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Biomedical subjects

D Kuh

Publications and source records attributed to D Kuh.

At least 19 recordsLinked to original sources
PubMed2006

Breast cancer in relation to childhood parental divorce and early adult psychiatric disorder in a British birth cohort.

BACKGROUND: Jacobs and Bovasso reported (Psychological Medicine 2000, 30, 669-678) that maternal death in childhood and chronic severe depression in adulthood were associated with subsequent breast cancer. We have examined the effects of parental loss in childhood and psychiatric disorder in adult life on breast cancer risk using a national birth cohort study. METHOD: Eighty-three cases of breast cancer were diagnosed in a study of 2253 women followed from birth to age 59 years. Cox proportional hazards models were used to test whether breast cancer rates were higher in women who experienced parental death and divorce before age 16, psychiatric disorders between 15 and 32 years, symptoms of anxiety and depression at 36 years, or use of antidepressant medication at 31 or 36 years than in women who did not have these experiences. RESULTS: There was no overall association between parental death, parental divorce or psychiatric disorder and the incidence of breast cancer. There was some evidence that women with more severe psychiatric disorders between the ages of 15 and 32 years were more likely to develop breast cancer early. The interaction between parental divorce and severe psychiatric disorder was non-significant (p=0.1); however, the group who experienced both these events had an increased breast cancer risk compared with those who experienced neither [hazard ratio (HR) 2.64, 95% confidence interval (CI) 1.13-6.19]. CONCLUSIONS: Our study does not provide strong support for the hypothesis that early loss or adult psychiatric disorders are associated with breast cancer. A meta-analysis is needed that uses data from all available cohort studies and investigates possible interactive effects on breast cancer risk.

Adolescent↗
PubMed2006

Validity of age at menarche self-reported in adulthood.

OBJECTIVE: To test the validity of age at menarche self-reported in adulthood and examine whether socioeconomic position, education, experience of gynaecological events and psychological symptoms influence the accuracy of recall. DESIGN: Prospective birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: 1050 women from the Medical Research Council National Survey of Health and Development, with two measures of age at menarche, one recorded in adolescence and the other self-reported at age 48 years. RESULTS: By calculating the limits of agreement, kappa statistic and Pearson's correlation coefficients (r), we found that the validity of age at menarche self-reported in middle age compared with that recorded in adolescence was moderate (kappa = 0.35, r = 0.66, n = 1050). Validity was improved by categorising age at menarche into three groups: early, normal and late (kappa = 0.43). Agreement was influenced by educational level and having had a stillbirth or miscarriage. CONCLUSIONS: The level of validity shown in this study throws some doubt on whether it is justifiable to use age at menarche self-reported in middle age. It is likely to introduce error and bias, and researchers should be aware of these limitations and use such measures with caution.

Abortion, Spontaneous↗
PubMed2005

Cardiovascular risk at age 53 years in relation to the menopause transition and use of hormone replacement therapy: a prospective British birth cohort study.

