Birth weight, subsequent growth, and cholesterol metabolism in children 8-12 years old born preterm.

AIMS: To test the hypothesis that plasma lipids, lipoproteins, and markers of cholesterol biosynthesis (lathosterol) and absorption efficiency (campesterol) in children aged 8-12 years are related to birth size and subsequent growth. METHODS: A total of 412 girls and boys weighing less than 1850 g at birth were studied. Birth weight, gestation, and weight at 18 months were recorded and followed up at 8-12 years. Plasma total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B, triacylglycerol, lathosterol, and campesterol were measured. RESULTS: Birth weight for gestational age was positively related to plasma campesterol, and remained so after adjusting for current body size or fatness. Birth weight was negatively related to current plasma lathosterol but only after adjusting for current body size or fatness. For both lathosterol and campesterol the significant relation with birth size adjusted for current size indicates that the change in size between these points (postnatal upward centile crossing) was influential. These relations were absent for total cholesterol, lipoproteins, apolipoproteins, and triacylglycerol. CONCLUSION: Preterm children who were smaller for gestational age at birth had lower predicted cholesterol absorption efficiency 8-12 years later. Among children of the same current size, predicted endogenous cholesterol synthesis was higher and cholesterol absorption efficiency lower in those who showed the greatest increase in weight centile between birth and follow up. This finding was not confined to children with the smallest birth weights for gestational age. We suggest that both fetal and childhood growth relate to programming of cholesterol metabolism in children born preterm.     

Errors in registered birth weight and its implications for mortality statistics

BACKGROUND—Birth weight mortality statistics are important for examining trends and monitoring the outcomes of neonatal care.
AIM—To determine the effects of errors in the registered birth weight on birth weight specific mortality.
METHODS—All twins born in England and Wales during 1993-95 comprise the denominator population. For those twins that died, the Office for National Statistics (ONS) provided copies of the death certificates. From the information on the death certificates, the registered birth weight was validated and amended using predetermined rules. The neonatal, postneonatal, and infant mortality rates were recalculated.
RESULTS—In 2.5% of cases the registered birth weight was "not stated" and in others there were miscoding errors. Important differences between published and amended birth weight specific mortality rates especially in <500 g and ⩾3500 g groups were evident.
CONCLUSIONS—The bias arising from these errors should be taken into account in interpreting mortality rates and their trends.

     

Final height of short subjects of low birth weight with and without growth hormone treatment

AIM—To compare final height in two groups of low birth weight children examined for short stature: the first group untreated because of normal growth hormone (GH) secretion, the second treated with human growth hormone (hGH) because of abnormal secretion.
METHODS—A total of 49 subjects born at term of birth weight below the 10th centile were consecutively examined for idiopathic short stature. The first group of subjects (n = 20) with normal GH peaks after pharmacological tests (>8 µg/l) spontaneously reached final height. The second group (n = 29) with abnormal secretion were treated with hGH (20 U/m²/week) for 36-84 months. At diagnosis the two groups were of similar height for chronological age and bone age, and had similar target height.
RESULTS—In both groups final height was significantly lower than target height (−0.65 (SEM 0.20) in untreated cases, −0.61 (0.18) in treated cases). Fewer than one third of subjects had a final height above target height. Final height data of untreated and treated cases were not different. In the treated group the best results were obtained by those subjects who improved their height for bone age after three years of therapy.
CONCLUSIONS—Our subjects with birth weight below the 10th centile remained as short adults with final height below target height. Treatment with hGH 20 U/m²/week in those diagnosed as deficient was not effective, with final results overlapping those of untreated subjects.

     

Birth weight and cognitive function at age 11 years: the Scottish Mental Survey 1932

AIMS—To examine the relation between birth weight and cognitive function at age 11 years, and to examine whether this relation is independent of social class.
METHODS—Retrospective cohort study based on birth records from 1921 and cognitive function measured while at school at age 11 in 1932.Subjects were 985 live singletons born in the Edinburgh Royal Maternity and Simpson Memorial Hospital in 1921. Moray House Test scores from the Scottish Mental Survey 1932 were traced on 449of these children.
RESULTS—Mean score on Moray House Test increased from 30.6 at a birth weight of <2500 g to 44.7 at 4001-4500 g, after correcting for gestational age, maternal age, parity, social class, and legitimacy of birth. Multiple regression showed that 15.6% of the variance in Moray House Test score is contributed by a combination of social class (6.6%), birth weight (3.8%), child''s exact age (2.4%), maternal parity (2.0%), and illegitimacy (1.5%). Structural equation modelling confirmed the independent contribution from each of these variables in predicting cognitive ability. A model in which birth weight acted as a mediator of social class had poor fit statistics.
CONCLUSION—In this 1921 birth cohort, social class and birth weight have independent effects on cognitive function at age 11. Future research will relate these childhood data to health and cognition in old age.

