本稿では、日本の高学歴女性の就業率がOECD諸国の平均就業率より低い(OECD 2014)原因を数量分析により検証した。本稿は、「母親が就業していると子どもの育児・教育が十分にできないのではないかという不安感が高学歴の母親にある」ことが日本の高学歴女性の就業率に影響しているという仮説を立てた。分析の結果、「子どもの育児・教育のために就業しない」人の中には、高学歴の母親の割合が高いことが検証された。 / The employment rate of highly educated Japanese women is below the average for OECD countries (OECD 2014). Here, I investigated the reason for this by conducting a quantitative analysis to examine the following hypothesis: Highly educated mothers are anxious that, if they become employed, they will be unable to provide sufficient childcare and education for their child. The analysis revealed that highly educated women accounted for a large proportion of women who were not employed in order to prioritize child care and education. / 博士(政策科学) / Doctor of Philosophy in Policy and Management / 同志社大学 / Doshisha University

<p>&nbsp;Acorus calamus L. је вишегодишња зељаста биљка влажних подручја, чија су лековита својства одавно позната. Дрогу иђирота чини ризом који се употребљава као чај, прах, сок, гел, уље или крема. Због прекомерне експлоатације и високог степена угрожености ове дивље лековите биљне врсте у Србији је уведена забрана његовог сакупљања из природе. Да би се задовољила повећана потражња од стране индустрија које га користе, гајење иђирота се намеће као једно од најпрагматичнијих решења. За потребе утврђивање начина гајења, прво се приступило истраживању услова успевања и варирање својстава иђирота са пет локалитета природних станишта: Обедска бара, Делиблатска пешчара, Засавица, Раковац и Дубовац. Потом је заснован двогодишњи пољски оглед на ком је испитиван утицај примене основних агротехничких мера, односно густине садње и ђубрења азотом, на својства биљака. Оглед је постављен 2013. године, на подручју засеока Ћумуране у насељу Рипањ. Код биљка са природних станишта и са огледног поља праћена су следећа својства: висина биљака, дужина ризома, број и дужина бочних грана на ризому, број пупољака на ризому и бочним гранама, број нодуса на ризому и бочним гранама, проценат суве материје ризома, маса свежег и сувог ризома, однос масе свежег и сувог ризома. Код гајених биљака праћен је и принос свежег и сувог ризома. Код свих узорака иђирота испитиван је садржај и састав етарског уља из ризома. Идентификоване су, такође, најзаступљеније компоненте и утврђен је садржаја &beta;-азарона. За утврђивање нивоа плоидије популација из Србије рађено је пребројавање хромозома. Испитивањем биљака са природних станишта, констатовано је да на већину њихових морфолошких одлика, локалитет није имао утицаја. Утицај локалитета испољен је само на: број нодуса на ризому (највећи је био у Дубовцу - 58 а најмањи на Обедској бари - 15), проценат суве материје (највећи је био у Раковцу - 50,2%, а најмањи на Делиблатској пешчари - 37,9%) и однос масе свежег и сувог ризома (највећи је на Делиблатској пешчари - 2,64, а најмањи у Раковцу - 1,90). У пољском огледу добијени су следећи резултати: висина биљака је била највећа при најмањој густини усева (35000 биљака/ha) и најмањој дози азота (60 kg/ha) дужина ризома, као и број и дужина њихових бочних грана су највећи при средњој густини садње (48000 биљака/ha) и најмањој дози азота; број пупољака на ризому има највећу вредност при најмањој густини садње и најмањој дози азота. Број пупољака прве бочне гране је био највећи на највећој густини садње (62000 биљака/ha) и при најмањој дози азота, а број нодуса на ризому није зависио од густине садње, као ни од доза ђубрења. Највећа маса свежег и сувог ризома остварена је при средњој густини садње (48000 биљака/ha) и најмањој (62000 биљака/ha) дози азота, док је проценат суве материје био највећи при највећој густини и најмањој дози азота (60 kg/ha). На однос масе свежег и сувог ризома утицај нису имали ни ђубрење ни густина</p><p>садње усева, док су приноси свежег и сувог ризома били највећи на највећој густини садње и при најмањој дози азота. Садржај етарског уља иђирота из природе није показао значајна одступања између