OBJECTIVES: To investigate cardiovascular risk factors and changes in risk factor levels in relation to menopausal stage, hysterectomy status and hormone replacement therapy use in a cohort of women aged 53 years with prospective data on smoking, lifetime socio-economic circumstances, and blood pressure and obesity at age 43 years. DESIGN: A prospective study. SETTING: England, Scotland and Wales. POPULATION: A cohort of women from the Medical Research Council Survey of Health and Development. METHODS: A total of 1303 women, aged 53 years, from a UK birth cohort study with measures of cardiovascular risk factors were classified by five menopausal status groups (premenopause, perimenopause, postmenopause, hysterectomy and hormone replacement therapy user). Body mass index, glycosolated haemoglobin, blood pressure, high density lipoprotein, low density lipoprotein and total cholesterol measurements were taken, and analysed within the groups taking confounding variables into account. Changes in body mass index and blood pressure measurement in the same women obtained when 43 years of age were also compared. MAIN OUTCOME MEASURES: Body mass index, glycosolated haemoglobin, blood pressure, high density lipoprotein, low density lipoprotein and total cholesterol. RESULTS: At 53 years, body mass index, waist circumference, total and low density lipoprotein cholesterol, and glycosolated haemoglobin (HbA1c) varied by menopausal status group, but blood pressure did not. Levels of total cholesterol and HbA1c increased across the natural menopause transition, before and after adjustment for body mass index, smoking and lifetime socio-economic circumstances. After adjustment for confounders, levels of risk factors for hysterectomised women were similar to those of naturally postmenopausal women. Women on hormone replacement therapy had lower levels of total and low density lipoprotein cholesterol, HbA1c, and were less obese than postmenopausal women. The lower obesity levels were partly due to these women already being less obese at age 43 years. CONCLUSIONS: This study showed that naturally postmenopausal or hysterectomised women had higher levels of metabolic risk factors compared with premenopausal or perimenopausal women of the same age. The long term stability of these differences and their translation into variations in incidence of cardiovascular disease remain to be seen. The lower levels of metabolic risk factors for women on hormone replacement therapy may protect against future cardiovascular disease or may be overwhelmed by other adverse, and as yet unknown, effects of hormone replacement therapy.

Blood Pressure↗
PubMed2003

Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort.

Dense mammographic parenchymal patterns are associated with an increased risk of breast cancer. Certain features of body size have been found to be associated with breast cancer risk, but less is known about their relation to breast density. We investigated the association of birth size, childhood growth and life-course changes in body size with Wolfe grade in 1298 perimenopausal women from a British cohort of women born in 1946. The cohort benefits from repeated measures of body size in childhood and adulthood. We obtained mammograms for 90% of women who at age 53 years reported having previously had a mammogram. We found no associations with birth weight or maximum attained height. Body mass index (BMI) at age 53 years and breast size were independently and inversely associated with Wolfe grade (P-value for trend <0.001 for both). Women who reached puberty later were at a greater odds of a higher Wolfe grade than women who had an earlier puberty (odds ratio associated with a 1 year delay in menarche 1.14, 95% CI: 1.01-1.27, adjusted for BMI and breast size at mammography). A higher BMI at any age during childhood or adult life was associated with a reduction in the odds of a higher Wolfe grade, after controlling for breast size and BMI at mammography, for example, standardised odds ratio for height at age 7 was 0.72 (95% CI: 0.64, 0.81). These findings reveal the importance of taking life-course changes in body size, and not just contemporaneous measures, into account when using mammographic density as an intermediate marker for risk of breast cancer.

Adolescent↗
PubMed2003

Weight from birth to 53 years: a longitudinal study of the influence on clinical hand osteoarthritis.

OBJECTIVE: To determine the influence of body weight throughout the life course on the development of clinical hand osteoarthritis (OA). METHODS: A British national survey was used to perform a prospective cohort study of 1,467 men and 1,519 women born in 1946. Weight was measured at birth and at subsequent followup visits through childhood and adulthood. The main outcome measure was the odds ratio for the presence of hand OA at the age of 53 years. RESULTS: Two hundred eighty men (19%) and 458 women (30%) had OA in at least 1 hand joint. Hand OA was significantly associated with increased weight at ages 26 years, 43 years, and 53 years and with decreased weight at birth in men. Birth weight and adult weight showed independent effects, such that men with the highest risk for OA represented those who had been heaviest at age 53 years and lightest at birth. These findings were not explained by grip strength. There was no significant relationship between weight and hand OA in women. CONCLUSION: The results of this study show that increased adult weight is associated with, and may precede, development of hand OA in men. An association between hand OA and weight was not observed in women. The relationship between hand OA and decreased birth weight is a new finding and may reflect the persisting influence of prenatal environmental factors on adult joint structure and function.

Adolescent↗
PubMed2003

Central and total obesity in middle aged men and women in relation to lifetime socioeconomic status: evidence from a national birth cohort.

