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JAMA Network Open Jul 2023Plant-based diets are known to improve cardiometabolic risk in the general population, but their effects on people at high risk of cardiovascular diseases (CVDs) remain... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Plant-based diets are known to improve cardiometabolic risk in the general population, but their effects on people at high risk of cardiovascular diseases (CVDs) remain inconclusive.
OBJECTIVE
To assess the association of vegetarian diets with major cardiometabolic risk factors, including low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and body weight in people with or at high risk of CVDs.
DATA SOURCES
This meta-analysis was registered before the study was conducted. Systematic searches performed included Embase, MEDLINE, CINAHL, and CENTRAL from inception until July 31, 2021.
STUDY SELECTION
Eligible randomized clinical trials (RCTs) that delivered vegetarian diets in adults with or at high risk of CVDs and measured LDL-C, HbA1c or SBP were included. Of the 7871 records screened, 29 (0.4%; 20 studies) met inclusion criteria.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted data including demographics, study design, sample size, and diet description, and performed risk of bias assessment. A random-effects model was used to assess mean changes in LDL-C, HbA1c, SBP, and body weight. The overall certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool.
MAIN OUTCOMES AND MEASURES
Mean differences between groups in changes (preintervention vs postintervention) of LDL-C, HbA1c, and SBP; secondary outcomes were changes in body weight and energy intake.
RESULTS
Twenty RCTs involving 1878 participants (range of mean age, 28-64 years) were included, and mean duration of intervention was 25.4 weeks (range, 2 to 24 months). Four studies targeted people with CVDs, 7 focused on diabetes, and 9 included people with at least 2 CVD risk factors. Overall, relative to all comparison diets, meta-analyses showed that consuming vegetarian diets for an average of 6 months was associated with decreased LDL-C, HbA1c, and body weight by 6.6 mg/dL (95% CI, -10.1 to -3.1), 0.24% (95% CI, -0.40 to -0.07), and 3.4 kg (95% CI, -4.9 to -2.0), respectively, but the association with SBP was not significant (-0.1 mm Hg; 95% CI, -2.8 to 2.6). The GRADE assessment showed a moderate level of evidence for LDL-C and HbA1c reduction.
CONCLUSIONS AND RELEVANCE
In this study, consuming a vegetarian diet was associated with significant improvements in LDL-C, HbA1c and body weight beyond standard therapy in individuals at high risk of CVDs. Additional high-quality trials are warranted to further elucidate the effects of healthy plant-based diets in people with CVDs.
Topics: Adult; Humans; Middle Aged; Cardiovascular Diseases; Cholesterol, LDL; Glycated Hemoglobin; Vegetarians; Research Design; Body Weight
PubMed: 37490288
DOI: 10.1001/jamanetworkopen.2023.25658 -
BMC Oral Health Mar 2021Mouth breathing is closely related to the facial skeletal development and malocclusion. The purpose of this systematic review and meta-analysis was to assess the effect... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mouth breathing is closely related to the facial skeletal development and malocclusion. The purpose of this systematic review and meta-analysis was to assess the effect of mouth breathing on facial skeletal development and malocclusion in children.
METHODS
An electronic search in PubMed, the Cochrane Library, Medline, Web of Science, EMBASE and Sigle through February 23rd, 2020, was conducted. Inclusion criteria were children under 18 years of age with maxillofacial deformities due to mouth breathing. The risk of bias in nonrandomized studies of interventions (ROBINS-I) tool for controlled clinical trials. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used for the quality assessment. The included indicators were SNA, SNB, ANB, SN-OP, SN-PP, PP-MP, SNGoGn, MP-H, 1-NA, 1. NA, 1. NB, 1-NB, Overjet, Overbite, SPAS, PAS, and C3-H. Data concerning the mean difference in mesial molar movement and extent of canine retraction were extracted for statistical analysis. The mean differences and 95% confidence intervals were analyzed for continuous data. Review Manager 5.3, was used to synthesize various parameters associated with the impact of mouth breathing on facial skeletal development and malocclusion.
