Abstract
Background:
Features of the metabolic syndrome comprise a major risk for cardiovascular disease and will increase in prevalence with rising childhood obesity. We sought to identify early life influences on development of obesity, hypertension and dyslipidemia in children.
Methods and results:
Cluster analysis was used on a subset of a longitudinal Australian birth cohort who had blood samples at age 8 (n=406). A quarter of these 8-year-olds fell into a cluster with higher body mass index, blood pressure (BP), more adverse lipid profile and a trend to higher serum glucose resembling adult metabolic syndrome. There was a U-shaped relationship between percentage of expected birth weight (PEBW) and likelihood of being in the high-risk cluster. The high-risk cluster had elevated BP and weight as early as 1 and 3 years old. Increased likelihood of the high-risk cluster group occurred with greatest weight gain from 1 to 8 years old (odds ratio (OR)=1.4, 95% confidence interval (CI)=1.3–1.5/kg) and if mothers smoked during pregnancy (OR=1.82, CI=1.05–3.2). Risk was lower if children were breast fed for ⩾4 months (OR=0.6, 95% CI=0.37–0.97). Newborns in the upper two quintiles for PEBW born to mothers who smoked throughout pregnancy were at greatest risk (OR=14.0, 95% CI=3.8–51.1) compared to the nadir PEBW quintile of non-smokers.
Conclusion:
A U-shaped relationship between birth weight and several components of the metabolic syndrome was confirmed in a contemporary, well-nourished Western population of full-term newborns, but post-natal weight gain was the dominant factor associated with the high-risk cluster. There was a prominence of higher as well as lowest birth weights in those at risk. Future health programs should focus on both pre- and post-natal factors (reducing excess childhood weight gain and smoking during pregnancy), and possibly the greatest benefits may arise from targeting the heaviest, as well as lightest newborns, especially with a history of maternal smoking during pregnancy.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Childhood obesity: an emerging public health problem. Lancet 2001; 357: 1989.
Booth ML, Chey T, Wake M, Norton K, Hesketh K, Dollman J et al. Change in the prevalence of overweight and obesity among young Australians, 1969–1997. Am J Clin Nutr 2003; 77: 29–36.
Kvaavik E, Tell GS, Klepp KI . Predictors and tracking of body mass index from adolescence into adulthood: follow-up of 18 to 20 years in the Oslo Youth Study. Arch Pediatr Adolesc Med 2003; 157: 1212–1218.
Pinhas-Hamiel O, Zeitler P . The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr 2005; 146: 693–700.
Eckel RH, Grundy SM, Zimmet PZ . The metabolic syndrome. Lancet 2005; 365: 1415–1428.
Jorgensen ME, Bjerregaard P, Gyntelberg F, Borch-Johnsen K . Prevalence of the metabolic syndrome among the Inuit in Greenland. A comparison between two proposed definitions. Diabet Med 2004; 21: 1237–1242.
The IDF consensus worldwide definition of the metabolic syndrome [article online]. Available from www.idf.org/webdata/docs/IDF_Metasyndrome_definition.pdf, International Diabetes Federation.
Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ . Weight in infancy and death from ischaemic heart disease. Lancet 1989; 2: 577–580.
Barker K, Osomond C, Golding J, Kuh D, Wadsworth MEJ . Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 1989; 298: 564–567.
Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS . The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics 2005; 115: 22–27.
Barker DJ, Osmond C, Forsen TJ, Kajantie E, Eriksson JG . Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005; 353: 1802–1809.
Stettler N, Zemel BS, Kumanyika S, Stallings VA . Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics 2002; 109: 194–199.
Hales CN, Barker DJ, Clark PM, Cox LJ, Fall C, Osmond C et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 1991; 303: 1019–1022.
Eriksson JG, Forsen T, Tuomilehto J, Osmond C, Barker DJ . Early growth and coronary heart disease in later life: longitudinal study. BMJ 2001; 322: 949–953.
