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      Body size trajectories and cardio‐metabolic resilience to obesity

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          Abstract

          Individuals with obesity do not represent a single homogenous group in terms of cardio‐metabolic health prospects. The concept of metabolically healthy obesity is a crude way of capturing this heterogeneity and has resulted in a plethora of research linking to future outcomes to show that it is not a benign condition. By contrast, very few studies have looked back in time and modelled the life course processes and exposures that explain the heterogeneity in cardio‐metabolic health and morbidity and mortality risk among people with the same body mass index ( BMI) (or waist circumference or percentage body fat). The aim of the Medical Research Council New Investigator Research Grant ( MR/P023347/1) ‘Body size trajectories and cardio‐metabolic resilience to obesity in three United Kingdom birth cohorts’ is to reveal the body size trajectories, pubertal development patterns and other factors ( e.g. early‐life adversity) that might attenuate the positive associations of adulthood obesity makers ( e.g. BMI) with cardio‐metabolic disease risk factors and other outcomes, thereby providing some degree of protection against the adverse effects of obesity. This work builds on the Principle Investigator's previous research as part of the Cohort and Longitudinal Studies Enhancement Resources initiative and focuses on secondary data analysis in the nationally representative UK birth cohort studies (initiated in 1946, 1958 and 1970), which have life course body size and exposure data and a biomedical sweep in adulthood. The grant will provide novel evidence on the life course processes and exposures that lead to some people developing a cardio‐metabolic complication or disease or dying while other people with the same BMI do not. This paper details the grant's scientific rationale, research objectives and potential impact.

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          Most cited references42

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          Beyond body mass index.

          Body mass index (BMI) is the cornerstone of the current classification system for obesity and its advantages are widely exploited across disciplines ranging from international surveillance to individual patient assessment. However, like all anthropometric measurements, it is only a surrogate measure of body fatness. Obesity is defined as an excess accumulation of body fat, and it is the amount of this excess fat that correlates with ill-health. We propose therefore that much greater attention should be paid to the development of databases and standards based on the direct measurement of body fat in populations, rather than on surrogate measures. In support of this argument we illustrate a wide range of conditions in which surrogate anthropometric measures (especially BMI) provide misleading information about body fat content. These include: infancy and childhood; ageing; racial differences; athletes; military and civil forces personnel; weight loss with and without exercise; physical training; and special clinical circumstances. We argue that BMI continues to serve well for many purposes, but that the time is now right to initiate a gradual evolution beyond BMI towards standards based on actual measurements of body fat mass.
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            Weight in infancy and death from ischaemic heart disease.

            Environmental influences that impair growth and development in early life may be risk factors for ischaemic heart disease. To test this hypothesis, 5654 men born during 1911-30 were traced. They were born in six districts of Hertfordshire, England, and their weights in infancy were recorded. 92.4% were breast fed. Men with the lowest weights at birth and at one year had the highest death rates from ischaemic heart disease. The standardised mortality ratios fell from 111 in men who weighed 18 pounds (8.2 kg) or less at one year to 42 in those who weighed 27 pounds (12.3 kg) or more. Measures that promote prenatal and postnatal growth may reduce deaths from ischaemic heart disease. Promotion of postnatal growth may be especially important in boys who weigh below 7.5 pounds (3.4 kg) at birth.
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              Health inequalities among British civil servants: the Whitehall II study.

              The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10,314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall II study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.
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                Author and article information

                Contributors
                w.o.johnson@lboro.ac.uk
                Journal
                Nutr Bull
                Nutr Bull
                10.1111/(ISSN)1467-3010
                NBU
                Nutrition Bulletin
                John Wiley and Sons Inc. (Hoboken )
                1471-9827
                1467-3010
                15 October 2018
                December 2018
                : 43
                : 4 ( doiID: 10.1111/nbu.2018.43.issue-4 )
                : 456-462
                Affiliations
                [ 1 ] Loughborough University Loughborough UK
                Author notes
                [*] [* ] Correspondence: Dr. William Johnson, Lecturer in Human Biology and Epidemiology, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3 TU, UK.

                E‐mail: w.o.johnson@ 123456lboro.ac.uk

                Article
                NBU12350
                10.1111/nbu.12350
                6283272
                363694b4-0f4c-413f-b1e4-5c9d4c5854d2
                © 2018 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 0, Tables: 0, Pages: 7, Words: 5312
                Funding
                Funded by: UK Medical Research Council (MRC) New Investigator Research
                Award ID: MR/P023347/1
                Funded by: National Institute for Health Research (NIHR) Leicester Biomedical Research Centre
                Categories
                Emerging Research
                ORIGINAL ARTICLES
                Emerging Research
                Custom metadata
                2.0
                nbu12350
                December 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.3 mode:remove_FC converted:06.12.2018

                Nutrition & Dietetics
                body mass index,body size trajectories,cardio‐metabolic health,healthy obesity,life course epidemiology,resilience

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