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Abstract Objective To examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and investigate how these relate to distributions in risk factors. Design National [...]

Background:Clinical recommendations to limit gestational weight gain (GWG) imply high GWG is causally related to adverse outcomes in mother or offspring, but GWG is the sum of several inter-related complex phenotypes (maternal fat deposition and vascular expansion, placenta, amniotic fluid and fetal growth). Understanding the genetic contribution to GWG could help clarify the potential effect of its different components on maternal and offspring health. Here we explore the genetic contribution to total, early and late GWG.Participants and methods:A genome-wide association study was used to identify maternal and fetal variants contributing to GWG in up to 10 543 mothers and 16 317 offspring of European origin, with replication in 10 660 mothers and 7561 offspring. Additional analyses determined the proportion of variability in GWG from maternal and fetal common genetic variants and the overlap of established genome-wide significant variants for phenotypes relevant to GWG (for example, maternal body mass index (BMI) and glucose, birth weight).Results:Approximately 20% of the variability in GWG was tagged by common maternal genetic variants, and the fetal genome made a surprisingly minor contribution to explain variation in GWG. Variants near the pregnancy-specific beta-1 glycoprotein 5 (PSG5) gene reached genome-wide significance (P=1.71 × 10−8) for total GWG in the offspring genome, but did not replicate. Some established variants associated with increased BMI, fasting glucose and type 2 diabetes were associated with lower early, and higher later GWG. Maternal variants related to higher systolic blood pressure were related to lower late GWG. Established maternal and fetal birth weight variants were largely unrelated to GWG.Conclusions:We found a modest contribution of maternal common variants to GWG and some overlap of maternal BMI, glucose and type 2 diabetes variants with GWG. These findings suggest that associations between GWG and later offspring/maternal outcomes may be due to the relationship of maternal BMI and diabetes with GWG.

Objectives:Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum.Subjects and methods:We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire.Results:A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference −0.14 s.d., 95% confidence interval −0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (−0.49 to −0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (−35.34; −48.0 to −22.67; P<0.001) and saturated fat intake (−1.93% energy; −2.64 to −1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet.Conclusions:This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.

Purpose To report the early results of a multicenter registry of endovascular aneurysm repair (EVAR) using the Endurant stent-graft.Methods Patients having elective treatment of infrarenal abdominal aortic aneurysm (AAA) with the Endurant stent-graft at 3 Canadian centers were enrolled in a prospective registry between September 2008 and January 2010. In the 16-month period, 111 patients (90 men; mean age 75 years, range 53–93) were registered. Thirty-seven (33.3%) patients had challenging anatomy: short proximal aortic necks (n = 17), large diameter (>28 mm) aortic necks (n = 4), angulated (>60°) necks (n=3), and small (<15 mm) external iliac arteries (n=21). Outcomes evaluated included survival, endoleak, aneurysm expansion >5 mm, secondary intervention, stent-graft migration, and graft thrombosis.Results The overall technical success rate was 100%. Nineteen (17.1%) patients experienced perioperative complications. After a mean follow-up of 6 months (range 0.1–16), mortality in the series was 4.5%: 1 perioperative death (multisystem organ failure) and 4 (3.6%) late deaths (3 cardiac, 1 cancer). Clinical and imaging follow-up past the perioperative period were available in 107 (96.4%) and 99 (89.2%) patients, respectively. Among the latter, 9 (9.1%) had a type II endoleak on the first scan; 4 resolved spontaneously. Three (3.0%) patients developed graft limb thrombosis in follow-up; one required an intervention. There was no graft migration, aneurysm expansion, secondary intervention for endoleak, aneurysm rupture, or conversion.Conclusion Early results from this prospective multicenter registry indicate that the Endurant stent-graft is a safe option for elective EVAR in selected AAA patients. Longer follow-up is required to determine the durability of these outcomes.

Successful endovascular repair of abdominal aortic aneurysms (AAAs) requires specific infrarenal neck anatomy to allow for a durable seal and fixation. This is a single-center study reviewing outcomes in relation to neck length after placement of a Zenith endograft.

