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Nutrition 30 (2014) 150–158

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Nutrition
journal homepage: www.nutritionjrnl.com

Applied nutritional investigation

The association of birth weight with cardiovascular risk factors and mental
problems among Iranian school-aged children: The CASPIAN-III Study
Leila Azadbakht Ph.D. a, Roya Kelishadi M.D. b, *, Sahar Saraf-Bank M.Sc. a,
Mostafa Qorbani Ph.D. c, Gelayol Ardalan M.D. d, Ramin Heshmat Ph.D. e,
Mahnaz Taslimi M.Sc. f, Mohammad Esmaeil Motlagh M.D. g
a
Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
b
Pediatrics Department, Faculty of Medicine and Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
c
Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran
d
Office of School Health, Health and Medical Education, Tehran, Iran
e
Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Endocrinology and Metabolism Research
Institute, Tehran University of Medical Sciences, Tehran, Iran
f
Bureau of Health and Fitness, Tehran, Iran
g
Pediatrics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

a r t i c l e i n f o a b s t r a c t

Article history: Objective: Both high and low birth weights (HBW and LBW) are risk factors for adulthood diseases.
Received 28 December 2012 The aim of this study was to investigate the association of birth weight with cardiovascular disease
Accepted 2 June 2013 (CVD) risk factors and mental problems among Iranian school-aged children.
Methods: This national multicenter study of school-aged children entitled CASPIAN III was con-
Keywords: ducted among 5528 students in ranging from ages 10 to 18 y. Biochemical indices and anthro-
Birth weight
pometric measurements were collected. Mental health was assessed by questionnaire. To
Cardiovascular risk
investigate the association between birth weight categories and CVD risk factors and mental
Mental health
problems, multivariate logistic regression was used.
Results: HBW adolescents were at higher risk for elevated diastolic blood pressure (DBP)
(Ptrend < 0.05), low levels of high-density lipoprotein cholesterol (HDL-C) (Ptrend < 0.05), and lower
risk for general obesity (Ptrend < 0.05) compared with the LBW category. HBW had no significant
association with mental problems (Ptrend > 0.05) compared with LBW adolescents. The results of
regression analysis, which considered normal birth weight as the reference group, showed that
LBW students had lower risk for overweight and obesity (P < 0.01), as well as higher DBP (P < 0.05)
but they were at higher risk for lower levels of HDL-C (P < 0.01). Furthermore, birth-weight cat-
egories had a U-shaped relationship with mental problems and sleep disorders (P < 0.05). Risk for
confusion was higher among the LBW group (P < 0.05).
Conclusion: Findings from this population-based study revealed a positive relation between birth
weight categories and CVD risk factors. Compared with students born with normal weight, those
born with HBW and LBW were at higher risk for mental problems, sleep disorders, and confusion.
Ó 2014 Elsevier Inc. All rights reserved.

Introduction increase the risk for cardiovascular diseases (CVDs), hyperten-
sion, and type 2 diabetes [2,3]. Several studies have implied the
Prenatal factors have important effects on future health sta- relation of birth weight and the incidence of chronic diseases
tus, and birth weight is an important marker of prenatal health later in life [4,5].
[1]. Fetal programming hypothesis explains that adverse uterine Both birth weights <2500 g and >4000 g are risk factors
environment during the critical period of fetus development, as for adulthood diseases [1]. It is estimated that the worldwide
characterized by birth weight, may have lifelong consequences prevalence of low birth weight (LBW) is 15.5%, of which 72%
on organ development and mental health status, and may are born in Asia [6]. According to a Centers for Disease Control
and Prevention (CDC) report, the percentage of infants born at
* Corresponding author. Tel.: 00983117923060; fax: 00983116687898. 4000 to 4499 g declined from 9.1% to 7% from 1990 to 2005
E-mail address: kelishadi@med.mui.ac.ir (R. Kelishadi). [7]. It is estimated that 7.1% and 1.3% of Iranian newborn
0899-9007/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.nut.2013.06.005

and seldom or never. terval [CI]. student’s feeding during infancy. The results of cohort studies demonstrated a relationship between body weight and depres.5) and WHO GSHS. This study was approved by ethics committee and other relevant compared with a reference group (OR. as well as family history of chronic diseases (premature CVD. and cancers). behavior. Biochemical indices (fasting blood glucose and lipid profile) were measured in this group. The popu- tively [8]. respec.. and catecholamine levels and decreasing measured. / Nutrition 30 (2014) 150–158 151 infants are LBW and very low birth weight (VLBW).2 cm. A cohort study in Taiwan demonstrated a U-shaped relation attitude.78. Low-density lipoprotein (LDL) was measured in samples in which TG concentrations were <400 mg/dL. Additionally. respectively. For weight measurement. Azadbakht et al. and those who are Anthropometric measurements born large for gestational age had higher body mass index (BMI) Students and one of their parents were invited to school. Ministry of Health and Medical Education. all students were barefoot and in an Australian cohort [14]. family history of diseases. total CVD events by increasing platelet activity and aggregation. large-for-gestational-age children [10]. student’s birth weight. and knowledge. Further- two time measurements was recorded and included in the analysis [29]. sion and anxiety symptoms in 14-y-old adolescents [17] and SBP and diastolic blood pressure (DBP) were measured twice after more than 5 min rest. dietary habits of between birth weight and risk for type 2 diabetes. consent were obtained from children and their parents. therefore. 