51
|
Bekkering S, Saner C, Riksen NP, Netea MG, Sabin MA, Saffery R, Stienstra R, Burgner DP. Trained Immunity: Linking Obesity and Cardiovascular Disease across the Life-Course? Trends Endocrinol Metab 2020; 31:378-389. [PMID: 32305098 DOI: 10.1016/j.tem.2020.01.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 02/06/2023]
Abstract
Obesity, a chronic inflammatory disease, is the most prevalent modifiable risk factor for cardiovascular disease. The mechanisms underlying inflammation in obesity are incompletely understood. Recent developments have challenged the dogma of immunological memory occurring exclusively in the adaptive immune system and show that the innate immune system has potential to be reprogrammed. This innate immune memory (trained immunity) is characterized by epigenetic and metabolic reprogramming of myeloid cells following endogenous or exogenous stimulation, resulting in enhanced inflammation to subsequent stimuli. Trained immunity phenotypes have now been reported for other immune and non-immune cells. Here, we provide a novel perspective on the putative role of trained immunity in mediating the adverse cardiovascular effects of obesity and highlight potential translational pathways.
Collapse
Affiliation(s)
- Siroon Bekkering
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christoph Saner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Endocrinology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Niels P Riksen
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands; Department for Immunology & Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Matthew A Sabin
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Endocrinology, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Rinke Stienstra
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - David P Burgner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
52
|
Fogel A, McCrickerd K, Aris IM, Goh AT, Chong YS, Tan KH, Yap F, Shek LP, Meaney MJ, Broekman BF, Godfrey KM, Chong MFF, Cai S, Pang WW, Yuan WL, Lee YS, Forde CG. Eating behaviors moderate the associations between risk factors in the first 1000 days and adiposity outcomes at 6 years of age. Am J Clin Nutr 2020; 111:997-1006. [PMID: 32219418 PMCID: PMC7332343 DOI: 10.1093/ajcn/nqaa052] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several risk factors in the first 1000 d are linked with increased obesity risk in later childhood. The role of potentially modifiable eating behaviors in this association is unclear. OBJECTIVES This study examined whether the association between cumulated risk factors in the first 1000 d and adiposity at 6 y is moderated by eating behaviors. METHODS Participants were 302 children from the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort. Risk factors included maternal prepregnancy and paternal overweight, excessive gestational weight gain, raised fasting plasma glucose during pregnancy, short breastfeeding duration, and early introduction of solid foods. Composite risk scores reflecting the prevalence and the importance of the risk factors present were computed. Adiposity outcomes were child BMI and sum of skinfolds (SSF), and candidate eating behavior moderators were portion size, eating rate, and energy intake during lunch and in an eating in the absence of hunger task. RESULTS Higher composite risk score predicted higher BMI z scores (B = 0.08; 95% CI: 0.04, 0.13) and larger SSF (0.70 mm; 0.23, 1.18 mm), and was associated with larger self-served food portions (5.03 kcal; 0.47, 9.60 kcal), faster eating rates (0.40 g/min; 0.21, 0.59 g/min), and larger lunch intakes (7.05 kcal; 3.37, 10.74 kcal). Importantly, the association between composite risk score and adiposity was moderated by eating behaviors. The composite risk score was unrelated to SSF in children who selected smaller food portions, ate slower, and consumed less energy, but was positively associated with SSF among children who selected larger food portions, ate faster, and consumed more energy (eating behavior × risk score interactions: P < 0.05). CONCLUSIONS The association between risk factors in the first 1000 d and adiposity at 6 y varies by eating behaviors, highlighting modifiable behavioral targets for interventions.This trial was registered at clinicaltrials.gov as NCT01174875.
Collapse
Affiliation(s)
- Anna Fogel
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore
| | - Keri McCrickerd
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore
| | - Izzuddin M. Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ai Ting Goh
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Fabian Yap
- KK Women’s and Children’s Hospital, Singapore
| | - Lynette P. Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore,Department of Psychiatry, McGill University & Sackler Institute for Epigenetics & Psychobiology at McGill University, Montreal, Quebec, Canada,Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, Montreal, Canada
| | - Birit F.P. Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore,Department of Psychiatry, VU Medical Centre, VU University, Amsterdam
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mary Foong Fong Chong
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ciarán G. Forde
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Author to whom correspondence should be addressed: Ciaran Gerard Forde: Centre for Translational Medicine, 14 Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore 117599; Tel: +65 64070104;
| |
Collapse
|
53
|
Jacobson LT, Collins TC, Lucas M, Zackula R, Okut H, Nazir N, Robbins D, Stern JE, Wolfe M, Grainger DA. Electronic Monitoring Of Mom's Schedule (eMOMS™): Protocol for a feasibility randomized controlled trial to improve postpartum weight, blood sugars, and breastfeeding among high BMI women. Contemp Clin Trials Commun 2020; 18:100565. [PMID: 32346648 PMCID: PMC7183152 DOI: 10.1016/j.conctc.2020.100565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 12/23/2022] Open
Abstract
Background Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program that includes breastfeeding education and support. Purpose To describe the design and justification of a combined breastfeeding, national Diabetes Prevention Program (DPP)-based feasibility randomized controlled trial, the electronic Monitoring Of Mom's Schedule (eMOMSTM) study. eMOMSTM compares the feasibility and efficacy of three interventions on six-month postpartum weight loss among women with a BMI ≥25. Methods The intervention is delivered via Facebook and includes three groups: DPP and breastfeeding (eMOMS1); DPP only (eMOMS2); and Usual Care (eMOMS3). Recruitment is ongoing at two clinical sites (rural and urban). A total of 72 women, 24 per group, will be randomly assigned to one of the three groups. It is anticipated that women in eMOMS1 will have greater weight loss and increased length of breastfeeding at three and six months postpartum compared to women in eMOMS2 and eMOMS3. Additional data will be collected on metabolic markers, anthropometrics, physical activity, nutrition, breastfeeding, and depression. Program cost will be compared to that of traditionally scheduled group meetings. Expected study completion date: October 2021. Conclusions This study has the potential to define a high impact, cost effective intervention that can improve public health by reducing negative health outcomes associated with gestational diabetes among an at-risk population.
Collapse
Affiliation(s)
- Lisette T Jacobson
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Tracie C Collins
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA.,The University of New Mexico, College of Population Health, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Meredith Lucas
- University of Kansas School of Medicine-Wichita, Department of Population Health, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Hayrettin Okut
- University of Kansas School of Medicine-Wichita, Office of Research, 1010 North Kansas, Wichita, KS, 67214, USA
| | - Niaman Nazir
- University of Kansas School of Medicine-Kansas City, Department of Population Health, 3901 Rainbow Boulevard, Mailstop 1003, Kansas City, KS, 66160, USA
| | - David Robbins
- University of Kansas Medical Center-Kansas City, Diabetes Institute, 3901 Rainbow Boulevard, Mailstop 1064, Kansas City, KS, 66160, USA
| | - Judy E Stern
- Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine, Department of Obstetrics and Gynecology, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Michael Wolfe
- Ascension Via Christi Hospitals Wichita, Inc., Ascension Via Christi Maternal Fetal Medicine Clinic, 1515 South Clifton Avenue, Suite 130, Wichita, KS, 67218, USA
| | - David A Grainger
- University of Kansas School of Medicine-Wichita, Department of Obstetrics and Gynecology, 1010 North Kansas, Wichita, KS, 67214, USA
| |
Collapse
|
54
|
Falkner B, Lurbe E. Primordial Prevention of High Blood Pressure in Childhood: An Opportunity Not to be Missed. Hypertension 2020; 75:1142-1150. [PMID: 32223379 DOI: 10.1161/hypertensionaha.119.14059] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is a condition with increased risk for subsequent adverse events, and treatment of hypertension is prescribed for primary prevention of adverse events. Primordial prevention is a concept that precedes primary prevention and focuses on risk factor prevention. Primordial prevention of hypertension consists of strategies to maintain blood pressure in a normal range and prevent development of elevated blood pressure or hypertension. Childhood is a period in which primordial prevention could be effective and if sustained throughout childhood could contribute to a healthier young adulthood. Targets for primordial prevention in childhood include preventing and reducing childhood obesity, achieving an optimal diet that includes avoiding excessive salt consumption, and removing barriers to physical activity and healthy sleep throughout childhood. Primordial prevention also includes the prenatal period wherein some maternal conditions and exposures are associated with higher blood pressure in child offspring.
Collapse
Affiliation(s)
- Bonita Falkner
- From the Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.F.)
| | - Empar Lurbe
- Pediatric Department, Hospital General, University of Valencia, Spain (E.L.)
| |
Collapse
|
55
|
Díaz-Rodríguez M, Pérez-Muñoz C, Lendínez-de la Cruz JM, Fernández-Gutiérrez M, Bas-Sarmiento P, Ferriz-Mas BC. Effectiveness of a Multifactorial Intervention in the First 1000 Days of Life to Prevent Obesity and Overweight in Childhood: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072239. [PMID: 32225027 PMCID: PMC7177794 DOI: 10.3390/ijerph17072239] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
(1) Background: Obesity is a global health problem, and its prevention must be a priority goal of public health, especially considering the seriousness of the problem among children. It is known that fetal and early postnatal environments may favor the appearance of obesity in later life. In recent years, the impact of the programs to prevent obesity in childhood has been scarce. The aim of this research is to evaluate the effectiveness of an intervention based on the concept of early programming. (2) Methods: Non-randomized controlled trial design. Inclusion criteria are: two-year-old infants whose gestational period begins in the 14 months following the start of the intervention, and whose mothers have made the complete follow-up of their pregnancy in the same clinical unit of the study. The intervention will be developed over all the known factors that affect early programming, during pregnancy up to 2 years of life. Data will be collected through a data collection sheet by the paediatricians. A unibivariate and multivariate analysis of the data will be carried out. (3) Ethics and dissemination: The trial does not involve any risk to participants and their offspring. Signed informed consent is obtained from all participants. Ethical approval has been obtained. (4) Results: It is expected that this study will provide evidence on the importance of the prevention of obesity from the critical period of the first 1000 days of life, being able to establish this as a standard intervention in primary care.
Collapse
Affiliation(s)
- Mercedes Díaz-Rodríguez
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Andalusia, Spain; (M.D.-R.); (M.F.-G.); (P.B.-S.)
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Andalusia, Spain; (M.D.-R.); (M.F.-G.); (P.B.-S.)
| | - José Manuel Lendínez-de la Cruz
- Ribera del Muelle Health Centre, Clinic Management Unit (CMU) Puerto Real, Cádiz, Andalusian Health System, 11510 Andalusia, Spain;
| | - Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Andalusia, Spain; (M.D.-R.); (M.F.-G.); (P.B.-S.)
| | - Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Andalusia, Spain; (M.D.-R.); (M.F.-G.); (P.B.-S.)
| | - Bernardo C. Ferriz-Mas
- Río San Pedro Health Centre, Clinic Management Unit (CMU) Puerto Real, Cádiz, Andalusian Health System, 11519 Andalusia, Spain
- Correspondence:
| |
Collapse
|
56
|
Shomaker LB, Gulley LD, Clark ELM, Hilkin AM, Pivarunas B, Tanofsky-Kraff M, Nadeau KJ, Barbour LA, Scott SM, Sheeder JL. Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents. Pilot Feasibility Stud 2020; 6:39. [PMID: 32206334 PMCID: PMC7082950 DOI: 10.1186/s40814-020-00578-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 02/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity. METHODS The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography. DISCUSSION This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring. TRIAL REGISTRATION ClinicalTrials.gov NCT03086161, retrospectively registered.
