Why are poorer children at higher risk of obesity and overweight? A UK cohort study

There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors

Well-being of children born after medically assisted reproduction

Background: The increasing number and proportion of children born after medically assisted reproduction (MAR) has raised concerns and motivated research about the impact of MAR on the well-being and development of children. // Objective: We summarize existing studies on the well-being and development of children conceived through MAR. // Materials and methods: Review of existing studies. // Results: Children conceived through MAR are at increased risk of adverse birth outcomes such as low birthweight and preterm delivery compared to naturally conceived children. The higher rates of multiple births amongst MAR-conceived children continue to represent an important driving factor behind these disparities. Reassuringly, elective single embryo transfer (eSET)—which is associated with more favourable pregnancy outcomes among MAR-conceived children—is becoming more common. Despite the early life health disadvantages, the evidence on later life outcomes such as physical, cognitive and psychosocial development is generally reassuring. On average, MAR-conceived children show similar or better outcomes than naturally conceived children. The selected and advantaged socioeconomic characteristics of parents who conceive through MAR are likely to play an important role in explaining why, on average, MAR-conceived children perform better than naturally conceived children—particularly in terms of cognitive outcomes. In contrast, there is some evidence pointing to potentially increased risks of mental health problems among MAR-conceived children. // Conclusion: There is need for continued monitoring and longer follow-up studies on the well-being of these children in order to better understand whether their outcomes are similar to or different from those of naturally conceived children, and, if so, why

The cognitive development from childhood to adolescence of low birthweight children born after medically assisted reproduction-a UK longitudinal cohort study.

BACKGROUND: Previous research has documented that children conceived through medically assisted reproduction (MAR) are at increased risk of poor birth outcomes, such as low birthweight (LBW), which are risk factors for stunted longer-term cognitive development. However, parents who undergo MAR to conceive have, on average, advantaged socioeconomic backgrounds which could compensate for the negative effects of being born LBW. Previous studies have not analysed whether the negative effects of LBW are attenuated among MAR conceived children. METHODS: We draw on the UK Millennium Cohort Study (sweeps 1-6) which contains a sub-sample of (N = 396) MAR-conceived children. The dependent variable measures cognitive ability at around ages 3, 5, 7, 11 and 14. We examine the cognitive development of four groups of children: MAR-conceived low birthweight (MAR LBW); MAR-conceived non-low birthweight (MAR NLBW); naturally conceived low birthweight (NC LBW); naturally conceived non-low birthweight (NC NLBW). We estimate the two following linear regression models for each sweep: (i) a baseline model to examine the unadjusted association between cognitive development and low birthweight by mode of conception; and (ii) a model adjusted by socio-demographic family characteristics. RESULTS: In baseline models, MAR LBW children [age 3: β  =  0.021, 95% confidence interval (CI): -0.198, 0.241; age 5: β  =  0.21, 95% CI: 0.009, 0.418; age 7: β  =  0.163, 95% CI: -0.148, 0.474; age 11: β  =  0.003, 95% CI: -0.318, 0.325; age 14: β  =  0.156, 95% CI: -0.205, 0.517], on average perform similarly in cognitive ability relative to NC NLBW at all ages, and display higher cognitive scores than NC LBW children until age 7. When we account for family characteristics, differences are largely attenuated and become close to zero at age 14. CONCLUSIONS: Despite the higher incidence of LBW among MAR compared with NC children, they do not seem to experience any disadvantage in their cognitive development compared with naturally conceived children. This finding is likely explained by the fact that, on average, MAR children are born to socioeconomically advantaged parents

Health outcomes of only children across the life course: An investigation using Swedish register data

Only children (with no full biological siblings) are a growing subgroup in many high-income settings. Previous studies have largely focused on the short-term developmental outcomes of only children, but there is limited evidence on their health outcomes. Using Swedish population register data for cohorts born 1940–75, we compare the health of only children with that of children from multi-child sibling groups, taking into account birth order, family size, and presence of half-siblings. Only children showed lower height and fitness scores, were more likely to be overweight/obese in late adolescence, and experienced higher later-life mortality than those with one or two siblings. However, only children without half-siblings were consistently healthier than those with half-siblings, suggesting that parental disruption confers additional disadvantages. The health disadvantage was attenuated but not fully explained by adjustment for parental characteristics and after using within-family maternal cousin comparison designs

