between 1990–2003 and 2003–2018 in (1) BMI and WC internal Z-scores and (2) WC in cm before and after adjustment for BMI. Binary logistic regression was used to model differences between 2003 and 2018 in low HDL-C, before and after adjustment for BMI or WC.ResultsSecular increases in BMI and WC were larger between 1990 and 2003 than 2003 and 2018 and at the upper ends of the distributions. At the 85th quantile, effect sizes were larger for WC than BMI Z-scores in females but not males. Adjustment for BMI attenuated estimates of secular increases in WC in cm more in males than females. Odds ratios for low HDL-C in 2018 compared to 2003 were 1.73 (95% CI 1.32, 2.28) in males and 1.34 (1.01, 1.78) in females. Adjustment for WC did not substantially change the estimate in males but attenuated the estimate for females to 1.09 (0.81, 1.47).ConclusionsIn women much more so than in men, secular increases in mid-adulthood WC appear to have occurred independently of BMI and largely explain the observed rise in low HDL-C prevalence between 2003 and 2018.</div

The relationship of early-life adversity with adulthood weight and cardiometabolic health status in the 1946 National Survey of Health and Development

ObjectivesEvidence linking early-life adversity with an adverse cardiometabolic profile in adulthood is equivocal. This study investigates early-life adversity in relation to weight and cardiometabolic health status at age 60-64 years.MethodsWe included 1,059 individuals from the 1946 National Survey of Health and Development (NSHD). Data on adversity between ages 0-15 years were used to create a cumulative childhood psychosocial adversity score and a socioeconomic adversity score. Cardiometabolic and weight/height data collected at ages 60-64 years were used to create four groups: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUO). Associations between the two exposure scores and weight/health status were examined using multinomial logistic regression, with adjustment for sex and age at the outcome visit.Results62% of normal weight individuals were metabolically healthy, whereas only 34% of overweight/obese individuals were metabolically healthy. In a mutually adjusted model including both exposure scores, a psychosocial score of ≥ 3 (compared to 0) was associated with increased risk of being metabolically unhealthy (compared to healthy) in both normal weight adults (RR 2.49; 95% CI 0.87, 7.13) and overweight/obese adults (1.87; 0.96, 3.61). However, the socioeconomic adversity score was more strongly related to metabolic health status in overweight/obese adults (1.60; 0.98, 2.60) than normal weight adults (0.95; 0.46, 1.96).5ConclusionsIndependently of socioeconomic adversity, psychosocial adversity in childhood may be associated with a poor cardiometabolic health profile, in both normal weight and overweight/obese adults.</div

Supplementary Information Files for: Is the positive relationship of infant weight gain with adolescent adiposity attenuated by moderate-to-vigorous physical activity in childhood?

Supplementary Information Files for: Is the positive relationship of infant weight gain with adolescent adiposity attenuated by moderate-to-vigoroObjectiveRapid infant weight gain is a key risk factor for pediatric obesity, yet there is very little evidence on how healthy behaviours in childhood might modify this association. We aimed to examine how the association of infant weight gain with adolescent adiposity might be attenuated by moderate-to-vigorous physical activity (MVPA) in childhood.MethodsThe sample comprised 4,666 children in the UK Millennium Cohort Study. The two outcomes were BMI Z-score and % fat at 14 years. Sex-stratified regression models were developed testing for interactions between infant weight Z-score gain between 0-3 years (continuous or categorical) and MVPA at 7 years (continuous or binary). Models were sequentially adjusted for basic covariates, socioeconomic variables, and parental BMI levels.ResultsEffect modification was observed in boys but not girls and, among boys, was stronger for % fat than BMI. In a fully adjusted model for boys, the association between infant weight Z-score gain and adolescent % fat was 1.883 (1.444, 2.322) if MVPA ConclusionsIn boys, approximately 75% of the excess % fat at 14 years associated with rapid infant weight gain was attenuated by meeting the MVPA guideline. In boys known to have demonstrated rapid infant weight gain, increasing childhood MVPA levels, with the target of ≥60 mins/day, might therefore go a long way to towards offsetting their increased risk for adolescent obesity. The lack of effect modification in girls is likely due to lower MVPA levelsus physical activity in childhood

Supplementary Information files for: Contribution of 20-year body mass index and waist circumference history to poor cardiometabolic health in overweight/obese and normal weight adults: a cohort study

