Size at Birth, Weight Gain in Infancy and Childhood, and Adult Diabetes Risk in Five Low- or Middle-Income Country Birth Cohorts

Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Diabetes care (Impact Factor: 8.42). 11/2011; 35(1):72-9. DOI: 10.2337/dc11-0456
Source: PubMed


We examined associations of birth weight and weight gain in infancy and early childhood with type 2 diabetes (DM) risk in five cohorts from low- and middle-income countries.
Participants were 6,511 young adults from Brazil, Guatemala, India, the Philippines, and South Africa. Exposures were weight at birth, at 24 and 48 months, and adult weight, and conditional weight gain (CWG, deviation from expected weight gain) between these ages. Outcomes were adult fasting glucose, impaired fasting glucose or DM (IFG/DM), and insulin resistance homeostasis model assessment (IR-HOMA, three cohorts).
Birth weight was inversely associated with adult glucose and risk of IFG/DM (odds ratio 0.91[95% CI 0.84-0.99] per SD). Weight at 24 and 48 months and CWG 0-24 and 24-48 months were unrelated to glucose and IFG/DM; however, CWG 48 months-adulthood was positively related to IFG/DM (1.32 [1.22-1.43] per SD). After adjusting for adult waist circumference, birth weight, weight at 24 and 48 months and CWG 0-24 months were inversely associated with glucose and IFG/DM. Birth weight was unrelated to IR-HOMA, whereas greater CWG at 0-24 and 24-48 months and 48 months-adulthood predicted higher IR-HOMA (all P < 0.001). After adjusting for adult waist circumference, birth weight was inversely related to IR-HOMA.
Lower birth weight and accelerated weight gain after 48 months are risk factors for adult glucose intolerance. Accelerated weight gain between 0 and 24 months did not predict glucose intolerance but did predict higher insulin resistance.

