Cesarean Section Is Associated with Increased Peripheral and Central Adiposity in Young Adulthood: Cohort Study

Abstract

BackgroundCesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI.Objective: To assess the association between CS and indicators of peripheral and central adiposity in young adults.MethodsThe study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables.ResultsFollow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF.ConclusionSubjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.

Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study

“…The mean 6 SD age of subjects was 23.9 6 0.7 y, and 51.8% (n = 1068) of the cohort was women. The CD rate was 32.0% (n = 661), which was similar to that of those not included in the follow-up (29.7%) (19). Table 1 shows maternal and offspring characteristics according to type of delivery.…”

“…Following our pioneer work on this topic (16,18,19), many studies, including 2 meta-analyses (17,29), provided largely consistent confirmatory evidence. Moreover, it has been shown that this association persists after the inclusion of important confounders including maternal BMI (30).…”

“…A systematic review and meta-analysis showed that, compared with vaginal delivery (VD), CD was associated with a 33% increase in overweight and obesity in adulthood (17). Furthermore, CD has been associated with increased peripheral and central adiposity (18,19).…”

Early-life adversity and brain development: Is the microbiome a missing piece of the puzzle?

“…A potential microbial basis for obesity can be inferred from the fundamental role of the microbiota in supporting host digestion and metabolism (Grenham et al, 2011). There are indications that caesarean-section delivery influences adiposity and might be linked to an increased risk for obesity as determined by body mass index, both in childhood and in adults (Goldani et al, 2011, Huh et al, 2012, Mesquita et al, 2013. Although an altered microbiota could precede the development of obesity, a causal relationship is still far from certain .…”

Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings

“…102 It is not known what alterations occur in the microbiome of women in LRS who may have multiple comorbid illnesses. To date, there is compelling evidence that characteristics of the microbiota are associated with being overweight and obesity, 103 and that the microbiome varies for HIV-infected and -uninfected individuals 104 and likely with enteric and other infections. Exactly how any of this impacts the neurodevelopment of infants and children remains unclear.…”