Size at Birth, Postnatal Growth and Risk of Obesity

Child-caregivers' body weight and habitual physical activity status is associated with overweight in kindergartners

Background

The aim of this study was to examine whether child-caregivers’, both parents and kindergarten teachers, health parameters (age, weight status, habitual physical activity score) are significantly associated with the risk of overweight in young children.

Methods

We assessed the individual body mass index standard deviation score in a regional cross-sectional health study and matched a representative sample of 434 kindergartners aged 3 to 6-years with their caregivers’ weight and habitual physical activity status. Furthermore, we identified factors associated with the general ability of child-caregivers to identify overweight in children, and the awareness to classify a child within the correct weight category.

Results

Our study confirmed most of the known associations between parental anthropometrics and psychosocial factors with childhood overweight and obesity. A significantly higher proportion of boys tended to be overweight or obese (p = 0.027) and parents were more likely to misclassified boys overweight as normal weight (OR: 1.86; 95% CI 1.21-2.86). Adjusted for confounders, logistic regression analysis revealed that kindergarten teachers’ weight status (OR: 1.97; 95%-CI: 1.01-3.83) and habitual physical activity scores (OR: 2.32; 95%-CI: 1.10-4.92) were associated with children’s weight status.

Conclusions

Kindergarten teachers’ weight and habitual physical activity score seem to be new independent risk factors for overweight in kindergartners 3 to 6-years of age. Our results suggest that the psychosocial, non-genetic association of non-parental child-caregivers on children’s weight is relatively high and that the association of non-parental child-caregivers warrants further investigation.

Maternal short-chain fatty acids are associated with metabolic parameters in mothers and newborns

During the course of pregnancy, dynamic remodeling of the gut microbiota occurs and contributes to maternal metabolic changes through an undefined mechanism. Because short chain fatty acids (SCFAs) are a major product of gut microbiome fermentation, we investigated whether serum SCFA levels during pregnancy are related to key metabolic parameters in mothers and newborns. In this prospective study, 20 pregnant women without gestational diabetes were evaluated at 36-38 weeks of gestation, and their newborns were assessed after parturition. In this cohort, which included normal (n = 10) and obese (n = 10) subjects based on prepregnancy body mass index, serum levels of SCFAs (acetate, propionate, and butyrate), maternal adipokines, maternal glucose, and C-peptide were measured at 36-38 weeks of gestation. Maternal weight gain and newborn anthropometrics were also determined. Data were analyzed using linear regression to test for associations, adjusting for prepregnancy obesity. In this cohort, serum acetate levels were associated with maternal weight gain and maternal adiponectin levels. In addition, serum propionate correlated negatively with maternal leptin levels, newborn length, and body weight. Taken together, this study observed that novel relationships exist among maternal SCFA levels and multiple interrelated maternal/newborn metabolic parameters.

Postnatal growth velocity and overweight in early adolescents: a comparison of rural and urban African boys and girls

Objectives

To compare growth velocity of two African child cohorts and examine the relationship between postnatal growth velocity in infancy/early childhood and the risk of overweight/stunting in early adolescence.

Methods

The study used data from two child cohorts from urban (Birth to Twenty Cohort, South Africa) and rural (Lungwena Child Survival Study, Malawi) African settings. Mixed effect modelling was used to derive growth and peak growth velocities. T-tests were used to compare growth parameters and velocities between the two cohorts. Linear and logistic regression models were used to determine the relationship between growth velocity and early adolescent (ages 9–11 years) body mass index and odds of being overweight.

Results

Children in the BH cohort were significantly taller and heavier than those in the Lungwena cohort, and exhibited faster weight and height growth velocity especially in the first year of life (P < 0.05). No significant association was shown between baseline weight (α_w) and overweight in early adolescence (OR = 1.25, CI = 0.67, 2.34). The weight growth velocity parameter β_w was highly associated with odds of being overweight. Association between overweight in adolescence and weight velocity was stronger in infancy than in early childhood (OR at 3 months = 4.80, CI = 2.49, 9.26; OR at 5 years = 2.39, CI = 1.65, 3.47).

Conclusion

High weight and height growth velocity in infancy, independent of size at birth, is highly associated with overweight in early adolescence. However, the long term effects of rapid growth in infancy may be dependent on a particular population's socio-economic status and level of urbanization. Am. J. Hum. Biol. 26:643–651, 2014. © 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

How growth due to infant nutrition influences obesity and later disease risk

Infant nutrition has a major impact on immediate outcomes and long-term health and later disease risks, such as obesity and related disorders, a phenomenon referred to as 'metabolic programming'. This review discusses the currently postulated hypotheses and mechanisms investigated by the EarlyNutrition project.

CONCLUSION

Rapid weight gain in the first 2 years of life, most notably mediated by diary protein, affects the insulin-like growth factor metabolic pathways. Epigenetic processes seem to play a role.

Impact of overweight and obesity on obstetric outcomes

Abnormal nutritional status is an increasingly common complication in developed countries and, as reproductive age women are a part of this trend, the effect of maternal obesity on the pregnancy and neonate must be investigated. Pregestational obesity or overweight condition or an excessive gestational weight gain can be an independent risk factor for feto-maternal complications and long-term risks in adult life for the fetus. The selected risks include infertility, miscarriage, congenital anomalies, hypertensive disorders, gestational diabetes, intrauterine fetal death, macrosomia, and delivery complications. From an etiological point of view, the causes of the adverse outcomes include maternal body habitus, proinflammatory state of obesity, and metabolic dysfunction. Actually, a weight management guidance for obese pregnant women is limited, recommending a gain between 5 and 9 kg during the pregnancy period, while weight loss is discouraged. Mainly, therapeutic approach is prevention using specific programs of reducing weight before pregnant status. In addition, mechanistic studies, in animal models especially, have identified potential areas for intervention which might limit adverse risk factors for obesity from mothers to infants during pregnancy. In this article, a review of the literature on selected obstetrical risks associated with maternal overweight and obesity has been performed and both the target prevention and management strategies have been assessed.

Perinatal factors and the risk of atopic dermatitis: a cohort study

OBJECTIVE

To analyze the effects of pregnancy and early events in the newborn on the risk of subsequent atopic dermatitis (AD) during the first year of life.

PATIENTS AND METHODS

This is a prospective multicenter cohort study of newborns during the first year of life. Newborns identified on random days in three obstetrics departments in the area of Bergamo, Lombardy, Northern Italy, were eligible. At baseline, the mothers were interviewed by medical staff during their stay in hospital after delivery. At 6 and 12 months after delivery, a postal questionnaire was sent to the parents. Relative risks were calculated with and without adjustment by multiple regression analysis.

