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Weight gain in children: possible relation to the development of diabetes
Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics .
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The prevalence of overweight and obesity among children has increased the last decades and is now defined as a global epidemic disease by the World Health Organization. Also the incidence of type 1 diabetes has increased and there are some hypothesises that argue there is a connection between overweight/obesity and type 1 diabetes.

Aim: The general aim of this thesis was to study factors contributing to the development of overweight and obesity among children and to study possible relations to the development of diabetes.

Method: All Babies in Southeast Sweden, ABIS, is a prospective cohort study. The study includes all babies who were born in southeast Sweden between Oct 1st 1997 until Oct1st 1999 and the design was to follow them up to school age in ABIS I and to follow them until 14 years in ABIS II, of the eligible 74 % entered the study. The families have answered questionnaires and biological samples were taken mainly from the children at the different time points: birth, 1 year, 2.5 years, 5 years and 8-9 years. In this thesis studies have been made including the whole cohort, but some studies have also been made involving only a part of the children.

Results: The prevalence of overweight and obesity among children in the ABIS study was 12.9% overweight and 2.5 % obese at 5 years of age. One risk factor which appeared to have a great impact on the development of overweight and obesity at 5 years of age was the child’s own BMI at an early age and also the heredity for overweight/ obesity and the heredity for type 2 diabetes. If the father had a university degree, the child was less likely to be obese at 5 years of age. Other factors, such as the parents´ age, if the child had any siblings, and if the child lived with a single parent, did not show any significant correlation to the child’s BMI at 5 years of age.

Early nutrition has been studied and no correlation could be found between breastfeeding less than 4 months and the development of overweight/obesity at 5 years of age. The parents answered questions about how frequent the child ate different food at 2.5 years and at 5 years. Intake of sweet lemonade was the only single food which was correlated to a higher BMI in 5 years old children. Porridge seemed to be protective against overweight/ obesity. In one of the studies the physical activity was measured by a step counter. The fewer steps the children were taking, the higher BMI and waist circumference they had. Low physical activity was also associated with a higher C-peptide value and decreased insulin sensitivity. Children who spent more time in front of TV/video had a higher fasting blood glucose value.

Conclusions: A strong factor for the development of overweight and obesity among children is the child’s own BMI at an early age and also its heredity for overweight/ obesity and the heredity for type 2 diabetes. Early nutrition did not show any obvious correlations with overweight and obesity at 5 year old children. Low physical activity was associated with higher fasting C-peptide value and decreased insulin sensitivity. Low physical activity may cause β-cell stress which might contribute to an autoimmune process in individuals genetically predisposed to autoimmunity and, thereby, to the increasing incidence of Type 1 diabetes in children.

Abstract [sv]

Bakgrund: Förekomsten av övervikt och fetma bland barn har ökat under de senaste decennierna och klassas av Världshälsoorganisationen (WHO) som en global epidemi. Antalet barn som insjuknar i typ 1 diabetes har också ökat och det finns en del hypoteser som argumenterar för att det finns en koppling mellan övervikt/fetma och typ 1 diabetes.

Syfte: Den här avhandlingens syfte var att studera faktorer som bidrar till utvecklingen av övervikt och fetma hos barn och att studera om det möjligen finns en relation till utvecklingen av typ 1 diabetes.

Metod: Alla Barn I Sydöstra Sverige, ABIS, är en prospektiv kohort studie. Alla barn, som föddes mellan 1:a oktober 1997 till 1:a oktober 1999 i sydöstra Sverige, erbjöds delta. Barnen följdes sedan upp till skolåldern i ABIS I och till 14 års ålder i ABIS II. Från starten valde 74% av de tillfrågade familjerna att gå med i studien. Familjerna har besvarat frågeformulär, och biologiska prover är tagna huvudsakligen från barnen vid de olika åldrarna: födseln, 1 år, 2.5 år, 5 år och 8-9år. I avhandlingen ingår dels studier med hela ABIS kohorten, men i två av studierna deltar endast en del av barnen.

Resultat: Hos de barn som igår i ABIS studien var 12,9% överviktiga vid 5 års ålder och 2,5% var feta. En faktor som visade sig ha betydelse för utvecklingen av övervikt och fetma hos 5 år gamla barn var barnets eget BMI vid tidig ålder samt hereditet för övervikt/fetma och hereditet för typ 2 diabetes. Om föräldrarna, framförallt pappan, läst på högskola eller universitet var barnen mindre ofta överviktiga/feta. Andra faktorer som föräldrarnas ålder, om barnet hade några syskon och om barnet levde med en ensamstående förälder visade sig inte ha betydelse för utvecklingen av övervikt och fetma hos barnen. Tidig uppfödning har också studerats. Vi fann ingen korrelation mellan kort amning, dvs. mindre än 4 månader, och utvecklingen av övervikt/ fetma hos 5 år gamla barn. Föräldrarna har också fått svara på hur frekvent barnet åt olika livsmedel vid 2.5 år och vid 5 år. Saft var det enda livsmedel som enskilt hade ett samband med utveckling av övervikt och fetma vid 5 år. Gröt föreföll ha en skyddande effekt. I en delstudie har fysisk aktivitet mätts med stegräknare. Ju färre steg ett barn tog, desto större risk förelåg för övervikt och fetma. Låg fysisk aktivitet var också associerad till ett högre C-peptidvärde och minskad insulinkänslighet. Barn som tittar mycket på TV/video hade ett högre fasteblodsocker.

