The Comorbidity of Physical,Mental, and Developmental Conditions Associated with Childhood Adversity: A Population Based Study

Objective Adverse childhood experiences (ACEs) are associated with myriad health conditions and risk behaviors in both adolescents and adults. In this study we examine the association between ACEs and specific physical, mental, and developmental conditions, as well as their comorbidity, in a nationally representative sample of children 0–17 years. Methods Data from the 2011–2012 National Survey for Child Health (NSCH) were used. A total of 95,677 random-digit-dial interviews with parents of children 0–17 years were conducted across all 50 states and the District of Columbia. Outcomes included singular condition domains (physical, mental, and developmental) as well as combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). Results Twenty-three percent of parents reported that their child experienced 1 ACE; 9.2 % experienced 2 ACEs, and 10.3 % experienced three or more. Across all three condition domains and combinations of domains, children who experienced at least one ACE were more likely than children who experienced 0 ACEs to have at least one condition. Additionally, greater ACEs was associated with increased likelihood of at least one condition in each domain and in multiple domains. Conclusions for practice These findings support the extension of existing family environment screening tools in pediatric practices as well as the establishment of a system for monitoring ACEs in families with multiple or complex conditions.     

Obesity and sleep disorders: A nationwide study of 1.3 million Israeli adolescents

ObjectivesTo assess the association between sleep disorders prevalence and obesity in Israeli adolescents.MethodsA nationwide, population-based, cross-sectional study of 1,348,817 Israeli adolescents (57% males) who were medically examined prior to military service between 1997 and 2015; height and weight were measured along with assessment of medical status at age 17.3⬰±⬰0.4 years. The diagnosis of a sleep disorder was made based on objective diagnostic criteria. The prevalence and odds ratio (OR) for a sleep disorder were computed across BMI subgroups and were adjusted for socio-demographic confounders.ResultsOverall sleep disorders prevalence was 1.8:1000 (males) and 0.45:1000 (females), with a total of 1601 cases. There was a gradual increase in the odds ratio for sleep disorders with increasing BMI. Multivariable-adjusted ORs for sleep disorders were 1.29 (95% CI 1.10⬜1.52), 1.44 (1.18⬜1.75), 3.03 (2.32⬜3.96) and 3.38 (1.98⬜5.75) for overweight, obese class I, II and III, respectively (5^th⬜49th BMI percentile was the reference). Results persisted in extensive sensitivity analyses including limiting the study sample to participants with unimpaired health.ConclusionsWe found a higher prevalence of sleep disorders in males and a dose-dependent association between sleep disorders and adolescent BMI in both sexes. Our findings warrant clinical awareness among healthcare providers, given the rise in obesity in teenagers, and particularly in light of the obesity epidemic that we are experiencing in this era. Sleep related complaints should be actively screened in adolescents who suffer obesity.     

Associations between body mass index,weight control concerns and behaviors,and eating disorder symptoms among non-clinical Chinese adolescents

Background  

Previous research with adolescents has shown associations of body weight, weight control concerns and behaviors with eating disorder symptoms, but it is unclear whether these associations are direct or whether a mediating effect exists. This study was conducted to investigate the prevalence of overweight and obesity, weight control concerns and behaviors, and eating disorder symptoms and to examine the mediating function of weight control concerns and behaviors on the relationship between body mass index (BMI) and eating disorder symptoms among non-clinical adolescents in China.     

Ethnicity, socio-economic status, overweight and underweight in East London adolescents

Background The developed world is experiencing an ‘epidemic’ of childhood obesity but little is known about the prevalence of obesity, or underweight, amongst adolescents from minority ethnic groups in the UK. An understanding of the prevalence of obesity and overweight in these populations is important since some ethnic groups may be particularly vulnerable to the adverse health effects associated with obesity.

Study Objectives To examine levels of extreme obesity, obesity, overweight and underweight amongst a representative sample of adolescents from different ethnic groups in East London and to explore the association between socio-economic status and body mass index (BMI).

