Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans

Strategies for feeding the preterm infant

According to many experts in neonatal nutrition, the goal for nutrition of the preterm infant should be to achieve a postnatal growth rate approximating that of the normal fetus of the same gestational age. Unfortunately, most preterm infants, especially those born very preterm with extremely low birth weight, are not fed sufficient amounts of nutrients to produce normal fetal rates of growth and, as a result, end up growth-restricted during their hospital period after birth. Growth restriction is a significant problem, as numerous studies have shown definitively that undernutrition, especially of protein, at critical stages of development produces long-term short stature, organ growth failure, and both neuronal deficits of number and dendritic connections as well as later behavioral and cognitive outcomes. Furthermore, clinical follow-up studies have shown that among infants fed formulas, the nutrient content of the formula is directly and positively related to mental and motor outcomes later in life. Nutritional requirements do not stop at birth. Thus, delaying nutrition after birth 'until the infant is stable' ignores the fundamental point that without nutrition starting immediately after birth, the infant enters a catabolic condition, and catabolism does not contribute to normal development and growth. Oxygen is necessary for all metabolic processes. Recent trends to limit oxygen supply to prevent oxygen toxicity have the potential, particularly when the blood hemoglobin concentration falls to less than 8 g/dl, to develop growth failure. Glucose should be provided at 6-8 mg/min/kg as soon after birth as possible and adjusted according to frequent measurements of plasma glucose to achieve and maintain concentrations >45 mg/dl but <120 mg/dl to avoid the frequent problems of hyperglycemia and hypoglycemia. Similarly, lipid is required to provide at least 0.5 g/kg/day to prevent essential fatty acid deficiency. However, the high rate of carbohydrate and lipid supply that preterm infants often get, based on the incomplete assumption that this is necessary to promote protein growth, tends to produce increased fat in organs like the liver and heart as well as adipose tissue. More and better essential fatty acid nutrition is valuable, but more organ and adipose fat has no known benefit and many problems. Amino acids and protein are essential not only for body growth but for metabolic signaling, protein synthesis, and protein accretion. 3.5-4.0 g/kg/day are necessary to produce normal protein balance and growth in very preterm infants. Attempts to promote protein growth with insulin has many problems - it is ineffective while contributing to even further organ and adipose tissue fat deposition. Enteral feeding always is indicated and to date nearly all studies have shown that minimal enteral feeding approaches (e.g., 'trophic feeds') promote the capacity to feed enterally. Milk has distinct advantages over formulas in avoiding necrotizing enterocolitis (NEC), and while feeding is associated with NEC, minimal enteral feeding regimens produce less NEC than those geared towards more aggressive introduction of enteral feeding. Finally, overfeeding has the definite potential to produce adipose tissue, or obesity, which then leads to insulin resistance, glucose intolerance, and diabetes. This scenario occurs more commonly as infants are fed more and gain weight more rapidly after birth, regardless of their birth weight. Infants with IUGR and postnatal growth failure may be uniquely 'set up' for this outcome, while infants with in utero obesity, such as infants of diabetic mothers, already are well along this adverse outcome pathway.

Pediatric overweight or obesity: does the label really matter?

PURPOSE

To discuss the issue of early identification of overweight and obesity in infants and young children and provide some clinical recommendations based on the current evidence and the World Health Organization's (WHO) newly released guidelines for growth and development.

DATA SOURCES

Comparison of the growth charts from the WHO and the Centers for Disease Control as well as current literature.

CONCLUSIONS

Although healthcare providers and the general public recognize overweight and obesity as serious problems, there is still disagreement on what constitutes obesity in infants and young children and when and how to intervene. More research on interventions and outcomes is particularly needed.

IMPLICATIONS FOR PRACTICE

The primary care provider deals with the sequelae of obesity on a daily basis. Some recommendations are provided for nurse practitioners who care for infants and children based on current evidence and expert opinion.

Healthcare providers' perceptions of the factors contributing to infant obesity in a low-income Mexican American community

PURPOSE

To examine healthcare professionals' perceptions of Mexican American infant feeding practices and obesity.

DESIGN AND METHODS

Five provider focus groups (n = 38 providers) were conducted in two agencies in the Denver area on the topic of contributors to childhood obesity in the Mexican American community.

RESULTS

Healthcare providers believe obesity in Mexican American infants is related to: (a) a chubby baby being a healthy baby, (b) introducing complementary foods early, (c) extended family members' infant feeding practices, (d) offering infants high-calorie foods, and (e) prolonged bottle feeding and sweet beverages. Providers reported ambivalence regarding their role in addressing infant obesity.

PRACTICE IMPLICATIONS

Healthcare providers working with Mexican American families should deliver consistent, culturally specified messages regarding infant feeding and activity practices.

Infant growth and later body composition: evidence from the 4-component model

BACKGROUND

Rapid weight gain in infancy is associated with higher body mass index in later life, but its relation with individual body-composition components remains unclear.

OBJECTIVE

We aimed to investigate associations between weight gain during different periods in infancy and later fat mass (FM) and fat-free mass (FFM).

DESIGN

Body composition was assessed by using the 4-component model, dual-energy X-ray absorptiometry, and anthropometry in 234 healthy UK children and adolescents (105 boys; x +/- SD age: 11.4 +/- 3.8 y). Early growth measurements were prospective in 52 subjects and retrospective in 182. Relative weight gain was calculated as change in SD score (SDS) during different periods.

RESULTS

Relative weight gain from 0 to 3 mo and from 3 to 6 mo showed positive relations with childhood FM, waist circumference, and trunk FM that were equivalent to increases in FMI (FM/height(2)) of 0.24 SDS (95% CI: 0.04, 0.44) and 0.50 SDS (0.25, 0.75) per 1-SDS increase in early weight and that were comparable to the effect of current obesity risk factors. Relative weight gain from 0 to 3 mo was also positively associated with later FFMI (FFM/height(2)). Relative weight gain from 6 to 12 mo was not associated with later body composition. Associations were independent of birth weight, sex, puberty, physical activity, socioeconomic class, ethnicity, and parental body mass index.

CONCLUSIONS

In this Western population, greater relative weight gain during early infancy was positively associated with later FM and central fat distribution and with FFM. Rapid weight gain in infancy may be a risk factor for later adiposity. Early infancy may provide an opportunity for interventions aimed at reducing later obesity risk.

Catch-up growth following fetal growth restriction promotes rapid restoration of fat mass but without metabolic consequences at one year of age

Background

Fetal growth restriction (FGR) followed by rapid weight gain during early life has been suggested to be the initial sequence promoting central adiposity and insulin resistance. However, the link between fetal and early postnatal growth and the associated anthropometric and metabolic changes have been poorly studied.

Methodology/Principal Findings

Over the first year of post-natal life, changes in body mass index, skinfold thickness and hormonal concentrations were prospectively monitored in 94 infants in whom the fetal growth velocity had previously been measured using a repeated standardized procedure of ultrasound fetal measurements. 45 infants, thinner at birth, had experienced previous FGR (FGR+) regardless of birth weight. Growth pattern in the first four months of life was characterized by greater change in BMI z-score in FGR+ (+1.26+/−1.2 vs +0.58 +/−1.17 SD in FGR−) resulting in the restoration of BMI and of fat mass to values similar to FGR−, independently of caloric intakes. Growth velocity after 4 months was similar and BMI z-score and fat mass remained similar at 12 months of age. At both time-points, fetal growth velocity was an independent predictor of fat mass in FGR+. At one year, fasting insulin levels were not different but leptin was significantly higher in the FGR+ (4.43+/−1.41 vs 2.63+/−1 ng/ml in FGR−).

Conclusion

Early catch-up growth is related to the fetal growth pattern itself, irrespective of birth weight, and is associated with higher insulin sensitivity and lower leptin levels after birth. Catch-up growth promotes the restoration of body size and fat stores without detrimental consequences at one year of age on body composition or metabolic profile. The higher leptin concentration at one year may reflect a positive energy balance in children who previously faced fetal growth restriction.