RESULTS
Following full-text evaluations for eligibility, 10 studies were included in the final quantitative synthesis. In Sagittal direction, SNA (MD: - 1.63, P < 0.0001), SNB (MD: - 1.96, P < 0.0001) in mouth-breathing children was lower than that in nasal-breathing children. ANB (MD: 0.90, P < 0.0001), 1. NA (MD: 1.96, P = 0.009), 1-NA (MD: 0.66, P = 0.004), and 1-NB (MD: 1.03, P < 0.0001) showed higher values in children with mouth breathing. In vertical direction, SN-PP (MD: 0.68, P = 0.0050), SN-OP (MD: 3.05, P < 0.0001), PP-MP (MD: 4.92, P < 0.0001) and SNGoGn (MD: 4.10, P < 0.0001) were higher in mouth-breathing individuals. In airway, SPAS (MD: - 3.48, P = 0.0009), PAS (MD: - 2.11, P < 0.0001), and C3-H (MD: - 1.34, P < 0.0001) were lower in mouth breathing group.
CONCLUSIONS
The results showed that the mandible and maxilla rotated backward and downward, and the occlusal plane was steep. In addition, mouth breathing presented a tendency of labial inclination of the upper anterior teeth. Airway stenosis was common in mouth-breathing children. Trial registration [email protected], registration number CRD42019129198.
Topics: Adolescent; Cephalometry; Child; Face; Humans; Malocclusion, Angle Class II; Mandible; Mouth Breathing; Overbite
PubMed: 33691678
DOI: 10.1186/s12903-021-01458-7 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Jun 2023This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group.
METHODS
PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis.
RESULTS
Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group.
CONCLUSIONS
The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.
Topics: Humans; Malocclusion, Angle Class II; Mandibular Advancement; Orthodontics, Corrective; Orthodontic Appliances, Functional; Mandible; Orthodontic Appliances, Removable; Cephalometry
PubMed: 37277797
DOI: 10.7518/hxkq.2023.2022453 -
Sports Medicine (Auckland, N.Z.) Dec 2023Resting metabolic rate (RMR) prediction equations are often used to calculate RMR in athletes; however, their accuracy and precision can vary greatly. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Resting metabolic rate (RMR) prediction equations are often used to calculate RMR in athletes; however, their accuracy and precision can vary greatly.
OBJECTIVE
The aim of this systematic review and meta-analysis was to determine which RMR prediction equations are (i) most accurate (average predicted values closest to measured values) and (ii) most precise (number of individuals within 10% of measured value).
DATA SOURCES
A systematic search of PubMed, CINAHL, SPORTDiscus, Embase, and Web of Science up to November 2021 was conducted.
ELIGIBILITY CRITERIA
Randomised controlled trials, cross-sectional observational studies, case studies or any other study wherein RMR, measured by indirect calorimetry, was compared with RMR predicted via prediction equations in adult athletes were included.
ANALYSIS
A narrative synthesis and random-effects meta-analysis (where possible) was conducted. To explore heterogeneity and factors influencing accuracy, subgroup analysis was conducted based on sex, body composition measurement method, athlete characteristics (athlete status, energy availability, body weight), and RMR measurement characteristics (adherence to best practice guidelines, test preparation and prior physical activity).
RESULTS
Twenty-nine studies (mixed sports/disciplines n = 8, endurance n = 5, recreational exercisers n = 5, rugby n = 3, other n = 8), with a total of 1430 participants (822 F, 608 M) and 100 different RMR prediction equations were included. Eleven equations satisfied criteria for meta-analysis for accuracy. Effect sizes for accuracy ranged from 0.04 to - 1.49. Predicted RMR values did not differ significantly from measured values for five equations (Cunningham (1980), Harris-Benedict (1918), Cunningham (1991), De Lorenzo, Ten-Haaf), whereas all others significantly underestimated or overestimated RMR (p < 0.05) (Mifflin-St. Jeor, Owen, FAO/WHO/UNU, Nelson, Koehler). Of the five equations, large heterogeneity was observed for all (p < 0.05, I range: 80-93%) except the Ten-Haaf (p = 0.48, I = 0%). Significant differences between subgroups were observed for some but not all equations for sex, athlete status, fasting status prior to RMR testing, and RMR measurement methodology. Nine equations satisfied criteria for meta-analysis for precision. Of the nine equations, the Ten-Haaf was found to be the most precise, predicting 80.2% of participants to be within ± 10% of measured values with all others ranging from 40.7 to 63.7%.