Collapse
Affiliation(s)
- Lauren B. Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Lauren D. Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Emma L. M. Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Allison M. Hilkin
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Bernadette Pivarunas
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology and Department of Medicine, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD USA
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Linda A. Barbour
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - Stephen M. Scott
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - Jeanelle L. Sheeder
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| |
Collapse
|
57
|
Lumeng JC, Li X, He Y, Gearhardt A, Sturza J, Kaciroti NA, Li M, Asta K, Lozoff B. Greater analgesic effects of sucrose in the neonate predict greater weight gain to age 18 months. Appetite 2020; 146:104508. [PMID: 31698014 DOI: 10.1016/j.appet.2019.104508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
Intraoral sucrose has analgesic effects in the newborn period. The hedonic and analgesic effects of sucrose overlap and hedonic response to sweet food is associated with adiposity. The potential association between the analgesic effects of intraoral sucrose in the newborn period and subsequent weight gain has not been examined. Healthy, term newborns received 25% intraoral sucrose or water prior to metabolic screen heel stick. Negative affect, quiet alert behavior, and sleepiness were coded during heel stick. Weight and length were measured and z-score (WLZ) calculated at birth, 9, and 18 months. Mixed models tested associations of behavioral response to heel stick with WLZ trajectory among infants receiving sucrose (n = 154) versus water (n = 117). Among infants receiving sucrose prior to heel stick with birth WLZ ≥ the median, less negative affect and more sleepiness during heel stick were each associated with greater increases in WLZ. These associations were not present among infants receiving water only prior to heel stick. Greater analgesic effects of sucrose in the neonate were associated with greater future increases in WLZ, especially among infants with higher birth WLZ. Greater opioid-mediated newborn behavioral response to intraoral sucrose may be a marker for future obesity risk. CLINICAL TRIALS NUMBER: NCT02728141.
Collapse
Affiliation(s)
- Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Xing Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yunyi He
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Julie Sturza
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Niko A Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Katharine Asta
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
58
|
Shi X, Huang P, Wang L, Lu W, Su W, Yan B, Liu C, Xiao F, Song H, Lin M, Li X. Maternal postload 1-hour glucose level during pregnancy and offspring's overweight/obesity status in preschool age. BMJ Open Diabetes Res Care 2020; 8:e000738. [PMID: 32049640 PMCID: PMC7039585 DOI: 10.1136/bmjdrc-2019-000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/12/2019] [Accepted: 12/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Childhood obesity is associated with adverse outcomes such as metabolic syndrome, diabetes, and cardiovascular diseases in adulthood. Identifying risk factors related to excessive adiposity in early childhood is of great importance for obesity intervention. The results of studies for associations between maternal with gestational diabetes and offspring obesity are conflicting. Nonetheless, the association of maternal glucose across a spectrum of glucose values with childhood adiposity outcomes is less clear. AIM To assess the association of maternal glucose across a spectrum of glucose values with childhood adiposity at age 5 years. METHODS A population-based cohort study was conducted between 2011 and 2018. Using the healthcare records data were from the Medical Birth Registry in Xiamen, China. The primary outcome was offspring obese/obesity. Primary predictors were maternal oral glucose tolerance test values during pregnancy. RESULTS 6090 mother-child pairs were analyzed. The mean age of the children at follow-up was 5.2 years. At multiple logistic regression, after adjustment for variables, including maternal pre-pregnancy body mass index (BMI), birth weight of offspring, and insulin therapy, ORs for offspring overweight/obesity were 1.13 (95% CI 0.90 to 1.42) for maternal fasting glucose levels, 1.12 (95% CI 1.04 to 1.22) for 1-hour glucose, and 1.04 (95% CI 0.95 to 1.14) for 2-hour glucose. The adjusted association of offspring BMI Z-score with maternal 1-hour glucose level remained significant. There were no significant associations between BMI Z-score and maternal fasting glucose and 2-hour glucose level. Exploratory sex-specific analyses indicated generally consistent associations for boys and girls. CONCLUSION Maternal postload 1-hour glucose across a spectrum of glucose values during pregnancy was an independent risk for offspring weight gain at age 5 years, indicating the importance of screen and management of maternal 1-hour glucose level, except for fasting glucose and 2-hour glucose level during pregnancy in order to prevent offspring weight gain in early childhood.
Collapse
Affiliation(s)
- Xiulin Shi
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Peiying Huang
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Liying Wang
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Wei Lu
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Weijuan Su
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Bing Yan
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Changqin Liu
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Fangsen Xiao
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Haiqu Song
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Mingzhu Lin
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| | - Xuejun Li
- Xiamen Diabetes Institute, Xiamen, China
- Department of Endocrinology and Diabetes, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China
| |
Collapse
|
59
|
Chen YL, Han LL, Shi XL, Su WJ, Liu W, Wang LY, Huang PY, Lin MZ, Song HQ, Li XJ. Adverse pregnancy outcomes on the risk of overweight offspring: a population-based retrospective study in Xiamen, China. Sci Rep 2020; 10:1549. [PMID: 32005877 PMCID: PMC6994466 DOI: 10.1038/s41598-020-58423-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/14/2020] [Indexed: 11/09/2022] Open
Abstract
The growth trajectory of Chinese preschoolers still remains unclear. Our objective was to determine whether there was an association between adverse pregnancy outcomes and overweight offspring. We analyzed population-based retrospective cohort data from the Medical Birth Registry of Xiamen, which comprised 33,157 children examined from 1 to 6 years of age. Longitudinal analyses were used to evaluate the growth trajectories of offspring body mass index (BMI). Multivariate logistic regression was used to assess the effects of two adverse pregnancy outcomes, gestational diabetes mellitus (GDM) and being large-for-gestational age (LGA), on childhood overweight. Offspring of mothers with GDM and LGA has a higher annual BMI z-score from 1 to 6 years of age (all P < 0.05). But, a higher annual BMI z-score was only observed in children aged 1-5 years in models 1-3. Overall BMI z-score of offspring aged 1-6 who were born to mothers with GDM and LGA were also higher in models 1-3 (all P < 0.05). Additionally, offspring of mothers with GDM and LGA had a higher risk for overweight in model 1, from 1 to 6 years of age (odds ratio (OR), 1.814; 95% confidence interval (CI), 1.657-1.985; P < 0.0001). However, this association was attenuated after adjusting for maternal pre-pregnancy BMI (OR, 1.270; 95% CI, 0.961-1.679; P = 0.0930). Offspring of mothers with GDM and LGA had a higher BMI z-score and increased risk for overweight. Indeed, intrauterine exposure to maternal GDM and LGA could bias offspring to overweight, whereas maternal pre-pregnancy BMI may play a key role in offspring overweight for children born to mothers with GDM and LGA.
Collapse
Affiliation(s)
- Yin-Ling Chen
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li-Li Han
- Fujian Medical University, Fuzhou, China
| | - Xiu-Lin Shi
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wei-Juan Su
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wei Liu
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li-Ying Wang
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Pei-Ying Huang
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ming-Zhu Lin
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Hai-Qu Song
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xue-Jun Li
- Department of Endocrinology and Diabetes, the First Affiliated Hospital of Xiamen University, Xiamen, China.
| |
Collapse
|
60
|
Wang G, DiBari J, Bind E, Steffens AM, Mukherjee J, Azuine RE, Singh GK, Hong X, Ji Y, Ji H, Pearson C, Zuckerman BS, Cheng TL, Wang X. Association Between Maternal Exposure to Lead, Maternal Folate Status, and Intergenerational Risk of Childhood Overweight and Obesity. JAMA Netw Open 2019; 2:e1912343. [PMID: 31577354 PMCID: PMC6777254 DOI: 10.1001/jamanetworkopen.2019.12343] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE The first pediatric lead screening typically occurs at 1-year well-child care visits. However, data on the extent of maternal lead exposure and its long-term consequences for child health are lacking. OBJECTIVE To investigate the associations between maternal red blood cell (RBC) lead levels and intergenerational risk of overweight or obesity (OWO) and whether adequate maternal folate status is associated with a reduction in OWO risk. DESIGN, SETTING, AND PARTICIPANTS Prospective birth cohort study. The analysis was conducted from July 14, 2018, to August 2, 2019, at Johns Hopkins Bloomberg School of Public Health. This study included 1442 mother-child pairs recruited at birth from October 27, 2002, to October 10, 2013, and followed up prospectively at Boston Medical Center. MAIN OUTCOMES AND MEASURES Child body mass index (BMI) z score, calculated according to US national reference data, and OWO, defined as BMI at or exceeding the 85th percentile for age and sex. Maternal RBC lead levels and plasma folate levels were measured in samples obtained 24 to 72 hours after delivery; child whole-blood lead level was obtained from the first pediatric lead screening. RESULTS The mean (SD) age of mothers and children was 28.6 (6.5) years and 8.1 (3.1) years, respectively; 50.1% of children were boys. The median maternal RBC lead level and plasma folate level were 2.5 (interquartile range [IQR], 1.7-3.8) μg/dL and 32.2 (IQR, 22.1-44.4) nmol/L, respectively. The median child whole-blood lead level and child BMI z score were 1.4 (IQR, 1.4-2.0) μg/dL and 0.78 (IQR, -0.08 to 1.71), respectively. Maternal RBC lead level was associated with child OWO risk in a dose-response fashion, with an odds ratio (OR) of 1.65 (95% CI, 1.18-2.32) for high maternal RBC lead level (≥5.0 μg/dL) compared with low maternal RBC lead level (<2.0 μg/dL). Child OWO was highest among children of OWO mothers with high RBC lead levels (adjusted OR, 4.24; 95% CI, 2.64-6.82) compared with children of non-OWO mothers with low RBC lead levels. Children of OWO mothers with high RBC lead levels had 41% lower OWO risk (OR, 0.59; 95% CI, 0.36-0.95; P = .03) if their mothers had adequate plasma folate levels (≥20.4 nmol/L) compared with their counterparts. CONCLUSIONS AND RELEVANCE In this sample of a US urban population, findings suggest that maternal elevated lead exposure was associated with increased risk of intergenerational OWO independent of postnatal blood lead levels. Adequate maternal folate status appeared to be associated with lower OWO risk. If confirmed by additional studies, these findings have implications for prenatal lead screening and management to minimize adverse health consequences on children.
Collapse
Affiliation(s)
- Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica DiBari
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Eric Bind
- Metals Laboratory, Environmental and Chemical Laboratory Services, State of New Jersey Department of Health, Trenton
| | - Andrew M. Steffens
- Metals Laboratory, Environmental and Chemical Laboratory Services, State of New Jersey Department of Health, Trenton
| | - Jhindan Mukherjee
- Metals Laboratory, Environmental and Chemical Laboratory Services, State of New Jersey Department of Health, Trenton
| | - Romuladus E. Azuine
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Gopal K. Singh
- Office of Health Equity, Health Resources and Services Administration, Rockville, Maryland
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yuelong Ji
- Center on the Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Barry S. Zuckerman
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Tina L. Cheng
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
61
|
Koplin JJ, Kerr JA, Lodge C, Garner C, Dharmage SC, Wake M, Allen KJ. Infant and young child feeding interventions targeting overweight and obesity: A narrative review. Obes Rev 2019; 20 Suppl 1:31-44. [PMID: 31419047 DOI: 10.1111/obr.12798] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 12/21/2022]
Abstract
findings from systematic reviews into infant feeding and later adiposity are largely negative. World Health Organization (WHO) is auspicing Healthy Life Trajectories Initiative (HeLTI), a suite of trials aiming to prevent overweight/obesity in childhood. To inform planning, this narrative review sought to detail potentially effective components of nutrition-related interventions involving children aged 0 to 2 years. Systematic searches of PubMed and the Cochrane Library (2006-2016) identified 108 systematic reviews. These included 31 randomized trials in the age group of interest. Of these, 11 reported greater than or equal to 1 statistically significant (P < 0.05) benefit on body weight and/or composition. Six multicomponent trials whose interventions incorporated education to promote breastfeeding (four trials), responsive feeding (two trials), and healthy diet (eg, increasing fruit and vegetables and limiting unhealthy snack foods; five trials), delivered through home visits or at baby health clinics, reported relative reductions in body mass index (BMI) at the end of intervention. Early benefits were not maintained in the two trials reporting follow-up 1 to 3 years later. Other potentially effective approaches included lower protein formulas in formula-fed infants and education around reducing sugar-sweetened beverages. There is some evidence that infant feeding interventions can have a transient positive impact on a child's BMI. It is not known whether ongoing intervention can avoid the subsequent expected wash-out.