Conjugated linoleic acid reduces body fat accretion and lipogenic gene expression in neonatal pigs fed low- or high-fat formulas

Childhood obesity is an increasing problem and may predispose children to adult obesity. Weight gain during infancy has been linked to excessive weight later in life. Conjugated linoleic acids (CLA) have been shown to reduce fat gain and body fat mass in animal models and in humans. The effects of CLA in a piglet model of human infancy have not been determined. The objective of this experiment was to examine the regulation of body composition and lipid metabolism in pigs fed low- and high-fat milk formulas supplemented with CLA. Twenty-four piglets were fed low- (3%) or high-fat (25%) diets with or without 1% CLA in a 2 x 2 factorial design. Formulas were fed for 16-17 d. Piglet body weight gains did not differ, although pigs fed the low-fat diets consumed greater amounts of diet. Piglets fed the high-fat formula accreted 50% more body fat during the feeding period than low-fat fed piglets and CLA reduced body fat accretion regardless of dietary fat content. Liver and muscle in vitro oxidation of palmitate was not influenced by dietary treatments. Adipose tissue expression of acetyl-CoA carboxylase-alpha and lipoprotein lipase were significantly reduced by CLA treatment. Overall, CLA reduced body fat accretion without influencing daily gain in a piglet model of human infancy. Results indicate that inhibition of fatty acid uptake and synthesis by adipose tissue, and not increased fatty acid oxidation in liver or muscle, were involved in reducing body fat gain.

A new 'crowded uterine horn' mouse model for examining the relationship between foetal growth and adult obesity

Obesity is an increasing health problem, not only in developed countries but also all over the world. In addition to the focus on food intake and energy expenditure, current studies suggest two other important influences on adult body weight: birth weight and postnatal rate of growth. A common procedure in laboratory animal studies to examine the relationship of low birth weight and adult obesity is maternal nutrient restriction, but maternal undernutrition is not the basis for the majority of obese individuals in developed countries. We have thus developed a new mouse model for human obesity referred to as 'the crowded uterine horn model'. By removing one ovary from a female CD-1 mouse, the female produces a litter of about 13 pups in one uterine horn, resulting in crowding and a 4-fold difference in placental blood flow among foetuses in a litter. Restricted placental blood flow results in intrauterine growth restriction (IUGR); these animals show a 2-fold increase in body weight during the week after weaning, while macrosomial foetuses that go through a very small amount of growth during the same postnatal period. Male mice categorized as IUGR or macrosomic at birth both are obese in adulthood. This pattern of changes in body weight throughout life in male mice mirrors findings from epidemiological studies of human foetuses with IUGR and macrosomia who become obese, and thus may provide a new model that reflects the condition of people in developed countries who become obese.

Teaching children with diabetes about adequate dietary choices

Recent recommendations by the American Diabetes Association suggest that children with type 1 diabetes should follow the recommendations for age, sex and body size of the general population. In the case of being overweight or obese, weight-control strategies should be applied. Adherence to recommendations should be pursued by continuous nutritional education that should start at the onset of diabetes and maintained by means of nutritional counselling to the family. The second main target of nutritional intervention is to encourage a reproducible daily meal plan that can be maintained by acquiring good habits when making nutritional choices. Finally, children and parents should be taught how to count carbohydrates, which would help them manage exceptions in their daily meal plan. Specifically, nutritional recommendations for children with diabetes focus on limiting the intake of foods of animal origin (red meat, cheese, cold cuts), moderating fat intake and promoting the intake of foods that naturally contain fibre (mainly vegetables, legumes, fruit). There are two at-risk periods in the lives of children when nutritional education procedures as well as diabetes care in general are less likely to be effective: early years of life and adolescence. In the case of very young children, new behavioural-based intervention strategies to help parents improve mealtimes could be useful in teaching diabetic children to learn to follow a structured eating schedule, which is desirable for long-lasting efficacy in diabetes care. In adolescents, eating disorders and insulin misuse for weight control purposes are concrete and difficult problems to deal with. A good balance between eating for pleasure and maintaining one's health is a challenge for anyone. Appropriate nutritional education helps children with diabetes to find this balance and enjoy a better quality of life.

Growth of low birth weight preterm children

Very low birth weight premature (VLBWPT) infants demonstrate growth patterns in the early years of life which differ from those of term and large low birth weight preterm (LBWPT) peers. Optimal post natal growth of VLBWPT children is associated with more positive later health and neurodevelopmental outcomes. The neonatologist engaged in the follow of care of VLBWPT infants after discharge from the Neonatal Intensive Care Unit should monitor over time the velocity of weight, length, head circumference and weight/length ratio utilizing appropriate growth references. VLBW children who demonstrate atypically low weight gain in the early years of life have a higher probability of less than optimal cognitive development over time, while those with excessive weight gain have a greater likelihood of later childhood and adult obesity, cardiovascular disease, and diabetes. Nutritional planning should provide adequate calories for gradual normalization in all growth variables, while attempting to avoid atypically low or excessive weight gain. This nutritional planning should take into account the child's genetic growth potential, small for gestational age (SGA) or at gestational age (AGA), and clinical issues such as the presence of diseases like gastroesophageal (GE) reflux or chronic lung disease. Whatever nutritional approach is used, the neonatologist in follow up should track weight, length, head circumference, and weight/length ratio and adjust the nutrition plan and caloric intake to assure gradual return to normal in all growth variables while avoiding excessive weight gain.

Impact of early postnatal weight gain and feeding patterns on body mass index in adolescence

Postnatal weight gain may predispose to the development of obesity during childhood. The aims of this study were to study the impact of weight gain during specific periods of the first year of life and of feeding patterns on the body mass index (BMI) of adolescents. Growth records during the first 24 months of life of 88 obese and 214 non-obese 12 year-old Arab children were evaluated. Birth weight and length were similar for obese and non-obese adolescents, while the rate of breastfeeding was significantly lower in the obese group (p < 0.01). Obese adolescents demonstrated a small yet significant accelerated weight gain at 4 (p = 0.002) and 12 (p = 0.01) months of age. Weight gain during the first 2 months of life and feeding pattern were independent predictors of BMI at the age of 12 years. Thus, early postnatal weight gain is associated with obesity in adolescence, while breastfeeding seems to have a protective effect.

Early weaning is related to weight and rate of weight gain in infancy

BACKGROUND

Evidence relating to the effect of early weaning on infant weight and weight gain is conflicting. The aim of this paper is to compare weight and weight gain in two groups of infants; one group weaned before 4 months (early weaned), the other weaned at 4 months or after.

METHODS

Feeding practices were assessed through semistructured interviews with mothers of 1-year-old infants. Weight at birth, 8 weeks and 7 months were taken from an administrative database (Child Health System), and an additional measure of weight was taken at 14 months.

RESULTS

Infants weaned early were heavier at 7 and 14 months, and gained more weight between 8 weeks and 14 months, even after breastfeeding was controlled for.

CONCLUSION

Early weaning is related to rapid weight gain in infancy. This may have implications for childhood obesity.

Measuring the body composition of preterm and term neonates: from research to clinical applications

Assessment of body and weight gain composition is one of the major keys for the evaluation of nutritional requirements in preterm and term infants. The changes in body composition during the first years of life seem to play an important role in the nutritional programming of adult morbidity. Noninvasive and indirect techniques are the most suitable methods for measuring body composition in preterm and term infants. Most of these techniques are used in clinical practice, whereas others are used mainly for research.

