Associação entre parto cesáreo e adiposidade corporal em adultos da Coorte RPS, em Ribeirão Preto, SP

Abstract

Introduction: Cesarean delivery (CD) has been associated with an increased risk of obesity measured by body mass index (BMI), which has limitations. One of the plausible mechanisms to explain this association is related to changes in the gut microbiota of the newborn during childbirth. However, little is known whether cesarean delivery is associated with increased adiposity measured by more accurate methods. Objective: This study aimed to estimate the association between cesarean delivery and total and central body adiposity in adults of a Brazilian birth cohort. Methods: A prospective cohort study was conducted on 1094 adults aged 37 to 39 years, in 2016/17, participants of the birth cohort in Ribeirao Preto, southeastern Brazil, in 1978/79. Total body adiposity was assessed by the Fat Mass Index (FMI) and BMI; central adiposity was measured by the ratio of Androide/Ginoide fats and Waist Circumference (WC). Air displacement plethysmography (ADP-BodPod) and dual X-ray absorptiometry (DEXA) were used to estimate body fat. The association between cesarean delivery and body adiposity was determined by linear regression models, Poisson regression with robust variance estimation and inverse-weighted of the probability of treatment (exposure by type of delivery) by propensity score, adjusted for confounders identified by a Directed Acyclic Graphs (DAG). Results: The CD rate was 32.4%. Cesarean delivery was associated with a 9% higher risk of overweight (p = 0.020, CI 95% 1.01, 1.16) and 27% higher risk of obesity (p = 0.009, CI 95% 1.06, 1.52), according to BMI, when compared to vaginal delivery. Adults born by cesarean delivery had an increase of 1.20kg/m² in BMI (p=0.002, CI 95% 0.45, 1.95), FMI (BodPod) 0,74kg/m² higher (p=0.023; CI 95% 0.10, 1.38), FMI (DEXA) 0,64kg/m² higher (p=0.048; CI 95% 0.01, 1.28), an increase of 0.04 in the androide/gynoid ratio (p = 0.003, CI 95% 0.01, 0.06) and 3.06cm more for CC (p=0.002, CI 95% 1.17, 4.94). Conclusion: Cesarean delivery was associated with an increased risk of overweight and obesity, according to BMI, and increase in total and central fat measurements in adulthood. This effect, however, was small, suggesting that this association may suffer variation throughout life.