Collapse
Affiliation(s)
- Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Caroline Lodge
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Carley Garner
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics & the Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Katrina J Allen
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
62
|
Avecilla-Benítez MA, Sospedra I, Cano-Climent A, Richart-Martínez M, Oliver-Roig A. Development and Validation of a New Questionnaire Assessing Feeding Styles in Toddlers: Toddler Feeding Style Questionnaire (TFSQ). J Pediatr Nurs 2019; 47:e65-e74. [PMID: 31130342 DOI: 10.1016/j.pedn.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ). DESIGN AND METHODS An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12-24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested. RESULTS The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p < .01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months. CONCLUSIONS The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers. PRACTICE IMPLICATIONS Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness.
Collapse
Affiliation(s)
| | - Isabel Sospedra
- Nursing Department, Faculty of Health Science, University of Alicante, Alicante, Spain.
| | - Antonio Cano-Climent
- Hospital General d'Ontinyent, Conselleria de Sanitat Universal i Salut Pública, Ontinyent, Spain
| | | | - Antonio Oliver-Roig
- Nursing Department, Faculty of Health Science, University of Alicante, Alicante, Spain.
| |
Collapse
|
63
|
van Poppel MNM, Simmons D, Devlieger R, van Assche FA, Jans G, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Tanvig M, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Snoek FJ, Jelsma JGM, Desoye G. A reduction in sedentary behaviour in obese women during pregnancy reduces neonatal adiposity: the DALI randomised controlled trial. Diabetologia 2019; 62:915-925. [PMID: 30840112 PMCID: PMC6509072 DOI: 10.1007/s00125-019-4842-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Offspring of obese women are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity. METHODS In the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, 436 women with a BMI ≥29 kg/m2 were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or HE&PA, or to usual care (UC). In secondary analyses of the lifestyle trial, intervention effects on neonatal outcomes (head, abdominal, arm and leg circumferences and skinfold thicknesses, estimated fat mass, fat percentage, fat-free mass and cord blood leptin) were assessed using multilevel regression analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed. RESULTS Outcomes were available from 334 neonates. A reduction in sum of skinfolds (-1.8 mm; 95% CI -3.5, -0.2; p = 0.03), fat mass (-63 g; 95% CI -124, -2; p = 0.04), fat percentage (-1.2%; 95% CI -2.4%, -0.04%; p = 0.04) and leptin (-3.80 μg/l; 95% CI -7.15, -0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (-5.79 μg/l; 95% CI -11.43, -0.14; p = 0.05) compared with UC. Reduced sedentary time, but not gestational weight gain, mediated intervention effects on leptin in both the HE&PA and PA groups. CONCLUSIONS/INTERPRETATION The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary time seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity and diabetes risk of the offspring need to be elucidated. TRIAL REGISTRATION ISRCTN70595832.
Collapse
Affiliation(s)
- Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
- Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Roland Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - F Andre van Assche
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Goele Jans
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fidelma Dunne
- Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
- College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Jürgen Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lise-Lotte Andersen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Tanvig
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- , Region of Southern Denmark, Denmark
| | - Annunziata Lapolla
- Dipartimento di Medicina, Università Degli Studi di Padova, Padua, Italy
| | - Maria G Dalfra
- Dipartimento di Medicina, Università Degli Studi di Padova, Padua, Italy
| | - Alessandra Bertolotto
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - David Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| |
Collapse
|
64
|
Nettore IC, Rocca C, Mancino G, Albano L, Amelio D, Grande F, Puoci F, Pasqua T, Desiderio S, Mazza R, Terracciano D, Colao A, Bèguinot F, Russo GL, Dentice M, Macchia PE, Sinicropi MS, Angelone T, Ungaro P. Quercetin and its derivative Q2 modulate chromatin dynamics in adipogenesis and Q2 prevents obesity and metabolic disorders in rats. J Nutr Biochem 2019; 69:151-162. [PMID: 31096072 DOI: 10.1016/j.jnutbio.2019.03.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/28/2019] [Accepted: 03/25/2019] [Indexed: 12/18/2022]
Abstract
Recently the attention of the scientific community has focused on the ability of polyphenols to counteract adverse epigenetic regulation involved in the development of complex conditions such as obesity. The aim of this study was to investigate the epigenetic mechanisms underlying the anti-adiposity effect of Quercetin (3,3',4',5,7-pentahydroxyflavone) and of one of its derivatives, Q2 in which the OH groups have been replaced by acetyl groups. In 3 T3-L1 preadipocytes, Quercetin and Q2 treatment induce chromatin remodeling and histone modifications at the 5' regulatory region of the two main adipogenic genes, c/EBPα and PPARγ. Chromatin immunoprecipitation assays revealed a concomitant increase of histone H3 di-methylation at Lys9, a typical mark of repressed gene promoters, and a decrease of histone H3 di-methylation at Lys 4, a mark of active transcription. At the same time, both compounds inhibited histone demethylase LSD1 recruitment to the 5' region of c/EBPα and PPARγ genes, a necessary step for adipogenesis. The final effect is a significant reduction in c/EBPα and PPARγ gene expression and attenuated adipogenesis. Q2 supplementation in rats reduced the gain in body weight and in white adipose tissue, as well as the increase in adipocyte size determined by high fat diet. Moreover, Q2 improved dyslipidemia, glucose tolerance and decreased the hepatic lipid accumulation by activating the expression of beta-oxidation related genes. Our data suggest that Q2, as well as Quercetin, has the potential to revert the unfavorable epigenomic profiles associated with obesity onset. This opens the possibility to use these compounds in targeted prevention strategies against obesity.
Collapse
Affiliation(s)
- Immacolata Cristina Nettore
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli, "Federico II", Napoli, Italy
| | - Carmine Rocca
- Dipartimento di Biologia, Ecologia e Scienze della Terra, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Giuseppina Mancino
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli, "Federico II", Napoli, Italy
| | - Luigi Albano
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli, "Federico II, Napoli, Italy; Istituto per l'Endocrinologia e l'Oncologia Sperimentale, "G.Salvatore", Consiglio Nazionale delle Ricerche, Napoli, Italy
| | - Daniela Amelio
- Dipartimento di Biologia, Ecologia e Scienze della Terra, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Fedora Grande
- Dipartimento di Farmacia e Scienze della Salute e della Nutrizione, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Francesco Puoci
- Dipartimento di Farmacia e Scienze della Salute e della Nutrizione, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Teresa Pasqua
- Dipartimento di Biologia, Ecologia e Scienze della Terra, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Silvio Desiderio
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli, "Federico II", Napoli, Italy
| | - Rosa Mazza
- Dipartimento di Biologia, Ecologia e Scienze della Terra, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Daniela Terracciano
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli, "Federico II, Napoli, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli, "Federico II", Napoli, Italy
| | - Francesco Bèguinot
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli, "Federico II, Napoli, Italy; Istituto per l'Endocrinologia e l'Oncologia Sperimentale, "G.Salvatore", Consiglio Nazionale delle Ricerche, Napoli, Italy
| | - Gian Luigi Russo
- Istituto di Scienze dell'Alimentazione, Consiglio Nazionale delle Ricerche, Avellino, Italy
| | - Monica Dentice
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli, "Federico II", Napoli, Italy
| | - Paolo Emidio Macchia
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli, "Federico II", Napoli, Italy
| | - Maria Stefania Sinicropi
- Dipartimento di Farmacia e Scienze della Salute e della Nutrizione, Università della Calabria, Arcavacata di Rende, (CS), Italy
| | - Tommaso Angelone
- Dipartimento di Biologia, Ecologia e Scienze della Terra, Università della Calabria, Arcavacata di Rende, (CS), Italy; Istituto Nazionale Ricerche Cardiovascolari (INRC), Bologna, Italy
| | - Paola Ungaro
- Istituto per l'Endocrinologia e l'Oncologia Sperimentale, "G.Salvatore", Consiglio Nazionale delle Ricerche, Napoli, Italy.
| |
Collapse
|
65
|
Fang J, Gong C, Wan Y, Xu Y, Tao F, Sun Y. Polygenic risk, adherence to a healthy lifestyle, and childhood obesity. Pediatr Obes 2019; 14:e12489. [PMID: 30515989 DOI: 10.1111/ijpo.12489] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/14/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Both polygenic and unhealthy lifestyle factors contribute to individual-level risk of obesity during childhood. The extent to which increased polygenic risk can be offset by healthy lifestyle is unknown. OBJECTIVE To examine whether increased polygenic risk of obesity is modified by a healthy lifestyle during childhood. METHODS A total of 997 children (418 boys and 579 girls) who had complete DNA genotyping and body mass index (BMI) were eligible for the study were analyzed from an established prospective puberty cohort. The polygenic risk score (PRS) was computed based on 11 BMI-increasing single nucleotide polymorphisms (SNPs) derived from a published genome-wide association study (GWAS) for child obesity. Seven lifestyle factors were selected to determine a composite healthy lifestyle, such as food responsiveness, slowness in eating, satiety responsiveness, physical activity, screen time, sleep duration, and sugar-sweetened beverages consumption, and which was classified as healthy (<P25 ), intermediate (P25 -P75 ) and unhealthy (>P75 ) lifestyle. Linear and logistic regression analyses were conducted. RESULTS Children carrying additional BMI susceptibility alleles increased the BMI by 0.11 kg/m2 , after adjusting gender, age and socio-economic status (SES). A healthy lifestyle was associated with a substantially lower risk of obesity than an unhealthy lifestyle, regardless of the polygenic risk category. Among children at high polygenic risk, a healthy lifestyle was associated with an 85% lower risk of obesity than an unhealthy lifestyle (odds ratio, 0.15; 95% CI, 0.04 to 0.59; p = 0.007). CONCLUSIONS Our findings suggest that increased polygenic risk might be largely offset by healthy lifestyle as early as in childhood.
Collapse
Affiliation(s)
- Jiao Fang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Chun Gong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Yuanyuan Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui Medical University, Hefei, China
| |
Collapse
|
66
|
Emmons KM, Gandelman E. Translating behavioral medicine evidence to public policy. J Behav Med 2019; 42:84-94. [PMID: 30825091 DOI: 10.1007/s10865-018-9979-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022]
Abstract
Behavioral medicine has made significant contributions to our understanding of how to prevent disease and improve health. However, social and environmental factors continue to have a major influence on health in ways that will be difficult to combat on a population level without concerted efforts to scale interventions and translate the evidence into public health policies. Now is also the right time to increase our efforts to produce policy relevant research and partnerships that will maximize the chances that our evidence is taken to scale in ways that can influence population health broadly, and perhaps contribute to the reduction of the recalcitrant health disparities that plague virtually every area of behavioral medicine focus. As a field we must take an active role in policy translation, learning from the public policy and political science disciplines, and our own pioneers in policy translation. This article discusses importance of accelerating evidence translation to policy, and suggests several factors that could enhance our translation efforts, including embracing policy translation as a key goal in behavioral medicine, increasing our understanding in variability of evidence-based policy adoption across and within states, improving our understanding of how to most effectively communicate our findings to policy makers, conducting research that is responsive to policy makers' needs, and considering the important role of local policy partnerships.