ABSTRACTThis review was undertaken for the Faculty and Institute of Actuaries as part of their programme to encourage research collaborations between health researchers and actuaries in order to understand better the factors influencing mortality and longevity. The authors presented their findings in a number of linked sessions at the Edinburgh conference (Joining Forces on Mortality and Longevity) in October 2009 and contributed to this overview. The purpose is to review evidence for the impact on adult mortality of characteristics of the individual's lifetime socioeconomic or psychosocial environment or phenotype at the behavioural; multi-system (e.g. cognitive and physical function); or body system level (e.g. vascular and metabolic traits) that may be common risk factors for a number of major causes of death. This review shows there is growing evidence from large studies and systematic reviews that these individual characteristics, measured in pre-adult as well as the adult life, are associated with later mortality risk. The relative contribution of lifetime environment, genetic factors and chance, whether these contributions change with age, and the underlying social and biological pathways are still to be clarified. This review identifies areas where further life course research is warranted.

OBJECTIVE: To examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and investigate how these relate to distributions in risk factors. DESIGN: National and international data were used to examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and risk factors. SETTING: England and Wales, 1921-98; Australia, France, Japan, Sweden, and the United States, 1947-97; 50 countries, 1992-6. DATA SOURCES: Office for National Statistics, World Health Organization, and Food and Agriculture Organization of the United Nations. RESULTS: The 20th century epidemic of coronary heart disease affected only men in most industrialised countries and had a very rapid onset in England and Wales, which has been examined in detail. If this male only epidemic had not occurred there would have been 1.2 million fewer deaths from coronary heart disease in men in England and Wales over the past 50 years. Secular trends in mean per capita fat consumption show a similar pattern to secular trends in coronary heart disease mortality in men. Fat consumption is positively correlated with coronary heart disease mortality in men (r(s)=0.79; 95% confidence interval 0.70 to 0.86) and inversely associated with coronary heart disease mortality in women (-0.30; -0.49 to -0.08) over this time. Although sex ratios for mortality from coronary heart disease show a clear period effect, those for lung cancer show a cohort effect. Sex ratios for stroke mortality were constant and close to unity for the entire period. Geographical variations in the sex ratio for coronary heart disease were associated with mean per capita fat consumption (0.64; 0.44 to 0.78) but were not associated with the sex ratio for smoking. CONCLUSION: Sex differences are largely the result of environmental factors and hence not inevitable. Understanding the factors that determine sex differences has important implications for public health, particularly for countries and parts of countries where the death rates for coronary heart disease are currently increasing.

OBJECTIVE: To determine the effectiveness of exercise as an intervention in the management of depression. DESIGN: Systematic review and meta-regression analysis of randomised controlled trials obtained from five electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library) and through contact with experts in the field, bibliographic searches, and hand searches of recent copies of relevant journals. MAIN OUTCOME MEASURES: Standardised mean difference in effect size and weighted mean difference in Beck depression inventory score between exercise and no treatment and between exercise and cognitive therapy. RESULTS: All of the 14 studies analysed had important methodological weaknesses; randomisation was adequately concealed in only three studies, intention to treat analysis was undertaken in only two, and assessment of outcome was blinded in only one. The participants in most studies were community volunteers, and diagnosis was determined by their score on the Beck depression inventory. When compared with no treatment, exercise reduced symptoms of depression (standardised mean difference in effect size -1.1 (95% confidence interval -1.5 to -0.6); weighted mean difference in Beck depression inventory -7.3 (-10.0 to -4.6)). The effect size was significantly greater in those trials with shorter follow up and in two trials reported only as conference abstracts. The effect of exercise was similar to that of cognitive therapy (standardised mean difference -0.3 (95% confidence interval -0.7 to 0.1)). CONCLUSIONS: The effectiveness of exercise in reducing symptoms of depression cannot be determined because of a lack of good quality research on clinical populations with adequate follow up.

