Do childhood sleeping problems predict obesity in young adulthood? Evidence from a prospective birth cohort study

It has been suggested that sleeping problems are causally associated with obesity in early life, but most studies examining this association have been cross-sectional. The authors used a population-based birth cohort of 2,494 children who were born between 1981 and 1983 in Brisbane, Australia, to examine the prospective association between early-life sleeping problems (at ages 6 months and 2-4 years) and obesity at age 21 years. The authors compared mean body mass indices (BMIs; weight (kg)/height (m)2) and persons in the categories of overweight (BMI 25.0-29.9) and obesity (BMI > or =30) among offspring at age 21 years according to maternally reported childhood sleeping problems. They found that young adult BMI and the prevalence of obesity were greater in offspring who had had sleeping problems at ages 2-4 years than in with those who had not had sleeping problems. These associations were robust to adjustment for a variety of potential confounders, including offspring sex, maternal mental health, and BMI, and several mediators, including adolescent dietary patterns and television-watching. These findings provide some evidence for a long-term impact of childhood sleeping problems on the later development of obesity.     

Does maternal smoking during pregnancy cause childhood overweight?

The objective of this study was to examine a possible association between maternal smoking in pregnancy and childhood overweight. From a population-based cohort of 5722 women from Trondheim, Bergen (Norway) and Uppsala (Sweden) enrolled in early pregnancy during 1986-92, a random sample of 482 women was selected for participation. They were followed up throughout pregnancy, and their children from birth until 5 years of age. Data on maternal smoking and diet, socio-economic determinants and breast feeding were recorded prospectively. During pregnancy and childhood, anthropometric measures were also recorded. Maternal smoking status was based on reported number of cigarettes smoked in week 17 of pregnancy. Child overweight was defined by body mass index (BMI) and sum of skinfold thickness (SFT) >or= 85th percentile at 5 years of age. Children of mothers who smoked in pregnancy had increased risk of overweight at 5 years of age (RR 2.5, 95% CI 1.5, 4.2 for BMI; and RR 1.8, 95% CI 1.1, 3.0 for SFT). Adjusting for maternal diet, breast feeding, maternal obesity and socio-economic status did not suggest confounding. However, adjustment for birthweight increased the observed risk. A linear increase in BMI and SFT was observed with increasing number of cigarettes smoked. In conclusion, smoking during pregnancy may be a risk factor for development of childhood overweight. This study may support the hypothesis of 'fetal origin of adult disease', but the risk of overweight associated with smoking during pregnancy was independent of intrauterine growth retardation, and may thus be attributed to specific effects of cigarette smoke.     

Understanding maternal smoking during pregnancy: Does residential context matter?

The goal of this paper was to investigate whether or not the factors beyond individual characteristics were associated with maternal smoking during pregnancy. Social capital has been found to have both negative and positive implications for health behaviors, and this study attempted to understand its association with maternal smoking during pregnancy. Specifically, the association between county-level social capital and rurality and maternal smoking during pregnancy was investigated. In this study, Putman's definition of social capital was used (e.g., connections among individuals—social networks and the norms of reciprocity and trustworthiness that arise from them). The ecological dimension of rurality was used to define rurality, where rural areas are smaller in population size and are less densely populated when compared to non-rural areas. Using data for all women who gave birth during the year 2007 in the United States, we implemented a series of multilevel logistic regression models. The results showed that social capital was significantly associated with maternal smoking during pregnancy. Specifically, higher social capital in a county was associated with higher odds that women smoked during their pregnancy. However, in rural counties, higher social capital was associated with a decrease in the odds that a woman smoked during her pregnancy. A one unit increase in the social capital index was found to reduce the risk of smoking during pregnancy among those women living in rural counties by 11 percent. The results also showed that improvement of the socioeconomic status of the counties in which women live reduced the risk of maternal smoking during pregnancy. As this study found that factors beyond individual characteristics are important for reducing the risk that women smoked during pregnancy, county characteristics should be taken into account when developing policies focused on intervening maternal smoking during pregnancy.     

Does active leisure protect cognition? Evidence from a national birth cohort

Social, physical and intellectual activities are thought to facilitate cognitive performance and slow the rate of age associated cognitive decline, but little is known about this association in younger adulthood. We used multiple regression to test the association between two kinds of activity at 36 years-physical exercise and spare-time activity-and verbal memory at 43 and 53 years in 1919 males and females enrolled in the MRC National Survey of Health and Development (the British 1946 birth cohort). Both kinds of activities were significantly and positively associated with memory performance at 43 years, after controlling for sex, education, occupational social class, IQ at 15 years, and recurrent ill health and significant mental distress. Furthermore, physical exercise at 36 years (but not spare-time activity) was associated with a significantly slower rate of decline in memory from 43 to 53 years, after controlling for the same factors, with evidence that continuing physical exercise after 36 years was important for protection. We conclude that physical exercise and spare-time activity are significantly associated with benefit to memory in midlife, although these two kinds of voluntary activity may exert their effects on cognition via different paths.     