Collapse
Affiliation(s)
- Karen M Emmons
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Room 601, 677 Huntington Ave, Boston, MA, 02115, USA.
| | | |
Collapse
|
67
|
Liao XP, Yu Y, Marc I, Dubois L, Abdelouahab N, Bouchard L, Wu YT, Ouyang F, Huang HF, Fraser WD. Prenatal determinants of childhood obesity: a review of risk factors 1. Can J Physiol Pharmacol 2019; 97:147-154. [PMID: 30661367 DOI: 10.1139/cjpp-2018-0403] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Childhood obesity is a predictor of adult obesity and has its roots in the pre-pregnancy or pregnancy period. This review presents an overview of the prenatal risk factors for childhood obesity, which were categorized into 2 groups: biological risk factors (maternal pre-pregnancy body mass index, gestational weight gain, diabetes in pregnancy, and caesarean section), and environmental and behavioural risk factors (maternal smoking and exposure to obesogens, maternal dietary patterns, maternal intestinal microbiome and antibiotics exposure, and maternal psychosocial stress). Identifying modifiable predisposing prenatal factors for obesity will inform further development of inventions to prevent obesity over the life course, and future directions for research and intervention are discussed.
Collapse
Affiliation(s)
- Xiang-Peng Liao
- a Department of Pediatrics, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China.,b Centre de recherche de Centre Hospitalier Universitaire de Sherbrooke (CRCHUS) and Department of Obstetrics and Gynecology, Université de Sherbrooke, Quebec, QC J1H 5N4, Canada
| | - Yamei Yu
- c School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Isabelle Marc
- d Centre Hospitalier Universitaire de Québec Research Centre and Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, QC G1V 4G2, Canada
| | - Lise Dubois
- c School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Nadia Abdelouahab
- b Centre de recherche de Centre Hospitalier Universitaire de Sherbrooke (CRCHUS) and Department of Obstetrics and Gynecology, Université de Sherbrooke, Quebec, QC J1H 5N4, Canada
| | - Luigi Bouchard
- e Department of Medical Biology, CIUSSS-SLSJ, Université de Sherbrooke, Saguenay, QC G7H 7K9, Canada
| | - Yan-Ting Wu
- f International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,g Institute of Embryo-Fetal Original Adult Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiu Ouyang
- h Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng-Feng Huang
- f International Peace Maternity & Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,g Institute of Embryo-Fetal Original Adult Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - William D Fraser
- b Centre de recherche de Centre Hospitalier Universitaire de Sherbrooke (CRCHUS) and Department of Obstetrics and Gynecology, Université de Sherbrooke, Quebec, QC J1H 5N4, Canada
| |
Collapse
|
68
|
Lifestyle intervention strategies in early life to improve pregnancy outcomes and long-term health of offspring: a narrative review. J Dev Orig Health Dis 2018; 10:314-321. [PMID: 30409238 DOI: 10.1017/s2040174418000855] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adverse exposures during fetal life and the postnatal period influence physical, cognitive and emotional development, and predispose to an increased risk of various chronic diseases throughout the life course. Findings from large observational studies in various populations and experimental animal studies have identified different modifiable risk factors in early life. Adverse maternal lifestyle factors, including overweight, unhealthy diet, sedentary behavior, smoking, alcohol consumption and stress in the preconception period and during pregnancy, are the most common modifiable risk factors leading to a suboptimal in-utero environment for fetal development. In the postnatal period, breastfeeding, infant growth and infant dietary intake are important modifiable factors influencing long-term offspring health outcomes. Despite the large amount of findings from observational studies, translation to lifestyle interventions seems to be challenging. Currently, randomized controlled trials focused on the influence of lifestyle interventions in these critical periods on short-term and long-term maternal and offspring health outcomes are scarce, have major limitations and do not show strong effects on maternal and offspring outcomes. New and innovative approaches are needed to move from describing these causes of ill-health to start tackling them using intervention approaches. Future randomized controlled lifestyle intervention studies and innovative observational studies, using quasi-experimental designs, are needed focused on the effects of an integrated lifestyle advice from preconception onwards on pregnancy outcomes and long-term health outcomes in offspring on a population level.
Collapse
|
69
|
Wood CT, Linthavong O, Perrin EM, Leviton A, Allred EN, Kuban KC, O’Shea TM. Antecedents of Obesity Among Children Born Extremely Preterm. Pediatrics 2018; 142:peds.2018-0519. [PMID: 30291168 PMCID: PMC6317645 DOI: 10.1542/peds.2018-0519] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Childhood obesity is a pervasive public health problem with risk factors such as maternal prepregnancy BMI and rapid infant weight gain. Although catch-up weight gain promotes more favorable neurodevelopment among infants born preterm, it is not clear whether faster weight gain early in life, or other correlates of preterm birth, are associated with later obesity in this population. METHODS We used prospective data from the multicenter, observational Extremely Low Gestational Age Newborn Study. Among 1506 eligible individuals in the initial cohort, 1198 were eligible for follow-up at 10 years of age. We examined BMI in 871 children (58% of the cohort; 74% of survivors) and analyzed relationships between antecedents and overweight or obesity at 10 years of age. A time-oriented approach to multinomial multivariable regression enabled us to calculate odds of overweight and obesity associated with pre- and postnatal antecedents. RESULTS Prepregnancy maternal BMI ≥25 and top quartile infant weight gain in the first year were associated with increased risk of both overweight and obesity at 10 years of age. Single marital status was a risk factor for later child obesity and exposure to tobacco smoke was a risk factor for later child overweight. CONCLUSIONS The risk profiles for overweight and obesity at 10 years of age among children born extremely preterm appear to be similar to the risk profiles of overweight and obesity among children born at term.
Collapse
Affiliation(s)
- Charles T. Wood
- Division of Primary Care Pediatrics, Department of Pediatrics, Duke Center for Childhood Obesity Research, School of Medicine, Duke University, Durham, North Carolina
| | - Olivia Linthavong
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eliana M. Perrin
- Division of Primary Care Pediatrics, Department of Pediatrics, Duke Center for Childhood Obesity Research, School of Medicine, Duke University, Durham, North Carolina
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Harvard University and Neuroepidemiology Unit, and Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Elizabeth N. Allred
- Department of Neurology, Harvard Medical School, Harvard University and Neuroepidemiology Unit, and Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Karl C.K. Kuban
- Department of Pediatrics, Boston Medical Center, Boston University, Boston, Massachusetts
| | - T. Michael O’Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | |
Collapse
|
70
|
Wright CM, Marryat L, McColl J, Harjunmaa U, Cole TJ. Pathways into and out of overweight and obesity from infancy to mid-childhood. Pediatr Obes 2018; 13:621-627. [PMID: 29998577 PMCID: PMC6220864 DOI: 10.1111/ijpo.12427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether high weight in infancy predicts obesity in childhood. METHOD Data from two UK cohorts (Newcastle Growth and Development N = 795, Gateshead Millennium N = 393) and one Finnish (Tampere N = 1262) were combined. Z scores of weight at 3 and 12 months and body mass index (BMI) at 5 and 8 years were categorized as raised/overweight (1 to <2 SD) or high/obese (≥2 SD). RESULTS The majority of infants with raised or high weight at birth tended to revert to normal by 3 months and to track in the same category from 3 to 12 months. Although infants with high weight were five times more likely to have BMI ≥ 2 SD at 8 years (p < 0.001), only 22% went on to have BMI ≥ 2 SD, while 64% of infants with raised weight had normal BMI at 8 years. Of children with BMI ≥ 2 SD aged 8 years, only 22% had raised weight in infancy and half had BMI ≥ 2 SD for the first time at that age. CONCLUSIONS Infants with raised weight in infancy tend to remain so, but most children who go on to have BMI ≥ 2 SD were not unusually heavy infants and the majority of infants with high weight reverted to overweight or normal weight in childhood.
Collapse
Affiliation(s)
- C. M. Wright
- School of Medicine, College of MVLSUniversity of GlasgowGlasgowUK
| | - L. Marryat
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
- Farr Institute @ Scotland/Scottish Collaboration for Public Health Research and PolicyUniversity of EdinburghEdinburghUK
| | - J. McColl
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
| | - U. Harjunmaa
- Center for Child Health ResearchUniversity of Tampere Faculty of Medicine and Life Sciences, and Tampere University HospitalTampereFinland
| | - T. J. Cole
- Population, Policy and Practice ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
| |
Collapse
|
71
|
Ludwig DS, Ebbeling CB. 90th Anniversary Commentary: Obesity among Offspring of US Immigrants: After 20 Years, a Need to Safeguard Children from the Obesogenic Environment. J Nutr 2018; 148:1674-1677. [PMID: 30281107 PMCID: PMC6669943 DOI: 10.1093/jn/nxy152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/03/2018] [Accepted: 06/26/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center at Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center at Boston Children's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
72
|
Patel N, Dalrymple KV, Briley AL, Pasupathy D, Seed PT, Flynn AC, Poston L. Mode of infant feeding, eating behaviour and anthropometry in infants at 6-months of age born to obese women - a secondary analysis of the UPBEAT trial. BMC Pregnancy Childbirth 2018; 18:355. [PMID: 30176807 PMCID: PMC6122563 DOI: 10.1186/s12884-018-1995-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal obesity and rapid infant weight gain have been associated with increased risk of obesity in childhood. Breastfeeding is suggested to be protective against childhood obesity, but no previous study has addressed the potential benefit of breastfeeding as a preventive method of childhood obesity amongst obese women. The primary aim of this study was to assess the relationship between mode of feeding and body composition, growth and eating behaviours in 6-month-old infants of obese women who participated in UPBEAT; a multi-centre randomised controlled trial comparing a lifestyle intervention of diet and physical activity to standard care during pregnancy. METHODS Three hundred and fifty-three mother and infant pairs attended a 6-months postpartum follow-up visit, during which they completed the Baby-Eating Behaviour Questionnaire, a parent-reported psychometric measure of appetite traits. Measures of infant body composition were also undertaken. As there was no effect of the antenatal intervention on infant feeding and appetite the study was treated as a cohort. Using regression analyses, we examined relationships between: 1) mode of feeding and body composition and growth; 2) mode of feeding and eating behaviour and 3) eating behaviour and body composition. RESULTS Formula fed infants of obese women in comparison to those exclusively breastfed, demonstrated higher weight z-scores (mean difference 0.26; 95% confidence interval 0.01 to 0.52), higher rate of weight gain (0.04; 0.00 to 0.07) and greater catch-up growth (2.48; 1.31 to 4.71). There was also a lower enjoyment of food (p = 0.002) amongst formula fed infants, following adjustment for confounders. Independent of the mode of feeding, a measure of infant appetite was associated with sum of skinfold thicknesses (β 0.66; 95% CI 0.12 to 1.21), calculated body fat percentage (0.83; 0.15 to 1.52), weight z-scores (0.21; 0.06 to 0.36) and catch-up growth (odds ratio 1.98; 1.21 to 3.21). CONCLUSIONS In obese women, exclusive breastfeeding was protective against increasing weight z-scores and trajectories of weight gain in their 6-month old infants. Measures of general appetite in early infancy were associated with measures of adiposity, weight and catch up growth independent of cord blood leptin concentrations and mode of early feeding.
