S U M M A R Y / S A M E N V A T T I N G Summary Obesity in childhood is nowadays and will be in future one of the greatest health care problems. The metabolic syndrome, characterized by abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum tri-‐ glycerides and low high-‐density cholesterol (HDL) levels is one of the dangerous health consequences of obesity. Also joint problems and psychosocial problems can occur. The idea that the origin of the metabolic syndrome has to be found in early life is based on Barker’s hypothesis, who stated that malnutrition in utero perma-‐ nently changes the metabolism. During the last decades the prevalence of obesity increases in children and thereby the risk of an increasing prevalence in adulthood. It is therefore important to pre-‐ vent obesity at a young age in childhood, preferably before a child has become obese. A lot of prevention programs for obesity in children are available worldwide, but most of them are applied at the moment a child is already overweight. In this thesis we analyzed the longitudinal growth data of height and weight in a healthy Dutch population to detect the start of becoming obese in a better way. Based on these data, we created a prediction model to detect the risk on obesity at a moment a child has still a healthy weight. The use of the prediction model can be an important tool in the Youth Health Care Practice to prevent obesity. A risk group for development of obesity is children born small for gestational age (SGA). In this thesis we investigated the growth and change in body composition of SGA children, treated with recombinant human growth hormone therapy (rhGH). The results of this study give more information in the change of body composition of SGA children and thereby in the development of obesity. In the second chapter, we explored whether the trend of becoming obese already starts during the prenatal period and whether the increase in weight in children is related to a secular trend in height during the last 80 years. Over the last decades the improved condition in Western society led indeed to a tendency for children to increase in height, but also in weight at all ages. We investigated if this secular trend in height and weight is already visible during intrauterine growth. For this purpose we compared growth data of three prenatal growth studies, performed in The Netherlands in the period between 1970 and 2007. No differences between birth weights were found for these years. In postnatal data during that period, in-‐ creasing weight, height and Body Mass Index (BMI) in both boys and girls were visible, known as the secular trend. The increase in weight starts from five years onwards. The secular trend in height starts from the age of two and a half years onwards in both boys and girls. In conclusion, no prenatal secular trend could be 119
Proefschrift binnenwerk Manon Ernst_DEF.indd
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