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    • "As noted by Sunguya et al. (2014), Bchildren born with low weight or those who succumb to undernutrition in their early childhood have a high risk of early adulthood obesity and NCDs, including diabetes and heart diseases.^ Hence the importance of taking an holistic view of nutrition, particularly in countries undergoing a rapid economic, dietary and nutrition transition (Uauy et al. 2011; Norris et al. 2012). However, there are three main problems relating to this particular metric of (over)nutrition: a) very few developing countries systematically monitor trends in child overweight, b) there is as yet no empirically-documented intervention that has prevented an increase in overweight and obesity at a population-wide level anywhere in the world (which also represents an important opportunity for innovation and better documentation of potentially impactful practices), and c) there is a strong statistical inverse association over the long run between poverty reduction per capita in developing countries and the rise of child overweight – that is, while a policy of support for agriculture in poorer economies, for example, may be associated with a decline in stunting over time, that same policy may be associated with an increase in child obesity (Webb and Block 2012). "
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    ABSTRACT: Attention to nutrition continues to grow. The recent surge in interest has included widening agreement on two major issues: first, nutrition goals cannot be achieved through targeted actions alone; nutrition-sensitive interventions are needed as well. Second, the multiple actions required to address all forms of malnutrition through the lifecycle cannot be proxied by a single target or metric. Although the Millennium Development Goals included one concrete measure of nutrition (children underweight), the post-2015 Sustainable Development Goals will include multiple measures that better inform a diversity of policy and programming actions. This suggests a need for improved understanding of how multiple forms of malnutrition are linked, how public investments may affect one form of malnutrition but possibly not others, and how best to measure progress on multiple nutrition fronts, including through nutrition-sensitive actions, such as investments in agriculture. This paper proposes a composite index that highlights the state of nutrition across six separate nutrition goals endorsed by the World Health Assembly in 2012, allowing for ranking (comparison among countries) and monitoring of change (within countries) over time. Establishing an index that captures gains or losses in nutrition across all six goals simultaneously highlights the complexity of nutrition problems and required solutions. Such an index can be used to track progress towards goals set for 2025, but also support dialogue on the individual index components and how investments should be prioritized for maximum impact.
    Food Security 04/2015; 7(3). DOI:10.1007/s12571-015-0450-0 · 1.50 Impact Factor
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    • "Birth weight is now recognized to have important implications for cardio-metabolic health in adulthood. Children born small (SGA) and large (LGA) for gestational age are at greater risk of developing type 2 diabetes and cardiovascular disease as they age [1]–[6]. These groups have been shown to have metabolic alterations in childhood and adolescence, suggesting a phenotype of metabolic dysfunction in early life, finally leading to the emergence of disease in adulthood [2], [6]–[10]. "
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    ABSTRACT: Background Subjects born small (SGA) and large (LGA) for gestational age have an increased risk of cardio-metabolic alterations already during prepuberty. Nevertheless, the progression of their cardio-metabolic profile from childhood to adolescence has not been fully explored. Our aim was to assess potential changes in the cardio-metabolic profile from childhood to adolescence in subjects born SGA and LGA compared to those born appropriate (AGA) for gestational age. Methods This longitudinal study included 35 AGA, 24 SGA and 31 LGA subjects evaluated during childhood (mean age (±SD) 8.4±1.4 yr) and then re-assessed during adolescence (mean age 13.3±1.8 yr). BMI, blood pressure, insulin resistance (fasting insulin, HOMA-IR) and lipids were assessed. A cardio-metabolic risk z-score was applied and this consisted in calculating the sum of sex-specific z-scores for BMI, blood pressure, HOMA-IR, triglycerides and triglycerides:high-density lipoprotein cholesterol ratio. Results Fasting insulin and HOMA-IR were higher in SGA and LGA than AGA subjects both during childhood (all P<0.01) and adolescence (all P<0.01). Similarly, the clustered cardio-metabolic risk score was higher in SGA and LGA than AGA children (both P<0.05), and these differences among groups increased during adolescence (both P<0.05). Of note, a progression of the clustered cardio-metabolic risk score was observed from childhood to adolescence within SGA and within LGA subjects (both P<0.05). Conclusions SGA and LGA subjects showed an adverse cardio-metabolic profile during childhood when compared to AGA peers, with a worsening of this profile during adolescence. These findings indicate an overtime progression of insulin resistance and overall estimated cardiovascular risk from childhood to adolescence in SGA and LGA populations.
    PLoS ONE 08/2014; 9(8):e104278. DOI:10.1371/journal.pone.0104278 · 3.23 Impact Factor
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    • "Box plot analysis showing median values and interquartile range for plasma insulin (a), HOMA (b), adiponectin (c), and the leptin/adiponectin ratio (d) in obese adolescents when separated by quintiles representing the range of birth weights for the same individuals. 1: <2500 g [7]; 2: 2500–3000 g [8]; 3: 3001–3500 g [27]; 4: 3501–4000 g [28]; 5: >4000 g [19]. P < 0.05 or less for insulin (1 versus 3, 4, and 5), HOMA (1 versus 5), adiponectin (1 and 3 versus 5), and the leptin/adiponectin ratio (1 versus 4 and 5). "
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    ABSTRACT: Objective. To examine the relationships between birth weight and body mass index, percent body fat, blood lipids, glycemia, insulin resistance, adipokines, blood pressure, and endothelial function in a cohort of obese adolescents. Design and Methods. Ninety-five subjects aged 10-16 years (mean age 13.5 years) with a body mass index >95th centile (mean [±SEM] 33.0 ± 0.6) were utilized from two prospective studies for obesity prevention prior to any interventions. The mean term birth weight was 3527 ± 64 g (range 1899-4990 g;). Results. Body mass index z-score correlated positively with birth weight (r (2) = 0.05, P = 0.03), but not percent body fat. Insulin resistance negatively correlated with birth weight (r (2) = 0.05, P < 0.001), as did fasting plasma insulin (r (2) = 0.05, P < 0.001); both being significantly greater for subjects of small versus large birth weight (Δ Homeostasis Model Assessment = 2.5 and Δ insulin = 10 pmol/L for birth weight <2.5 kg versus >4.5 kg). Adiponectin, but not leptin, blood pressure z-scores or peripheral arterial tomography values positively correlated with birth weight (r (2) = 0.07, P = 0.008). Conclusions. Excess body mass index in obese adolescents was positively related to birth weight. Birth weight was not associated with cardiovascular risk factors but represented a significant determinant of insulin resistance.
    08/2013; 2013:490923. DOI:10.1155/2013/490923
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