Mothers' pelvic size, fetal growth, and death from stroke and coronary heart disease in men in the UK

BACKGROUND: People who have a low birthweight show increased death rates from coronary heart disease and a higher prevalence for its risk factors. These findings have led to the hypothesis that the disease is programmed in fetal life. The aim of this study was to explore whether risk of stroke in adult life was linked to impaired fetal growth. METHODS: We ascertained deaths from stroke and coronary heart disease in 13 249 men in two cohorts from Hertfordshire and Sheffield, UK. We related death rates from these disease to body size at birth, weight at 1 year, and to measurements of the mothers' pelvises. FINDINGS: Death rates from both stroke and coronary heart disease tended to be highest in men whose birthweight had been low. Standardised mortality ratios (SMRs) for stroke fell by 12% (95% Cl 1-22) and for coronary heart disease by 10% (6-14) between each of five groupings of increasing birthweight (< or = 5.5 lb, 5.6-6.5 lb, 6.6-7.5 lb, 7.6-8.5 lb, and > 8.5 lb). Mortality from stroke was most strongly associated with low birthweight in relation to head size, and low placental weight in relation to head size. These patterns of growth occurred in offspring of mothers with flat bony pelvises. The SMR in sons of these women was 184 (67-396) compared with 104 (78-138) in the remainder of the cohort. In contrast, mortality from coronary heart disease was associated with small head circumference, thinness or shortness at birth and an altered ratio of placental weight to birthweight. INTERPRETATION: Stroke may originate in poor nutrition during the mother's childhood, which deforms the bony pelvis and subsequently impairs her ability to sustain the growth of the placenta and fetus in late pregnancy. Coronary heart disease, on the other hand, seems to originate in adaptations made by the fetus to inadequate delivery of nutrients when it occurs for reasons other than failure of placental growth.     

Birth weight, adult weight, and girth as predictors of the metabolic syndrome in postmenopausal women: the Rancho Bernardo Study

OBJECTIVE: Recent studies have demonstrated an association between low birth weight and chronic and metabolic disorders in adulthood such as type 2 diabetes, hypertension, and dyslipidemia. These disorders tend to cluster in a condition known as the metabolic syndrome (syndrome X). Only two studies have reported an association of birth weight to the metabolic syndrome. The present study is distinguished as the only study to focus on postmenopausal women. RESEARCH DESIGN AND METHODS: Subjects were 303 community-dwelling, postmenopausal Caucasian women aged 50-84 years. Metabolic and anthropometric variables were measured at a clinic visit; birth weight was assessed by self-report on a mailed questionnaire. RESULTS: The metabolic syndrome, defined as the simultaneous presence of hypertension, dyslipidemia, and abnormal glucose tolerance, was present in 7.9% of these women. Compared with women in the highest birth weight tertile (8.1-13.0 lb, mean 9.4 lb), those in the lowest birth weight tertile (2.5-6.8 lb, mean 5.5 lb) exhibited an increased prevalence (12.0 vs. 4.3%, P < 0.05) and 2.41 times the risk (95% CI 1.06-5.51) of developing the metabolic syndrome. Women with a heavy birth weight had an increased risk of adult obesity. Nevertheless, women in the lowest birth weight tertile who became adults in the highest tertile of BMI (>25.2 kg/m2) or waist circumference (>80.7 cm) had the highest prevalence of the metabolic syndrome (approximately 30%). CONCLUSIONS: Low birth weight coupled with adult obesity is a strong determinant of the metabolic syndrome in postmenopausal women.     

Fetal growth and hyperinsulinaemia in adult life

To explore the relation between reduced fetal growth and impaired glucose tolerance in adult life, an oral glucose tolerance test (75 g glucose) was carried out on 218 men and women, now aged around 50 years, who had been measured in detail at birth. Measurements of plasma concentrations of glucose and insulin were made at 0, 30, and 120 min. Fasting plasma concentrations of proinsulin and 32-33 split proinsulin were also measured. People in the highest category of birthweight tended to have the lowest plasma concentrations of insulin as adults at both 0 and 120 min, though both these relations were weak. Plasma insulin concentrations in adult life were more strongly related to abdominal circumference at birth than to birthweight. After adjusting for sex and body mass index, mean insulin concentrations at 0 min fell from 50 pmol l-1 to 46 pmol l-1 (p = 0.04) and at 120 min from 235 pmol l-1 to 144 pmol l-1 (p = 0.003) between people whose abdominal circumference at birth had been less than 11.5 in and those who abdominal circumference had been greater than 13 in. Plasma glucose concentrations at 120 min also fell with increasing abdominal circumference at birth. Because abdominal circumference at birth is an indicator of the growth of the liver in fetal life, one interpretation of these findings is that the sensitivity of the liver to insulin is permanently reduced if the intrauterine development of this organ is impaired.     

