Attachment security and obesity in US preschool-aged children

Parent-child interaction, appetite self-regulation, and BMIz in Chinese preschoolers: a mediation analysis

OBJECTIVES

Research on parent-child interaction (PCI) and its impact on children's weight status is a thriving study area. However, their potential pathways have not been established. This study investigated the association between PCI and children's body-mass index z score (BMIz) examining the role of appetite self-regulation (ASR) as a mediator.

STUDY DESIGN

Mediation analysis.

METHODS

We included children from 33 kindergartens in Wuhan with parents' consent, measuring children's height and weight, and calculating BMIz. To assess the PCI quality, we utilized the Brigance Parent-Child Interactions Scale. Additionally, children's ASR was tested by satiety responsiveness (SR) and food responsiveness (FR) using the Children's Eating Behavior Questionnaire. Quantile regression was employed to examine the PCI-BMIz association, while mediation analysis was conducted to explore ASR's mediating effect on the relationship between PCI and BMIz.

RESULTS

Of 3973 children (53.88% boys) included in the analysis, the mean BMIz was 0.24 ± 1.13. The results revealed that children with poorer PCI quality have higher BMIz across all selected BMIz percentiles, except for the 5th percentile. Furthermore, these associations were significant across most percentiles, whether for boys or girls. Mediation analysis suggested that these associations were partially mediated by children's ASR (indFR = -0.026, PFR < 0.001; indSR = -0.058, PSR < 0.001), with stronger effects observed among boys.

CONCLUSION

The variation in how strongly BMIz was linked to PCI across different percentiles suggests that children with poorer PCI have higher BMIz. The link is partially mediated through children's ASR. It's important to pay attention to the PCI quality in children with higher BMIz levels, especially in boys.

Association between maternal closeness with parents and mother-toddler relationship quality

Objective

Understanding how positive parenting is conveyed across generations informs early childhood policy.

Background

The extant literature has focused on how a mother's relationship with her own mother sets the stage for her parenting of her own children, yet less understood is how a mother's relationship with her father supports her responsive parenting and potentially informs her child's attachment security.

Method

We analyzed data from 6,400 mothers of singleton infants participating in the Early Childhood Longitudinal Study, Birth Cohort. We examined whether a mother's closeness with her own mother and father (Generation 1) related to her responsiveness and child attachment security (Generation 3) at age 24 months.

Results

Most mothers reported being extremely (25.7%) or at least quite close (25.1%) with both their mother and father. How close mothers felt to their own parents was not associated with their observed level of responsiveness to their toddler or their toddler's attachment security, adjusting for sociodemographic covariates. Maternal education was the strongest predictor of responsiveness and attachment security.

Conclusion

Maternal education is strongly related to responsiveness, and to a lesser extent, child attachment security, in toddlerhood.

Implications

Programs aimed at addressing the challenges of caregiving may overcome the limitations of lower education status.

Complementary feeding approach and maternal responsiveness in 8- and 12-month-old Italian infants: A longitudinal study

In Western countries, infants are usually introduced to solids through spoon-fed puréed foods (parent-led weaning, PLW). However, an alternative approach known as "baby-led weaning" (BLW), in which infants usually participate in family meals and eat independently, is becoming increasingly popular. We investigated the relationship between the type of complementary feeding approach and maternal responsiveness to infant feeding cues in a longitudinal sample of 178 infants observed at 8 and 12 months. Mothers reported the complementary feeding method used and, from video-recorded meals, we coded the proportion of time infants self-fed and rated maternal responsiveness by means of the Responsiveness to Child Feeding Cues Scale (Hodges et al., 2013). Responsiveness to infant receptiveness and fullness cues were significantly correlated at 8 months, but not at 12 months, when unresponsiveness decreased for receptiveness but remained stable for fullness cues. Thus, as infants got older, mothers were increasingly tuned in to their receptiveness cues. However, we did not observe the same pattern for fullness cues, perhaps because mothers were concerned that their infants did not eat enough. Moreover, at both time points, mothers were more responsive to infants' receptiveness than fullness cues, possibly due to an evolutionary drive to protect infants from starvation. Finally, responsiveness to fullness, but not responsiveness to receptiveness, was positively related to the proportion of infant self-feeding, but there were no significant differences in responsiveness depending on the self-reported complementary feeding approach. Thus, a weaning style that emphasizes independent feeding, regardless of whether this is labeled as BLW, may promote more infant-centered maternal responses at the end of the meal, with potential implications for promoting infant self-regulation not only at mealtimes, but also in other domains.

