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Interventions using social networking sites to promote contraception in women of reproductive age (Protocol)
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Is there an association between adolescents' high caloric food portion size and body mass index?
Get PDFAdolescents' preferences in developing a UK online dietary assessment tool (myfood24): focus group study
Get PDFEarly life predictors of obesity and hypertension comorbidity at midlife: findings from the 1958 National Child Development Study (NCDS)
No full textBackground: early life exposures can increase the risk of both obesity and hypertension in adulthood. In this paper we identify exposures across five pre-hypothesised childhood domains, explore them as predictors of obesity and hypertension comorbidity using the 1958 National Child Development Study (NCDS), and discuss these results in comparison to a similar approach using another birth cohort (the 1970 British Cohort Study (BCS70)).Methods: the analytical sample included 9150 participants. The outcome was obesity (BMI of ≥30) and hypertension (blood pressure>140/90mm Hg) comorbidity at age 44. Domains included: ‘prenatal, antenatal, neonatal and birth’, ‘developmental attributes and behaviour’, ‘child education and academic ability’, ‘socioeconomic factors’ and ‘parental and family environment’. Stepwise backward elimination selected variables for inclusion for each domain, and predicted risk scores of obesity-hypertension for each cohort member within each domain were calculated. We performed multivariable logistic regression analysis including domain-specific risk scores, sex and ethnicity to assess how well the outcome could be predicted taking all domains into account. In additional analysis we included potential adult factors.Results: including all domain-specific risk scores, sex, and ethnicity in the same prediction model the area under the curve was 0.70 (95%CI 0.67-0.72). The strongest domain predictor for obesity-hypertension comorbidity was for the socioeconomic factors domain (OR 1.28 95%CI 1.18-1.38), similar to the BCS70 results. However, the parental and family environment domain was not a significant predictor for obesity-hypertension comorbidity (OR 1.08 95%CI 0.94-1.24) unlike the BCS70 results. After considering adult predictors, robust associations remained to the socioeconomic, education and academic abilities, development and behaviour, and prenatal, antenatal, neonatal and birth domains.Conclusions: in the NCDS some early life course domains were found to be significant predictors of obesity-hypertension comorbidity, supporting previous findings. Shared early-life characteristics could have a role in predicting obesity-hypertension comorbidity, particularly for those who faced socioeconomic disadvantage
Exploring the relationship between education and academic ability in childhood with healthcare utilisation in adulthood: findings from the Aberdeen Children of the 1950s (ACONF)
No full textBackground: interactions with secondary care, including multiple outpatient appointments and hospital admissions, represents a common and often burdensome aspect of healthcare utilisation for people living with multiple long-term conditions. Lifecourse factors such as education and academic ability may play a role in shaping the risk of healthcare utilisation later in adulthood. We explored the association between education and academic ability in childhood and both outpatient appointments and hospital admissions in adulthood, accounting for the mediating role of adult factors, including long-term conditions.Method: the analytical sample consisted of 7183 participants in the Aberdeen Children of the 1950’s. Three outcomes were measured using routine healthcare records (SMR00/SMR001/SMR004) over a five-year period (2004-2008) using the ‘burden’ cut-offs of: (1) ≥5 outpatient appointments, (2) ≥2 hospital admissions, or (3) ≥3 outpatient appointments plus ≥1 hospital admission. We constructed a childhood (age 6-11) education and academic ability domain and calculated predicted risk scores of the three outcomes for each cohort member. Nested logistic regression models investigate the association between domain predicted risk scores and odds of each of the three outcomes accounting for childhood confounders (maternal age, Rutter behaviour, physical grade at birth, birthweight, sex mother’s pre-marital occupation, and father’s social class) and self-reported adult mediators, including body mass index, smoking, employment status, housing tenure, having long-term conditions, and age left school.Result: adjusting for childhood confounders, lower childhood education and academic ability was associated with ≥ 5 outpatient appointments (OR1.03 95%CI 1.01-1.05), ≥ 2 hospital