Environmental influences on childhood obesity: ethnic and cultural influences in context

Ethnicity is associated with differences in food-related beliefs, preferences, and behaviors, and cultural influences may contribute to the higher than average risk of obesity among children and youth in U.S. ethnic minority populations. However, cultural attitudes and beliefs are not the only potential source of ethnic variation in childhood obesity prevalence and should not be studied in isolation. Demographic, socio-structural, and environmental variables must also be considered. Available evidence indicates ethnic differences along several pathways that may increase risks of obesity development during gestation, infancy, childhood and adolescence. These include above-average prevalence of obesity in adult females and of maternal diabetes during pregnancy, parental attitudes and practices that may lead to overfeeding children, above-average levels of consumption of certain high calorie foods and beverages, and inadequate physical activity. Environments with lower than average neighborhood availability of healthful foods and higher than average availability of fast food restaurants, along with exposure to ethnically targeted food marketing may contribute to reliance on high calorie foods and beverages, and these foods may be socially and culturally valued. Attitudes about and environmental contexts for physical activity are also relevant. Increasingly, it is acknowledged that individual behaviors and lifestyles, e.g. food choices or child feeding practices, are responsive to the ecological contexts in which they are practiced. Focusing attention on the fluid interactions of cultural influences with contextual factors, of recognized importance for the study of childhood undernutrition, can also lead to further understanding of how to address ethnic disparities in childhood obesity.

Child and adolescent obesity: epidemiology and developmental perspectives

From infancy through adolescence, more and more children are becoming overweight. National prevalence data show that more than 17% of youth have a body mass index (BMI) above the 95th percentile of the US age and sex-specific reference. Particularly alarming are rates in children as young as 2 years of age, and among minority children. Periods of heightened vulnerability to weight gain have been identified, and research supports the notion that obesity has its origins in early life. This paper focuses on susceptibility to increased adiposity during the prenatal period, infancy, mid-childhood and adolescence, and how factors operating in each of these periods influence risk of becoming overweight. Prenatal exposure to over or undernutrition, rapid growth in early infancy, an early adiposity rebound in childhood, and early pubertal development have all been implicated in the development of obesity. The persistence of obesity from young ages emphasizes the importance of understanding growth trajectories, and of developing prevention strategies to overcome strong influences of obesigenic environments at young ages.

Genetic and environmental influences on infant weight and weight change: the Fels Longitudinal Study

Despite significant progress in understanding the mechanisms by which the prenatal/maternal environment can alter development and adult health, genetic influences on normal variation in growth are little understood. This work examines genetic and nongenetic contributions to body weight and weight change during infancy and the relationships between weight change and adult body composition. The dataset included 501 white infants in 164 nuclear and extended families in the Fels Longitudinal Study, each with 10 serial measures of weight from birth to age 3 years and 232 with body composition data in mid-adulthood. Heritability and covariate effects on weight and weight z-score change from birth to 2 years of age were estimated using a maximum likelihood variance decomposition method. Additive genetic effects explained a high proportion of the variance in infant weight status (h2=0.61-0.95), and change in weight z-score (h2=0.56-0.82). Covariate effects explained 27% of the phenotypic variance at 0-1 month of age and declined in effect to 6.9% of phenotypic variance by 36 months. Significant sex, gestational age, birth order, birth year, and maternal body mass index effects were also identified. For both sexes, a significant increase in weight z-score (>2 SD units) (upward centile crossing) was associated with greater adulthood stature, fat mass, and percent body fat than decrease or stability in weight z-score. Understanding genetic influences on growth rate in a well-nourished, nutritionally stable population may help us interpret the causes and consequences of centile crossing in nutritionally compromised contexts.

Birth weight; postnatal, infant, and childhood growth; and obesity in young adulthood: evidence from the Barry Caerphilly Growth Study

BACKGROUND

Birth weight has been shown to be positively associated with adult obesity, but relatively few studies have examined the associations with growth in specific periods of early childhood.

OBJECTIVE

The objective was to assess the association of measures of growth between birth and 5 y of age with adult measures of adiposity.

DESIGN

We conducted a longitudinal study of young adults from Barry and Caerphilly, United Kingdom, who had previously taken part between 1972 and 1974 in a randomized controlled trial of milk supplementation. We reexamined 679 men and women (72% of the target population) to measure body mass index (BMI; in kg/m(2)), waist-to-hip ratio, sagittal abdominal diameter, and waist circumference.

RESULTS

An increase in weight velocity from 1 y and 9 mo to 5 y of age was the most important predictor of BMI, waist circumference, and sagittal abdominal diameter. A z-score increase in weight gain in this period was associated with an increase in BMI of 1.13 (95% CI: 0.69, 1.57; P < 0.001). Infant weight gain from 5 mo to 1 y and 9 mo was the strongest predictor of waist-to-hip ratio (0.51; 95% CI: 0.00, 1.02; P = 0.05).

CONCLUSIONS

Birth weight does not predict adiposity on the basis of weight gain in childhood. The association between adult adiposity and weight gain in different periods is variable and depends on the measure of adiposity that is used. It remains unclear whether early childhood is the optimum period in the life course for the primary prevention of adult adiposity.

Programming of body composition by early growth and nutrition

There is now compelling evidence that growth patterns in early life are associated with risk of the metabolic syndrome in adulthood, although the relative importance of prenatal v. postnatal growth for such associations remains controversial. Body composition may play a key role in the ‘programming’ of such diseases, through itself being programmed by early growth, and perhaps also by being a mediator of the programming process. Early studies reporting positive associations between birth weight and adult BMI suggested a tendency for large babies to become obese adults. Such findings appeared contradictory to the many studies linking low birth weight with increased risk of the metabolic syndrome. Recent studies now indicate that birth weight is strongly predictive of later lean mass, and has a much weaker association with later fatness. Studies that link low birth weight with a more central adipose distribution in later life remain controversial, and require confirmation using more sophisticated methodologies. Findings for infant growth rate appear population-specific, with infant weight gain predicting subsequent lean mass in developing countries, but predicting subsequent fat mass and obesity in industrialised populations. Further studies are required on this issue, to ensure that appropriate public health policies are recommended for countries across the range of economic development. Although the links between early growth and later disease risk implicate early-life nutrition, either in utero or during infancy, few prospective studies have explored the influence of early diet on later body composition. Many studies have associated breast-feeding with a reduced prevalence of obesity categorised by BMI; however, the few studies directly evaluating childhood fatness provide little support for this hypothesis. Recent advances in the ability to measure body composition during the infant period offer a major opportunity to improve the understanding of the nutritional programming of body composition and its contribution, or lack thereof, to subsequent disease risk.

Nature and strength of epidemiological evidence for origins of childhood and adulthood obesity in the first year of life

Increased interest in early life origins of chronic disease, a concept often referred to as programming, has resulted in several studies investigating the origins of childhood or adulthood obesity during infancy. Rapid infancy weight gain as a risk factor and breastfeeding as a protective factor for later obesity have been most thoroughly studied. The association between rapid infancy weight gain and later obesity is supported by several observational studies, but not by the two, relatively small, randomized trials. This association is strong, suggests a dose-response effect and has biological plausibility, but is not consistent between study designs. Rapid infancy weight gain as a risk factor for later obesity has been experimentally reproduced in animal models, but not in humans. The protective effect of breastfeeding on obesity is also supported by several observational studies, but randomized trials are not available. Considering the potential for residual confounding factors, current evidence is insufficient to demonstrate origins of obesity during infancy or to change public health recommendations, but the potential for obesity prevention during infancy is promising.

Size at birth and growth trajectories to young adulthood

Few studies in developing countries follow growth trajectories from birth to adulthood. Such studies are important because size at birth and postnatal growth affect risk of chronic disease in adulthood. This study examines the inter-relationships of maternal factors during pregnancy, infant birth weight and length, early postnatal growth, and young adult height, weight, BMI, and skinfold thicknesses, with particular attention to patterns of growth associated with increased chronic disease risk. Women were recruited in pregnancy, and offspring were followed from birth to age 21 in the community-based Cebu (Philippines) Longitudinal Health and Nutrition Survey. Birth weight and length are independently, positively associated with height, BMI and sum of skinfolds in young adult males and females, and inversely associated with the subscapular to triceps ratio in males only. The effects of size at birth on adult size were modified by birth order, and remained significant after adjusting for maternal nutritional status, socioeconomic status at birth and throughout the growth period, and maturation. Early postnatal growth was strongly influenced by BMI at birth, with rapid early infant weight gain associated with thinness. The growth pattern of the at-risk group most often associated with increased risk of chronic disease (small at birth, relatively heavy as an adult), was characterized by more rapid growth in the first 4 postnatal months. The high level of inter-relatedness of maternal nutrition in pregnancy, prenatal growth, and postnatal growth emphasizes the need to consider the full growth trajectory in studies of developmental origins of adult disease.

