title: First-borns carry a higher metabolic risk in early adulthood: evidence from a prospective cohort study.
abstract: BACKGROUND
  Birth order has been associated with early growth variability and subsequent increased adiposity, but the consequent effects of increased fat mass on metabolic risk during adulthood have not been assessed. We aimed to quantify the metabolic risk in young adulthood of being first-born relative to those born second or subsequently.
  
  
  RESULTS
  Body composition and metabolic risk were assessed in 2,249 men, aged 17-19 years, from a birth cohort in southern Brazil. Metabolic risk was assessed using a composite z-score integrating standardized measurements of blood pressure, total cholesterol, high density lipoprotein, triglycerides and fat mass. First-borns had lower birth weight z-score (Δ = -0.25, 95%CI -0.35, -0.15,p<0.001) but showed greater weight gain during infancy (change in weight z-score from birth to 20 months: Δ = 0.39, 95%CI 0.28-0.50, p<0.0001) and had greater mean height (Δ = 1.2 cm, 95%CI: 0.7-1.6, p<0.0001) and weight (Δ = 0.34 kg, 95%CI: 0.13-0.55, p<0.002) at 43 months. This greater weight and height tracked into early adulthood, with first-borns being significantly taller, heavier and with significantly higher fat mass than later-borns. The metabolic risk z-score was significantly higher in first-borns.
  
  
  CONCLUSIONS
  First-born status is associated with significantly elevated adiposity and metabolic risk in young adult men in Brazil. Our results, linking cardiovascular risk with life history variables, suggest that metabolic risk may be associated with the worldwide trend to smaller family size and it may interact with changes in behavioural or environmental risk factors.
authors.affiliation: Department of Neuroscience, University Federico II, Naples, Italy. masiervo@yahoo.com
authors.forename: Mario
authors.initials: M
authors.lastname: Siervo
authors.forename: Bernardo L
authors.initials: BL
authors.lastname: Horta
authors.forename: Blossom C M
authors.initials: BC
authors.lastname: Stephan
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.forename: Jonathan C K
authors.initials: JC
authors.lastname: Wells
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism*; D050154:Adiposity / Q000502:physiology*; D000293:Adolescent; D001794:Blood Pressure; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D001938:Brazil; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000503:physiopathology; D002784:Cholesterol / Q000378:metabolism; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D016014:Linear Models; D008075:Lipoproteins, HDL / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014280:Triglycerides / Q000378:metabolism; D015430:Weight Gain / Q000502:physiology; D055815:Young Adult
chemical_list: D008075:Lipoproteins, HDL; D014280:Triglycerides; D002784:Cholesterol