STUDY OBJECTIVE: To investigate the influence of social class in childhood, young adulthood and middle age, and intergenerational mobility, on adult central and total obesity. DESIGN: Prospective, population based, birth cohort study. PARTICIPANTS AND SETTING: 1472 men and 1563 women born in 1946 in England, Scotland, and Wales. OUTCOME MEASURES: Waist-hip ratio, waist-height ratio, waist circumference, and body mass index at age 53 years. MAIN RESULTS: Father's social class at participant's age 4 years was inversely associated with adult central and total obesity at age 53 years in men and women. For example, the mean difference of waist-hip ratio (95% confidence intervals) between father's professional social class I and unskilled manual social class V was 2.6% (0.7 to 4.6) for men and 2.5% (0.5 to 4.4) for women. The effect of father's social class remained after adjustment for participant's own social class in young adulthood and middle age. Both adult social classes were inversely related to obesity among women, but not men, after adjustment for childhood circumstances. Upwardly mobile men and women were less obese than participants remaining in their father's social class and their levels of obesity tended to be between the class they left and the class they joined. CONCLUSIONS: The effect of social class on adult obesity differed according to the stage in the life course at which social class was measured, and gender. Childhood circumstances had enduring influences on adult obesity, although our results on intergenerational mobility indicate potential reversibility of early life disadvantage.

Anthropometry↗
PubMed2002

Birth weight, childhood growth and abdominal obesity in adult life.

OBJECTIVE: To examine the relationship of adult abdominal obesity to birth weight, childhood growth and lifetime socioeconomic circumstances. METHODS: A cohort of 3200 men and women with measured waist and hip circumference, height and weight at age 43 who have been followed since their birth in March 1946 in England, Scotland and Wales. Regression models were used to examine mean waist-hip ratio and waist circumference in relation to prospective measures of birth weight, weight relative to height in childhood at ages 4, 7, 11 and 15 and adult body mass index, and to test the independent and interactive nature of the associations and adjust for childhood and adult social class. RESULTS: There was a small inverse effect of birth weight on waist-hip ratio (P=0.037) but not waist circumference in women, after adjustment for current body size. Relative weight at age 7 was inversely related to waist-hip ratio and waist circumference in men (P<0.001 for both) and waist circumference in women (P=0.007) after adjustment for current body size. These relationships were attenuated in men of large body mass index (P<0.01 for interactions between relative weight at 7 y and body mass index in both cases) but were not modified by birth weight. Relative weights at other ages showed similar patterns to those observed at age 7, the effect being weakest at age 4. These findings were independent of lifetime socioeconomic circumstances. CONCLUSION: This study found a small prenatal inverse effect of fetal growth on adult waist-hip ratio due to a reduced hip size. There was also an inverse postnatal effect of childhood growth such that for any given adult body size those who had been lighter in childhood were more at risk of abdominal obesity. These relationships were independent of childhood socioeconomic circumstances and support the idea that insulin resistance may be linked to low weight in childhood.

Abdomen↗
PubMed2002

Does early growth influence timing of the menopause? Evidence from a British birth cohort.

BACKGROUND: Few adult environmental or behavioural factors have been consistently associated with age at menopause. The peak number of follicles attained in utero or lost before ovulation begins may be more important. This study investigates whether birthweight, childhood body size, having been breastfed and early socioeconomic circumstances are associated with age at menopause. METHODS: Menopausal status and risk factor information have been collected prospectively from 1572 British women followed up since their birth in 1946, so far until 53 years. Cox's regression models were used to investigate the relationships between early life factors and rate of menopause. RESULTS: Age at menopause varied by duration of breastfeeding, weight at age 2 years, childhood socioeconomic status, but not birthweight. In a multiple regression model, women of low weight at 2 years had an earlier menopause [hazard ratio (HR) = 0.75 for highest versus lowest quarter: 95% confidence interval (CI) 0.54-1.02] and those who had been breastfed had a later menopause (HR = 0.69 for vertical line 7 months versus never breastfed: 95% CI 0.51-0.92) than others. The influence of socioeconomic status was attenuated. CONCLUSIONS: Early life influences may influence ovarian ageing, highlighting the importance of investigating factors from across the life course.