Eriksson J, Forsen T, Tuomilehto J, Osmond C, Barker D . Fetal and childhood growth and hypertension in adult life. Hypertension 2000; 36: 790–794.
Tu Y-K, West R, Ellison GTH, Gilthorpe MS . Why evidence for the fetal origins of adult disease might be a statistical artifact: the ‘Reversal Paradox’ for the relation between birth weight and blood pressure in later life. Am J Epidemiol 2005; 161: 27.
Burke V, Beilin LJ, Blake KV, Doherty D, Kendall GE, Newnham JP et al. Indicators of fetal growth do not independently predict blood pressure in 8-year-old Australians: a prospective cohort study. Hypertension 2004; 43: 208–213.
Lucas A, Fewtrell MS, Cole TJ . Fetal origins of adult disease – the hypothesis revisited. BMJ 1999; 319: 245–249.
Huxley R, Owen CG, Whincup PH, Cook DG, Colman S, Collins R . Birth weight and subsequent cholesterol levels: exploration of the ‘fetal origins’ hypothesis. JAMA 2004; 292: 2755–2764.
Huxley R, Neil A, Collins R . Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure? Lancet 2002; 360: 659–665.
Newnham JP, Evans SF, Michael CA, Stanley FJ, Landau LI . Effects of frequent ultrasound during pregnancy: a randomised controlled trial. Lancet 1993; 342: 887–891.
Oddy WH, Sly PD, de Klerk NH, Landau LI, Kendall GE, Holt PG . Breast feeding and respiratory morbidity in infancy: a birth cohort study. Arch Dis Child 2003; 88: 224–228.
Blair E . The undesirable consequences of controlling for birth weight in perinatal epidemiological studies. J Epidemiol Commun Health 1996; 50: 559–563.
Everitt B, Landau S, Leese M . Cluster Analysis. Edward Arnold Publishers Ltd: London, 2001.
Blake KV, Gurrin LC, Evans SF, Beilin LJ, Landau LI, Stanley FJ et al. Maternal cigarette smoking during pregnancy, low birth weight and subsequent blood pressure in early childhood. Early Hum Dev 2000; 57: 137–147.
Conwell LS, Trost SG, Brown WJ, Batch JA . Indexes of insulin resistance and secretion in obese children and adolescents: a validation study. Diabetes Care 2004; 27: 314–319.
Karlamangla AS, Singer BH, Williams DR, Schwartz JE, Matthews KA, Kiefe CI et al. Impact of socioeconomic status on longitudinal accumulation of cardiovascular risk in young adults: the CARDIA Study (USA). Soc Sci Med 2005; 60: 999–1015.
McCance DR, Pettitt DJ, Hanson RL, Jacobsson LT, Knowler WC, Bennett PH . Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ 1994; 308: 942–945.
Wei JN, Sung FC, Li CY, Chang CH, Lin RS, Lin CC et al. Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in Taiwan. Diabetes Care 2003; 26: 343–348.
Barker DJ, Bull AR, Osmond C, Simmonds SJ . Fetal and placental size and risk of hypertension in adult life. BMJ 1990; 301: 259–262.
Barker DJ, Hales CN, Fall CH, Osmond C, Phipps K, Clark PM . Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36: 62–67.
Barker DJ, Eriksson JG, Forsen T, Osmond C . Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol 2002; 31: 1235–1239.
Ravelli AC, van der Meulen JH, Michels RP, Osmond C, Barker DJ, Hales CN et al. Glucose tolerance in adults after prenatal exposure to famine. Lancet 1998; 351: 173–177.
Yajnik CS, Fall CH, Coyaji KJ, Hirve SS, Rao S, Barker DJ et al. Neonatal anthropometry: the thin–fat Indian baby. The Pune maternal nutrition study. Int J Obes Relat Metab Disord 2003; 27: 173–180.