RESULTS

A total of 1081 newborns entered the study: 796 (74%) parents answered the 12-month questionnaire. Hundred and thirty-eight (17%) reported a diagnosis of AD at 6 months and 222 (28%) at 12 months. Parental history of AD and/or asthma was associated with an increased risk of AD (RR 1.5, 95%CI 1.1-2.0). Birth weight was slightly associated with an increased risk of AD: RR 1.04, 95%CI 1.001-1.08 (continuous variable, increment of 100 grams). No association emerged between breast feeding, smoking, and risk of AD.

CONCLUSIONS

This study in an Italian offspring cohort points to family history of atopic diseases and body weight at birth as relevant risk factors. The study was unable to document associations with other perinatal factors particularly breast feeding and parental smoking in the perinatal period.

The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants

What is already known about this subject Samoan adults are recognized for their particularly high body mass index and prevalent obesity. While Polynesians are understudied, in other populations infancy is a critical period in the development of obesity. Breastfeeding has been shown to attenuate obesity risk. What this study adds Samoan infants show remarkably rapid gain in weight but not length in early infancy resulting in a prevalence of overweight and obesity far higher than has been previously reported elsewhere. Breastfeeding is associated with slower weight gain in infancy suggesting that its protective benefits for obesity risk are generalizable outside of European-derived populations.

BACKGROUND

Samoans are recognized for their particularly high body mass index and prevalent adult obesity but infants are understudied.

OBJECTIVE

To examine the prevalence of overweight and obesity and determine the contribution of feeding mode to obesogenic growth trajectories in American Samoan infants.

METHODS

Data were extracted from the well baby records of 795 (n = 417 male) Samoan infants aged 0-15 months. Mixed-effects growth models were used to produce individual weight and length curves. Further mixed-effects models were fitted with feeding mode (breastfed, formula- or mixed-fed) as a single observation at age 4 (±2) months. Weight and length values were converted to z-scores according to the Centers for Disease Control 2000 reference.

RESULTS

At 15 months, 23.3% of boys and 16.7% of girls were obese (weight-for-length > 95th percentile). Feeding mode had a significant effect on weight and length trajectories. Formula-fed infants gained weight and length faster than breastfed infants. Formula-fed boys were significantly more likely to be obese at 15 months (38.6%) than breastfed boys (23.4%), χ(2)  = 8.4, P < 0.01, odds ratio = 2.05, 95% confidence interval (1.04, 4.05).

CONCLUSION

Obesity in American Samoans is not confined to adults. Obesity prevention efforts should be targeted at early life and promotion of breastfeeding may be a suitable intervention target.

Postinfancy growth, schooling, and cognitive achievement: Young Lives

BACKGROUND

Early life growth failure and resulting cognitive deficits are often assumed to be very difficult to reverse after infancy.

OBJECTIVE

We used data from Young Lives, which is an observational cohort of 8062 children in Ethiopia, India, Peru, and Vietnam, to determine whether changes in growth after infancy are associated with schooling and cognitive achievement at age 8 y.

DESIGN

We represented the growth by height-for-age z score at 1 y [HAZ(1)] and height-for-age z score at 8 y that was not predicted by the HAZ(1). We also characterized growth as recovered (stunted at age 1 y and not at age 8 y), faltered (not stunted at age 1 y and stunted at age 8 y), persistently stunted (stunted at ages 1 and 8 y), or never stunted (not stunted at ages 1 and 8 y). Outcome measures were assessed at age 8 y.

RESULTS

The HAZ(1) was inversely associated with overage for grade and positively associated with mathematics achievement, reading comprehension, and receptive vocabulary. Unpredicted growth from 1 to 8 y of age was also inversely associated with overage for grade (OR range across countries: 0.80-0.84) and positively associated with mathematics achievement (effect-size range: 0.05-0.10), reading comprehension (0.02-0.10), and receptive vocabulary (0.04-0.08). Children who recovered in linear growth had better outcomes than did children who were persistently stunted but were not generally different from children who experienced growth faltering.

CONCLUSIONS

Improvements in child growth after early faltering might have significant benefits on schooling and cognitive achievement. Hence, although early interventions remain critical, interventions to improve the nutrition of preprimary and early primary school-age children also merit consideration.

Parental anthropometrics, early growth and the risk of overweight in pre-school children: the Generation R Study

BACKGROUND

There are limited data regarding the associations of both maternal and paternal anthropometrics with longitudinally measured post-natal growth measures in early childhood.

OBJECTIVE

To assess the associations of maternal and paternal anthropometrics with growth characteristics and the risk of overweight in pre-school children.

STUDY DESIGN

Population-based prospective cohort study from early foetal life onwards in the Netherlands.

METHODS

Maternal pre-pregnancy anthropometrics and gestational weight gain, and paternal anthropometrics were related to foetal and post-natal growth measures and the risk of overweight until the age of 4 years. Analyses were based on 5674 mothers, fathers and their children.

RESULTS

Both pre-pregnancy maternal and paternal height, weight and body mass index were associated with corresponding foetal and post-natal anthropometric measures. Maternal body mass index had a significantly stronger effect on childhood body mass index than paternal body mass index. As compared to children from parents with normal body mass index, children from two obese parents had an increased risk of overweight at the age of 4 years (odds ratio 6.52 (95% confidence interval 3.44, 12.38). Maternal gestational weight gain was only among mothers with normal body mass index associated with body mass index and the risk of overweight in the children.

CONCLUSION

Maternal and paternal anthropometrics affect early growth in pre-school children differently. Gestational weight gain in mothers without overweight and obesity is related to the risk of overweight in early childhood.

Impact of maternal obesity on fetal health

The obesity epidemic is a problem of global importance with a profound impact on maternal-fetal health. Maternal overweight and obesity causes pregnancy complications such as gestational diabetes, hypertension and preeclampsia and affects fetal growth. Maternal obesity offers an altered genetic, hormonal and biochemical environment for the developing fetus/embryo and influences fetal growth and organ development. Offspring of obese mothers are subject to an increased risk of fetal demise, congenital anomalies and disrupted growth patterns, causing an increase in perinatal mortality. The impact of maternal obesity extends beyond intrauterine and neonatal life to childhood, adolescence and adulthood.