локалитета. Садржај етарског уља ризома гајеног иђирота опадао је са порастом густине садње, док различите дозе азота нису утицале на ову особину. Максимална концентрација &beta;-азарона у етарском уљу иђирота са природног станишта била је 17,07 % (локалитет Раковац), док је највећи садржај &beta;-азарона код гајеног иђирота био 21,41 %. Повећана концентрација &beta;- азарона се објашњава интензивнијим метаболизмом азота, због повећане количине из ђубрива. обијени резултати потврђују да је концентрација &beta;-азарона у етарском уљу ризома иђирота слична резултатима из других земаља Европе. Бројањем хромозома утврђено је да иђирот припада триплоидном, европском варијетету Аcоrus cаlаmus vаr. cаlаmus.</p> / <p>&nbsp;Acorus calamus L. je višegodišnja zeljasta biljka vlažnih područja, čija su lekovita svojstva odavno poznata. Drogu iđirota čini rizom koji se upotrebljava kao čaj, prah, sok, gel, ulje ili krema. Zbog prekomerne eksploatacije i visokog stepena ugroženosti ove divlje lekovite biljne vrste u Srbiji je uvedena zabrana njegovog sakupljanja iz prirode. Da bi se zadovoljila povećana potražnja od strane industrija koje ga koriste, gajenje iđirota se nameće kao jedno od najpragmatičnijih rešenja. Za potrebe utvrđivanje načina gajenja, prvo se pristupilo istraživanju uslova uspevanja i variranje svojstava iđirota sa pet lokaliteta prirodnih staništa: Obedska bara, Deliblatska peščara, Zasavica, Rakovac i Dubovac. Potom je zasnovan dvogodišnji poljski ogled na kom je ispitivan uticaj primene osnovnih agrotehničkih mera, odnosno gustine sadnje i đubrenja azotom, na svojstva biljaka. Ogled je postavljen 2013. godine, na području zaseoka Ćumurane u naselju Ripanj. Kod biljka sa prirodnih staništa i sa oglednog polja praćena su sledeća svojstva: visina biljaka, dužina rizoma, broj i dužina bočnih grana na rizomu, broj pupoljaka na rizomu i bočnim granama, broj nodusa na rizomu i bočnim granama, procenat suve materije rizoma, masa svežeg i suvog rizoma, odnos mase svežeg i suvog rizoma. Kod gajenih biljaka praćen je i prinos svežeg i suvog rizoma. Kod svih uzoraka iđirota ispitivan je sadržaj i sastav etarskog ulja iz rizoma. Identifikovane su, takođe, najzastupljenije komponente i utvrđen je sadržaja &beta;-azarona. Za utvrđivanje nivoa ploidije populacija iz Srbije rađeno je prebrojavanje hromozoma. Ispitivanjem biljaka sa prirodnih staništa, konstatovano je da na većinu njihovih morfoloških odlika, lokalitet nije imao uticaja. Uticaj lokaliteta ispoljen je samo na: broj nodusa na rizomu (najveći je bio u Dubovcu - 58 a najmanji na Obedskoj bari - 15), procenat suve materije (najveći je bio u Rakovcu - 50,2%, a najmanji na Deliblatskoj peščari - 37,9%) i odnos mase svežeg i suvog rizoma (najveći je na Deliblatskoj peščari - 2,64, a najmanji u Rakovcu - 1,90). U poljskom ogledu dobijeni su sledeći rezultati: visina biljaka je bila najveća pri najmanjoj gustini useva (35000 biljaka/ha) i najmanjoj dozi azota (60 kg/ha) dužina rizoma, kao i broj i dužina njihovih bočnih grana su najveći pri srednjoj gustini sadnje (48000 biljaka/ha) i najmanjoj dozi azota; broj pupoljaka na rizomu ima najveću vrednost pri najmanjoj gustini sadnje i najmanjoj dozi azota. Broj pupoljaka prve bočne grane je bio najveći na najvećoj gustini sadnje (62000 biljaka/ha) i pri najmanjoj dozi azota, a broj nodusa na rizomu nije zavisio od gustine sadnje, kao ni od doza đubrenja. Najveća masa svežeg i suvog rizoma ostvarena je pri srednjoj gustini sadnje (48000 biljaka/ha) i najmanjoj (62000 biljaka/ha) dozi azota, dok je procenat suve materije bio najveći pri najvećoj gustini i najmanjoj dozi azota (60 kg/ha). Na odnos mase svežeg i suvog rizoma uticaj nisu imali ni đubrenje ni gustina</p><p>sadnje useva, dok su prinosi svežeg i suvog rizoma bili najveći na najvećoj gustini sadnje i pri najmanjoj dozi azota. Sadržaj etarskog ulja iđirota iz prirode nije pokazao značajna odstupanja između lokaliteta. Sadržaj etarskog ulja rizoma gajenog