Vi har undersökt riskmarkörer och tidiga påverkansfaktorer för fetma under för-skoleåldern. Mycket talar idag för att faktorer tidigt i livet, som foster och under första levnadsåret har stor betydelse för hälsorisker som vuxen. Att födas liten, antingen tillväxthämmad eller för tidigt, är kopplat till ökad risk för fetma och hjärtkärlsjukdom och diabetes. Att redan under första levnadsåret identifiera barn som har ökad risk utgör basen för möjligheter att förebygga barnfetma. Det är fram-för allt bukfetma som är kopplad till ökad sjuklighet och hos vuxna finns defini-erade gränsvärden för bukomfång som korrelerar till risk. I Sverige har vi saknat referenskurvor för bukomfång för barn. ettväven producerar flera hormon såsom leptin och adiponektin, som reglerar aptit och energiomsättning i kroppen. Även skelettet producerar ämnen såsom osteocalcin som påverka insulinkänsligheten. När vi föds koloniseras vår tarm av bakterier i samband med och efter födelsen. Dessa bakterier är noga utvalda för att fungera i tarmens miljö och hjälper tillgodogöra oss vissa näringsämnen. Feta vuxna har visat sig ha en annorlunda sammansättning mellan de vanligaste bakteriegrupperna och en minskad mångfald i tarmfloran. Om feta personers tarmflora överförs till möss uppfödda i helt steril miljö så blir mössen överviktiga, trots att de inte äter mer än vanligt. Den tidiga kosten som för spädbar-net är bröstmjölk eller ersättning är en viktig påverkansfaktor för tarmbakterierna. Vissa studier har visat att amning verkar skyddande mot övervikt men resultaten är inte entydiga.
Vi undersöker i denna avhandling flera möjliga riskfaktorer för barnfetma såsom bukomfång, uppfödning och tarmflora, och hur dessa samspelar med markörer från ben- och fettväv samt insulinkänslighet. Vi konstruerade de första svenska referen-skurvorna för bukomfång för förskolebarn i Sverige och testade kurvorna mot en grupp barn födda förtidigt. Dessa barn hade förhöjt bukomfång jämfört med ref-erensen speciellt under slutet av spädbarnstiden trots att de var smala. Senare under förskoletiden försvann dessa skillnader. Vi har även undersökt specifika faktorer i kosten s som vitamin D och dess relation till benmarkörer, kroppssammansättning och insulinkänslighet vid 3 års ålder. Låga nivåer av D-vitamin och benmarkören osteocalcin i navelsträngsprov kunde förutsäga högt BMI och bukomfång vid 3 årsåldern. Amning påverkade nivåer av osteocalcin under första levnadsåret. Det fanns en stor grad av succession av bakterier mellan mor och barn i nyföddhetsperi-oden och tarmfloran påverkades av om barnet ammades eller inte. När barnet var ett år gammalt så blev tarmfloran mer vuxenlik, framförallt hos de barn som nu slutat att amma.
Sammanfattningsvis Vi fann konkreta förklaringar till att kosten har betydelse för fetmautvecklingen under förskoleåren. Amning påverkar BMI och bukomfångsut-veckling genom att bland annat påverka tarmfloran och benmarkörer som har be-tydelse för insulinkänslighet. Det behövs fortfarande mer forskning för att kunna avgöra om bukomfång fungerar som en riskmarkör i tidig barndom. Kanske kan den uttalade fettspurten tidigt under första levnadsåret, som är mer uttalad hos po-jkar, utgöra en kritisk tidpunkt där barn med risk för bukfetma skiljer ut sig.
Acknowledgements
This thesis was conducted at the University of Gothenburg and was supported by the Region of Halland, I thank the children and parents participating in the studies. Many people have made this work possible and inspired me along the way.
Jovanna Dahlgren, a better mentor could not be found. You have generously shared
your knowledge, network and family with me. You have bought just enough candies for the PhD student and there are no places in the world not suitable for research. We both need to work on our time optimistic personalities though!
Stefan Bergman, leading me in my first steps in SPSS and always putting focus
back on good research has been important for the progress of our studies. You are leading the ice cream league!
Gerd Almqvist-Tangen, my sister-in-arms. We have fought many wars of science
and without our collaboration there would be no “TP”. You are an incredible moth-er, woman, researchmoth-er, developer and lobbyist. Your loyalty is worth everything.
Bernt Alm, your important role and experience in Child Health Clinic care and
your interest in epidemiology, is important for our research group
Ola Andersson, you brought cord clamping into my world and an endless amount
of new possible and impossible research ideas. Helping each other in planning and conducting our two studies made it all possible. Hopefully there will now be time for other joint ventures.
Eivor Kjellberg och Monika Nygren - a perfect research nurse match. Taking so
good care of the study partcipants as the both of you do is very important for good and reliable research. Nothing would work without the both of you.
Ann Britt Bengtsson - thanks for the coordinating work when collecting data for
the first crossectional study and your keen interest and engagement in the endocri-nology patients of our clinic.
Child Health Clinic nurses in Halland. Everyone of you is important in the
growth data collection. During the many seminars focusing on growth and nutri-tion over the last years, we all learnt a lot, and I think that the CHC infrastructure is an important health factor for the preschool children in Halland.
Midwifes of the maternal health clinic and the delivery ward in Halmstad I am
thankful for the important work done by you all in the recruitment and sampling of mothers and their newborn babies.
Dan Andersson - as my head of department during a long time your way of being
and your interest of knowledge and good health care for children has been impor-tant to me. You made it possible to combine the clinical work with research.I think it is an excellent combination for me and for the patients
Nils Östen Nilsson - my clinical mentor and the one who introduced
endocrinol-ogy into my world. You finally convinced me to go further with the ideas of studies of early influencing factors of childhood obesity.
sup-ported us in the firts steps towards starting our thesis works.
Research and Devolopment Department Halland. Without the kind support
from many different people at the Research and Devolopment Department in Hal-land these studies would not have been possible. Special thanks goes to Anders
Hol-mén for all support related to my research work and to Marit Petrius and Annika
Flink Persson in the handling of researh funds and salaries.
Linnea Holmén, Viktoria Almqvist, Inger Bermlid, Lydia Dahlgren, Cecilia
Olsson, Ingrid Bratt and Linnea Bergman, have all been very helpful with
im-portant quality checks of the data.
Andreas Neirop and Aimon Nicklasson In different parts of my work, I would
not have survived, without my two "growth philosophers". I hope we will have more opportunities to meet in Särdal for research and bird watching.
Ann Katrin Karlsson and Kerstin Allvin. I thank you for the opportunity to
col-laborate around the waist circumference in moderately preterm children.
Fredrik Bäckhed, Valentina Tremaroli, Petia Katechova, Pia Kiilerich, Karsten
Kristiansen, Pengqing Yang, Quin Feng, Wan Jun. The research group around
gut microbiota has open a new field to my and I feel priviledged to be part of the collaboration . I look forward to exciting future research.
Anna Westerståhl Stenport for intellectual support, good friendship and for telling
my that dissertation is only the first step.
Lina Eklöv, Petra Strandell. Friends important for support and advice on the
chal-lenge of everyday life. Lina Strand Backman, thanks for the everlasting discussions about alternative and creative carriers. Maybe we should buy that barn after all?
My parents, for bringing me up believing in the importance of knowledge and
making me curious enough to do research. Your contribution to this thesis also include many hours taking care of my lovely boys while their mom had research meetings and poster presentations.
My brother - inspiring idol and research coach
My family - Peter, Oscar, Ludwig and Jonathan. I thank you for this opportunity
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