Developmental origins of obesity: programmed adipogenesis

The metabolic syndrome epidemic, including a marked increase in the prevalence of obesity and gestational diabetes mellitus (GDM) among pregnant women, represents a significant public health problem. There is increasing recognition that the risk of adult obesity is clearly influenced by prenatal and infant environmental exposures, particularly nutrition. This tenet is the fundamental basis of developmental programming. Low birth weight, together with infant catch-up growth, is associated with a significant risk of adult obesity. Exposure to maternal obesity, with or without GDM, or having a high birth weight also represents an increased risk for childhood and adult obesity. Animal models have replicated human epidemiologic findings and elucidated potential programming mechanisms that include altered organ development, cellular signaling responses, and epigenetic modifications. Prenatal care has made great strides in optimizing maternal, fetal, and neonatal health, and now has the opportunity to begin interventions which prevent or reduce childhood/adult obesity. Guidelines that integrate optimal pregnancy nutrition and weight gain, management of GDM, and newborn feeding strategies with long-term consequences on adult obesity, remain to be elucidated.

Environmental factors associated with overweight and obesity in taiwanese children

BACKGROUND

We explored the relationship among sociodemographic, behavioural, household environmental and perinatal factors, and risks of childhood overweight and obesity in Taiwan.

METHODS

A total of 7930 children aged 9 to 14 years were recruited from 14 randomly selected Taiwanese communities in 2007 and 2010. Height and weight were measured using standard protocols during school visits. Questionnaires that contained children's family information, birth conditions, exercise habits and household environmental factors were answered by the parents. Associations between risk factors and childhood overweight and obesity were estimated through odds ratio and 95% confidence interval from mixed models.

RESULTS

In this cohort, 32.3% of the children were overweight and 17.5% were obese. Male gender, high birthweight, exposure to in utero maternal smoking and current exposure to household environmental tobacco smoke (stronger effect of maternal than paternal smoking) were positively associated with childhood overweight/obesity. In contrast, higher parental education level, number of siblings, active exercise habits and taking vitamins were associated with reduced risks of childhood obesity. Birthweight revealed a J-shaped relationship with the probability of childhood overweight/obesity.

CONCLUSIONS

This study uncovers several modifiable risk factors for childhood overweight and obesity, and parents are encouraged to provide an anti-obesity environment such as quitting smoking, controlling birthweight of child during pregnancy and building up exercise habits.

Impacts of infancy rapid weight gain on 5-year childhood overweight development vary by age and sex in China

OBJECTIVES

To investigate the critical period for overweight development during early childhood by examining growth trajectory and related sex differences.

METHODS

Using piecewise linear mixed models and logistic regression, we examined the effect of growth trajectory at different periods on overweight at age 4-5 by sex among 13,6 971 regularly followed children (mean: 12.2 times) during 2000-2005 in south China.

RESULTS

The high-body mass index (BMI) group (>top tertile of BMI Z score at age of 4-5 years) had faster growth rates of BMI, BMI Z score, weight and height than the low-BMI group in the first 3 months of life. Boys were more likely to be overweight [odds ratio (OR) = 2.0, 95% confidence interval: 1.5-2.7] than girls; the male high-BMI group had higher growth rates during the first 3 months than girls with high-BMI, independently of environmental factors. Those fast grown (in the upper tertile of growth rates in BMI and BMI Z score) in periods 0-3 months had relatively higher OR of at risk of overweight at age of 4-5 years than those in other periods.

CONCLUSIONS

Overweight risk develops during the first 3 months of life. Boys have an earlier peak in growth than girls, which may help explain why overweight is more prevalent in boys in China.

Feeding and growth of normal birth weight infants during the first year of life in Shanghai

AIM

This study aimed to explore the relationship between infant feeding practices and growth outcomes in the first 12 months of life.

DESIGN

Investigators completed 262 questionnaires, which included infant feeding patterns, feeding environment, feeding beliefs/attitudes and caregivers' feeding behaviors through on-site face-to-face interviews with the main caregivers of infants at 12 months of age. The infant's weight and length at ages 6 and 12 months were measured.

SETTING

The study was conducted in urban Shanghai, China.

SUBJECTS

This study included 262 healthy normal birth weight full-term singleton 6-month-old infants and their main caregivers.

RESULTS

Among 262 infants, 86 (32.82%) infants were overweight [BMI-for-age z scores (BAZ)>+1] at 12 months. Compared with normal weight infants, the overweight infants had higher birth weights (P=0.009). Furthermore, the overweight infants gained significantly more weight (P<0.001) in the first year of life. In normal weight infants, caregivers worried more about infants being "underweight" and "eating less" (P<0.001) whereas caregivers with overweight infants worried more about infants being "overweight" (P<0.001). Consequently, the total score of caregivers' over-feeding behaviors was significantly higher in normal weight infants (P=0.029). However, in overweight infants, the scores of "fed quickly within 10 min" (r=0.223, P=0.039) and "feeding was the best way to stop the infant's fussiness" (r=0.285, P=0.008) were positively correlated with BAZ.

CONCLUSIONS

Overweight in early life is associated with carelessness about excessive appetite and some particular infant feeding behaviors of caregivers in Shanghai.

Frequency and risk factors of fetal malnutrition among liveborn singleton term neonates using a computerised perinatal database, 2000-2006

AIM

The aim of this study was to determine the frequency, risk factors and anthropometric measurements of fetally malnourished, liveborn singleton term neonates.

METHODS

The computed delivery room data of 11.741 liveborn singleton term neonates was used to compare malnourished and nourished newborns.

RESULTS

Of the total subjects, 577 (4.9%) were malnourished. There were no differences between the groups with regard to gender distribution, Apgar scores, maternal parity, smoking during pregnancy and type of delivery. Maternal age and neonatal gestational age (GA) were significantly lower in malnourished newborns (P < 0.001). Birthweight (BW), birth length (BL) and head circumference (HC) were significantly lower in the malnourished group compared with well-nourished group (P < 0.001). Mean BW (g) was 2724.7 ± 17.0 in the malnourished group versus 3234.3 ± 3.8 in the well-nourished group; BL (cm) was 47.8 ± 0.1 in malnourished versus 49.5 ± 0.0 in well-nourished neonates; HC (cm) was 33.25 ± 0.1 in the malnourished versus 34.3 ± 0.0 in the well-nourished group. Between the groups, there were significant differences in the ratio of small, appropriate and large for GA (P < 0.001). Of the malnourished newborns, 35.5% were small for GA, 63.3% were appropriate for GA and 1.2% were large for GA.

CONCLUSION

Fetal malnutrition (FM) still exists despite the advances in current obstetric care. Neonates of adolescent mothers and of low GA are particularly at risk for FM. The BW, BL and HC of fetally malnourished neonates are lower than that of well-nourished neonates. Like term singleton appropriate and small for GA neonates, term singleton large for GA neonates could also have been fetally malnourished.

