Issa Al Salmi (2008). BIRTHWEIGHT AND SUSCEPTIBILITY TO CHRONIC DISEASE , School of Medicine, The University of Queensland.

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n40617347_PhD_abstract.pdf ABSTRACT application/pdf 50.78KB 4
n40617347_PhD_totalthesis.pdf FULL THESIS application/pdf 2.20MB 9
Author Issa Al Salmi
School, Centre or Institute School of Medicine
Institution The University of Queensland
Publication date 2008-04
Supervisor GLENDA C GOBE
Total pages 234
Total colour pages 5
Total black and white pages 229
Subjects 320000 Medical and Health Sciences
Abstract/Summary The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.
Keyword birth weight
birthweight, chronic disease, diabetes, blood pressure, anthropometric measurements, glomerular filtration rate, chronic kidney disease
birth weight and renal volume
chronic disease
Barker Hypothesis
Foetal development
gestational age
Anthropometric Characteristics
body composition
body mass index
Waist Circumference
hip circumference
Waist-hip Ratio
Central Obesity
Lean Body Mass
Lean Mass
Fat Mass
body fat mass
Body Fat Percentage
body fatness
Body Surface Area
Fasting Glucose
fasting insulin level
glucose tolerance
Impaired Fasting Glucose
Impaired Glucose Tolerance
Glycosylated Hemoglobin
glucose control
glycaemic control
Metabolic Syndrome
Syndrome X
blood pressure
Systolic Blood-pressure
Diastolic Blood-pressure
Systolic Hypertension
high blood pressure
Total Cholesterol
Low Density Lipoprotein Cholesterol
Ldl Cholesterol
High Density Lipoprotein
Hdl Cholesterol
coronary artery disease
cardiovascular disease
Framingham Heart Study
Framingham Score
coronary heart disease
Glomerular Filtration
glomerular filtration rate
Glomerular Hyperfiltration
Glomerular Injury
Glomerular Number
Nephron Endowment
Nephron Number
NKF-K/DQQI Classification
Chronic Kidney Disease (ckd)
Chronic Kidney Failure
Kidney Failure
end-stage renal disease (ESRD)
end-stage renal failure
MDRD formula
Serum Creatinine
Urinary Creatinine
Albuminuria:creatinine Ratio
Kidney Development
Kidney dysfunction
low birth weight
low birth weight
Pre-term Birth
AusDiab Study
Australian Diabetes, Obesity and Lifestyle Study (AusDiab)
case control
longitudinal observational study
Additional Notes number of colour pages required are fig1.8 page 57) and fig 3.1 (page 74)AND PAGE 203-205 Landscape pages (for tables) are quite few: tables number (page) as follow; chapter 4: taable:4.1 (85-86), chapter 5: tables (pages):5.2(95),5.3(96),5.4(97),5.5(98-99),5.6(100-101),5.9(106), chapter 6: tables(pages):6.1(112-113),6.3(117),6.4(118-119) chapter 7:tables(pages):7.1(128),7.2(129),7.3(130),7.4(131),7.5(132),7.6(133),7.7(135) chapter8:tables(pages):8.1(147-148),8.2(149-150),8.3(152-153),8.4(154-155),8.5(157-158) chapter9:tables(pages):9.1(167),9.2(168),9.3(169),9.5(172-173),9.6(174-175) chapter10:tables(pages):10.2(184),10.3(187)10.4A(188),10.4B(189),10.5A(190),10.5B(191),10.6A(192),10.6B(193),10.7(194)

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Created: Fri, 12 Jun 2009, 11:20:18 EST by Mr Issa Al Salmi on behalf of Library - Information Access Service