Design A school-based survey of adolescents aged 11–14. Obesity and overweight were estimated using the 1990 UK growth reference (UK 90) and the International Obesity Task Force (IOTF) cut-off points. Extreme obesity was defined as a BMI more than three SD above the UK 90 mean. Underweight was examined by looking at those with a BMI below the 15th or the 5th UK 90 percentiles.

Main Results A total of 2,482 adolescents were surveyed (response rate 84%), 73% from non-white ethnic groups. Although there were significant differences in BMI between ethnic groups, high levels of overweight were seen in all ethnic groups. More than one-third were overweight and one-fifth were obese using the UK 90; and over a quarter were overweight and almost one-tenth were obese using the IOTF cut-offs. Two per cent were extremely obese. Indian males were at higher risk of being overweight than white British males. The prevalence of obesity and overweight was similar in white British and Bangladeshi males. Overall the prevalence of underweight was slightly lower than that predicted by the UK 90, but South Asian ethnic groups, especially males, had a higher prevalence of underweight than other groups. No associations between BMI and measures of socio-economic status were found in this relatively deprived population.

Conclusions The ‘epidemic’ of childhood obesity observed in the UK involves adolescents from all ethnic groups, although there are some differences between ethnic groups in the prevalence of overweight. Indian males appear to be at increased risk of being overweight. There is no evidence of a simultaneous increase in underweight amongst this population overall, but Bangladeshi, Indian and Pakistani boys appear to be at increased risk of being underweight.     

Correlates of obesity in adolescents with and without autism spectrum disorder: The 2017–2018 National Survey of Children's Health

BackgroundThe prevalence of autism spectrum disorder (ASD) and childhood obesity are increasing, and youth with ASD are at an increased risk of obesity compared to typically developing youth. Specific obesity risk factors in adolescents with ASD remain poorly understood.ObjectiveThis study examined correlates of obesity among adolescents with and without ASD using extant 2017–2018 National Survey of Children's Health (NSCH) data.MethodsThis cross-sectional study examined the co-occurrence of obesity among US adolescents with ASD aged 10–17 years compared to those without ASD, adjusting for sociodemographic characteristics, co-occurring conditions, and relevant covariates, using 2017–2018 NSCH data. Multiple logistic regression was used to compare the odds of obesity among children with mild ASD, moderate/severe ASD, and without ASD.ResultsOdds of obesity were higher in adolescents with ASD compared to adolescents without ASD (cOR 1.9, CI 1.3–2.7). In the adjusted model, the odds of obesity were not significantly higher in those with mild or moderate/severe ASD compared to those without ASD. Odds of obesity were higher for all adolescents who were Hispanic or Black, as well as those with lower household income or with one or more co-occurring conditions.ConclusionsThe association between obesity and ASD in this study highlights the need for greater attention to nutrition, physical activity, and co-occurring conditions among adolescents with ASD. Effective interventions to curtail the risks among racial/ethnic minority adolescents and adolescents with lower household income are needed. Further research is needed to examine additional factors associated with obesity in adolescents with ASD, including family, community, organizational, and policy factors.     

The prevalence of obesity and lifestyle behaviors of parents of youth with intellectual and developmental disabilities

BackgroundParents of youth with intellectual and developmental disabilities (IDD) may have a higher prevalence of overweight and obesity and poorer weight management behaviors compared to the general population.ObjectiveTo describe the prevalence of overweight/obesity and related socioeconomic and lifestyle factors including diet quality, physical activity, and reported health habits in parents of youth with IDD.MethodsWe assessed: BMI (kg/m²), moderate-to-vigorous physical activity (MVPA), fruit and vegetable intake (FVI), parental diet and physical activity habits, and socioeconomic characteristics. Associations of BMI on MVPA and FVI were assessed with Spearman's correlation; differences in BMI by parental diet and physical activity habits were assessed with Kruskall-Wallis tests; and the relationships of BMI to household income, race, and education were assessed with Kendall Tau-b and Mann Whitney U tests.ResultsData was obtained from 110 parents (97.3% female) who were study partners for their adolescents/young adults with IDD participating in a weight loss clinical trial. Approximately 81% of parents were overweight or obese (25.7% overweight, 55.1% obese), with 46.3% and 20% meeting the recommended U.S. guidelines for MVPA and FVI, respectively. Higher FVI and higher income were significantly associated with lower parent BMI. BMI was significantly lower in parents who reported to be physically active and choose healthy food.ConclusionWe observed a high prevalence of overweight/obesity, low FVI and low levels of MVPA in parents of adolescents with IDD. These observations suggest that interventions designed to address these factors have the potential to improve the health and wellbeing of both parents and adolescents with IDD.Clinical trials numberNCT02561754.     