Parent overweight predicts daughters' increase in BMI and disinhibited overeating from 5 to 13 years

OBJECTIVE

To assess whether parental overweight status and disinhibited overeating are predictive of daughters' accelerated weight gain and disinhibited overeating.

RESEARCH METHODS AND PROCEDURES

Participants were part of a longitudinal study of girls (N = 197) and their parents. Measured height and weight were used to calculate BMI [weight (kilograms)/height (meters)(2)]. Parents' disinhibited eating behavior was assessed using the Eating Inventory. Girls' disinhibited eating was assessed using a behavioral protocol to measure eating in the absence of hunger. Girls were classified based on parental overweight at study entry into four groups: neither, mother only, father only, or both parents overweight.

RESULTS

Girls with both parents overweight had the most rapid increases in BMI from 5 to 13 years of age; BMI increased most slowly among the neither parent overweight group, with intermediate increases in BMI among mother only and father only overweight groups. Daughters with both parents overweight at study entry were eight times more likely to be overweight at age 13, controlling for daughters' weight at age 5. Girls with both parents overweight had higher levels of disinhibited eating across all ages than all other groups. Although girls in all parental weight status groups showed increases in disinhibited eating over time, girls with both parents overweight had larger increases in disinhibited eating over time compared with all other groups.

DISCUSSION

Girls growing up in families differing in parental overweight had divergent developmental trajectories for BMI and disinhibited overeating. Findings reveal the need to focus prevention efforts on overweight parents of young children.

Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population

BACKGROUND

Pre-natal and post-natal growth are associated with adult body composition, but the relative importance of growth in different periods of childhood is still unclear, particularly in stunted populations.

METHODS

We studied 358 women and 352 men measured as children in 1969-77 in four villages in Guatemala, and re-measured as adults in 2002-04 (mean age 32.7 years). We determined the associations of body mass index (BMI) and length at birth, and changes in BMI and length during infancy (0-1.0 year) and early (1.0-3.0 years) and later (3.0-7.0 years) childhood, with adult BMI ((a)BMI), percentage of body fat ((a)PBF), abdominal circumference ((a)AC) and fat-free mass ((a)FFM).

RESULTS

Prevalence of stunting was high (64% at 3 years; HAZ < -2SD). Obesity (WHZ > 2SD) prevalence in childhood was <2%, while overweight prevalence in adulthood was 52%. BMI at birth was positively associated with (a)BMI and (a)FFM while length at birth was positively associated with (a)AC and (a)FFM. Increased BMI in infancy and later childhood were positively associated with all four adult body composition measures; associations in later childhood with fatness and abdominal fatness were stronger than those with (a)FFM. Change in length during infancy and early childhood was positively associated with all four adult body composition outcomes; the associations with (a)FFM were stronger than those with fat mass.

CONCLUSIONS

Increases in BMI between 3.0 and 7.0 years had stronger associations with adult fat mass and abdominal fat than with (a)FFM; increases in length prior to age 3.0 years were most strongly associated with increases in (a)FFM.

Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model

BACKGROUND

A better understanding of the associations of early infant nutrition and growth with adult health requires accurate assessment of body composition in infancy.

OBJECTIVE

This study evaluated the performance of an infant-sized air-displacement plethysmograph (PEA POD Infant Body Composition System) for the measurement of body composition in infants.

DESIGN

Healthy infants (n = 49; age: 1.7-23.0 wk; weight: 2.7-7.1 kg) were examined with the PEA POD system. Reference values for percentage body fat (%BF) were obtained from a 4-compartment (4-C) body-composition model, which was based on measurements of total body water, bone mineral content, and total body potassium.

RESULTS

Mean (+/- SD) reproducibility of %BF values obtained with the PEA POD system was 0.4 +/- 1.3%. Mean %BF obtained with the PEA POD system (16.9 +/- 6.5%) did not differ significantly from that obtained with the 4-C model (16.3 +/- 7.2%), and the regression between %BF for the 4-C model and that for the PEA POD system (R2 = 0.73, SEE = 3.7%BF) did not deviate significantly from the line of identity (y = x).

CONCLUSIONS

The PEA POD system provided a reliable, accurate, and immediate assessment of %BF in infants. Because of its ease of use, good precision, minimum safety concerns, and bedside accessibility, the PEA POD system is highly suitable for monitoring changes in body composition during infant growth in both the research and clinical settings.

Developmental programming of obesity in mammals

Converging lines of evidence from epidemiological studies and animal models now indicate that the origins of obesity and related metabolic disorders lie not only in the interaction between genes and traditional adult risk factors, such as unbalanced diet and physical inactivity, but also in the interplay between genes and the embryonic, fetal and early postnatal environment. Whilst studies in man initially focused on the relationship between low birth weight and risk of adult obesity and metabolic syndrome, evidence is also growing to suggest that increased birth weight and/or adiposity at birth can also lead to increased risk for childhood and adult obesity. Hence, there appears to be increased risk of obesity at both ends of the birth weight spectrum. Animal models, including both under- and overnutrition in pregnancy and lactation lend increasing support to the developmental origins of obesity. This review focuses upon the influence of the maternal nutritional and hormonal environment in pregnancy in permanently programming appetite and energy expenditure and the hormonal, neuronal and autocrine mechanisms that contribute to the maintenance of energy balance in the offspring. We discuss the potential maternal programming 'vectors' and the molecular mechanisms that may lead to persistent pathophysiological changes resulting in subsequent disease. The perinatal environment, which appears to programme subsequent obesity, provides a potential therapeutic target, and work in this field will readily translate into improved interventional strategies to stem the growing epidemic of obesity, a disease which, once manifest, has proven particularly resistant to treatment.

Rapid growth among term children whose birth weight was appropriate for gestational age has a longer lasting effect on body fat percentage than on body mass index

BACKGROUND

It is not clear whether and how rapid growth in infancy, a risk factor for later obesity, differentially affects growth and body-composition development throughout childhood in term children with an appropriate-for-gestational age (AGA) birth weight.

OBJECTIVE

The aim was to examine the effect of rapid growth in infancy on body mass index SD score (BMI SDS) and body fat percentage (%BF) trajectories until age 7 y.

DESIGN

This analysis included 206 (50.5% female) AGA term participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Repeated anthropometric measurements were obtained between 0.5 and 7 y of age.

RESULTS

Fifty-nine of the 206 children (28.6%) displayed rapid growth (an increase in SDS for weight of >0.67 between birth and age 2 y). From 6 mo of age, their growth trajectories diverged from normal growers, and by age 7 y they had a higher BMI, more fat mass, and a higher risk of overweight (odds ratio: 6.2; 95% CI: 2.4, 16.5; P = 0.0002). Multilevel model analyses showed that the differences in BMI were achieved within the first 2 y of life [beta (+/-SE) SDS: 1.22 +/- 0.13], after which they persisted at this level until the age of 7 y, whereas differences in %BF, which were also already discernible by age 2 y (1.52 +/- 0.34%), became progressively larger over the next 5 y (adjusted difference: 0.23 +/- 0.11%/y; P = 0.03).

CONCLUSIONS

Rapid growth in infancy and early childhood results in an increased BMI and %BF throughout childhood and an increased risk of overweight at age 7 y among AGA children. Rapid growth in AGA children has a more pronounced effect on %BF than on BMI.

Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter?

OBJECTIVE

We sought to evaluate whether maternal diabetes or weight status attenuates a previously reported beneficial effect of breast-feeding on childhood obesity.