Systematic Review of General Parenting Intervention Impacts on Child Weight as a Secondary Outcome

General parenting interventions have improved parent-child relationships and child behavior, with emerging evidence that they may also reduce prevalence of pediatric overweight/obesity. We conducted a systematic review on interventions that were designed to promote positive parenting and examined child weight post-hoc. We searched for studies published through January 2022 that promoted positive parenting among parents of children ages 0-18 years and reported effects on body weight as an ancillary outcome, with no intervention content focused on energy balance (e.g., feeding, physical activity). This search was carried out within ClinicalTrials.gov, ISRCTN Registry, PubMed, PsycINFO, Web of Science, and Connected Papers. Studies were imported into EndNote X9 and assessed independently by two investigators. In total, 753 clinical trials and 723 publications were assessed, and six publications met inclusion criteria. All cohorts were low-income and interventions targeted expectant mothers up through parents of adolescents. Follow-ups occurred when participants were between 2 and 25 years. Significant improvements in weight-related outcomes were observed across all studies for the intervention arm as a whole or for certain subgroups, and reasons underlying these gains tended to differ by participants' age. The magnitude of effect sizes ranged from medium to large. Interventions focused on general positive parenting are efficacious at lowering risk of overweight/obesity without focusing on physical health. Promoting attachments among infants, restructuring a toddler's home environment, praising preschoolers, and communicating with adolescents may optimize weight outcomes in parenting interventions adapted for obesity prevention.

Attachment, Feeding Practices, Family Routines and Childhood Obesity: A Systematic Review of the Literature

Childhood obesity is considered a major public health problem. To help prevention and intervention programs targeting families with obese children, this paper is aimed at synthesizing multifactorial and transactional data resulting from studies and reviews assessing relational factors between the child and his or her parents and the child's obesity risk, including the child's and CG's attachment quality, parental feeding practices, and family routines. It is also aimed at assessing the mediation of these links by specific self-regulatory capacities across different developmental periods (0-2, 2-8, and 8-18 years old). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were applied in the review methodology. Ten papers were analyzed, including seven empirical studies and three reviews proposing etiological models of childhood obesity. The quality of empirical studies was assessed, and a synthetical model of the results was proposed. This literature review showed that the caregiver's (CG) and the child's attachment quality, along with controlling or permissive feeding practices, and few family routines are mostly mediated by appetite dysregulation and emotional regulation strategies with the development of child obesity. New research topics are proposed to understand other facets of childhood obesity, as well as how to better prevent and treat it.

Self-regulation linking the quality of early parent-child relationship to adolescents' obesity risk and food consumption

BACKGROUND

The quality of parent-child relationships has been examined as a contributor to children's healthy behaviours and weight outcomes, but the mechanisms accounting for associations remain understudied.

OBJECTIVE

This study examined whether the quality of early parent-child relationship is associated with adolescent obesity risk and whether self-regulation and (un)healthful food consumption mediate these associations.

METHODS

Employing structural equation modelling, two theory-driven models were examined using a large sample (N = 1237) drawn from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Indicators of the quality of parent-child relationship included assessments of child attachment security and observational assessments of maternal sensitivity (15, 24, and 36 months). Self-regulation at 54 months was assessed using behavioural and computerized tasks and, at ages 11-12 and 15 years, using parental ratings of self-control. Food consumption was self-reported at age 11-12. Height and weight measures in early/middle childhood and adolescence were used to compute BMI z-scores.

RESULTS

No direct associations between the quality of parent-child relationship and adolescent obesity risk were found in either model. Instead, child self-regulation was found to mediate the associations between the quality of parent-child relationship and both unhealthy food consumption and higher adolescent BMI status.