admissions (OR1.04 95%CI 1.03-1.6) and combined ≥3 outpatient appointments plus ≥ 1 hospital admissions (OR1.04 95%CI 1.02-1.06). Accounting for adult mediators (including long-term conditions), associations remained statistically significant, but their effect sizes were slightly reduced. When age left school was included in the final model, the association between the exposure and the combined outpatient appointments and hospital admissions (OR1.02 95%CI 1.00-1.04), ≥ 2 hospital admissions (OR1.02 95%CI 0.99-1.05) and ≥ 5 outpatient appointments (OR1.01 95%CI 0.99-1.03) were attenuated.Conclusions: education and academic ability in early life may be related to the burden of multiple hospital admissions and outpatient appointments later in life. This relationship was not fully explained by accounting for multiple long-term conditions and other potential mediating factors in adulthood. However, the age at which the participant left school seems to substantially mediate this relationship underscoring the positive impact of time spent in formal education on health during the lifecourse
Iron intake during early pregnancy and birth size: insights revealed through structural equation modelling
Get PDFExploring the relationship between early life exposures and the comorbidity of obesity and hypertension: findings from the 1970 the British cohort study (BCS70)
No full textBackground: epidemiological research commonly investigates single exposure-outcome relationships, while children’s experiences across a variety of early lifecourse domains are intersecting. To design realistic interventions, epidemiological research should incorporate information from multiple risk exposure domains to assess effect on health outcomes. In this paper we identify exposures across five pre-hypothesised childhood domains and explored their association to the odds of combined obesity and hypertension in adulthood.Methods: we used data from 17,196 participants in the 1970 British Cohort Study. The outcome was obesity (BMI of ≥30) and hypertension (blood pressure>140/90mm Hg or self-reported doctor’s diagnosis) comorbidity at age 46. Early life domains included: ‘prenatal, antenatal, neonatal and birth’, ‘developmental attributes and behaviour’, ‘child education and academic ability’, ‘socioeconomic factors’ and ‘parental and family environment’. Stepwise backward elimination selected variables for inclusion for each domain. Predicted risk scores of combined obesity and hypertension for each cohort member within each domain were calculated. Logistic regression investigated the association between domain-specific risk scores and odds of obesity-hypertension, controlling for demographic factors and other domains.Results: adjusting for demographic confounders, all domains were associated with odds of obesity-hypertension. Including all domains in the same model, higher predicted risk values across the five domains remained associated with increased odds of obesity-hypertension comorbidity, with the strongest associations to the parental and family environment domain (OR1.11 95%CI 1.05-1.18) and the socioeconomic factors domain (OR1.11 95%CI 1.05-1.17).Conclusions: targeted prevention interventions aimed at population groups with shared early-life characteristics could have an impact on obesity-hypertension prevalence which are known risk factors for further morbidity including cardiovascular disease
Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort
Full text linkBackground: Evidence is conflicting regarding the relationship between low maternal alcohol consumption and birth outcomes. This paper aimed to investigate the association between alcohol intake before and during pregnancy with birth weight and gestational age and to examine the effect of timing of exposure.
Methods: A prospective cohort in Leeds, UK, of 1303 pregnant women aged 18–45 years. Questionnaires assessed alcohol consumption before pregnancy and for the three trimesters separately. Categories of alcohol consumption were divided into ≤2 units/week and >2 units/week with a non-drinking category as referent. This was related to size at birth and preterm delivery, adjusting for confounders including salivary cotinine as a biomarker of smoking status.
Results: Nearly two-thirds of women before pregnancy and over half in the first trimester reported alcohol intakes above the Department of Health (UK) guidelines of ≤2 units/week. Associations with birth outcomes were strongest for intakes >2 units/week before pregnancy and in trimesters 1 and 2 compared to non-drinkers. Even women adhering to the guidelines in the first trimester were at significantly higher risk of having babies with lower birth weight, lower birth centile and preterm birth compared to non-drinkers, after adjusting for confounders (p<0.05).
