Commentary: The relationship between parity and overweight--a life course perspective.
Explore the source record for details and available documents.
Body Mass Index↗
Biomedical subjects
Diana Kuh
Publications and source records attributed to Diana Kuh.
Postnatal depression and the original mother-child relationship: a prospective cohort study.
BACKGROUND: Previous studies assessing the role of early mother-child relationship as a risk factor for postnatal depression have been cross-sectional and/or retrospective in nature. AIMS: To examine associations between early mother-child relationship (assessed prospectively and retrospectively) and later risk of postnatal depression. METHODS: Dataset from national 1946 birth cohort study; 1137 women at age 51, completed a modified version of the Bromley Postnatal Depression Scale. RESULTS: Compared with women who did not experience maternal separation or recalled moderate to best level of care, women who experienced maternal separation for 3.5 days or more in early childhood and who felt they received a low level of maternal care were at higher risk of postnatal depression (odds ratio (95% CI): 2.4 (1.51-3.79), p=0.001); this relationship was robust to adjustment for current psychological status. Regular enuresis at age of 6 years (2.2 (1.01-4.90), p=0.05), and lack of emotional closeness in current maternal relationship (1.6 (1.01-2.46), p=0.04) were also associated with increased postnatal depression risk. Insufficient evidence was found for a link between other indicators of early behaviour and temperament (anxious, antisocial, or neurotic behaviour) and reported postnatal depression. LIMITATIONS: Postnatal depression was assessed retrospectively using self-report, introducing potential bias in recall. CONCLUSION: Women who experienced early maternal separation and recalled the lowest level of maternal care had a particularly high risk of postnatal depression. In the treatment and management of postnatal depression, the results support health professionals in their consideration of the woman's past and current relationship with her mother; both actual events and the woman's perceptions of them.
Cohort Studies↗
A life course perspective on telomere length and social inequalities in aging.
Longitudinal studies will be needed to test the idea that social class in adult life, or in childhood, influences the rate of change in telomere length in peripheral blood samples.
Aging↗
Social circumstances and education: life course origins of social inequalities in metabolic risk in a prospective national birth cohort.
OBJECTIVES: We investigated the relative importance of education and childhood and adult social class in the risk of metabolic syndrome. METHODS: We conducted a prospective birth cohort study of 1311 men and 1318 women aged 53 years in 1999, when metabolic syndrome components were measured. Logistic regression analyses were used to calculate relative index of inequality estimates. RESULTS: Relative to men and women at the highest education levels, men (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.2, 3.2) and women (OR=2.7; 95% CI=1.5, 4.6) with the least education were at twice the risk or more of having the metabolic syndrome. Adjustment for childhood and adult social class strengthened this result among men and weakened it among women. Childhood social class was independently associated with the metabolic syndrome in women (OR=2.0; 95% CI=1.1, 3.6) but not in men (OR=1.1; 95% CI= 0.7, 1.8). Associations between adult social class and the metabolic syndrome or its components were largely accounted for by childhood socioeconomic measures. CONCLUSIONS: Educational differences should be considered in the design of interventions aimed at reducing the burden of the metabolic syndrome in socially disadvantaged groups.
Child, Preschool↗
Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women.
BACKGROUND: Investigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious. METHODS: We applied latent variable models for factor analysis of ordinal/categorical data to a 42-item version of Ryff's psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later. RESULTS: Inter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a second-order general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression. CONCLUSION: Our preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.
Cohort Studies↗
Developmental origins of midlife physical performance: evidence from a British birth cohort.
The authors hypothesized that 1) physical growth, as a marker of the early development of muscle fibers, and 2) advanced childhood motor and cognitive abilities, as markers of central nervous system development, would be positively related to midlife standing balance and chair rising, independently of later life experiences. They tested these hypotheses in a representative British sample of 1,374 men and 1,410 women aged 53 years in 1999 with prospective childhood measures of heights and weights, age at first standing and walking, cognitive ability, and motor coordination. Weight gain before age 7 years was positively related to adult performance in men but not women, independently of later body size, social class, physical activity, and health status. Attainment of motor milestones at the modal age and higher scores on tests of cognitive ability and motor coordination were associated with better performance, independently of other factors. This study is the first to show that childhood growth and development affect midlife performance; prevention of disability and frailty in later life may need to start early.
Adolescent↗
Cessation of hormone replacement therapy after reports of adverse findings from randomized controlled trials: evidence from a British Birth Cohort.