CONCLUSION

The findings highlight how the nature of parent-child relationships impacts developing regulatory processes in children which, in turn, have implications for obesity-related behaviours and outcomes. Interventions to reduce childhood obesity should consider self-regulation skills across multiple domains, and early parenting practices that foster these capacities.

Parenting Styles in Relation to Childhood Obesity, Smoking and Drinking: A Gene-Environment Interaction Study

OBJECTIVES

This study assessed gene-environment interactions linking maternal parenting styles to childhood obesity and alcohol and tobacco use.

METHODS

Data was retrieved from the first wave of the German Twin Family Panel. Participants comprised 3 birth cohorts aged 5, 11, and 17 years, with approximately 500 pairs of same-sex monozygotic twins and 500 pairs of same-sex dizygotic twins per cohort. Self-reported parenting styles were measured in 5 dimensions: emotional warmth, psychological control, negative communication, monitoring, and inconsistent parenting. Outcome variables included children's body mass index z-score (BMIz) and smoking and alcohol drinking frequency. Gene-environment interaction models were used to assess how parenting styles might moderate genetic and environmental influences on BMIz and smoking and drinking behaviors.

RESULTS

A positive interaction of genetic effects with psychological control was found for BMIz at age 5, indicating that genetic influences on BMIz increased with psychological control. No interaction effect was found for BMIz at age 11 and 17. Regarding adolescent smoking, positive interaction between genetic effects and negative communication was found, indicating that genetic influences on smoking increased with negative communication. There was no significant moderating effect of parenting styles on adolescent drinking.

CONCLUSIONS

This study found some preliminary evidence that parenting styles moderated genetic and environmental impacts on body weight status and smoking. Moderation effects of parenting on BMIz were observed only at a very young age. The moderating effects of parenting influenced adolescent smoking but not drinking. This article is protected by copyright. All rights reserved.

Socioeconomic Gradients in Prostate Cancer Incidence Among Canadian Males: A Trend Analysis From 1992 to 2010

Introduction

Understanding the effects of socioeconomic status on cancer incidence and their trends over time will help inform public health interventions for cancer control. This study sought to investigate trends in socioeconomic inequalities in prostate cancer incidence among Canadian males.

Methods

Using a census division level dataset (n = 280) constructed from the Canadian Cancer Registry, Canadian Census of Population (1992, 1996, 2001, 2006) and 2011 National Household Survey, we examined the effect of socioeconomic status on prostate cancer incidence among Canadian males between 1992 and 2010. The age-adjusted concentration index was used to quantify education/income-related inequalities in prostate cancer incidence.

Results

The crude prostate cancer incidence increased from 115 to 137 per 100 000 males in Canada from 1992 to 2010 with a peak in 2007. The rate increased significantly in all but three of four western provinces. The age-adjusted concentration index showed a higher concentration of prostate cancer diagnoses among males living in high-income neighbourhoods in Canada in particular from 1996 to 2005. In contrast, the index was higher among males living in less-educated neighbourhoods in the most recent study years (2006–2010).

Conclusions

The concentration of new prostate cancer cases among high-income populations in Canada may be explained by the rise of opportunistic screening of asymptomatic males; however, this should be studied in further detail. Since we found a higher incidence rate of prostate cancer among less-educated males in Canada in recent years, risk-benefit investigation of primary prevention and opportunistic screening for less-educated males is advised.

Timing, duration, and differential susceptibility to early life adversities and cardiovascular disease risk across the lifespan: Implications for future research

Early life adversities (ELA), include experiences such as child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization, and are recognized as social determinants of cardiovascular disease (CVD). Strong evidence shows exposure to ELA directly impacts cardiometabolic risk in adulthood and emerging evidence suggests there may be continuity in ELA's prediction of cardiometabolic risk over the life course. Extant research has primarily relied on a cumulative risk framework to evaluate the relationship between ELA and CVD. In this framework, risk is considered a function of the number of risk factors or adversities that an individual was exposed to across developmental periods. The cumulative risk exposure approach treats developmental periods and types of risk as equivalent and interchangeable. Moreover, cumulative risk models do not lend themselves to investigating the chronicity of adverse exposures or consider individual variation in susceptibility, differential contexts, or adaptive resilience processes, which may modify the impact of ELA on CVD risk. To date, however, alternative models have received comparatively little consideration. Overall, this paper will highlight existing gaps and offer recommendations to address these gaps that would extend our knowledge of the relationship between ELA and CVD development. We focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines ELA and CVD risk across the life course.