Maternal Obesity and the Fetal Origins of the Metabolic Syndrome

Over recent decades there has been a rapid rise in metabolic disorders throughout the world. Whilst lifestyle and societal habits have contributed to the obesity epidemic, there is now increasing evidence that the early developmental environment of an infant can play a pivotal role in the 'programming' of an adverse physiological phenotype in later life. Clinical evidence highlights that maternal over-nutrition and/or obesity during pregnancy presents not only adverse effects on maternal health, but also persistent and deleterious effects in the developing child. Animal models are providing essential information into the underlying cellular and molecular mechanisms that contribute to this adverse phenotype. The use of this information will aid our understanding of the programming signals related to maternal and paternal over-nutrition and the improved healthcare for both mother and infant.

How could complementary feeding patterns affect the susceptibility to NCD later in life?

AIMS

The purpose of this paper is to provide a general framework for thinking about pathways and potential mechanisms through which complementary feeding may influence the risk of developing non-communicable diseases (NCDs).

DATA SYNTHESIS

To provide a context for the lack of clear and consistent evidence relating complementary feeding to NCD risk, methodological challenges faced in trying to develop an evidence base are described. Potential pathways through which complementary feeding may influence obesity-related NCD risk are described and illustrated with examples.

CONCLUSIONS

Numerous aspects of complementary feeding, including diet composition as well as patterns of feeding have the potential to influence the early development of obesity, which in turn predicts later obesity and NCD risk. Specific dietary exposures during the period of complementary feeding also have the potential to program future disease risk through pathways that are independent of adiposity. These factors all require consideration when making recommendations for optimal complementary feeding practices aimed at prevention of future NCDs.

Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study

OBJECTIVE

To investigate associations between early pregnancy homocysteine, folate and vitamin B12 concentrations and placental weight, birthweight and adverse pregnancy outcomes.

DESIGN

Population-based birth cohort study.

SETTING

Rotterdam, the Netherlands.

POPULATION

Cohort of 5805 pregnant women.

METHODS

To analyse homocysteine, folate and vitamin B12 concentrations, blood was drawn in early pregnancy. These concentrations were divided into quintiles. Information on birth outcomes was retrieved from medical records. Multivariate regression analyses were used.

MAIN OUTCOME MEASURES

Placental weight, birthweight, small for gestational age at birth (SGA) (<5th centile), prematurity and pre-eclampsia.

RESULTS

High homocysteine concentrations (highest quintile) were associated with lower placental weight (difference 30 g; P < 0.001) and birthweight (difference 110 g; P < 0.001), and increased risk of SGA [odds ratio (OR) 1.7; P = 0.006] compared with lowest quintile (reference). Low folate concentrations (lowest quintile) were associated with lower placental weight (difference 26 g; P = 0.001) and birthweight (difference 125 g; P < 0.001), and increased risks of SGA (OR 1.9; P = 0.002), prematurity (OR 2.2; P = 0.002) and pre-eclampsia (OR 2.1; P = 0.04) compared with highest quintile (reference). The risk of developing SGA and pre-eclampsia was substantially higher in women who had higher homocysteine and lower folate concentrations. No associations were found with vitamin B12.

CONCLUSIONS

Higher homocysteine and lower folate concentrations in early pregnancy are associated with lower placental weight and birthweight, and higher risk of adverse pregnancy outcomes. These findings suggest that high homocysteine and low folate concentrations in early pregnancy may adversely influence placentation and subsequently affect the success of pregnancy and birth outcomes.

Relationship between body mass index at age 3 years and body composition at age 11 years among Japanese children: the Shizuoka population-based study

Background

A few studies reported an association between body weight during early childhood and body composition in later life, as measured by dual-energy X-ray absorptiometry (DXA); however, none of those studies investigated an East Asian population. In a Japanese population, we examined the association between body weight at age 3 years and body composition at age 11 years, as measured using DXA.

Methods

The source population was 726 fifth-grade school children enrolled at 3 public schools in Shizuoka Prefecture, Japan from 2008–2010. All children who lived in the study area went to 1 of these 3 schools. DXA was used to obtain data on body composition, and the Maternal and Child Health Handbook was used to calculate body mass index (BMI). The general linear model was used for statistical analysis.

Results

We were able to analyze data on body composition at age 11 years and BMI in early childhood for 550 children. BMI at age 3 and change in BMI z-score from birth to age 3 were positively associated with bone mineral content (BMC), fat-free soft tissue mass (FFSTM), and fat mass (FM) at age 11. After adjusting for confounding factors, mean BMC, FFSTM, and FM were significantly lower among children who were underweight at age 3 and significantly higher among children who were overweight at age 3, as compared with values for normal-weight children at age 3.

Conclusions

Among Japanese children, body weight at age 3 years predicts body composition at age 11 years.

Overweight and obesity in twenty-year-old Swedes in relation to birthweight and weight development during childhood

AIM

To describe the frequency of overweight and obesity from birth to 20 years of age and analyse weight at 20 years of age in relation to weight and weight development during early childhood and adolescence.

METHODS

A longitudinal, population-based study, which followed 496 children from birth to 20 years of age. Information about weight and height was collected from health records at child health centres and school health care. At 20 years of age, weight and height measurements were taken by one of the authors.

RESULTS

At 20 years of age, 124 (25%) of the youth were obese or overweight. Of these youths, 60% had normal weight at 5.5 years. Of the teenagers who were overweight/obese at 15 years, 79% remained overweight/obese at 20 years of age. Out of the 124 overweight/obese at 20, 47% had normal weight at 15 years. [Corrections added after online publication on April 18, 2012: 'Out of the 124 obese at 20' has been changed to 'Out of the 124 overweight/obese at 20']. No relation was found between rapid weight gain during preschool age and overweight and obesity in 20-year-olds.

CONCLUSIONS

The majority of those who were overweight/obese at 20 years of age were recruited after 5.5 years of age, and half of them in their late teens. Thus, during the preschool period, the entire population should be the target of primary prevention from overweight/obesity and, in the case of teenagers, prevention strategies should be developed for the whole population as well as treatment strategies for teenagers with established overweight/obesity.

Maternal inflammatory bowel disease and offspring body size: a prospective cohort study

BACKGROUND

Maternal inflammatory bowel disease (IBD) may influence intrauterine growth and hence size at birth, but the consequences for offspring in later life remain uncertain. This study investigated the growth of children of mothers with Crohn's disease (CD) or ulcerative colitis (UC).

METHODS

The Danish National Birth Cohort, comprising 40,640 mother-child pairs with 7-year follow-up of children's height and weight, were linked to the Danish National Disease Register, whereby 50 mothers with CD and 147 mothers with UC were identified. Associations were tested by regression analyses, taking several covariates into account.