     

Body index measurements in 1996-7 compared with 1980

OBJECTIVES—To compare the distribution of body mass index (BMI) in a national representative study in The Netherlands in 1996-7 with that from a study in 1980.
METHODS—Cross sectional data on height, weight, and demographics of 14 500 boys and girls of Dutch origin, aged 0-21 years, were collected from 1996 to 1997. BMI references were derived using the LMS method. The 90th, 50th, and 10th BMI centiles of the 1980 study were used as baseline. Association of demographic variables with BMI-SDS was assessed by ANOVA.
RESULTS—BMI age reference charts were constructed. From 3 years of age onwards 14-22% of the children exceeded the 90th centile of 1980, 52-60% the 50th centile, and 92-95% the 10th centile. BMI was related to region, educational level of parents (negatively) and family size (negatively). The −0.9, +1.1, and +2.3 SD lines in 1996-7 corresponded to the adult cut off points of 20, 25,and 30 kg/m² recommended by the World Health Organisation/European childhood obesity group.
CONCLUSION—BMI age references have increased in the past 17 years. Therefore, strategies to prevent obesity in childhood should be a priority in child public health.

     

Height and weight reference curves for homozygous sickle cell disease

OBJECTIVE—To derive height and weight growth reference curves for children with homozygous sickle cell disease.
STUDY DESIGN—Subjects (n = 315) were participants in a population based, longitudinal cohort study of sickle cell disease in Kingston, Jamaica. Regular measurements of height and weight were made from enrollment into the study at birth up to 22 years of age.
RESULTS—Sex specific growth reference curves for height for age and weight for age covering the age range 0-18 years are presented.
CONCLUSION—These growth reference curves are suitable for identifying coincidental growth problems in children with homozygous sickle cell disease.

     

Infant feeding and adult glucose tolerance, lipid profile, blood pressure, and obesity

BACKGROUND—It is generally accepted that breast feeding has a beneficial effect on the health of infants and young children. Recently, a few studies have shown that the method of infant feeding is also associated with cardiovascular disease and its risk factors in adult life.
AIMS—To examine the association between the method of infant feeding in the first weeks after birth and glucose tolerance, plasma lipid profile, blood pressure, and body mass in adults aged 48-53 years.
METHODS—Subjects born at term between 1 November 1943 and 28 February 1947 in the Wilhelmina Gasthuis in Amsterdam around the time of a severe period of famine (late November 1944 to early May 1945). For 625 subjects, information was available about infant feeding at the time of discharge from hospital (on average 10.4days after birth), and at least one blood sample after an overnight fast.
RESULTS—Subjects who were bottle fed had a higher mean 120 minute plasma glucose concentration after a standard oral glucose tolerance test than those who were exclusively breast fed. They also had a higher plasma low density lipoprotein (LDL) cholesterol concentration, a lower high density lipoprotein (HDL) cholesterol concentration, and a higher LDL/HDL ratio. Systolic blood pressure and body mass index were not affected by the method of infant feeding.
CONCLUSIONS—Exclusive breast feeding seems to have a protective effect against some risk factors for cardiovascular disease in later life.

     

Cholesterol metabolism in 8 to 12-year-old children born preterm or at term

Studies in animals have indicated that cholesterol metabolism is susceptible to manipulation by diet and growth in early life. In humans, low birthweight has been associated with increased risk of coronary heart disease. AIM: To establish whether plasma lipids and indicators of cholesterol absorption, synthesis and breakdown differ in children born preterm and at term. METHODS: Plasma total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, lathosterol (indicator of cholesterol synthesis), campesterol (indicator of cholesterol absorption), 7-alpha hydroxycholesterol (indicator of cholesterol breakdown) were measured in up to 407 children born preterm and 36 children born at term. RESULTS: Children born preterm had lower cholesterol synthesis (p = 0.002) and lower cholesterol breakdown (p < 0.001) than those born at term, but their plasma cholesterol concentration was not significantly different. After adjusting for current size, birthweight and gestational age were significantly related to plasma lathosterol and 7-alpha hydroxycholesterol. However, when both birthweight and gestational age were adjusted, only gestational age remained significant. There were no significant differences in plasma campesterol between the two groups. CONCLUSION: Being born preterm may have a long-term effect on cholesterol metabolism in children 8-12 y later. Those born prematurely had lower cholesterol synthesis and breakdown, but their plasma cholesterol concentration was similar at this age. These parameters need to be studied in older cohorts.     

