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Associations of prematurity and low birth weight with blood pressure and kidney function in middle-aged participants of the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil

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Abstract

Background

An adverse intrauterine environment reflected by low birth weight (LBW) and prematurity may induce fetal programming that favors kidney dysfunction in adulthood. We examined the association of LBW and prematurity with blood pressure (BP) and kidney function markers in non-diabetic, middle-aged adults without kidney disease from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

A cross-sectional analysis of 768 subjects aged 35–54 years was conducted. Comparisons were performed according to self-reported birth weight: LBW (< 2.5 kg) or normal birth weight (2.5–4.0 kg). Associations of LBW and prematurity with BP levels and kidney function markers "(estimated glomerular filtration rate [eGFR], albumin-creatinine ratio [ACR] and serum cystatin-C) were tested by multiple linear regression using adjustments based on Directed Acyclic Graphs. Propensity score matching was applied to control imbalances.

Results

Mean age of participants was 45.5 ± 4.6 years and 56.8% were female; 64 (8.3%) participants reported LBW and 39 (5.0%) prematurity. The LBW group had higher systolic (p = 0.015) and diastolic BP (p = 0.014) and ACR values (p = 0.031) and lower eGFR (p = 0.015) than the normal birth weight group, but no group difference for cystatin-C was found. The preterm group had higher mean levels of systolic and diastolic BP, but no difference in kidney function markers was evident. In a regression model adjusted for sex, skin color and family history of hypertension, both systolic and diastolic BP levels were associated with LBW, but this association disappeared after adding for prematurity, which remained associated with BP (p = 0.017). Having applied a propensity score matching, LBW was associated with ACR values (p = 0.003), but not with eGFR or BP levels.

Conclusion

The study findings of independent associations of prematurity with higher BP levels, and of LBW with markers of kidney function in adulthood, support that early life events may predict risk for hypertension and kidney dysfunction in adulthood. The study design precluded the inferring of causality, and prospective studies are needed to further investigate this hypothesis.

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Data Availability

The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.

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Acknowledgements

The authors would like to acknowledge the participation of the 5,061 individuals recruited for this study, without them this study and those based on the ELSA-Brasil cohort would not have been possible.

Funding

The current study was supported by a grant from the São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo—FAPESP—Protocol 2009/15041-9). Also it was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nı́vel Superior—Brasil (CAPES)—(Finance Code 001). The baseline ELSA-Brasil study was supported by the Brazilian Ministry of Health (Science and Technology Department), the Brazilian Ministry of Science and Technology, and CNPq-National Research Council (# 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ).

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The authors have no financial interests to disclose.

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Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil

    Julia Ines F. Branda & Sandra Roberta G. Ferreira

  2. Department of Preventive Medicine, Federal University of São Paulo, São Paulo, Brazil

    Bianca de Almeida-Pititto

  3. Department of Internal Medicine, Medical School, University of São Paulo, São Paulo, Brazil

    Isabela Bensenor & Paulo A. Lotufo

  4. Center of Clinical and Epidemiological Research at University of São Paulo, São Paulo, Brazil

    Julia Ines F. Branda, Bianca de Almeida-Pititto, Isabela Bensenor, Paulo A. Lotufo & Sandra Roberta G. Ferreira

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Contributions

Study design, analysis, interpretation and preparation of the manuscript: JB, BA-P and SF. Acquisition of data and critical revision for the manuscript content: PL and IB. All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

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Correspondence to Sandra Roberta G. Ferreira.

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The study was approved by the National Commission on Ethics Research (CONEP) and the local ethics committee, the Research Ethics Committee (CEP) under registration number 76 of the University of São Paulo (HU-USP). The patients/participants provided written informed consent to participate in this study.

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Branda, J.I.F., de Almeida-Pititto, B., Bensenor, I. et al. Associations of prematurity and low birth weight with blood pressure and kidney function in middle-aged participants of the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil. J Nephrol 36, 1373–1382 (2023). https://doi.org/10.1007/s40620-022-01549-w

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