Study links large body size during childhood to diabetes and CAD later

Researchers have found in a new study that child body size is linked to risk of heart disease and diabetes in later life. The increased risk is most likely when large body size persists into adulthood.
Having a large body size in childhood is associated with an increased risk of coronary artery disease and type 2 diabetes, particularly when it persists into adult life. The new study has been published by The BMJ today.

The results also suggest that a larger early life body size may help protect women against breast cancer in later life. 

Obesity in children is widely recognised as a global public health crisis, yet levels continue to rise. 

Having a high body mass index (BMI) in early life is thought to increase the risk of various health conditions in later life. But it is unclear whether an individual can reverse the impact of childhood obesity through lifestyle changes, particularly as those who are obese in early life tend to remain obese as adults.

So researchers at the University of Bristol used a technique called Mendelian randomisation to examine the genetic influence of body size in early life on risk of four diseases in later life - coronary artery disease, type 2 diabetes, breast and prostate cancer.

 Their findings are based on more than 450,000 people from the UK Biobank database using measures of BMI in adulthood (average age 57) and self-reported perceived body size at age 10 and over 700,000 individuals from four large scale genome-wide association studies.

Analysing genetic information in this way avoids some of the problems that may hinder traditional observational studies, making the results less prone to unmeasured (confounding) factors, and therefore more likely to be reliable. An association that is observed using Mendelian randomisation therefore strengthens the inference of a causal relationship. 

The researchers found that early life body size is associated with an increased risk of coronary artery disease and type 2 diabetes. However, when early life body size was analysed together with adult body size, the effects were considerably reduced, suggesting that the increased risk is most likely in those with a large body size in childhood that persists into later life.

They also found strong evidence that larger early life body size has a protective effect on risk of breast cancer, although they say timing of puberty might play an important role here and this requires further investigation before firm conclusions can be made. 

However, no strong evidence was found of a causal effect of either early or later life measures on prostate cancer.

The authors point to some study limitations, such as relying on self reported early life body size which may have affected the accuracy of their estimates. However, strengths include the large number of participants and the sophisticated analytical methods used.

 As such, they say their findings suggest that the positive association between body size in childhood and risk of coronary artery disease and type 2 diabetes in adulthood can be attributed to individuals remaining large into later life.

"Our approach therefore yields insight into the pathway between early life risk factors such as BMI and disease outcomes," they conclude.

 This study suggests that the effect of self-reported adiposity at age 10 on coronary artery disease and type 2 diabetes "can be obviated by achieving and maintaining a normal body mass index (BMI) in adulthood," writes Professor Mary Schooling in a linked editorial.

The study used sophisticated and up-to-date mendelian randomization methods. Nevertheless, she says its findings "need careful interpretation and contextualization before they can be applied to population health."

 She points to adolescence - the transition from childhood to adulthood - as a key point of intervention, and suggests that "puberty might be a key time to reduce adiposity."

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People with autism risk more likely to report self harm

People with a higher genetic likelihood of autism are more likely to report higher childhood maltreatment, self-harm and suicidal thoughts, according to a new study.

The study, shows that the findings hold true even for those with a higher genetic likelihood of autism rather than a formal diagnosis.
Previous studies from the University of Cambridge established that autistic individuals experience higher levels of self-harm, including suicidal thoughts and feelings, and higher rates of childhood maltreatment.
"This new study extends our earlier work by showing that individuals who carry more of the genes associated with autism have higher risks for maltreatment and self-harm," said a study researcher.

"Our work highlighting unacceptably higher rates of suicide in autistic people was published 5 years ago, yet almost no new support has been provided," he added.
For the study, the research team calculated the genetic likelihood for autism in 100,000 individuals from the UK Biobank Study who had their DNA analysed and had also provided self-reported information about childhood maltreatment, suicidal ideation and self-harm.
Those with the highest genetic predisposition to autism on an average have 28 per cent increase in childhood maltreatment and a 33 per cent increase in self-harm and suicidal ideation compared to those with the lowest genetic predisposition to autism.
"While we have found an association between a genetic likelihood for autism and adverse life events, we cannot conclude the former causes the latter," said study lead author.

"We suspect this association reflects that genes partly influence how many autistic traits you have, and some autistic traits such as difficulties in social understanding may lead to a person to be vulnerable to maltreatment, he added.
This research highlights the risks of such adverse outcomes for those with a high number of autistic traits, if adequate safeguarding and support aren't provided.

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Childhood trauma increases the chance of delivering baby early in life and outside of marriage

While childhood trauma is known to have poor impact on a woman’s midlife health, a new study has uncovered the reason behind it and found that these females are more likely to have their first child both earlier in life and outside of marriage – factors associated with poorer health later in life.

