Intergenerational Cardiovascular Disease Risk Factors Involve Both Maternal and Paternal BMI

OBJECTIVE

To examine the association between parental BMI and offspring cardiovascular disease (CVD) risk factors.

RESEARCH DESIGN AND METHODS

The study comprised 940 children (9.5 ± 0.4 years) and 873 adolescents (15.5 ± 0.5 years). Parental weight and height were reported by the mother and the father, and BMI was calculated. CVD risk factors included total (sum of five skinfolds) and central (waist circumference) body fat, blood pressure, cardiorespiratory fitness, insulin sensitivity, total cholesterol, HDL cholesterol, triglycerides, and fibrinogen.

RESULTS

Maternal and paternal BMI were positively associated with total and central fatness in offspring (P < 0.001). BMIs of both parents were significantly related to fibrinogen levels (P < 0.02), but these associations disappeared when controlling for fatness. There was a positive relationship between maternal and paternal BMI and waist circumference in the offspring regardless of total adiposity and height (P < 0.001). Maternal BMI was negatively associated with offspring cardiorespiratory fitness independently of fatness (P < 0.02). These relationships persisted when overweight descendants were excluded from the analysis. There were no significant associations between parental BMI and the other CVD risk factors.

CONCLUSIONS

Both maternal and paternal BMI increase CVD risk factors of their offspring, characterized by total and central body fat, and higher maternal BMI was associated with poorer cardiorespiratory fitness. Our findings give further support to the concept that adiposity in parents transmits susceptibility to CVD risk to descendants, which is detectable even in the absence of overweight in offspring.Parental obesity substantially increases the risk of obesity in offspring through genetic, biological, or environmental influences (1). The fetal overnutrition hypothesis suggests that maternal obesity and/or gestational diabetes may predispose offspring to increased adiposity in adulthood (2). Human studies showed a greater influence of maternal than paternal BMI on offspring adiposity (3,4). In contrast, others suggested that the contribution of the mother and the father on both prenatal and postnatal programming of intergenerational obesity may be similar according to the genomic imprinting (5).Most of the studies focused on the relationships of maternal and paternal BMI with their offspring BMI provided contradictory results (3,6,7), and only one study compared the association of maternal and paternal BMI with total body fat in the offspring (8). Whether the parental BMI-offspring body fat relationship applies to other established cardiovascular disease (CVD) risk factors remains to be elucidated.Excess adiposity leads to increased CVD risk factors and biological pathway alterations as insulin resistance, dyslipemia, hypertension, systemic inflammation, and low cardiorespiratory fitness (9). Therefore, the parental BMI-offspring CVD risk factor relationship may be influenced by the offspring body composition.The European Youth Heart Study (EYHS) provides an opportunity to better understand the parental-descendant aggregation of CVD factors by controlling for other potential confounding factors that could mediate in this relationship. Therefore, the aim of this study was to determine the association between both maternal and paternal BMI and the offspring CVD risk factors including total and central body fat, cardiorespiratory fitness, insulin sensitivity, blood pressure, blood lipids, and fibrinogen. We also examined the role of offspring adiposity in this relationship.     

Effects of the serotonin transporter (5-HTTLPR) and α<Subscript>2A</Subscript>-adrenoceptor (C-1291G) genotypes on substance use in children and adolescents: a longitudinal study

Rationale and objective  

Twin studies suggest that substance use initiation in children and adolescents is determined primarily by environmental influences, whereas the establishment of use patterns is strongly controlled by genetic factors. The present study analysed the effects of the serotonin transporter promoter polymorphism [5-HT transporter gene-linked polymorphic region (5-HTTLPR)] and the α_2A-adrenoceptor C-1291G genotype (ADRA2A C-1291G) as well as their interaction effects on alcohol, tobacco and drug use from preadolescence to the late adolescence.     

Passive smoking and respiratory symptoms in the FinEsS Study.

The aim of the present study was to examine the relationship between reported environmental tobacco smoke (ETS) exposure and respiratory symptoms. In 1996, a postal questionnaire was randomly distributed in three areas of Estonia to a population-based sample, of which 4,995 females and 1,822 males had never smoked. The main outcome measures were current respiratory symptoms and the amount of reported ETS exposure outside the home. ETS exposure at home was more common in females (31% versus 19%), while exposure outside of the home was more common in males (53% versus 7%). Females reported more symptoms from tobacco smoke than males (37.7% versus 21.6%). If ETS exposure outside of the home exceeded 5 h daily, the risk for wheeze (odds ratio (OR) 2.67, 95% confidence interval (CI) 1.98-3.61) and physician-diagnosed asthma (OR 1.79, 1.02-3.16) were increased. ETS exposure outside of the home was shown to be strongly related to almost all respiratory symptoms in a dose/response manner. ETS exposure at home did not show significantly elevated ORs for any respiratory symptoms. This study shows that females seem to be more troubled by environmental smoke exposure than males and provides further evidence of the serious health hazards associated with environmental smoke exposure. Indeed, the findings of this study support a ban on smoking in the workplace and public areas.     