A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research

BACKGROUND

Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships.

METHODS

We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos.

RESULTS

Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred.

CONCLUSIONS

Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

Relation between Attachment and Obesity in Preschool Years: A Systematic Review of the Literature

Increasing evidence suggests that attachment plays an important role in obesity. However, few studies examined this relationship in preschool children. This study aimed to systematically examine the empirical, peer-reviewed evidence regarding the relationship between attachment quality and obesity in the preschool years. Using established guidelines, relevant peer-reviewed literature published between 2000 and July 2021 was searched through EBSCO. This yielded a total of 1124 records for review. Established inclusion criteria comprised: empirical studies published in peer-review journals; include at least one anthropometric measure and/or food consumption measure. Exclusion criteria comprised: attachment measures not following Bowlby-Ainsworth conceptualization of the construct; children in institutionalized settings; context of severe mental illness, documented substance use disorders, or eating disorders; include only a measure of the psychological aspects of eating; intervention programs. After exclusions, eight studies with a total of 9225 participants met the inclusion criteria. Results support the role of attachment in weight-related outcomes, suggesting that considering attachment in the risk of obesity could contribute to the elaboration of effective prevention and intervention programs. Limitations included the small number of studies, predominately cross-sectional designs, the diversity of methodologies, most samples not including fathers, and lack of evidence about the developmental mechanisms underlying the association between attachment and obesity. More evidence is needed to determine how attachment and obesity are linked, and the potential underlying mechanisms accounting for this relationship.

Targeting Parenting Quality to Reduce Early Life Adversity Impacts on Lifespan Cardiometabolic Risk

Mounting evidence that early life adversity (ELA) exposures confer risk for cardiometabolic disease over the lifespan motivated this narrative review to examine parenting quality as a potential intervention target to reduce ELA exposures or mitigate their impact as a way of reducing or preventing cardiometabolic disease. We describe findings from the limited number of family-based intervention studies in ELA-exposed children that have tested parenting impacts on cardiometabolic health outcomes. We then describe the implications of this work and make recommendations for future research that will move this field forward.

Early Life Adversity and Pubertal Timing: Implications for Cardiometabolic Health

OBJECTIVE

To identify early life adversity (ELA) risk factors for earlier pubertal timing, itself a risk factor for poor cardiometabolic health, and to determine whether such ELA-related risk may be mediated by pre-pubertal body mass index (BMI).

METHODS

Subjects included 426 female participants in a prospective birth cohort study, the NICHD Study of Early Child Care and Youth Development. Survival analysis models were fit to examine ELA exposures, representing childhood socioeconomic status (SES), maternal sensitivity, mother-child attachment, and negative life events, along with child health indicators and covariates, in relation to pubertal timing outcomes, including age at menarche and ages at Tanner stage II for breast and pubic hair development.

RESULTS

Higher childhood SES emerged as an independent predictor of older age at menarche, showing each one standard deviation increase in childhood SES corresponded to a 1.3% increase in age at menarche (factor change = 1.013; 1.003-1.022; p < .01), but did not predict breast or pubic hair development (ps > .05). In mediation analyses, indirect (mediated) effects of mother-child attachment on the pubertal timing outcomes, via pre-pubertal BMI, were all statistically significant (ps < .05).

CONCLUSIONS

Higher childhood SES predicted directly, and secure (vs. insecure) mother-child attachment predicted indirectly (via pre-pubertal BMI), later pubertal timing, suggesting these factors may protect girls from earlier pubertal development. By extension, clinical implications are that intervention strategies designed to lessen ELA- and pre-pubertal obesity-related risk may be effective in remediating life course pathways linking ELA, accelerated pubertal development, and cardiometabolic risk.