Maternal recall of birthweights of adult children: validation by hospital and well baby clinic records

BACKGROUND: Several studies have suggested that maternal recall of offspring birthweight compares well to data from birth certificates or medical records. However, these studies describe relatively short recall periods and pertain to populations where hospitalized childbirth is the norm. Accuracy of maternal recall has not been confirmed after long recall periods or in populations where non-hospitalized childbirth is common. METHODS: Accuracy of recalled birthweights is assessed among 626 women interviewed at an average age of 43.3 years (standard deviation [SD] 1 year), at which time the average age of their 1297 offspring was 17.9 years (range 1-29 years, SD 4.8 years). One-third of these infants were delivered at home. Recalled birthweight was compared to hospital or Well Baby clinic records, available for 66% (861/1297) of all births. RESULTS: Record availability was not related to birthweight. For the 861 infants for whom both sources were available mean recorded birthweight was 3342 g (SD 586 g) and mean recalled birthweight 3340 g (SD 675 g). Recalled weights overestimated recorded weights by 109 g (95% Cl: 68-151) among infants weighing > 3750 g and underestimated recorded weights by 83 g (95% Cl: 54-111) among infants weighing < or = 3250 g. CONCLUSIONS: As an outcome variable recalled birthweights were unbiased, but less precise than recorded birthweights. Use of recalled birthweight does not sacrifice study power however and may increase generalizability provided recalled weights are available for 30% more infants than recorded weights. For individual birthweight assessment and for use as an independent variable recalled weights are biased and may have to be adjusted using recorded data as available.     

Plasma concentrations of inactive renin in adult life are related to indicators of foetal growth

OBJECTIVES: To determine whether plasma concentrations of inactive and active renin in adult life are related to foetal development. DESIGN: A follow-up study of a group of men and women whose weight and other measurements of body size had been recorded at birth. SETTING: Sheffield, England. SUBJECTS: In total 148 men and women born in the Jessop Hospital, Sheffield, during 1939-40 and now aged 50-53 years. MAIN OUTCOME MEASUREMENT: Plasma concentrations of inactive and active renin in adult life. RESULTS: Plasma concentrations of inactive and active renin in adult life tended to be higher in people who had been large at birth. The strongest relationship was between concentrations of inactive renin and abdominal circumference at birth; the median plasma concentration of inactive renin was 88.5 mu/ml in people whose abdominal circumference at birth had been 13 inches (33.02 cm) or more compared with 61 mu/ml in people whose abdomens had measured 11.5 inches (29.21 cm) or less. CONCLUSION: Impairment of foetal growth is associated with lower plasma concentrations of inactive renin in adult life. Alterations in the activity of the renin-angiotensin system may be a mechanism by which reduced foetal growth leads to raised adult blood pressure.     

Chromosomal variability in the genus Nycticebus

The outcome of pregnancy was studied in 148 women over a two year period in a rural area of Kenya as part of a prospective longitudinal study whose main objective was to study the functional effects of mild to moderate malnutrition. Data were collected on maternal anthropometric variables monthly, haemoglobin levels were determined by blood samples taken every six months, food intake was based on two days each month of actual weight and recall. Each woman's past reproductive history was established at the beginning of the study. Birth weight was taken and recorded within seventy two hours of delivery. Discriminant analysis was used to identify predictors of low birthweight. The analysis was based on 123 cases who had complete data on all the variables used in the equation. Of those included in the analysis, 14 women (11%) delivered low birthweight babies and 109 had normal birthweight babies. Results of the discriminant analysis showed that mid upper arm circumference (MUAC), body mass index (BMI), Blood haemoglobin levels (HB) and socioeconomic status (SES), are the best predictors of low birthweight. Ranked in order of relative contribution to birthweight they are BMI, HB, MUAC and SES. Low birthweight prevalence was determined as being 11.2 per cent. Eighty per cent of all known cases were correctly classified using the four variables. As a screening tool for low birthweight this model with four variables has 93% sensitivity, 78.4% specificity, 35.13% positive predictive value and 98.98% negative predictive value. The results suggest that it is possible to identify women at high risk for delivering low birthweight babies at the community level.     

