Caesarean section and adiposity at 6, 18 and 30 years of age: results from three Pelotas (Brazil) birth cohorts

Abstract

BackgroundAssociation between caesarian section (C-section) and obesity is controversial and mostly based on body mass index (BMI), which has inherent limitations. Using direct estimates of body fat mass, we aimed to assess the association between C-section and adiposity using fat mass index and BMI z-score in three birth cohort studies from Pelotas, Brazil.MethodsWe measured weight, height and fat mass (using dual X-ray absorptiometry (DXA)) at ages 6, 18 and 30 years among participants in the 2004, 1993 and 1982 population-based Pelotas Birth Cohort Studies, respectively. We used multiple linear regression analysis to examine the crude and adjusted association between C-section and the body composition indicators. We also modelled height as an outcome to explore the presence of residual confounding.ResultsWe observed that fat mass index and BMI z-score were strongly and positively associated with C-section in the crude analysis. However, when we adjusted for socioeconomic characteristics, maternal BMI, parity, age and smoking during pregnancy, effect estimates were attenuated towards the null, except for 30-year-old women. In those women from the 1982 cohort, C-section remained associated with fat mass index (β = 0.82; CI95% 0.32;1.32) and BMI z-score (β = 0.15; CI95% 0.03;0.28), even after adjusting for all potential confounders, suggesting an increase in fat mass index and BMI at 30 years among those born by C-section.ConclusionWe found no consistent association of C-section with fat mass index measured by DXA and BMI z-score in individuals aged 6, 18 and 30 years, except for women in the latter group, which might be explained by residual confounding. Confounding by socioeconomic and maternal characteristics accounted for all the other associations.

Increased weight gain by C-section: Functional significance of the primordial microbiome

“…S3). These results are consistent with the epidemiological association between C-section and increased risk of obesity ( 4 , 13 – 16 ).…”

“…However, C-section delivery is often overused, with some regions of the world reaching 43% of births ( 3 ). Concomitantly with the increase in C-section, obesity ( 4 – 6 ) and immune-related diseases [type 1 diabetes ( 7 , 8 ), allergies ( 3 , 9 ), and celiac disease ( 10 )] are on the rise.…”

The association between caesarean section delivery and later life obesity in 21-24 year olds in an Urban South African birth cohort

“…(2015) reported increase in fat accumulation due to delivery by CS: measured by either waist-hip ratio (IRR 1.45, 95% CI 1.18-1.79) [23] or BMI (β coefficient 0.12, 95% CI 0.01-0.03) [24]. More recently, Yuan et al (2016) and Barros et al (2017) reported increased risks of obesity in CS-delivered YAs (RR 1.15, 95% CI 1.06-1.26, n= 8 486; β coefficient 0.15, 95% CI 0.08-0.23, n= 1 794, respectively) in Boston (USA) and Pelotas (Brazil) [19,26]. Finally, in a commentary published in 2017, Kuhle et al .…”

Obesity-Related Asthma: Immune Regulation and Potential Targeted Therapies

“…NLRP3 activation induces IL-1 β secretion primarily by M1 macrophage, which induces AHR that is considered as a major feature of asthma [ 95 ]. Many epidemiological studies have shown that with the increased number of caesarean section deliveries, there has also been an increase in obesity, type 1 diabetes, allergies, celiac disease, and some neurological disorders [ 96 ]. Caesarean-born children did not pass through the mother's birth canal, which causes intestinal microbial abnormalities, thus resulting in offspring obesity [ 97 ].…”