Collapse
Affiliation(s)
- Nashita Patel
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Kathryn V. Dalrymple
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Annette L. Briley
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Dharmintra Pasupathy
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Paul T. Seed
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Angela C. Flynn
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - on behalf of the UPBEAT Consortium
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| |
Collapse
|
73
|
Herrera-Cuenca M, Sifontes Y, Landaeta-Jiménez M, Contreras M. Public Health Nutrition Programs for the Elderly: Epidemiological Basis. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
74
|
Wray CV, Brauer PM, Heuberger RA, Logomarsino JV. Improving Documentation of Pediatric Height, Weight, and Body Mass Index by Primary Care Providers. CAN J DIET PRACT RES 2018; 79:186-190. [PMID: 30014715 DOI: 10.3148/cjdpr-2018-019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The regular documentation of anthropometric data in an electronic medical record (EMR) is one tracking method used by primary care providers to follow the growth trajectory and development of children in their health care practices. EMR reminders have been proposed as a method to increase recording of pediatric height and weight by primary care providers, leading to potentially better detection and management of children classified as overweight or obese. The aim of this pre-post study was to improve a Family Health Team's physician documentation of pediatric height and weight through the implementation of an EMR reminder alert tool. The documentation rate for children 4-7 years old in the 6 months before intervention was 36% of children seen. After implementation of EMR reminder alerts, primary care physicians' documentation rate rose to 45% (9% increase; P < 0.01), but it was below the 15% target increase. Better documentation of pediatric height and weight by family physicians is needed to improve monitoring of children's growth trajectories. Additional strategies to increase documentation rates are needed.
Collapse
Affiliation(s)
| | - Paula M Brauer
- b Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | - Roschelle A Heuberger
- c Department of Human Environmental Studies, Central Michigan University, Mount Pleasant, MI
| | - John V Logomarsino
- d Department of Human Environmental Studies, Central Michigan University, Mount Pleasant, MI
| |
Collapse
|
75
|
Hellmuth C, Lindsay KL, Uhl O, Buss C, Wadhwa PD, Koletzko B, Entringer S. Maternal Metabolomic Profile and Fetal Programming of Offspring Adiposity: Identification of Potentially Protective Lipid Metabolites. Mol Nutr Food Res 2018; 63:e1700889. [PMID: 29714050 DOI: 10.1002/mnfr.201700889] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/06/2018] [Indexed: 01/09/2023]
Abstract
SCOPE The fetal programming paradigm posits that the origins of obesity can be traced, in part, to the intrauterine period of life. However, the mechanisms underlying fetal programming are not well understood, and few studies have measured offspring adiposity in the neonatal period. The aim of this study is to identify maternal metabolites, and their determinants, that are associated with neonatal adiposity. METHODS AND RESULTS A targeted metabolomics approach is applied to analyze plasma samples collected across gestation from a well-characterized cohort of 253 pregnant women participating in a prospective study at the University of California, Irvine. Whole-body dual X-ray absorptiometry (DXA) imaging of body composition is obtained in N = 121 newborns. Statistical models are adjusted for potential confounders and multiple testing. The authors identify six alkyl-linked phosphatidylcholines (PCae), containing fatty acid 20:4, that are significantly and negatively associated with neonatal body fat percentage. Factors indicating higher socioeconomic status, non-Hispanic ethnicity, and higher nonesterified fatty acid percentages are positively associated with these PCae. CONCLUSIONS The polyunsaturated fatty acid 20:4 contained in PCae may exert a beneficial effect with respect to future propensity for obesity development. Prepregnancy and early pregnancy factors are determinants of these PCae, highlighting the importance of addressing preconceptional conditions for fetal programming of newborn adiposity.
Collapse
Affiliation(s)
- Christian Hellmuth
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Ludwig-Maximilian-Universität München, 80337, München, Germany
| | - Karen L Lindsay
- Department of Pediatrics, University of California, Irvine, CA, 92697, USA.,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA, 92697, USA
| | - Olaf Uhl
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Ludwig-Maximilian-Universität München, 80337, München, Germany
| | - Claudia Buss
- Department of Pediatrics, University of California, Irvine, CA, 92697, USA.,Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany.,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA, 92697, USA
| | - Pathik D Wadhwa
- Department of Pediatrics, University of California, Irvine, CA, 92697, USA.,Department of Psychiatry and Human Behavior and Department of Obstetrics and Gynecology, University of California, Irvine, CA, 92697, USA.,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA, 92697, USA
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Ludwig-Maximilian-Universität München, 80337, München, Germany
| | - Sonja Entringer
- Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany.,UC Irvine Development, Health and Disease Research Program, University of California, Irvine, CA, 92697, USA
| |
Collapse
|
76
|
Olson CM, Groth SW, Graham ML, Reschke JE, Strawderman MS, Fernandez ID. The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial. BMC Pregnancy Childbirth 2018; 18:148. [PMID: 29743026 PMCID: PMC5944067 DOI: 10.1186/s12884-018-1767-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/24/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG. METHODS This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided). RESULTS In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses. CONCLUSION The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations. TRIAL REGISTRATION NCT01331564 , ClinicalTrials.gov.
Collapse
Affiliation(s)
- Christine M Olson
- Division of Nutritional Sciences, 406 Savage Hall, Cornell University, Ithaca, NY, 14853, USA.
| | - Susan W Groth
- School of Nursing, University of Rochester, Box SON, 601 Elmwood Ave., Rochester, NY, 14642, USA
| | - Meredith L Graham
- Division of Nutritional Sciences, 352 MVR Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Jennifer E Reschke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, NY, 14642, USA
| | - Myla S Strawderman
- Division of Nutritional Sciences, 352 MVR Hall, Cornell University, Ithaca, NY, 14853, USA
| | - Isabel Diana Fernandez
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, NY, 14642, USA
| |
Collapse
|
77
|
Li S, Zhu Y, Yeung E, Chavarro JE, Yuan C, Field AE, Missmer SA, Mills JL, Hu FB, Zhang C. Offspring risk of obesity in childhood, adolescence and adulthood in relation to gestational diabetes mellitus: a sex-specific association. Int J Epidemiol 2017; 46:1533-1541. [PMID: 29024955 PMCID: PMC5837775 DOI: 10.1093/ije/dyx151] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/10/2017] [Accepted: 07/18/2017] [Indexed: 01/08/2023] Open
Abstract
Background Animal data suggest sexually dimorphic programming of obesity in response to altered intrauterine environment, but the longitudinal impact of gestational diabetes mellitus (GDM) on sex-specific risk of offspring obesity in humans is unclear. Methods We conducted a prospective analysis of 15 009 US individuals (7946 female and 7063 male) from the Growing-Up Today Study, who were followed from 1996 (ages 9-14 years) through 2010. Height and weight from validated questionnaires were used to derive body mass index (BMI) at different ages. Obesity during childhood (< 18 years) and adulthood (≥ 18 years) were defined using the International Obesity Task Force and the World Health Organization criteria. GDM exposure was identified through self-reported questionnaires from mothers. Relative risks were estimated using multivariable log-binomial regression models with generalized estimating equations accounting for clustering within the same family. Results Male offspring born from pregnancies complicated by GDM had higher BMI compared with non-GDM offspring and had increased risk of obesity; the adjusted relative risk [RR, 95% confidence interval (CI)] was 1.47 (1.11-1.95) for all age groups, 1.59 (1.05-2.41) for late childhood, 1.48 (1.06-2.06) for adolescence and 1.39 (1.00-1.94) for early adulthood. No significant association between obesity and maternal GDM was observed among female participants (RR = 0.97, 95% CI: 0.71-1.33). Conclusions The association of GDM with offspring obesity from late childhood through early adulthood may differ by sex; a significant association was observed among male but not female offspring.
Collapse
Affiliation(s)
- Shanshan Li
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Yeyi Zhu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Edwina Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Changzheng Yuan
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Alison E Field
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - James L Mills
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| |
Collapse
|
78
|
Salahuddin M, Pérez A, Ranjit N, Hoelscher DM, Kelder SH. The associations of large-for-gestational-age and infant feeding practices with children's body mass index z-score trajectories: the Early Childhood Longitudinal Study, Birth Cohort. Clin Obes 2017; 7:307-315. [PMID: 28707388 DOI: 10.1111/cob.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022]
Abstract
Very few studies have examined if high birth weight and infant feeding practices have implications for the trajectory of body mass index (BMI) growth across the early childhood period. The goal of this study was to assess if large-for-gestational-age (LGA) and infant feeding practices (exclusive breastfeeding for 6 months, and early introduction of complementary food prior to 4 months) are associated with BMI z-score trajectories over the early childhood period. Group-based trajectory modelling (GBTM) methods were employed to describe and classify developmental BMI z-score trajectories (the outcome of interest) in children from 9 months to 4 years of age (n = 4497) born to prenatal non-smoking mothers in the Early Childhood Longitudinal Study, Birth Cohort (2001-2005). Further analyses examined if the identified BMI z-score trajectories varied systematically with the exposures, LGA and specific infant feeding practices, after accounting for sociodemographic and other early-life factors. Two BMI z-score trajectory groups were identified: normal BMI z-score (56.2%) and high BMI z-score (43.8%). Children who were LGA infants had 2.3 times (risk ratio 95% confidence interval: 1.2, 4.5) greater risk of being in high BMI z-score group relative to normal BMI z-score group. BMI z-score trajectory groups did not differ by infant feeding practices, after controlling for LGA at birth. Membership in the high BMI z-score group was associated with LGA, but not with infant feeding practices. Healthcare professionals should provide early obesity counselling to parents of LGA infants so that parents can take appropriate obesity prevention measures for their children.
Collapse
Affiliation(s)
- M Salahuddin
- School of Public Health in Austin, University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Population Health, Office of Health Affairs, UT System, Austin, TX, USA
| | - A Pérez
- School of Public Health in Austin, University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health in Austin, Austin, TX, USA
| | - N Ranjit
- School of Public Health in Austin, University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health in Austin, Austin, TX, USA
| | - D M Hoelscher
- School of Public Health in Austin, University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health in Austin, Austin, TX, USA
| | - S H Kelder
- School of Public Health in Austin, University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health in Austin, Austin, TX, USA
| |
Collapse
|
79
|
Abstract
Ronald Ma and Barry Popkin discuss the urgent need and challenges to reduce intergenerational transmission of obesity and diabetes.
Collapse
Affiliation(s)
- Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
80
|
Dugas C, Perron J, Kearney M, Mercier R, Tchernof A, Marc I, Weisnagel SJ, Robitaille J. Postnatal Prevention of Childhood Obesity in Offspring Prenatally Exposed to Gestational Diabetes mellitus: Where Are We Now? Obes Facts 2017; 10:396-406. [PMID: 28848122 PMCID: PMC5644967 DOI: 10.1159/000477407] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/02/2017] [Indexed: 12/15/2022] Open
Abstract
Children exposed to gestational diabetes mellitus (GDM) in utero are at high risk of developing many health problems such as obesity. There is an urgent need to find new strategies to prevent obesity development among high-risk populations such as those children. Accordingly, the aim of this review was to summarize current knowledge on the postnatal prevention of childhood obesity in offspring born from mothers with GDM. Specifically, this review addresses the impact of breastfeeding, complementary feeding practices as well as dietary intake and physical activity during childhood on obesity risk of children exposed to GDM in utero. Furthermore, breast milk composition of diabetic mothers and its potential impact on growth is discussed. According to the available literature, breastfeeding may reduce obesity risk in children exposed to GDM in utero but a longer duration seems necessary to achieve its protective effect against obesity. Detailed analysis of breast milk composition of mothers with GDM will be necessary to fully understand the relationship between breastfeeding and obesity in this specific population. This review highlights the need for more studies addressing the impact of complementary feeding practices and lifestyle habits during childhood on obesity risk of children exposed to GDM in utero.