Perception of Neighborhood Crime and Drugs Increases Cardiometabolic Risk in Chilean Adolescents

PurposeStudies report an association between neighborhood risk and both obesity and cardiometabolic risk factors (CMR) among adolescents. Here we describe the effect of perceived neighborhood risk on adiposity and CMR among Chilean adolescents.MethodsParticipants were 523 low- to middle-income Chilean adolescents. We assessed neighborhood risk in early adolescence, adiposity in childhood and in early and later adolescence, and blood pressure and fasting glucose in later adolescence. Neighborhood risk profiles were estimated using latent profile analysis (LPA) and based on reported perceptions of crime and drug sales/use. Using linear and logistic regression, we examined the effect of neighborhood risk on adiposity and CMR.ResultsMean age in early and later adolescence was 14 and 17 years, respectively. Participants were 52% male, with a mean BMI z-score of .67, and 8% met criteria for metabolic syndrome. LPA identified two neighborhood profiles: 61% low risk and 39% high risk. In later adolescence, being in the high risk profile predicted a higher BMI z-score, waist-to-height ratio, and fat mass index (p < .05). Adolescents in the high risk profile had three times greater odds of meeting criteria for metabolic syndrome (OR = 3.1, 95% CI: 1.5, 5.8) compared with those in the low risk profile.ConclusionsOur findings suggest that there are physiological responses to living in a neighborhood perceived as “risky,” which may contribute to obesity and CMR even in adolescence. For Chilean neighborhoods with high crime and drugs, targeted public health interventions and policies for youth could be beneficial.     

Triceps skinfold thickness and body mass index and the risk of gestational diabetes mellitus: Evidence from a multigenerational cohort study

BackgroundPre-pregnancy obesity is a well-recognized risk factor for gestational diabetes mellitus (GDM). There is a continuity of obesity from childhood to adolescence and then adulthood. However, it is unknown whether early childhood obesity predicts GDM.MethodsWe investigated the prospective association of childhood triceps skinfold thickness and body mass index (BMI) with GDM risk among women from the Mater-University of Queensland Study of Pregnancy (MUSP), a multigenerational cohort study. A multiple logistic regression model was applied to estimate the odds of experiencing GDM by childhood skinfold thickness and BMI.ResultsOut of 552 women in the study for whom data were available on triceps skinfold thickness and BMI at average age 5 (range 3–7) years old, 52 (9.42%) developed GDM by average age 30 (range 28–33) years. We found that the risk of developing GDM was greater among women who had greater skinfold thickness but not greater BMI at age 5 years. Women who were classified as overweight or obese based on skinfold thickness at age 5 years had an increased odds ratio of GDM compared to women who had normal skinfold thickness. This association remained significant after adjustment for the potential confounders (OR 2.74; 95% confidence interval = 1.28–5.86).ConclusionThe risk of developing GDM was associated with higher skinfold thickness at age 5 years.     

Adverse childhood experiences and development of obesity and diabetes in adulthood—A mini review

Obesity has been steadily rising in the last few decades and to some extent, have been linked to exposure of adverse childhood experiences (ACEs). ACEs are intense stressors or traumatic events experienced or witnessed by children, ranging from all types of abuse (physical, emotional, and sexual), neglect, substance abuse or community violence. These traumatic events deprive the sense of safety and stability of a child, leaving psychological and physiological effects that span into adulthood. The prevalence of ACEs is common across developed and developing countries alike, though the rates differ across ethnicities. Using the United States as an example, the prevalence of ACEs experienced by communities of color is higher than white children. Children around the world could all be exposed to ACEs, hence the original questionnaire capturing the score of ACE has been adapted to different cultural situations. The mechanism linking ACEs to obesity during adulthood include biological, psychological, and environmental factors. Nevertheless, a higher ACE score heightens the risk of poor mental health, attempted suicide and development of obesity and diabetes in adulthood. Prevention of ACEs starts from building positive relationships within families, developing healthy relationship skills, and screening of ACEs during early and routine pediatrician’s and primary care visits. Intervention needs to include case management services and psychosocial support programs. When these risk factors are intervened early, it lessens the risk of obesity and diabetes in adulthood.     