Supplementary Information files for: Contribution of 20-year body mass index and waist circumference history to poor cardiometabolic health in overweight/obese and normal weight adults: a cohort studyBackground and Aims: We investigated the associations of 20-year body mass index (BMI) and waist circumference (WC) histories with risk of being 1) metabolically unhealthy overweight/obese (MUOO) vs metabolically healthy overweight/obese (MHOO) and 2) metabolically unhealthy normal weight (MUNW) vs metabolically healthy normal weight (MHNW). Methods and Results: Participants comprised 3,018 adults (2,280 males; 738 females) with BMI and WC measured, every ~5 years, in 1991-1994, 1997-1999, 2002-2004, 2007-2009, and 2012-2013. Mean age in 2012-2013 was 69.3 years, with a range of 59.7-82.2 years. Duration was defined as the number of times a person was overweight/obese (or centrally obese) across the 5 visits, severity as each person’s mean BMI (or WC), and variability as the within-person standard deviation of BMI (or WC). At the 2013-2013 visit, participants were categorised based on their weight (overweight/obese or normal weight; body mass index (BMI) ≥25 kg/m2 ) and health status (healthy or unhealthy; two or more of hypertension, low high-density lipoprotein cholesterol, high triglycerides, high glucose, and high homeostatic model assessment of insulin resistance). Logistic regression was used to estimate associations with the risk of being MUNW (reference MHNW) and MUOO (reference MHOO) at the last visit. BMI and WC severity were each related to increased risk of being unhealthy, with estimates being stronger among normal weight than overweight/obese adults. The estimates for variability exposures became null upon adjustment for severity. Individuals who were overweight/obese at all 5 time points had a 1.60 (0.96-2.67) times higher risk of being MUOO than MHOO compared to those who were only overweight/obese at one (i.e., the last) time point. The corresponding estimate for central obesity was 4.20 (2.88-6.12). Greater duration was also related to higher risk of MUNW than MHNW. Conclusion: Being overweight/obese yet healthy seems to be partially attributable to lower exposure to adiposity across 20 years of adulthood. The results highlight the importance of maintaining optimum and stable BMI and WC, both in adults who become and do not become overweight/obese.<br

Contribution of 20-year body mass index and waist circumference history to poor cardiometabolic health in overweight/obese and normal weight adults: a cohort study

Background and Aims: We investigated the associations of 20-year body mass index (BMI) and waist circumference (WC) histories with risk of being 1) metabolically unhealthy overweight/obese (MUOO) vs metabolically healthy overweight/obese (MHOO) and 2) metabolically unhealthy normal weight (MUNW) vs metabolically healthy normal weight (MHNW).Methods and Results: Participants comprised 3,018 adults (2,280 males; 738 females) with BMI and WC measured, every ~5 years, in 1991-1994, 1997-1999, 2002-2004, 2007-2009, and 2012-2013. Mean age in 2012-2013 was 69.3 years, with a range of 59.7-82.2 years. Duration was defined as the number of times a person was overweight/obese (or centrally obese) across the 5 visits, severity as each person’s mean BMI (or WC), and variability as the within-person standard deviation of BMI (or WC). At the 2013-2013 visit, participants were categorised based on their weight (overweight/obese or normal weight; body mass index (BMI) ≥25 kg/m2) and health status (healthy or unhealthy; two or more of hypertension, low high-density lipoprotein cholesterol, high triglycerides, high glucose, and high homeostatic model assessment of insulin resistance). Logistic regression was used to estimate associations with the risk of being MUNW (reference MHNW) and MUOO (reference MHOO) at the last visit. BMI and WC severity were each related to increased risk of being unhealthy, with estimates being stronger among normal weight than overweight/obese adults. The estimates for variability exposures became null upon adjustment for severity. Individuals who were overweight/obese at all 5 time points had a 1.60 (0.96-2.67) times higher risk of being MUOO than MHOO compared to those who were only overweight/obese at one (i.e., the last) time point. The corresponding estimate for central obesity was 4.20 (2.88-6.12). Greater duration was also related to higher risk of MUNW than MHNW.Conclusion: Being overweight/obese yet healthy seems to be partially attributable to lower exposure to adiposity across 20 years of adulthood. The results highlight the importance of maintaining optimum and stable BMI and WC, both in adults who become and do not become overweight/obese.</div