RESULTS

Children of mothers with IBD were significantly shorter at birth than children of unaffected mothers (adjusted; CD, difference in cm, -0.82; 95% confidence interval [CI], -1.39 to -0.25; UC, -0.41; 95% CI, -0.75 to -0.07) and they tended to be of lower birth weight (adjusted; CD, difference in grams, -119.7; 95% CI, -246.7 to 7.3; UC, -64.0; 95% CI, -138.7 to 10.7). However, during the first year of life children of IBD mothers reached similar body sizes as children of unaffected mothers. At the 7-year follow-up, girls, but not boys, of CD mothers tended to be overweight (adjusted odds ratio [OR], 2.47; 95% CI, 0.98-6.24) and had increased waist circumference (adjusted difference in cm, 3.48; 95% CI, 1.40-5.58) compared to the unaffected population.

CONCLUSIONS

The present study confirms that maternal history of IBD leads to decreased birth size in offspring. Reassuringly, body size in children of IBD mothers approached body size in children of unaffected mothers during childhood.

Can we modify the intrauterine environment to halt the intergenerational cycle of obesity?

Child obesity is a global epidemic whose development is rooted in complex and multi-factorial interactions. Once established, obesity is difficult to reverse and epidemiological, animal model, and experimental studies have provided strong evidence implicating the intrauterine environment in downstream obesity. This review focuses on the interplay between maternal obesity, gestational weight gain and lifestyle behaviours, which may act independently or in combination, to perpetuate the intergenerational cycle of obesity. The gestational period, is a crucial time of growth, development and physiological change in mother and child. This provides a window of opportunity for intervention via maternal nutrition and/or physical activity that may induce beneficial physiological alternations in the fetus that are mediated through favourable adaptations to in utero environmental stimuli. Evidence in the emerging field of epigenetics suggests that chronic, sub-clinical perturbations during pregnancy may affect fetal phenotype and long-term human data from ongoing randomized controlled trials will further aid in establishing the science behind ones predisposition to positive energy balance.

Maternal depression and child BMI: longitudinal findings from a US sample

OBJECTIVE

To examine the association between maternal depression and child body mass index (BMI) from Kindergarten (K) to fifth grade.

METHODS

Analysis of four waves of data from the Early Childhood Longitudinal Study - Kindergarten spanning K to fifth grade. Maternal depressive symptoms (MDSs) were measured by a brief version of the Center for Epidemiological Studies Depression scale. Data were analyzed using multiple regression analyses, adjusting for key covariates and potential confounders. The analytic sample was restricted to children of normal birth weight.

RESULTS

The relationship between MDS and child BMI varies by child gender and age. Among girls, severe MDS at K was related to lower BMI at third grade (but not later at fifth grade) and to an increase in BMI from K to third and K to fifth grades. Among boys, severe MDS at K was related to higher boys' BMI at fifth grade. When severe MDS occurred at third grade, it was related to higher BMI at fifth grade among girls whereas no statistically significant relationship was found for boys. Low levels of physical activity in comparison to peers at fifth grade and more screen time on weekends at third grade are likely mediators of the relationship between MDS and child BMI among girls, while among boys the relationship appears to be mediated by unhealthy eating habits.

CONCLUSIONS

Our findings, indicating developmental and gender differences in the relationship between maternal depression and child BMI, if confirmed, suggest that interventions addressing maternal depression may have concomitant impact on childhood obesity.

Maternal active smoking and newborn body composition

OBJECTIVE

Maternal smoking during pregnancy is associated with a reduction in birth size but very few studies have collated changes in neonatal anthropometry. Our aims were both to assess body composition differences by anthropometry between new-borns from smoking mothers and those from non-smoking mothers, and to show whether these differences affect proportional body mass distribution.

METHODS

Caucasian mothers and their full term singleton new-borns (N=1216) were selected during 2009. A structured questionnaire was completed regarding obstetric and demographic data, as well as tobacco consumption. Women were categorized, according to their smoking habits, into a non-smoking group (never smoked or stopped smoking prior to pregnancy) and a smoking group (smoked throughout pregnancy).

RESULTS

22.1% of mothers smoked during pregnancy (median: 6 cigarettes/day, range: l-40). Smoking mothers were significantly younger than non-smoking mothers but there were no differences regarding other aspects which could affect infant weight. Infants from non-smoking mothers were heavier, longer, and body circumferences were all larger than those from smoking mothers (p<0.001), but the Ponderal Index showed no statistical differences. Skinfold thicknesses were significantly lower in new-borns from smoking mothers but these differences were less evident than those from body size. Subcutaneous fat distribution did not show statistical differences between the two groups. After gestational age, to smoke during gestation is the second main determinant of birth weight.

CONCLUSIONS

Smoking during pregnancy involves a generalized reduction of most axiological parameters as a result of proportionate fetal growth impairment. In those infants born from mothers who smoked during gestation, neonatal lean body mass appears to be more affected than body fat, and distribution of subcutaneous fat is not different.

Gemini: A UK Twin Birth Cohort With a Focus on Early Childhood Weight Trajectories, Appetite and the Family Environment

Gemini is a cohort study of young twins in the United Kingdom designed to assess genetic and environmental influences on early childhood weight trajectories with a focus on infant appetite and the family environment. A total of 2402 families with twins born in England and Wales between March and December 2007 agreed to participate and returned completed baseline questionnaires. The sample includes 1586 same-sex and 816 opposite-sex twins. The study is currently funded for 5 years of follow-up, but is planned to continue into early adolescence and beyond, pending funding. With current funding of the study, families will be followed up when twins are: 8 months old (baseline), and then at 15, 20, 24, 36 and 48 months of age. Gemini is in its early stages, with baseline and first follow-up data collection completed. This is the first twin cohort to focus on childhood weight gain with detailed and repeated measures of children's appetite, food preferences, activity behavior and parental feeding styles, alongside detailed and repeated collection of anthropometrics. This article reviews the rationale for the Gemini study, its representativeness and the main measures.

Obesity and the developmental origins of health and disease

The concept that environmental stimuli imparted on a developing organism have the potential to affect both its short- and long-term developmental profiles is intuitively appealing and, more importantly, supported by a growing body of experimental and observational evidence. A number of groups have posited model hypotheses in tandem with experimental data, linking extrinsic factors to the development of a host of human diseases. Here, we review the evolution of 'the developmental origins of health and disease' as a concept and discuss recent advances in the association of specific stimuli to obesity, an epidemic cause of human morbidity and mortality.

Lifecourse approach to racial/ethnic disparities in childhood obesity

Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child's diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.

Differences in weight gain in hypertensive and diabetic elderly patients primary care study

BACKGROUND

Treatment and care of elderly patients with diabetes and hypertension means a hard task in primary care. Patients with these two components of metabolic syndrome are often overweight or obese. Although some parameters of metabolic syndrome are usually measured in a medical setting, checking body weight is usually done by the patients.