Protocol for iGrow (Infant Growth and Development Study): biopsychosocial predictors of childhood obesity risk at 2 years

Background

Childhood obesity remains a significant public health problem. To date, most research on the causes and correlates of obesity has focused on a small number of direct predictors of obesity rather than testing complex models that address the multifactorial nature of the origins of obesity in early development. We describe the rationale and methods of iGrow (Infant Growth and Development Study) which will test multiple pathways by which (a) prenatal maternal psychobiological risk predicts infant weight gain over the first 6 months of life, and (b) this early weight gain confers risk for obesity at age 2. Infant hormonal and psychobiological risk are proposed mediators from prenatal risk to early weight gain, though these are moderated by early maternal sensitivity and obesogenic feeding practices. In addition, higher maternal sensitivity and lower obesogenic feeding practices are proposed predictors of adaptive child self-regulation in the second year of life, and all three are proposed to buffer/reduce the association between high early infant weight gain and obesity risk at age 2.

Methods

iGrow is a prospective, longitudinal community-based study of 300 diverse mothers and infants to be followed across 5 data waves from pregnancy until children are age 2. Key measures include (a) maternal reports of demographics, stress, well-being, feeding practices and child characteristics and health; (b) direct observation of maternal and infant behavior during feeding, play, and distress-eliciting tasks during which infant heart rate is recorded to derive measures of vagal withdrawal; (c) anthropometric measures of mothers and infants; and (d) assays of maternal prenatal blood and infant saliva and urine. A host of demographic and other potential confounds will be considered as potential covariates in structural equation models that include tests of mediation and moderation. Efforts to mitigate the deleterious effects of COVID-19 on study success are detailed.

Discussion

This study has the potential to inform (1) basic science about early life processes casually related to childhood obesity and (2) development of targeted intervention and prevention approaches that consider mother, infant, and family risks and resources.

Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial

BACKGROUND

Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children.

METHODS

A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap.

RESULTS

No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents.

CONCLUSIONS AND RECOMMENDATIONS

A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.

Attachment, Parenting, and Obesogenic Behavior: A Dyadic Perspective

Pediatric obesity is a growing health concern afflicting the United States. The treatment for pediatric obesity, as a health epidemic, costs billions of dollars to our nation, leaving providers and researchers searching for effective and sustainable ways to better manage the biological, psychological, and social health of individuals and families. While many assessments and interventions continue to emerge, researchers have predominately focused on intra-individual concerns among white non-Hispanic populations. This quantitative study was grounded in a relational theory (attachment theory), with a dyadic and primarily Hispanic sample. Evidence from our study supported that child attachment predicted child obesogenic behavior and that this relationship was mediated by child self-regulation. Children with insecure attachments had more obesogenic behaviors and lower self-regulation of eating than those with secure attachments. Family therapists should be on the frontlines of relational research and clinical interventions that interface with biopsychosocial health across diverse cultures and families.

Intergenerational transmission of the effects of maternal exposure to childhood maltreatment on offspring obesity risk: A fetal programming perspective

Childhood obesity constitutes a major global public health challenge. A substantial body of evidence suggests that conditions and states experienced by the embryo/fetus in utero can result in structural and functional changes in cells, tissues, organ systems and homeostatic set points related to obesity. Furthermore, growing evidence suggests that maternal conditions and states experienced prior to conception, such as stress, obesity and metabolic dysfunction, may spill over into pregnancy and influence those key aspects of gestational biology that program offspring obesity risk. In this narrative review, we advance a novel hypothesis and life-span framework to propose that maternal exposure to childhood maltreatment may constitute an important and as-yet-underappreciated risk factor implicated in developmental programming of offspring obesity risk via the long-term psychological, biological and behavioral sequelae of childhood maltreatment exposure. In this context, our framework considers the key role of maternal-placental-fetal endocrine, immune and metabolic pathways and also other processes including epigenetics, oocyte mitochondrial biology, and the maternal and infant microbiomes. Finally, our paper discusses future research directions required to elucidate the nature and mechanisms of the intergenerational transmission of the effects of maternal childhood maltreatment on offspring obesity risk.