These results suggest that early trauma – such as the death of a parent, physical abuse or emotional neglect – may affect young people’s decision-making in ways that they can’t entirely control.

“It’s easy to tell teens that they shouldn’t have kids before marriage, but the message won’t be effective if they haven’t developed the capacity to do that because of the trauma they experienced in childhood,” said lead author.

Previous research has shown that childhood trauma is strongly associated with multiple health risks, including cancer, diabetes, stroke and early death, she said.

Much of this work has focused on how early adversity may have biological and neurological effects that would lead to worse health throughout life.

“But there hasn’t been any attention given to how childhood adversity may affect social and developmental processes in adolescence and young adulthood – factors that we know are also strong predictors of later health,” she added.

One of those factors in women is the timing and context of first birth.

Data for this study came from the 1979 National Longitudinal Survey of Youth, which includes a representative sample of people who were aged 14 to 22 in 1979.

Participants were interviewed every year through 1994 and once every two years since. The final sample for this study included 3,278 women.

Each participant reported whether she experienced one or more of six adverse childhood experiences before age 18: emotional neglect, physical abuse, alcoholism in the home, mental illness in the home, death of a biological parent and parental absence.

The researchers examined data on how old each participant was when she first gave birth and whether she was married, cohabiting or neither. Finally, participants rated their health at or near age 40.

Findings showed that each additional childhood trauma experienced by the participants was associated with earlier age at first birth and a greater probability for a first birth during adolescence or young adulthood compared to later (age 25 to 39).

In addition, each additional trauma was associated with a 24 per cent increase in the probability of being unmarried and not cohabiting at first birth compared to the likelihood that they were married when their first child was born.

Researchers then conducted statistical tests that showed early and non-marital births were a key reason why children who experienced trauma were more likely to report poorer health at midlife.
“Childhood trauma leads to social and biological risks that lead to early and non-marital birth which can lead to health problems later in life,” she explained.

She added “when people experience traumas early in life, they are less likely to make those positive choices.

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TB survivors at higher risk of developing lung damage

Tuberculosis (TB) survivors, especially those living in India, are at a higher risk of developing lasting damage to lungs, according to a study done on more than 2,000 Indian patients.

The study has found that more than one-third of patients who are successfully cured of TB with antibiotics developed permanent lung damage, which, in the worst cases, results in large holes in the lungs called cavities and widens the airways called bronchiectasis.

According to the World Health Organisation’s Global TB Report 2018, an estimated 2.8 million people have contracted TB in India which represents one quarter of all TB cases worldwide.

“This study calls urgent attention to the problem of post-TB lung damage worldwide. TB is a curable condition with antibiotics and great steps forward have been made towards eliminating the disease,” said study's lead author.

“But this study is a wake-up call because even if we manage to eliminate all TB worldwide tomorrow, we are going to be left with a legacy of chronic lung damage and bronchiectasis which will require better recognition and better treatment,” he said.

For the study, the research team recruited 2,195 patients with established bronchiectasis from 14 Indian states.

TB survivors and patients with a history of severe infections such as childhood pneumonia made up the majority of patients with lung damage in India. The researchers found that these infections left a legacy of daily cough, further chest infections and poor quality of life.

Patients required further hospitalisations for treatment of their lung conditions in nearly 40 per cent of cases. Patients with post-TB lung damage had lost approximately 40 per cent of their lung capacity, leaving many patients with persistent breathlessness.

Compared with patients in Europe and the US, those in India had more severe lung damage, lung function was worse and patients were more likely to be hospitalised for severe infections.

Recommended treatment for these patients such as inhalers, physiotherapy and antibiotic treatment for infections were rarely provided.

Physiotherapy exercises and antibiotics are inexpensive treatments which are proven to improve quality of life and reduce lung infections, but were available to less than 50 per cent of Indian patients.

The Indian government has pledged to eradicate TB by 2025, however this study warns that the TB epidemic could have lasting consequences for the treatment of lung conditions.

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Clean germ-free childhood makes children prone to leukemia

Parents go to any limit to protect their little ones from germs ! A new study, however, has highlighted that a childhood free from germs followed by infections later in life makes children prone to childhood leukemia.

This happens because of the fact that when a child is exposed to infection in their first year, their immune system gets strong.

A study finds that acute lymphoblastic leukemia, the most common type of childhood cancer, is caused by a two-step process.

The first step is a genetic mutation before birth that predisposes a child to the risk of developing this form of leukemia.

On the other hand, the 2nd step is exposure to certain infections later in childhood, after clean early childhoods that limited exposure to infections.

