Birth size and coronary heart disease risk score in young adulthood. The Atherosclerosis Risk in Young Adults (ARYA) study.

Data of the Atherosclerosis Risk in Young Adults (ARYA) study were used to investigate the association between birth size and the absolute risk for coronary heart disease in healthy young adults. The cohort study comprises 750 (46.9% men) subjects born between 1970 and 1973. Birth characteristics were obtained from school health records. At young adulthood, blood pressure, anthropometry and fasting lipid levels were measured. Questionnaires were taken about smoking and diabetes. The young adult 10-year risk for coronary heart disease was calculated using the Framingham risk score. The overall 10-year risk for coronary heart disease was 1.6% (standard deviation (SD) 1.9), 3.0% (SD 1.9) in men and 0.3% (SD 0.2) in women. Using linear regression it was shown that a SD lower birth weight (=0.54 kg) was associated with 0.1% greater risk in the overall population (95% confidence interval (CI): -0.19, -0.004). Similarly, a lower ponderal index at birth was associated with an 0.11% higher risk (95% CI: -0.21, -0.002). These relations were stronger in men. Lower birth length was related with an increased risk in women (-0.02% risk/SD birth length; 95% CI: -0.04, 0.0001). These results suggest that small birth size is associated with an increased risk score for coronary artery disease in young adulthood.

Change in body mass index from adolescence to young adulthood and increased carotid intima-media thickness at 28 years of age: the Atherosclerosis Risk in Young Adults study.

UNLABELLED: Obesity has become a major health problem in Western societies by increasing the risk of atherosclerosis and cardiovascular disease. Although data on tracking of body mass index (BMI) are available, little is known about the impact of weight change over time on the development of vascular damage. OBJECTIVE: To evaluate the relationship between adolescent BMI as well as change in BMI from adolescence into young adulthood and cardiovascular risk, as estimated by common carotid intima-media thickness (CIMT). DESIGN: Cohort study. SUBJECTS: A total of 750 healthy young adults, aged 27-30 y, who attended secondary school in Utrecht, the Netherlands. MEASUREMENTS: Data on adolescent weight, height, blood pressure and puberty stage were available from the original school health records of the Municipal Health Service. At young adulthood, a questionnaire on cardiovascular risk factors was completed and fasting blood sample was drawn and common CIMT was measured. RESULTS: One standard deviation (s.d.) increase in adolescent BMI was associated with 2.3 microm [95% confidence interval (CI): 1.3; 3.3] increase in mean common CIMT in young adults after adjustment for gender, adolescent age, adolescent blood pressure, puberty stage and lumen diameter. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1). Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. Subjects who remained in the upper BMI distribution from adolescence into young adulthood had a significantly higher common CIMT compared to those who showed relative weight loss over time (mean difference 14.7 mum; P<0.001). These latter showed similar CIMT values as individuals with constant low BMI. CONCLUSION: Adolescent BMI predicts cardiovascular risk, as estimated by common CIMT in young adulthood. Individuals who experience the largest increase in BMI and those who remain overweight over time have the thickest common CIMT.

The Atherosclerosis Risk in Young Adults (ARYA) study: rationale and design.

INTRODUCTION: Despite recent advances in treatment, cardiovascular disease (CVD) is still health problem number one in western societies. Aiming at specific prevention strategies for high-risk individuals and shifting the available prevention programs towards younger age groups might increase the success of primary prevention. However, before addressing age-specific prevention programs, more insight in the determinants of early vascular damage and increased cardiovascular risk is warranted as well as insight in determinants increased cardiovascular risk, including vascular damage, at an early age. The Atherosclerosis Risk in Young Adults (ARYA) study was specifically designed to address this issue. OBJECTIVES: The ARYA study started off with studies evaluating (1) whether it is possible to predict cardiovascular risk at young adulthood by routinely measured adolescent data, and (2) evaluating the role of birth characteristics and adolescent characteristics to the development of vascular damage at young adulthood. METHODS: The ARYA study comprises of two cohorts of young adults. The Utrecht cohort includes 750 young adults, aged 27-30 years. The Hague-cohort includes 261 young adults born between 1963 and 1968. Data on birth characteristics, growth in early infancy as well as adolescent anthropometry, blood pressure, lipids, body mass index were obtained from the original medical records of the Municipal Health Service. In 1999/2001, the extent of subclinical vascular damage was measured using carotid wall thickness and aortic stiffness. Also, data on adult cardiovascular risk profile, bone density and central blood pressure were assessed, fasting blood was drawn and timed overnight urine samples were collected. CONCLUSION: The ARYA study is aimed to provide data on early determinants of cardiovascular risk, including vascular damage, at an early age. This knowledge enhances the understanding of atherosclerosis development and CVD risk and is needed to improve the available primary prevention programs.

Teenage pregnancy and ethnicity in The Netherlands: frequency and obstetric outcome.