CONCLUSION
Many RMR prediction equations have been used in athletes, which can differ widely in accuracy and precision. While no single equation is guaranteed to be superior, the Ten-Haaf (age, weight, height) equation appears to be the most accurate and precise in most situations. Some equations are documented as consistently underperforming and should be avoided. Choosing a prediction equation based on a population of similar characteristics (physical characteristics, sex, sport, athlete status) is preferable. Caution is warranted when interpreting RMR ratio of measured to predicted values as a proxy of energy availability from a single measurement.
PROSPERO REGISTRATION
CRD42020218212.
Topics: Adult; Humans; Basal Metabolism; Cross-Sectional Studies; Athletes; Sports; Body Composition; Body Mass Index
PubMed: 37632665
DOI: 10.1007/s40279-023-01896-z -
Progress in Orthodontics Sep 2020The aim of this systematic review and meta-analysis is to assess the degree of stability of anterior open bite (AOB) treatment performed through the molar intrusion... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this systematic review and meta-analysis is to assess the degree of stability of anterior open bite (AOB) treatment performed through the molar intrusion supported with skeletal anchorage at least 1 year posttreatment.
METHODS
This study was registered in PROSPERO (CRD42016037513). A literature search was conducted to identify randomized (RCT) or non-randomized clinical trials based including those considering before and after design. Data sources were electronic databases including PubMed, Cochrane Library, Science Direct, Google Scholar, Scopus, Lilacs, OpenGrey, Web of Science, and ClinicalTrials.gov . The quality of evidence was assessed through the JBI tool and certainty of evidence was evaluated through the GRADE tool. Random effects meta-analysis was conducted when appropriate.
RESULTS
Six hundred twenty-four articles met the initial inclusion criteria. From these, only 6 remained. The mean posttreatment follow-up time was 2.5 years (SD = 1.04). The overbite showed a standardized mean relapse of - 1.23 mm (95% CI - 1.64, - 0.81, p < 0.0001). Maxillary and mandibular incisors presented a non-significant mean relapse, U1-PP - 0.04 mm (95% CI - 0.55, 0.48) and L1-MP - 0.10 mm (95% CI - 0.57, 0.37). Molar intrusion showed a relapse rate around 12% for the maxillary molars and a 27.2% for mandibular molars.
CONCLUSION
The stability of AOB through molar intrusion using TADs can be considered relatively similar to that reported to surgical approaches, since 10 to 30% of relapse occurs both in maxillary and mandibular molars. The level of certainty ranged between very low and low. RCTs reporting dropout during the follow-up are in dire need.
Topics: Cephalometry; Humans; Maxilla; Molar; Open Bite; Orthodontic Anchorage Procedures; Tooth Movement Techniques
PubMed: 32888097
DOI: 10.1186/s40510-020-00328-2 -
BMC Pregnancy and Childbirth Oct 2019Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to systematically analyze published data on maternal and fetal factors for successful VBAC.
METHODS
A comprehensive search of Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, from each database's inception to March 16, 2018. Observational studies, identifying women with a trial of labor after one previous low-transverse cesarean section were included. Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale.
RESULTS
We included 94 eligible observational studies (239,006 pregnant women with 163,502 VBAC). Factors were associated with successful VBAC with the following odds ratios (OR;95%CI): age (0.92;0.86-0.98), obesity (0.50;0.39-0.64), diabetes (0.50;0.42-0.60), hypertensive disorders complicating pregnancy (HDCP) (0.54;0.44-0.67), Bishop score (3.77;2.17-6.53), labor induction (0.58;0.50-0.67), macrosomia (0.56;0.50-0.64), white race (1.39;1.26-1.54), previous vaginal birth before cesarean section (3.14;2.62-3.77), previous VBAC (4.71;4.33-5.12), the indications for the previous cesarean section (cephalopelvic disproportion (0.54;0.36-0.80), dystocia or failure to progress (0.54;0.41-0.70), failed induction (0.56;0.37-0.85), and fetal malpresentation (1.66;1.38-2.01)). Adjusted ORs were similar.
CONCLUSIONS
Diabetes, HDCP, Bishop score, labor induction, macrosomia, age, obesity, previous vaginal birth, and the indications for the previous CS should be considered as the factors affecting the success of VBAC.