OBJECTIVES: We examined the cessation of hormone replacement therapy (HRT) among British women, by educational level, social class, and cardiovascular risk factors, at the time of publicity about 2 clinical trials of HRT that were halted after adverse findings. METHODS: A total of 1387 women aged 57 years reported their monthly HRT use between January 2002 and February 2003. A succession of regression-based time-series models were fitted to detect changes in the proportion of HRT users stratified by education level, social class, hypertension, and obesity. RESULTS: The overall percentage of HRT users declined from 31% in January 2002 to less than 26% by February 2003. Changes in trends of HRT use were first detected in June 2002 (for women with advanced secondary educational qualification or higher) and in July 2002 (for all other groups). The rate of decline was greatest for women with no formal educational qualifications, from the manual social class, or who were hypertensive or obese. CONCLUSIONS: These decreases coincided with the announced cessation of a large US clinical trial of HRT. This publicity may have had a differential influence on the immediate decline in HRT use by various groups of British women.
Educational Status↗
Women's health in mid-life: life course social roles and agency as quality.
Data from a prospective British birth cohort study showed that women who were childless, lone mothers or full-time homemakers between the ages of 26 and 53 were more likely to report poor health at age 54 than women who occupied multiple roles between these ages. To explain this finding we developed and tested a theory of role quality based on the concept of agency by drawing on Giddens' theory of structuration and Doyal and Gough's theory of human needs. According to our theory, the patriarchal structuration (drawing on Giddens' term) of work and family roles provides both limitation and opportunity for the expression of agency. Doyal and Gough's theory of human needs was then used to identify the restriction of agency as a possible influence on health. This theory of role quality was operationalised using a measure of work (paid and unpaid) quality at age 36 and a measure of work and family stress between ages 48 and 54. The relatively poor subjective health in mid-life of lone mothers was explained by work and family stress and adult social class. In contrast, the poor health in mid-life of long-term homemakers and childless women was less easily explained. Homemaker's excess risk of reporting poor health at age 54 remained strong and significant even after adjusting for role quality and socioeconomic indicators, and childless women were at an increased risk of reporting poor health despite the social advantage inherent in attaining educational qualifications and occupying professional or managerial occupations. This study highlights the need to develop measures of role quality specifically designed to capture agency aspects of social roles.
Adult↗
Commentary: BMI and mortality in the elderly--a life course perspective.
Explore the source record for details and available documents.
Aged↗
Childhood socioeconomic status predicts physical functioning a half century later.
BACKGROUND: Socioeconomic status (SES) affects health outcomes at all stages of life. Relating childhood socioeconomic environment to midlife functional status provides a life course perspective on childhood factors associated with poor and good health status later in life. METHODS: The British 1946 birth cohort was prospectively evaluated with periodic examinations from birth through age 53 years, when physical performance tests assessing strength, balance, and rising from a chair were administered. Early childhood socioeconomic factors were examined as predictors of low, middle, or high function at midlife. We tested the hypothesis that adulthood behavioral risk factors would explain the childhood SES-midlife physical function associations. RESULTS: Multiple measures of childhood deprivation were associated with midlife function but in multivariate analyses only father's occupation was associated with low function (relative risk [RR] for manual occupation = 1.6; 95% confidence interval [CI], 1.1-2.3), and only mother's education was associated with high function (RR for lower mother's education = 0.49; 95% CI, 0.34-0.72). Early adulthood behavioral risk factors and middle-age SES and disease status only modestly attenuated the relationship between father's occupation and low function and had no impact on the relationship of mother's education with high function. CONCLUSIONS: The social environment in which a child grows up has a strong association with midlife, objectively measured functional status, which is a reflection of the aging process and chronic diseases accumulated over the life course. Of particular interest is the role of higher maternal education in promoting high midlife functioning.
Activities of Daily Living↗
Developmental origins of midlife grip strength: findings from a birth cohort study.
BACKGROUND: There is growing evidence that the prenatal environment has long-term effects on adult grip strength, but little is known about the effects of the postnatal environment. We tested whether prepubertal growth, pubertal growth, or the development of motor and cognitive capabilities was associated with midlife muscle strength independently of other determinants of grip strength. METHODS: Handgrip strength and body size were measured in a representative British sample of 1406 men and 1444 women 53 years old with prospective childhood data. Normal regression models were used to examine the effects of birth weight, postnatal height and weight gain before 7 years and between 7 and 15 years, motor milestones and cognitive ability on grip strength at age 53, taking account of lifetime social class, current physical activity, and health status. RESULTS: Birth weight and prepubertal height gain were associated with midlife grip strength, independently of later weight and height gain and other determinants. Pubertal growth was also independently associated with midlife grip strength; for men weight gain during puberty was beneficial, whereas for women it was height gain. Those participants with earlier infant motor development had better midlife grip strength, which was partly confounded by the growth trajectory. CONCLUSIONS: This study showed that components of prenatal, prepubertal, and pubertal growth have long-term effects on midlife grip strength. To the extent that these associations are modifiable, interventions in childhood that help to build muscle mass and strength, such as increased physical exercise, may have long-term beneficial effects on adult muscle strength and may help to prevent sarcopenia, disability, and frailty in later life.