RESEARCH DESIGN AND METHODS

Growing Up Today Study (GUTS) participants were offspring of women who participated in the Nurses' Health Study II. In the present study, 15,253 girls and boys (aged 9-14 years in 1996) were included. Maternal diabetes and weight status and infant feeding were obtained by maternal self-report. We defined maternal overweight as BMI > or = 25 kg/m2. Childhood obesity, from self-reported height and weight, was based on the Centers for Disease Control and Prevention definitions as normal, at risk for overweight, or overweight. Maternal status categories were nondiabetes/normal weight, nondiabetes/overweight, or diabetes. Logistic regression models used generalized estimating equations to account for nonindependence between siblings.

RESULTS

For all subjects combined, breast-feeding was associated with reduced overweight (compared with normal weight) in childhood. Compared with exclusive use of formula, the odds ratio (OR) for exclusive breast-feeding was 0.66 (95% CI 0.53-0.82), adjusted for age, sex, and Tanner stage. Results did not differ according to maternal status (nondiabetes/normal weight OR 0.73 [95% CI 0.49-1.09]; nondiabetes/overweight 0.75 [0.57-0.99]; and diabetes 0.62 [0.24-1.60]). Further adjustment for potential confounders attenuated results, but results remained consistent across strata of maternal status (P value for interaction was 0.50).

CONCLUSIONS

Breast-feeding was inversely associated with childhood obesity regardless of maternal diabetes status or weight status. These data provide support for all mothers to breast-feed their infants to reduce the risk for childhood overweight.

Reductions in caloric intake and early postnatal growth prevent glucose intolerance and obesity associated with low birthweight

AIMS/HYPOTHESIS

Low birthweight (LBW) and rapid postnatal weight gain, or catch-up growth, are independent risk factors for the development of obesity and diabetes during adult life. Individuals who are both small at birth and have postnatal catch-up growth are at the highest risk. We hypothesised that dietary interventions designed to attenuate catch-up growth in LBW subjects may have long-term beneficial consequences.

MATERIALS AND METHODS

We used our previously described mouse model of LBW-associated diabetes, created by restricting maternal food intake to 50% during the last week of gestation. Control (C) dams and dams that had been subjected to undernutrition (U) were then provided either chow ad libitum after delivery or 50% food restriction on a per-day basis from delivery until weaning. We designated the resulting four groups control-control (CC), undernutrition-control (UC), control-undernutriton (CU) and undernutrition-undernutrition (UU), indicating the prenatal and postnatal experimental conditions, respectively. Carbohydrate metabolism and adiposity were assessed prospectively in offspring until age 6 months.

RESULTS

Males that were small at birth and exhibited early postnatal catch-up growth developed glucose intolerance and obesity by age 6 months. In contrast, LBW mice without catch-up growth (UU) remained smaller than controls (CC), and glucose intolerance and obesity was prevented. Similarly, mice with normal birthweight that had blunted catch-up growth (CU) were leaner and had better tolerance test than CC mice. Catch-up growth during the first week of life correlated better than birthweight with glucose, fat mass and glucose tolerance up to 6 months of age.

CONCLUSIONS/INTERPRETATION

Prevention of early catch-up growth reversed the development of glucose intolerance and obesity in our mouse model of LBW-associated diabetes.

Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions

In a systematic review, we identified 21 separate studies with data on the association between rapid infancy weight gain, up to age 2 y, and subsequent obesity risk. Uniformly all studies reported significant positive associations. We transformed the reported effect sizes to a standard infancy weight gain exposure, and found that further differences in study design accounted for much of the variation in risk. An accompanying paper by Melinda Yeung reminds us that there are benefits of postnatal catch-up growth in certain populations, and suggests that genetic and nutritional factors could moderate the unhealthy translation of rapid infancy weight gain to visceral fat and insulin resistance. Further evidence is needed, and we will need to rigorously test the benefits and risks of any interventions. However, the concept of "healthy" rapid catch-up infancy growth is an attractive prospect.

CONCLUSION

Rapid infancy weight gain is consistently associated with increased subsequent obesity risk, but the predictive ability of different weight gain cut-offs needs to be tested.

Trends in overweight from 1980 through 2001 among preschool-aged children enrolled in a health maintenance organization

OBJECTIVE

To examine overweight trends over a 22-year period among preschool-aged children from primarily middle-income families enrolled in a health maintenance organization.

RESEARCH METHODS AND PROCEDURES

From well-child care visits to a Massachusetts health maintenance organization, we randomly selected one visit per child per calendar year, yielding a study sample of 120,680 children seen at 366,109 visits from 1980 through 2001. Using multivariate logistic regression models accounting for repeated observations of individual children across years, we estimated trends in prevalence of overweight (weight-for-length/height > or = 95th percentile) and at-risk-for-overweight (85th to 95th percentile).

RESULTS

Over the 22-year study period, the observed prevalence of overweight increased from 6.3% to 10.0% and at-risk-for-overweight increased from 11.1% to 14.4%. These increases were evident among all groups of children including infants < 6 months of age. Overall, the adjusted odds ratios were 1.21 per decade (95% confidence interval, 1.17 to 1.25) for overweight and 1.06 per decade (95% confidence interval, 1.03 to 1.08) for at-risk-for-overweight.

DISCUSSION

Rates of overweight are increasing in very young children, even infants, from primarily middle-class families.

Preventing obesity: a life cycle perspective

Traditional approaches to treating overweight and obese adults by focusing on individual weight loss have not been effective in stemming the tide of obesity in the population. Recent research has identified critical factors that, as they accumulate and interact over an individual's life span, may put a person at risk for obesity. These factors include rapid weight gain in infancy and childhood, early puberty, and excessive weight gain in pregnancy. Based on this research, a life cycle perspective can be used to develop comprehensive interventions that address the multiple determinants of obesity. Because obesity tracks across generations, it is essential to adopt effective obesity prevention measures now to prevent even higher rates of obesity in future generations. Dietetics professionals can reduce individual risks by providing nutritional services that support appropriate weight gain in childhood and pregnancy. We can also advocate for policies in communities, schools, and worksites that support breastfeeding, ensure access to health-promoting foods, and provide opportunities to be physically active.

Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years

BACKGROUND

Early growth rate has been linked to later obesity categorised by body mass index (BMI), but the development of body composition has rarely been studied.

METHODS

We tested the hypotheses that (1) birthweight and weight gain in (2) infancy or (3) childhood are associated with later body composition, in 172 Brazilian boys followed longitudinally since birth. Growth was assessed using measurements of weight and height at birth, 6 months, and 1 and 4 y. Measurements at 9 y comprised height, weight and body composition using foot-foot impedance.

RESULTS

Birthweight was associated with later height and lean mass (LM), but not fatness. Weight gain 0-6 months was associated with later height and LM, and with obesity prevalence according to BMI, but not with fatness. Weight gain 1-4 y was associated with later fatness and LM. Weight gain 4-9 y was strongly associated with fatness but not LM. Early growth rate did not correlate positively with subsequent growth rate.

CONCLUSIONS

Early rapid weight gain increased the risk of later obesity, but not through a direct effect on fatness. Childhood weight gain remained the dominant risk factor for later obesity. The reported link between early growth and later obesity may be due partly to hormonal programming, and partly to the contribution of LM to obesity indices based on weight and height. Whether our findings apply to other populations requires further research.

Dietary energy intake at the age of 4 months predicts postnatal weight gain and childhood body mass index

OBJECTIVE

Rapid infant weight gain has been shown to predict later obesity risk; however, it is unclear which factors influence infant diet and weight gain. The objective of this study was to determine whether different feeding patterns and energy intakes that are provided to infants affect body weight and BMI later in childhood.

METHODS

This representative birth cohort study was conducted in the United Kingdom. Energy intake at age 4 months was estimated from 1-day unweighed dietary records in 881 infants and related to their childhood weight gain and BMI.

