Rossem, L. van

Response to childrenê 1/4s home blood pressure and growth environment (Article)

2013-04-01T00:00:00Z

Blood pressure in 12-year-old children is associated with fatty acid composition of human milk: The prevention and incidence of asthma and mite allergy birth cohort (Article)

2012-10-01T00:00:00Z

Breastfed individuals have a lower blood pressure than formula-fed individuals. Supplementation with n-3 long-chain polyunsaturated fatty acids in adults is also associated with a lower blood pressure. We studied whether children receiving human milk with a relatively high content of n-3 long-chain polyunsaturated fatty acids have a lower blood pressure at age 12 years, and, if so, whether this association is explained by the n-3 long-chain polyunsaturated fatty acids content in erythrocyte membranes at age 12 years. Within a 12-year follow-up of a population-based birth cohort, we compared blood pressure of 205 never-breastfed children and 109 children who had fatty acid composition of their mothers' breast milk measured during lactation. In addition, 973 children had information on erythrocyte fatty acid composition and blood pressure at age 12 years. Children who received human milk with an n-3 long-chain polyunsaturated fatty acids content above the median (ie, 0.51 weight percentage) had a 4.79-mm Hg lower systolic (95% CI, -7.64 to -1.94) and a 2.47-mm Hg lower diastolic (95% CI, -4.45 to -0.49) blood pressure at age 12 years than never-breastfed children. N-3 long-chain polyunsaturated fatty acids levels in human milk below the median value and current n-3 long-chain polyunsaturated fatty acid status were not associated with blood pressure at age 12 years. Thus, a relatively high content of n-3 long-chain polyunsaturated fatty acids in human milk is associated with a lower blood pressure in children at age 12 years, a finding not explained by current n-3 long-chain polyunsaturated fatty acids status.

The role of prenatal, perinatal and postnatal factors in the explanation of socioeconomic inequalities in preschool asthma symptoms: The Generation R Study (Article)

2012-01-19T00:00:00Z

Background: The authors assessed whether socioeconomic inequalities in asthma symptoms were already present in preschool children and to what extent prenatal, perinatal and postnatal risk factors for asthma symptoms mediate the effect of socioeconomic status (SES). Methods: The study included 3136 Dutch children participating in the Generation R Study, a prospective cohort study. Adjusted ORs of asthma symptoms for low and middle SES (household income and maternal education) compared to high SES were calculated after adjustment for potential confounders and also adjusted for prenatal, perinatal and postnatal mediators at preschool age. Results: At age 1 year, low-SES children had a 40% lower risk of asthma symptoms compared to high-SES children (p<0.01). However, the risk of asthma symptoms in 3- and 4-year-old low-SES children was 1.5 times higher compared to their high-SES age mates (p<0.05). The positive associations at age 1 year were particularly modified by postnatal factors (up to 38%). In toddlers, prenatal factors explained up to 58% of the negative associations between SES and asthma symptoms. Conclusions: SES indirectly affects asthma symptoms at preschool age. The inverse association between SES and asthma symptoms emerges at age 3 years. This is particularly due to a high level of adverse prenatal circumstances in low-SES toddlers. Future research should evaluate public health programs (during pregnancy) to reduce socioeconomic inequalities in childhood asthma. Copyright Article author (or their employer) 2012.

An observational study on socio-economic and ethnic differences in indicators of sedentary behavior and physical activity in preschool children (Article)

2012-01-01T00:00:00Z

Objective: We studied associations between social disadvantage and indicators of sedentary behavior and physical activity at preschool age. Methods: Data from 4688 children enrolled in a birth cohort in Rotterdam, the Netherlands, between 2002 and 2006 were analyzed. Indicators of sedentary behavior (watching television ≥ 2 h/day and sitting in a buggy ≥ 0.5 h/day) and physical inactivity (playing outside < 3 h/day) were measured by a parent-reported questionnaire at age 3. Adjustments were made for social circumstances and indicators of health behaviors. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI). Results: Children with low-educated mothers (OR: 3.27, 95% CI 2.12-5.05) and non-Dutch children (ORnonWestern: 2.67, 95% CI 2.04-3.49, ORWestern: 2.09, 95% CI 1.42-3.0) were more likely to watch television for at least 2h/day. Similar results were seen for sitting in a buggy for at least 0.5h/day. Non western children were more likely to play outside for less than 3h/day (OR: 1.95, 95% CI: 1.39-2.73) than native Dutch children, while no differences were seen for other western children or children from mothers with a low educational level. Conclusions: Socio-economic status and ethnicity are already associated with indicators of sedentary lifestyles at preschool age.