AIM

The aim of this study is to analyse the patients' self-recorded data on weight and compare them according to hypertension and diabetes.

PATIENTS AND METHODS

Five hundred and forty people (225 men and 315 women) between 60 and 75 years of age were eventually selected in primary care settings. Retrospective self-recorded data on recent weights and every decade since the age of 20, as well as the decade prior to diagnosis were collected. The data of patients with and without diabetes and/or hypertension were compared.

RESULTS

The current mean body weight was significantly higher in all groups than at the age of 20. Compared with the control group, hypertensive men and women were approximately of the same weight in their twenties and, also, recently, but they gained more weight in the 4th and 5th decades of their life. Diabetics started at higher weights. The greatest weight gain was observed as follows: between 20-30 years and 30-40 years in men and women, respectively, as well as between 50-60 years of age and in the last decade prior to diagnosis in both genders. Weight gain in the control group was steady at a lower rate.

CONCLUSIONS

Weight gain between 20-40 years of age could be an important factor in the aetiology of diabetes. Stable or at least limited weight gain may be a preventive factor. Considering the limitations of the study, further and decades long epidemiological evaluations are suggested in a larger study population.

Predictors of growth in children based on 2007 Korean National Growth Charts

BACKGROUND

Postnatal growth patterns in children are associated with various factors within the birth and infancy periods. The aim of the present study was to examine the correlation between growth patterns and parameters including gestational age (GA), birthweight (BW), sex, and feeding method in the records of 61,631 children aged 6-72 months.

METHODS

The data were obtained from the 2007 Korean National Growth Charts provided by the Korean Centers for Disease Control. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple linear regression.

RESULTS

BW and sex were highly correlated with weight and height by 72 months (P < 0.01), with BW being the primary predictor (P < 0.001). Sex was the second predictor of weight and height in children by 66 months (P < 0.01). Feeding method was the predictor of weight in children aged 12-48 months and 60 months (P < 0.05), and was also influential in the height of children by 48 months (P < 0.05). GA was the predictor of weight at 12 months and from 30 to 42 months (P < 0.05).

CONCLUSION

GA, BW, sex and feeding method were the predictors of weight and height among children at different times. Therefore, the present population-based study strengthens the consideration of these factors for routine monitoring of growth patterns in Korean children.

Fetal and infant growth and the risk of obesity during early childhood: the Generation R Study

OBJECTIVE

To examine whether infant growth rates are influenced by fetal growth characteristics and are associated with the risks of overweight and obesity in early childhood.

DESIGN

This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life onward.

METHODS

Fetal growth characteristics (femur length (FL) and estimated fetal weight (EFW)) were assessed in the second and third trimesters and at birth (length and weight). Infant peak weight velocity (PWV), peak height velocity (PHV), and body mass index at adiposity peak (BMIAP) were derived for 6267 infants with multiple height and weight measurements.

RESULTS

EFW measured during the second trimester was positively associated with PWV and BMIAP during infancy. Subjects with a smaller weight gain between the third trimester and birth had a higher PWV. FL measured during the second trimester was positively associated with PHV. Gradual length gain between the second and third trimesters and between the third trimester and birth were associated with higher PHV. Compared with infants in the lowest quintile, the infants in the highest quintile of PWV had strongly increased risks of overweight/obesity at the age of 4 years (odds ratio (95% confidence interval): 15.01 (9.63, 23.38)).

CONCLUSION

Fetal growth characteristics strongly influence infant growth rates. A higher PWV, which generally occurs in the first month after birth, was associated with an increased risk of overweight and obesity at 4 years of age. Longer follow-up studies are necessary to determine how fetal and infant growth patterns affect the risk of disease in later life.

Anthropometric changes in Sweden during the obesity epidemic--increased overweight among adolescents of non-Nordic origin

AIM

To compare overweight, obesity and thinness prevalences in adolescents born in 1979 and 1985 and to evaluate the influence of parental migration background.

METHODS

A total of 2306 15- to 16-year-old girls and boys in Gothenburg, Sweden, participated in two cross-sectional surveys (1994 and 2000). Height and weight were measured and interviews about parental origin were conducted. Overweight and obesity were classified according to International Obesity Task Force (IOTF) and WHO. Thinness was classified according to Cole.

RESULTS

Among girls, the prevalence of thinness decreased, 8.4% vs. 4.7%. The prevalence of overweight, including obesity, according to IOTF criteria, was 11.8% and 13.7% in 1994 and 2000, respectively. The corresponding figures according to WHO criteria were 14.5% and 17.5%. No significant changes occurred between cohorts in prevalences of overweight and obesity. However, when interaction between survey year and origin was tested, there was a significant difference in overweight according to WHO criteria (p=0.022).

CONCLUSION

A shift entailing increased risk for overweight in adolescents of non-Nordic origin was observed, while no changes occurred in the general population. Individual background factors are important to consider both for correct conclusions about health development in the population and for identification of target groups for health-promoting interventions.

Birth weight and subsequent risk of obesity: a systematic review and meta-analysis

This report describes the association between birth weight (BW) and obesity. Screening of 478 citations from five electronic databases resulted in the inclusion of 33 studies, most of medium quality. The meta-analysis included 20 of these published studies. The 13 remaining articles did not provide sufficient dichotomous data and were systematically reviewed, revealing results consistent with the meta-analysis. Our results revealed that high BW (>4000 g) was associated with increased risk of obesity (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.91-2.24) compared with subjects with BW ≤ 4000 g. Low BW (<2500 g) was associated with decreased risk of obesity (OR, 0.61; 95% CI, 0.46-0.80) compared with subjects with BW ≥ 2500 g. However, when two studies exhibited selection bias were removed, the results indicated no significant association between low BW and obesity (OR, 0.77; 95% CI, 0.58-1.04). Sensitivity analyses showed that differences in the study design, sample size and quality grade of the study had an effect on the low BW/obesity association, which low BW was not associated with the risk of obesity in cohort studies, studies with large sample sizes and studies with high quality grades. Pooled results were similar when normal birth weight (2500-4000 g) was used as the reference category. Subgroup analyses based on different growth and developmental stages (pre-school children, school children and adolescents) also revealed that high BW was associated with increased risk of obesity from childhood to early adulthood. No significant evidence of publication bias was present. These results suggest that high BW is associated with increased risk of obesity and may serve as a mediator between prenatal influences and later disease risk.

Low and high birth weight as risk factors for obesity among 4 to 5-year-old Australian children: does gender matter?