Does non-responder bias have a significant effect on the results in a postal questionnaire study?

Background and aim: In epidemiological questionnaire studies results can be influenced by non-responder bias. However, in respiratory epidemiology this has been analysed in very few recently published papers. The aim of our paper is to assess if the results found in our previous postal questionnaire study in an adult population in Northern Finland were biased by non-response. Methods: A random sample of 385 persons from the 1284 non-responders in a previous postal questionnaire study was examined. The same questionnaire as in the original study was again mailed to these persons, and those still not answering were contacted by phone. Results: Totally 183 complete answers (48%) were collected. Lack of interest (56%) and forgetting to mail the response letter (22%) were the most common reasons to non-response. Typical non-responders were young men and current smokers who less frequently reported respiratory symptoms in exercise and asthma than the responders in the original study. Answers collected by phone gave for some questions higher prevalence rates than postal answers. Conclusion: Firstly, in this population the response rate (83.6%) in the original study was high enough to provide reliable results for respiratory symptoms and diseases, only the prevalence of current smoking was biased by non-response. Secondly, the methods used for collecting responses in a non-response study may influence the results.     

Evidence that a maternal “junk food” diet during pregnancy and lactation can reduce muscle force in offspring

Background  Obesity is a multi-factorial condition generally attributed to an unbalanced diet and lack of exercise. Recent evidence suggests that maternal malnutrition during pregnancy and lactation can also contribute to the development of obesity in offspring. We have developed an animal model in rats to examine the effects of maternal overeating on a westernised “junk food” diet using palatable processed foods rich in fat, sugar and salt designed for human consumption. Using this model, we have shown that such a maternal diet can promote overeating and a greater preference for junk food in offspring at the end of adolescence. The maternal junk food diet also promoted adiposity and muscle atrophy at weaning. Impaired muscle development may permanently affect the function of this tissue including its ability to generate force. Aims  The aim of this study is to determine whether a maternal junk food diet can impair muscle force generation in offspring. Methods  Twitch and tetanic tensions were measured in offspring fed either chow alone (C) or with a junk food diet (J) during gestation, lactation and/or post-weaning up to the end of adolescence such that three groups of offspring were used, namely the CCC, JJC and JJJ groups. Results  We show that adult offspring from mothers fed the junk food diet in pregnancy and lactation display reduced muscle force (both specific twitch and tetanic tensions) regardless of the post-weaning diet compared with offspring from mothers fed a balanced diet. Conclusions  Maternal malnutrition can influence muscle force production in offspring which may affect an individual’s ability to exercise and thereby combat obesity.     

Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches

ObjectivesThe aim of this study was to investigate the relationship between maternal diet during pregnancy and lactation and development of atopic disorders in childhood.MethodsWe included studies published up to August 2011 that assessed food-based maternal dietary interventions or that examined associations between maternal dietary intake during pregnancy and/or lactation and allergic outcomes (eczema, asthma, hay fever, and sensitization) in their children.ResultsWe included 42 studies (>40 000 children): 11 intervention studies (including 7 randomized control trials), 26 prospective cohort studies, 4 retrospective cohort studies, and 1 case–control study. In the randomized control trials, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish, and foods containing vitamin D and Mediterranean dietary patterns were among the few consistent associations with lower risk for allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts, and fast food.ConclusionThis review did not find widespread or consistent links between mothers' dietary intake and atopic outcomes in their children. However, maternal consumption of Mediterranean dietary patterns, diets rich in fruits and vegetables, fish, and vitamin D-containing foods were suggestive of benefit, requiring further evaluation.     

Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring?

A number of cross-sectional and prospective studies suggested a priming effect of maternal smoking in pregnancy on offspring’s obesity. It has been hypothesized that this association might be explained by low birth weight and subsequent catch-up growth in the causal pathway. We therefore examined the role of birth weight in children exposed versus not exposed to cigarette smoking in utero on later body mass index (BMI). Using data of 12,383 children and adolescents (3–17 years of age) recorded in a German population-based survey (KiGGS), we assessed mean body mass index standard deviation scores (BMI-SDS) in different birth weight SDS categories, stratified for children with smoking and non-smoking mothers. We calculated spline regression models with BMI-SDS as outcome variable, cubic splines of birth weight SDS, and potential confounding factors. Children whose mothers had been smoking during pregnancy had lower birth weight SDS and higher BMI-SDS at interview compared to children of non-smoking mothers. However, we observed a linear association between birth weight SDS and BMI-SDS in crude analyses for both groups. Similarly, almost linear effects were observed in adjusted spline regression analyses, except for children with very low birth weight. The respective 95% confidence bands did not preclude a linear effect for the whole birth weight SDS distribution. Our findings suggest that low birth weight is unlikely to be the main cause for the association between intrauterine nicotine exposure and higher BMI in later life. Alternative mechanisms, such as alterations in the noradrenergic system or increased food efficiency, have to be considered.     