RESULTS

Among formula- or mixed-fed infants (N = 582), energy intake was higher in first-born infants (mean +/- SE: 2730 +/- 29.4 kJ/day; n = 263) than in subsequent-born infants (2620.8 +/- 25.2 kJ/day; n = 296). Energy intake at 4 months was also higher in infants who were given solid foods earlier (1-2 months: 2805.6 +/- 50.4 kJ/day, n = 89; 2-3 months: 2658.6 +/- 25.2 kJ/day, n = 339; 4+ months: 2587.2 +/- 46.2 kJ/day, n = 111). Higher energy intake at 4 months predicted greater weight gain between birth to age 1, 2, or 3 years and larger body weight and BMI at ages 1 to 5 years. No significant associations were seen in breastfed infants (N = 299).

CONCLUSIONS

Among formula- or mixed-fed infants, dietary energy intake at age 4 months predicted postnatal weight gain and childhood obesity risk. Both prenatal and postnatal factors may influence infant energy intake and postnatal weight gain.

Rapid infant weight gain predicts childhood overweight

OBJECTIVE

To determine among a contemporary cohort whether rapid weight gain between birth and 6 months is associated with risk of childhood overweight and if this risk differs by ethnicity and/or breast-feeding history.

RESEARCH METHODS AND PROCEDURES

This was a cross-sectional survey in 1999 to 2000 of parents/guardians of children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. Measurements were abstracted by chart review, including weight at birth and 6 months, and height and weight at time of survey and every 6 months subsequently. Overweight at 4 years of age was defined as a BMI > or = 95th age- and sex-specific percentiles.

RESULTS

The study sample was 32% Hispanic, 19% black, and 49% white; 17% of children were overweight. Rate of infant weight gain (expressed in terms of 100 g/mo) was significantly associated with being overweight at 4 years (odds ratio, 1.4; 95% confidence interval, 1.3 to 1.6 after adjusting for history of breast-feeding, birth weight, and ethnicity). The odds of being overweight at 4 years of age for Hispanic children were twice those of non-Hispanic children (odds ratio, 2.2; 95% confidence interval, 1.5 to 3.3). The population-attributable risk of overweight at 4 years of age was 19% for children in the highest quintile of infant weight gain.

DISCUSSION

Among this contemporary, multi-ethnic cohort, rapid infant weight gain was associated with increased risk of being overweight at 4 years of age, independently of potential confounders. Identification of the risk factors contributing to rapid weight gain during infancy might improve early recognition and guide strategies for optimal nutrition to prevent the development of childhood overweight.

Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations

Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. Available estimates for the period between the 1980s and 1990s show the prevalence of overweight and obesity in children increased by a magnitude of two to five times in developed countries (e.g. from 11% to over 30% in boys in Canada), and up to almost four times in developing countries (e.g. from 4% to 14% in Brazil). The goal of this synthesis research study was to develop best practice recommendations based on a systematic approach to finding, selecting and critically appraising programmes addressing prevention and treatment of childhood obesity and related risk of chronic diseases. An international panel of experts in areas of relevance to obesity provided guidance for the study. This synthesis research encompassed a comprehensive search of medical/academic and grey literature and the Internet covering the years 1982-2003. The appraisal approach developed to identify best practice was unique, in that it considered not only methodological rigour, but also population health, immigrant health and programme development/evaluation perspectives in the assessment. Scores were generated based on pre-determined criteria with programmes scoring in the top tertile of the scoring range in any one of the four appraisal categories included for further examination. The synthesis process included identification of gaps and an analysis and summary of programme development and programme effectiveness to enable conclusions to be drawn and recommendations to be made. The results from the library database searches (13,158 hits), the Internet search and key informant surveys were reduced to a review of 982 reports of which 500 were selected for critical appraisal. In total 158 articles, representing 147 programmes, were included for further analysis. The majority of reports were included based on high appraisal scores in programme development and evaluation with limited numbers eligible based on scores in other categories of appraisal. While no single programme emerged as a model of best practice, synthesis of included programmes provided rich information on elements that represent innovative rather than best practice under particular circumstances that are dynamic (changing according to population subgroups, age, ethnicity, setting, leadership, etc.). Thus the findings of this synthesis review identifies areas for action, opportunities for programme development and research priorities to inform the development of best practice recommendations that will reduce obesity and chronic disease risk in children and youth. A lack of programming to address the particular needs of subgroups of children and youth emerged in this review. Although immigrants new to developed countries may be more vulnerable to the obesogenic environment, no programmes were identified that specifically targeted their potentially specialized needs (e.g. different food supply in a new country). Children 0-6 years of age and males represented other population subgroups where obesity prevention programmes and evidence of effectiveness were limited. These gaps are of concern because (i) the pre-school years may be a critical period for obesity prevention as indicated by the association of the adiposity rebound and obesity in later years; and (ii) although the growing prevalence of obesity affects males and females equally; males may be more vulnerable to associated health risks such as cardiovascular disease. Other gaps in knowledge identified during synthesis include a limited number of interventions in home and community settings and a lack of upstream population-based interventions. The shortage of programmes in community and home settings limits our understanding of the effectiveness of interventions in these environments, while the lack of upstream investment indicates an opportunity to develop more upstream and population-focused interventions to balance and extend the current emphasis on individual-based programmes. The evidence reviewed indicates that current programmes lead to short-term improvements in outcomes relating to obesity and chronic disease prevention with no adverse effects noted. This supports the continuation and further development of programmes currently directed at children and youth, as further evidence for best practice accumulates. In this synthesis, schools were found to be a critical setting for programming where health status indicators, such as body composition, chronic disease risk factors and fitness, can all be positively impacted. Engagement in physical activity emerged as a critical intervention in obesity prevention and reduction programmes. While many programmes in the review had the potential to integrate chronic disease prevention, few did; therefore efforts could be directed towards better integration of chronic disease prevention programmes to minimize duplication and optimize resources. Programmes require sustained long-term resources to facilitate comprehensive evaluation that will ascertain if long-term impact such as sustained normal weight is maintained. Furthermore, involving stakeholders in programme design, implementation and evaluation could be crucial to the success of interventions, helping to ensure that needs are met. A number of methodological issues related to the assessment of obesity intervention and prevention programmes were identified and offer insight into how research protocols can be enhanced to strengthen evidence for obesity interventions. Further research is required to understand the merits of the various forms in which interventions (singly and in combination) are delivered and in which circumstances they are effective. There is a critical need for the development of consistent indicators to ensure that comparisons of programme outcomes can be made to better inform best practice.

Upward weight percentile crossing in infancy and early childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES)

BACKGROUND

Rapid early postnatal weight gain predicts increased subsequent obesity and related disease risks. However, the exact timing of adverse rapid postnatal weight gain is unclear.

OBJECTIVE

The objective was to examine the associations between rapid weight gain in infancy and in early childhood in relation to body composition at age 17 y.

DESIGN

This prospective cohort study was conducted in 248 (103 males) singletons and their mothers. Height and weight were measured at birth, 6 mo, and 3 and 6 y. The rates of weight gain during infancy (0-6 mo) and early childhood (3-6 y) were calculated as changes in sex- and age-adjusted weight SD scores during these time periods. At 17 y, body composition was measured by air-displacement plethysmography.

RESULTS

Increasing weight gain during infancy and early childhood were both independently associated with larger body mass index, fat mass, relative fat mass, fat-free mass, and waist circumference at 17 y (P < 0.005 for all; adjusted for sex, birth weight, gestational age, current height, maternal socioeconomic status, and maternal fat mass). Rapid weight gain in infancy, but not in early childhood, also predicted taller height at 17 y (P < 0.001).

CONCLUSIONS

Rapid weight gain in both infancy and early childhood is a risk factor for adult adiposity and obesity. Rapid weight gain in infancy also predicted taller adult height. We hypothesize that rapid weight gains in infancy and early childhood are different processes and may allow separate opportunities for early intervention against obesity risk later in life.