Plasma concentrations of fibrinogen and factor VII in adult life and their relation to intra-uterine growth

To examine the relation between fetal development and plasma concentrations of fibrinogen and factor VII in adult life we followed up 202 men and women, now aged around 50 years, who had been measured in detail at birth. Plasma concentrations of fibrinogen were related to weight and abdominal circumference at birth. In men, after adjustment for cigarette smoking and current obesity, plasma concentrations of fibrinogen fell by 0.12 g/l (95% CI 0.05-0.19) for each pound increase in birthweight and by 0.10 g/l (95% CI 0.03-0.17) for each inch increase in abdominal circumference. In contrast, analysis of the data for women showed no statistically significant relation between plasma fibrinogen concentration and weight or abdominal circumference at birth. No relation was seen between concentrations of factor VII and measurements made at birth in either sex. These findings suggest that, in men, reduced growth of the liver in fetal life has a long-term influence on fibrinogen metabolism.     

Increased birth weights in the Nordic countries. A growing proportion of neonates weigh more than four kilos

The proportion of children with high birthweights is increasing in Sweden, as in the other Nordic countries. According to the Swedish national birth registry (founded in 1973), the proportion of term (i.e. (37 gestational weeks) offspring of singelton pregnancies, and weighing four kg or more, increased from 16.9 per cent in 1973 to 20.3 per cent in 1995. The respective figures for the first-born subgroup were 12.9 and 15 per cent, the increase in mean birthweight being from 3400 to 3520 g. There was a corresponding increase in head circumference. The risk of delivery-related complications increases with birthweight over four kg, and a higher incidence of major perineal rupture (grade 3 or 4) has been reported, as well as a disturbing increase in the incidence of brachial plexus damage. Findings in recent studies suggest high birthweight to be associated with an increased risk of subsequent morbidity, both in childhood and in adulthood, specifically diabetes type 1, eczema and certain malignancies, particularly breast cancer and prostate cancer. Although the cause of the increasing proportion of large newborns is not known, it may be partly due to weight increase among gravidae. Another possible explanation is reduced maternal smoking, as smoking is less common now than in the 1970s.     

Ultrastructure of the taste disc in the red-bellied toad Bombina orientalis (Discoglossidae, Salientia)

To establish the prevalence, with 95% confidence limits, of some of the indicators of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala state, India, we did a field survey on a cluster sample with probability proportionate to size (PPS sample) of 500 households from five villages. Altogether the sample consisted of 1253 individuals who were more than 25 years of age, of which 1130 responded (90%). The survey instruments included the Malayalam translation of the Rose questionnaire, a standard 12-lead electrocardiogram with a battery operated portable electrocardiograph machine, blood pressure measurements using a mercury sphygmomanometer, and routine anthropometric measurements. The prevalence rates estimated were: (a) ECG changes suggestive of coronary heart disease, 36/1000 (95% C.L., 18, 55), (b) Rose questionnaire angina, 48/1000 (95% C.L. 35, 62), (c) definitive evidence of coronary heart disease, 14/1000 (95% C.L., 7, 21), (d) possible evidence of coronary heart disease, 74/1000 (95% C.L., 55, 93). Prevalence of major risk factors were, (a) hypertension by the WHO criteria, 179/1000 (95% C.L., 137, 221), (b) smoking, 219/1000 (95% C.L., 151, 287), (c) diabetes, 40/1000 (95% C.L., 17, 63), (d) obesity, 55/1000 (95% C.L., 6, 104). We have found that objective criteria indicate a lower prevalence of coronary heart disease in rural Thiruvananthapuram district when compared to studies from urban centres in India, but the prevalence of angina by Rose questionnaire is greater.     

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.     