Association of childhood and teen school performance and obesity in young adulthood in the US National Longitudinal Survey of Youth

BackgroundThe literature suggests an association between poor school performance and obesity. However, little is known about academic achievement and behavior as possible risk factors for future obesity.MethodThe analysis was based on data from 3172 participants aged 6 to 25 years from the US National Longitudinal Survey conducted 1986 to 2010. Academic achievement, behavior problems and body mass index (BMI) were assessed at childhood (6–9) and teenhood (10–14). Height and weight were self-reported at pre-young adulthood (15–18) and young adulthood (19–25).ResultsBased on logistic regression stratified by sex and race/ethnicity, academic and behavioral deficiencies during childhood and teenhood were risk factors for young adult obesity with some sex and ethnic/racial differences. The highest prevalence rates of obesity by race/ethnicity and sex are as follows: black/Hispanic females, those in the lowest quartile of teen reading and math (32.8%); black/Hispanic males, those in lowest quartile of teen reading (26.1%); white males, those in the highest quartile of behavioral problems (21.9%); and white females, those in the lowest quartile teen math (23.2%).ConclusionPoor school performance in childhood and teenhood is associated with an increased risk of adult obesity. Prospective studies should further examine the association of school performance and adult obesity and whether programs directed at improving school performance may have secondary gains in preventing obesity.     

Frequency and Patterns of Eating Disorder Symptoms in Early Adolescence

PurposeThere are still uncertainties about manifestations of early adolescent eating disorders (ED) and their effects. We aimed to determine the prevalence of ED symptoms in early adolescence, derive symptoms dimensions, and determine their effects on social and psychological outcomes and subsequent body mass index (BMI).MethodsData on 7,082 adolescents aged 13 years from the Avon Longitudinal Study of Parents and Children were obtained on ED symptoms, resulting impairment and family burden and emotional and behavioral disorders using the parental version of the Developmental and Well-being Assessment. Exploratory structural equation models were used to derive ED symptoms dimensions separately by sex and to relate these to contemporary outcomes (impairment, burden, and emotional and behavioral disorders) and a distal outcome (objective BMI at age 15 years).ResultsExtreme levels of fear of weight gain, avoidance of fattening foods, and distress about weight and shape were common among girls (11%). Three ED symptoms dimensions were identified: bingeing/overeating, weight/shape concern and weight-control behaviors, and food restriction. Bingeing/overeating was strongly associated with higher functional impairment, family burden, and comorbid psychopathology. Bingeing/overeating and weight/shape concern and weight-control behaviors predicted higher BMI 2 years later, whereas food restriction predicted lower BMI. These effects did not change when BMI at age 13 years was included in the model.ConclusionsEating disorder cognitions are common among young teenage girls. Eating disorder symptoms have adverse cross-sectional and distal consequences, in particular on increasing body weight 2 years later. These findings have important implications for early identification of adolescents engaging in ED behaviors and for obesity prevention.     

Persistent disparities in obesity risk among public schoolchildren from childhood through adolescence