Adult↗
PubMed2001

Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study.

OBJECTIVE: To examine the association between birth weight and cognitive function in the normal population. DESIGN: A longitudinal, population based, birth cohort study. PARTICIPANTS: 3900 males and females born in 1946. MAIN OUTCOME MEASURES: Cognitive function from childhood to middle life (measured at ages 8, 11, 15, 26, and 43 years). RESULTS: Birth weight was significantly and positively associated with cognitive ability at age 8 (with an estimated standard deviation score of 0.44 (95% confidence interval 0.28 to 0.59)) between the lowest and highest birthweight categories after sex, father's social class, mother's education, and birth order were controlled for. This association was evident across the normal birthweight range (>2.5 kg) and so was not accounted for exclusively by low birth weight. The association was also observed at ages 11, 15, and 26, and weakly at age 43, although these associations were dependent on the association at age 8. Birth weight was also associated with education, with those of higher birth weight more likely to have achieved higher qualifications, and this effect was accounted for partly by cognitive function at age 8. CONCLUSIONS: Birth weight was associated with cognitive ability at age 8 in the general population, and in the normal birthweight range. The effect at this age largely explains associations between birth weight and cognitive function at subsequent ages. Similarly, the association between birth weight and education was accounted for partly by earlier cognitive scores.

Adolescent↗
PubMed2000

The influence of childhood weight and socioeconomic status on change in adult body mass index in a British national birth cohort.

OBJECTIVE: To investigate the effect of childhood weight and childhood socioeconomic status on the pattern of change in body mass index (BMI) between 20 and 43 years. METHODS: A British birth cohort study where the survey members have been followed up regularly since their birth in 1946, with the most recent of 19 follow-ups when the cohort were aged 43 years. BMI was available at 20, 26, 36 and 43 years of age and thus multilevel models for repeated outcome measures were used to model the patterns of change in BMI. RESULTS: The rate of increase in BMI with age was non-linear, with the rate of increase in mean BMI accelerating with increasing age at different rates for men and women. The mean BMI for men was higher than that for women at all ages. Childhood manual social class, defined in terms of father's occupation, and high relative weight at 14 years of age were associated with higher mean BMI across adult life, and these effects increased with age. The effects of childhood relative weight and social class were independent of educational attainment and adult social class. CONCLUSION: The study provides evidence of a long-term effect of childhood social and biological circumstances on BMI. The pathways underlying these relationships may be social or biological, but are not yet fully understood.

Adolescent↗
PubMed2000

Birthweight, childhood growth and risk of breast cancer in a British cohort.

We have examined the relationship between birthweight and risk of breast cancer, taking into account growth in childhood, using data on a total of 2221 women born in 1946 and followed up to 1997. Thirty-seven breast cancers occurred during follow-up. There was evidence of greater risk of breast cancer with greater birthweight (rate ratio = 1.76 (95% CI: 0.92, 3.35) for birthweight >/= 3.5 kg vs birthweight < 3.5 kg), which was more marked at pre-menopausal ages (RR = 2.31, 95% CI: 0.93, 5.74). The relation with birthweight was not substantially confounded by any of the measured adult risk factors. A significant interaction was observed between the effects of birthweight and height at age 7 years. Relative to those born lighter than 3.5 kg, women who were heavy at birth (>/= 3.5 kg) and short or average at 7 years (< 1.22 m) had a 21% increase in breast cancer rates (RR = 1.21; 95% CI = 0.49-2.99), while women who were heavy at birth (>/= 3.5 kg) but tall at 7 years (>/= 1.22 m) had a four-fold increase (RR = 4.01; 95% CI = 1.82-8.83). These results suggest that the effect of birthweight on breast cancer risk may be modulated by childhood growth.

Adolescent↗
PubMed2000

Smoking, body mass index, socioeconomic status and the menopausal transition in a British national cohort.