Does substantiated childhood maltreatment lead to poor quality of life in young adulthood? Evidence from an Australian birth cohort study

Purpose

To examine the independent effect of single and multiple forms of substantiated childhood maltreatment (CM) on quality of life (QoL), controlling for selected potential confounders and/or covariates, and concurrent depressive symptoms.

Methods

We used data from a prospective pre-birth cohort of 8556 mothers recruited consecutively during their first antenatal clinic visit at the Mater Hospital from 1981 to 1983 in Brisbane, Australia. The data were linked to substantiated cases of CM reported to the child protection government agency up to the age of 14 years. The sample consisted of 3730 (49.7% female) young adults for whom there were complete data on QoL at the 21-year follow-up. The mean age of participants was 20.6 years. Logistic regression models were used to assess the association between CM and QoL measured at the 21-year follow-up.

Results

There were statistically significant associations between exposure to substantiated CM and poorer QoL. This also applied to the subcategories of childhood physical abuse, childhood emotional abuse (CEA), and neglect. These associations were generally stable after adjusting for confounders/covariates and concurrent depressive symptoms, except physical abuse. CEA with or without neglect significantly and particularly predicted worse subsequent QoL.

Conclusions

Exposure to any substantiated maltreatment substantially contributed to worse QoL in young adulthood, with a particular association with CEA and neglect. Prior experiences of CM may have a substantial association with subsequent poorer QoL.

     

Does educational level influence the effects of smoking, alcohol, physical activity, and obesity on mortality? A prospective population study

OBJECTIVES: This study aims at examining whether the relation between established risk factors and mortality differs with socioeconomic status as measured by level of education. METHODS: A population-based sample of 14,399 women and 16,236 men aged 20-93 years from Copenhagen was stratified into three educational levels measured as basic schooling, and the effect of smoking habits, alcohol consumption, physical activity, and body mass index, respectively, on mortality was assessed. RESULTS: Those with the lowest level of education were most frequently heavy smokers, heavy drinkers, physically inactive, and obese. During a mean follow up of 16 years 10,952 subjects died. Compared with subjects with the lowest educational level, women with the highest educational level had a relative risk of 0.80 (95% CI; 0.70-0.91), and men of 0.71 (0.65-0.78). Heavy smoking compared with never smoking implied a more than twofold increased risk at all three educational levels among both men and women. The relation between alcohol intake and mortality was J-shaped on all three educational levels. There were decreasing risk functions describing the relations between physical activity and mortality on all three strata. Further, subjects who were either very lean or obese had increased risks of death compared with those of normal weight at all educational levels in both genders. CONCLUSIONS: The difference in distribution of the main known risk factors may be part of the explanation for the differences in mortality risk. However, these risk factors seem to influence mortality equally at different educational levels. Therefore, social inequalities in mortality do not seem to be explained only by differences in effect of lifestyle risk factors, but are also related to the social rank or unexamined factors within.     

Does budget-holding have a long-term effect on expenditure, staff and patients?

Kupat Holim Clalit (KHC), Israel's largest sick fund, initiated a unique demonstration program to transform primary care clinics into autonomous budget-holding units. The program was accompanied by an evaluation study that examined the influence of the program on clinic staff, level of expenditure, quality of service and patient satisfaction. Few studies have empirically examined the influence of a budget-holding program in relation to such a wide range of expected outcomes. A longitudinal study was conducted from 1991 to 1994 employing two methodologies: (a) a controlled case study of one experimental and one control clinic and (b) monitoring of all nine budget-holding clinics over time, compared to other clinics in the district. Multiple research tools were used: staff surveys, patient surveys, in-depth interviews, and analysis of financial data. The findings indicate that the budget-holding program has the potential to achieve cost containment without injuring staff morale, the service to patients or patient satisfaction. However, the KHC program did not lead to the expected improvement in staff motivation and attitudes, clinic services and clinic responsiveness to patients' needs. Implications for the literature on organization and management and for organizations considering the implementation of budget-holding programs are discussed.