Repeated ultrasound measures identified the effects of GDM as early as 16-18 weeks' gestation, well before a diagnosis of GDM would usually be made. Sex differences in fetal growth were observed, with GDM-exposed male fetuses being more affected with larger abdominal circumferences than females. A low rate of macrosomia was observed compared with historical GDM populations.

BackgroundElevated blood pressure in childhood is a risk factor for adult hypertension which is a global health problem. Excess adiposity in childhood creates a predisposition to develop adult hypertension. Our aim was to explore distinct sex-specific adiposity trajectories from childhood to late adolescence and examined their association with blood pressure.MethodsLatent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to derive sex-specific and distinct body mass index (BMI: kg/m2) trajectories. We studied 1824 black children (boys = 877, girls = 947) from the Birth to Twenty (Bt20) cohort from Soweto, South Africa, and obtained BMI measures at ages 5 through 18 years. Participants with at least two age-point BMI measures, were included in the analysis. Analysis of variance (ANOVA), chi-square test, multivariate linear and standard logistic regressions were used to test study characteristics and different associations.ResultsWe identified three (3) and four (4) distinct BMI trajectories in boys and girls, respectively. The overall prevalence of elevated blood pressure (BP) was 34.9 % (39.4 % in boys and 30.38 % in girls). Boys and girls in the early onset obesity or overweight BMI trajectories were more likely to have higher BP values in late adolescence. Compared to those in the normal weight BMI trajectory, girls in early onset obesity trajectories had an increased risk of elevated BP with odds ratio (OR) of 2.18 (95 % confidence interval 1.31 to 4.20) and 1.95 (1.01 to 3.77). We also observed the weak association for boys in early onset overweight trajectory, (p-value = 0.18 and odds ratio of 2.39 (0.67 to 8.57))ConclusionsDistinct weight trajectories are observed in black South African children from as early as 5 years. Early onset adiposity trajectories are associated with elevated BP in both boys and girls. It is important to consider individual patterns of early-life BMI development, so that intervention strategies can be targeted to at-risk individuals.

Objectives To explore the association between sex-specific adiposity trajectories among Adolescents to early adulthood with incident high blood pressure (HBP) and high plasma glucose (HPG). Methods We studied body mass index (BMI) trajectories among1159 (male = 517) and 664 (male = 263) Iranian adolescents, aged 12–20 years, for incident HPG and HBP, respectively. Latent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to determine sex-specific and distinct BMI trajectories. Logistic regressions were applied to estimate the relationship between latent class membership with HBP and HPG, considering normal trajectory as the reference. Results For both HBP and HPG, LCGMM determined two and three distinct BMI trajectories in males and females, respectively. During a follow-up of 12Years 104 (male = 62) and 111(male = 59) cases of HPG and HBP were found, respectively. Among females, faster BMI increases (i.e. overweight to early obese trajectory) but not overweight (i.e. those with BMI = 27.3 kg/m 2 at baseline) trajectories increased the risk of HPG by adjusted odds ratios (ORs), 2.74 (1.10–5.80) and 0.79 (0.22–2.82), respectively; regarding HBP, the corresponding value for overweight to late obese trajectory was 3.72 (1.37–11.02). Among males, for HBP, the overweight trajectory increased the risk [2.09 (1.04–4.03)]; however, for incident HPG, none of the trajectories showed significant risk. Conclusions Among females, trend of increasing BMI parallel with age can be a better predictor for risk of developing HPG and HBP than those with higher BMI at baseline.

ObjectivesThis systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.SettingOnly studies reporting data from Africa were included.ParticipantsA systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.Main outcome measuresIncidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.ResultsOf 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively).ConclusionsMeta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.Trial registration numberPROSPERO42016038689.

Socio-economic status (SES) is an important predictor of obesity, but how it is associated with differences in physical activity and sedentary behaviour is less clear. This cross-sectional study examined the association between SES (sum of household assets), physical activity and sedentary time, and how they predict adiposity. Socio-demographic, anthropometric, and physical activity data on rural (n = 509) and urban (n = 510) South African women (18–23 years) were collected. Overweight and obesity prevalence, and sedentary time, were higher; and moderate-vigorous intensity physical activity (MVPA) was lower, in the urban sample. Structural equation models (SEMs) were constructed for BMI and waist circumference. In the urban sample SES had a direct inverse effect on MVPA (ß; 95% CI, −41.69; −73.40 to −9.98), while in the rural sample SES had a direct effect on BMI (ß; 95% CI, 0.306; 0.03 to 0.59). In the pooled sample, SES had a direct inverse effect on MVPA (ß; 95% CI, −144; −170.34 to −119.04), and MVPA was directly associated with BMI (ß; 95% CI, 0.04; 0.01 to 0.08). The influence of SES, and the role of physical activity and sedentary time on adiposity differs between the urban and rural samples, and the importance of other environmental and behavioural factors must be considered in the development of obesity and the design of effective interventions.