Studies testing whether birth weight and childhood obesity differ by gender are lacking. We aimed to describe the relationship between birth weight and childhood overweight/obesity and investigate the influence that gender has on this relationship among 4 to 5-year-old children. We performed a secondary analysis of an Australian nationally representative cross-sectional study in 4 to 5-year-old children. The main outcome measure was child overweight and obesity. We found that low birth weight (LBW) was associated with lower risk of overweight/obesity among girls at 4-5 years before (OR 0.50, 95%CI 0.32, 0.77) and after adjusting for socio-demographic factors (OR 0.51 95% CI 0.33, 0.80) and ethnicity (OR 0.52, 95%CI 0.33, 0.81) but was not associated with child overweight/obesity among boys before or after adjustment. High birth weight (HBW) was associated with a higher risk of overweight/obesity among both girls (adjusted OR: 1.76, 95% CI 1.12, 2.78) and boys (adjusted OR: 2.42 95% CI 2.06, 2.86).

CONCLUSION

There are gender differences in the association of birth weight with child overweight/obesity. HBW was associated with a higher risk of child overweight/obesity in boys and girls before and after adjustment for socio-demographic factors. However, LBW was associated with a lower risk of child overweight/obesity in girls but not in boys. These gender differences need to be considered when planning interventions to reduce child overweight/obesity.

Evaluating the indirect effect of infant weight velocity on insulin resistance in young adulthood: a birth cohort study from the Philippines

The authors assessed the relation between infant weight velocity and adult insulin resistance, specifically evaluating whether adult size and body fat distribution mediated the association. Data were from the Cebu Longitudinal Health and Nutrition Survey (Cebu, the Philippines), in which a birth cohort was followed to age 22 years (n=1,409; 1983-2005). Insulin resistance was measured using homeostasis model assessment of insulin resistance (HOMA-IR). Weight velocity (g/month) from 0 to 4 months and from 0 to 24 months was assessed. The authors examined direct and total associations between early growth and adult HOMA-IR in linear regression models and used a nonparametric bootstrapping procedure to test indirect effects through adult body mass index (BMI; weight (kg)/height (m)(2)) and waist circumference. Infant weight velocity was positively associated with adult BMI and waist circumference, which positively predicted HOMA-IR. There were no total or direct effects of immediate postnatal weight velocity (0-4 months) on adult HOMA-IR, although indirect effects through BMI and waist circumference were significant. Weight velocity from 0 to 24 months positively predicted HOMA-IR among males only, while indirect effects were significant in both sexes. In a relatively lean sample of young adults from a population with rising rates of diabetes and cardiovascular disease, the authors found evidence for small indirect effects of infant weight velocity on adult insulin resistance mediated through adult BMI and waist circumference.

Parental factors affecting the weights of the placenta and the offspring

AIM

To determine parental, especially paternal factors associated with the weight of the placenta and offspring.

METHODS

This population-based birth-cohort study includes 2947 singleton children born from April 2006 to 2007 and living in Drenthe, The Netherlands. Placental weight and birth weight were measured and questionnaires were filled out for this cohort. Associations between parental factors, and the weight of the placenta and the offspring were evaluated using univariate and multivariate linear regression models.

RESULTS

Univariate regression revealed that the paternal birth weight and body mass index (BMI) of the father were predictors for placental and birth weight of the offspring. However, they were not independent predictors. Independent predictors for placental weight were the maternal factors of pre-pregnancy BMI, birth weight, and diabetes. The maternal factors of weight gain during pregnancy, birth weight, smoking during pregnancy, and diabetes were independent predictors for birth weight of the offspring.

CONCLUSION

Paternal as well as maternal factors influence the weight of the placenta and the offspring.

Early childhood weight status in relation to asthma development in high-risk children

BACKGROUND

Obesity has been proposed to be a risk factor for the development of childhood asthma.

OBJECTIVE

We sought to examine weight status from birth to age 5 years in relation to the occurrence of asthma at ages 6 and 8 years.

METHODS

Two hundred eighty-five full-term high-risk newborns with at least 1 asthmatic/atopic parent enrolled in the Childhood Origin of Asthma project were studied from birth to age 8 years. Overweight was defined by weight-for-length percentiles of greater than the 85th percentile before the age of 2 years and a body mass index percentile of greater than the 85th percentile at ages 2 to 5 years.

RESULTS

No significant concurrent association was found between overweight status and wheezing/asthma occurrence at each year of age. In contrast, longitudinal analyses revealed complex relationships between being overweight and asthma. Being overweight at age 1 year was associated with a decreased risk of asthma at age 6 (odds ratio [OR], 0.32; P = .02) and 8 (OR, 0.35; P = .04) years, as well as better lung function. However, being overweight beyond infancy was not associated with asthma occurrence. In fact, only children who were overweight at age 5 years but not at age 1 year had an increased risk of asthma at age 6 years (OR, 5.78; P = .05).

CONCLUSION

In children genetically at high risk of asthma, being overweight at age 1 year was associated with a decreased risk of asthma and better lung function at ages 6 and 8 years. However, being overweight beyond infancy did not have any protective effect and even could confer a higher risk for asthma.

The Early Prevention of Obesity in CHildren (EPOCH) Collaboration--an individual patient data prospective meta-analysis

Background

Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori.

Methods/Design

The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children's dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics.

Discussion

Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013.

Trial registration number

ACTRN12610000789066

Associations between severity of obesity in childhood and adolescence, obesity onset and parental BMI: a longitudinal cohort study

OBJECTIVE

To explore the relationship between severity of obesity at age 7 and age 15, age at onset of obesity, and parental body mass index (BMI) in obese children and adolescents.

DESIGN

Longitudinal cohort study.

SUBJECTS

Obese children (n = 231) and their parents (n = 462) from the Swedish National Childhood Obesity Centre.

METHODS

Multivariate regression analyses were applied with severity of obesity (BMI standard deviation score (BMI SDS)) and onset of obesity as dependent variables. The effect of parental BMI was evaluated and in the final models adjusted for gender, parental education, age at onset of obesity, severity of obesity at age 7 and obesity treatment.

RESULTS

For severity of obesity at age 7, a positive correlation with maternal BMI was indicated (P = 0.05). Severity of obesity at this age also showed a strong negative correlation with the age at onset of obesity. Severity of obesity at age 15 was significantly correlated with both maternal and paternal BMI (P < 0.01). In addition, BMI SDS at age 15 differed by gender (higher for boys) and was positively correlated with severity of obesity at age 7 and negatively correlated with treatment. Also, a negative correlation was indicated at this age for parental education. No correlation with age at onset was found at age 15. For age at onset of obesity there was no relevant correlation with parental BMI. Children within the highest tertile of the BMI SDS range were more likely to have two obese parents.

