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Table 4 Phenotypic outcomes in the children in both cohorts

From: Protocol for the EMPHASIS study; epigenetic mechanisms linking maternal pre-conceptional nutrition and children’s health in India and Sub-Saharan Africa

Domain Primary outcomes Secondary outcomes
Birth outcomes Measured: Measured:
Birth weight (g)
Birth length (cm)
Head, chest, abdomen and mid-upper arm circumferences (cm)
Triceps and subscapular skinfolds (mm)
Derived:
Small for gestational age (SGA, N [%])a
Derived:
Gestational age (weeks)
Low birth weight (<2500 g) (N [%])
Pre-term (<37 completed weeks’ gestation) N [%])
At follow-up in childhood
 Anthropometry Measured: Measured:
Standing height (cm) Weight (kg)
Sitting height (cm)
Head, chest, waist, hip and mid-upper arm circumferences (cm)
Biceps, triceps, subscapular, supra-iliac skinfolds (mm)
Derived: Derived:
Body mass index (BMI) (kg/m2)
Weight-, height- and BMI-for-age Z-scoresb (SD)
Stunted, wasted, underweightb (N [%])
Leg length (cm)
Sitting height/leg length ratio
Head circumference-for-age Z-scoreb (SD)
Sum of skinfolds (mm)
Waist/hip ratio
Longitudinal growth measures
 Body composition (DXA) Measured: Measured:
  Total lean mass (kg)
Total fat mass (kg)
Android fat (kg)
Gynoid fat (kg)
  Derived:
Lean mass index (kg/m2)
Fat mass index (kg/m2)
Derived:
Body fat %
 Bone (DXA and pQCT) Measured: Measured:
  DXA:
Total and spine bone area (BA) (cm2)
Total and spine bone mineral content (BMC) (g)
Derived:
DXA:
Spine bone mineral apparent density (BMAD; (g/cm3)
DXA:
Total and spine bone mineral density (BMD) (g/cm2)
pQCT (Gambia only):
Metaphyseal (8%) and diaphyseal (50%) tibia. Measurements taken using voxel size 0.5 mm, slice thickness 2 mm.
Tibial total and trabecular BA (mm2) and volumetric BMD (vBMD) (mg/mm3).
Diaphysial BA (mm2), BMC (mg/mm), vBMD (mg/mm3), cortical area (mm2) and thickness (mm), and strength (cross-sectional moment of inertia) (mm4).
 Cardio-metabolic risk markers Measured: Measured:
Systolic blood pressure (mmHg)
Fasting glucose (mmol/l)
30- &120-min glucose (mmol/l)
LDL-cholesterol (mmol/l)
HDL-cholesterol (mmol/l)
Triglycerides (mmol/l)
Diastolic blood pressure (mmHg)
Fasting insulin (pmol/l)
30-min insulin (pmol/l)
Derived: Derived:
Insulin resistance (HOMA-IR)c
Disposition indexd
High blood pressure (mmHg)e
Insulinogenic indexf
Metabolic syndrome N [%])g
 Cognitive function Measured:  
  Scores from Atlantis, Pattern reasoning, Kohs block design, Word order, Verbal fluency and Coding tests  
Derived:  
Mental processing indexh (SD)  
  1. Legend: a SGA defined as below the 10th percentile for birth weight for gestational age using INTERGROWTH data [51]
  2. b according to WHO/CDC growth reference: http://www.who.int/growthref/en/
  3. c Insulin resistance according to Homeostasis Model Assessment: https://www.dtu.ox.ac.uk/homacalculator/
  4. d Disposition index: an estimate of insulin secretion taking into account insulin resistance, to be calculated as insulinogenic index/HOMA-IR [52]
  5. e High blood pressure defined as >99th percentile according to an international reference: https://www.nhlbi.nih.gov/health-pro/guidelines/current/hypertension-pediatric-jnc-4/blood-pressure-tables
  6. f Insulinogenic index: an estimate of first-phase insulin secretion, calculated as (insulin at 30 min – fasting insulin)/(glucose at 30 min – fasting glucose) [53]
  7. g Metabolic Syndrome: There is no accepted definition of metabolic syndrome in children of this age; a binary variable will be created, where 1 represents children who are above the highest sex-specific within-cohort quartiles for android fat on DXA, systolic blood pressure, plasma triglyceride concentration and HOMA-IR, and below the lower quartile for HDL-cholesterol
  8. h a composite score of cognitive function, calculated as the mean of the standardised scores from the 6 individual cognitive tests