Cho, Su Jin
(Department of Pediatrics, Ewha Womans University School of Medicine)
,
Lee, Hye Ah
(Department of Preventive Medicine, Ewha Womans University School of Medicine)
,
Park, Bo Hyun
(Department of Preventive Medicine, Ewha Womans University School of Medicine)
,
Ha, Eun Hee
(Department of Preventive Medicine, Ewha Womans University School of Medicine)
,
Kim, Young Ju
(Department of Obstetrics, Ewha Womans University School of Medicine)
,
Park, Eun Ae
(Department of Pediatrics, Ewha Womans University School of Medicine)
,
Park, Hyesook
(Department of Preventive Medicine, Ewha Womans University School of Medicine)
BACKGROUND/OBJECTIVES: Cardiovascular diseases is a major cause of death and is responsible for 23.8% of deaths in Korea. Clinical symptoms manifest in adulthood, but susceptibility begins in utero. Elevated homocysteine levels and adiposity might be linked to a greater risk in children as well as a...
BACKGROUND/OBJECTIVES: Cardiovascular diseases is a major cause of death and is responsible for 23.8% of deaths in Korea. Clinical symptoms manifest in adulthood, but susceptibility begins in utero. Elevated homocysteine levels and adiposity might be linked to a greater risk in children as well as adults. We hypothesized that those who have simultaneous risk for folate and adiposity would be affected with elevated homocysteine levels at 3 years of age. SUBJECTS/METHODS: From the ongoing birth cohort at Ewha Womans University Mok-Dong Hospital, we compared adiposity parameters, serum homocysteine, and folate levels in 238 children (118 boys and 120 girls) at three years of age. The relationship between birth outcome, current weight and body mass index (BMI), postnatal growth, and homocysteine level were assessed using correlation and general linear model. Additionally, we assessed the combined effect between blood folate status and adiposity on current homocysteine levels. RESULTS: Birth characteristics were not correlated with homocysteine. Current weight, BMI, upper-arm circumference, skinfold thickness, waist circumference, and hip circumference were positively correlated with homocysteine at three years of age (P < 0.05). Folate level was negatively correlated with homocysteine at three years of age (P < 0.0001). A relative high anthropometric measure which is compatible with adiposity and low folate level was associated with high homocysteine levels. CONCLUSION: We found a combined effect of adiposity and folate levels with homocysteine levels at three years of age. This implicates the beneficial role of folate supplementation in the high-risk population at an early age.
BACKGROUND/OBJECTIVES: Cardiovascular diseases is a major cause of death and is responsible for 23.8% of deaths in Korea. Clinical symptoms manifest in adulthood, but susceptibility begins in utero. Elevated homocysteine levels and adiposity might be linked to a greater risk in children as well as adults. We hypothesized that those who have simultaneous risk for folate and adiposity would be affected with elevated homocysteine levels at 3 years of age. SUBJECTS/METHODS: From the ongoing birth cohort at Ewha Womans University Mok-Dong Hospital, we compared adiposity parameters, serum homocysteine, and folate levels in 238 children (118 boys and 120 girls) at three years of age. The relationship between birth outcome, current weight and body mass index (BMI), postnatal growth, and homocysteine level were assessed using correlation and general linear model. Additionally, we assessed the combined effect between blood folate status and adiposity on current homocysteine levels. RESULTS: Birth characteristics were not correlated with homocysteine. Current weight, BMI, upper-arm circumference, skinfold thickness, waist circumference, and hip circumference were positively correlated with homocysteine at three years of age (P < 0.05). Folate level was negatively correlated with homocysteine at three years of age (P < 0.0001). A relative high anthropometric measure which is compatible with adiposity and low folate level was associated with high homocysteine levels. CONCLUSION: We found a combined effect of adiposity and folate levels with homocysteine levels at three years of age. This implicates the beneficial role of folate supplementation in the high-risk population at an early age.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
At the three year check-up program, all anthropometric indicators were measured by well-trained examiners. Height and weight were measured to one decimal place while wearing light clothing and without shoes using a stadiometer and calibrated scale (DS-102 model, Dong Sahn Jenix Co. Ltd, Seoul, Korea). Waist circumferences, upper-arm circumferences, skinfold thickness, and hip circumference were also measured as anthropometric indicators for adiposity.
Indeed, normal concentration of serum folate suggested by WHO ranges from 6 to 20 ng/ml for all aged person [18]. In turn the subjects were grouped into four groups: low adiposity measures with high folate (low risk group), low adiposity measures with low folate, high adiposity measures with high folate, and high adiposity measures with low folate (high risk group). Regarding the characteristics at birth and postnatal growth, preterm, low birth weight, and catch-up growth were considered as risk group on the basis of previous studies [2,4-6,8].
