Zhonghai Zhu

Sarcopenia is a key contributor to functional decline in aging populations, yet the role of oral health in its development remains unclear. Understanding t

While early-life growth patterns are thought to be pivotal for long-term cardiovascular health, their specific links to adolescent blood pressure (BP) and potential mediators remain unclear. We aimed to examine the associations of growth trajectories from birth to age two with systolic and diastolic BP in adolescence, and to quantify the proportion mediated by concurrent adolescent BMI. In a prospective birth cohort in rural China, we repeatedly measured infant weight and length at birth and at 1, 3, 6, 9, 12, 18, and 24 months of age. Adolescent BP was measured and converted into percentiles. We used group-based trajectory modeling to identify early-life weight-, length-, BMI- and weight-for-length z-score trajectories and examined their associations with adolescent BP. A general causal mediation estimated the natural indirect effects and corresponding proportions mediated through adolescent BMI. Among the 1388 infants enrolled, 741 (60.9% male; mean age, 11.26 (SD, 0.57) years old) were followed at adolescence. Greater and rapid BMI and weight-for-length growth trajectories were statistically associated with elevated adolescent BP and BP percentiles, with adjusted mean differences ranging from 2.32 to 5.29 mmHg. Adolescent BMI mediated a substantial portion (up to 85%) of the association with systolic BP, but it showed no significant mediating effect for diastolic BP. Conclusion: Rapid adiposity growth in infancy predicts elevated adolescent BP. Since adolescent BMI did not fully explain this association, especially for diastolic BP, preventive interventions within the first 1000 days may be critical for lifelong cardiovascular health beyond managing later childhood weight. Trial registration: ISRCTN08850194, retrospectively registered December 14, 2006. https://www.isrctn.com/ISRCTN08850194?q=ISRCTN08850194&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10. What is Known • Childhood body mass index (BMI) is positively associated with blood pressure at later life. What is New • This study identifies distinct weight, length, BMI, and weight-for-length growth trajectories from birth to two years of age and links rapid weight-related growth trajectories to elevated blood pressure in early adolescence. • Using causal mediation analysis, it shows adolescent BMI largely mediates the association for systolic, but not diastolic, blood pressure, highlighting interventions within the first 1000 day for lifelong cardiovascular health beyond managing later childhood weight.

This study directly examined the effects of antenatal micronutrient supplementation on adolescent blood pressure (BP). This study involved adolescents from two rural counties in western China. Their mothers had previously participated in a cluster-randomized trial of antenatal micronutrient supplementation. All pregnant women were randomized to take a daily capsule of folic acid (FA) as control, folic acid plus iron (IFA), or multiple micronutrients (MMNs) until delivery. Adolescent BP was assessed using a validated electronic sphygmomanometer and converted into percentiles by population reference. We examined the effects of antenatal micronutrient supplementation on adolescent BP and BP percentiles using generalized estimation equations. Multinomial logistic regression was employed to examine the associations between antenatal micronutrient supplementation and categorical BP outcomes, with relative risk reduction estimated. Among 4488 singleton births eligible for long-term follow-up, 1994 (44.4%) adolescents were followed, and among them, 59.2% were male, with a mean age of 11.73 (SD, 0.86) years old. After adjusting for a range of covariates, antenatal MMNs supplementation relative to FA alone was associated with a 1.13 (95% CI -2.09, -0.17) mmHg lower systolic blood pressure (SBP) and a 2.59 (95% CI -5.01, -0.17) points lower SBP percentile. The similar benefits of MMNs were observed for categorized adolescent high BP (SBP and/or diastolic blood pressure (DBP) ≥ the 95th percentile for age, sex, and height). Compared with folic acid alone, antenatal MMNs supplementation was associated with lower adolescent SBP. This finding suggests that comprehensive antenatal nutritional interventions may offer a potential strategy for the primordial prevention of hypertension in offspring. ISRCTN08850194, retrospectively registered December 14, 2006. https://www.isrctn.com/ISRCTN08850194?q=ISRCTN08850194&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10.

Background: The association between cumulative endogenous estrogen exposure across the lifespan, especially considering reproductive events, and women’s cardiometabolic health remain unclear. We aimed to examine the associations between lifetime endogenous estrogen exposure and the risks of diabetes, hypertension, and cardiovascular disease (CVD) among postmenopausal women. Methods: We used baseline data from the Regional Ethnic Cohort Study in Northwest China. Reproductive factors were self-reported using a structured questionnaire, and surrogate indicators of estrogen exposures—reproductive lifespan, endogenous estrogen exposure, cumulative gestation duration and other proportional indicators—were calculated. Diabetes, hypertension and CVD were defined based on self-reported physician diagnoses at the hospital. Multivariable logistic regression models were employed to estimate adjusted odds rations (aORs) and 95% confidence intervals (CIs). Results: Among 35,498 postmenopausal women (median age 59.0 years [interquartile range: 54.0–65.0], each additional year of reproductive lifespan was associated with lower risks of diabetes (aOR 0.971; 95%CI 0.961, 0.982), hypertension (aOR 0.969; 95%CI 0.962, 0.975) and CVD (aOR 0.954; 95%CI 0.946, 0.962). Similar inverse associations were observed for endogenous estrogen exposure. In contrast, a higher ratio of gestation-to-reproductive lifespan duration was positively associated with increased risks of diabetes, hypertension, and CVD. Multiple incomplete pregnancies were associated with increased diabetes risk, while multiple complete pregnancies were linked to elevated risks of hypertension and CVD. Conclusions: Longer exposure to endogenous estrogen was associated with decreased risk of cardiometabolic disease, while a higher burden of gestational events was associated with increased risks. Reproductive history could be considered as an indicator for risk stratification and management of cardiometabolic disease in women.