1. We also categorized participants’ birth the pediatric population of the Middle East and North Africa weights to <2500 g. osteopo- relation between HBW and obesity among children ages 6 to 18 y rosis. national regulatory organizations. lation of study was selected by a multi-stage cluster random sampling method. Study design and participants Statistical analysis This national multicenter study of school-aged children entitled CASPIAN III was conducted in 2009–2010 among 5528 urban and rural students ages 10 to We categorized general characteristics of boys and girls separately by 18 y. Some studies demonstrated a correlation between mental center nearest to their schools.2 kg. All questionnaires.g. and confusion sense. A cross-sectional study demonstrated that among patients with type 1 diabetes. (MENA) on the relationship between birth weight and mental Assessment of mental health health. a U-shaped relation of students were registered. while participants were in a sitting position and calm. questionnaire about sociodemographic status. and >4000 g.5 kg) have higher risk for major depressive disorder (MDD) and anx.04–3. HBW infants had higher odds ratio (OR) for type 2 diabetes Survey (GSHS). obesity. L.2 cm. A team of expert nurses examined the anthropo- between size at birth and cardiometabolic risk was documented metric measurements. 9. An oral assent and an informed written categories of birth weight including <2500 g (term babies with birth weight . One part of general health status questionnaire of GSHS was about mental health. Isfahan University of Medical between birth weight and systolic blood pressure (SBP) among Sciences. Parents were questioned whether their child was ever breastfed (yes/no) and There is no national report with such a large sample size among total duration of breastfeeding (in mos). sanitary habits. Detailed born small for gestational age had higher central obesity than methodology of this study has been reported previously [26]. a longitudinal study declared that LBW infants (<2. The results of the first survey of the validity and reliability of all questionnaires have been confirmed in the first CASPIAN (Childhood & Adolescence Surveillance and Prevention survey of this surveillance system. in. students and their parents were invited to the health [19]. but recent studies have shown that LBW increases the risk for psychiatric problems such as stress. including questions on mental health. The questions concerning sociodemo- developing countries compared with industrialized countries graphic characteristics. Age and birth date and hemoglobin (Hb)A1c [13]. tween birth weight status and mental health in adulthood. weights >4000 g. we used a mercury sphygmomanometer. A healthy snack problems such as depression or anxiety can elevate the risk for was given to students after blood sampling. Trained health care providers questioned of Adult Non-communicable disease) study showed that girls parents about variables related to sociodemographic issues and past history (e. wearing light cloths. For BMI calculation. angry rapidly. and Endocrinology and Metabolism Research Institute of Tehran young males [9]. almost every mo. For blood pressure measurement. and general association between birth weight and CVD risk factors. as defined in previous studies [27. Weight was measured nearest to 0. which was added to the abovementioned questionnaire [30]. having anxiety. Waist circumference (WC) was studies have examined the relationship between infant’s birth measured with a non-elastic tape with accuracy of 0. Biochemical assessments iety disorders compared with infants weighing >3500 g at birth For blood sampling. and the child’s birth weight were included in the parents’ may be one of the reasons for high prevalence of chronic diseases questionnaire. Moreover. the association between HBW and mental problems later in life The ratio of WC to height was considered a marker of abdominal obesity. High prevalence of LBW in The questionnaire was prepared based on the WHO STEP-wise approved by NCD (Tools ver. Weight and height were measured twice and the mean of two values was reported. were based on World Health Organization (WHO) Global School Health [11]. as well as infant duration of breastfeeding). Students recorded frequency of their mental problems according to given structure: almost every Methods day. these relationships in developing countries are less clear. are at higher risk for metabolic syndrome [25]. almost each week. more than one time per week. and triglyceride (TG) levels were flammatory cytokines. maternal education.21]. Ministry of Education and Training. and anxiety Blood pressure measurement during the life cycle [15. Adolescents answered the mental questions including getting some mental problems among this group of children. family dietary habits.16]. insomnia. One study demonstrated that children who are University of Medical Sciences collaborated in this national survey. The average of depression symptoms in young women ages 21 y [18]. The in such countries [24]. Height was Few studies have investigated the potential association be. depression. Participants were asked to fast over 12 h before problems and development of CVD later in life [20. 1. high-density lipoprotein (HDL). child’s birth weight. high birth Students and their parents completed a self-administered reliable and validated weight (HBW) infants have elevated risk for CVD risk factors. Blood samples were taken between 0800 and 0930.28]. Some weight (kg) was divided to height square (m2). 2500 to 4000 g. more.06) [12]. we decided to investigate the demographic status. The tape was placed weight and future mental health. and a positive family. heart rate variability. 95% confidence in. Mental doing tests. cholesterol (TC). Fasting blood sugar (FBS). as well as health status. as well as endothelial dysfunction [22]. There is no evidence regarding between last rib and iliac crest and WC was registered after a normal expiration. family history of who are born small for gestational age and boys who had birth obesity and other chronic diseases. To our knowledge. living in 27 provinces of Iran. skills. A prospective cohort study reported a negative relationship Child Growth and Development Research Center. However. It is noticeable that most relevant studies have been done Assessment of sociodemographic variables and birth weight in developed countries [23]. measured without shoes on with accuracy of 0. there is no data about the relationship between birth weight and CVD risk factors among Iranian Students completed a comprehensive questionnaire about their socio- school-aged children.