OBJECTIVES: To study differences in frequency and obstetric outcome of teenage pregnancy (not ending in induced abortion) between the main ethnic groups in The Netherlands. DESIGN: A retrospective cohort study based on the 1990-93 birth cohort in the National Obstetric Registry. SUBJECTS: A total of 10,583 teenagers and 54,501 20-24-year-old women who had a singleton pregnancy and were primiparous. MAIN OBSTETRIC OUTCOME MEASURES: These were perinatal death occurring between the 16th week of pregnancy and 24 h after birth, preterm birth and operative delivery (vaginal extraction and Cesarean section). METHOD: Comparison of the frequency of teenage pregnancy between ethnic groups and by bivariate and multivariate analysis of the three outcome measures between the teenage groups, the teenage groups and ethnically related 20-24-year-old women, and the teenage groups and Dutch 22-24-year-old women. RESULTS: A total of 55.2% of pregnant teenagers had non-Dutch ethnicity compared to 13.8% of all pregnant women. Islamic-Mediterranean teenagers constituted the largest group, one in four of all primiparous Mediterranean women being younger than 20 years of age, followed by black teenagers. Except for Hindustani teenagers, perinatal death occurred in all non-Dutch teenage groups more frequently than in Dutch teenagers, but the differences were only significant for black teenagers (odds ratios of black compared to Dutch teenagers were 2.89 (95% confidence interval (CI) 1.89-4.4) and 1.53 (95% CI 1.19-1.98), respectively). Rates for preterm birth were higher in black and Asian than in Dutch teenagers, but the difference was only significant for black teenagers (odds ratio 1.53, 95% CI 1.19-1.98). Compared to ethnically related 20-24-year-old women, rates of perinatal death and preterm birth were significantly higher in Dutch, black and Asian teenagers and, for preterm birth only, in Mediterranean teenagers. Correction for preterm birth showed that only part of these differences in perinatal death could be explained by preterm birth. Vaginal extraction and Cesarean section occurred less frequently in teenagers than in ethnically related (and in Dutch) 20-24-year-old women. Mediterranean teenagers had the lowest Cesarean section rate and Blacks the lowest vaginal extraction rate. CONCLUSION: Teenage pregnancy in The Netherlands is much more common in minority ethnic groups than in the indigenous population, particularly among Islamic-Mediterraneans and Blacks. Obstetric outcomes vary considerably, these being best in Hindustani and poorest in black teenagers, and being worse in teenagers than in 20-24-year-old women. However, teenagers less often had assisted delivery.

[Teenage pregnancy distribution by ethnicity in the Netherlands, 1990-1993]. / Tienerzwangerschappen naar etniciteit in Nederland, 1990-1993.

OBJECTIVE: To determine and compare the obstetrical results of teenage pregnancies among the main ethnic groups in the Netherlands. DESIGN: Retrospective cohort study. METHODS: From the cohorts 1990-1993 of the Landelijke Verloskundige Registratie (LVR, National Obstetrical Registration) the data were analysed concerning primiparae aged 14-19 years with a single pregnancy. RESULTS: During the period 1990-1993, 14.9% of the women whose parturitions were recorded in the LVR were allochtonous, of the teenage pregnancies recorded 55.2% occurred in an allochtonous population group. The numbers (percentages) of teenage pregnancies (primiparae, singles) in the various ethnic groups were 4742 (2.2%) in the autochtonous group, 3974 (25.9%) in the (Muslim) mediterraneous, 340 (7.8%) in the non-Dutch European, 588 (14.9%) in the Afro-allochtonous, 316 (9.7%) in the Hindustani, 263 (5.5%) in the Asian (excluding Hindustani and Asian Turkish) and 360 (10.4%) in the remaining ethnic groups. Hindustani and orthodox Muslims regard teenage pregnancy positively. The perinatal mortality was higher among Afro-allochtonous than among autochtonous teenagers (odds ratio: 2.89 (95% confidence interval: 1.89-4.40)), and the same was true of premature and immature parturition. Both findings occurred significantly more often in the autochtonous, Afro-allochtonous and Asian population parts than among women of the same ethnic groups aged 20-24 years. In relation to autochtonous women aged 20-24, the odds ratios for perinatal mortality and premature and immature parturition among Afro-allochtonous women were 3.64 (2.50-5.30) and 2.02 (1.59-2.55), respectively; after correction for pre- and immature parturition the odds ratio for perinatal mortality decreased to 2.35 (1.51-3.66). Low birth weight was less frequent among the Mediterraneans and more frequent among the Afro-allochtonous and Hindustani than among the autochtonous. Induced vaginal deliveries were less frequent among allochtonous teenagers, the risk of caesarean section was lower among Mediterranean teenagers but higher among Afro-allochtonous, Hindustani and other ethnic teenagers than among autochtonous teenagers. All groups of teenagers had lower frequencies of induced delivery than women of the same ethnic groups aged 20-24 years. CONCLUSIONS: Teenage pregnancy in the Netherlands occurs much more often among allochtonous than among autochtonous women and is encountered most often among (Muslim) mediterranean and Afro-allochtonous groups. Obstetrical results vary greatly from one ethnic teenage group to another; they are poorest among the Afro-allochtonous, best among the Hindustani group. Among the mediterranean teenagers, they are similar to those among the autochtonous group.

Hearing deficits at school age; the predictive value of otitis media in infants.

AIM: To evaluate the long-term predictive value of persistent/recurrent otitis media with effusion (OME) in infants in relation with hearing levels at (early) school age. DESIGN: A case-cohort study among a population-based sample of school-age children screened for hearing deficits. POPULATION AND METHODS: Schoolchildren (second grade, 5-6 years of age) in the city of Utrecht, the Netherlands, who failed the hearing screening test and a sample of children invited for this screening. History of otitis media (serosa and acute) was assessed using three sources of information: a self-completion questionnaire mailed to the parents; medical records of otolaryngology visits; data from the (Ewing) hearing screening test at 9 months of age. RESULTS: Children who failed the primary Ewing test and children with recurrent and or persistent OME in the first 2 years of life showed an increased risk of failing school audiometry compared to children without such an OME history (OR=1.6 and 2.3, respectively). In a logistic model, the results of the primary Ewing test and the frequency of acute otitis media, proved to be moderately predictive for the screening test result at school age. CONCLUSION: OME in infants is a prognostic factor for hearing performance in the early school years.