Infant weight gain is strongly linked to a higher risk of childhood and adolescent obesity. However, limited growth assessments and inconsistent weight gain measures hinder the identification of sensitive early-life periods. This study aims to use various methods to quantify weight gain across different periods during the first two years of life and further identify sensitive periods of infant growth. We conducted a prospective birth cohort in rural western China. Infant weight was collected at birth, 1, 3, 6, 9, 12, 18, 24 months of age and early adolescence. We used four methods to quantify weight gain across four periods (0–6, 6–12, 12–18, and 12–24 months of age): weight gain velocity z-score (WGV-Z), change in weight-for- age and sex z-score (CWAZ), conditional weight standardized residuals (CWR), and area under the growth prediction curve of each individual (AUC). Generalized estimating equation was used to examine the associations between infant weight gain and adolescent zBMI, underweight and overweight/obesity. Among 1388 infants enrolled, 735 adolescents (61.0% male) were assessed, with a mean age of 11.74 (SD,0.49) years old. The results of the AUC method indicate that the period from birth to 6 months of age is a sensitive period for infant weight gain. A higher AUC during birth to 6 months of age is associated with a higher adolescent zBMI (beta = 0.152, 95%CI 0.119, 0.186), an increased risk of overweight/obese (OR = 1.159, 95%CI 1.066, 1.261) and a decreased risk of underweight (OR = 0.653,95% CI 0.571, 0.747). Additionally, the AUC method showed the highest predictive power, although the observed difference did not reach statistical significance. AUC method based on multiple anthropometric measurements is able to quantify weight gain and consequently identify a sensitive period that has long-lasting influences on life-course health outcomes.

Introduction: Iron is an essential nutrient during pregnancy and may influence the early development of the neonatal gut microbiota. This study aimed to investigate the association between maternal dietary iron intake during pregnancy and the gut microbiota (GM) characteristics of both the mother and neonate in a well-characterized cohort.Methods: Ninety-five mother-neonate dyads were included in this study. Mothers completed a food frequency questionnaire (FFQ) providing estimates of dietary iron intake during pregnancy, and participants were categorized into higher (≥ median) or lower (< median) groups of maternal dietary iron intake. Fecal samples were collected from mothers (third trimester) and from neonates, and assessed via 16S rRNA amplicon sequencing. Differences in diversity and abundance of GM were compared between groups.Results: There was no difference in profile or diversity in maternal samples however, neonatal samples indicated greater diversity of GM in infants of mothers with higher intakes of iron (Shannon p = 0.04; Simpson p = 0.01). After stratification by delivery mode, in the stratum of normal vaginal delivery (NVD), Simpson diversity remained higher in the infants’ GM of mothers with higher intakes of iron (p = 0.04). The relative abundance of the core genus Bifidobacterium in NVD and cesarean section (CS) neonates showed higher in the higher group than that in the lower group, as the difference was not statistically significant. Maternal dietary iron intake was significantly associated with the neonate GM composition with variation explained 10.24% (p = 0.007).Conclusion: Adequate dietary iron intake during pregnancy may promote beneficial bacterial colonization and increase the biodiversity of the neonate GM.

Maternal adiposity has been identified as a predictor of child overweight/obesity; however, it remains unclear whether the association changes as the child ages. We aimed to examine the associations between maternal weight status during pregnancy and offspring physical growth from birth to early adolescence using data from a birth cohort study in rural western China. Maternal weight measurements during the first, second and third trimesters were used to calculate body mass index (BMI) and gestational weight gain (GWG) rate, and then were classified following the Institute of Medicine recommendation. Offspring length/height and weight were measured at birth, mid‐childhood (age 7–10 years) and early adolescence (age 10–14 years) and converted into z‐scores using the INTERGROWTH‐21st and WHO standards, respectively. Generalized linear models were applied to examine the associations of maternal BMI and GWG with offspring BMI‐for‐age and sex (BAZ) and length‐/height‐for‐age and sex z‐score (LAZ/HAZ) at birth, mid‐childhood and early adolescence, respectively, adjusting for potential confounders. Among 411 mother‐offspring pairs (62% boys), higher maternal BMI during the first trimester was associated with increased offspring BAZ at birth (adjusted mean differences [aMD]: 0.07, 95% confidence interval [CI]: 0.001–0.14), mid‐childhood (aMD 0.09, 95% CI: 0.05–0.14) and early adolescence (aMD 0.11, 95% CI: 0.05–0.17). Maternal excessive GWG was associated with higher HAZ in early adolescence (aMD 0.44; 95% CI: 0.17–0.69). The strongest point estimate of maternal gestational weight status on offspring physical growth emerged in early adolescence, suggesting the potential age‐dependent amplifying impact. Additionally, updated GWG guidelines should consider regional characteristics and long‐term offspring growth.