06 Obesity 41.05.8 0.09 Birth order (%) <0. that is. HBW boys were at higher risk for The number of girls and boys included in the present study mental disorders and insomnia.01 <0.2 2h 4. age.4 11 >2 h 60. cording to Table 1.2 1 0–6 mo 29. WC. and height) according to birth-weight categories.4 14.1 24. P-value between birth weight <2500 g and two other groups is P < 0.g.0  12.8 9. a significant relationship was found serum lipid profile and glucose levels. insomnia.8 >8 h 64. Statistical analyses were performed by using SPSS for Windows software (version 16. 33.1 61. IL).5  2.1 22.5 58.6 6. The boys assigned (using Tukey as post hoc) with 95% confidence interval across different categories to the birth-weight category >4000 g.6  4.8 7.4 12. self-employed fa- made versus commercial).2 25.6  2. Birth order had a significant response correlation between birth weight and CVD risk factors.9 18–24 mo 39. was more frequent in the LBW girls than in their significant.8  17.6 6–12 mo 15.4 20. as well as BP were reported by using ANOVA only between BMI and birth-weight category.9 11.9 0. no status (SES).4 40.01 No 2.7 1. x According to Tukey post hoc test.5 <0.39 <2 h 66.0  39.7 0.4 32.01k 1.6% of HBW adolescents were fourth or more.9 49.67 BMI (kg/m2) 19.7  10.152 L. y According to Tukey post hoc test.9 0. P-value between birth weight <2500 g and two other groups is P < 0.05).1 54.1  3. z According to Tukey post hoc test.5 14.7 34. breastfeeding duration. The low SES (rented home and not obesity.7 36. had a higher prevalence of of birth weight. WC.2 29.49  11.2 Third 14.05.1 46.7 65.88 Height (m) 1.29 Osteoporosis 17.9 51. In girls.05x 69.53  11.9 19. however.44 <0.5 14 13.8 34.7 64.4 38.1 0.05 were considered statistically having car).8 0. Chicago.5 32.2 0. In multivariable logistic regression.5 6.3 5. respectively. as well as mental correlation with birth-weight categories in this population.1 <0. We used multivariable logistic regression and odds ratios (with family history of obesity.51  11.8  13.8 28.4 11.11 43.2 0.05 <0.9 31.24 0.2 27.7 45. birth order. and sedentary lifestyle.3 16.8 41.06). . such as (P < 0.05 <6 h 8.4 0.7 20.8 66.6  15.4 15.6  16.1 0. body mass index * P-values are resulted from ANOVA. BMI.1 42.3  32.3 1.8 0. weight. Table 1 General characteristics of participants according to birth-weight (g) categories Boys birth weight P-value* Girls birth weight P-value* <2500 g 2500–4000 g >4000 g <2500 g 2500–4000 g >4000 g Age (y) 14. The first adjusted model was only adjusted for age and sex.6 68.8 17.4 14.1 59.3 39. Mean of cardiovascular risks.9 60. The second adjusted model was additionally adjusted for other characteristics including socioeconomic Regarding the parental education level and their occupation.3 67.3 37.7  15.2 21. and housekeeper mothers were dominant among all additionally adjusted for BMI in all abnormalities except for overweight and birth-weight categories.6 1. P-value between birth weight >4000 g and birth weight <2500 is P < 0..4 Second 25.3 6–8 h 27 28.2 47.4 16 20.5 1. One-way analysis of variance (ANOVA) characteristics and SES of population across birth weight cate- with post-hoc test (Tukey test) were performed to evaluate significant differences gories are shown in Tables 1 and 2. parents’ income.05.8 66.5 0.01 First 33.8 10.7 Fourth or more 26.7 Watching TV (%) 0.05y 14.8 57.6  15.05.2 38.9  12.0  2.6 24.5 71. Boys with the birth weight in general features regarding the quantitative variables (e.7 24 31.4 1.5 <0.7 47. whereas this association was margin- 95% CI) to determine the association between several risk factors of CVD and birth weight.4  15. P for trend was reported to investigate dose– ally significant in girls (P ¼ 0.9 24.1 1.6 23.8 <0.6 22.3 Family history of (yes %) Diabetes 36.2 <0.05.48 Weight 43.0. 2500 to 4000 g.5 20.8 69.8 48. family history of significant difference existed between the three birth weight chronic diseases. analysis of variance.3 15.7 21. We reported c2 test for signifi- >4000 g had the highest amount of weight. A significant relationship was observed between mental Results disorders.01{ 46.6 29.09 Breastfeeding duration (%) <0.9 48.7 24.7 2h 18.9 8.2 19.36 34.8 46. { According to Tukey post hoc test.01 31.30  4.3 18.6  3.8 45.5 <0.9 ANOVA.7 29.8  2.6 17.8 14 13.1 5. and confusion among boys across their birth-weight categories.2 69.06 Hypertension 50. of family and 32.6 1.7 51. type of complementary food (home. Ac- health. and height cant differences of qualitative characteristics.2 56.1  4.09 <2 h 34. and values of P < 0.11 28.5 19.5 12.3 23.8 Sleeping (%) 0.8 7.3 1.5  21.05). this relation was not were 2726 and 2802. we used crude model without adjust.8 15.1 7.3 14.7 26.61 13. groups.8 <0. / Nutrition 30 (2014) 150–158 <2500 g).4 64.5 0.4  16. k According to Tukey post hoc test.7  2. SPSS.8  12. P-value between birth weight >4000 g and two other groups is P < 0.5 16 18.5 31 26. However.1 20.5 16.05.4 32.17  2.2 41. P-value between birth weight >4000 g and birth weight <2500 is P < 0.05z 18.7 60 64.4 25.05# Waist (cm) 66.4 14. The mean and SD of general significant among girls.06 High blood lipids 41.8 44. Azadbakht et al. other counterparts (P < 0.7 34.9 27.4 15. as well as mental health. BMI.1 12–18 mo 12. low-educated parents (<6 y). # According to Tukey post hoc test.4 48. BMI.2  3.4 >2 h 15 15. parents’ education.15 0.8% of LBW adolescents were the first child ment and three additionally adjusted models for several potential confounders.2 64.6 60. The third adjusted model was thers. and >4000 g.0 19. P-value between birth weight <2500 g and birth weight 2500–4000 g is P < 0.8 Working computer (%) 0.2 63.