Birthweight and blood pressure among children in Harare,Zimbabwe

AIM—To determine whether poor uterine growth may be associated with increased blood pressure and subsequent hypertension in adulthood.
METHODS—A retrospective cohort study of 756 schoolchildren (mean age 6.5 years) was carried out in six low income areas in Harare city, Zimbabwe. Indices of intrauterine growth and blood pressure were assessed.
RESULTS—Adjusted for current weight, the children''s systolic blood pressure was inversely related to their birthweight; for each decreasing kg of birthweight, systolic blood pressure rose by 1.73 mm Hg (95% CI; 0.181 to 3.28). After adjustment for current weight, systolic blood pressure was also inversely associated with occipito-frontal circumference, but not with birth length or gestational age. Diastolic blood pressure was not associated with any of the intrauterine indices.
CONCLUSION—Fetal size may be inversely related to systolic blood pressure in childhood in an African population.

     

Social class difference in catch up growth in a national British cohort

AIM—To examine the influence of socioeconomic status on growth pattern in height from age 7 to 23years.
METHODS—Prospective cohort study. A total of 10 200 white singleton born children from the 1958 British birth cohort (National Child Development Study) were analysed.
RESULTS—Differences in height by birth weight persisted throughout the follow up period. However, the mean differences in height between low birth weight infants (<2500 g) and adequate birth weight infants (⩾2500 g) were less notable in social classes I and II than in the lower social classes. The catching up of growth in height of low birth weight infants was also more pronounced in social classes I and II than in other social classes. That is, the mean height deficits of low birth weight infants were decreased from 2.9 cm at age 7, to 1.6 cm at age 16, and 2.5 cm at age 23; the significant difference disappeared after age 16 in social classes I and II. Although such improving tendency was more pronounced among the preterm born infants, a similar growth pattern was observed among the term infants. Such improvement was not observed in the other social classes.
CONCLUSION—The growth retardation in height by birth weight can be overcome by improved social conditions and proper health care from childhood to adulthood.

     

The association between low birth weight and high levels of cholesterol is not due to an increased cholesterol synthesis or absorption: analysis in twins

Low birth weight may be associated with high levels of cholesterol in later life through genetic factors that affect both birth weight and cholesterol metabolism. Alterations in cholesterol synthesis and absorption may play an important role in this association. We examined birth weight and plasma ratios of a precursor of cholesterol, lathosterol (an estimate of cholesterol synthesis), and plant sterols, campesterol and beta-sitosterol (estimates of cholesterol absorption), to cholesterol in 53 dizygotic and 58 monozygotic adolescent twin pairs. After adjustment for current weight, birth weight was not associated with the ratios of lathosterol, campesterol, and beta-sitosterol either in the overall sample [+0.07 micro mol/mmol/kg (95% confidence interval: -0.11 to 0.25), p = 0.5; +0.02 micro mol/mmol/kg (-0.33 to 0.37), p = 0.9; and -0.04 micro mol/mmol/kg (-0.23 to 0.15), p = 0.8, respectively] or in the intrapair analysis in dizygotic twins [+0.27 micro mol/mmol/kg (-0.28 to 0.82), p = 0.3; -0.03 micro mol/mmol/kg (-1.07 to 1.01), p = 1.0; and +0.04 micro mol/mmol/kg (-0.56 to 0.64), p = 0.9, respectively] or in the intrapair analysis in monozygotic twins [+0.54 micro mol/mmol/kg (-0.09 to 1.18), p = 0.09; -0.60 micro mol/mmol/kg (-1.59 to 0.39), p = 0.2; and -0.43 micro mol/mmol/kg (-0.99 to 0.14), p = 0.14, respectively]. Plasma levels of lathosterol, campesterol, and beta-sitosterol, which are indicators of cholesterol synthesis and absorption, thus do not explain the association of low birth weight with high levels of total and LDL cholesterol. As an alternative hypothesis, we suggest that a decrease in cholesterol clearance may play an important role.     