Background. Excess winter mortality is higher in England and Wales than in other European countries with similar or lower average winter temperatures. It might be expected that excess winter mortality would be higher in areas with greater socio-economic deprivation, and if this were so preventive interventions could be directed at populations in these areas. The association between deprivation and excess winter mortality has not been adequately investigated in the past. The aim of this study was to look at the association between excess winter mortality and socio-economic deprivation, so that policy decisions to reduce this excess mortality could be appropriately directed.
Method. Super Profile groups derived from the 1991 Census were used as a measure of socio-economic status. The age-standardized excess winter death index (EWDI) was calculated for each Super Profile group, for the population of Bradford. The EWDI was also calculated for the manufacturing districts (Office for National Statistics area classification), a relatively deprived group, and compared with that for England and Wales.
Results. No significant trend was found in age-standardized excess winter mortality across the Super Profile groups. The manufacturing districts had similar EWDI to the national value.
Conclusion. Excess winter mortality is not associated with deprivation. Further research to identify the important aetiological factors and appropriate interventions to reduce excess winter mortality is needed.

Purpose: Hepatic dysfunction may contribute to death from multiple organ dysfunction after abdominal aortic surgery. Several factors are likely responsible, and the purpose of this study was to determine whether the cytokines tumor necrosis factor-@a (TNF-@a) and interleukin 1 (IL-1) are involved in initiating this remote hepatic injury. Methods: In a normotensive rat model of 4-hour bilateral hindlimb ischemia/reperfusion (I/R), we measured systemic TNF-@a and IL-1 levels throughout the I/R period. Rats were randomly assigned to either the 3-hour control group, the 3-hour I/R group, or the I/R group with administration of a polyclonal antibody (PAb) to TNF-@a (I/R + TNF-@a PAb). Direct evidence of lethal hepatocyte injury through the labeling of nuclei by propidium iodide (per 10^-^1mm^3) and altered microvascular perfusion were assessed by using intravital microscopy. Results: Systemic TNF-@a peaked at 83.97 pg/mL (P < .05, n = 5) at 30 minutes of reperfusion and returned to baseline in 60 to 90 minutes. No significant change in systemic IL-1 was detected (P < .05, n = 4). Alanine aminotransferase increased 2.5-fold in the I/R group through 3 hours of reperfusion (P < .05, n = 4), and TNF-@a PAb did not attenuate this alanine aminotransferase increase (P < .05, n = 6). Lethal hepatocyte injury increased by 8-fold in the I/R group compared with the control group (P < .05, n = 5), whereas TNF-@a PAb significantly reduced this injury (P < .05, n = 4). No regional differences in injury were noted within the acinus. Total perfusion within the microvascular unit did not drop; however, significant flow heterogeneity was observed. The proportion of continuously perfused sinusoids declined in the I/R group after 3 hours of reperfusion in both periportal (62.0 +/- 2.2, P < .05) and, to a lesser, although significant, degree, in the pericentral regions (73.2 +/- 1.73, P < .05). Conclusion: By scavenging extracellular TNF-@a with a PAb, we provide direct evidence that TNF-@a contributes to, but is not solely responsible for, early remote hepatocellular injury and microvascular dysfunction. The administration of TNF-@a PAb reduced lethal hepatocyte injury in both regions of the acinus and also improved perfusion in the periportal region (76.8 +/- 5.41, P < .05), but not in the pericentral region. This suggests that TNF-@a released during reperfusion mediates early remote hepatocellular injury and microvascular dysfunction after a remote ischemic insult. (J Vasc Surg 1999;30:533-41.)

GPs have the potential to increase population levels of activity and thus produce important health gains.

The Royal Commission into Aboriginal Deaths in Custody has focused attention on people who are held in custody in police cells, prisons, remand centres and detention centres. A series of research papers has been released by the Royal Commission which delineates some important aspects of the needs of these people. Nearly half of the deaths which occur in these custodial settings appear to be self-inflicted. Suicide seems to be particularly common among younger age groups of those in custody [1,2]. This pattern parallels suicide levels among young people in the Australian community generally, so that suicide is now a leading cause of death among young Australians [3,4].

Results are presented for an experiment in 1979 in which mobile shelters were used to exclude rainfall; responses are compared with those in a hotter and drier year, 1976. The continuous drought treatment achieved a larger maximum deficit in 1979 than in 1976. The relationship between rate of water use as a fraction of the potential evaporation rate and soil water deficit was similar in the two years. Yield reductions due to drought were smaller in 1979, as expected from the smaller evaporation rates and therefore smaller potential soil water deficits. Dry matter production was related to water use, but the relationship differed between years. The difference can be related to the saturation vapour pressure deficit. Components of yield were affected differently in the two years; drought after anthesis decreased yield in 1979 by decreasing grain numbers not grain size.