Collapse
Affiliation(s)
- Camille Dugas
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| | - Julie Perron
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
| | - Michèle Kearney
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
| | - Roxanne Mercier
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
| | - André Tchernof
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| | - Isabelle Marc
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| | - S. John Weisnagel
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
- Diabetes Research Unit, Laval University Medical Research Center, Quebec City, Quebec City, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| |
Collapse
|
81
|
Aris IM, Bernard JY, Chen LW, Tint MT, Pang WW, Soh SE, Saw SM, Shek LPC, Godfrey KM, Gluckman PD, Chong YS, Yap F, Kramer MS, Lee YS. Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status. Int J Obes (Lond) 2017; 42:44-51. [PMID: 28751763 DOI: 10.1038/ijo.2017.178] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/12/2017] [Accepted: 07/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort. METHODS Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m-2), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l-1), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models. RESULTS Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41-1.15) for BMI, 0.79 (0.41-1.16) for WHtR, 0.46 (0.06-0.83) for SSF and 0.67 (0.07-1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5-49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8-13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity. CONCLUSIONS Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.
Collapse
Affiliation(s)
- I M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - J Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - L-W Chen
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - M T Tint
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - W W Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - S-M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - L P-C Shek
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Y-S Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - F Yap
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Faculty of Medicine, Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| |
Collapse
|
82
|
Molnar DS, Rancourt D, Schlauch R, Wen X, Huestis MA, Eiden RD. Tobacco Exposure and Conditional Weight-for-Length Gain by 2 Years of Age. J Pediatr Psychol 2017; 42:679-688. [PMID: 28169405 PMCID: PMC5896634 DOI: 10.1093/jpepsy/jsw095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/26/2016] [Accepted: 11/08/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To prospectively examine dose-response and timing effects of prenatal (PTE) and postnatal tobacco exposure on obesity risk assessed by conditional weight-for-length gain (CWFLG), by 2 years of age. CWFLG over the first 2 years of life was examined for 117 PTE and 57 nonexposed children. Repeated assessments of PTE were conducted beginning in the first trimester of pregnancy, using multiple methods. PTE or postnatal exposure status was not predictive of CWFLG. However, there was a dose-response association and an association with fetal exposure ascertained by infant meconium positive for nicotine and metabolites. PTE is related to restricted growth at birth, yet associated with accelerated CWFLG by 2 years of age, a measure that controls for birthweight differences. Results highlight the importance of examining dose-response and timing of exposure associations, along with the importance of obesity risk-reduction interventions within the first 2 years of life among PTE children.
Collapse
Affiliation(s)
- Danielle S. Molnar
- Department of Child and Youth Studies, Brock University
- Research Institute on Addictions, State University of New York at Buffalo
| | | | | | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, National Institutes of Health
| | - Rina D. Eiden
- Research Institute on Addictions, State University of New York at Buffalo
| |
Collapse
|
83
|
Evensen E, Emaus N, Kokkvoll A, Wilsgaard T, Furberg AS, Skeie G. The relation between birthweight, childhood body mass index, and overweight and obesity in late adolescence: a longitudinal cohort study from Norway, The Tromsø Study, Fit Futures. BMJ Open 2017; 7:e015576. [PMID: 28645970 PMCID: PMC5734247 DOI: 10.1136/bmjopen-2016-015576] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/10/2017] [Accepted: 04/03/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Childhood overweight/obesity is associated with later overweight/obesity. However, the association between birth weight and later overweight/obesity has not been established. The aim of this study was to investigate the relation between both birth weight and childhood body mass index (BMI), and adolescent overweight/obesity in a Norwegian population. METHODS The Tromsø Study - Fit Futures is a population-based cohort study conducted in 2010-2011 and 2012-2013 in Tromsø, Norway. A representative sample of 961 adolescents participated. Longitudinal anthropometric data were obtained from the Medical Birth Registry of Norway, childhood health records at 2-4 and 5-7 years of age, and repeated measurements at 15-18 and 18-20 years of age. Outcome was defined as normal weight (adult BMI <25 kg/m2) or overweight/obese (adult BMI ≥2 5 kg/m2) at 15-20 years of age according to international age- and sex-specific cut-off values for children. Associations were investigated using generalised estimating equations. RESULTS In adjusted analyses, a 1-SD (586 g) higher birth weight was associated with a higher OR for overweight/obesity at 15-20 years of age (OR 1.25, 95% CI 1.06 to 1.48). Childhood BMI was also associated with overweight/obesity at 15-20 years of age: a 1-SD (1.35 kg/m2) increase in BMI at age 2-4 years rendered an OR of 1.66 (95% CI 1.40 to 1.96); a 1-SD (1.83 kg/m2) increase in BMI at age 5-7 years rendered an OR of 3.23 (95% CI 2.56 to 4.07). When compared with normal-weight children, those with severe overweight/obesity in childhood (adult BMI ≥27 kg/m2) showed stronger associations with overweight/obesity at 15-20 years of age: OR 3.01 (95% CI 1.47 to 6.18) and OR 11.51 (95% CI 6.63 to 19.99) at ages 2-4 and 5-7, respectively. CONCLUSION Associations between birth weight and overweight/obesity at 15-20 years of age were modest, whereas the influence of BMI at 2-4 and 5-7 years on overweight/obesity at 15-20 years was moderate to strong.
Collapse
Affiliation(s)
- Elin Evensen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ane Kokkvoll
- Department of Paediatrics, Finnmark Hospital Trust, Hammerfest, Norway
- Paediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne-Sofie Furberg
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
84
|
Rifas-Shiman SL, Taveras EM, Gortmaker SL, Hohman KH, Horan CM, Kleinman KP, Mitchell K, Price S, Prosser LA, Gillman MW. Two-year follow-up of a primary care-based intervention to prevent and manage childhood obesity: the High Five for Kids study. Pediatr Obes 2017; 12:e24-e27. [PMID: 27231236 PMCID: PMC6067009 DOI: 10.1111/ijpo.12141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The obesity epidemic has spared no age group, even young infants. Most childhood obesity is incident by the age of 5 years, making prevention in preschool years a priority. OBJECTIVE To examine 2-year changes in age- and sex-specific BMI z-scores and obesity-related behaviours among 441 of the 475 originally recruited participants in High Five for Kids, a cluster randomized controlled trial in 10 paediatric practices. METHODS The intervention included a more intensive 1-year intervention period (four in-person visits and two phone calls) followed by a less intensive 1-year maintenance period (two in-person visits) among children who were overweight or obese and age 2-6 years at enrolment. The five intervention practices restructured care to manage these children including motivational interviewing and educational modules targeting television viewing and intakes of fast food and sugar-sweetened beverages. RESULTS After 2 years, compared with usual care, intervention participants had similar changes in BMI z-scores (-0.04 units; 95% CI -0.14, 0.06), television viewing (-0.20 h/d; -0.49 to 0.09) and intakes of fast food (-0.09 servings/week; -0.34 to 0.17) and sugar-sweetened beverages (-0.26 servings/day; -0.67 to 0.14). CONCLUSION High Five for Kids, a primarily clinical-based intervention, did not affect BMI z-scores or obesity-related behaviours after 2 years.
Collapse
Affiliation(s)
- Sheryl L. Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health Boston, MA
| | | | - Christine M. Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Ken P. Kleinman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Sarah Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Lisa A. Prosser
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
| | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| |
Collapse
|
85
|
Gillman MW. Early infancy interventions to prevent childhood obesity. Obesity (Silver Spring) 2017; 25:817-818. [PMID: 28337849 DOI: 10.1002/oby.21829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Matthew W Gillman
- Environmental Influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Rockville, Maryland, USA
| |
Collapse
|
86
|
Developmental origins of type 2 diabetes: a perspective from China. Eur J Clin Nutr 2017; 71:870-880. [PMID: 28378847 DOI: 10.1038/ejcn.2017.48] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/04/2017] [Indexed: 12/20/2022]
Abstract
There has been a marked increase in the prevalence of diabetes in Asia, including China, over the last few decades. While the increased prevalence of diabetes has often been attributed to the nutritional transition associated with recent economic development, emerging data suggest that early-life exposures also play a major role in shaping developmental trajectories, and contributes to alter an individual's susceptibility to diabetes and other non-communicable diseases (NCDs). Early-life exposures such as in utero exposure to undernutrition has been consistently linked with later risk of diabetes and obesity. Furthermore, in utero exposure to maternal hyperglycemia, maternal obesity and excess gestational weight gain are all linked with increased childhood obesity and later risk of diabetes. Emerging data have also highlighted the potential link between early-feeding practices, the role of one-carbon metabolism in metabolic programming and endocrine disrupting chemicals (EDCs) with later risk of diabetes. These different developmental exposures may all be highly relevant to the current epidemic of diabetes in China. For example, the prevalence of gestational diabetes has increased markedly over the last two decades, and may contribute to the diabetes epidemic by driving macrosomia, childhood obesity and later risk of diabetes. In order to address the current burden of diabetes, a lifecourse perspective, incorporating multisectoral efforts from public health policy down to the individuals, will be needed. Several major initiatives have been launched in China as part of its national plans for NCD prevention and treatment, and the experience from these efforts would be invaluable.
Collapse
|
87
|
Gregory EF, Goldshore MA, Showell NN, Genies MC, Harding ME, Henderson JL. Parent and Clinician Perspectives on Sustained Behavior Change after a Prenatal Obesity Program: A Qualitative Study. Child Obes 2017; 13:85-92. [PMID: 27854496 PMCID: PMC6435345 DOI: 10.1089/chi.2016.0149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Infants of obese women are at a high risk for development of obesity. Prenatal interventions targeting gestational weight gain among obese women have not demonstrated consistent benefits for infant growth trajectories. METHODS To better understand why such programs may not influence infant growth, qualitative semi-structured interviews were conducted with 19 mothers who participated in a prenatal nutrition intervention for women with BMI 30 kg/m2 or greater, and with 19 clinicians (13 pediatric, 6 obstetrical). Interviews were transcribed and coded with themes emerging inductively from the data, using a grounded theory approach. RESULTS Mothers were interviewed a mean of 18 months postpartum and reported successful postnatal maintenance of behaviors that were relevant to the family food environment (Theme 1). Ambivalence around the importance of postnatal behavior maintenance (Theme 2) and enhanced postnatal healthcare (Theme 3) emerged as explanations for the failure of prenatal interventions to influence child growth. Mothers acknowledged their importance as role models for their children's behavior, but they often believed that body habitus was beyond their control. Though mothers attributed prenatal behavior change, in part, to additional support during pregnancy, clinicians had hesitations about providing children of obese parents with additional services postnatally. Both mothers and clinicians perceived a lack of interest or concern about infant growth during pediatric visits (Theme 4). CONCLUSIONS Prenatal interventions may better influence childhood growth if paired with improved communication regarding long-term modifiable risks for children. The healthcare community should clarify a package of enhanced preventive services for children with increased risk of developing obesity.
Collapse
Affiliation(s)
- Emily F. Gregory
- General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Nakiya N. Showell
- General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Marquita C. Genies
- General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | |
Collapse
|
88
|
Amaro H, Cortés DE, Garcia S, Duan L, Black DS. Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers. Am J Public Health 2017; 107:800-806. [PMID: 28323473 DOI: 10.2105/ajph.2017.303725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. METHODS From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). RESULTS Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. CONCLUSIONS Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.