Adolescent↗
Age at puberty and adult blood pressure and body size in a British birth cohort study.
OBJECTIVE: To investigate the association between age at puberty and blood pressure at age 53 years. DESIGN: A prospective birth cohort study with regular contacts through childhood and adulthood until the age of 53 years. PARTICIPANTS: A total of 1193 men and 1204 women, from a sample of 5362 born in Britain in March 1946. MAIN OUTCOME MEASURE: Blood pressure at age 53 years. RESULTS: Regression models indicated that men who had reached puberty latest had a lower mean systolic blood pressure (SBP; P = 0.03) and diastolic blood pressure (DBP; P = 0.01) at 53 years than others. The mean SBP (95% confidence interval) was 6.4 mmHg (1.8, 10.9) greater in the earliest puberty group compared with the latest; for DBP the difference was 4.6 mmHg (1.9, 7.4). The associations were not accounted for by current body size, even though later puberty was associated with a decreasing body mass index (BMI) at 53 years. Neither were they accounted for by prepubertal body size, birth weight, or childhood and adult social class. Although women who reached puberty early had a higher BMI and shorter stature at 53 years compared with other women, they did not have higher blood pressure. CONCLUSIONS: Better health behaviours in men reaching puberty late may explain the association between age at puberty and blood pressure. Alternatively, age at puberty may be a marker of the whole growth trajectory, distinguishing characteristics important in the later development of high blood pressure. The association of early puberty with high adult BMI in both sexes highlights the importance of controlling obesity in those who mature early.
Aging↗
Life course social roles and women's health in mid-life: causation or selection?
STUDY OBJECTIVE: To investigate whether relations between social roles and health are explained by health selection into employment and parenthood by examining the influence of early health on relations between long term social role histories and health in mid-life. DESIGN: Prospective, population based, birth cohort study. PARTICIPANTS AND SETTING: Women from a national British cohort born in 1946, including 1171 women with a valid measure of self reported health at age 54 and valid work and family role measures at ages 26, 36, 43, and 53, as well as 1433 women with a valid body mass index (BMI) measure at age 53 and valid work and family role measures at ages 26, 36, 43, and 53. OUTCOME MEASURES: Self reported health at age 54 and obesity at age 53, taken from objective height and weight measures conducted by a survey nurse during face to face interviews in respondents' homes. MAIN RESULTS: Women who occupied multiple roles over the long term reported relatively good health at age 54 and this was not explained by early health. Women with weak long term ties to the labour market were more likely to be obese at age 53. Examination of body mass index (BMI) from age 15 showed that long term homemakers were larger than other women from age 26, but their mean BMI increased significantly more with age than that of other women. CONCLUSIONS: Relations between social roles and health were generally not explained by health selection into employment and parenthood, although some health selection may occur for obesity.
Adult↗
Cohort Profile: The 1946 National Birth Cohort (MRC National Survey of Health and Development).
Explore the source record for details and available documents.
Adolescent↗
Childhood cognitive ability and age at menopause: evidence from two cohort studies.
OBJECTIVE: To investigate whether poorer cognitive ability in childhood is associated with an earlier menopause. DESIGN: Two cohorts were included: a nationally representative British birth cohort study of 1,350 women born in March 1946 and followed up to age 54 years, and an Aberdeen cohort study of 3,465 women born in Aberdeen from 1950 to 1956 and followed up to age 44 to 50 years. Both cohorts had prospective information on childhood cognitive ability at age 7 or 8 years. RESULTS: In both cohorts, women with lower cognitive scores in childhood reached menopause earlier than women with higher scores. With follow-up of menopause to 49 years, the hazard ratio (HR) for one standard deviation of the cognitive score was 0.80 (95% CI, 0.72-0.90) in the Aberdeen cohort and 0.84 (95% CI, 0.73-0.97) in the older 1946 birth cohort. The effect was still evident in the 1946 birth cohort with follow-up of menopause to 53 years (HR = 0.87; 95% CI, 0.79-0.95). These ratios were weakly attenuated by adjustment for potential confounding effects of lifetime socioeconomic circumstances, parity, and smoking. CONCLUSIONS: The association between early cognitive ability and timing of menopause only partially reflects common risk factors, although residual confounding remains a possibility. Alternatively, early environmental or genetic programming may explain this association, perhaps through setting lifelong patterns of hormone release or causing transient hormonal changes at sensitive periods of development. These findings have implications for the interpretation of studies investigating an association between age at menopause and adult cognitive function.
Adult↗
Perceived change in quality of life during the menopause.