Medically Assisted Reproduction Treatment Types and Birth Outcomes: A Between- and Within-Family Analysis

OBJECTIVE: To compare risks of adverse birth outcomes among pregnancies conceived with and without medically assisted reproduction treatments. METHODS: Birth certificates were used to study birth outcomes of all neonates born in Utah from 2009 through 2017. Of the 469,919 deliveries, 52.8% (N=248,013) were included in the sample, with 5.2% of the neonates conceived through medically assisted reproduction. The outcome measures included birth weight, gestational age, low birth weight (LBW, less than 2,500 g), preterm birth (less than 37 weeks of gestation), and small for gestational age (SGA, birth weight less than the 10th percentile). Linear models were estimated for the continuous outcomes (birth weight, gestational age), and linear probability models were used for the binary outcomes (LBW, preterm birth, SGA). First, we compared the birth outcomes of neonates born after medically assisted reproduction and natural conception in the overall sample (between-family analyses), before and after adjustment for parental background and neonatal characteristics. Second, we employed family fixed effect models to investigate whether the birth outcomes of neonates conceived through medically assisted reproduction differed from those of their naturally conceived siblings (within-family comparisons). RESULTS: Neonates conceived through medically assisted reproduction weighed less, were born earlier, and were more likely to be LBW, preterm, and SGA than neonates conceived naturally. More invasive treatments (assisted reproductive technology [ART] and artificial insemination [AI] or intrauterine insemination) were associated with worse birth outcomes; for example, the proportion of LBW and preterm birth was 6.1% and 7.9% among neonates conceived naturally and 25.5% and 29.8% among neonates conceived through ART, respectively. After adjustments for various neonatal and parental characteristics, the differences in birth outcomes between neonates conceived through medically assisted reproduction and naturally were attenuated yet remained statistically significant; for example, neonates conceived through ART were at 3.2 percentage points higher risk for LBW (95% CI 2.4–4.1) and 4.8 percentage points higher risk for preterm birth (95% CI 3.9–5.7). Among siblings, the differences in the frequency of adverse outcomes between neonates conceived through medically assisted reproduction and neonates conceived naturally were small and statistically insignificant for all types of treatments. CONCLUSION: Medically assisted reproduction treatments are associated with adverse birth outcomes; however, those risks are unlikely to be associated with the infertility treatments itself

Childbearing postponement and child well-being: a complex and varied relationship?

Over the past several decades, U.S. fertility has followed a trend toward the postponement of motherhood. The socioeconomic causes and consequences of this trend have been the focus of attention in the demographic literature. Given the socioeconomic advantages of those who postpone having children, some authors have argued that the disadvantage experienced by certain groups would be reduced if they postponed their births. The weathering hypothesis literature, by integrating a biosocial perspective, complicates this argument and posits that the costs and benefits of postponement may vary systematically across population subgroups. In particular, the literature on the weathering hypothesis argues that as a consequence of their unique experiences of racism and disadvantage, African American women may experience a more rapid deterioration of their health, which could offset or eventually reverse any socioeconomic benefit of postponement. But because very few African American women postpone motherhood, efforts to find compelling evidence to support the arguments of this perspective rely on a strategy of comparison that is problematic because a potentially selected group of older black mothers are used to represent the costs of postponement. This might explain why the weathering hypothesis has played a rather limited role in the way demographers conceptualize postponement and its consequences for well-being. In order to explore the potential utility of this perspective, we turn our attention to the UK context. Because first-birth fertility schedules are similar for black and white women, we can observe (rather than assume) whether the meaning and consequences of postponement vary across these population subgroups. The results, obtained using linked UK census and birth record data, reveal evidence consistent with the weathering hypothesis in the United Kingdom and lend support to the arguments that the demographic literature would benefit from integrating insights from this biosocial perspective

Fertility History and Physical and Mental Health Changes in European Older Adults