ATTACHMENT STYLE IN CHILDREN WITH CHRONIC DISEASES: A COMPREHENSIVE REVIEW

Objective:

To investigate how attachment style has been studied in children with chronic disease in the scientific literature, and what repercussions this attachment has on this population.

Data sources:

An integrative review of the literature was carried out from a survey in the LILACS, MEDLINE and SciELO databases, including original national and international publications in Portuguese, Spanish and English from 2007 to 2018, using the descriptors “apego” and “criança” in the Health Sciences Descriptors (DeCS), and “attachment” and “children” for the Medical Subject Headings (MeSH). Sixteen (16 articles) were obtained for the sample analysis.

Data synthesis:

The chronic diseases found in the research were neurobehavioral disorders such as attention deficit hyperactivity disorder (ADHD) and autism, childhood obesity, and chronic migraine. The predominant attachment style was insecurity, which could compromise the biopsychosocial development of the child.

Conclusions:

The type of attachment between child and primary caregiver may be considered a protective or risk factor for child development. Considering this premise, it is important to equip/inform families based on dialogic educational practices, in which professionals create opportunities and means for families to develop their skills and competencies, and acquire resources which meet the child’s needs. It is important that this professional helps the family to build secure bases for their child with chronic disease, understanding that the main focus for promoting child development is in the family unit.

Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review

Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.

Residential mobility in early childhood and obesity at kindergarten age among children from the United States

BACKGROUND

Children who frequently move have poorer behavioural, emotional, and overall health. For similar reasons, the experience of changing home may contextualize children's risk for obesity. Few studies have assessed the relationship between residential mobility and obesity; even fewer explore this relationship with assessment of obesity before school age.

METHODS

We analysed data from the Early Childhood Longitudinal Study-Birth Cohort. Obesity at kindergarten age was determined from measured height and weight. Early childhood residential mobility was categorized as not moving or having moved once, twice, or three or more times. Analyses are weighted to be representative of children from the United States and variance estimates account for the complex survey design.

RESULTS

The prevalence of obesity at kindergarten age was 17.5%, and most children (71%) moved in early childhood. Compared with children who did not move, the adjusted odd ratios for obesity at kindergarten age were 0.72 (95% CI, 0.57-0.92), 0.70 (95% CI, 0.55-0.89), and 0.64 (95% CI, 0.50-0.84) for children who experienced 1, 2, or 3+ moves.

CONCLUSIONS

Our study suggests that obesity and mobility in early life are associated, but not in the way we might expect. Residential mobility may fit into a broader picture of instability and, on its own, may not elevate a child's risk for obesity.

Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk

BACKGROUND

Current evidence indicates that to prevent the intergenerational transfer of overweight and obesity from parent to child, interventions are needed across the early life stages, from preconception to early childhood. Maternal body image is an important but often overlooked factor that is potentially implicated in both short- and long-term maternal and child health outcomes, including maternal gestational weight gain, postpartum weight retention, obesity, child feeding practices and early parenting.

AIM

The aim of this paper is to propose a conceptual model of the relationship between maternal body image (with a specific focus on body dissatisfaction) and maternal and child excess body weight risk across the pregnancy, postpartum and early childhood periods, as well as to highlight opportunities for intervention.

CONCLUSION

Our conceptual model proposes factors that mediate the associations between antenatal and postpartum maternal body dissatisfaction and maternal and childhood obesity risk. Pregnancy and postpartum present key risk periods for excess weight gain/retention and body dissatisfaction. Psychosocial factors associated with maternal body dissatisfaction, including psychopathology and disordered eating behaviours, may increase maternal and child obesity risk as well as compromise the quality of mother-child interactions underpinning child development outcomes, including physical weight gain. Our conceptual model may be useful for understanding modifiable psychosocial factors for preventing the intergenerational transfer of obesity risk from mothers to their children, from as early as pregnancy, and highlights next steps for multidisciplinary research focused on combatting maternal and child obesity during critical risk periods.