A marginal significant difference positive significant association was detected between high DBP was observed in serum TG levels across birth-weight categories and birth-weight categories in the crude model and the adjusted (P ¼ 0.3 0.9 26.4 5.01 <0.3 6. we did not find any significant as- Furthermore.9 0. according to birth-weight categories in this population.7 1.3 3.01 <2 6.3 No 59 47.9 0.8 10.4 23.6 Father’s occupation (%) <0.1 78.9 48.6 1.3 17.3 34. However.4 5.05).01 <0. Among partici. Partici- the large sample size of the study population.2 0 3.1 0 0.9 91.8 51 50.8 41.06).9 10.2 1. model for age and sex (Ptrend < 0.6 0. Means  SDs of serum lipid profiles.8 20.8 0.9 89.8 62.1 49. participants with birth weight >4000 g.2 39.9 51.2 13. angriness.5 4.2 80.8 2.23 54. After additional adjustment The results of multivariate adjusted regression analyses for for other possible confounders.3 23.4 23.4 35. we found a marginal Table 5 shows the odds ratios (95% CI) for mental problems correlation in crude model (Ptrend ¼ 0.6 Unemployed 7.4 8.2 57.9 4. pants who were assigned to the highest birth weight category.3 Socioeconomic status (%) 0.5 46.5 32.2 52.3 19.6 Personal car (%) <0.1 48.3 59.6 Imagination of size (%) <0.2 5.6 19.4 15.1 Mental disordersc (yes%) 74 71.06 Thin 32.9 11.8 17 25.3 48.3 6–9 y 23.1 64.9 55.6 17. this significant association was cardiovascular abnormalities according to birth-weight categories disappeared.8 51. but sometimes used home-made foods.4 35.1 Usually home-made foodsa 22.16 Angriness (yes%) 62.55 62.1 5.01 Always home-made food 62.4 Rented home 21.4 0.5 3.7 54.8 60.71 Insomnia (yes%) 54.7 9–12 y 16.2 18.8 81.05).2 28.1 Type of complementary feeding (%) <0.2 1 0.3 7 6.5 27. There cant association in model 2.7 30.8 Workman/labor 30.01 <0.6 10. and serum glucose (Ptrend < 0. Odds ratios for having other CVD risks among are presented in Table 4.5 23.01 <0.7 69.01 <6 y 67. HDL and birth-weight categories was observed in crude model There was a significant association between mean of HDL-C (Ptrend ¼ 0. L.01 Yes 41 52.1 32.3 Workwoman/labor 2 1. c Including angriness.8 3.3 54.8 0.2 36.7 Number of children (%) <0. which may be because of positive relationship became significant (Ptrend < 0.2 1.4 >4 28.7 57.4 Always commercial foods 8. A marginally significant relationship between low levels according to birth weight categories are shown in Table 3.9 24.8 15. .2 6.2 20. anxiety.9 0.6 61. / Nutrition 30 (2014) 150–158 153 Table 2 Socioeconomic status and mental disorders of participants according to birth-weight (g) categories Boys birth weight P-value* Girls birth weight P-value* <2500 g 2500–4000 g >4000 g <2500 g 2500–4000 g >4000 g Father’s education (%) <0.9 21.6 19. Azadbakht et al.7 24.8 0.06 40.5 21.05 0.5 12 15.2 Agriculturist 10.8 19.9 Normal 23.1 45.62 Confusion (yes%) 40.5 11.7 5. which is adjusted for age and sex were no significant trends between mental disorders.4 54.4 25.2 61.7 21.3 Others 2.3 7.6 25.07).3 Mother’s education (%) <0.9 21.05 66.2 72.8 24. However.62 <0.7 Housewife 92.3 61.4 66.13 * P-values are resulted from analysis of variance (ANOVA).8 21.9 >12 y 2.4 74.01 <0. the mean of HDL cholesterol a higher risk for low HDL levels.1 41.9 35.5 53.2 25.3 5.7 91.8 1. confusion.9 24.5 3.01 Employed/office work 16.1 2 2–4 65.05).2 5.3 6–9 y 18.2 18. for all confounding variables.2 0.4 52.7 91.2 51. BP.7 68 72.4 33.2 9–12 y 11.8 2. general obesity and birth-weight categories. this levels across birth weight categories.9 18.1 58.1 22.5 23.1 24.9 51.6 5.5 1. had pants with normal birth weight. b Using commercial foods.6 6.6 61.6 Self-employed 34.4 Agriculturist 0 0.8 80.1 48.6 6.8 90.01 Personal home 78.3 39.6 25.1 48.9 55.3 21.4 18. had higher sociation between birth weight and low HDL levels.01 Employed/office work 3 6.9 68.6 27.2 19.1 24.05).2 <0.3 8.7 15.06) and a negative signifi.7 Mother’s occupation (%) 0. after adjusting for age and sex.9 Obese 44.4 2.01 51.4 24.01 <6 y 54 36.11 <0.4 Usually commercial foodsb 7 5.6 14. a Using home-made foods.8 81. but sometimes used commercial foods.1 26. insomnia.1 30 35.2 67.68 Anxiety (yes%) 62. in the model adjusted (HDL-C) levels was higher compared with other categories.5 47.1 4.1 48.6 39.5 30.7 65 63.3 19.8 9.2 39.01 <0.9 <0. Additionally.7 >12 y 5. In the conducted analyses between different categories of birth weight were not significant. a means of DBP (P < 0.

