For South Asian adults lowered BMI cut-offs for overweight and obesity are recommended as these are more in agreement with their body composition (low muscle mass, high fat mass) and the... Show moreFor South Asian adults lowered BMI cut-offs for overweight and obesity are recommended as these are more in agreement with their body composition (low muscle mass, high fat mass) and the considerably higher risk of cardiovascuar and metabolic disease. For South Asian children living in a Western country lowered BMI norms have not been established, nor other ethnic specific growth standards. The aims of this thesis are 1. to gain more insight into the normal physical growth of South Asian children 2. to develop South Asian specific height-for-age (0-21 years) and BMI-for-age (2-18 years) references, including BMI cut-offs. The studies in this thesis show that South Asian children are generally lighter and shorter than other ethnic groups. The mean birth weight is at 3012 grams around 450 grams lower than of Dutch babies and has remained unchanged for the past 35 years. In children 3-15 years thinness is highly prevalent and overweight prevalence is relatively low. Application of the developed height-for-age charts and lowered BMI cut-offs will expectedly lead to a better assessment of height and nutritional status (thinness, overweight) in this group. Consequently, thinness rates will be lower while overweight will be detected earlier, leading to earlier preventive interventions. Show less
Wilde, J.A. de; Buuren, S. van; Middelkoop, B.J.C. 2013
Children born small-for-gestational-age (SGA) are at risk for short stature, and cardiovascular disease and type 2 diabetes in later life. There is some preliminary evidence for a similar phenotype... Show moreChildren born small-for-gestational-age (SGA) are at risk for short stature, and cardiovascular disease and type 2 diabetes in later life. There is some preliminary evidence for a similar phenotype in survivors of preterm birth. In contrast to children born SGA, preterm infants born appropriate-for-gestational-age who experienced neonatal growth retardation, resulting in a small size at term, are excluded from growth hormone therapy if they fail to catch up in height subsequently. We tested in 19-year-olds born before 32 gestational weeks from the Project On Preterm and Small-for-gestational-age infants cohort the effect of early growth on the growth pattern and adult metabolic health. Childhood growth and adult height were similar in preterm infants born SGA and those with neonatal growth retardation (weight and/or length at 3 months <-2 SD score). Young adults born preterm had a waist circumference and a waist-to-hip ratio much greater than the population reference mean, especially women. In addition, they showed a tendency towards insulin resistance and a high prevalence of hypertension. These findings were not explained by antenatal glucocorticoid treatment. Carriers of the 23K variant of the R23K polymorphism in the glucocorticoid receptor, associated with a mild glucocorticoid resistance, were less insulin-resistant and showed complete catch-up growth early in infancy and attained height was similar to the population reference mean, whereas stature in non-carriers was on average 0.5 SD below this mean Show less
Vascular maladaptation prior and during implantation may lead to serious complications during pregnancy, perinatally, but also later in life (Barker hypothesis). The consequences later in life... Show moreVascular maladaptation prior and during implantation may lead to serious complications during pregnancy, perinatally, but also later in life (Barker hypothesis). The consequences later in life often appear to be related to endothelial dysfunction. Angiogenesis, the formation of new blood vessels from pre-existing ones, is an important endothelial function and plays a key role in the process of implantation and placentation. Two epidemiological studies described here, show that myocardial infarction is related to low birth weight and that assisted procreation adversely affects birth weight. An optimal intra-uterine environment forms the basis for a good perinatal outcome and is created by a receptive endometrium in which angiogenesis is crucial. To study endometrial angiogenesis, human endometrial endothelial cells were isolated. The high expression of u-PA by these cells was found to contribute to their high angiogenic properties. Furthermore, these cells depend on MT3-MMP to form tubes. The ovarian steroids overall regulate endometrial angiogenesis indirectly via the endometrial stromal cells. During implantation, the embryo takes over as the main (local) regulator by inducing angiogenesis at its implantation site through the expression of VEGF. These results provide more insight in the (patho-)physiology of endometrial angiogenesis and in the role of the embryo in this. Show less