BACKGROUND: This study investigates whether cigarette smoking, body mass index (BMI) and socioeconomic status are independently associated with age at menopausal transition. METHODS: Menopausal status and risk factor information were collected prospectively from 1572 British women followed up since their birth in 1946, so far until 50 years. Cox's regression models were used to investigate the relationships of interest. RESULTS: Cigarette smokers started the perimenopause and reached the menopause earlier than ex-smokers and non-smokers. The relative risk for smokers compared with non-smokers was 1.31 (95% CI : 1.09-1.56) for perimenopause and 1.63 (95% CI : 1.17-2.27) for menopause. Body mass index was associated with the age at inception of the perimenopause only among smokers and ex-smokers, with underweight women having the earliest perimenopause. No association was observed between BMI and age at menopause. Smokers and underweight women were more likely than others to start hormone replacement therapy (HRT) before becoming postmenopausal. There was no effect of education or social class on age at inception of the perimenopause or age at menopause. Single women had an earlier perimenopause but the effect was confounded by parity. CONCLUSIONS: Smoking was independently related to an earlier menopausal transition, although the effect on inception of the perimenopause was particularly observed among underweight women. There was no independent effect of socioeconomic status. The popularity of HRT use in this cohort may have had an impact on the findings.

Adult↗
PubMed2000

Social and behavioural influences on the uptake of hormone replacement therapy among younger women.

OBJECTIVE: To describe the social and behavioural influences on the uptake of hormone replacement therapy before the age of 50. DESIGN: Nationally representative birth cohort study with detailed hormone replacement therapy histories and prospective data on health, social and behavioural factors collected throughout life. SETTING: England, Scotland and Wales. POPULATION: General population sample of 1,572 women followed to the age of 50 years. MAIN OUTCOME MEASURE: Age at first hormone replacement therapy use RESULTS: By the age of 50 years, 45% of women had tried hormone replacement therapy and one third were current users. Over two-fifths of users had tried more than one preparation and over one quarter had episodic use. For the vast majority, prescribing conformed to current guidelines. More educated women took hormone replacement therapy for long term prevention compared with their less educated peers. Hysterectomy increased the chances of taking hormone replacement therapy, particularly where an oophorectomy had also been performed, and was associated with longer and more continuous use. Results of a Cox's proportional hazards model showed that the age at which first hormone replacement therapy is used by women who have not had a hysterectomy was influenced by previous contact with health services for menstrual disorders, previous use of oral contraception and cigarettes, past reporting of health problems and low social class. The relation between smoking and low social class with early use of hormone replacement therapy may be due to their association with early menopause. CONCLUSIONS: The trend over the last two decades towards greater use of hormone replacement therapy has continued unabated for younger women. So far, hormone replacement therapy users in this generation have had less healthy lifestyles and social advantages than nonusers, in contrast to many older mainly American studies based on earlier generations. This may have long term implications for health and health care as the postwar baby boom generation ages.

Adult↗
PubMed1999

Lifetime cognitive function and timing of the natural menopause.

BACKGROUND: There is evidence that ovarian steroids influence both reproductive aging and neural development. OBJECTIVE: We investigated the relationship between menopause and lifetime cognitive function in a prospective birth cohort study. METHODS: Participants were 1,572 women enrolled in the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). By age 50, 245 women were postmenopausal, 724 were pre- or perimenopausal, 288 had had a hysterectomy or bilateral oophorectomy, and 291 women had started taking hormone replacement therapy (HRT) before their menopause. The remaining 24 women, for various reasons, could not be classified into any of these groups. We investigated the association between cognitive function at ages 8, 11, 15, 26, and 43 years and menopause timing using Cox proportional hazard models, censoring for hysterectomy and bilateral oophorectomy, and initially for HRT use. The effect of including HRT use before menopause as an additional outcome was investigated using a competing risks analysis. RESULTS: Higher cognitive scores were associated with later menopause. The effect was strongest in childhood. This finding could not be explained by a variety of potential confounders, including early social background, physical development, education, adult social class, parity, smoking, and alcohol consumption. CONCLUSIONS: Childhood cognitive function is related to timing of the natural menopause. Both may be influenced by ovarian steroids across the life-span.

Adolescent↗