Another study showed that lipid profiles were not U-shaped relation disappeared and only a negative significant different among LBW. HBW children had higher but non-significant family history of Table 7 shows the results of multivariate adjusted logistic hypertension. a. The results of previous studies regarding the risk for mental problems (P < 0.5 93. After further adjustment for other factor for adulthood hypertension [37]. Findings from a meta-analysis ascertained that HBW resulted in CVD risks. fasting blood sugar.and sex-adjusted model (model 2) weight 3700 g) had higher weight and BP at birth and weight compared with normal birth-weight category. HBW adolescents had an increased risk In this large nationwide study.2  14. weight [46].1 0.7  14. A longitudinal study that was conducted on 120 documented between birth-weight categories and mental dis.1  43.05) [36]. showed a U-shaped relation- LBW adolescents had lower risk for overweight. LBW and HBW adolescents had higher levels of HDL-C. However. confounding variables. analysis of variance.18 TG (mg/dL) 94.07 SBP (mm hg) 102. after and BP had a tendency to remain high later in life [31].40]. Azadbakht et al.45].4 0. Additionally.2  12.9 84. increased risk for high DBP. the opportunity to assess the link between birth-weight status. this relation became insignificant.7a 46.6 87. association between birth weight and central obesity. Limited studies confirmed our results The results of multivariate adjusted regression analyses for CVD [13. LDL.76 kg/m2 increments in BMI compared with normal birth relation to birth-weight categories and lack of association be. After additional adjustment.3  28. FBS. insomnia. However. HBW infants (birth DBP in crude model and age. All reviewed studies demonstrated tween birth-weight status and metabolic syndrome. In the present study.1  40. tween mental disorders and birth-weight categories are similar Furthermore.1  10. SBP. the reference group is normal birth According to previous studies. this children [41].5 0. categories.01 ab <0. observed among all participants after adjusting for sex [43]. after adjusting for current BMI and height.4b 46. DBP. this obesity were lower than normal birth weight adolescents. As per Table 6. Having high BP early in life is an important risk regression for mental problems according to the birth-weight factor for being hypertensive in adulthood [38]. a negative significant association However. blood pressure.29 ANOVA.1 88. TG. triglyceride * P-values are resulted from ANOVA. and HBW infants association remained significant between LBW and insomnia.22 TC (mg/dL) 147. Another cohort study indicated that birth weight had a positive relation with serum TG levels and an inverse relation with serum Discussion LDL and HDL levels among adolescents [32].2 85.c Mean values in a row with unlike superscripts letters are significantly different. this association did not remain study showed that SBP in HBW infants would increase from significant. high density lipoprotein. Furthermore.154 L. after adjusting relationship between birth weight and serum HDL levels were for all confounding variables. and confusion with birth-weight categories In the present study.1 104.01 bc <0.4  16. that those with increased birth weight paid more attention to Although there are few reports regarding the association be. However. serum glucose levels.14 DBP (mm hg) 65.1 0.9  13.32] and several studies showed an inverse relationship be- risk factors across birth-weight groups are presented in Table 6. TC. this relationship was no more significant. HBW adolescents were at for overweight and obesity. We documented a U-shaped relationship considered a CVD risk factor [39.05).05 ac <0. Our results regarding increased risk for CVD in by 0. no significant association was controversial. but their odds for overweight and higher risk for CVD risk factors.2  32. / Nutrition 30 (2014) 150–158 Table 3 Mean of lipid profiles.1  14.01 FBS (mg/dL) 87. HDL.6 86. A cohort adjusting for other confounders. total cholesterol. after adjusting for all confounding variables.0 103.35]. low-density lipoprotein. the risk for low level HDL-C cholesterol pre-puberty to late puberty (P < 0. higher birth weight was associated with (Ptrend > 0. and mental health status in a large sample of Iranian further risk for overweight/obesity in adulthood and can develop adolescents. diastolic blood pressure. normal birth weight. we provide a positive association between birth weight and BMI [44.8  13.8  29.6  14.b.9c <0. We observed a positive between birth weight and mental disorders in models 1 and 2 relation between birth-weight categories and risk for low serum (adjusted for age and sex). A U-shaped relation was observed between have any effect on BMI and serum lipid measures among 6-y-old insomnia and birth weight. y Within group P-values are resulted from Tukey post hoc test and are reported just for significant variables in ANOVA test. The results of another was higher among the LBW group in crude model and model 2 that cohort study declared that family history of hypertension is a risk is adjusted for age and sex.05).6  28. and high ship between birth weight and BP at 4 y. Results of . having low levels of HDL-C is weight participants. according to birth-weight (g) categories Birth weight P-value* P-value within groupy <2500 g 2500–4000 g >4000 g HDL-C (mg/dL) 44. A cohort study showed no association between birth weight LBW adolescents had higher risk for insomnia according to and serum HDL levels among men and women aged 53 y. a positive was documented between LBW and confusion in the first three relation was observed among women and a positive relation was models.5  38. A longitudinal study that considering the normal birth-weight group as reference group. It seems relationship between birth-weight status and mental health. By tween birth weight and BP [34.1 149.9b 67.05 LDL-C (mg/dL) 82.1  32. anxiety. systolic blood pressure. [42]. However. This is the first study in developing countries that considers the might be due to the cross-sectional nature of the study.05 ab <0.6c <0. we observed a marginally significant positive to previous studies [31–33]. Additionally. followed infants from birth to 4 y.8 0.3 146. in our study.2a 65.7  12.7  10.3  10. According to our knowledge. obesity. models 3 and 4.4  27. their trend of weight gain. randomly selected children revealed that birth weight did not orders.