Duration of exclusive breast-feeding: introduction of complementary feeding may be necessary before 6 months of age

The WHO recommends exclusive breast-feeding for the first 6 months of life. At present, <2 % of mothers who breast-feed in the UK do so exclusively for 6 months. We propose the testable hypothesis that this is because many mothers do not provide sufficient breast milk to feed a 6-month-old baby adequately. We review recent evidence on energy requirements during infancy, and energy transfer from mother to baby, and consider the adequacy of exclusive breast-feeding to age 6 months for mothers and babies in the developed world. Evidence from our recent systematic review suggests that mean metabolisable energy intake in exclusively breast-fed infants at 6 months is 2.2-2.4 MJ/d (525-574 kcal/d), and mean energy requirement approximately 2.6-2.7 MJ/d (632-649 kcal/d), leading to a gap between the energy provided by milk and energy needs by 6 months for many babies. Our hypothesis is consistent with other evidence, and with evolutionary considerations, and we briefly review this other evidence. The hypothesis would be testable in a longitudinal study of infant energy balance using stable-isotope techniques, which are both practical and valid.

Children at high risk for overweight: a classification and regression trees analysis approach

OBJECTIVE

Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry.

RESEARCH METHODS AND PROCEDURES

A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex- and age-specific BMI cut-points proposed by the International Obesity Task Force.

RESULTS

Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10,000 grams was found in about one-half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children.

DISCUSSION

A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high-risk children.

Weight gain in the first week of life and overweight in adulthood: a cohort study of European American subjects fed infant formula

BACKGROUND

Successful prevention of obesity and related cardiovascular risk factors requires a clear understanding of its determinants over the life course. Rapid infancy weight gain is associated with childhood obesity, whereas low infancy weight is associated with coronary heart disease. Our aim was to identify during which periods in infancy weight gain is associated with adult obesity.

METHODS AND RESULTS

A cohort of European American formula-fed subjects, measured on 7 occasions during infancy as part of several infant formula studies, were contacted at age 20 to 32 years, when they reported usual adult weight and height. A life-course plot was used to identify critical periods of weight gain associated with adulthood overweight (body mass index > or =25 kg/m2). These associations were tested with logistic regressions. Data were available for 653 subjects (72% of eligible subjects). Approximately 32% of them were overweight adults. The period between birth and age 8 days was identified as potentially critical. After adjustment for important confounding factors, weight gain during the first week of life was associated with adulthood overweight status (OR for each 100-g increase 1.28, 95% CI 1.08 to 1.52), as was weight gain during the first 112 days of life (OR 1.04, 95% CI 1.01 to 1.08). Similar results were obtained after standardization with z scores from a reference population.

CONCLUSIONS

In formula-fed infants, weight gain during the first week of life may be a critical determinant for the development of obesity several decades later. These results contribute to the understanding of chronic disease programming and suggest new approaches to obesity prevention.

Early growth and childhood obesity: a historical cohort study

OBJECTIVE

To investigate to what extent prenatal, early postnatal, and late postnatal growth predicts risk of childhood obesity.

METHODS

This was a historical cohort study of 1335 full term singletons born in southwest England in 1989. The main outcome measure was body mass index (BMI) at age 7. Absolute weights at birth, 6 weeks, and 18 months, and change in weights during the intervening periods were measured. Measures were examined as z scores standardised to the 1990 UK reference population.

RESULTS

BMI at age 7 was positively associated with z scores for weight at all ages. Regression coefficients (95% confidence intervals) were: 0.16 (0.11 to 0.22), 0.19 (0.15 to 0.24), and 0.29 (0.26 to 0.33) for weights at birth, 6 weeks, and 18 months, respectively. Regression coefficients for birth weight, early weight gain (change in weight z score between birth and 6 weeks), and late weight gain (change in weight z score between 6 weeks and 18 months), adjusted for each other were: 0.32 (0.27 to 0.38), 0.31 (0.26 to 0.37), and 0.28 (0.23 to 0.32), respectively. There was no statistical evidence for interaction among weights, weight gains, or social deprivation. Social deprivation independently predicted BMI at age 7, the major influence being weight gain after 6 weeks of life.

CONCLUSIONS

These data suggest that obesity risk is acquired gradually over the perinatal and postnatal periods, instead of during a prenatal or early postnatal critical window. The association of obesity risk with social circumstances and the timing of its origin offer pointers to some underlying determinants of obesity.

Being big or growing fast: systematic review of size and growth in infancy and later obesity

OBJECTIVES

To assess the association between infant size or growth and subsequent obesity and to determine if any association has been stable over time.

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase, bibliographies of included studies, contact with first authors of included studies and other experts.

INCLUSION CRITERIA

Studies that assessed the relation between infant size or growth during the first two years of life and subsequent obesity.

MAIN OUTCOME MEASURE

Obesity at any age after infancy.

RESULTS

24 studies met the inclusion criteria (22 cohort and two case-control studies). Of these, 18 assessed the relation between infant size and subsequent obesity, most showing that infants who were defined as "obese" or who were at the highest end of the distribution for weight or body mass index were at increased risk of obesity. Compared with non-obese infants, in those who had been obese odds ratios or relative risks for subsequent obesity ranged from 1.35 to 9.38. Ten studies assessed the relation of infant growth with subsequent obesity and most showed that infants who grew more rapidly were at increased risk of obesity. Compared with other infants, in infants with rapid growth odds ratios and relative risks of later obesity ranged from 1.17 to 5.70. Associations were consistent for obesity at different ages and for people born over a period from 1927 to 1994.

CONCLUSIONS

Infants who are at the highest end of the distribution for weight or body mass index or who grow rapidly during infancy are at increased risk of subsequent obesity.

Early rapid weight gain and current overweight in relation to asthma in adolescents born with very low birth weight

Early catch-up growth and subsequent overweight are suggested to be associated with later cardiovascular diseases and later type II diabetes. However, the impact of early catch-up growth and childhood overweight on the development of asthma has been less studied, particularly in children born with very low birth weight (VLBW). A birth cohort of 74 VLBW children (birth weight < or = 1500 g) was followed from birth and investigated on asthma at 12 yr of age. Early rapid weight gain was in one way defined as an increase of weight > or =1 standard deviation score (SDS) at 6 months of corrected postnatal age. Current overweight was defined by body mass index (BMI) exceeding 21.2 and 21.7 kg/m(2), respectively, for boys and girls at 12 yr of age. Current asthma was diagnosed by a pediatrician, according to asthma ever in combination with a positive response to hypertonic saline bronchial provocation test and/or wheeze at physical examination at 12 yr old. Being overweight at 12 yr of age was associated with an increased risk for current asthma in the VLBW children [crude odds ratio (OR): 5.5, 95% confidence interval (CI): 1.3-22.2]. After adjustment for early weight gain and neonatal risk, the OR of overweight increased nearly three times (adjusted OR: 15.3, 95% CI: 2.5-90.6). Early rapid weight gain seemed to be inversely associated with current asthma (adjusted OR: 0.49 for an increase of weight equal to 1 SDS, 95% CI: 0.23-1.02, p = 0.06). In addition, early rapid weight gain was inversely associated with the magnitude of bronchial responsiveness at 12 yr (coefficient -1.15, p < 0.01). There was a strong and positive association between overweight and asthma at 12 yr of age in the VLBW children. This strong association had been reduced by early rapid weight gain, possibly via the reduction of bronchial responsiveness.

Supplementation of infant formula with long-chain polyunsaturated fatty acids does not influence the growth of term infants

BACKGROUND

Adequate growth is an important indicator of health and well-being in infants.

OBJECTIVE

Our objective was to determine the effect of supplementing infant formula with long-chain polyunsaturated fatty acids (LCPUFAs) on the growth of term infants.

DESIGN

Using the methodology outlined by the Cochrane Collaboration, we reviewed all known randomized controlled trials that involved LCPUFA supplementation of infant formula fed to term infants. Outcome measures were weight, length, and head circumference. Original data obtained from the investigators of published trials were used. Outcomes were analyzed with fixed-effects or random-effects model meta-analyses and were reported as weighted mean differences with 95% CIs.