In long-term field experiments, during consecutive years, microswards of subterranean clover were irrigated to minimise water deficits or subjected to progressively increasing drought over 30 days. Both leaf water potential and relative water content steadily decreased during the experiments. Plants affected by drought grew more slowly and photosynthesis was decreased. Photosynthetic rate (A) and Rubisco were analysed in relation to midday water potentials and relative water contents. The difference in A between draughted and irrigated plants increased progressively, in part as a result of decreased stomatal conductance and CO2concentration within leaf (Ci). However, A-Ci curves suggest that the photosynthetic capacity in plants experiencing long-term stress was reduced by 50 when compared with irrigated plants. Drought decreased both the initial and the total Rubisco activity per unit area in a similar way but did not reduce the amount of Rubisco protein per unit leaf area. Thus, the specific activity of Rubisco, rather than its activation state, decreased suggesting that under water stress the active sites were blocked by inhibitors.

The base temperature for growth is an important element in plant growth models that utilize heat accumulation methods. The effect of location (environment) on the base temperature for growth of sorghum [Sorghum bicolor(L.) Moench] genotypes was studied. Seeds of six sorghum genotypes were obtained from three locations: Manhattan, KS, College Station and Lubbock, TX. The seeds were placed on moist germination blotter paper on a one‐way thermal gradient plate. Observations were made at least daily for 3 wk to determine the number of days required for (i) germination (i.e., protrusion of the radicle from the seed), (ii) root elongation to 10 mm or longer, and (iii) shoot elongation to 10 mm or longer. The base temperature for germination of each genotype was then determined as the x‐intercept from regressing the rate of germination (i.e., the reciprocal of the number of days required to germinate) vs. the mean temperature. A similar regression was used to determine the base temperatures for shoot elongation and for root elongation of each genotype. The values of base temperature for shoot and root elongation were similar for the genotypes studied, and were consistent with the values of base temperature for emergence of sorghum reported in the literature; whereas the base temperature for germination values were up to 4.6 °C lower than reported values. Results indicated that: the base temperature for shoot elongation is not affected, the base temperature for root elongation is somewhat affected, and the base temperature for germination is more affected by the location (environment) of seed production.

Rates of true photosynthesis (TPS), apparent photosynthesis (APS) and photorespiration (PR) of sunflower (Helianthus annuus L., Var. Mennonite) leaves were measured in air (21% O2, 300 vpm CO2) at 25° C and 400 µEinsteins m-2 s-1 radiant flux density. The plants were water stressed by application of osmoticum (polyethylene glycol 4000) to the root system. TPS and APS decreased linearly from maxima at-4 bar leaf-water potential (?) to become very small and zero respectively at about-18 bar ?; at smaller potential CO2 was evolved from the leaf. Statistical analysis shows that TPS and APS were more closely correlated with ? than stomatal conductance (rs-1), because rs-1 changed only in the range-4 to-13 bar but ? exerted an effect at smaller potential. Photorespiration decreased linearly with stress and at-18 bar was 30% of the control plant rate; ? and TPS accounted for only part of the variance in PR, both independently and in combination, and rs-1 accounted for little of the variance. Tricarboxylic acid cycle respiration of leaves placed for 20 min in darkness, remained almost constant with changing ? and rs-1. It was one-third of photorespiration in control plants but increased as a proportion in severely stressed plants. The relative specific activity (RSA) of the CO2 released by PR of wellwatered plants was 90% after 20 min photosynthesis in 14CO2 but decreased to 18% at-18 bar ?. Therefore, under stress mpre CO2 was derived by respiration from reserve materials and less from immediate photosynthate. Elimination of CO2 production by the glycollate pathway with small oxygen concentration (1.5%), showed that the contribution of TCA cycle respiration to photorespiration was small in unstressed plants but increased at small ? to almost the same rate as photorespiration. It is concluded that desiccation decreased photosynthesis by decreasing the stomatal conductance to CO2 diffusion and by changing the balance between CO2 assimilation and production of the leaf. As a consequence carbon flux through the glycollate pathway decreased as did the rate of CO2 produced by it. However, TCA cycle respiration in the light increased with stress, so that total photorespiration remained large. The importance of maintaining carbon flux through the glycollate pathway and TCA cycle is discussed.