8 (0.8 (0.7 (0.0) <0.7–1.7–1.39 Model III 1 1.3–1.8 (0.9–2.2) 0. family history of chronic disease.1–1.6) 0.9) 1. High SBP Model I 1 1.5) 0.9 (0.1 (0.3) 0.4) 0.93 Model IV 1 1.4–1.6–1.8 (0.8–2. inconsistent.2) 0.6 (0.6) 0. Model III 1 0.1) 1.5) 1.2) 0.0 (0.7–1.38 Model III 1 0. This relation- High FBS ship showed a specific pattern of fat deposition among Iranian Model I 1 1.0 (0.0–3.9–1. Low HDL c Additionally adjusted for other characteristics including SES.28 across birth-weight categories.24 Model II 1 1. findings of previous studies were c Additionally adjusted for other characteristics including SES. Model II 1 1.7–0. Central obesity is a risk factor Model IV 1 1.2) 1.3) 2.7–1. Model II 1 1.8 (0.7–1.4 (0. anxiety.31 Model IIIc 1 0.8 (0.7–1.5) 0.3) 0.06 Model I 1 1.8 (0.4) 0.0–4.1 (0. blood pressure.5–1.8) <0. insomnia.2) 0.0 (0. triglyceride * Birth weight in grams.1–3. high BP: >95th adjusted by age.0 (0.3 (0. mental disorders as well as angriness.6–1. birth order. we can explain the observed relationship be- cardiovascular disease.1–3.05 weight women [33].2 (1.55 for high DBP [49] and low serum levels of HDL-C [50]. obesity: BMI >95th.8 (0.2) 1.49 Model IV 1 0.0 (1.9) 0.6–1.7 (0.1 (0.66 Model II 1 0.8–1. body mass index. birth order. parents’ education.2) 0.0 (0.7) 1.9 (0.7–1.9–2.26 Model III 1 1.1 (0.8 (0. and fasting blood ATPIII criteria modified for children and adolescents (overweight: BMI: 85th– glucose had no significant association with birth-weight cate- 95th.7–1.2) 0. TG.9–1.2) 1.0–4.7–1.2) 0.8–1. any significant association between birth-weight categories and a Without adjusted (crude models).58 Model I 1 0.8 (0.8–1.2) 0.0 (0.9 (1.6–1. fasting blood sugar.0) 0.45 Model III 1 1.9) 0.2–1.1) 1. socioeconomic status. parents’ in.19 d Additionally adjusted for BMI in all abnormalities except for overweight and Model IV 1 0.56 obesity is a major risk for CVD [48].6) 1.5) 1.6) 0. FBS.51 cm larger WC compared with normal birth High DBP Model I 1 1.1–4.3–1.0) 1.3) 0.58 Model III 1 1.55 Model III 1 0.0) 0.8 (0. low HDL: <50 mg/dL (except in boys 15–19 y.7–0.8 (0.2) <0.9–1.2) 0. Several studies have demonstrated that central Model III 1 1.8–1.6) 1.0 (0.3 (0.2) 0.6 (0.6–1.8–1.1 (1.35 High LDL Insomnia Model I 1 1.43 b Adjusted for age and sex.5–1.3–2.4–1.2) 1.8 (0.2) 1.5–1.2) 0.6 (0.76 weight and 5.9) 0.0 (0.0 (0. Other CVD risk factors including high TG. / Nutrition 30 (2014) 150–158 155 Table 4 Table 5 Odds ratios (95% confidence interval) for cardiovascular abnormalities according Odds ratios (95% confidence interval) for mental problems according to birth- to birth-weight (g) categories* weight (g) categories Birth weight Ptrendy Birth weight Ptrend* <2500 g 2500–4000 g >4000 g <2500 g 2500–4000 g >4000 g Overweight Mental disordersy Model Ia 1 1.3 (1.8 (0.0 (0.5–2.9 (0.0 (0. family history of chronic disease.5–4.9) 1. CVD abnormalities following criteria.0–1. total cholesterol.9 (0.7–1.5 (1.7–1.3) 0.3) 1.4–1.3) 0.7–1.6–2.6–1.6 (0.0 (1.0 (0.2) 0.7–0.65 adolescents [47].1–3.8 (0.99 Abdominal obesity Anxiety Model I 1 1.2 (1.5 (0.80 Model I 1 0. BMI.9–2.5 (0. Model IV 1 0.1 (0.4 (0.6) 0.8–1.6) 0.2 (0. socioeconomic status Model I 1 1.72 Model III 1 1.2 (0.5–1.06 Model I 1 1.6) 0.0 (0.8–2. high TG: L00 mg/dl.71 Model II 1 0.15 Model III 1 1.1–2.9 (0.9–1.0 (1.6–0.7–1.9 (0.6–1.7–1.0 (0.9 (0.8 (0.5–1.3 (0.8) 0.3 (1.0) 0.8) 1. Adult Treatment Panel III.1) 0.7) 0.6) 0.0 (0. high FBS: >100 mg/dL.8 (0.0 (0. high-density lipoprotein.8) 0. A meta-analysis that reviewed five cohort studies did not . [19]. Model III 1 0.4 (0.6 (0.9 (1.8 (0. total cholesterol.80 Model IIb 1 1.34 adiposity increased among the study population.7 (0.7 (0.0) 1.7–1.8–2.2 (0. tween birth-weight categories and serum HDL levels as well as LDL.9) 0.4–1.0) 0.34 Model IV 1 1.0 (0.3) 0. According ATPIII.0) 1.6–1.8–1.3) 0.9 (0.4) 0.31 * Ptrends are resulted from logistic regression.4) 0.51 Model IVd Model IVd 1 0.56 Model II 1 1. insomnia.5–1.6–0.8–1. high TC: [24.6) 1.99 Model IIIc 1 1.0–1.3) 0. and confusion.3) 0.1) 0.7–1.13 Model Ia 1 0.9 (0.2) 1. L.9) 1.9–1.0–1.62 Model II 1 1.4) 0.6) 0. In this regard.0 (0.05 feeding duration.60 Model II 1 1. sex.5) 1.80 Model IV Model IV 1 1.3 (1.8–1. and b