Background: Infertility is increasingly recognized as a global health issue affecting couples of reproductive age, with male factors contributing to approximately 50% of infertility cases. However, the association between depression and anxiety-two of the most prevalent mental health conditions-and impaired male fertility remains a subject of ongoing debate.Methods: In this cross-sectional study, male participants seeking fertility counseling at an IVF clinic were recruited. Symptoms of depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Generalized linear regression models (GLMs) were employed to investigate the relationships between mental health status and semen parameters.Results: Status of depression was negatively associated with semen quality parameters, whereas no statistically significant association was recognized between anxiety and semen quality except that sperm concentration was decreased by 25.60 (95% CI, 1.226 to 49.965, P=0.040) ×10⁶/ml in moderate to severe anxiety group referring to normal group. Furthermore, when stratified by sleep duration, moderate to severe depression group showed a great decrease in progressive motility (PR), total motility, concentration and total sperm count (TSC) as referred to normal group in participants with sleep duration less than 7 hours.Conclusion: The present study revealed that depression rather than anxiety was a negative factor that affected semen quality, especially in individuals with shorter sleep duration.

Background: The relationship between parental age at pregnancy and offspring development in low- and middle-income countries remains unclear. We aimed to examine the associations of parental age at pregnancy with adolescent development in rural China. Methods: We conducted a prospective birth cohort study of offspring born to pregnant women who participated in an antenatal micronutrient supplementation trial in rural Western China. Adolescent cognitive development and emotional and behavioural problems were assessed by using the Wechsler Intelligence Scale for Children-IV and the Youth Self-Report-2001, respectively. After accounting for the possible nonlinear relationships, we examined the linear associations between parental age (in years) at pregnancy and scores of adolescent cognitive development and emotional and behavioural problems by performing generalized estimating equations. Results: Among 1897 adolescents followed from birth to early adolescence, 59.5% were male with a mean age of 11.8 (standard deviation (SD): 0.8) years. The mean ages of mothers and fathers at pregnancy were 24.6 (SD: 4.4) and 27.9 (SD: 4.1) years old, respectively. All the P values of the nonlinear terms between parental age and adolescent development in all domains were greater than 0.05. Each one-year increase in maternal age at pregnancy was associated with a 0.29-point (95% confidence interval (CI) 0.06, 0.52) increase in the full-scale intelligence quotient in early adolescence. After parental age was categorized into quartiles, the total behavioural problem scores of adolescents with fathers with an age in the fourth quartile (Q4) were 6.71 (95% CI 0.86, 12.57) points higher than those of adolescents with fathers with an age in the first quartile (Q1), with a linear trend P value of 0.01. Similarly, higher scores (worse behavioural problems) were observed for internalizing behavioural problems and other emotional and behavioural symptoms related to anxiety, withdrawal, social problems, thought problems and aggressive behaviour. Conclusions: At conception, older maternal age was independently linked to better adolescent cognitive development, whereas advanced paternal age was independently associated with a greater risk of adolescent emotional and behavioral problems. These findings suggest that public health policies targeting an optimal parental age at pregnancy should be developed in the context of offspring developmental consequences.

Several gestational weight gain (GWG) guidelines have been established based on monocenter or multicenter researches. We aimed to examine the associations between categories of GWG under the Institute of Medicine (IOM) recommendation guideline, the Chinese National Health Commission (NHC) guideline, and weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21^st Project and adverse birth outcomes. We used data from an antenatal micronutrient supplementation trial in rural western China between 2002 and 2006. Maternal weekly average GWG during the second and third trimesters was calculated and classified into inadequate, adequate and excessive GWG according to the IOM and NHC, respectively. Weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21^st Project were grouped into three subgroups using two approaches: z-score percentile75^th and z-score <-1, -1 to 1, >1 SD. Infant birth weight and gestational age were measured using standard approaches. Generalized linear model with binomial family and logit link was applied to estimate the odds ratio (OR) and 95% confidential intervals (CI) for GWG categories and adverse birth outcomes. Among 1,239 women with normal weight (18.5 kg/m² to 23.9 kg/m²) during early pregnancy, 18.0% and 34.2% were classified as adequate GWG according to IOM and NHC, respectively. Less than half of Chinese women reached optimal GWG by any recommendation guideline. According to NHC, excessive GWG showed a significant association with macrosomia (OR 3.75, 95% CI 1.03, 13.74), large-for-gestation-age (LGA) (OR 2.12, 95% CI 1.01, 4.45), and inadequate GWG was associated with post-term birth (OR 2.25, 95% CI 1.21, 4.16), compared with adequate GWG. Inappropriate GWG was associated with adverse birth outcomes even among women with normal weight during early pregnancy. The monitoring and interventions of weight status during pregnancy, especially for the second and third trimesters, are of great public health importance for optimal birth outcomes. Additionally, developing guideline of appropriate GWG ranges should account for the traits of regional population.