Breast-feeding and growth in children until the age of 3 years: The Generation R Study (Article)

2011-06-14T00:00:00Z

Breast-feeding has been suggested to be associated with lower risks of obesity in older children and adults. We assessed whether the duration and exclusiveness of breast-feeding are associated with early postnatal growth rates and the risks of overweight and obesity in preschool children. The present study was embedded in a population-based prospective cohort study from early fetal life onwards, among 5047 children and their mothers in The Netherlands. Compared with children who were breast-fed, those who were never breast-fed had a lower weight at birth (difference 134 (95 % CI ' 190,' 77) g). No associations between breast-feeding duration and exclusivity with growth rates before the age of 3 months were observed. Shorter breast-feeding duration was associated with an increased gain in age- and sex-adjusted standard deviation scores for length, weight and BMI (P for trend < 0•05) between 3 and 6 months of age. Similar tendencies were observed for the associations of breast-feeding exclusivity with change in length, weight and BMI. Breast-feeding duration and exclusivity were not consistently associated with the risks of overweight and obesity at the ages of 1, 2 and 3 years. In conclusion, shorter breast-feeding duration and exclusivity during the first 6 months tended to be associated with increased growth rates for length, weight and BMI between the age of 3 and 6 months but not with the risks of overweight and obesity until the age of 3 years.

Is the association of breastfeeding with child obesity explained by infant weight change? (Article)

2011-06-01T00:00:00Z

Objective. Breastfeeding and infant weight change are both associated with adiposity. We examined the extent to which infant weight change mediates the association between breastfeeding and adiposity at age 3 years. Methods. We studied 884 children in a prospective cohort study. We determined breastfeeding status in the first 6 months. Our primary outcomes at 3 years were body mass index (BMI) z score and the sum of subscapular and triceps skinfold thicknesses (SS + TR); we also assessed obesity. We defined infant weight change as change in weight-for-age z score between birth and 6 months. We performed multivariable regression analyses. Results. At age 6 months, 25.0% of infants were fully breastfed. At age 3 years, mean (standard deviation) BMI z score was 0.45 (1.03). In linear regression analyses adjusted for mother's educational level, race/ethnicity, smoking, BMI, pregnancy weight gain and birth weight (adjusted for gestational age), the BMI z score of fully breastfed children was 0.17 (95% CI: -0.43, 0.09) units lower than never breastfed children. After additional adjustment for infant weight change, the estimate was attenuated (-0.03, 95% CI: -0.27, 0.20). Adjustment for infant weight change only modestly attenuated estimates for SS + TR (from -1.48 mm [95% CI: -2.52, -0.44] to -1.16 mm [95% CI: -2.18, -0.14]), and for the odds of being obese (from 0.21 [95% CI: 0.07, 0.68] to 0.29 [95% CI: 0.08, 1.05]). Conclusion. Infant weight change between birth and 6 months mediates associations of breastfeeding with BMI, but only partially with indicators of child adiposity.

Early Life Risk Factors in the Development of Social Inequalities in Preschool-Age Overweight: The Generation R Study (Doctoral Thesis)

2011-01-12T00:00:00Z

Social disadvantage, a collective term which may (among others) refer to low socioeconomic status (i.e. low educational level, low income, low job status) or non-native ethnicity, is a strong determinant of health. Socioeconomic status and ethnicity (the latter being strongly associated with socioeconomic status) are of particular interest in the context of the subject of this thesis, i.e. overweight.