IntroductionArkansas is among the poorest states and has high rates of childhood obesity. In 2003, it became the first state to systematically screen public schoolchildren for unhealthy weight status. This study aims to examine the socioeconomic disparities in Body Mass Index (BMI) growth and the risk of the onset of obesity from childhood through adolescence.MethodsThis study analyzed (in 2015) the data for a large cohort of Arkansas public schoolchildren for whom BMIs were measured from school years 2003/2004 through 2009/2010. A linear growth curve model was used to assess how child-level sociodemographics and neighborhood characteristics were associated with growth in BMI z-scores. Cox regression was subsequently used to investigate how these factors were associated with the onset of obesity. Because children might be classified as obese in multiple years, sensitivity analysis was conducted using recurrent event Cox regression.ResultsSurvival analysis indicated that the risk of onset of obesity rose sharply between ages of 5 and 10 and then again after age 15. The socioeconomic disparities in obesity risk persisted from kindergarten through adolescence. While better access to full service restaurants was associated with lower risk of the onset of obesity (Hazard Ratio (HR) = 0.98, 95% CI = 0.97–0.99), proximity to fast food restaurants was related to increased risk of the onset of obesity (HR = 1.01, 95% CI = 1.00–1.01).ConclusionsThis analysis stresses the need for policies to narrow the socioeconomic gradient and identifies important time periods for preventative interventions in childhood obesity.     

Short sleep duration at night in 2.5-year-old children is associated with childhood obesity at age 5.5 years: The Japanese children cohort study

BackgroundObesity in children contributes to higher risks of various chronic diseases in adulthood and the prevalence has increased worldwide including Japan.ObjectivesThis study aims to examine the association between sleep duration at night in children aged 2.5 years and the subsequent risk of obesity at age 5.5 years.MethodsThis study is embedded in the Longitudinal Survey on Babies Born in the 21st Century, which recruited families who had a child born in Japan in 2001. The multivariable logistic regression models were applied to calculate odds ratios (OR) and 95 % confidence intervals (CI) of childhood obesity at 5.5 years, defined as percentage of overweight (POW) ≥ 20 % and body mass index (BMI) ≥ 95th percentile of this study population according to sleep duration at night collected at 2.5 years child age.ResultsAmong 25,378 children, 2.6 % and 3.7 % were obese at age 5.5 years defined by POW and BMI respectively. Compared with night sleep duration > 11 h/d, shorter sleep durations in 2.5 years-old children were associated with higher risk of obesity at 5.5 years; the multivariable ORs (95 %CI) were 1.05 (0.81–1.35), 1.23 (0.93–1.62) and 1.54 (1.04–2.31) for sleep duration 10, 9 and ≤ 8 h/d, respectively; p-trend = 0.03. The observed association differed according to the children (child’s sex, napping habits, and children frequently play at park), and family characteristics (mother’s age at delivery and mother’s level of education).ConclusionShort night sleep duration among girls aged 2.5 years was associated with risk of obesity at age 5.5 years, suggesting the importance of sufficient sleep duration at night for the prevention of obesity.     

Adverse Childhood Experiences and Pregnancy Intentions among Pregnant Women Seeking Prenatal Care

BackgroundThis study examined whether adverse childhood experiences (ACEs) are associated with increased risk of having an unwanted or mistimed pregnancy.MethodsWomen in two medical centers within an integrated health system were screened for ACEs during standard prenatal care (N = 745). Multinomial multivariable logistic regression analyses examined the associations of ACEs (count and type) with pregnancy intentions, adjusting for covariates.ResultsOverall, 58.3% of pregnant women reported no ACEs, 19.1% reported one ACE, and 22.7% reported two or more ACEs; 76.2% reported wanting to get pregnant, 18.5% reported wanting to get pregnant but not at this time (i.e., mistimed pregnancy), and 5.2% reported not wanting to get pregnant at all (i.e., unwanted pregnancy). Having two or more (vs. 0) ACEs was associated with higher odds of an unwanted pregnancy (odds ratio, 2.60; 95% confidence interval, 1.19–5.68). Further, childhood loss of parent (odds ratio, 2.20; 95% confidence interval, 1.03–4.71) and neglect (odds ratio, 5.67; 95% confidence interval, 1.72–18.72) were each associated with higher odds of an unwanted pregnancy in separate analyses. ACEs count and type were not significantly associated with having a mistimed pregnancy.ConclusionsAmong women screened for ACEs during standard prenatal care, ACEs were associated with increased odds of having an unwanted pregnancy, but not a mistimed pregnancy. Additional research is needed to better understand the mechanisms through which ACEs and other individual, social, and contextual factors impact pregnancy intentions to better support women and provide appropriate resources to help prevent unintended pregnancies.     

