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【资讯翻译】Mom's Gestational Diabetes Raises Childhood Risk of Obesity...

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发表于 2016-8-16 10:55:49 | 显示全部楼层 |阅读模式
Mom's Gestational Diabetes Raises Childhood Risk of Obesity: Worldwide Study

Maternal gestational diabetes (GDM) is associated with increased odds of offspring obesity at age 9 to 11 years, suggests a multinational study of more than 4700 children. However, note the authors, the association was only partially independent of current maternal body mass index (BMI).
The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was published online August 11 inDiabetologia and led by Pei Zhao, MD, from Tianjin Women’s and Children’s Health Center, China, in collaboration with researchers from Asia, Europe, Africa, and North and South America.
Children born to mothers who had gestational diabetes had significantly higher prevalence of general obesity (18.4% vs 12.0%, P = .006), central obesity (16.0% vs 9.6%, P = .003), and high body fat (12.1% vs 7.9%, P = .030) at age 9 to 11 years compared with children of mothers without gestational diabetes, according to the report. These children also had significantly higher mean birth weight (3415 g vs 3274 g, P = .001).
Previous studies have found that children born to women with gestational diabetes, which the authors note affects up to 28% of pregnancies, are at increased risk of obesity. But to date the majority of research has been in high-income countries, with limited data from countries with low to middle incomes. In light of this, the researchers acknowledged the need for studies of children from multiple regions of the world.
"Our study is the first to evaluate the association between maternal GDM and childhood obesity using such widespread, multinational data," write the authors. "Moreover, our results indicate that the positive associations between maternal GDM and the risk of childhood obesity were significant among children from low- to middle-income countries and between maternal GDM and an increased risk of central obesity among children from high-income countries."
The inclusion of a large multinational sample of children from low- to high-income countries was said to be a key strength of the study. In total, the study included 4740 children aged 9 to 11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States.
The cross-sectional study aimed to examine the association between maternal gestational diabetes, diagnosed according to the American Diabetes Association (ADA) or World Health Organization (WHO) criteria, and three indicators of childhood obesity (BMI, waist circumference, and body fat) in children aged 9 to 11 years.
Worldwide Association, but "Not Fully Independent"
The authors report that they found an association between maternal GDM and increased odds of general childhood obesity and central obesity in children aged 9 to 11 years old across the 12 countries. "However, these associations were not fully independent of maternal BMI."
Birth weights, obesity rates, and percentage body fat varied widely around the world. Overall prevalence of reported maternal gestational diabetes was 4.3% but ranged from 1.9% in the United Kingdom and China to 8.8% in Portugal. Mothers with gestational diabetes had significantly older age at delivery than mothers without gestational diabetes (29.9 years vs 28.3 years, P < .001).
Of note, adjusted odds ratios among children of mothers with GDM compared with children of mothers without gestational diabetes were 1.53 (P = .034) for general obesity, 1.73 (P = .01) for central obesity, and 1.42 (P = .14) for high body fat. Adjustments were made for maternal age at delivery, maternal education, infant feeding mode, gestational age, number of younger siblings, child unhealthy-diet pattern scores, moderate to vigorous physical activity, sleeping time, sedentary time, age, sex, and birth weight.
Of note, according to the group, these associations were no longer significant after further adjustment for current maternal BMI (about 10 years' postpartum).
Mechanisms Behind the Findings?
Areas for further research, the authors write, include exploration of the effects of maternal gestational diabetes on the risks of childhood obesity and central obesity. Also, the mechanisms responsible for increased obesity risk in these children need further clarification.

Of note, according to the authors, "exposure to maternal diabetes is associated with excess fetal growth in utero, possibly mainly due to an increase in fetal fat mass and alterations in fetal hormone levels. In addition, exposure to maternal diabetes results in elevated hyperglycemia, hyperinsulinemia, and elevated leptin synthesis in offspring."
Some research also suggest that gestational diabetes might cause an epigenetic alteration in the fetal genome, the group notes, influencing the expression of genes that direct the accumulation of body fat or related metabolism.

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发表于 2016-8-16 11:16:03 | 显示全部楼层
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发表于 2016-8-17 10:21:31 | 显示全部楼层