Early growth is associated with blood pressure measured on one occasion, but whether early life growth patterns are associated with longitudinal blood pressure trajectories is under-researched. Therefore, we sought to examine the association between early growth and blood pressure trajectories from childhood to adulthood. Blood pressure was measured on seven occasions between ages 5 and 18 years in the Birth to Twenty cohort study and conditional variables for growth in infancy and mid-childhood were computed from anthropometric measures (n=1937, 52% girls). We used a group-based trajectory modeling approach to identify distinct height-adjusted blood pressure trajectories and then tested their association with growth between birth and mid-childhood adjusting for several covariates. Three trajectory groups were identified for systolic and diastolic blood pressure: ‘lower’, ‘middle’ and ‘upper’ in boys and girls, separately. In boys, predictors of the middle or upper systolic blood pressure trajectories versus the lower trajectory were in birth weight (odds ratio [OR] 0.75[95% CI 0.58–0.96] per SD) and relative weight gain in infancy (4.11[1.25–13.51] per SD). In girls, greater relative weight gain and linear growth in both infancy and mid-childhood were consistently associated with an almost 2-fold higher likelihood of being in the upper versus lower systolic blood pressure trajectory. The associations for the diastolic blood pressure trajectories were inconsistent. These findings emphasize the importance of identifying children at risk of progression to high blood pressure. Accelerated growth in infancy and mid-childhood may be a key target for early life intervention in prevention of elevated blood pressure progression.

Background Adolescence is a critical phase of human development that lays the foundation for health in later life. Of the 1.8 billion adolescents in the world, roughly 90% live in low and middle-income countries. Yet most longitudinal studies of adolescent physical activity, sedentary behavior, and sleep come from high-income countries. There is a need for a better understanding of these behaviors to inform obesity and chronic disease prevention strategies. Aims The aim of this study is to identify longitudinal patterns and associations between physical activity, sedentary behavior and sleep in urban South African adolescents. Methods We analyzed data from the Birth-to-Twenty Plus Cohort (Bt20+), a longitudinal study of children in Soweto, Johannesburg, South Africa. Behaviors were self-reported annually between ages 12 and 17 y. We used Latent Class Growth Analysis to group participants into classes based on common longitudinal trajectories of time spent in informal physical activity, organized sports, walking to and from school, sedentary behavior, and school-night and weekend sleep, respectively. We performed group-based multi-trajectory modeling to identify latent clusters of individuals who followed similar trajectories of informal physical activity, organized sports and walking to and from school, and who followed similar trajectories of these three domains together with sedentary behavior and sleep. Results The large majority of males (82%) and all females failed to meet the World Health Organization (WHO) physical activity recommendation for adolescents of 60 min of moderate-vigorous intensity physical activity per day. The physical activity domains clustered together in three multi-trajectory groups that define individuals’ overall physical activity pattern. While two patterns indicated decreases in physical activity throughout adolescence, one pattern, including 29% of the sample in males and 17% of the sample in females, indicated higher levels of activity throughout adolescence. Sedentary behavior and sleep trajectories did not cluster together with the physical activity domains. Conclusion Most adolescents in this South African population did not meet WHO recommendations for physical activity. In this population, trajectories of sedentary behavior and sleep were independent of physical activity. Electronic supplementary material The online version of this article (10.1186/s12887-019-1619-z) contains supplementary material, which is available to authorized users.

BackgroundThe growing prevalence of overweight and obesity in low- or middle-income countries precipitates the need to examine early life predictors of adiposity.ObjectivesTo examine growth trajectories from birth, and associations with adult body composition in the Birth to Twenty Plus Cohort, Soweto, South Africa.MethodsComplete data at year 22 was available for 1088 participants (536 males and 537 females). Conditional weight and height indices were generated indicative of relative rate of growth between years 0–2, 2–5, 5–8, 8–18, and 18–22. Whole body composition was measured at year 22 (range 21–25 years) using dual energy x-ray absorptiometry (DXA). Total fat free soft tissue mass (FFSTM), fat mass, and abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were recorded.ResultsBirth weight was positively associated with FFSTM and fat mass at year 22 (β = 0.11, p<0.01 and β = 0.10, p<0.01 respectively). Relative weight gain from birth to year 22 was positively associated with FFSTM, fat mass, VAT, and SAT at year 22. Relative linear growth from birth to year 22 was positively associated with FFSTM at year 22. Relative linear growth from birth to year 2 was positively associated with VAT at year 22. Being born small for gestational age and being stunted at age 2 years were inversely associated with FFSTM at year 22.ConclusionsThe importance of optimal birth weight and growth tempos during early life for later life body composition, and the detrimental effects of pre- and postnatal growth restriction are clear; yet contemporary weight-gain most strongly predicted adult body composition. Thus interventions should target body composition trajectories during childhood and prevent excessive weight gain in early adulthood.