Diversity in 39 HLA-A, -B, and -C molecules is derived from 20 amino acid positions of high variability and 71 positions of low variability. Variation in the structurally homologous alpha 1 and alpha 2 domains is distinct and may correlate with partial segregation of peptide and T-cell receptor binding functions. Comparison of 15 HLA-A with 20 HLA-B molecules reveals considerable locus-specific character, due primarily to differences at polymorphic residues. The results indicate that genetic exchange between alleles of the same locus has been a more important mechanism in the generation of HLA-A, -B, and -C diversity than genetic exchange events between alleles of different loci.

14 gorilla class I major histocompatibility complex (MHC) alleles have been isolated, sequenced, and compared to their counterparts in humans and chimpanzees. Gorilla homologues of HLA-A, -B, and -C were readily identified, and four Gogo-A, four Gogo-B, and five Gogo-C alleles were defined. In addition, an unusual Gogo class I gene with features in common with HLA-A and its related pseudogene, HLA-H, is described. None of the gorilla alleles is identical or even closely related to known class I alleles and each encodes a unique antigen recognition site. However, the majority of polymorphic substitutions and sequence motifs of gorilla class I alleles are shared with the human or chimpanzee systems. In particular, elements shared with HLA-A2 and HLA-B27 are found in Gogo-A and -B alleles. Diversity at the Gogo-B locus is less than at the Gogo-A locus, a trend the opposite of that seen for HLA-A and -B. The Gogo-C locus also appears to have limited polymorphism compared to Gogo-A. Two basic Gogo-C motifs were found and they segregate with distinctive sets of HLA-C alleles. HLA-A allels are divided into five families derived from two ancient lineages. All chimpanzee A alleles derived from one of these lineages and all gorilla alleles derive from the other. Unlike chimpanzee Patr-A alleles, the Gogo-A alleles do not clearly partition with one of the HLA-A families but have similarities with two. Overall, gorilla class I diversity appears from this sampling to show more distinctions from class I HLA than found for chimpanzee class I.

With the atmospheric concentration of CO2increasing, it is importanto know how this will affect crop growth. The objective of the study was to determine the effect of elevated CO2on big bluestem (Andropogon gerardiiVitman) growing in a tallgrass prairie on Tully silty clay loam (fine, mixed, mesic Pachic Argiustoll) kept a high water level (field capacity) or a low water level (half field capacity). Sixteen cylindrical plastic chambers were placed on the prairie to maintain the two levels of CO2(mean ± SD: 337 ± 32 and 658 ± 81 µmol mol‐1) over a full growing season. Soil‐water content was measured weekly with a neutron probe. Photosynthesis, transpiration, stonmtal resistance, and intercellular CO2concentration were determined with a portable leaf photosynthetic system. Canopy temperature was monitored with an infrared thermometer. Elevated (doubled) CO2reduced transpiration rate of big binestem by 25 and 35% under the high‐ and low‐water treatments, respectively. Under both watering regimes, stomatal resistance was greater by ≈1.6 s cm‐1with doubled CO2than with ambient CO2. Plants grown with doubled CO2at high‐ and low‐water levels had warmer canopy temperatures (average 1.15 and 0.70 °C warmer, respectively) than plants grown ambient CO2. Carbon‐dioxide concentration did not affect the rate of photosynthesis, even though intercellular CO2concentration was increased under high CO2. Elevated CO2did not increase the height of plants grown at the high water level, but it did increase the height at the low water level by an average of 9 cm.

We examined the epidemiology of community-acquired bacterial meningitis among adults in England and Wales between 1991 and 2002. Among 3169 cases, meningococcal infection was predominant among young adults and pneumococcal meningitis among older adults. Whilst infection due to most causes decreased, the incidence of tuberculous (TB) meningitis doubled over the 12 years. The mortality rate among meningococcal and pneumococcal infections fell from 0·45/105 to 0·31/105 (P=0·0001). This study demonstrates important changes in the epidemiology of bacterial meningitis among UK adults. Improvements in clinical management, childhood vaccination programmes and the re-emergence of tuberculosis are likely to be drivers of these changes.