Conclusions: We found the first trimester to be the period most sensitive to the effect of alcohol on the developing fetus. Women adhering to guidelines in this period were still at increased risk of adverse birth outcomes. Our findings suggest that women should be advised to abstain from alcohol when planning to conceive and throughout pregnanc
Maternal alcohol intake up to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort
No full textBackground High maternal alcohol consumption has been linked to adverse birth outcomes such as small for gestational age and preterm birth, which in turn have been linked to increased risk of development of cardiovascular diseases and type 2 diabetes in adulthood. The UK Department of Health (DH) recommends that pregnant women and those trying to conceive should avoid alcohol and never drink more than 1GÇô2 units once or twice a week. This study aimed to investigate the association between alcohol intake before and during different stages of pregnancy with both birthweight and gestational age. Methods Data were used from the Caffeine and Reproductive Health Study (CARE), a prospective birth cohort that included 1303 low-risk pregnant women aged 18GÇô45 years, recruited from September, 2003, to June, 2006. Questionnaires administered in the first and second trimester and postpartum assessed alcohol consumption before pregnancy and for the three trimesters. Frequency of weekly alcohol consumption was analysed by categories of intake to accord with DH guidelines (Gëñ2 units per week, >2 units per week, and a non-drinking category as the referent) and was related to preterm birth and size at birth, measured as grams and as customised birthweight centile, which takes into account maternal prepregnancy weight, height, parity, ethnicity, gestation, and baby's sex in multivariable linear and logistic regression models. We also adjusted for maternal age, caffeine intake, education, energy intake, and salivary cotinine as a biomarker of smoking status. Only participants with complete data for all variables were included in the analyses, which excluded just under 10% of the sample. All women provided informed consent and the study was approved by the Leeds West Local Research Ethics Committee (ref 03/054). Findings 1153, 1135, 793, and 377 women, respectively, had data available for birth outcomes and alcohol consumption before pregnancy and during the three trimesters. 74% of women before pregnancy and 53% in the first trimester reported alcohol intakes above the DH recommendation. For intakes above 2 units per week compared with non-drinkers, the adjusted differences in birth centile were GêÆ7-À7 (95% CI GêÆ12-À8 to GêÆ2-À6; ptrend=0-À009), GêÆ8-À2 (GêÆ12-À6 to GêÆ3-À7; ptrend=0-À002), and GêÆ6-À4 (GêÆ11-À8 to GêÆ1-À1, ptrend=0-À06) before pregnancy and during trimesters 1 and 2, respectively. The association with small for gestational age and preterm birth was strongest in trimester 1, with adjusted odds ratios of 2-À0 (95% CI 1-À2GÇô3-À4; ptrend=0-À03) and 3-À5 (1-À1GÇô11-À2, ptrend=0-À04), respectively. Women who adhered to the recommendations in the first trimester of 2 units or fewer per week were also at a significantly higher risk of having babies born with lower birthweight (adjusted difference GêÆ98-À5, 95% CI GêÆ170-À9 to GêÆ26-À1; ptrend=0-À007), birth centile (GêÆ5-À8, GêÆ10-À8 to GêÆ0-À7; ptrend=0-À002), and preterm birth (adjusted odds ratio 4-À6, 95% CI 1-À4GÇô14-À7; ptrend=0-À04) compared with non-drinkers. Interpretation The first trimester was the most sensitive period for the association of alcohol with restricted fetal growth. However, this finding could be explained by under-reporting of alcohol intake. Our small sample size in the third trimester did not allow us to detect a change in birthweight, and larger prospective studies that take into account timing of exposure to alcohol are needed. We showed no evident safe level of alcohol consumption in pregnancy, and the safe advice should be to abstain from alcohol when planning to conceive and during pregnancy, particularly during its early stages. Funding The CARE study was supported by a grant from the Food Standards Agency, UK (T01033
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