To provide an updated birth weight-for-gestational age (BW-for-GA) reference in the United States by using the most recent, nationally representative birth data with obstetric estimates of ...gestational age (GA).
We abstracted 3 285 552 singleton births between 22 and 42 weeks' gestation with nonmissing race and/or ethnicity, infant sex, parity, birth weight, and obstetric estimate of GA from the 2017 US natality files. We used 2 techniques (nonlinear, resistant smoothing 4253H and lambda-mu-sigma) to derive smoothed BW-for-GA curves and compared resulting BW-for-GA cut-points at the third, 10th, 90th, and 97th percentiles with US references from 1999 to 2009.
The smoothed BW-for-GA curves from both techniques overlapped considerably with each other, with strong agreements seen between the 2 techniques (>99% agreement; κ-statistic >0.9) for BW-for-GA cut-points at the third, 10th, 90th, and 97th percentiles across all GAs. Cut-points from 2017 using the lambda-mu-sigma method captured 9.8% to 10.2% of births <10th and >90th percentiles and 2.6% to 3.3% of births below the third and above the 97th percentile across all GAs. However, cut-points from US references in 1999 and 2009 (when GA was based on last menstrual period) captured a much larger range of proportions of 2017 births at these thresholds, especially among preterm and postterm GA categories.
We have provided an updated BW-for-GA reference in the United States using the most recent births with obstetric estimates of GA and information to calculate continuous measures of birth size that are sex or parity specific.
Moderate alcohol consumption is associated with decreased risk for depression, but it remains unclear whether this is a causal relationship or a methodological artifact. To compare the effects of ...consistent abstinence and occasional, moderate, and above-guideline alcohol consumption throughout early to middle adulthood on depression at age 50, the authors conducted a secondary analysis of the National Longitudinal Survey of Youth 1979 cohort and employed a marginal structural model (MSM) approach.
Baseline was set at 1994, when individuals were ages 29-37. The MSM incorporated measurements of alcohol consumption in 1994, 2002, and 2006, baseline and time-varying covariates, and repeated measurements with the Center for Epidemiologic Studies Depression Scale-Short Form (CES-D-SF). A total of 5,667 eligible participants provided valid data at baseline, 3,593 of whom provided valid outcome data. The authors used all observed data to predict CES-D-SF means and rates of probable depression for hypothetical trajectories of consistent alcohol consumption.
The results approximated J-curve relationships. Specifically, both consistent occasional and consistent moderate drinkers were predicted to have reduced CES-D-SF scores and rates of probable depression at age 50 compared with consistent abstainers (CES-D-SF scores: b=-0.84, 95% CI=-1.47, -0.11; probable depression: odds ratio=0.58, 95% CI=0.36, 0.88 for consistent occasional drinkers vs. abstainers; CES-D-SF scores: b=-1.08, 95% CI=-1.88, -0.20; probable depression: odds ratio=0.59, 95% CI=0.26, 1.13 for consistent moderate drinkers vs. consistent abstainers). Consistent above-guideline drinkers were predicted to have slightly increased risk compared with consistent abstainers, but this was not significant. In sex-stratified analyses, results were similar for females and males.
This study contributes preliminary evidence that associations between moderate alcohol consumption and reduced risk for depression may reflect genuine causal effects. Further research using diverse methodologies that promote causal inference is required.
The Child Opportunity Index (ChOI) is a publicly available surveillance tool that incorporates traditional and novel attributes of neighborhood conditions that may promote or inhibit healthy child ...development. The extent to which ChOI relates to individual-level cardiometabolic risk remains unclear.
We geocoded residential addresses obtained from 743 participants in midchildhood (mean age 7.9 years) in Project Viva, a prebirth cohort from eastern Massachusetts, and linked each location with census tract-level ChOI data. We measured adiposity and cardiometabolic outcomes in midchildhood and early adolescence (mean age 13.1 years) and analyzed their associations with neighborhood-level ChOI in midchildhood using mixed-effects models, adjusting for individual and family sociodemographics.
On the basis of nationwide distributions of ChOI, 11.2% (
= 83) of children resided in areas of very low overall opportunity (ChOI score <20 U) and 55.3% (
= 411) resided in areas of very high (ChOI score ≥80 U) overall opportunity. Children who resided in areas with higher overall opportunity in midchildhood had persistently lower levels of C-reactive protein from midchildhood to early adolescence (per 25-U increase in ChOI score: β = .14 mg/L; 95% confidence interval, .28 to .00). Additionally, certain ChOI indicators, such as greater number of high-quality childhood education centers, greater access to healthy food, and greater proximity to employment in midchildhood, were associated with persistently lower adiposity, C-reactive protein levels, insulin resistance, and metabolic risk
scores from midchildhood to early adolescence.
Our findings suggest more favorable neighborhood opportunities in midchildhood predict better cardiometabolic health from midchildhood to early adolescence.
Abstract Aim To investigate whether cardiovascular health (CVH) is associated with periodontitis. Materials and Methods We used data from the 2009 to 2014 National Health and Nutrition Examination ...Survey. We quantified CVH using Life's Essential 8, which includes four health behaviours (diet, smoking, physical activity and sleep) and four health factors (body mass index, blood cholesterol, glucose and pressure). We categorized scores as low (0–49), moderate (50–79) and high (80–100). We calculated subscores of health behaviours and factors and categorized them as low, moderate and high. We used logistic regression to assess the association of CVH with periodontitis, adjusting for age, gender, race/ethnicity, education, poverty index, marital status and health insurance. We computed odds ratios (ORs) and 95% confidence intervals (CIs). Results This study included 9296 adults ≥30 years old. Multivariable‐adjusted models showed that subjects with moderate (OR, 0.62; 95% CI: 0.52–0.74) or high (OR, 0.43; 95% CI: 0.33–0.57) CVH had significantly lower odds of periodontitis compared to those with low CVH. These results were consistent in the health behaviours model, but the estimates in the health factors model were not significant. Conclusions Improving CVH may help prevent periodontitis. Longitudinal studies are needed to confirm our findings.