iđirota opadao je sa porastom gustine sadnje, dok različite doze azota nisu uticale na ovu osobinu. Maksimalna koncentracija &beta;-azarona u etarskom ulju iđirota sa prirodnog staništa bila je 17,07 % (lokalitet Rakovac), dok je najveći sadržaj &beta;-azarona kod gajenog iđirota bio 21,41 %. Povećana koncentracija &beta;- azarona se objašnjava intenzivnijim metabolizmom azota, zbog povećane količine iz đubriva. obijeni rezultati potvrđuju da je koncentracija &beta;-azarona u etarskom ulju rizoma iđirota slična rezultatima iz drugih zemalja Evrope. Brojanjem hromozoma utvrđeno je da iđirot pripada triploidnom, evropskom varijetetu Acorus calamus var. calamus.</p> / <p>&nbsp;&nbsp;Acorus calamus L. is a perennial herbaceous plant found in wet areas, whose medicinal properties have been long known. The drug of sweet flag is made from the rhizome which is used as tea, powder, juice, gel, oil or cream. Because of overexploitation and the high degree of endangerment of this wild medicinal plant species in Serbia collecting was banned. In order to meet the increased demand for this plant by industries that use it, cultivation of sweet flag is emerging as one of the most pragmatic solutions. For the purpose of determining the method for plant growth, the first approach was studying the growing conditions and the variation of properties of sweet flag from five natural habitats: Obedska pond, Deliblato Sands, Zasavica, Rakovac and Dubovac.After that a two-year field experiment was designed in which the effect of application of basic agrotechnical measures, i.e., different planting density and doses of nitrogen fertilization on the plants, was studied. The experiment was set up in 2013, in the area of the hamlet Ćumurana in the settlement Ripanj. In plants from natural habitats and the experiment, the following properties were measured: the height of the plants, the length of the rhizome, the number and length of lateral branches on the rhizome, the number of buds on the rhizome and lateral branches, the number of leaf scars on the rhizome and lateral branches, the percentage of dry matter of the rhizome, the mass of the fresh and the dry rhizome, the ratio of mass between the fresh and the dry rhizome. In the experiment with cultivated plants, the yield of the fresh and the dry rhizome was also measured. For all samples of sweet flag, the content and composition of the essential oil from the rhizome was measured. Also, the main components were identified and the content of the &beta;-asarone was determined. For the purposes of identifying the ploidy, i.e., which varieties the sweet flag from Serbia belongs to, counting of chromosomes was done. By examining plants from natural habitats, it was noted that the site had no influence on the majority of morphological features of plants. The impact of the sites was manifested only in the number of leaf scars (the largest number was in Dubovac-58,0 and the smallest number was in Obedska pond-15,0), percentage of dry matter (the largest percentage was in Rakovac-50.2% and the smallest percentage was in Deliblato Sands-37,9 %) and the ratio of mass between a fresh and a dry rhizome (the largest ratio was in Deliblato Sands-2,6 and the smallest ratio was in Rakovac-2,2). In the field experiment, the following results were obtained: the height of the plants is the largest at the lowest planting density (35000 plants/ha) and lowest nitrogen dosage (60 kg/ha), the length of the rhizome, as well as number and length of lateral branches of the rhizome are largest at medium planting density (48000 plants/ha) and the lowest dosage of nitrogen (60 kg/ha), the number of buds on the rhizome has the highest value at the lowest planting density (35000 plants/ha) and the lowest dosage of nitrogen (60 kg/ha). The number of buds on the first lateral branch was largest at the largest planting density (62000 plants/ha) and the lowest dosage of nitrog (60 kg/ha) , and the number of