Explained and unexplained racial and regional inequality in obesity prevalence in the United States

ABSTRACT

Objective: There are substantial racial and regional disparities in obesity prevalence in the United States. This study partitioned the mean Body Mass Index (BMI) and obesity prevalence rate gaps between non-Hispanic blacks and non-Hispanic whites into the portion attributable to observable obesity risk factors and the remaining portion attributable to unobservable factors at the national and the state levels in the United States (U.S.) in 2010.

Design: This study used a simulated micro-population dataset combining common information from the Behavioral Risk Factor Surveillance System and the U.S. Census data to obtain a reliable, large sample representing the adult populations at the national and state levels. It then applied a reweighting decomposition method to decompose the black-white mean BMI and obesity prevalence disparities at the national and state levels into the portion attributable to the differences in distribution of observable obesity risk factors and the remaining portion unexplainable with risk factors.

Results: We found that the observable differences in distribution of known obesity risk factors explain 18.5% of the mean BMI difference and 20.6% of obesity prevalence disparities between non-Hispanic blacks and non-Hispanic whites. There were substantial variations in how much the differences in distribution of known obesity risk factors can explain black-white gaps in mean BMI (?67.7% to 833.6%) and obesity prevalence (?278.5% to 340.3%) at the state level.

Conclusion: The results from this study demonstrate that known obesity risk factors explain a small proportion of the racial, ethnic and between-state disparities in obesity prevalence in the United States. Future etiologic studies are required to further understand the causal factors underlying obesity and racial, ethnic and geographic disparities.     

Gender Differences in the Association between Adverse Childhood Experiences and Cancer

ObjectivesAdverse childhood experiences (ACEs) have been linked to a variety of diseases in adulthood, including cancer. However, current research has yet to determine if all abuse types are associated with cancer and if women are more adversely impacted by ACEs than men.MethodsData from the 2011 Behavioral Risk Factor Surveillance System, a national survey of American adults 18 and older (N = 111,964) were analyzed. Logistic regression models were fit to estimate odds of ever being diagnosed with cancer after experiencing one or more of eight different ACEs, while adjusting for potential confounders. These analyses were then stratified by gender.ResultsAmong women, childhood experiences of physical abuse, sexual abuse, emotional abuse, living with someone who was mentally ill, living with a problem drinker, living with a drug user, and living in a household where adults treated each other violently were associated with higher odds of cancer. Among men, only emotional abuse was associated with higher odds of cancer.ConclusionsResults suggest that ACEs increase risk of cancer later in life. However, this impact occurs mostly among women. This finding may be because women experience many ACEs at higher rates than men and because women, via sexual abuse, can be exposed to cancer-causing viruses.     

Entrenched obesity in childhood: findings from a national cohort study

PurposeGiven the high levels of obesity among U.S. children, we examine whether obesity in childhood is a passing phenomenon or remains entrenched into adolescence.MethodsData are from the prospective nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (analytic sample = 6600). Anthropometrics were measured six times during 1998–2007. Overweight and obesity were defined using CDC cut-points. Entrenched obesity was defined as obesity between ages 5–9 coupled with persistent obesity at ages 11 and 14.ResultsAlmost 30% of children experienced obesity at some point between ages 5.6 and 14.1 years; 63% of children who ever had obesity between ages 5.6 and 9.1 and 72% of those who had obesity at kindergarten entry experienced entrenched obesity. Children with severe obesity in kindergarten or who had obesity at more than 1 year during early elementary were very likely to experience obesity through age 14, regardless of their sex, race, or socioeconomic backgrounds.ConclusionsPrevention should focus on early childhood, as obesity at school entry is not often a passing phenomenon. Even one timepoint of obesity measured during the early elementary school years may be an indicator of risk for long-term obesity.     