Topics: Birth Weight; Body Mass Index; Female; Gestational Age; Humans; Infant, Newborn; Maternal Age; Pregnancy; Pregnancy Outcome; Prenatal Care; Vaginal Birth after Cesarean
PubMed: 31623587
DOI: 10.1186/s12884-019-2517-y -
Advances in Nutrition (Bethesda, Md.) Jul 2019There is some evidence supporting the beneficial effects of a Paleolithic Diet (PD) on cardiovascular disease risk factors. This diet advises consuming lean meat, fish,... (Meta-Analysis)
Meta-Analysis
There is some evidence supporting the beneficial effects of a Paleolithic Diet (PD) on cardiovascular disease risk factors. This diet advises consuming lean meat, fish, vegetables, fruits, and nuts and avoiding intake of grains, dairy products, processed foods, and added sugar and salt. This study was performed to assess the effects of a PD on cardiovascular disease risk factors including anthropometric indexes, lipid profile, blood pressure, and inflammatory markers using data from randomized controlled trials. A comprehensive search was performed in the PubMed, Scopus, ISI Web of Science, and Google Scholar databases up to August, 2018. A meta-analysis was performed using a random-effects model to estimate the pooled effect size. Meta-analysis of 8 eligible studies revealed that a PD significantly reduced body weight [weighted mean difference (WMD) = -2.17 kg; 95% CI: -3.48, -0.87 kg], waist circumference (WMD = -2.90 cm; 95% CI: -4.51, -1.28 cm), body mass index (in kg/m2) (WMD = -1.15; 95% CI: -1.68, -0.62), body fat percentage (WMD = -1.38%; 95% CI: -2.08%, -0.67%), systolic (WMD = -4.24 mm Hg; 95% CI: -7.11, -1.38 mm Hg) and diastolic (WMD = -2.95 mm Hg; 95% CI: -4.72, -1.18 mm Hg) blood pressure, and circulating concentrations of total cholesterol (WMD = -0.22 mg/dL; 95% CI: -0.42, -0.03 mg/dL), TGs (WMD = -0.23 mg/dL; 95% CI: -0.46, -0.01 mg/dL), LDL cholesterol (WMD = -0.13 mg/dL; 95% CI: -0.25, -0.01 mg/dL), and C-reactive protein (CRP) (WMD = -0.41 mg/L; 95% CI: -0.81, -0.008 mg/L) and also significantly increased HDL cholesterol (WMD = 0.05 mg/dL; 95% CI: 0.005, 0.10 mg/dL). However, sensitivity analysis revealed that the overall effects of a PD on lipid profile, blood pressure, and circulating CRP concentrations were significantly influenced by removing some studies, hence the results must be interpreted with caution. Although the present meta-analysis revealed that a PD has favorable effects on cardiovascular disease risk factors, the evidence is not conclusive and more well-designed trials are still needed.
Topics: Adult; Anthropometry; Biomarkers; Blood Pressure; C-Reactive Protein; Cardiovascular Diseases; Diet, Paleolithic; Humans; Inflammation; Lipids; Middle Aged; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 31041449
DOI: 10.1093/advances/nmz007 -
Advances in Nutrition (Bethesda, Md.) Sep 2023Ghrelin is an orexigenic hormone primarily released by the stomach and has 2 isoforms: acylated ghrelin (AG) and de-acylated ghrelin (DAG), that appear to have different... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ghrelin is an orexigenic hormone primarily released by the stomach and has 2 isoforms: acylated ghrelin (AG) and de-acylated ghrelin (DAG), that appear to have different functions in humans.
OBJECTIVES
To perform a systematic review and meta-analysis of the association between plasma concentrations of total ghrelin (TG), AG, and DAG and perceptions of hunger in healthy adults.
METHODS
The following criteria were used for inclusion: 1) sample contained adults ≥18 y of age, 2) body mass index [BMI kg/m] was ≥18.5, 3) ghrelin was sampled through blood, 4) subjective hunger was measured on a validated scale, 5) study reported a Pearson product correlation of ghrelin or had relevant figure(s) for data extraction, 6) participants were healthy with no overt disease, 7) protocols contained no physical activity or weight loss medication that suppressed appetite, 8) interventions were conducted without environmental manipulations. Moderators assessed were age, BMI, percentage of body fat (%BF), macronutrient content of test meals, energy intake (kcals), sex, and ghrelin isoform (AG, DAG, or TG).