Although a number of different reconstructive techniques have been described for the treatment of axillary skin defects, split-thickness skin grafting continues to be the most common surgical modality. Here, we present our recent experience of using split-thickness skin grafts together with negative-pressure dressings for the management of defects following wide surgical excision of severe hidradenitis suppurativa. This technique ensures complete skin-graft take whilst allowing full shoulder mobility, thereby minimising the undesirable sequelae associated with split-thickness skin grafting alone.

Sub-Saharan African (SSA) countries are facing a rising epidemic of non-communicable diseases (NCDs) alongside a persistent burden from undernutrition and infectious diseases. Mendelian randomization (using genetic variants as instrumental variables) and randomised controlled trial (RCT) evidence show that high levels of total (TC) and low-density lipoprotein-cholesterol (LDL-C) and of triglycerides (TG) are key causal risk factors for coronary heart diseases (CHD), that can be effectively modified to prevent CHD. Studies in high-income countries show that higher adiposity results in an adverse lipid profile, but whether this association is similar in SSA populations is unclear. One previous small study from Cameroon suggested higher adiposity increased dyslipidaemia in urban dwelling SSA populations but not in those in rural areas, but to our knowledge previous studies have not sought to replicate this. This study aimed to (i) assess the association between total and central adiposity measures and lipid profile in Malawi, exploring differences by sex and area of residence and (ii) compare the associations with observations from a predominantly white European-origin population cohort from the United Kingdom (UK).

Observational studies consistently suggest that maternal obesity is related to a number of adverse perinatal outcomes. However, which of these are causal or due to confounding is unclear. We aimed to carry out Mendelian randomization (MR), which uses genetic variants robustly associated with the exposure of interest as instrumental variables (IV), to determine the causal effect of maternal BMI on clinically important obstetric and perinatal outcomes.

BackgroundSouth Asians have an increased risk of stroke and coronary heart disease (CHD) compared to white European populations. High blood pressure (BP) is an important risk factor for CHD and higher diastolic BP has previously been reported in both South Asian adults and children. Our aim was to examine whether maternal pregnancy, social and lifestyle characteristics are associated with BP at age 4/5 and contribute to these differences.MethodsBorn in Bradford is a prospective study of children born to 12 453 mothers between 2007 and 2010 in Bradford, UK. All mothers completed an oral glucose tolerance test in pregnancy and provided detailed social and lifestyle data. We present data from 2129 White British and 2528 Pakistani mother/offspring pairs from the Born in Bradford study. Associations of BMI, gestational diabetes (GD), fasting and post load glucose, maternal hypertension (HDP), smoking in pregnancy and maternal education with offspring systolic and diastolic BP at age 4/5 were examined. We adjusted our results for sex and age at BP measurement.ResultsPakistani children had lower systolic (mean difference −0.16 95% CI −0.79, 0.47) but higher diastolic (mean difference 1.38 95% CI 0.74, 2.03) compared to White British children. In Pakistani children maternal BMI and HDP were strongly associated with higher systolic and diastolic BP but the effect was minimal and weak in White British children. Associations of maternal glucose and BP were consistent with the null hypothesis in both groups. Smoking and education were not associated with BP in either group.ConclusionEthnic differences in systolic and diastolic BP are present in children at age 4/5. Consistent with findings in adults, Pakistani origin children have on average lower systolic and higher diastolic BP compared to White British children. Maternal BMI and HDP influence BP in Pakistani children but have minimal effect in White British children. These results suggest a role for some maternal pregnancy and lifestyle exposures in ethnic differences in systolic and diastolic BP at age 4/5.

The article reports on the findings of a study of the association between early life body mass index (BMI) and risk of ischemic heart disease (IHD) and stroke. A description of the experimental set-up and measurement methods is given. The study showed that BMI was not associated with future risk of IHD or stroke. It points out that the findings do not support the hypothesis that being overweight or obese in childhood is associated with cardiovascular risk in the future.

To investigate the association between paternal circulatory health in middle age and offspring blood pressure across childhood and adolescence in order to examine the importance of inter-generational influences on blood pressure trajectories and the potential development of hypertension in later adult life.