Differences in growth and adiposity between UK Pakistani and White British children: the causes and consequences of smaller size and greater adiposity

出生时的大小和儿童时期的生长被认为是我们一生中重要的发育阶段，并且已知对婴儿和儿童健康和发育问题的风险很重要。近年来，这些重要的早期发育阶段也与我们晚年患病的风险有关，特别是糖尿病和冠心病。众所周知，南亚人群患糖尿病（高出2 - 4倍）和冠心病（高出50 - 80%）的风险特别高，这可能是由于他们与瘦体重相比有更多脂肪的倾向。出生时，南亚婴儿通常较小，体重较轻，但最近的研究表明，像南亚成年人一样，他们比白色英国人更胖。对于一个给定的体重来说，这种更大的肥胖可能对糖尿病和冠心病的风险非常重要，但到目前为止，其原因还不是很清楚。这是可能的，是糖尿病在怀孕期间，这是更常见的南亚妇女，“过度喂养”的婴儿导致更大的肥胖在出生时，并可能在整个生命。如果这是真的，那么后代也会在怀孕期间过度喂养他们的婴儿，一个健康和发育不良的循环可能会开始。移民到英国的南亚人所经历的环境和生活方式的变化可能会使这种风险的持续恶化，例如高能量饮食的可用性，减少运动的文化和肥胖率的上升。南亚和白色英国儿童从出生到童年的生长模式如何不同，也可能影响这两个群体之间在儿童感染和其他儿童健康问题方面的健康差异，甚至可能影响儿童在学校的表现。然而，这一领域的研究经常使用设计不佳的研究，参与者太少，无法给出准确的结果。使用出生在布拉德福德出生队列研究的数据和信息，我将：1.看看一个女人在怀孕开始时的体重，怀孕期间她增加了多少体重，她在怀孕期间的葡萄糖（糖）水平以及她是否患上妊娠糖尿病，影响她的孩子在出生时和4/5岁时的体重和脂肪。我将研究这些测量的效果是否因母亲和孩子是巴基斯坦人还是白色英国人而不同。2.描述英国出生的巴基斯坦裔儿童和英国出生的白色英国儿童的生长模式以及肥胖和血压的差异3.观察英国出生的巴基斯坦裔儿童和英国出生的白色英国儿童的不同生长模式是否导致这两组儿童的不同儿童感染率和住院率。我还将研究不同的成长模式是否会影响孩子们在学校的表现。4.找出巴基斯坦婴儿的父母和祖父母是否出生在英国或南亚，出生时和儿童期的体重和脂肪是否不同。为此，我将联合收割机结合来自BiB队列的现有信息和首次收集的新信息，作为本提案的一部分。我将培训和支持布拉德福德的学校护士收集皮褶测量（用于估计肥胖）和血压，以及英国所有接待年龄儿童的身高和体重测量，包括布拉德福德的良好覆盖率。这些测量将在连续2个学年（2013/2014和2014/2015）收集，将涉及约8000名儿童。整个BiB队列的脐带血样本将用于比较巴基斯坦和白色英国婴儿出生时的脂肪量（约9000份样本）。此外，我将把来自常规卫生和教育系统的信息与现有的BiB数据合并。

Size at birth and growth in childhood are thought to be important stages of development in our lifespan and are known to be important to the risk of infant and childhood health and development problems. Over recent years these important phases of early development have also been linked to our risk of illness in later life, particularly diabetes and coronary heart disease. South Asian populations are known to be at particular risk of diabetes (2 - 4 fold higher) and coronary heart disease (50 - 80% higher) and this may be due to them having a tendency for more fat compared to lean mass. At birth, South Asian babies are generally smaller and lighter but recent studies show that like South Asian adults, they have more fat than White British individuals. This greater fatness for a given weight could be very important to the risk of diabetes and coronary heart disease but so far the reasons for it are not very clear. It is possible that being diabetic during pregnancy, which is more common in South Asian women, 'overfeeds' the infant leading to greater fatness at birth and possibly throughout life. If this is true then later generations would also overfeed their infants during pregnancy and a cycle of poor health and development could be set in motion. This continuation of risk could be made worse by the changes in environment and lifestyle experienced by South Asians who migrate to the UK such as the availability of high energy diets, a culture of less exercise and rising rates of obesity. How patterns of growth from birth to childhood differ in South Asian and White British children could also affect differences in health between these two groups in relation to childhood infections and other childhood health problems and could even affect how well children do in school. However research in this area has often used poorly designed studies with too few participants to give accurate results.Using data and information from the Born in Bradford birth cohort study I will:1.Look at whether how much a woman weighs at the start of pregnancy, how much weight she gains during pregnancy, her glucose (sugar) levels in pregnancy and whether she develops gestational diabetes, affect how much her child weighs and how fat they are at birth and also at age 4/5 years. I will look at whether the effect of any of these measurements is different depending on whether the mother and child are of Pakistani or White British origin. 2.Describe patterns of growth and differences in adiposity and blood pressure in UK born Pakistani origin children and UK born White British children3.Look at whether different patterns of growth in UK born Pakistani origin and UK born White British children result in different rates of childhood infection and hospital admissions between these two groups. I will also look at whether different patterns of growth affect how well the children do in school. 4.Find out whether weight and fatness at birth and in childhood is different depending on whether parents and grandparents of Pakistani infants are born in the UK or South Asia.To do this I will combine existing information from the BiB cohort with new information collected for the first time as part of this proposal. I will train and support school nurses in Bradford to collect skinfold measurements (used to estimate fatness) and blood pressure alongside the height and weight measurements recorded for all reception age children in the UK, including good coverage in Bradford. These measurements will be collected over 2 consecutive school years (2013/2014 and 2014/2015) and will involve approximately 8000 children. Cord blood samples for the whole BiB cohort will be used to compare fat mass in Pakistani and White British infants at birth (approx 9000 samples). In addition I will merge information from routine health and education systems with the existing BiB data.