Socioeconomic Status is not Inversely Associated with Overweight in Preschool Children (Article)

2010-12-01T00:00:00Z

Objective: To assess whether socioeconomic inequalities were already present in preschool children. Study design: We used data from 2954 Dutch children participating in a longitudinal birth cohort study. Indicators of socioeconomic status were mother's educational level and household income. Body mass index (BMI)-for-age standard deviation scores were derived from a national reference. Overweight was defined at 24 and 36 months according to age- and sex-specific cut-off points for BMI. Multivariable regression analyses were performed. Results: Relative to children from mothers with the highest educational level, mean BMI standard deviation scores was lower at age 24 months in children from mothers with the low, mid-low, and mid-high educational level, and in the mid-low group at 36 months (P < .001). Prevalence of overweight was lower in children from mothers with the mid-low educational level at age 24 and 36 months (adjusted odds ratio at 24 months: 0.61; 95% confidence interval: 0.43-0.87 and at 36 months: 0.65; 95% confidence interval: 0.44-0.96) but was not significantly different for the other educational levels. There were no significant differences in childhood overweight by income level. Conclusions: The inverse association between socioeconomic status and childhood overweight presumably emerges after age 3 years. Before this age, the gradient may be the reverse.

Breastfeeding patterns among ethnic minorities: The Generation R Study (Article)

2010-12-01T00:00:00Z

Background Because breastfeeding is the best method of infant feeding, groups at risk of low breastfeeding rates should be identified. Therefore, this study compared breastfeeding patterns of ethnic minority groups in The Netherlands with those of native mothers and established how they were influenced by generational status and socio-demographic determinants of breastfeeding. Methods We used data on 2914 Dutch, 366 Mediterranean first-generation, 143 Mediterranean second-generation, 285 Caribbean first-generation and 140 Caribbean second-generation mothers. Information on starting breastfeeding and breastfeeding at 2 and 6 months after birth were obtained from questionnaires during the first year after birth. Results Overall, 90.6% of women started breastfeeding after delivery. This percentage was lowest among the native Dutch (89.1%) and highest among the Mediterranean second-generation women (98.6%; p≤0.001). At 6 months postpartum, 30.6% of mothers were still breastfeeding, ranging from 19.3% in the Caribbean second-generation mothers to 42.6% in first-generation Mediterranean mothers. After adjustment for covariates, more non-native mothers started breastfeeding than native Dutch mothers. While Mediterranean first-generation mothers had higher breastfeeding rates at 6 months (OR: 2.71, 95% CI: 2.09 to 3.51), there were no differences in Mediterranean second-generation and Caribbean mothers compared to native Dutch mothers. Conclusion More non-native mothers started breastfeeding than native mothers, but relative fewer continued. Although both native Dutch and non-native mothers had low continuation rates, ethnic minorities may face other difficulties in continuing breastfeeding than native women.

The Generation R study: A candidate gene study and genome-wide association study (GWAS) on health-related quality of life (HRQOL) of mothers and young children (Article)

2010-10-01T00:00:00Z

Aim: The aim of this paper is to describe the Generation R study as a template that enables candidate gene study and genome-wide association study regarding health-related quality of life (HRQOL) of mothers and their young children. Methods: Generation R is a population-based prospective cohort study from fetal life onwards in Rotterdam, The Netherlands. Children were born in 2002-2006. Blood from mothers and placenta cord blood were sampled. Mothers' HRQOL was measured 5 times during pregnancy and after birth using SF-12 and EQ-5D. Children's HRQOL was measured 5 times between age 1 and 5/6 years using Infant-Toddler Quality Of Life questionnaire (ITQOL), Health Status Classification System PreSchool (HSCS-PS) and Child Health Questionnaire Parent Form 28 items (CHQ-PF28), respectively. Results: DNA is available for 8,055 mothers and 5,908 children. Genotyping of various candidate genes and a genome-wide association (GWA) scan (Illumina 610K) of child DNA were done. A template for gene-HRQOL analyses is provided. We start with candidate gene study on HRQOL of mothers and children. Gene-environment interaction and interaction with medical indicators of health status will be explored. Next, GWA study on HRQOL will be performed. Conclusions: Gaining insight into the determinants of HRQOL is essential to assisting efforts in health policy and clinical application to improve well-being and health. In the future, it might be possible to complement HRQOL assessments by examinations of genetic markers. Strengths and weaknesses of the Generation R study are discussed.

Are starting and continuing breastfeeding related to educational background? The generation R study (Article)

2009-06-01T00:00:00Z

OBJECTIVE. To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association. METHODS. We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously. RESULTS. Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics. CONCLUSIONS. Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women. Copyright