Gestational malaria: assessment of its consequences on fetal growth

In a region of Africa (Nord-Kivu, Zaire) where malaria is endemic, circulating malaria parasites, malaria-associated placental lesions, and a low hemoglobin level (< 10 g/dl) were observed, either singly or in combination, in 73.1% of women (n = 461) delivering at the maternity hospital. These pathologic findings were associated with low birthweight in 18.1% of the newborns, whereas the prevalence of low birthweight was 6.4% among cases without these findings (P < 0.05). Parasitemia was observed in 17.4% of all mothers and was associated with a significant decrease in birthweight. Malaria-associated lesions were found in 52.5% of all placentas and were associated with a decrease in birthweight, head circumference, and ponderal index of the newborns. Such lesions were more frequently observed among primiparae (60.5%) than among multiparae (49.5%; P < 0.05). Lastly, a low hemoglobin level, found in 38.6% of the mothers, was associated with a decrease in birthweight, length, and head circumference. The differences in the physical effects associated with each of the pathologic conditions suggest that parasitemia, placental lesions, and anemia result in acute, subacute, and chronic impairment of fetal growth, respectively. Moreover, their deleterious effects may be cumulative, since the most dramatically affected physical patterns were found when the pathologic findings were associated in the same patient. Frequent antenatal monitoring of maternal hemoglobin and parasitemia, accompanied, when necessary, with curative treatments, may help to reduce the prevalence of intrauterine growth retardation and its procession of perinatal complications.     

Risk factors for aboriginal low birthweight, intrauterine growth retardation and preterm birth in the Darwin Health Region

Risk factors for Aboriginal low birthweight (< 2500 g), preterm birth (< 37 weeks' gestation) and intrauterine growth retardation (under the tenth percentile of Australian birthweights for gestational age) were examined in 503 live-born singletons recorded as born to an Aboriginal mother and routinely delivered at the Royal Darwin Hospital between January 1987 and March 1990. Infants born to mothers with body mass index less than 18.5 kg/m2 had five times the risk of having low birthweight and 2.5 times the risk of intrauterine growth retardation. Population-attributable risk percentages suggest that 28 per cent of low birthweight and 15 per cent of growth retardation could be attributed to maternal malnutrition. Risk percentages for maternal smoking of more than half a packet of cigarettes a day were 18 per cent for low birthweight and 10 per cent for growth retardation. For growth retardation, 18 per cent could be attributed to a maternal age under 20 years. Risk factors for preterm birth were predominantly obstetric: the population-attributable risk percentage for pregnancy-induced hypertension was 26 per cent and for other obstetric conditions was 16 per cent. For Aboriginal births in the Darwin Health Region, maternal malnutrition and smoking are key elements in the prevention of low birthweight and intrauterine growth retardation. Teenage pregnancy is an important risk for intrauterine growth retardation, and pregnancy-induced hypertension is a risk for preterm birth.     

Social class and coronary disease in rural population of north India. The Indian Social Class and Heart Survey

OBJECTIVE: To demonstrate the association of socio-economic status with prevalence of coronary artery disease and coronary risk factors. DESIGN AND SETTING: Cross-sectional survey in two randomly selected villages in the Moradabad district in North India. SUBJECTS AND METHODS: One thousand seven hundred and sixty-seven subjects (894 males and 875 females; 25-64 years of age) were randomly selected from two villages. They were divided into social classes 1 to 4, according to education, occupation, housing conditions, ownership of land, ownership of consumer durables and per capita income. The survey was based on questionnaires administered by dietitians and physicians, physical examination and electrocardiography. RESULTS: Social classes 1 and 2 were mainly high and middle socio-economic groups and 3 and 4 low income groups. The prevalence of coronary artery disease was significantly higher among classes 1 and 2 in both sexes, and there was a higher prevalence of hypercholesterolaemia, hypertension, and sedentary lifestyle. This population also showed a significant association with higher serum cholesterol, body mass index, triglycerides and blood pressures. Logistic regression analysis with adjustment for age showed that social class positively related to coronary disease (odds ratio: men 0.83, women 0.61), hypercholesterolaemia (men 0.85, women 0.87), hypertension (men 0.89, women 0.87), body mass index (men 0.91, women 0.93) and smoking in men (0.68). Smoking and sedentary lifestyle were not associated with social class in women. The association between coronary artery disease and social class abated after adjustment for smoking, sedentary lifestyle, body mass index and blood pressure (odds ratio: men 0.96, women 0.81). CONCLUSION: Subjects in social classes 1 and 2 in rural North India have a higher prevalence of coronary artery disease and of the coronary risk factors hypercholesterolaemia, hypertension, higher body mass index and sedentary lifestyle. The overall prevalence of coronary artery disease was 3.3%.     