Diagnosis of Smith-Lemli-Opitz syndrome from stored filter paper blood specimens

BACKGROUND—Smith-Lemli-Opitz (SLO) syndrome is a recessively inheritable metabolic disease with deficiency of cholesterol and accumulation of dehydrocholesterols, caused by a defect in the last step of cholesterol biosynthesis. Biochemical methods for identification of affected individuals, even prenatally, have been developed. Reliable genetic counselling is now possible.
AIM—To find a method of proving or disproving whether a child in whom SLO syndrome had been suspected but not confirmed during lifetime had in fact died of the SLO syndrome.
METHODS—Lipid extracts of stored filter paper blood specimens collected at the national neonatal metabolic screening were used. The ratio of dehydrocholesterols to cholesterol was measured by combined gas chromatography-mass spectrometry.
RESULTS—The ratio of 8-dehydrocholesterol to cholesterol in stored filter paper specimens clearly distinguished affected infants from normal infants. SLO syndrome was thus proven in two children who had died more than seven years earlier.
CONCLUSION—It is possible to diagnose SLO syndrome from dried paper specimens, even when the samples were collected more than a decade ago. Genetic counselling is available for families of affected children who died before the discovery of the defect in cholesterol synthesis.

     

Quality of life in spina bifida: importance of parental hope

BACKGROUND AND AIMS—Prognosis in spina bifida (SB) is often based only on neurological deficits present at birth. We hypothesised that both parental hope and the neurophysical examination predict quality of life in children and adolescents with SB.
METHODS—A previously validated disease and age specific health related quality of life (HRQL) instrument was posted to families of children (aged 5-12 years) and adolescents (aged 13-20 years) with SB. We measured parental hope, determined the child''s current physical function, and obtained retrospective data on the neonatal neurophysical examination (NPE). Regression analysis modelled HRQL firstly as a dependent variable on parental hope and NPE ("birth status"); and secondly on parental hope and current physical function ("current function").
RESULTS—Response rates were 71% (137 of 194) for families of children, and 54% (74 of 138) for families of adolescents. NPE data were available for 121 children and 60 adolescents. In children, the birth status model predicted 26% of the variability (R² hope 21%) compared with 23% of the variability (R² hope 23%)in the adolescents. The current function model explained 47% of the variability (R² hope 19%) in children compared with 31% of the variability (R² hope 24%) in the adolescents.
CONCLUSIONS—In both age groups, parental hope was more strongly associated with the HRQL than neonatal or current physical deficits. A prospective study is required to determine whether a causal relation exists between parental hope and HRQL of children and adolescents with SB.

     

Social disadvantage, family composition, and diabetes mellitus: prevalence and outcome

OBJECTIVE—To present self reports by children and reports by parents on behalf of their children relating to general health, current conditions, and recent symptoms.
DESIGN—Questionnaires completed by children and parents as part of the longitudinal "West of Scotland 11 to 16 study: teenage health."
SETTING—135 primary schools in Central Clydeside.
SUBJECTS—2586 children aged 11 years, surveyed from October 1994 to March 1995 (response rate 93%). Questionnaires also completed by parents of 86% of the sample.
MAIN OUTCOME MEASURES—Ratings of health over the past 12 months, presence of (limiting) longstanding illness, nine current conditions, and 11 recent symptoms.
RESULTS—Only 47% of children described their health as "good" in the previous year. Around 20% reported a longstanding illness and 8% a limiting illness; 20% reported migraine or headaches, 13% reported asthma. Recent stomach aches or sickness, colds or flu, and headaches were each reported by around 60%. "Malaise" (emotional) symptoms were common. Parents reported similar levels of (limiting) longstanding illness, but rates of conditions and symptoms reported by parents were lower than reported by their children. Parent-child agreement was greatest for the presence of longstanding illness and the conditions of asthma, diabetes, and skin problems. It was lower for recent symptoms, particularly those categorised as reflecting malaise.
CONCLUSIONS—These results challenge assumptions of good health and wellbeing at this age. Illness reporting depends on various factors, including saliency, social desirability, and definitions of normality. Parent-child discrepancies may reflect different definitions of illness or symptoms; they do not mean that one should be dismissed as "wrong."

