The SA Journal Diabetes & Vascular Disease Vol 16 No 1 (July 2019)

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SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE
VOLUME 16 NUMBER 1 • JULY 2019 39
and suggests an association between raised total cholesterol
level and nucleoside reverse-transcriptase inhibitor (NRTI)-based
ART regimens in an HIV-infected African population. Our findings
provide further rationale for integrating routine cardiovascular risk-
factor screening into HIV-care services in resource-limited settings.
Larger studies with more detailed investigations and longer follow
up are recommended.
This work was supported by Grand Challenges Canada and
implemented in collaboration with ICAP Kenya, which implements
HIV PEPFAR care in the Nyanza region in Kenya.
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Weight gain in early childhood increases heart and metabolic risk in adolescence
Earlier onset of weight gain, under two years of age, is associated with
higher cholesterol, higher blood pressure, and more central fat in
adolescence, compared with onset of weight gain in children aged three to
five, finds a 14-year University of Sydney study.
The study tracked the body mass index (BMI) of children from birth to
14 years and found that earlier onset of high BMI (in children under two
years) resulted in higher cholesterol levels, higher blood pressure, and more
central (unhealthy) fat in adolescence, compared with onset of high BMI in
children aged three to five years.
Teenage obesity is a major health problem in Australia, but the
pathways to and the consequences of obesity in teenagers has not been
well studied. This is the first study to look at the consequences of weight
gain at two different stages of early childhood and its impact on developing
cardiovascular disease as an adult.
‘Our study found that there are two main pathways to obesity as a
teenager – rapid weight gain in the first two years of life (early weight gain)
or rapid weight gain between ages two and five years of age (later weight
gain),’ said senior author University of Sydney’s Professor David Celermajer,
Scandrett professor of cardiology at Sydney Medical School and the Heart
Research Institute.
‘The data show that there are consequences of the timing of the onset
of excess BMI in early childhood. Earlier onset of a rising BMI that persisted
through childhood results in greater central fat and higher cholesterol in
teenagers, independent of their BMI at 14 years.’
A group of 410 Australian children were assessed from birth throughout
childhood to age 14 years, recording their weight, height, and waist
circumference. Of the 410 children, 190 had detailed measurements of
cholesterol, blood pressure and central weight recorded at age 14 years.
Three groups were identified in the study: normal BMI, ‘early rising’ excess
BMI from two years, and ‘late rising’ excess BMI from five years.
Lead author Dr Jennifer Barraclough, cardiologist and PhD student
at University of Sydney and the Heart Research Institute said: ‘The early
weight-gain group have more centrally placed or unhealthy fat than
the later weight gain group. Fat around the middle is a key risk factor
for cardiovascular disease in adulthood. The early weight-gain group also
had significantly higher cholesterol levels compared to a group of healthy
weight teenagers.
‘Our study shows that the earlier the onset of excess fat before five
years of age, the more likely the individual is to have fat around the middle
by adolescence. The study also found that both early and late-weight gain
groups were more likely to have mothers with overweight or obesity and a
high BMI, than healthy weight teenagers.’
Co-author Professor Louise Baur, head of child adolescent health at the
University’s Sydney Medical School and The Children’s Hospital Westmead
said: ‘This study has shown that it is important for families and the
community to understand the risks of excess weight gain in early life and to
ensure healthy eating and activity are supported from a very young age.
‘These findings may provide an opportunity to identify “high risk” young
children and trial interventions at an early age, prior to the development
of high cholesterol and centrally placed fat, which becomes evident in
adolescence and increases the risk of heart disease as an adult.’
Baur highlighted the importance of healthy infant feeding.
‘Breastfeeding should be supported where possible until at least 12
months, with solids introduced from around six months. Healthy eating
and physical activity for all family members is also an important factor
promoting healthy weight gain in the young child. Family doctors and
early childhood nurses can also help to monitor weight gain in this critical
period of life,’ she said.
Source: Medical Brief 2019