中国儿童肥胖的遗传易感性与成年期缺血性心脏病发病风险的研究

目的分析儿童肥胖的测量学指标BMI相关基因序列变异与发生缺血性心脏病(IHD)、急性冠心病事件(MCE)的关联。方法利用中国慢性病前瞻性研究中6.9万余名具有全基因组遗传数据的样本, 剔除基线时患有冠心病、脑卒中、恶性肿瘤的个体, 最终纳入64 454人。采用既往全基因组关联研究显著性遗传位点构建儿童BMI遗传风险评分, 并根据其五分位数进行分组, 最低五分位组为低遗传风险组, 最高五分位组为高遗传风险组。采用Cox比例风险回归模型计算儿童BMI的遗传风险评分与IHD、MCE发生风险的关联。结果研究对象平均随访10.7年, 期间新发IHD 7 073例, MCE 1 845例。调整了性别、年龄、地区及前10个遗传主成分后, 与低遗传风险组相比, 高遗传风险组发生IHD、MCE的HRs值(95%CIs)分别为1.10(1.02～1.18)、1.10(0.95～1.27)。遗传风险评分每增加一个标准差, IHD的发病风险增加4%(2%～6%)(线性趋势P=0.001)。进一步调整基线BMI后, 高遗传风险组与低遗传风险组的效应值差异无统计学意义, 但遗传风险评分与IHD发病风险间仍具有线性...     

孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究

目的 探讨孕前BMI、妊娠期糖尿病（GDM）与儿童4岁时肥胖相关指标的关联。方法 基于已经建立的“马鞍山市优生优育队列”,对2013年10月至2015年4月出生的单胎活产儿,随访至4岁。在孕期首次填写问卷调查孕前身高、体重,在24～28周接受75 g口服糖耐量试验进行GDM诊断。在儿童4岁时测量身高、体重、腰围和体成分。组间比较采用χ²检验、方差分析或t检验,采用logistic回归模型与广义线性模型分析孕前超重/肥胖、孕前患有GDM与儿童肥胖相关特征的关系。结果 儿童4岁时超重、肥胖率分别为13.08%、6.03%。控制孕期和儿童人口统计学变量后,孕前母亲超重/肥胖者儿童在4岁时发生肥胖、腰围超标、腰围身高比超标的风险要高,其OR值（95% CI）分别为3.27（2.15～4.98）、2.32（1.72～3.14）和2.29（1.73～3.02）;且与体成分指标（骨骼肌、体脂肪、体脂百分比）相关（P<0.05）。孕期母亲患有GDM者,儿童4岁时肥胖发生风险要比母亲未患有GDM者高1.78倍（OR=1.78,95% CI：1.14～2.79）;但是孕期母亲患有GDM对4岁儿童腰围超标、腰围身高比超标发生风险并无影响,与体成分指标（骨骼肌、体脂肪、体脂百分比）无统计学关联。结论 孕前母亲超重/肥胖、孕期患有GDM是4岁儿童肥胖的独立危险因素,且孕前BMI与儿童体成分的各项指标相关。     

The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women

BackgroundThe impact of adverse childhood experiences (ACEs) on adult alcohol consumption is well-established, but little is known about the association with alcohol use during pregnancy.MethodsUsing data from the 2010 Nevada Behavioral Risk Factor Surveillance System, we assessed the relationship between ACEs and alcohol use during pregnancy in a representative sample of 1,987 adult women. An established ACEs scale was used to assess a range of childhood physical, emotional, and sexual abuse and household dysfunction (range, 0–8). Weighted logistic regression was used to assess the relationship between ACE scores and alcohol use during pregnancy after controlling for drinking before pregnancy and other covariates.ResultsSix percent of participants reported drinking alcohol during pregnancy. After controlling for race/ethnicity, age, employment status, smoking status, and prepregnancy alcohol use, increasing ACEs were positively associated with higher odds of alcohol use during pregnancy (1 ACE: adjusted odds ratio [AOR], 2.92; 95% CI, 1.08–7.87), (2–3 ACEs: AOR, 3.52; 95% CI, 1.46–8.48), and (≥4 ACEs: AOR, 4.79; 95% CI, 2.14–10.72). Prepregnancy drinking was also strongly associated with alcohol use during pregnancy (AOR, 11.95; 95% CI, 5.02–28.43).ConclusionsWe found evidence of a dose–response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for prepregnancy drinking and other covariates. Screening women of childbearing age as well as pregnant women for ACEs may be an effective way to identify and address many of the emotional, behavioral, and physical sequelae of childhood adversity.