Konklusion: Av betydelse för utveckling av övervikt och fetma hos barn är barnets eget BMI i tidig ålder och dess hereditet för övervikt och fetma samt hereditet för typ 2 diabetes. Tidig nutrition verkar inte ha några uppenbara samband med övervikt och fetma hos 5 år gamla barn. Låg fysisk aktivitet var associerad till högt faste C-peptid och ökad insulinresistens, vilket skulle kunna stressa β-cellerna och därmed, i enlighet med β- cell stress hypotesen, kunna bidra till en ökad förekomst av typ 1 diabetes hos barn.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 49 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1090
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16608ISBN: 978-91-7393-729-0 (print)OAI: oai:DiVA.org:liu-16608DiVA: diva2:159025
Public defence
2009-02-13, Qulturum, Länsjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2009-08-21Bibliographically approved
List of papers
1. Risk factors in childhood obesity: findings from the All Babies In Southeast Sweden (ABIS) cohort
Open this publication in new window or tab >>Risk factors in childhood obesity: findings from the All Babies In Southeast Sweden (ABIS) cohort
2007 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 9, 1321-1325 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-4690 (URN)17666104 (PubMedID)
Available from: 2007-11-22 Created: 2007-11-22 Last updated: 2017-12-12Bibliographically approved
2. Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: a prospective cohort study
Open this publication in new window or tab >>Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: a prospective cohort study
2008 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 8, no 42Article in journal (Refereed) Published
Abstract [en]

Background: Overweight and obesity are increasing among children all over the world. Socio-economic factors may influence the development of overweight and obesity in childhood, and it has been proposed that breastfeeding may protect against obesity. The aim of our study was to examine the relationship between exclusive breastfeeding and obesity when potential confounders, such as socioeconomic factors, are considered.

Methods: The data analyzed was from ABIS (All Babies in Southeast Sweden), a prospective cohort study. All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden (n = 21,700) were asked to participate. Parents were asked to answer periodic questionnaires from the time of the child's birth (n = 16,058) until he/she was five years of age (n = 7,356). Cutoffs for overweight and obesity were defined according to Cole et al, age and gender adjusted. Short-term exclusive breastfeeding was defined as < 4 months of exclusive breastfeeding. Multiple logistic regressions were used to identify variables that predict the child's BMI (Body Mass Index) at five years of age.

Results: At five years of age, 12.9% of the children in the study wereoverweight and 4.3% were obese. At the age of three months, 78.4% of the children were being breastfed exclusively. The median exclusive breastfeeding duration was four months. High maternal BMI > 30 (AOR = 1.07; CI = 1.05–1.09; P < 0.001), maternal smoking (AOR = 1.43; CI = 1.05–1.95; P = 0.023) and being a single parent (AOR = 2.10; CI = 1.43–3.09; P < 0.001) were associated with short-term exclusive breastfeeding (less than 4 months). Short-term exclusive breastfeeding was less common if one of the parents had a university degree (Mother: AOR = 0.74; CI = 0.61–0.90; P = 0.003 Father: AOR = 0.73; CI = 0.58–0.92; P = 0.008) or if the father was more than 37 years old (AOR = 0.74; CI = 0.55–0.99; P = 0.045). Short-term exclusive breastfeeding was associated with obesity in five-year-old children (simple logistic regression: OR = 1.44; CI = 1.00–2.07; P = 0.050), but when including other independent factors in the analysis, short-term exclusive breastfeeding did not attain statistical significance.

Conclusion: We cannot exclude the possibility that exclusive breastfeeding influences weight development, but it does not seem to protect against obesity at five years of age.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16604 (URN)10.1186/1471-2431-8-42 (DOI)
Available from: 2009-02-22 Created: 2009-02-06 Last updated: 2017-12-14Bibliographically approved
3. Relationship of food frequencies as reported by parents to overweight and obesity at 5 years
Open this publication in new window or tab >>Relationship of food frequencies as reported by parents to overweight and obesity at 5 years
2009 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 1, 139-143 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate if food frequencies are related to overweight/obesity in 5-year-old children.

