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Epidemiology and Population Health

Do body mass index and waist-to-height ratio over the preceding decade predict retinal microvasculature in 11–12 year olds and midlife adults?

International Journal of Obesity volume 44, pages 1712–1722 (2020)Cite this article

Subjects

Abstract

Background/objectives

Microvascular changes may contribute to obesity-associated cardiovascular disease. We examined whether body mass index (BMI) and waist-to-height ratio (WHtR) (1) at multiple earlier time points and (2) decade-long trajectories predicted retinal microvascular parameters in mid-childhood/adulthood.

Methods

Participants/design: 1288 11–12 year olds (51% girls) and 1264 parents (87% mothers) in the population-based Child Health CheckPoint (CheckPoint) module within the Longitudinal Study of Australian Children (LSAC). LSAC exposure measures: biennial BMI z-score and WHtR for children at five time points from age 2–3 to 10–11 years and self-reported parent BMI at six time points from child age 0–1 years to 10–11 years. CheckPoint outcome measures: retinal arteriolar and venular caliber. Analyses: BMI/WHtR trajectories were identified by group-based trajectory modeling; linear regression models estimated associations between BMI/WHtR at each time point/trajectories and later retinal vascular caliber, adjusted for age, sex, and family socioeconomic status.

Results

In time point analyses, higher child BMI/WHtR from age 4 to 5 years was associated with narrower arteriolar caliber at the age of 11–12 years, but not venular caliber. For example, each standard deviation higher in BMI z-score at 4–5 years was associated with narrower arteriolar caliber at 11–12 years (standardized mean difference (SMD): −0.05, 95% confidence interval (CI): −0.10 to 0.01); by 10–11 years, associations had doubled to −0.10 (95% CI: −0.16 to −0.05). In adults, these finding were similar, except the magnitude of BMI and arteriolar associations were similar across all time points (SMD: −0.11 to −0.13). In child and adult BMI trajectory analyses, less favorable trajectories predicted narrower arteriolar (p-trend < 0.05), but not venular (p-trend > 0.1), caliber. Compared with those in the average BMI trajectory, SMDs in arterial caliber for children and adults in the highest trajectory were −0.25 (95% CI: −0.44 to −0.07) and −0.42 (95% CI: −0.73 to −0.10), respectively. Venular caliber showed late associations with child WHtR, but not with BMI in children or adults.

Conclusions

Associations of decade-long high BMI trajectories with narrowed retinal arteriolar caliber emerge in children, and are clearly evident by midlife. Adiposity appears to exert its early adverse life course impacts on the microcirculation more via arteriolar than venular mechanisms.

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Fig. 1: Retinal images of a child with normal weight and a child with obesity on the grading platform of IVAN software.
Fig. 2: Trajectories of body mass index and waist-to-height ratio in children and adults.
Fig. 3: Flowchart of Longitudinal Study of Australian Children and Child Health CheckPoint.
Fig. 4: Associations of decade-long body mass index and waist-to-height ratio trajectories with retinal vascular caliber.

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Acknowledgements

This study uses data from the Longitudinal Study of Australian Children (LSAC) and Child Health CheckPoint. We thank the LSAC and CheckPoint study participants and families. We also thank the CheckPoint team and the Murdoch Children’s Research Institute. LSAC is conducted in partnership between the Department of Social Services (DSS), the Australian Institute of Family Studies (AIFS), and the Australian Bureau of Statistics (ABS). The findings and views reported in this paper are those of the authors and should not be attributed to DSS, AIFS, or the ABS. MW and ML had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

This work has been supported to date by the National Health and Medical Research Council of Australia (NHMRC; 1041352, 1109355), The Royal Children’s Hospital Foundation (2014-241), Murdoch Children’s Research Institute, The University of Melbourne, National Heart Foundation of Australia (100660), and Financial Markets Foundation for Children (2014-055; 2016-310). ML is supported by a Melbourne Research Scholarship. KL is supported by the Australian National Health & Medical Research Council (NHMRC) Early Career Fellowship 1091124 and National Heart Foundation Postdoctoral Fellowship 101239. MJ is supported by Juho Vainio Foundation and federal research grants to Turku University Hospital. DB is supported by NHMRC Senior Research Fellowship 1064629 and is an Honorary Future Leader Fellowship of the National Heart Foundation of Australia (100369). MW is supported by NHMRC Senior Research Fellowship 1046518, Principal Research Fellowship 1160906, and Cure Kids New Zealand. Research at the Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Program. The funding bodies did not play any role in the study other than the generous provision of funds.

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Authors and Affiliations

  1. Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia

    Mengjiao Liu, Kate Lycett, Tien Yin Wong, Jessica A. Kerr, Mingguang He, David Burgner & Melissa Wake

  2. Murdoch Children’s Research Institute, Melbourne, VIC, Australia

    Mengjiao Liu, Kate Lycett, Jessica A. Kerr, Tim Olds, David Burgner & Melissa Wake

  3. Centre for Social & Early Emotional Development, Deakin University, Melbourne, VIC, Australia

    Kate Lycett

  4. Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia

    Tien Yin Wong & Mingguang He

  5. Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore

    Tien Yin Wong

  6. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China

    Mingguang He

  7. Department of Medicine, University of Turku, Turku, Finland

    Markus Juonala

  8. Division of Medicine, Turku University Hospital, Turku, Finland

    Markus Juonala

  9. Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia

    Tim Olds

  10. The George Institute for Global Health, University of Oxford, Oxford, UK

    Terry Dwyer

  11. Department of Paediatrics, Monash University, Melbourne, VIC, Australia

    David Burgner

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Liu, M., Lycett, K., Wong, T.Y. et al. Do body mass index and waist-to-height ratio over the preceding decade predict retinal microvasculature in 11–12 year olds and midlife adults?. Int J Obes 44, 1712–1722 (2020). https://doi.org/10.1038/s41366-020-0584-9

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