Adjusted for age and sex.6–2.8 (0.0) 0.7–1. SES.2) 0.9–1. HDL.4) 0.6–1.0–4.0) 0.15 obesity.6) <0.37 Model IV 1 0.0 (0.0 (0.05 Model II 1 1.2) 0.9) 0.9–1.8–2.8 (0. Some of them failed to show any significant relation come.07 Model IIb 1 0.9 (0. sedentary lifestyle.1) 0.84 Model II 1 1.5 (0.3–2.8 (0. to these results.0) 0.9) 0.5 (1. >200 mg/dL.3) 0.1) 0. breast- Model II 1 0.0 (0. we did not find height). These findings are consistent with many previous studies cutoff was <45 mg/dL).8–1. that gories. body mass index.7–1. TC.2) 0.4) 0.1 (0.3) 0.2) 1.6–1. and According to the results of regression analysis.8–1.6–1.7–1.5–1.8 (0.0 (0.9–2. BP.6–2. parents’ in- Model I 1 0.0–1.6–1.7–1.3 (1.6) 0.7–1.1) 0.6) 1.1 (0. y Ptrends are resulted from logistic regression. anxiety.05 The odds ratio for overweight and obesity has decreased Model III 1 2.49 General obesity Angriness Model I 1 1.1) 2.0 (0.4) 0.3) 0.5) 0.0) 0. SES.19 Model IV 1 0.8–1.1 (0. low-density lipoprotein.6) 0.5 (0.9 (0.0) 0.8–1. SBP. DBP among adolescents.0–1.2–1.6–1. breast- between birth weight and mental disorders [51] and others feeding duration.5–1.2) 0.0) 0. CVD.41]. sedentary lifestyle. confusion.19 High TC Confusion Model I 1 1. d Additionally adjusted for BMI in all abnormalities except for overweight and displayed an association between LBW and mental problems obesity.5) 0.1 (0.8 (1.95 a longitudinal study revealed that HBW women had 13% more Model IV 1 1.8 (0.66 a Without adjustment (crude models).7–2.5 (0.9–1.8 (0. high LDL: >110 mg/dL.8–1.15 Model IV 1 1.47 Model II 1 1.2) 1.06 come.0 (0.0 (0.9 (1.6–1.0) 0.58 Model III 1 0.0 (0.8) 0. according levels of LDL-C.0) 1.1 (0.7–3.6–1.0–5.1 (0.3) 2.0) 0.2) 0.3) 0.8 (0. parents’ education.9 (0. Azadbakht et al.0) 1.8 (0.4) 0.29 y Including angriness.7–0.6–1.07 Model II 1 1. whereas the risk for central Model IV 1 2.9 (0.6–4.23 High TG BMI.2) 1.2 (0.8–1.

{ Additionally adjusted for other characteristics including SES.5) <0.5) 0.05 Model IV# 1 Model III{ 1 1.5) 0.9 (0.54 Angriness Model II 1 0.2) 0.7) 0.2 (1–1.05 Model III 1 1.05 1.1–1.4) 0.4) 0.3) 0.01 0.9) <0. parents’ education.8) 0.4) 0.6–1.16 High DBP Model I 1 0.79 0.3) 0.1 (0.8–1. parents’ education.09 BMI.7–1. sex.9 (0. high.6) 0. risk for CVD among adults. FBS.21 Model III 1 1.2) 0. In the present study.6) 0.24 Model I 1 0.5) <0.6–1.7) 0.1–1.08 socioeconomic status Model III 1 1.1–1.7 (0. high birth weight.5 (0. high weight was considered as reference group.45 1 (0.01 0.5) 0.8–1. Recently.6–1.31 Model III 1 1. Model II 1 1. SES. we found a positive FBS: >100 mg/dL.2 (0.71 Model II 1 1 (0.9 (0.4) 0.1 (0.15 Model III 1 0. Model III 1 0. levels of HDL-C.4–1.4–1. and height). TG.2–1.9–1.6–1.7–1.83 0. triglyceride no association between mental disorders and birth-weight * Birth weight in grams.9) 0.19 High LDL Model IV 1 1 (0.92 Insomnia Model II 1 0.90 normal birth weight.8–1.3) 0.3) 0.8–1.6–1) 0.3) 0.7–1.1–1. and confusion.50 1 (0.34 1 (0.8–1.9–1.3–1.6–1.08 0.7 (0.7–1.5) 0. Model II 1 1 (0. insomnia.6–0.7 (0.2) 0.98 Abdominal obesity Model IV 1 1 (0.9) <0.1 (0.44 Model II 1 0.05 1.9–1.71 0. and y P-values are resulted from logistic regression and comparing low birth high DBP. low birth weight.74 normal birth weight.88 1.99 k Adjusted for age and sex.27 0. CVD.01 1.9 (0.2 (1–1.01 1.8–1. significant relation between LBW and overweight.1 (0.85 0.3) 0.3–1.24 Model IV 1 Model III 1 1 (0.2) 0.2) 0.29 Model III 1 0.6–1. LBW students had higher risk for lower come. school children [57].4–1.1) 0.2 (1–1.4–0. LDL.2) 0.5 (0.1 (1–1.2 (1–1.5 (0.7 (0.3 (1–1. birth order.9 (0.4) <0. low-density lipoprotein.7–1. according to ATPIII categories.05 1.68 Model I 1 1 (0.1) 0.6 (0.73 1.18 Confusion Model II 1 0. diastolic blood pressure.50 mism [53].61 show any significant association between birth weight and Model IV 1 0.8–1.2 (1–1.4–1.2) 0.4) <0. that cutoff was <45 In further regression analysis in which normal birth mg/dL).2) 0.7–1. obesity.2) 0.1 (0.8–1.1) 0. breast- Model II 1 0.91 1 (0. TC.8–1.3–1) <0. HBW.01 1 (0.01 0.6–0.9 (0.4) 0.06 1.1 (0. aged 18 y [58]. LBW.4) 0.7–1.90 0.07 1 (0.1 (0.8–1.9 (0.3) 0.98 1.38 1 (0.4–1.1) 0.61 Model III 1 0. high blood pressure: >95th adjusted by age. criteria modified for children and