Previous studies have shown that aspects of reproductive history, such as earlier parenthood and high parity, are associated with poorer health in mid and later life. However, it is unclear which dimensions of health are most affected by reproductive history, and whether the pattern of associations varies for measures of physical, psychological and cognitive health. Such variation might provide more insight into possible underlying mechanisms. We use longitudinal data for men and women aged 50–79 years in ten European countries from the Survey of Health, Ageing and Retirement in Europe to analyse associations between completed fertility history and self-reported and observed health indicators measured 2–3 years apart (functional limitations, chronic diseases, grip strength, depression and cognition), adjusting for socio-demographic, and health factors at baseline. Using multiple imputation and pattern mixture modelling, we tested the robustness of estimates to missing data mechanisms. The results are partly consistent with previous studies and show that women who became mothers before age 20 had worse functional health at baseline and were more likely to suffer functional health declines. Parents of 4 or more children had worse physical, psychological and cognitive health at baseline and were more likely to develop circulatory disease over the follow-up period. Men who delayed fatherhood until age 35 or later had better health at baseline but did not experience significantly different health declines. This study improves our understanding of linkages between fertility histories and later life health and possible implications of changes in fertility patterns for population health. However, research ideally using prospective life course data is needed to further elucidate possible mechanisms, considering interactions with partnership histories, health behaviour patterns and socio-economic trajectories

Longitudinal associations between television in the bedroom and body fatness in a UK cohort study.

OBJECTIVE: To assess longitudinal associations between screen-based media use (television (TV) and computer hours, having a TV in the bedroom) and body fatness among UK children. METHODS: Participants were 12 556 children from the UK Millennium Cohort Study who were followed from age 7 to age 11 years. Associations were assessed between screen-based media use and the following outcomes: body mass index (BMI), fat mass index (FMI), and overweight. RESULTS: In fully adjusted models, having a bedroom TV at age 7 years was associated with significantly higher BMI and FMI (excess BMI for boys=0.29, 95% confidence interval (CI) 0.06-0.52; excess BMI for girls=0.57, 95% CI 0.31-0.84; excess FMI for boys=0.20, 95% CI 0.04-0.37; excess FMI for girls=0.39, 95% CI 0.21-0.57) and increased risk of being overweight (relative risk (RR) for boys=1.21, 95% CI 1.07-1.36; RR for girls=1.31, 95% CI 1.15-1.48) at age 11 years, compared with having no bedroom TV. Hours spent watching TV or digital versatile disks were associated with increased risk of overweight among girls only. Computer use at age 7 years was not related to later body fatness for either gender. CONCLUSION: Having a TV in the child's bedroom was an independent risk factor for overweight and increased body fatness in this nationally representative sample of UK children. Childhood obesity prevention strategies should consider TVs in children's bedrooms as a risk factor for obesity.International Journal of Obesity advance online publication, 27 June 2017; doi:10.1038/ijo.2017.129

Surgery versus Watchful Waiting in Patients with Craniofacial Fibrous Dysplasia – a Meta-Analysis

Fibrous dysplasia (FD) is a benign bone tumor which most commonly involves the craniofacial skeleton. The most devastating consequence of craniofacial FD (CFD) is loss of vision due to optic nerve compression (ONC). Radiological evidence of ONC is common, however the management of this condition is not well established. Our objective was to compare the long-term outcome of patients with optic nerve compression (ONC) due to craniofacial fibrous dysplasia (CFD) who either underwent surgery or were managed expectantly.We performed a meta-analysis of 27 studies along with analysis of the records of a cohort of patients enrolled in National Institutes of Health (NIH) protocol 98-D-0145, entitled Screening and Natural History of Fibrous Dysplasia, with a diagnosis of CFD. The study group consisted of 241 patients; 122 were enrolled in the NIH study and 119 were extracted from cases published in the literature. The median follow-up period was 54 months (range, 6-228 months). A total of 368 optic nerves were investigated. All clinically impaired optic nerves (n = 86, 23.3%) underwent therapeutic decompression. Of the 282 clinically intact nerves, 41 (15%) were surgically decompressed and 241 (85%) were followed expectantly. Improvement in visual function was reported in fifty-eight (67.4%) of the clinically impaired nerves after surgery. In the intact nerves group, long-term stable vision was achieved in 31/45 (75.6%) of the operated nerves, compared to 229/241 (95.1%) of the non-operated ones (p = 0.0003). Surgery in asymptomatic patients was associated with visual deterioration (RR 4.89; 95% CI 2.26-10.59).Most patients with CFD will remain asymptomatic during long-term follow-up. Expectant management is recommended in asymptomatic patients even in the presence of radiological evidence of ONC