RESULTS
The analysis included 47 studies (110 trials, n = 1799, age: 31.4 ± 12.0 y, BMI: 26.0 ± 4.75 kg/m) and measured AG (n = 47 trials), DAG (n = 12 trials), and TG (n = 51 trials). The overall model indicated that ghrelin concentrations and perceptions of hunger were moderately correlated (r = 0.43, P < 0.001), and ghrelin isoform significantly moderated this relationship (AG: r = 0.60, P < 0.001; TG: r = 0.215, P = 0.01; DAG: r = 0.53, P = 0.695). Other significant moderators included age (b = -0.02, P = 0.01), BMI (b = -0.03, P = 0.05), %BF (b = -0.03, P = 0.05), energy intake (b = 0.0003, P = 0.04), and percentage of carbohydrates of test meals (b = 0.008, P = 0.05).
CONCLUSIONS
Ghrelin is associated with perceptions of hunger in humans, and this relationship is strengthened when AG is isolated; thus, AG may have a large impact on hunger signals in various populations. Future research should attempt to understand the role of DAG in hunger sensations.
Topics: Adult; Humans; Young Adult; Child, Preschool; Hunger; Ghrelin; Energy Intake; Body Mass Index; Perception; Appetite
PubMed: 37536563
DOI: 10.1016/j.advnut.2023.07.011 -
Health Technology Assessment... Dec 2022Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients.
OBJECTIVE
To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition.
DATA SOURCES
MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021.
REVIEW METHODS
A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements.
RESULTS
Eleven studies ( = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval -0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval -0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m) using cheaper oral nutritional supplements products that require minimal staff time to administer.
LIMITATIONS
The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered.
CONCLUSIONS
Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults.
FUTURE WORK
Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42020170906.
FUNDING
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.
Topics: Aged; Humans; Frail Elderly; Quality of Life; Malnutrition; Cost-Benefit Analysis; Body Weight
PubMed: 36541454
DOI: 10.3310/CCQF1608 -
Archives of Disease in Childhood. Fetal... Jan 2017Maternal glycaemia and anthropometry-derived newborn adiposity are strongly correlated. The children of mothers with diabetes are at greater risk of adverse metabolic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Maternal glycaemia and anthropometry-derived newborn adiposity are strongly correlated. The children of mothers with diabetes are at greater risk of adverse metabolic health, and increased adiposity is a plausible mediator. We undertook a systematic review and meta-analysis to compare adiposity in infants of diabetic mothers (IDM) and infants of mothers without diabetes (NIDM).
DESIGN
We identified observational studies reporting adiposity in IDM and NIDM. We searched references, traced forward citations and contacted authors for additional data. We considered all body composition techniques and compared fat mass, fat-free mass, body fat % and skinfold thickness. We used random effects meta-analyses and performed subgroup analyses by maternal diabetes type (type 1, type 2 and gestational) and infant sex. We examined the influence of pre-pregnancy body mass index (BMI) and conducted sensitivity analyses.
RESULTS
We included data from 35 papers and over 24 000 infants. IDM have greater fat mass than NIDM (mean difference (95% CI)): 83 g (49 to 117). Fat mass is greater in infants of mothers with gestational diabetes: 62 g (29 to 94) and type 1 diabetes: 268 g (139 to 397). Insufficient studies reported data for type 2 diabetes separately. Compared with NIDM, fat mass was greater in IDM boys: 87 g (30 to 145), but not significantly different in IDM girls: 42 g (-33 to 116). There was no attenuation after adjustment for maternal BMI.
CONCLUSIONS
IDM have significantly greater adiposity in comparison with NIDM. These findings are justification for studies to determine whether measures to reduce infant adiposity will improve later health.
Topics: Adiposity; Birth Weight; Body Mass Index; Female; Humans; Infant, Newborn; Obesity; Pregnancy; Pregnancy in Diabetics; Risk Factors
PubMed: 27231266
DOI: 10.1136/archdischild-2015-309750