Collapse
Affiliation(s)
- Hortensia Amaro
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Dharma E Cortés
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Samantha Garcia
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Lei Duan
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - David S Black
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| |
Collapse
|
89
|
Early rapid weight gain and subsequent overweight and obesity in middle childhood in Peru. BMC OBESITY 2016; 3:55. [PMID: 27999679 PMCID: PMC5155392 DOI: 10.1186/s40608-016-0135-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 12/02/2016] [Indexed: 12/17/2022]
Abstract
Background Rapid postnatal weight gain is associated with risk of overweight and obesity, but it’s unclear whether this holds in populations exposed to concurrent obesogenic risk factors and for children who have been extensively breastfed. This study investigates whether an increase in weight for age from birth to 1 year (infancy) and from 1 to 5 years (early childhood) predicts overweight and obesity, and waist circumference at 8 years, using data from a longitudinal cohort study in Peru. Methods Generalized estimating equations (GEE) models were constructed for overweight and obesity, obesity alone and waist circumference at 8 years versus rapid weight gain in infancy, and early childhood including adjusted models to account for confounders. Results Rapid weight gain in both periods was associated with double the risk of overweight and obesity, obesity alone at 8 years and increased waist circumference even after controlling for maternal BMI and education level, sex of child, height-for-age at 8 years, consumption of “fast food” and number of days of active exercise. The association was significant, with some differences, for children in both rural and urban environments. Conclusions Rapid weight gain in infancy and in early childhood in Peru is associated with overweight and obesity at age 8 years even when considering other determinants of childhood obesity. Electronic supplementary material The online version of this article (doi:10.1186/s40608-016-0135-z) contains supplementary material, which is available to authorized users.
Collapse
|
90
|
Sun C, Foskey RJ, Allen KJ, Dharmage SC, Koplin JJ, Ponsonby AL, Lowe AJ, Matheson MC, Tang MLK, Gurrin L, Wake M, Sabin M. The Impact of Timing of Introduction of Solids on Infant Body Mass Index. J Pediatr 2016; 179:104-110.e1. [PMID: 27663213 DOI: 10.1016/j.jpeds.2016.08.064] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the associations between breastfeeding duration, age at solids introduction, and their interaction in relation to infant (age 9-15 months) above normal body mass index (BMI). STUDY DESIGN Cross-sectional, population-based study with 3153 infants from Melbourne (2007-2011). Above normal BMI (z score > 2, equivalent to >97.7th percentile) defined using the World Health Organization standard. RESULTS Both longer duration of full and any (full or partial) breastfeeding were associated with lower odds of above normal BMI (eg, aOR, 0.37 [95% CI, 0.22-0.60] for full breastfeeding 4-5 months versus 0-1 months). Compared with introduction of solids at 5-6 months, both early and delayed introduction were associated with increased odds of above normal BMI (aOR for 4 months, 1.75 [95% CI, 1.10-2.80] and for ≥7 months, 2.64 [95% CI, 1.26-5.54] versus 6 months). Such associations differ by breastfeeding status at 4 months (interaction P = .08). Early introduction of solids was associated with increased odds of above normal BMI in both infants fully or partially breastfed for ≥4 months (aOR, 3.66; 95% CI, 1.41-9.51) and those breastfed for <4 months (aOR, 3.11; 95% CI, 1.39-6.97). Introduction of solids at ≥7 months was associated with increased odds of above normal BMI (aOR, 5.79; 95% CI, 1.91-17.49) among infants breastfed for <4 months only. CONCLUSION Introduction of solids at 5-6 months, compared with either early or delayed introduction, is associated with decreased odds of above normal BMI at 1 year of age, regardless of infants' breastfeeding status at 4 months. These results may have implications for public health guidelines with regard to recommendations about the optimal timing of the introduction of solid foods in infancy.
Collapse
Affiliation(s)
- Cong Sun
- Environmental and Genetic Epidemiology Research Group, Murdoch Childrens Research Institute (MCRI), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Katrina J Allen
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, MCRI, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Centre for Food and Allergy Research, MCRI, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- Environmental and Genetic Epidemiology Research Group, Murdoch Childrens Research Institute (MCRI), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie C Matheson
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia; Allergy and Immune Disorders, MCRI, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lyle Gurrin
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Wake
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Centre for Community Child Health, MCRI, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Matthew Sabin
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Centre for Hormone Research, MCRI, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
91
|
Predictors of Obesity in a Cohort of Children Enrolled in WIC as Infants and Retained to 3 Years of Age. J Community Health 2016; 41:127-33. [PMID: 26280211 DOI: 10.1007/s10900-015-0077-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This longitudinal study of children enrolled as infants in the New York State (NYS) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) examined predictors of obesity (body mass index ≥ 95th percentile) at 3 years of age. NYS WIC administrative data which included information from parent interviews and measured heights and weights for children were used. All 50,589 children enrolled as infants in WIC between July to December 2008 and July to December 2009 and retained in WIC through age three were included. At 3 years of age, 15.1% of children were obese. Multiple logistic regression analysis showed that children of mothers who received the Full Breastfeeding Food Package when their infant was enrolled in WIC (adjusted OR = 0.52) and children with ≤2 h screen time daily at age 3 (adjusted OR = 0.88) were significantly less likely to be obese (p < 0.001) controlling for race/ethnicity, birth weight, and birthplace. In this cohort of NYS WIC participants, maternal receipt of the Full Breastfeeding Food Package (a surrogate measure of exclusive breastfeeding) is associated with lower levels of obesity in their children at age 3. The relationships between participation in WIC, exclusive breastfeeding, and obesity prevention merit further study.
Collapse
|
92
|
Moore GS, Allshouse AA, Fisher BM, Kahn BF, Hernandez TL, Reece MS, Reynolds RM, Lee W, Barbour LA, Galan HL. Can Fetal Limb Soft Tissue Measurements in the Third Trimester Predict Neonatal Adiposity? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1915-1924. [PMID: 27417735 DOI: 10.7863/ultra.15.06028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/03/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Neonatal adiposity is associated with chronic metabolic sequelae such as diabetes and obesity. Identifying fetuses at risk for excess neonatal body fat may lead to research aimed at limiting nutritional excess in the prenatal period. We sought to determine whether fetal arm and leg soft tissue measurements at 28 weeks' gestation were predictive of neonatal percent body fat METHODS : In this prospective observational cohort study of singleton term pregnancies, we performed sonography at 28 and 36 weeks' gestation, including soft tissue measurements of the fetal arm and thigh (fractional limb volume and cross-sectional area). We estimated the neonatal body composition (percent body fat) using anthropometric measurements and air displacement plethysmography. We estimated Spearman correlations between sonographic findings and percent body fat and performed modeling to predict neonatal percent body fat using maternal characteristics and sonographic findings. RESULTS Our analysis of 44 women yielded a mean maternal age of 30 years, body mass index of 26 kg/m(2), and birth weight of 3382 g. Mean neonatal percent body fat was 8.1% by skin folds at birth and 12.2% by air displacement plethysmography 2 weeks after birth. Fractional thigh volume measurements at 28 weeks yielded the most accurate model for predicting neonatal percent body fat (R(2) = 0.697; P = .001), outperforming models that used abdominal circumference (R(2)= 0.516) and estimated fetal weight (R(2)= 0.489). CONCLUSIONS Soft tissue measurements of the fetal thigh at 28 weeks correlated better with neonatal percent body fat than currently used sonographic measurements. After validation in a larger cohort, our models may be useful for prenatal intervention strategies aimed at the prevention of excess fetal fat accretion and, potentially, optimization of long-term metabolic health.
Collapse
Affiliation(s)
- Gaea S Moore
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado USA
| | - Amanda A Allshouse
- Department of Biostatics and Informatics, Colorado School of Public Health, Aurora, Colorado USA
| | - Barbra M Fisher
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado USA
| | - Bronwen F Kahn
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado USA
| | - Teri L Hernandez
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado USA, College of Nursing, University of Colorado, Boulder, Colorado USA
| | - Melanie S Reece
- Department of Pediatrics, Division of Neonatology, University of Colorado School of Medicine, Aurora, Colorado USA
| | - Regina M Reynolds
- Department of Pediatrics, Division of Neonatology, University of Colorado School of Medicine, Aurora, Colorado USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas USA
| | - Linda A Barbour
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado USA, Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado USA
| | - Henry L Galan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado USA
| |
Collapse
|
93
|
Dumas O, Varraso R, Gillman MW, Field AE, Camargo CA. Longitudinal study of maternal body mass index, gestational weight gain, and offspring asthma. Allergy 2016; 71:1295-304. [PMID: 26969855 DOI: 10.1111/all.12876] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sparse data are available on the relationship between prenatal exposures and asthma during later childhood. In a longitudinal study of adolescents and their mothers, we examined the association of (i) maternal prepregnancy body mass index (BMI) and (ii) gestational weight gain (GWG), with incidence of allergic and nonallergic asthma in offspring. METHODS Analyses were conducted using data from 12 963 children aged 9-14 years at enrolment in the Growing Up Today Study, and their mothers, who are participants in the Nurses' Health Study II. Physician-diagnosed asthma and allergies were assessed by questionnaires sent regularly to participants and their mothers. Logistic regression was used to evaluate associations of maternal BMI and GWG with offspring asthma, overall and by subtype. RESULTS Physician-diagnosed asthma during childhood or adolescence was reported by 2694 children (21%). Maternal prepregnancy overweight (OR: 1.19, 95% CI: 1.03-1.38) and obesity (1.34, 1.08-1.68) were associated with offspring asthma. In asthma subtype analyses, the association was seen only for asthma onset before age 12 years. Moreover, the association of maternal obesity with nonallergic asthma was observed in boys (2.39, 1.40-4.09) and not in girls (0.96, 0.50-1.85; Pinteraction = 0.03); the opposite pattern was suggested for allergic asthma. With regard to GWG, an association was suggested between gains of <15 lb and higher risk of offspring asthma (1.28, 0.98-1.66), without clear allergy- or sex-related patterns. CONCLUSION The relation of several prenatal factors to risk of childhood asthma supports the early origins hypothesis for asthma. The observed allergy- and sex-specific patterns suggest multiple etiologic pathways.
Collapse
Affiliation(s)
- O. Dumas
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Inserm, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - R. Varraso
- Inserm, VIMA: Aging and Chronic Diseases; Epidemiological and Public Health Approaches; Villejuif France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - M. W. Gillman
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - A. E. Field
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
- Division of Adolescent Medicine; Boston Children's Hospital and Harvard Medical School; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| | - C. A. Camargo
- Channing Division of Network Medicine; Department of Medicine; Brigham & Women's Hospital and Harvard Medical School; Boston MA USA
- Department of Emergency Medicine; Massachusetts General Hospital and Harvard Medical School; Boston MA USA
- Department of Epidemiology; Harvard T.H. Chan School of Public Health; Boston MA USA
| |
Collapse
|
94
|
Nutrition in the First 1000 Days: The Origin of Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090838. [PMID: 27563917 PMCID: PMC5036671 DOI: 10.3390/ijerph13090838] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 12/13/2022]
Abstract
Childhood obesity is a major global issue. Its incidence is constantly increasing, thereby offering a threatening public health perspective. The risk of developing the numerous chronic diseases associated with this condition from very early in life is significant. Although complex and multi-factorial, the pathophysiology of obesity recognizes essential roles of nutritional and metabolic aspects. Particularly, several risk factors identified as possible determinants of later-life obesity act within the first 1000 days of life (i.e., from conception to age 2 years). The purpose of this manuscript is to review those key mechanisms for which a role in predisposing children to obesity is supported by the most recent literature. Throughout the development of the human feeding environment, three different stages have been identified: (1) the prenatal period; (2) breast vs. formula feeding; and (3) complementary diet. A deep understanding of the specific nutritional challenges presented within each phase might foster the development of future preventive strategies.