The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60-64 years of age in the 1946 National Survey of Health and Development

BackgroundEarly life adversity is increasingly prevalent and associated with greater morbidity and mortality. It is hypothesised that the link between psychosocial early life adversity and poor health in adulthood is due to abnormal hypothalamic-pituitary-adrenal (HPA) axis functioning (often measured as cortisol patterning) and inflammation (often measured via c-reactive protein (CRP)). This study aimed to investigate the relationship between early life psychosocial adversity and cortisol patterning and CRP at 60-64 years of age.MethodsThe MRC National Survey of Health and Development (NSHD) was used. The analytic “cortisol sample” included 843 individuals and the “CRP sample” included 1,150 individuals. Data on adversity experienced between ages 0-15 years were utilised to compose a cumulative childhood psychosocial early life adversity (ELA) score (0, 1, 2, 3+). CRP and salivary cortisol (waking, 30 min after waking, and evening) were collected at 60-64 years. Associations between the psychosocial ELA score and cortisol outcomes (cortisol awakening response (CAR), diurnal slope (DS), and evening and morning cortisol) were assessed using general linear regression. Tobit regression was used to assess the association between psychosocial ELA score and CRP. Adjustments were made for age at follow-up, sex, childhood maternal education, childhood paternal social class, childhood housing tenure, and birth weight. After testing for sex by ELA score interactions, analyses were repeated stratified by sex for the CRP sample. ResultsIn fully adjusted models, individuals who experienced the highest level of childhood psychosocial adversity (3+) had a 24.63 (-41.49, -7.76) % lower waking cortisol and a 7.30 (1.49, 13.12) % lower decline in cortisol across the day compared to those with a psychosocial ELA score of zero. In females, the highest level of childhood psychosocial adversity, compared to the lowest, was associated with 32.61 (2.98, 62.25) % higher CRP at 60-64 years, which attenuated to 20.38 % (-9.38, 50.14) upon adjustment for measures of early life socioeconomic position. Conversely, the association between childhood psychosocial adversity and CRP in males was null.ConclusionsOur results suggest that high-levels of psychosocial adversity in childhood might result in a lower morning cortisol and flatter DS in mid-to-late-adulthood. The finding that adversity was related to higher CRP in females but not males requires replication and further investigation.</div

Supplementary information files for: The associations of maternal and paternal obesity with latent patterns of offspring BMI development between 7-17 years of age: pooled analyses of cohorts born in 1958 and 2001 in the United Kingdom

Supplementary information files for: The associations of maternal and paternal obesity with latent patterns of offspring BMI development between 7-17 years of age: pooled analyses of cohorts born in 1958 and 2001 in the United Kingdom Objective We aimed to 1) describe how the UK obesity epidemic reflects a change over time in the proportion of the population demonstrating adverse latent patterns of BMI development and 2) investigate the potential roles of maternal and paternal BMI in this secular process. Methods We used serial BMI data between 7-17 years of age from 13220 boys and 12711 girls. Half the sample was born in 1958 and half in 2001. Sex-specific growth mixture models were developed. The relationships of maternal and paternal BMI and weight status with class membership were estimated using the 3-step BCH approach, with covariate adjustment. Results The selected models had five classes. For each sex, in addition to the two largest normal weight classes, there were “normal weight increasing to overweight” (17% of boys and 20% of girls), “overweight increasing to obesity” (8% and 6%), and “overweight decreasing to normal weight” (3% and 6%) classes. More than 1-in-10 children from the 2001 birth cohort were in the “overweight increasing to obesity” class, compared to less than 1-in-30 from the 1958 birth cohort. Approximately 75% of the mothers and fathers of this class had overweight or obesity. When considered together, both maternal and paternal BMI were associated with latent class membership, with evidence of negative departure from additivity (i.e., the combined effect of maternal and paternal BMI was smaller than the sum of the individual effects). The odds of a girl belonging to the “overweight increasing to obesity” class (compared to the largest normal weight class) was 13.11 (8.74, 19.66) times higher if both parents had overweight or obesity (compared to both parents having normal weight); the equivalent estimate for boys was 9.01 (6.37, 12.75). Conclusions The increase in obesity rates in the UK over more than 40 years has been partly driven by the growth of a sub-population demonstrating excess BMI gain during adolescence. Our results implicate both maternal and paternal BMI as correlates of this secular process.</p