Pearson correlation was used to investigate the strength of linearity between homocysteine and possible independent variables above mentioned. The impact of adiposity including characteristics at birth and postnatal growth on homocysteine levels were analyzed under controlling for age and sex (model 1), additionally including blood folate level (model 2) using a generalized linear model. Considering the statistical power, we used an operational definition for high risk of obesity and low folate level to assess the combined effect between blood folate level and adiposity on current homocysteine levels.
The birth weight and current weight were transferred to an age- and gender- specific z score criteria reference source from the 2007 Korean Children and Adolescents Growth Standards [16]. To explain the postnatal growth, the change of weight z score was calculated by subtracting the birth weight z score from the current weight z score. Catch-up growth was defined as greater than 0.
대상 데이터
The Institutional Research Board on human subjects at Ewha Womans University approved the protocol and informed consents were obtained. Out of 734 children enrolled in the birth cohort, 527 children were contacted from November of 2005 to November of 2007 around their third birthday. Out of the 527 children contacted, 238 children (45.
Out of 734 children enrolled in the birth cohort, 527 children were contacted from November of 2005 to November of 2007 around their third birthday. Out of the 527 children contacted, 238 children (45.2%) participated in the three year check-up program.
이론/모형
Results represented as least squares means and standard error after adjusting for sex and life months. For multiple comparison test, Bonferroni method was used.
After controlling for age and sex, adjusted means differences of homocysteine among groups was tested using a generalized linear model. The multiple comparisons were conducted using Bonferroni method. Statistical significance was noted as P < 0.
성능/효과
When simultaneously controlling with preterm or low birth weight, the trend of the association was similar to the presented results of model 2 in Table 2 (data not shown). An effects of adiposity quartile groups on current homocysteine levels in BMI, upper arm circumferences and hip circumference still showed a borderline significance level, while birth outcomes were not significant. These findings suggest that those who were vulnerable to development of obesity have the risk of increased homocysteine levels.
Placental weight was associated with homocysteine levels at 3 years with a U shape. Those who belong to the highest quartile in weight, BMI, waist circumferences, skinfold thickness, and hip circumferences at 3 years of age showed the highest mean of homocysteine, but it was only a significant for group differences in placenta weight under controlling with sex and age. When adding folate level into consideration (model 2), it showed borderline significant in BMI, upper arm circumferences, and hip circumferences.
후속연구
Despite the paucity of information about possibility of correlation of homocysteine levels between childhood and adulthood, it is necessary to track homocysteine levels from childhood to prevent further CVD risks [32]. Therefore, further study of tracking homocysteine and the change of homocysteine resulting from the change of folate level is needed to suggest the strategy of intervention. Although this study did not cover dietary factors, blood folate level was considered as a biomarker.
참고문헌 (34)
1 Ross R The pathogenesis of atherosclerosis: a perspective for the 1990s Nature 1993 362 801 809 8479518
3 Berenson GS Wattigney WA Tracy RE Newman WP 3rd Srinivasan SR Webber LS Dalferes ER Jr Strong JP Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study) Am J Cardiol 1992 70 851 858 1529936
4 Barker DJ Osmond C Forsén TJ Kajantie E Eriksson JG Trajectories of growth among children who have coronary events as adults N Engl J Med 2005 353 1802 1809 16251536
5 Huxley RR Shiell AW Law CM The role of size at birth and postnatal catch-up growth in determining systolic blood pressure: a systematic review of the literature J Hypertens 2000 18 815 831 10930178
8 Groner JA Joshi M Bauer JA Pediatric precursors of adult cardiovascular disease: noninvasive assessment of early vascular changes in children and adolescents Pediatrics 2006 118 1683 1691 17015562
9 Jakubowski H Pathophysiological consequences of homocysteine excess J Nutr 2006 136 1741S 1749S 16702349
10 Haim M Tanne D Goldbourt U Doolman R Boyko V Brunner D Sela BA Behar S Serum homocysteine and long-term risk of myocardial infarction and sudden death in patients with coronary heart disease Cardiology 2007 107 52 56 16763372