Collapse
|
95
|
Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju S, Wormser D, Gao P, Kaptoge S, Berrington de Gonzalez A, Cairns B, Huxley R, Jackson C, Joshy G, Lewington S, Manson J, Murphy N, Patel A, Samet J, Woodward M, Zheng W, Zhou M, Bansal N, Barricarte A, Carter B, Cerhan J, Smith G, Fang X, Franco O, Green J, Halsey J, Hildebrand J, Jung K, Korda R, McLerran D, Moore S, O'Keeffe L, Paige E, Ramond A, Reeves G, Rolland B, Sacerdote C, Sattar N, Sofianopoulou E, Stevens J, Thun M, Ueshima H, Yang L, Yun Y, Willeit P, Banks E, Beral V, Chen Z, Gapstur S, Gunter M, Hartge P, Jee S, Lam TH, Peto R, Potter J, Willett W, Thompson S, Danesh J, Hu F. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016; 388:776-86. [PMID: 27423262 PMCID: PMC4995441 DOI: 10.1016/s0140-6736(16)30175-1] [Citation(s) in RCA: 1530] [Impact Index Per Article: 191.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. METHODS Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2). FINDINGS All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. INTERPRETATION The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. FUNDING UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.
Collapse
|
96
|
Taylor RW, Heath ALM, Galland BC, Cameron SL, Lawrence JA, Gray AR, Tannock GW, Lawley B, Healey D, Sayers RM, Hanna M, Meredith-Jones K, Hatch B, Taylor BJ. Three-year follow-up of a randomised controlled trial to reduce excessive weight gain in the first two years of life: protocol for the POI follow-up study. BMC Public Health 2016; 16:771. [PMID: 27514714 PMCID: PMC4982410 DOI: 10.1186/s12889-016-3383-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Prevention of Overweight in Infancy (POI) study was a four-arm randomised controlled trial (RCT) in 802 families which assessed whether additional education and support on sleep (Sleep group); food, physical activity and breastfeeding (FAB group); or both (Combination group), reduced excessive weight gain from birth to 2 years of age, compared to usual care (Control group). The study had high uptake at recruitment (58 %) and retention at 2 years (86 %). Although the FAB intervention produced no significant effect on BMI or weight status at 2 years, the odds of obesity were halved in those who received the sleep intervention, despite no apparent effect on sleep duration. We speculate that enhanced self-regulatory behaviours may exist in the Sleep group. Self-regulation was not measured in our initial intervention, but extensive measures have been included in this follow-up study. Thus, the overall aim of the POI follow-up is to determine the extent to which augmented parental support and education on infant sleep, feeding, diet, and physical activity in the first 2 years of life reduces BMI at 3.5 and 5 years of age, and to determine the role of self-regulation in any such relationship. METHODS/DESIGN We will contact all 802 families and seek renewed consent to participate in the follow-up study. The families have received no POI intervention since the RCT finished at 2 years of age. Follow-up data collection will occur when the children are aged 3.5 and 5 years (i.e. up to 3 years post-intervention). Outcomes of interest include child anthropometry, body composition (DXA scan), diet (validated food frequency questionnaire), physical activity (accelerometry), sleep (questionnaire and accelerometry), and self-regulation (questionnaires and neuropsychological assessment). DISCUSSION Our follow-up study has been designed primarily to enable us to determine whether the intriguing benefit of the sleep intervention suggested at 2 years of age remains as children approach school age. However, cohort analyses will also investigate how BMI, self-regulation, and sleep consolidation develop during the early years. This information will be valuable to researchers and policy makers progressing the field of early childhood obesity prevention. TRIAL REGISTRATION ClinicalTrials.gov number NCT00892983 .
Collapse
Affiliation(s)
- Rachael W. Taylor
- Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | | | - Barbara C. Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Sonya L. Cameron
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Julie A. Lawrence
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gerald W. Tannock
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Blair Lawley
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Dione Healey
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Rachel M. Sayers
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Maha Hanna
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Kim Meredith-Jones
- Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Burt Hatch
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Barry J. Taylor
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| |
Collapse
|
97
|
Shenassa ED, Wen X, Braid S. Exposure to Tobacco Metabolites via Breast Milk and Infant Weight Gain: A Population-Based Study. J Hum Lact 2016; 32:462-71. [PMID: 26644421 DOI: 10.1177/0890334415619154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the immutable benefits of breastfeeding are well documented, information on the potential consequences of exposure to tobacco metabolites specifically via breastfeeding is sparse. OBJECTIVE The aim was to conduct the first study of the association between exposure to tobacco metabolites specifically through breastfeeding and infant weight gain. METHODS We used historical data from the US Collaborative Perinatal Project. Mothers were classified as nonsmokers, light smokers (1-19 cigarettes/day), and heavy (20+ cigarettes/day) smokers. In-hospital feeding type was observed during a nursery stay after delivery. We conducted stratified analyses among average-for-gestational-age (AGA; N = 23 571) and small-for-gestational-age (SGA; N = 2552) infants. We isolated the effect of exposure to tobacco metabolites specifically through breastfeeding. RESULTS Overall, maternal smoking was associated with change in weight-for-length z-score in a dose-response manner. Change in weight z-score was most pronounced among SGA infants of heavy smokers (breastfed: 0.53; 95% confidence interval [CI], 0.12-0.94; formula fed: 0.17; 95% CI, 0.03-0.30). Exposure to tobacco metabolites specifically through breastfeeding was not associated with additional weight gain among AGA infants. Among the much smaller sample of SGA infants, exposure specifically through breastfeeding was associated with marginally significant additional weight gain (0.46; 95% CI, 0.00-0.91) among infants of heavy smokers. CONCLUSION Our findings are in accord with recommendations by health agencies for smokers to breastfeed. However, SGA infants exposed to tobacco metabolites via breastfeeding by heavy smokers appear to gain weight more rapidly than other infants. Practical implications of our findings are discussed.
Collapse
Affiliation(s)
- Edmond D Shenassa
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, USA Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA Department of Epidemiology, School of Medicine, University of Maryland, Baltimore, MD, USA Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Susan Braid
- Department of Family and Community Health, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
98
|
Brown CL, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater AM, Ravanbakht SN, Perrin EM. Parental Perceptions of Weight During the First Year of Life. Acad Pediatr 2016; 16:558-64. [PMID: 27002214 PMCID: PMC4976024 DOI: 10.1016/j.acap.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND More than half of parents underestimate their overweight child's weight; however, previous research focuses on children older than 2 years of age. The objective of this study was to assess whether parents of 2- to 12-month-old infants are able to accurately perceive their children's weight status. METHODS We performed a cross-sectional analysis of data collected from the Greenlight study, a cluster randomized obesity prevention trial, at 4 pediatric clinics serving diverse and low-income populations. Infants' length and weight were measured at well-child checks, and parents completed questionnaires including demographic characteristics and perception of their children's weight. Weight-for-length (WFL) percentile at the fifth to ≤95 was considered healthy weight and WFL percentile >95th was considered overweight. We used chi-squared tests to compare accuracy according to weight category and performed logistic regression analysis to assess accuracy at each time point. RESULTS Approximately 85% to 90% of infants (n = 853 at 2 months, n = 563 at 12 months) were at a healthy WFL at all measurement times, and parents of these infants were more likely to have an accurate perception of their child's weight (accuracy 89%-95%) than overweight children (accuracy 7%-26%; P < .001 across time points). Approximately 10% of healthy weight infants were perceived as underweight by their parents at all time points. At 12 months, mothers who were overweight were significantly more likely to underestimate their child's weight status (P = .008). CONCLUSIONS In our diverse and low-income sample, parents of overweight infants infrequently know that their infants are overweight. Future studies should examine how perception is related to feeding habits and weight status over time.
Collapse
Affiliation(s)
- Callie L. Brown
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Asheley C. Skinner
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - H. Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, New York, NY
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Lee M. Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA
| | - Alan M. Delamater
- Department of Pediatrics, University of Miami School of Medicine, Miami, FL
| | - Sophie N. Ravanbakht
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| |
Collapse
|
99
|
Adolescent education: an opportunity to create a Developmental Origins of Health and Disease (DOHaD) circuit breaker. J Dev Orig Health Dis 2016; 7:501-504. [PMID: 27383865 DOI: 10.1017/s204017441600026x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health before conception, and periconceptional nutritional environments, contribute to conditioning of later-life health and disease. Health behaviors developed during adolescence continue into adulthood. Thus, even when the gap between pregnancy and adolescence is substantial, behaviors developed during adolescence influence later-life non-communicable disease (NCD) vulnerability in offspring. Consequently, adolescence is an important life phase where development of positive health behaviors can contribute to disruption of transgenerational cycles of NCD risk. Schooling is a core activity during adolescence. Modern curricula focus on development of capabilities associated with critical, engaged citizenship, empowering learning that supports action-based engagement in complex issues. Contexts relevant to adolescents and their communities, such as the NCD epidemic, are used to facilitate learning. Thus, engaging the education sector as participants in the work of the Developmental Origins of Health and Disease community offers an important strategy to capture the potential of adolescence as a life stage for transgenerational primary prevention of obesity and NCD risk.
Collapse
|
100
|
Hivert MF, Rifas-Shiman SL, Gillman MW, Oken E. Greater early and mid-pregnancy gestational weight gains are associated with excess adiposity in mid-childhood. Obesity (Silver Spring) 2016; 24:1546-53. [PMID: 27345963 PMCID: PMC4968400 DOI: 10.1002/oby.21511] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/02/2016] [Accepted: 03/06/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE It is unclear how specific periods of gestational weight gain (GWG) during pregnancy relate to childhood adiposity. The goal of this study was to assess the differential impact of GWG timing on childhood body composition. METHODS In 979 mother-child pairs from the pre-birth Project Viva cohort, trimester-specific GWG was calculated using clinically recorded weights. Outcomes included body mass index (BMI) z-score, dual X-ray absorptiometry fat mass index (kg/m(2) ), and fat-free mass index (kg/m(2) ) in mid-childhood. Linear regression models were used to assess associations of each trimester's GWG (per 0.2 kg/week) with childhood outcomes, adjusted for maternal prepregnancy BMI, sociodemographic variables, lifestyle, and GWG in prior trimester(s). RESULTS Mean (SD) first trimester GWG was 0.22 (0.22) kg/week, second trimester 0.49 (0.18) kg/week, and third trimester 0.47 (0.20) kg/week. Faster first trimester GWG was associated with higher BMI z-score (0.06 units [95% CI: 0.01-0.12] per 0.2 kg/week) and with higher adiposity according to all indices; associations were strongest in women with prepregnancy BMI >30 kg/m(2) . Faster second trimester GWG was associated with higher BMI z-score (0.11 [0.04-0.18]), fat mass (fat mass index = 0.16 [0.02-0.31] kg/m(2) ), and lean mass (fat-free mass index = 0.11 [0.01-0.22] kg/m(2) ). Third trimester GWG was not associated with childhood adiposity. CONCLUSIONS These results reinforce the importance of addressing appropriate GWG in early pregnancy.
Collapse
Affiliation(s)
- Marie-France Hivert
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | - Sheryl L. Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| |
Collapse
|