leaf scars on the rhizome does</p><p>not depend on the planting dosage or the dosage of fertilizing. The largest mass of the fresh and the dry rhizome is accomplished at medium planting density and the lowest dosage of nitrogen, while the percentage of dry matter was largest at the largest density and the lowest dosage of nitrogen. The fertilization and the crop density had no effect on the ratio of mass between the fresh and the dry rhizome, while the yields of the fresh and the dry rhizome were largest at the largest planting density and the lowest dosage of nitrogen. The content of essential oils of natural sweet flag showed no significant discrepancies between the sites. The content of essential oil of cultivated sweet flag rhizomes declined with the increase of planting density, while different nitrogen doses had no effect on this property. The maximum concentration of &beta;-asarones in the essential oil of natural sweet flag was 17,07 % (Rakovac), while the largest content of &beta;-asarones in cultivated sweet flag was 21,41 %. The larger concentration of &beta;-asarones is explained through increased nitrogen metabolism, because of increased amounts of fertilizer. The results confirm that the concentration of &beta;-asarone in the essential oil of sweet flag rhizomes is similar to the concentration of essential oil of sweet flag rhizomes from Europe. By counting the chromosomes it is established that sweet flag belongs to the triploid, European variety of Аcоrus cаlаmus vаr. cаlаmus.</p>

<p>Испитивање повезаности особина из перформанс теста назимица са<br />величином легла крмача, обављено је на седам генотипова животиња (чистих<br />раса: дански ландрас, холандски ландрас, немачки ландрас, шведски ландрас и<br />велики јоркшир и програмских мелеза: мелеза чија је мајка ландрас и мелеза чија<br />је мајка велики јоркшир).<br />Фенотипска повезаност особина из перформанс теста (ектеријер, маса на<br />крају теста, старост на крају теста, дневни прираст у тесту, дебљина сланине<br />у слабинском делу, дебљина сланине у леђном делу, дубина МЛД-а, број легла,<br />приплодна вредност назимица процењена селекцијским индексом и проценат меса<br />у трупу) и два основна репродуктивна параметра (број живорођене прасади и број<br />залучене прасади), статистички је анализирана софтверским пакетом &bdquo;Статистика<br />13&ldquo; и &bdquo;SPSS верзија 23&ldquo;. Испитано је постојање/непостојање утицаја сваке<br />појединaчне особине из перформанс теста на репродуктивне особине<br />Није утврђена општа повезаност свих особина перформанс теста и<br />репродуктивних особина<br />Анализиране особине показале су велику зависност од генотипа<br />испитиваних животиња.</p> / <p>Ispitivanje povezanosti osobina iz performans testa nazimica sa<br />veličinom legla krmača, obavljeno je na sedam genotipova životinja (čistih<br />rasa: danski landras, holandski landras, nemački landras, švedski landras i<br />veliki jorkšir i programskih meleza: meleza čija je majka landras i meleza čija<br />je majka veliki jorkšir).<br />Fenotipska povezanost osobina iz performans testa (ekterijer, masa na<br />kraju testa, starost na kraju testa, dnevni prirast u testu, debljina slanine<br />u slabinskom delu, debljina slanine u leđnom delu, dubina MLD-a, broj legla,<br />priplodna vrednost nazimica procenjena selekcijskim indeksom i procenat mesa<br />u trupu) i dva osnovna reproduktivna parametra (broj živorođene prasadi i broj<br />zalučene prasadi), statistički je analizirana softverskim paketom &bdquo;Statistika<br />13&ldquo; i &bdquo;SPSS verzija 23&ldquo;. Ispitano je postojanje/nepostojanje uticaja svake<br />pojedinačne osobine iz performans testa na reproduktivne osobine<br />Nije utvrđena opšta povezanost svih osobina performans testa i<br />reproduktivnih osobina<br />Analizirane osobine pokazale su veliku zavisnost od genotipa<br />ispitivanih životinja.</p>

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.