adolescents (overweight: BMI: 85th–95th.6–1.6 (0.26 # Additionally adjusted for BMI in all abnormalities. .7–1.4) 0.31 Model II 1 1.4) 0.2 (1–1.2) 0.1 (0.4–1. / Nutrition 30 (2014) 150–158 Table 6 Table 7 Odds ratios (95% confidence interval) for cardiovascular abnormalities according Odds ratios (95% confidence interval) for mental problems according to birth to birth weight categories* weight (g) categories Birth weight Birth weight 2500– <2500 g P-valuey >4000 g P-valuez 2500– <2500 g P-value* >4000 g P-valuey 4000 g 4000 g Overweight Mental Model Ix 1 0.24 Model II 1 1.8–1.6 Model I 1 1 (0.8–1.8–1.1) 0.84 Model I 1 1.57 Model I 1 1 (0.1 (0.8) 0.156 L.77 0.6–1.1) 0.9 (0.82 1 (0.8 (0.6–1.9 (0. insomnia [55].2) 0.3) 0. BMI.7–1.9) <0. DBP.01 0.6–1. sedentary lifestyle.6) 0.9 (0.9 (0.4) 0.3) 0.5) 0.5) <0.3) 0.43 1 (0.5) <0.6) <0.8–1.91 x Without adjustment (crude models).80 0.9 (0.3–1.8–1.84 Model I 1 0.4) 0.95 General obesity Model IV# 1 1. in this study we observed SES. association between LBW and elevated BP among individuals k Adjusted for age and sex. fasting blood sugar. high LDL: >110 mg/dL.1 (0.09 1 (0.2 (1–1.8–1.6) 0.1) 0.90 z Including angriness.3) 0.3) 0. and anxiety [56] and density lipoprotein.3) 0.08 0.7 (0. HDL. low HDL: <50 mg/dL (except in boys ages 15–19 y.3–0. body mass index.6 (0.07 1. high TC: >200 mg/dL.4) 0. SBP. body mass index.7 (0.4–1. z increase the risk for overweight and obesity among elementary P-values are resulted from logistic regression and comparing high birth weight with normal birth weight.8 (0.79 0.2 (1–1.7 (0.3) 0.8 (0.7–1.9 (0.7–1.7–1.54 Model Ix 1 1.8–1.56 High TC Model IV 1 1.9 (0.3) 0.3 (1.7) 0.72 High TG Model IV 1 1.9 (0.1) 0.58 0.4) 0.22 Model I 1 1.8–1.90 1.4–1) 0.23 Model IV 1 0.2) 0. Low HDL y P-values are resulted from logistic regression and compares HBW with Model I 1 1.25 come. A cross-sectional study demonstrated that LBW did not weight with normal birth weight.5) 0.08 0.5–1. total cholesterol. CVD abnormalities following criteria. socioeconomic status.4–0.41 Model III 1 0. A cohort study provided no data about the x Without adjusted (crude models).5) 0.01 1.39 1 (0. High SBP { Additionally adjusted for other characteristics including SES.39 disordersz Model IIk 1 0.9–1.46 Model III 1 1 (0.05 Model III{ 1 0.1) 0. A study conducted among Korean children re- # Additionally adjusted for BMI in all abnormalities except for overweight and ported lower levels of HDL-C in LBW rather than in normal birth obesity.3 (1.8 (0.7 (0.6–1.83 0.1) 0.7–1.2 (1–1. several studies investigated the linkage Model IV 1 1 (0.1 (0.5) <0.86 1 (0.6 (0.7 (0.7 (0.05 Model IV 1 1. However.9 (0.3) 0.6–1. anxiety.7 (0.16 feeding duration.6–1.2) 0.8–1.8–1. weight individuals [59].2 (1–1.2–1.6–1) 0. Model III 1 1.2) 0.46 1.6–1.3) 0.4) 0. parents’ in- Model I 1 0.60 0.4) 0.05 1.5) <0.8–1. between angriness [54]. parents’ in.01 1 (0.8) 0.1 (1–1.2) 0.4–1.3) 0.4) 0.05 1 (0.6) 0. Several studies have documented a positive relation ATPIII. high TG: 100 mg/dL. birth order.9 (0.9 (0.5) 0.4) 0. family history of chronic disease.6–1.9) <0.7 (0.5 (0.1) 0.5) <0.50 Anxiety Model II 1 0.8–1.05 1.2 (1–1. Model IV 1 1.73 Model IIk 1 1.62 between birth-weight percentiles and anxiety as well as opti- Model II 1 1 (0.7) 0.82 1 (0.3) 0.7 (0.95 Model I 1 0.5) 0.5) 0.4) <0.4–1) 0.6 (0.35 0.3–1.2 (1–1.83 Model II 1 1 (0.4) 0.77 0.1) 0. Model IV 1 0.1 (0.6–1.55 anxiety as well as depression among older people [52].8–1.6) <0.1 (0.6–1.6–1.3 (1.5) <0.89 Model III 1 1 (0.50 between mental disorders and its effect on future incidence of CVD [20.05 1.6) 0. Results of High FBS another cohort study demonstrated no substantial relation Model I 1 1 (0.7–1.21].7–1.87 * P-values are resulted from logistic regression and compares LBW with Model IV 1 1.7–1.90 0.2 (1–1.3–1.07 0.7–1.1 (0.5) 0.28 Model IV 1 0.2 (0. sedentary lifestyle.8) <0.2 (1–1.3 (1.5) <0.6) <0.3) 0.2 (1–1. cardiovascular disease.77 1 (0. Azadbakht et al. breast feeding duration.05 1.6–1.8 (0.8–1. Adult Treatment Panel III.8–1.8) 0.8–1.61 Model I 1 0.6 (0.78 1 (0.4–1.7 (0.08 1. systolic blood pressure. obesity: BMI > 95th. family history of chronic disease.4–1) 0.

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