RESULTS

We identified 14 eligible trials that had data available for meta-analysis (1846 infants). Trial quality was generally high. Meta-analysis showed no significant effect of LCPUFA supplementation on infant weight, length, or head circumference at any assessment age. Similarly, subgroup analyses showed that supplementation with only n-3 LCPUFAs (no arachidonic acid) had no significant effect on infant weight, length, or head circumference. The source of LCPUFA supplementation (phospholipid or triacylglycerol) also did not significantly affect infant growth.

CONCLUSION

We found no evidence that LCPUFA supplementation of infant formula influences the growth of term infants in either a positive or a negative way.

Rapid growth in infancy and childhood and obesity in later life--a systematic review

The association between obesity and morbidity resulting from chronic diseases is well known. This systematic review addresses studies of the role of rapid growth in infancy and childhood as possible determinants of overweight and obesity later in the life course. We reviewed MEDLINE for studies reporting on growth in infancy and childhood, as well as measures of weight or adiposity in later childhood, adolescence or adulthood. The methodological quality of the papers was assessed using the criteria suggested by Downs and Black. Sixteen articles that fulfilled review criteria were located. There was wide variability in the indicators used for defining rapid growth as well as overweight or obesity. The age range in which weight or adiposity was measured ranged from 3 to 70 years. In spite of differences in definitions used, 13 articles that reported on early rapid growth found significant associations with later overweight or adiposity. Efforts should be made to standardize the definition of rapid growth, as well as that of overweight and obesity in children and adolescents. The most frequent definition for rapid growth in this review was a Z-score change greater than 0.67 in weight for age between two different ages in childhood. Regarding obesity, the definition proposed by the International Obesity Task Force also appears to be most appropriate. The present results indicate that early growth is indeed associated with the prevalence of obesity later in the life course.

Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm

BACKGROUND

Increasing evidence indicates that adult body composition is associated with prenatal and infancy weight gain, but the relative importance of different time periods has not been elucidated.

OBJECTIVE

The objective was to study the association between prenatal, early postnatal, and late infancy weight gain and body mass index (BMI), fat mass, and fat distribution in young adulthood.

DESIGN

We included 403 men and women aged 19 y from a Dutch national prospective follow-up study who were born at <32 wk of gestation. BMI, waist circumference, and waist-to-hip ratio SD scores and subscapular-to-triceps ratio, percentage body fat, fat mass, and fat-free mass at age 19 y were studied in relation to birth weight SD scores, weight gain from preterm birth until 3 mo postterm (early postnatal weight gain), and weight gain from 3 mo until 1 y postterm (late infancy weight gain).

RESULTS

Birth weight SD scores were positively associated with weight, height, BMI SD scores, and fat-free mass at age 19 y but not with fat mass, percentage body fat, or fat distribution. Early postnatal and late infancy weight gain were positively associated with adult height, weight, BMI, waist circumference SD scores, fat mass, fat-free mass, and percentage body fat but not with waist-to-hip ratio SD scores or subscapular-to-triceps ratio.

CONCLUSIONS

In infants born very preterm, weight gain before 32 wk of gestation is positively associated with adult body size but not with body composition and fat distribution. More early postnatal and, to a lesser extent, late infancy weight gain are associated with higher BMI SD scores and percentage body fat and more abdominal fat at age 19 y.

Nutrition for preterm infants after hospital discharge

Preterm infants accrue significant nutrient deficits during hospitalization, and at the time of discharge most VLBW preterm infants have moderate to severe growth failure. Infants with significant morbidities and infants with ELBW have more severe growth failure since they regain birth weight at a later age, and they gain weight more slowly. Catch-up growth accelerates after hospital discharge. The rates of catch-up growth vary according to many factors including birth weight, gestational age, parental size, adequacy of intrauterine growth, neurologic impairment, clinical course, and nutrition. Most catch-up growth occurs within the first 2 to 3 years of life; however, compensatory catch-up growth may continue into adolescence and adulthood. Despite evidence of ongoing catch-up growth, the mean growth measurements of children and adults who were born preterm and with VLBW are lower than their term-born peers. Accelerated rates of catch-up growth are associated with better neurodevelopmental outcomes. Inadequate head circumference growth, in particular, may have long-term prognostic significance for later neurodevelopment in preterm infants. Nutrient-enriched formulas that provide 22 kcal/oz are often prescribed for VLBW preterm infants after hospital discharge. Several studies have reported that preterm infants fed the enriched versus standard term infant formulas have greater rates of catch-up growth during the first year of life, including greater increases in head circumference. The nutrient-enriched formulas appear to be of particular benefit for male infants. There is less information regarding the nutrient needs of breast-fed infants after hospital discharge. However, several studies have demonstrated that preterm infants fed unfortified human milk after discharge have growth rates and bone mass that are lower than formula-fed infants during infancy. The use of fortified human milk, or alternate feedings with a nutrient-enriched formula may be useful for breast-fed infants who have delays in catch-up growth. Additional studies are needed to determine whether enriched feedings might be of particular benefit for preterm infants who are at greater risk for postnatal growth failure, including infants born SGA, or with extremely low birth weights, intrauterine growth restriction, or chronic conditions such as bronchopulmonary dysplasia. The potential effect of nutritional programming on long-term outcomes of preterm infants also requires further investigation.

Beverage consumption and risk of obesity among Native Americans in Arizona

Native Americans face some of the highest rates of obesity and diabetes in the world. Despite numerous education programs to reduce obesity among Native Americans, little attention has been paid to reducing fructose, particularly in the form of high-fructose corn syrup in beverages. Considerable data indicate that energy from beverages does not displace energy from other foods throughout the day, often leading to energy imbalance, and numerous studies have documented that beverages are a leading contributor to energy intakes among Native Americans. Prevention programs that target pregnant women and parents of infants and very young children are necessary to halt the epidemic of obesity among Native Americans; one approach may be by promoting sugar-free beverages.

Children grow and horses race: is the adiposity rebound a critical period for later obesity?

Background

The adiposity rebound is the second rise in body mass index that occurs between 3 and 7 years. An early age at adiposity rebound is known to be a risk factor for later obesity. The aim here is to clarify the connection between the age at rebound and the corresponding pattern of body mass index change, in centile terms, so as to better understand its ability to predict later fatness.

Discussion

Longitudinal changes in body mass index during adiposity rebound, measured both in original (kg/m²) and standard deviation (SD) score units, are studied in five hypothetical subjects. Two aspects of the body mass index curve, the body mass index centile and the rate of body mass index centile crossing, determine a child's age at rebound. A high centile and upward centile crossing are both associated separately with an early rebound, while a low centile and/or downward centile crossing correspond to a late rebound. Early adiposity rebound is a risk factor for later fatness because it identifies children whose body mass index centile is high and/or crossing upwards. Such children are likely to have a raised body mass index later in childhood and adulthood. This is an example of Peto's "horse racing effect". The association of centile crossing with later obesity is statistical not physiological, and it applies at all ages not just at rebound, so adiposity rebound cannot be considered a critical period for future obesity. Body mass index centile crossing is a more direct indicator of the underlying drive to fatness.

Summary

An early age at adiposity rebound predicts later fatness because it identifies children whose body mass index centile is high and/or crossing upwards. Such children are likely to have a raised body mass index later. Body mass index centile crossing is more direct than the timing of adiposity rebound for predicting later fatness.

An analysis of the effects of prenatal alcohol exposure on growth: A teratologic model

The association between prenatal exposure to alcohol and growth is linear, and effects have been measured at levels of exposure that are considerably below one drink per day. Thus, with respect to growth deficits, there is no safe level of drinking during pregnancy. Alcohol exposure during gestation causes growth deficits among the offspring at birth and during infancy. At older ages, however, growth deficits are reported in some, though not all, studies. Exposed offspring who grow up in more privileged environments are apparently able to make up their growth deficits, while those raised in less optimal circumstances do not. This means that there is an interaction between the environment in which a child is raised and the expression of the effects of prenatal alcohol exposure. The long-term implications of growth deficits are not yet well understood.