     

Reliability of percentage ideal weight for height

AIMS—To assess the reliability of percentage ideal weight for height (%WFH) as a measure in children.
METHODS—Forty two dietitians calculated %WFH of six children. Eleven of the 42 repeated the calculations.
RESULTS—Interexaminer estimates varied by 16.5 to 40 percentage points (mean 27.8). Intraexaminer variability was also large.
CONCLUSIONS—%WFH is an unreliable measure of nutritional status.

     

Antioxidant activity,packed cell transfusions,and outcome in premature infants

AIM—To evaluate the relative importance of biochemical markers of antioxidant status, gestational age, and parameters of neonatal care in the clinical outcome of premature infants.
METHOD—A prospective, observational, longitudinal study of the association between these factors was conducted. Blood was collected from an in situ arterial line within two hours of birth and at intervals thereafter, when blood was drawn for routine clinical purposes. Outcome was assessed as death, or survival with or without bronchopulmonary dysplasia (BPD). One hundred and forty four babies of 22 to 39 weeks of gestation, who required intensive care at the Jessop Hospital for Women, between January 1993 and April 1994, were recruited.
RESULTS—Low gestational age at birth was the most important predictor of mortality and the development of BPD. Having corrected for gestational age, low plasma antioxidant activity at birth was an independent risk factor for mortality. Plasma vitamin C at birth was significantly higher in the babies who died compared with those with a good outcome, but this effect was not sustained after correcting for gestational age. Repeated measures of Analysis of Variance revealed a postnatal increase in antioxidant activity, caeruloplasmin, retinol, cholesterol corrected α tocopherol, and red blood cell superoxide dismutase (SOD) activity. Vitamin C, on the other hand, declined in all groups after birth. Logistic regression analysis revealed that the greater the number of packed cell transfusions received during intensive care, and the higher the concentration of vitamin C on the second day of life, the greater the risk of developing BPD.
CONCLUSIONS—After correcting for the effect of gestational age, low plasma antioxidant activity at birth was an independent risk factor for mortality. Frequent blood cell transfusions over the first week of life are associated with an increased risk of developing BPD. This association may be causal.

     

Trends in growth and obesity in ethnic groups in Britain

AIM—To estimate trends in growth for 5 to 11 year old ethnic minority and inner city children and comparative representative samples from 1983 to 1994.
DESIGN—Mixed longitudinal.
SUBJECTS—At each of six surveys, more than 2000 inner city white, 1500 Urdu or Punjabi speaking, 5000 English representative white, 3000 Scottish representative white, and around 1000 Afro-Caribbean, 500 falling to 300 Gujarati speaking, and 260 increasing to 300other Indian children.
MAIN OUTCOME MEASUREMENTS—Height, weight for height, and triceps skinfold thickness.
RESULTS—Height increased in all inner city groups by ~ 1.5 cm, but group differences were maintained. Trends in triceps skinfold varied, but increased by 4-12% in Indian subcontinent girls. Weight for height increased generally. Inner city white children showed conflicting trends in weight for height and fatness.
CONCLUSIONS—Afro-Caribbean children are maintaining their tall, slim build, but other groups emphasise the diversity of obesity patterns in a multi-ethnic society, with a predominant trend towards greater obesity. Monitoring of these groups should continue.

     

Living at high altitude and risk of sudden infant death syndrome

OBJECTIVE—To investigate the association between altitude of residence and risk of sudden infant death syndrome (SIDS).
METHODS—A retrospective, case control study in the Tyrol, Austria enrolled 99 infants with SIDS occurring between 1984 and 1994, and 136 randomly selected control cases. Data on pregnancy, delivery, child care practice, and sociodemographic characteristics including altitude of residence were collected with a standardised questionnaire.
RESULTS—The risk of SIDS increased gradually with increasing altitude of residence. This relation remained independently significant when the analysis was adjusted for gestational age, birth weight, prenatal care, mother''s age at delivery, educational level of parents, and cigarette smoking during pregnancy. The prone sleeping position emerged as an obligatory cofactor in this association. In the whole of Austria, a similar trend of association emerged between the average altitudes in the 99 political counties and the rates of SIDS.
CONCLUSIONS—This study identified altitude of residence as a significant risk predictor of SIDS, primarily in combination with the prone sleeping position. Respiratory disturbances, reduced oxygen saturation, and lower temperatures at high altitude might explain this association.