Our results are consistent with other studies that have shown a significant, but small, inverse association between breastfeeding and childhood obesity. Findings from this study suggest the need to improve breastfeeding rates in the rural Appalachian state of WV as one of the potential strategies to prevent obesity during childhood and adolescence.
Introduction: Few studies have examined the relationship between perinatal and postnatal birth factors with later childhood obesity. One notable exception found only infant weight-related factors (such as adiposity rebound) related to weight at age 7, but not other potential risk factors (such as breastfeeding, parity, maternal age, etc., Reilly et al 2005) Our goal with the current study was to expand earlier work, utilizing an Appalachian sample, and to develop a risk score based on an expanded set of risk factors. Methods: The study used longitudinally linked data from three cross-sectional datasets in West Virginia (N=22136). Risk score development followed the tutorial by Sullivan et al (2004). The outcome was defined as childhood obesity at age 10 and calculated as children with 95th percentile BMI for their age and gender. The perinatal predictors included sex, race, health insurance status, family history of cholesterol and cardiovascular disease, smoking during pregnancy, maternal age at birth, breastfeeding intention at birth, and birth weight of the infant. ROC analysis was then performed to establish a cut-off that would maximize the sensitivity and specificity of the perinatal risk factor scores in predicting childhood obesity. Results: Table 1 shows the significant risk factors and associated points. A score of 17 maximized sensitivity (50%) and specificity (60%) using the combined risk factor system for predicting childhood obesity at age 10. Nearly 43% (N=4054 of 9494) of the children had a high perinatal risk score; of those, 34.24% (N=1388) were obese (compared to 26.53% of those with a low perinatal risk score). The odds of being obese in fifth grade were 1.44 (95%CI: 1.32, 1.58) times among those who had a high perinatal score compared to those who had a low score. Discussion: The results of the study can help in identifying infants at birth who are at higher risk of developing childhood obesity. Future research should include other predictors to increase sensitivity and specificity of the risk score system.
Introduction: Maternal smoking during pregnancy is a well-established risk factor for childhood obesity. However, the relationship between maternal smoking and other childhood cardiovascular disease (CVD) risk factors is unclear. The objective of the study was to assess these associations in fifth grade children. Methods: The study used longitudinally linked data from three cross-sectional datasets (the WV Birth Score Project, the Birth certificate at birth, and the Coronary Artery Risk Detection in Appalachian Communities Project in fifth grade West Virginian children who were born full term (N=19,583). The main outcome variables included fifth-grade CVD risk factors (e.g., systolic blood pressure [SBP], diastolic blood pressure and lipid levels including total cholesterol, high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol, log transformed triglyceride [log-TG]), which were significantly correlated with maternal smoking during pregnancy at the bivariate level. Each significant dependent variable was regressed on the main exposure variable with additional covariates (child’s age, sex, race, maternal education at child’s birth, family history of CVD, and birth weight). Childhood body mass index (BMI) was added to the regression model to assess for its role as a potential mediator. Results: The significant CVD risk factors associated with maternal smoking during pregnancy included SBP: r=0.02, p= 0.002; HDL: r=-0.06 p<0.0001, and TG: r=0.06, p<0.0001. The results of multiple regression analysis showed significant association between maternal smoking during pregnancy and TG and HDL, which attenuated but remained statistically significant after assessing for BMI as a potential mediator. The association was not significant for SBP (Table 1). Conclusion: Our results showed that maternal smoking during pregnancy was an independent risk factor for higher TG and lower HDL after adjusting for covariates and the relationship is partially mediated by the childhood current BMI.
Introduction: Reported associations between birth weight (BTW) and childhood cardiovascular disease (CVD) risk factors have been inconsistent. The relationship between infants’ BTW and later maternal CVD is also a more recent and active area of research. We aimed to examine the association between BTW and subsequent childhood and maternal CVD risk factors 11 years post-partum. Methods: The study used longitudinally linked data from three cross-sectional datasets in West Virginia (N=19,583). The outcome variables included blood pressure for children and lipid levels for both mothers and children. The exposure was BTW of the infants born full-term. The role of the child’s current body mass index (BMI) was assessed as a potential mediator. Results: Unadjusted analyses showed a positive association between BTW and the child’s systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL), and a negative association with triglycerides (TGs). When adjusted for the child’s BMI, the association became non-significant for SBP and DBP but remained significant for HDL [β= 0.14 mg/dL (95% CI: 0.11, 0.18) per1000g increase in BTW] and TGs [β= -0.007 mg/dL (-0.008, -0.005) per 1000g increase in BTW]. Low-density lipoprotein cholesterol (LDL) and non-HDL became significant and negatively associated with BTW in the adjusted analysis [LDL (β = -0.1 mg/dL (-0.19, - 0.16) per 1000 g increase in BTW; non-HDL (b = - 0.18 mg/dL (-0.28, -0.09) per 1000 g increase in BTW]. There was a positive association between infant’s birth weight and maternal total cholesterol (TC) levels, which became non-significant in the adjusted analysis [β = 0.4 (95% CI: -0.01, 0.90) mg/dL per1000g increase in birth weight]. None of the other maternal lipids levels (LDL, HDL, and TG) were significant in the unadjusted or the adjusted analysis. Conclusion: Low BTW was associated with higher LDL, non-HDL, and TGs, and lower HDL levels in fifth grade children independent of the current weight status. As childhood CVD risk factors persist and are often amplified over time, these small effect sizes can have potential unfavorable consequences on lipid levels in later adulthood.
Introduction: There is growing evidence that early-life risk factors may influence the development of cardiovascular disease (CVD) in later life. The goal of this study was to examine the associations between numerous early life exposures and subsequent childhood hypertension and dyslipidemia at 11 years of age to identify the modifiable risk factors. Methods: The study used longitudinally linked data from three cross-sectional datasets in West Virginia (N= 22,136). The outcome variables included pre-hypertension/hypertension defined as ≥ 90th percentile for SBP (>124mmHg) or DBP (>80mmHg) and dyslipidemia defined as LDL ≥130mg/dl and HDL <40 mg/dl. Logistic regression was used to examine the association between the two outcomes and an extensive list of perinatal predictors, including sex, race, health insurance status, family history of cholesterol and cardiovascular disease, smoking during pregnancy, maternal age at birth, breastfeeding intention at birth, and birth weight of the infant. Results: The results showed that approximately 21% (4482 of 21817) of the children had hypertension and one fourth had dyslipidemia (24.6%, 4481 of 18184) in fifth grade. Increased odds for childhood hypertension was associated with age of the child in fifth grade, male gender, race (other compared to white), family history of cholesterol, and no maternal intention of exclusively breastfeeding their infant. Increased odds for childhood dyslipidemia was associated with family history of cholesterol, family history of cardiovascular disease, and maternal smoking during pregnancy. Notably, two modifiable perinatal risk factors stood out: mothers who did not intend to exclusively breastfeed had children who had significantly higher odds of having hypertension in fifth grade (OR: 1.2, 95%CI: 1.1, 1.3) compared to mothers who intended to exclusively breastfeed. Additionally, mothers who smoked during pregnancy had children who had significantly higher odds of having dyslipidemia in fifth grade compared to mothers who did not smoke (OR: 1.3, 95%CI: 1.2, 1.4). Conclusion: Surprisingly few perinatal factors were associated with childhood hypertension and dyslipidemia. The perinatal modifiable factors for hypertension and dyslipidemia included intent to breastfeed and maternal smoking during pregnancy; thus, smoking cessation and exclusive breastfeeding should be encouraged.
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