Thinness at birth in a northern industrial town

OBJECTIVE: To determine whether babies in an area of Britain with unusually high perinatal mortality have different patterns of fetal growth to those born elsewhere in the country. DESIGN: Measurement of body size in newborn babies. SETTING: Burnley (perinatal mortality in 1988 15.9/1000 total births) and Salisbury (perinatal mortality 10.8/1000 total births), England. SUBJECTS: Subjects comprised 1544 babies born in Burnley, Pendle, and Rossendale Health District, and 1025 babies born in Salisbury Health District. MAIN OUTCOME MEASURES: Birthweight, length, head, arm and abdominal circumferences, and placental weight were determined. RESULTS: Compared with babies born in Salisbury, Burnley babies had lower mean birthweight (difference 116 g, 95% confidence interval (CI) 77,154), smaller head circumferences (difference 0.3 cm, 95% CI 0.2, 0.4), and were thinner as measured by arm circumference (difference 0.3 cm, 95% CI 0.3, 0.4), abdominal circumference (difference 0.5 cm, 95% CI 0.4, 0.6) and ponderal index (difference 0.8 kg/m3, 95% CI 0.6, 1.0). The ratio of placental weight to birthweight was higher in Burnley (difference 0.6%, 95% CI 0.4, 0.9). These differences were found in boys and girls and did not depend on differences in duration of gestation or on the different ethnic mix of the two districts. Mothers in Burnley were younger, shorter in stature, had had more children, were of lower social class, and more of them smoked during pregnancy than mothers in Salisbury. These differences did not explain the greater thinness of their babies. CONCLUSIONS: Babies born in Burnley, an area with high perinatal mortality, are thin. The reason is unknown. Poor maternal nutrition is suspected because Burnley babies have a higher ratio of placental weight to birthweight. The greater thinness at birth of Burnley babies could have long term consequences, including higher rates of cardiovascular disease.     

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.     

Birthweight of children with phenylketonuria

The assumption that children with phenylketonuria (PKU) develop normally until birth was brought into question by the recent report that PKU children weigh several hundred grams less at birth than their unaffected siblings. We have examined intrafamily differences in birthweight in 40 sibships with at least one affected and one unaffected child. The difference in mean birthweights computed by taking a weighted average of the intrafamily differences was 69 gm, and the adjusted estimate of the birthweight difference between children with PKU and their siblings, obtained from a fitted multiple regression function, is -51 gm. The findings are not consistent with the large difference in birthweight reported previously and are compatible with the assumption that the intrauterine physical growth of children with classical PKU is not adversely affected.     

The effect of smoking cessation during pregnancy on preterm delivery and low birthweight

BACKGROUND: Evidence exists that maternal cigarette smoking is associated with preterm birth. Our purpose was to investigate the relation between maternal smoking cessation at different points during pregnancy and the preterm delivery rate and low birthweight. METHODS: Data from the 1988 National Health Interview Survey were analyzed. The study included women who gave birth to children within 6 years of the 1988 interview date (N = 4876). Preterm delivery and infant low birthweight were the main outcome measures. These measures were compared with maternal smoking status during pregnancy. Logistic regression models were computed to control for maternal age at the time of birth, parity, race, and total family income. RESULTS: Women who did not smoke cigarettes during pregnancy were less likely to give birth prematurely (5.9% vs 8.2%, P = .003) or give birth to a low-birthweight baby (5.5% vs 8.9%, P < .001) than women who smoked at some time during the year before giving birth. A significant association existed between maternal smoking status and both preterm delivery and low birthweight. Compared with those who smoked beyond the first trimester, those who quit smoking within the first trimester had reductions in the proportion of preterm deliveries (6.7% vs 9.1%) and low birthweight infants (7.9% vs 9.6%). CONCLUSIONS: Low birthweight and preterm delivery are reduced in women who stop smoking in the first trimester of pregnancy.     