The directly attributable effect of menopausal transition on women's quality of life (QoL) remains unclear. This study investigates the relationship between perceived change in QoL and menopausal transition status, socio-economic circumstances, lifestyle factors, and life stress. Prospective data were collected from a cohort of 1525 British women followed up since their birth in 1946 and annually from 47 to 54 years. Following factor analysis, the 10 survey items for perceived change were combined into three QoL domains: physical health (physical health, energy level, and body weight), psychosomatic status (nervous and emotional state, self-confidence, work life, ability to make decisions, and ability to concentrate), and personal life (family life and time for self, hobbies, and interests). In the fully adjusted model, the most important risk factor for decline in all three domains was work or family related stress (p<0.001). Menopausal transition status was significantly associated with change in physical health (p<0.001) and psychosomatic (p<0.001) domains, but not personal life. Women who were perimenopausal for at least a year perceived decline in physical (p=0.009) and psychosomatic (p=0.05) domains compared with premenopausal women, while those on hormone replacement therapy (HRT) for at least a year reported relative improvement (physical p=0.02, psychosomatic p=0.06). Apart from work and family-related stress, physical inactivity was associated with a relative decline (p=0.03) in the physical health domain, and nulliparity with a relative decline in the personal life domain (p=0.006). Both psychosomatic and personal life domains declined significantly with age (p<0.0001 and p=0.003, respectively). Women with four or more children reported a relative improvement in the psychosomatic (p=0.05) domain. In terms of the three QoL domains, women's experience of the menopausal transition appears complex, potentially involving a range of other factors and influences in their lives, and is by no means overwhelmingly negative.
Female↗
Influence of short stature on the change in pulse pressure, systolic and diastolic blood pressure from age 36 to 53 years: an analysis using multilevel models.
BACKGROUND: Previous cross-sectional analyses of this cohort have shown that short height and leg length are associated with higher pulse pressure and systolic blood pressure in middle age. It is unclear how these adult measures of childhood growth influence the change in blood pressure as it increases with age. METHODS: Multilevel models were fitted to investigate associations between components of height and the change in blood pressure between 36, 43, and 53 years in a prospective national cohort of 1472 men and 1563 women followed-up since birth in 1946. RESULTS: Shorter height and leg length, but not trunk length, were associated with higher blood pressure, similarly in men and women. Longitudinal analyses showed that the effects of both height and leg length on pulse pressure and systolic blood pressure became significantly stronger with age. For example, the change in systolic blood pressure was found to be -0.021 mm Hg (95% confidence interval -0.029 to -0.013) per year lower for every centimetre increase in leg length (P < or = 0.001). In other words, the increase in systolic blood pressure over a 10 year period of a participant whose legs were 10 centimetres shorter was 2.1 mm Hg higher (P < or = 0.001), compared with a taller participant. Associations were independent of a number of potential confounders. CONCLUSIONS: These results support the hypothesis that short people may be more susceptible to the effects of ageing on the arterial tree. Childhood growth may contribute to the tracking of cardiovascular risk throughout life.
Adult↗
The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison.
BACKGROUND: Our objective was to investigate the contribution of childhood and adult socioeconomic position (SEP) to adult obesity and smoking behaviour, in particular to establish the role of childhood circumstances across different studies in Europe and the US. METHODS: Seven population-based surveys in six Western countries (Britain, Denmark, Finland, Netherlands, Sweden, US) were examined, with participants aged 30-50 yr and born between 1910 and 1960. Adult smoking was analysed using three outcomes (ever, current, or ex-) and adult obesity was defined as body mass index (kg/m(2)) > or =30. RESULTS: A strong effect of adult social position was observed for smoking outcomes and obesity. For example, manual SEP in adulthood increased the risk of ever smoking (adjusted odds ratio (OR) 1.47-2.00 for men; 0.94-1.81 for women), and obesity (adjusted OR 1.06-2.24 for men, 1.21-3.26 for women). In most studies, childhood position was not associated with ever-smoking. For current smoking, manual childhood position was associated among women (adjusted OR 1.09-1.54), but no consistent pattern was seen for men. For ex-smoking, manual childhood origins lowered the chance of quitting among women (adjusted OR 0.64-0.81) except in the US (OR = 1.17); among men this association was seen in fewer studies (adjusted OR 0.74-1.09). For obesity, manual origins increased the risk for women (adjusted OR 0.96-2.50); effects were weaker among men but mostly in the same direction (adjusted OR 0.79-1.42). CONCLUSIONS: As expected, adult SEP was an important influence on smoking behaviour and obesity. In addition, factors related to disadvantaged social origins appeared to increase the risk of obesity and reduce the probability of quitting smoking in adulthood, particularly in women.
Adult↗