11 Tonstad S Refsum H Sivertsen M Christophersen B Ose L Ueland PM Relation of total homocysteine and lipid levels in children to premature cardiovascular death in male relatives Pediatr Res 1996 40 47 52 8798245
12 Vilaseca MA Moyano D Ferrer I Artuch R Total homocysteine in pediatric patients Clin Chem 1997 43 690 692 9105277
13 Shen MH Chu NF Wu DM Chang JB Plasma homocyst(e)ine, folate and vitamin B(12) levels among school children in Taiwan: The Taipei Children Heart Study Clin Biochem 2002 35 495 498 12413612
14 Leal AA Palmeira AC Castro GM Simões MO Ramos AT Medeiros CC Homocysteine: cardiovascular risk factor in children and adolescents? Rev Assoc Med Bras 2013 59 622 628 24182942
15 Min JW Kong KA Park BH Hong JH Park EA Cho SJ Ha EH Park H Effect of postnatal catch-up growth on blood pressure in children at 3 years of age J Hum Hypertens 2007 21 868 874 17476289
16 Korea Center for Disease Control and Prevention Korean Pediatric Society 2007 Korean Children and Adolescents Growth Standard 2008 cited 2013 July 10 Available from: http://www.cdc.go.kr/CDC/notice/CdcKrInfo0301.jsp?menuIds=HOME001-MNU0004-MNU0036-MNU0037&cid=12103
17 Araki A Sako Y Determination of free and total homocysteine in human plasma by high-performance liquid chromatography with fluorescence detection J Chromatogr B Biomed Sci Appl 1987 422 43 52
18 World Health Organization (CH) Serum and Red Blood Cell Folate Concentrations for Assessing Folate Status in Populations. Vitamin and Mineral Nutrition Information System Geneva World Health Organization 2012
19 Fukagawa NK Martin JM Wurthmann A Prue AH Ebenstein D O'Rourke B Sex-related differences in methionine metabolism and plasma homocysteine concentrations Am J Clin Nutr 2000 72 22 29 10871556
20 Klerk M Verhoef P Clarke R Blom HJ Kok FJ Schouten EG MTHFR Studies Collaboration Group MTHFR 677C-->T polymorphism and risk of coronary heart disease: a meta-analysis JAMA 2002 288 2023 2031 12387655
21 Humphrey LL Fu R Rogers K Freeman M Helfand M Homocysteine level and coronary heart disease incidence: a systematic review and meta-analysis Mayo Clin Proc 2008 83 1203 1212 18990318
22 Barker DJ Gluckman PD Godfrey KM Harding JE Owens JA Robinson JS Fetal nutrition and cardiovascular disease in adult life Lancet 1993 341 938 941 8096277
23 Leeson CP Whincup PH Cook DG Donald AE Papacosta O Lucas A Deanfield JE Flow-mediated dilation in 9- to 11-year-old children: the influence of intrauterine and childhood factors Circulation 1997 96 2233 2238 9337195
24 Bergen NE Jaddoe VW Timmermans S Hofman A Lindemans J Russcher H Raat H Steegers-Theunissen RP Steegers EA Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study BJOG 2012 119 739 751 22489763
25 Ouyang F Parker M Cerda S Pearson C Fu L Gillman MW Zuckerman B Wang X Placental weight mediates the effects of prenatal factors on fetal growth: the extent differs by preterm status Obesity (Silver Spring) 2013 21 609 620 23592670
26 Thornburg KL O'Tierney PF Louey S Review: the placenta is a programming agent for cardiovascular disease Placenta 2010 31 Suppl S54 S59 20149453
27 Papandreou D Mavromichalis I Makedou A Rousso I Arvanitidou M Total serum homocysteine, folate and vitamin B12 in a Greek school age population Clin Nutr 2006 25 797 802 16690175
28 Wald DS Law M Morris JK Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis BMJ 2002 325 1202 1206 12446535
29 Osganian SK Stampfer MJ Spiegelman D Rimm E Cutler JA Feldman HA Montgomery DH Webber LS Lytle LA Bausserman L Nader PR Distribution of and factors associated with serum homocysteine levels in children: Child and Adolescent Trial for Cardiovascular Health JAMA 1999 281 1189 1196 10199428
30 Wald DS Wald NJ Morris JK Law M Folic acid, homocysteine, and cardiovascular disease: judging causality in the face of inconclusive trial evidence BMJ 2006 333 1114 1117 17124224
31 Lonn E Yusuf S Arnold MJ Sheridan P Pogue J Micks M McQueen MJ Probstfield J Fodor G Held C Genest J Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators Homocysteine lowering with folic acid and B vitamins in vascular disease N Engl J Med 2006 354 1567 1577 16531613
32 Berdanier CD Feldman EB Dwyer J Ch10. Potential benefits for the use of vitamin and mineral supplements Cotter R Moreines J Ellenbogen L Handbook of Nutrition and Food Second Edition Boca Raton (FL) CRC Press 2007 200
33 Delvin EE Rozen R Merouani A Genest J Jr Lambert M Influence of methylenetetrahydrofolate reductase genotype, age, vitamin B-12, and folate status on plasma homocysteine in children Am J Clin Nutr 2000 72 1469 1473 11101473
34 Hong J Lee HA Park EA Kim YJ Lee H Park BH Ha EH Kong KA Chang N Park H Association of mid-pregnancy antioxidative vitamin and oxidative stress levels with infant growth during the first 3 years of life Food Nutr Res 2014 58 20207
※ AI-Helper는 부적절한 답변을 할 수 있습니다.