Social work and toddler overweight risk: Identifying modifiable child and parent factors across the socioeconomic gradient

Objective: Childhood obesity is associated with long-term health consequences, yet little is known about the prevalence of child and parent risk factors of overweight across the socioeconomic gradient in early life. This exploratory study documents the prevalence of risk factors that contribute to overweight among toddlers within and across socioeconomic status (SES). Methods: Obesity risk factors were examined within and across SES quintiles in a nationally representative sample. Data were collected from 5,100 mothers and 2-year-old children. Weighted regression models assessed child and parent characteristics that predict toddler weight status in a national sample and samples stratified by SES quintiles. Results: Higher rates of overweight were observed in Q1 (29.2%) and reduced with each successive SES quintile (16.9%-Q5), suggesting a gradient effect. Results indicated factors unique within quintiles, distinct from the full national sample: Q1-motor development; Q2-motor and mental development, maternal BMI, breastfeeding, bottle feeding, introduction of solid foods; Q3-breastfeeding; and Q4-5-introduction of solid foods. Discussion: Findings further existing knowledge of toddler obesity by uncovering risks relevant for specific SES groups. Results yield implications for social workers to refine strategies for improving toddler health and preventing overweight/obesity.

Early Nonfood Parent-Infant Interactions and Development of Obesity in a High-Risk, Diverse Sample

OBJECTIVE

This study aimed to understand the protective role of positive mother-infant interactions in the context of food and nonfood behaviors against obesity risk later in life among a cohort of low-income children at high prenatal risk due to maternal substance use during pregnancy.

METHODS

The sample consisted of 216 mother-infant dyads (49% boys) participating in an ongoing longitudinal study. Mother-infant interactions during a feeding episode and a free-play task were measured at child age 1 and 7 months, respectively. Children's length/height and weight were measured at 1, 7, 13, 24, 36, and 48 months of age; at kindergarten age (approximately 60 months); and in second grade (approximately 84 months). BMI growth trajectories were modeled.

RESULTS

No significant associations were found between mother-child feeding interactions and child BMI trajectories. Maternal warmth (95% CI: -0.020 to -0.0005; P = 0.04) and child positive affect (95% CI: -0.020 to -0.002; P = 0.014) during free play were associated with a more normative child BMI trajectory.

CONCLUSIONS

Results from this study indicated that high maternal warmth and child positive affect during play, but not feeding interactions, are associated with reduced obesity risk from infancy to middle childhood in the context of high pre- and postnatal risks.

Early mother-child dyadic pathways to childhood obesity risk: A conceptual model

Understanding the emotional quality of the mother-child dyadic relationship and parent-child feeding interactions may further clarify early developmental pathways to eating behaviours and obesity risk. The quality of parent-child relationships fosters all aspects of child development but has not yet been extensively examined in relation to childhood weight gain. The aim of this paper is to propose a conceptual model, which outlines early mother-child dyadic pathways linking parent-child feeding interactions to child body mass index, where parent-child relationships have a central role. It maps out individual and dyadic mother-child factors (i.e., attachment, child temperament and maternal mental health) that influence the nature and quality of parent-child feeding interactions from infancy to toddlerhood. Our model bridges the gap between research fields by bringing together key maternal and child factors implicated in child development. Understanding early parent-child feeding interactional patterns and their influence on child self-regulation and eating behaviours may be relevant to multidisciplinary approaches toward preventing childhood obesity. High quality quantitative and observational data capturing meaningful parent, child and dyadic level interactions around food contexts, attachment security, maternal mental health, child temperament and self-regulation will help to inform new, aetiologically important, targets for preventative intervention.

Development and Validation of a New Questionnaire Assessing Feeding Styles in Toddlers: Toddler Feeding Style Questionnaire (TFSQ)

PURPOSE

To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ).

DESIGN AND METHODS

An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12-24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested.

RESULTS

The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p < .01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months.

CONCLUSIONS

The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers.

PRACTICE IMPLICATIONS

Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness.

Secure attachment predicts lower body mass index in young children with histories of child protective services involvement

BACKGROUND

Children who experience early adversity are at risk for obesity; secure attachment may be a protective factor as it has been linked to reduced obesity risk.