Stein CE, Fall CH, Kumaran K, Osmond C, Cox V, Barker DJP . Foetal growth and coronary heart disease in South India. Lancet 1996; 348: 1269–1273.
Pettitt DJ, Aleck KA, Baird HR, Carraher MJ, Bennett PH, Knowler WC . Congenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes 1988; 37: 622–628.
Silverman BL, Metzger BE, Cho NH, Loeb CA . Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care 1995; 18: 611–617.
Boney CM, Verma A, Tucker R, Vohr BR . Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115: e290–e296.
Goodman E, Dolan LM, Morrison JA, Daniels SR . Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth. Circulation 2005; 111: 1970–1977.
Wilkin TJ, Metcalf BS, Murphy MJ, Kirkby J, Jeffery AN, Voss LD . The relative contributions of birth weight, weight change, and current weight to insulin resistance in contemporary 5-year-olds: the EarlyBird Study. Diabetes 2002; 51: 3468–3472.
Burke V, Gracey MP, Milligan RA, Thompson C, Taggart AC, Beilin LJ . Parental smoking and risk factors for cardiovascular disease in 10- to 12-year-old children. J Pediatr 1998; 133: 206–213.
Misra DP, Astone N, Lynch CD . Maternal smoking and birth weight: interaction with parity and mother's own in utero exposure to smoking. Epidemiology 2005; 16: 288–293.
Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hu FB, Michels KB et al. Breastfeeding during infancy and the risk of cardiovascular disease in adulthood. Epidemiology 2004; 15: 550–556.
Martin RM, Ben-Shlomo Y, Gunnell D, Elwood P, Yarnell JW, Davey Smith G . Breast feeding and cardiovascular disease risk factors, incidence, and mortality: the Caerphilly study. J Epidemiol Commun Health 2005; 59: 121–129.
Lawlor DA, Riddoch CJ, Page AS, Andersen LB, Wedderkopp N, Harro M et al. Infant feeding and components of the metabolic syndrome: findings from the European Youth Heart Study. Arch Dis Child 2005; 90: 582–588.
Gillman MW, Rifas-Shiman SL, Camargo Jr CA, Berkey CS, Frazier AL, Rockett HR et al. Risk of overweight among adolescents who were breastfed as infants. JAMA 2001; 285: 2461–2467.
Burke V, Beilin LJ, Simmer K, Oddy WH, Blake KV, Doherty D, Kendall GE et al. Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort. J Pediatr 2005; 147: 56–61.
Williams LA, Evans SF, Newnham JP . Prospective cohort study of factors influencing the relative weights of the placenta and the newborn infant. BMJ 1997; 314: 1864–1868.
Burke V, Beilin LJ, Dunbar D . Family lifestyle and parental body mass index as predictors of body mass index in Australian children: a longitudinal study. Int J Obes Relat Metab Disord 2001; 25: 147–157.
Acknowledgements
Dr Thomson is funded by NHMRC, Athelstan & Amy Saw and School of Medicine and Pharmacology scholarships, and the work was supported by grants from Healthway Western Australia, Pfizer and by the Raine Medical Research Foundation Western Australia. We acknowledge Eve Blair for her work on the percentage expected birth weight variable.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, R., Burke, V., Newnham, J. et al. Perinatal and childhood origins of cardiovascular disease. Int J Obes 31, 236–244 (2007). https://doi.org/10.1038/sj.ijo.0803394
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ijo.0803394
Keywords
This article is cited by
-
Relationships between intrauterine fetal growth trajectories and markers of adiposity and inflammation in young adults
International Journal of Obesity (2022)
-
Maternal and gestational influences on childhood blood pressure
Pediatric Nephrology (2020)
-
Different levels of cardiometabolic indicators in multiple vs. singleton children
BMC Pediatrics (2019)
-
Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India
BMC Public Health (2017)
-
The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins
Hypertension Research (2017)