Jansen M A C, Uiterwaal C S P M, van der Ent C K, Grobbee D E, Dalmeijer G W
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
J Dev Orig Health Dis. 2019 Oct;10(5):563-569. doi: 10.1017/S2040174418001149. Epub 2019 Jan 30.
Blood pressure (BP) tracks from childhood to adulthood, and early BP trajectories predict cardiovascular disease risk later in life. Excess postnatal weight gain is associated with vascular changes early in life. However, to what extent it is associated with children's BP is largely unknown. In 853 healthy 5-year-old children of the Wheezing-Illnesses-Study-Leidsche-Rijn (WHISTLER) birth cohort, systolic (SBP) and diastolic BP (DBP) were measured, and z scores of individual weight gain rates adjusted for length gain rates were calculated using at least two weight and length measurements from birth until 3 months of age. Linear regression analyses were conducted to investigate the association between weight gain rates adjusted for length gain rates and BP adjusted for sex and ethnicity. Each standard deviation increase in weight gain rates adjusted for length gain rates was associated with 0.9 mmHg (95% CI 0.3, 1.5) higher sitting SBP after adjustment for confounders. Particularly in children in the lowest birth size decile, high excess weight gain was associated with higher sitting SBP values compared to children with low weight gain rates adjusted for length gain rates. BMI and visceral adipose tissue partly explained the association between excess weight gain and sitting SBP (β 0.5 mmHg, 95% CI -0.3, 1.3). Weight gain rates adjusted for length gain rates were not associated with supine SBP or DBP. Children with excess weight gain, properly adjusted for length gain, in the first three months of life, particularly those with a small birth size, showed higher sitting systolic BP at the age of 5 years.
血压从儿童期到成年期具有轨迹连续性，早期血压轨迹可预测成年后的心血管疾病风险。出生后体重过度增加与生命早期的血管变化有关。然而，其与儿童血压的关联程度在很大程度上尚不清楚。在莱顿莱茵喘息疾病研究（WHISTLER）出生队列的853名健康5岁儿童中，测量了收缩压（SBP）和舒张压（DBP），并使用从出生到3个月大时至少两次的体重和身长测量值，计算了根据身长增加率调整后的个体体重增加率的z分数。进行线性回归分析以研究根据身长增加率调整后的体重增加率与根据性别和种族调整后的血压之间的关联。在对混杂因素进行调整后，根据身长增加率调整后的体重增加率每增加一个标准差，坐位收缩压就会升高0.9 mmHg（95%CI 0.3, 1.5）。特别是在出生体重最低十分位数的儿童中，与根据身长增加率调整后的低体重增加率的儿童相比，高体重过度增加与更高的坐位收缩压值相关。体重指数（BMI）和内脏脂肪组织部分解释了体重过度增加与坐位收缩压之间的关联（β 0.5 mmHg，95%CI -0.3, 1.3）。根据身长增加率调整后的体重增加率与仰卧位收缩压或舒张压无关。在生命的前三个月体重过度增加且根据身长增加进行适当调整的儿童，尤其是那些出生体重小的儿童，在5岁时坐位收缩压较高。