Pre-analytic and analytic sources of variations in thiopurine methyltransferase activity measurement in patients prescribed thiopurine-based drugs: A systematic review

ObjectivesLow thiopurine S-methyltransferase (TPMT) enzyme activity is associated with increased thiopurine drug toxicity, particularly myelotoxicity. Pre-analytic and analytic variables for TPMT genotype and phenotype (enzyme activity) testing were reviewed.Design and methodsA systematic literature review was performed, and diagnostic laboratories were surveyed.ResultsThirty-five studies reported relevant data for pre-analytic variables (patient age, gender, race, hematocrit, co-morbidity, co-administered drugs and specimen stability) and thirty-three for analytic variables (accuracy, reproducibility). TPMT is stable in blood when stored for up to 7 days at room temperature, and 3 months at ? 30 °C. Pre-analytic patient variables do not affect TPMT activity. Fifteen drugs studied to date exerted no clinically significant effects in vivo. Enzymatic assay is the preferred technique. Radiochemical and HPLC techniques had intra- and inter-assay coefficients of variation (CVs) below 10%.ConclusionTPMT is a stable enzyme, and its assay is not affected by age, gender, race or co-morbidity.     

Low Prevalence of Asthma in Westernizing Countries—Myth or Reality? Prevalence of Asthma in Estonia—A Report from the “FinEsS” Study

Aim: The aim of this study was to examine the prevalence of asthma among adults in Estonia by using different diagnostic methods and criteria for the disease. Methods: In 1995-1996, a postal questionnaire was randomly distributed in three areas of Estonia to a representative sample of 22,579 subjects aged 15-64 years. The participation rate was 78%. A clinical follow-up study including structured interview, skin prick test, lung function, and methacholine test, was performed from 1997 to 2000 among randomly selected responders to the postal questionnaire. Of 2676 subjects, 53% participated. Results: The prevalence of physician-diagnosed asthma for the postal questionnaire (PQ) was 2.7%, and in the same subjects for the structured interview (SI) 3.8%. Respiratory symptoms, except recurrent wheeze, were more common in the SI than PQ. Combinations of symptoms, except wheezing with breathlessness apart from cold, were more prevalent in the PQ responders. The prevalence of asthma defined by different symptom combinations varied from 5.4% to 8.2%. Among responders, 71-87% demonstrated bronchial hyperreactivity defined as methacholine reactivity ≤ 8 mg/mL. The symptom combinations used as surrogate variables for asthma were strongly associated with a positive skin test. Conclusion: The low prevalence of physician-diagnosed asthma probably reflects a considerable underdiagnosis of asthma in Estonia. Disease criteria for asthma based on symptom combinations together with hyperreactivity yielded a prevalence of 5%-8%, which is similar to the prevalence of asthma among adults in neighboring Western countries.     

Markers of insulin resistance are associated with fatness and fitness in school-aged children: the European Youth Heart Study

Aims/hypothesis Our aim was to examine the association between markers of insulin resistance and: (1) body fat and waist circumference, taking into account cardiorespiratory fitness in school-aged children; and (2) cardiorespiratory fitness at differing levels of body fat and waist circumference. Subjects and methods This was a cross-sectional study of 873 children aged 9.6 ± 0.4 years from Estonia and Sweden. Weight, height and waist circumference were measured. Body fat was expressed as the sum of five skinfold thicknesses. Cardiorespiratory fitness was estimated by a maximal cycle-ergometer test. The studied markers of insulin resistance were fasting insulin and glucose, and homeostasis model assessment (HOMA). Results HOMA and fasting insulin were positively associated with body fat and waist circumference after adjusting for cardiorespiratory fitness, age, pubertal status and study location. HOMA and fasting insulin were negatively associated with cardiorespiratory fitness in children in the third (highest) tertile of body fat and waist circumference after controlling for sex, age, pubertal status and study location. Fasting glucose was negatively associated with cardiorespiratory fitness in children in the third (highest) tertile of waist circumference, but it was not associated when body fat was taken into account. Conclusions/interpretation In school-aged children, HOMA and fasting insulin are significantly associated with body fat and waist circumference. In addition, cardiorespiratory fitness explains a significant proportion of the HOMA and fasting insulin variance in those children with high levels of body fat and waist circumference. The findings suggest that the deleterious consequences ascribed to high fatness could be counteracted by having high levels of cardiorespiratory fitness.     

Body fat is associated with blood pressure in school-aged girls with low cardiorespiratory fitness: the European Youth Heart Study

OBJECTIVE: To examine the association between anthropometric measurements of total and central adiposity and blood pressure in school-aged children, and to study whether these associations are modified by the levels of cardiorespiratory fitness. METHODS: Systolic and diastolic blood pressure, weight, height, skinfold thickness and waist circumference were measured in 873 children aged 9-10 years participating in the Estonian and Swedish part of the European Youth Heart Study. Mean arterial pressure was calculated. Body mass index and skinfold thickness were used as markers of total adiposity, whereas waist circumference and waist-height ratio were used as markers of central adiposity. Cardiorespiratory fitness was estimated by a maximal ergometer bike test, and dichotomized into low and high levels. RESULTS: Markers of total and central adiposity were positively associated with blood pressure. The results from the regression models showed that the markers of total and central adiposity were significantly associated with systolic blood pressure in girls with low levels of cardiorespiratory fitness. Similar results were observed when mean arterial pressure was the outcome variable. None of the markers of total and central adiposity were significantly associated with blood pressure in girls with high levels of cardiorespiratory fitness or in boys with low or high levels of cardiorespiratory fitness. CONCLUSIONS: The results show a positive influence of simple anthropometric measurements of total and central adiposity on blood pressure, and suggest that higher cardiorespiratory fitness may attenuate the association between body fat and blood pressure in school-aged children.