CONCLUSION

The impact of parental BMI on the severity of obesity in children is strengthened as the child grows into adolescence, whereas the age at onset is probably of less importance than previously thought. The influence of parental relative weight primarily affects the severity of childhood obesity and not the timing.

Birth weight was negatively correlated with plasma ghrelin, insulin resistance, and coenzyme Q10 levels in overweight children

The purpose of this study was to investigate the relationship between birth weight and appetite related hormones, insulin resistance, and antioxidant status in overweight children aged 9-10 years. Thirty-four healthy overweight children (18 boys, 16 girls) were evaluated with respect to anthropometric measurement, lipid profiles, leptin, ghrelin, glucose, insulin, C-peptide, lipid soluble vitamins, and antioxidant enzyme activities. I found that birth weight was negatively correlated with insulin resistance parameters, ghrelin, and coenzyme Q10 levels. There was a significant positive correlation between present BMI and leptin level, while a negative correlation was noted between the BMI and α-tocopherol and lycopene levels. When total subjects were classified into three groups by tertiles of birth weight, the lowest tertile of birth weight (LTB) group showed higher levels of fasting glucose, HOMA-IR, and ghrelin level than the highest tertile of birth weight (HTB) groups. On the other hand, HTB group showed an increased oxidative stress (decreased coenzyme Q10 level and catalase activity) compared to the LTB group. In conclusion, plasma ghrelin level might play an important role in accelerated growth in overweight children with LTB. Increased insulin resistance is present in overweight children with LTB, while decreased coenzyme Q10 and catalase activity in overweight children with HTB. These results suggest that birth weight might be an important factor for determination of treatment for obesity related complications in childhood obesity.

Infant overweight is associated with delayed motor development

OBJECTIVE

To examine how infant overweight and high subcutaneous fat relate to infant motor development.

STUDY DESIGN

Participants were from the Infant Care, Feeding, and Risk of Obesity Project, a prospective, longitudinal study of low-income African-American mother-infant dyads assessed from 3 to 18 months of age (836 observations on 217 infants). Exposures were overweight (weight-for-length z-score>or=90th percentile of 2000 Centers for Disease Control/National Center for Health Statistics growth reference) and high subcutaneous fat (sum of 3 skinfold measurements>90th percentile of our sample). Motor development was assessed by using the Bayley Scales of Infant Development-II. Developmental delay was characterized as a standardized Psychomotor Development Index score<85. Longitudinal models estimated developmental outcomes as functions of time-varying overweight and subcutaneous fat, controlling for age and sex. Alternate models tested concurrent and lagged relationships (earlier weight or subcutaneous fat predicting current motor development).

RESULTS

Motor delay was 1.80 times as likely in overweight infants compared with non-overweight infants (95% CI,1.09-2.97) and 2.32 times as likely in infants with high subcutaneous fat compared with infants with lower subcutaneous fat (95% CI, 1.26-4.29). High subcutaneous fat was also associated with delay in subsequent motor development (odds ratio, 2.27; 95% CI, 1.08-4.76).

CONCLUSIONS

Pediatric overweight and high subcutaneous fat are associated with delayed infant motor development.

Body composition from birth to 4.5 months in infants born to non-obese women

Infant body composition is affected by maternal obesity, which results in increased % body fat in the infant. With the rapidly increasing incidence of obesity, it is important that normative data are available for infant body composition that is not affected by this trend in maternal obesity. This study assessed body composition in infants born at term to women with a BMI between 18.5 and 25. Infant % body fat, fat mass (FM), and fat free mass (FFM) were assessed at birth, 6 wk, 3 mo, and 4.5 mo of age by air displacement plethysmography, using the PEA POD body composition system. The effects of age, gender, GA, and feeding mode on these parameters were assessed. The % body fat doubled between birth and 6 wk of age and then increased at a slower rate. FFM was higher in male infants at all ages, whereas % body fat was higher in female infants at 4.5 mo. There was a trend to increased % fat and decreased FFM in breastfed (BF) infants. The study provides unique data regarding changes in infant body composition and growth in infants born to women in the healthy weight range.

Maternal postpartum distress and childhood overweight

OBJECTIVE

We investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight.

METHODS

We performed a prospective cohort study, including 21,121 mother-child-dyads from the Danish National Birth Cohort (DNBC). Maternal distress was measured 6 months postpartum by 9 items covering anxiety, depression and stress. Outcome was childhood overweight at 7-years-of age. Multiple logistic regression analyses were performed and information on maternal age, socioeconomic status, pre-pregnancy BMI, gestational weight gain, parity, smoking during pregnancy, paternal BMI, birth weight, gestational age at birth, sex, breastfeeding and finally infant weight at 5 and 12 month were included in the analyses.

RESULTS

We found, that postpartum distress was not associated with childhood risk of overweight, OR 1.00, 95%CI [0.98-1.02]. Neither was anxiety, depression, or stress exposure, separately. There were no significant differences between the genders. Adjustment for potential confounders did not alter the results.

CONCLUSION

Maternal postpartum distress is apparently not an independent risk factor for childhood overweight at 7-years-of-age. However, we can confirm previous findings of perinatal determinants as high maternal pre-pregnancy BMI, and smoking during pregnancy being risk factors for childhood overweight.

Growth in foetal life and infancy is associated with abdominal adiposity at the age of 2 years: the generation R study

OBJECTIVE

Early weight gain is associated with an increased risk of obesity. It is not known whether rapid weight gain in foetal life and infancy is also associated with increased abdominal adiposity. We examined the associations of foetal and postnatal growth characteristics with abdominal fat mass at the age of 2 years.

DESIGN

This study was performed in 481 children participating in a prospective cohort study from early foetal life onward.

MEASUREMENTS

Foetal and postnatal growth characteristics in second and third trimester, at birth and at the age of 2 years were related to abdominal fat mass (subcutaneous distance and area, preperitoneal distance and area) measured by ultrasound at the age of 2 years.

RESULTS

Foetal and birth weight were not associated with abdominal subcutaneous fat mass. Estimated foetal weight in second trimester of pregnancy was inversely associated with preperitoneal fat area [-3.73% (95% confidence interval -7.23, -0.10)] per standard deviation score increase in weight. Weight gain from birth to the age of 2 years was positively associated with preperitoneal fat mass measures. These associations remained significant after adjustment for age, sex, breastfeeding and body mass index. Positive associations were found between catch-up growth in weight and abdominal fat mass measures.

CONCLUSIONS

Our results suggest that rapid growth rates during foetal life and infancy are associated with increased abdominal subcutaneous and preperitoneal fat mass in healthy children. Further studies need to explore whether these associations persist in later life and are related to metabolic syndrome outcomes.