METHODS: During 1997-1999, 21 700 infants were invited to participate in ABIS (All Babies in Southeast Sweden), a prospective, cohort study. Participants were followed from birth (n = 16 058) to 5 years (n = 7356). Food frequencies reported by parents at 2.5 and 5 years were studied in the relation to overweight/obesity at 5 years using multiple logistic regressions. A p-value < 0.01 was considered statistically significant.

RESULTS: At 2.5 years frequencies of intake of cheese were positively associated with overweight/obesity at 5 years while porridge, fried potatoes/french fries and cream/crème fraiche showed a negative association. When adjusting for known risk factors, porridge and fried potatoes/french fries remained negatively associated with overweight/obesity. At 5 years, chocolate and lemonade were positively associated with overweight/obesity whereas cream/crème fraiche, pastries and candy were negatively associated. Candy remained negatively associated to overweight/obesity after adjustment for potential confounders.

CONCLUSION: Food frequencies do not offer any simple explanation for overweight/obesity. Porridge at 2.5 years may protect against overweight/obesity at 5 years, while lemonade may contribute to overweight. Our finding that fried potatoes/french fries may protect against overweight/obesity is unexpected and must be interpreted with caution. These findings should be confirmed by prospective studies using objective recordings.

National Category
Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:oru:diva-3480 (URN)10.1111/j.1651-2227.2008.01043.x (DOI)18823298 (PubMedID)
Available from: 2008-12-08 Created: 2008-12-08 Last updated: 2017-12-14Bibliographically approved
4. Fasting plasma glucose levels in healthy preschool children: effects of weight and lifestyle
Open this publication in new window or tab >>Fasting plasma glucose levels in healthy preschool children: effects of weight and lifestyle
Show others...
2007 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 5, 706-709 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate whether a modern lifestyle, with a high-energy intake and a low level of physical activity, influences fasting plasma glucose concentration in healthy children.

Methods: As a part of the prospective study 'All Babies in Southeast Sweden', 127 children from six preschool units chose to participate. The children, 56% girls and 44% boys, were 5–7 years old. Parents answered a questionnaire about their children's heredity, and physical exercise and eating habits. In the morning, before the children ate breakfast, fasting plasma glucose levels and weight, height and waist circumference were measured.

Results: Fasting plasma glucose levels varied between 3.7 and 6.1 mmol/L, with both mean and median values of 4.7 mmol/L. There was no association between fasting plasma glucose level and body mass index (BMI), eating habits or degree of physical exercise. BMI and waist circumference were significantly correlated (p < 0.01). Children who play outdoors most frequently had a significantly lower BMI (p < 0.05) and waist circumference (p < 0.01), whereas children who more often watch TV had a significantly higher BMI (p < 0.01).

Conclusion: A modern lifestyle, with low levels of exercise and high-energy consumption, may explain the increasing weight and even obesity of otherwise healthy, preschool children, but does not influence their fasting plasma glucose levels.

Place, publisher, year, edition, pages
Wiley InterScience, 2007
Keyword
Accelerator hypothesis, BMI, Healthy children, Lifestyle, Plasma glucose
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16605 (URN)10.1111/j.1651-2227.2007.00253.x (DOI)
Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2017-12-14
5. Physical activity, blood glucose and c-peptide in healthy school-children
Open this publication in new window or tab >>Physical activity, blood glucose and c-peptide in healthy school-children
2010 (English)Article in journal (Refereed) Submitted
Abstract [en]

Background: The incidence of type 1 diabetes is increasing. This increase must be due to environmental factors. Low physical activity and overweight/obesity among children may play a role.

Objective: The aim of the current study was to investigate how lack of physical activity relates to blood glucose value and insulin sensitivity in healthy children. A second aim was to explore whether low physical activity is related to overweight/obesity in children.

Methods: This study is part of the prospective cohort study ‘All Babies In southeast Sweden’ (ABIS). 199 children from different schools participated. Pedometersteps during 4 days were registered as well as height and weight, and fasting blood glucose and serum C-peptide were determined. Parents answered a questionnaire.

Results: Fewer dailysteps correlated to higher BMI (P= 0.019) and waist circumference (P=0.018) as well as to higher C-peptide (P= 0.044), HOMA IR (P=0.046) and HOMA β-cell (P=0.022). Children who spent more hours/day in front of TV/Video had higher waist circumference (P= 0.033) and higher fasting blood glucose values (P=0.016).

Conclusion: Already in early school-age low physical activity is related to increased BMI and waist circumference. These signs and low physical activity are accompanied by a decreased insulin sensitivity compensated for by significantly increased insulin secretion. Low physical activity may cause beta cell stress which might contribute to an autoimmune process in individuals predisposed to autoimmunity, and thereby to the increasing incidence of Type 1 diabetes in children.

Keyword
Blood glucose, Children, Obesity, Physical activity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16606 (URN)
Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2010-04-20

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