PURPOSEDelaying high school start times prolongs weekday sleep. However, it is not clear if longer sleep reduces depression symptoms and if the impact of such policy change is the same across groups ...of adolescents.METHODSWe examined how gains in weekday sleep impact depression symptoms in 2,134 high school students (mean age 15.16 ± 0.35 years) from the Minneapolis metropolitan area. Leveraging a natural experiment design, we used the policy change to delay school start times as an instrument to estimate the effect of a sustained gain in weekday sleep on repeatedly measured Kandel-Davies depression symptoms. We also evaluated whether allocating the policy change to subgroups with expected benefit could improve the impact of the policy.RESULTSOver 2 years, a sustained half-hour gain in weekday sleep expected as a result of the policy change to delay start times decreased depression symptoms by 0.78 points, 95%CI (-1.32,-0.28), or 15.6% of a standard deviation. The benefit was driven by a decrease in fatigue and sleep-related symptoms. While symptoms of low mood, hopelessness, and worry were not affected by the policy on average, older students with greater daily screen use and higher BMI experienced greater improvements in mood symptoms than would be expected on average, signaling heterogeneity. Nevertheless, universal implementation outperformed prescriptive strategies.CONCLUSIONHigh school start time delays are likely to universally decrease fatigue and overall depression symptoms in adolescents. Students who benefit most with respect to mood are older, spend more time on screens and have higher BMI.
Abstract
Background
Few studies have examined the independent and combined relationships of body mass index (BMI) peak and rebound with adiposity, insulin resistance and metabolic risk later in life. ...We used data from Project Viva, a well-characterized birth cohort from Boston with repeated measures of BMI, to help fill this gap.
Methods
Among 1681 children with BMI data from birth to mid childhood, we fitted individual BMI trajectories using mixed-effects models with natural cubic splines and estimated age, and magnitude of BMI, at peak (in infancy) and rebound (in early childhood). We obtained cardiometabolic measures of the children in early adolescence (median 12.9 years) and analysed their associations with the BMI parameters.
Results
After adjusting for potential confounders, age and magnitude at infancy BMI peak were associated with greater adolescent adiposity, and earlier adiposity rebound was strongly associated with greater adiposity, insulin resistance and metabolic risk score independently of BMI peak. Children with a normal timing of BMI peak plus early rebound had an adverse cardiometabolic profile, characterized by higher fat mass index {β 2.2 kg/m2 95% confidence interval (CI) 1.6, 2.9}, trunk fat mass index 1.1 kg/m2 (0.8, 1.5), insulin resistance 0.2 units (0.04, 0.4) and metabolic risk score 0.4 units (0.2, 0.5) compared with children with a normal BMI peak and a normal rebound pattern. Children without a BMI peak (no decline in BMI after the rise in infancy) also had adverse adolescent metabolic profiles.
Conclusions
Early age at BMI rebound is a strong risk factor for cardiometabolic risk, independent of BMI peak. Children with a normal peak-early rebound pattern, or without any BMI decline following infancy, are at greatest risk of adverse cardiometabolic profile in adolescence. Routine monitoring of BMI may help to identify children who are at greatest risk of developing an adverse cardiometabolic profile in later life and who may be targeted for preventive interventions.
Background:
In the past decade, continuous glucose monitoring (CGM) has been proven to have similar accuracy to self-monitoring of blood glucose (SMBG) and yet provides better therapy optimization ...and detects trends in glucose values due to higher frequency of testing. Even though the feasibility and utility of CGM has been proven successfully in Type 1 and 2 diabetes, there is a lack of knowledge of its application and effectiveness in pregnancy, especially in gestational diabetes mellitus (GDM). In this review, we aimed to summarize and evaluate the updated scientific evidence on the application of CGM in pregnancies complicated with GDM.
Methods:
A search using keywords related to CGM and GDM on PubMed was conducted and articles were filtered based on full text, year of publication (Jan 1998–Dec 2018), human subject studies, and written in English. Reviews and duplicate articles were removed. A final total of 29 articles were included in this review.
Results:
In terms of maternal and fetal outcomes, inconsistent evidence was reported. Among GDM patients using CGM and SMBG, two randomized controlled trials (RCTs) found no significant differences in macrosomia, birth weight (BW), and gestational age (GA) at delivery between these two groups, while one prospective cohort found a lower incidence of cesarean section and macrosomia in CGM use subjects. Furthermore, CGM use was consistently found to have increased detection in dysglycemia and glycemic variability compared to SMBG. In terms of clinical utility, CGM use led to more treatment adjustments and lower gestational weight gain (GWG). Lastly, CGM use showed higher postprandial glucose levels in GDM-complicated pregnancies than in normal pregnancies.
Conclusion:
Current updated evidence suggests that CGM is superior to SMBG among GDM pregnancies in terms of detecting hypoglycemic and hyperglycemic episodes, which might result in an improvement of maternal and fetal outcomes. In addition, CGM detects a wider glycemic variability in GDM mothers than non-GDM controls. Further research with larger sample sizes and complete pregnancy coverage is needed to explore the clinical utility such as screening and predictive values of CGM for GDM.
PDF