一份全球性研究表明:孕妇患有妊娠期糖尿病将会增加孕儿在其儿童期患肥胖症的风险

近期,科学家完成了一项研究,范围涉及多个国家,被调查的儿童人数超过4700人。此项研究表明:孕妇患有妊娠期糖尿病(GDM),将会增加孕儿在其9岁到11岁期间患肥胖症的概率。然而,作者也指出,这种关联性仅独立于部分被调查的孕妇的身体质量指数(BMI)情况。
中国天津的妇女与儿童健康管理中心的医学博士Pei Zhao带领科研团队,与其他来自亚洲,欧洲,非洲与南北美洲的研究者们一起,共同编写了一份关于儿童肥胖症,生活习惯与环境三者相关性的国际性调查报告,并于今年8月11日,发布在相关糖尿病期刊网上。
研究数据表明,在9岁到11岁的孩子中,母亲患过GDM,孩子得肥胖症的患病率明显要高于不患有GDM的母亲的孩子:一般肥胖症患者(频率比=18.4%:12.0%,概率=0.006);中心型肥胖症患者(频率比=16.0%:9.6%,概率=0.003);高体脂肥胖症患者(频率比=12.1%:7.9%,概率=0.030)。与此同时,数据也表明前者的平均出生体重要高于后者(体重比=3415克:3274克,概率=0.001)。
先前有研究表明,孕妇患过妊娠性糖尿病,有28%的孩子会受母亲孕期影响,增加患肥胖症的风险。但是在那些调查中,研究数据主要来源于高收入国家,而来自低收入或中等收入国家的数据不多。鉴于此,研究者们认为,很有必要在全球范围内进一步展开相关调查。
“我们的研究是全球首次能在多区域,多国之间广泛开展有关于孕妇患过妊娠期糖尿病与其孕儿在儿童期患肥胖症相关性的调查”作者写道,“我们的结果表明,在低收入或中等收入的国家中,孕妇患有妊娠期糖尿病与孕儿在其童年患有肥胖症表现出明显的正相关性;在高收入国家中,孕妇患i过妊娠期糖尿病与孕儿在其儿童期患中心型肥胖症有正相关性"
在所有的调查数据中,调查不同收入水平的国家的孩子,获得的样本数据将是研究要点。总的来说,有4740名孩子参与调查,年龄都在9岁到11岁之间,分别来自于澳大利亚,巴西,加拿大,中国,哥伦比亚,芬兰,印度,肯尼亚,葡萄牙,南非,英国,美国。
研究主要采用横断面调查方法,参照ADA或WHO的标准诊断孕妇患妊娠期糖尿病情况,同时测量儿童的三种肥胖指标(BMI,腰围,胸围,身体脂肪比例),综合分析孕妇患妊娠期糖尿病与孕儿在儿童期患肥胖症之间的关系。
该相关性是全球性相关,而并非完全独立
研究者们在全球12个国家中,随机调查年龄在9岁到11岁的孩子,综合分析孕妇患有妊娠期糖是否能增加孕儿在童年期患一般肥胖症,中心型肥胖症的风险。“然而,这些相关性,并非完全独立于产妇的身体质量指数。”
婴儿出生体重,肥胖级别,身体脂肪比例等,在全球范围内的不同地区,评定标准也不一样。具体运用中,要综合考虑。另外,据报告显示,在调查人员中,总的孕妇患妊娠期糖尿病的患病率为4.3%。其中,在英国与中国境内有1.9%的孕妇患过妊娠期糖尿病;在葡萄牙有8.8%的孕妇患过妊娠期糖尿病。患过妊娠期糖尿病的孕妇的平均年龄要高于没有患过妊娠期糖尿病产妇的平均年龄(平均年龄比=29.9:28.3,概率<0.001)
对于调查所得数据,通过数据标准化处理,患过GDM的母亲的孩子与没有得过GDM的母亲的孩子各分为三组:在患有一般肥胖的患者中,前后两者的数量比值为1.53(概率=0.034);在中心型肥胖症患者中,两者的数量比值为1.42(概率=0,14);在高体脂肥胖症患者中,两者的数量比值为1.42(概率=0.14)。参与标准化处理的影响因素有:分娩时产妇的年龄,产妇的受教育程度,婴儿喂养模式,孕龄,是否为头胎,孩子的不健康饮食模式得分,中度到剧烈的身体运动情况,睡眠时间,久坐时间,年龄,性别,以及出生体重。
需要注意的是,现有的调查群体都是产后近10年的母亲群,取得的孕妇身体质量指数数据尽管进一步加以处理,但是获得的相关性表现并不明显。
支持性的研究机制
若要在该领域深入研究,可以探究孕妇妊娠期糖尿病对孕儿在儿童期的一般肥胖症与中心型肥胖症的影响。当然,增加儿童患肥胖症症风险的相关研究机制需要进一步明确化。
值得注意的是,作者有写到“患有妊娠期糖尿病的孕妇,孕儿在子宫内过度成长,主要表现为胎儿的身体脂肪量增加与激素水平增加。此外,孕妇患有妊娠期糖尿病,将会增加其孩子患高血糖,高胰岛素的风险,也会促进其瘦素水平的合成”
有些研究也提出:孕妇患有妊娠期糖尿病,有可能造成孕儿基因层面的遗传性改变,具体可直接表现为身体脂肪积累,相关代谢水平提高。

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