Low birth weight is associated with non-insulin-dependent diabetes mellitus in discordant monozygotic and dizygotic twins

Previous studies have demonstrated an association between low weight at birth and risk of later development of non-insulin dependent diabetes mellitus (NIDDM). It is unknown whether this association may be due to an impact of intrauterine malnutrition per se, or whether it may be due to a coincidence between the putative "NIDDM susceptibility genotype" and a genetically determined low weight at birth. We traced original midwife birthweight record determinations in a group of monozygotic (n = 14 pairs) and dizygotic (n = 14 pairs) twins who phenotypically appeared discordant for NIDDM at a mean age of 67 and 64 years respectively. Birthweights were lower in the NIDDM twins compared with both their identical and non-identical non-diabetic co-twins respectively (p < 0.02 both). Using a similar approach in twin pairs discordant for impaired glucose tolerance (IGT) per se, no significantly decreased birthweight was detected in the IGT twins compared with their non-diabetic co-twins. However, when a larger group of twins with different glucose tolerances were considered, birthweights were lower in twins with abnormal glucose tolerance including both NIDDM and IGT. Furthermore, the twins with the lowest birthweights among the two co-twins had the highest plasma glucose concentrations 120 min after the 75 g oral glucose load (n = 86 pairs, p = 0.02). The study supports the hypothesis that low birthweight and a non-genetically determined intrauterine component such af malnutrition may play a role for the development of NIDDM in twins.     

Perforating granuloma annulare

OBJECTIVE: To assess associations of adiposity with prevalent coronary heart disease (CHD) among elderly men. DESIGN: A cross-sectional epidemiologic study conducted between 1991 and 1993. SUBJECTS: 3741 Japanese-American men from the Honolulu Heart Program who were 71-93 y of age. MEASUREMENTS: CHD included documented myocardial infarction (electrocardiographic and enzyme criteria), acute coronary insufficiency, angina pectoris leading to surgical treatment identified through hospital surveillance, and reported history of heart attach or angina pectoris requiring hospitalization or surgical treatment. BMI was calculated as weight in kg divided by height in square meters. Waist circumference was measured at the horizontal level of the umbilicus and WHR was a ratio of waist circumference to hip circumference measured at the horizontal level of the maximal protrusion of the gluteal muscles. RESULTS: An elevated prevalence of CHD was observed in the elderly men with high BMI, WHR and waist circumference. The significant associations of BMI and waist circumference with CHD persisted after adjustment for fasting glucose, physical activity and pack-years of cigarette smoking but were no longer significant (odds ration (OR) = 1.03, 95% confidence level (CI) 0.94-1.12 and OR = 1.09, CI = 0.99-1.20, respectively) after adjustment for high density lipoprotein cholesterol (HDL-C). Also, the association of BMI with CHD was not found to be independent of abdominal adiposity. However, the associations of WHR and waist circumference remained significant (OR = 1.20, CI = 1.08-1.33 and OR = 1.17, CI = 1.01-1.37, respectively) after additional adjustment for BMI. In addition, the association of WHR with CHD was consistently significant and independent of fasting glucose, physical activity, smoking and HDL-C (OR = 1.11, CI = 1.00-1.23). CONCLUSION: WHR is associated with CHD independent of HDL-C and BMI, whereas the relation of BMI and waist circumference with CHD may be mediated through a relation of BMI and waist circumference with HDL-C level.     

Perinatal factors and atopic disease in childhood

BACKGROUND: Recent work has suggested possible linkages between perinatal factors and notably, head circumference and risks of subsequent atopic illness. OBJECTIVE: To examine the linkages between perinatal factors and risks of atopic conditions in a birth cohort of New Zealand children studied to the age of 16. METHODS: Measures of atopic illness including asthma, eczema, and other allergies were assessed prospectively during the course of a 16 year longitudinal study of a birth cohort of 1265 New Zealand children. In the initial stage of this research, measures of perinatal variables including birthweight, gestational age, head circumference and length at birth were obtained from hospital record data. RESULTS: Children with head circumference at birth of 37 cm or greater had (unadjusted) odds of asthma that were 1.8 (P < 0.01) to 3.0 (P < 0.0001) times higher than the odds for children of lesser head circumference. However, risks of asthma were not related to other perinatal measures including birthweight, gestational age or length or ratios of these measures. There were no consistent associations between perinatal measures and other measures of childhood atopy including eczema, allergic rhinitis and other allergies. The associations between head circumference and asthma risks persisted when due allowance was made for potentially confounding social and perinatal factors. CONCLUSIONS: It is concluded that large head circumference at birth may be associated with increased risks for the development of asthma. Possible explanations for the linkages between head circumference and asthma risks are considered.