To put it simply, the researchers explained that kids who lived in very clean, germ-free condition during their first years and had less interaction with other children are prone to lymphoblastic leukemia, a form of blood cancer most often diagnosed in children between the ages 0-4 years.

It develops quickly, over days or weeks, building up in the blood and spreads to other parts of the body, including the lymph nodes, liver and nervous system.

The research strongly suggests that this cancer has a clear biological cause, and is triggered by a variety of infections in predisposed children whose immune systems have not been properly primed, said the author of the study.

The author added that the study " busts some persistent myths about the causes of leukemia, such as the damaging but unsubstantiated claims that the disease is commonly caused by exposure to electro-magnetic waves or pollution."

Preventing childhood leukemia would have a huge impact on the lives of children and their families in the UK and across the glove, said a researcher.

It's also important to remember that infections themselves can pose a significant risk for young babies with a developing immune system, said a researcher.

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People with more education have reduced heart disease, says study

Increasing the years of childhood education may reduce the risk for heart disease in adulthood, a study has found.

Researchers have found that people with more education may have reduced heart disease because they have higher incomes, allowing them to afford better food and health care.

The study suggested that state policies requiring children to attend additional years of school may result in improvements in several cardiovascular risk factors in adulthood.

About the research by UC San Franciso researchers

The researchers in the US conducted a natural experiment by evaluating state compulsory schooling laws, which legislate the number of years children must attend school.

From two large, national surveys conducted from 1971 to 2012, they identified more than 75,000 people born from 1900 to 1950, when states required children to attend school between 0 and 12 years.

They then used US Census data on a group of similar individuals to predict the number of years of required schooling for each individual, based on their year and state of birth.

Overall, about a third of the study participants did not graduate from high school. While 34.5 percent reported heart disease, the researchers found that each year of additional compulsory schooling through high school was associated with a 2.5 percent reduction in occurrence.

They also noted improvements in several cardiovascular risk factors with each additional year, including reductions of more than 3 percent in smoking and nearly five percent in depression.

"For clinicians and health systems struggling to address disparities in heart disease between the rich and the poor, our findings suggest that cross-sectoral interventions to address social factors like education are important," said Rita Hamad, the lead author of the study.

"As a society, we should be thinking about investing in social policies to improve overall health and reduce health care costs," she said.

The 2019 guidelines have suggested using patients' social factors in clinical prediction tools for heart disease, since education is often a stronger predictor than traditional biomedical risk factors like cholesterol and diabetes.

The US Department of Health and Human Services also has proposed that patients' educational attainment be used as an input in determining physician payments for performance, to encourage physicians to care for more disadvantaged patients. The Prof. said this type of data could inform those efforts.

While more education also was associated with improved high-density lipoprotein (HDL), or "good" cholesterol, the researchers found that more education also was associated with higher body-mass index (BMI) and total cholesterol.

A possible explanation is that high-income people born between 1900-1950 tended to eat richer diets, they said. By contrast, higher BMI today tends to be associated more with low income, due to the inability to afford healthy food.

"Overall, people with more education may have reduced heart disease because they have higher incomes, allowing them to afford better food and health care. Or, it may be that they have more resources and therefore less stress, which has been previously linked with heart disease," he said.

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Varying brain energy expenditure in childhood associated with weight gain

It is well known that we tend to put on weight when we consume more calories than we spend. It is, however, less known that our brain uses half of the body's energy during early childhood.

Research says that variation in the energy needs of brain development across kids- in terms of the timing, intensity, and duration of energy use- can influence patterns of energy expenditure and weight gain.

We all know that how much energy out bodies burn is an important influence on weight gain. When kids are 5, their brains use almost half of their bodies' energy. And yet, we have no idea how much the brain's energy expenditure varies between kids. This is a huge hole in our understanding of energy expenditure, said the co-author of the study.

A major aim of our paper is to bring attention to this gap in understanding and to encourage researchers to measure the brain's energy use in future studies of child development especially those focused on understanding weight gain and obesity risk.

We believe it is plausible that increased energy expenditure by the brain could be an unanticipated benefit to early child development programme, which of course, have many other demonstrated benefits. That would be a great win-win, he said.

This new hypothesis was inspired by the team showing that the brain consumes a lifetime peak of two-thirds of the body's resting energy expenditure, and almost half of total expenditure when kids are 5 years old.

The study also shows that ages, when the brain's energy needs increase during early childhood, are also ages of declining weight gain. As the energy needed for brain development declines in older children and adolescents, the rate of weight gain increases in parallel.

This finding helped confirm a long-standing hypothesis in anthropology that human children evolved a much slower rate of childhood growth compared to other mammals and primates, he said.

 

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