Van Hulst Andraea, Barnett Tracie A, Paradis Gilles, Roy-Gagnon Marie-Hélène, Gomez-Lopez Lilianne, Henderson Mélanie
Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montreal, Canada.
Centre de recherche du CHU Sainte-Justine, Montreal, Canada.
J Am Heart Assoc. 2017 Aug 4;6(8):e006302. doi: 10.1161/JAHA.117.006302.
Different pathways likely underlie the association between early weight gain and cardiovascular disease risk. We examined whether birth weight for length relationship and weight gain up to 2 years of age are associated with lipid profiles and blood pressure (BP) in early adolescence and determined whether childhood adiposity mediates these associations.
Data from QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), a cohort of white children with parental history of obesity, were analyzed (n=395). Sex-specific weight for length scores from birth to 2 years were computed. Rate of postnatal weight gain was estimated using individual slopes of weight for length -score measurements. Percentage of body fat was measured at 8 to 10 years. Fasting lipids and BP were measured at 10 to 12 years. Using path analysis, we found indirect effects of postnatal weight gain, through childhood adiposity, on all outcomes: Rate of postnatal weight for length gain was positively associated with childhood adiposity, which in turn was associated with unfavorable lipid and BP levels in early adolescence. In contrast, small beneficial direct effects on diastolic BP scores, independent of weight at other time points, were found for birth weight for length (β=-0.05, 95% CI, -0.09 to -0.002) and for postnatal weight gain (β=-0.02, 95% CI, -0.03 to -0.002).
Among children with at least 1 obese parent, faster postnatal weight gain leads to cardiovascular risk factors in early adolescence through its effect on childhood adiposity. Although heavier newborns may have lower BP in early adolescence, this protective direct effect could be offset by a deleterious indirect effect linking birth weight to later adiposity.
早期体重增加与心血管疾病风险之间的关联可能存在不同的潜在途径。我们研究了出生体重与身长的关系以及2岁前的体重增加是否与青春期早期的血脂水平和血压（BP）相关，并确定儿童肥胖是否介导了这些关联。
对来自QUALITY（魁北克青少年脂肪与生活方式调查）队列的395名有肥胖家族史的白人儿童的数据进行了分析。计算了出生至2岁时按性别划分的体重与身长分数。使用体重与身长分数测量的个体斜率估计出生后体重增加率。在8至10岁时测量体脂百分比。在10至12岁时测量空腹血脂和血压。通过路径分析，我们发现出生后体重增加通过儿童肥胖对所有结局产生间接影响：出生后体重与身长增加率与儿童肥胖呈正相关，而儿童肥胖又与青春期早期不良的血脂和血压水平相关。相比之下，发现出生体重与身长（β=-0.05，95%CI，-0.09至-0.002）和出生后体重增加（β=-0.02，95%CI，-0.03至-0.002）对舒张压分数有小的有益直接影响，独立于其他时间点的体重。
在至少有1名肥胖父母的儿童中，出生后体重增加更快通过对儿童肥胖的影响导致青春期早期的心血管危险因素。尽管较重的新生儿在青春期早期可能血压较低，但这种保护性直接效应可能会被将出生体重与后期肥胖联系起来的有害间接效应所抵消。