OBJECTIVE

To evaluate whether (1) participation in a parenting intervention and (2) secure attachment were associated with body mass index (BMI) among young children with histories of child protective services (CPS) involvement.

METHODS

A total of 105 parent-child dyads referred following CPS involvement were randomly assigned to receive Attachment and Biobehavioral Catch-up (ABC), which was designed to increase parental sensitivity, or a control intervention. Attachment security was assessed during infancy, and BMI was assessed at annual follow-up visits until children were 4 years old.

RESULTS

Children in the ABC group were more likely to have secure attachments (52%) than children in the control intervention group (32%). Although the ABC intervention did not have a direct effect on children's BMI, secure attachment was associated with a steeper decline in BMI from age 2 to age 4, with secure children showing significantly lower BMI (M = 15.4, SD = 2.08; 16.6% overweight/obese) than insecure children (M = 17.6, SD = 3.81; 35.7% overweight/obese) at age 4.

CONCLUSIONS

Secure attachment was associated with reduced BMI among CPS-referred children; thus, secure attachment may be a novel target of early obesity prevention efforts.

The relationship between maternal stress during pregnancy and up to two years after birth and risk of child overweight and obesity: Protocol for a Systematic Review

Background: Childhood obesity presents a significant public health challenge globally. The period from conception to two years after birth, the first 1000 days, represents a critical period during which the experience of maternal stress may be related to the development of childhood obesity.  Research to date suggests some positive associations between maternal stress during the first 1000 days and childhood obesity, but findings are inconsistent and have not yet been comprehensively synthesised. The purpose of this review is to systematically examine the association between maternal stress during the first 1000 days and the risk of child overweight and obesity. Methods: The following electronic databases will be searched from inception using a detailed search strategy: the Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, Maternity and Infant Care, and Web of Science. Cohort, case-control, and cross-sectional studies examining maternal stress during the first 1000 days and child overweight and obesity up to the age of 10 years will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies. A standardised data extraction form will be used to extract data including: study design; maternal stress exposure; child outcome; exclusion criteria; participant characteristics; and assessment methods. The Cochrane Collaboration’s bias classification tool for observational studies will be used to assess study quality. This protocol is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol (PRISMA-P) checklist, and the systematic review will be conducted and reported following the PRISMA checklist. If possible, random effects models will be used to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study as it will not involve conducting experimental research, nor include identifying personal data.  The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018100363

Effects of maternal stress during pregnancy and up to two years after birth on risk of child overweight and obesity: Protocol for a Systematic Review

Background: Childhood obesity presents a significant public health challenge globally. The period from conception to two years after birth, the first 1000 days, represents a critical period during which the experience of maternal stress may be related to the development of childhood obesity.  Research to date suggests some positive associations between maternal stress during the first 1000 days and childhood obesity, but findings are inconsistent and have not yet been comprehensively synthesised. The purpose of this review is to systematically examine the association between maternal stress during the first 1000 days and the risk of child overweight and obesity. Methods: The following electronic databases will be searched from inception using a detailed search strategy: the Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, Maternity and Infant Care, and Web of Science. Cohort, case-control, and cross-sectional studies examining maternal stress during the first 1000 days and child overweight and obesity up to the age of 10 years will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies. A standardised data extraction form will be used to extract data including: study design; maternal stress exposure; child outcome; exclusion criteria; participant characteristics; and assessment methods. The Cochrane Collaboration’s bias classification tool for observational studies will be used to assess study quality. This protocol is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol (PRISMA-P) checklist, and the systematic review will be conducted and reported following the PRISMA checklist. If possible, random effects models will be used to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study as it will not involve conducting experimental research, nor include identifying personal data.  The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018100363

Promotion of Family Routines and Positive Parent-Child Interactions for Obesity Prevention: Protocol for the 3 Pillars Study Randomized Controlled Trial

Background

Childhood obesity is a challenging public health issue, with 30% of children aged 2 to 4 years classified as being overweight or obese in New Zealand. This is concerning, given that up to 90% of obese 3-year-old children are overweight or obese by the time they reach adolescence. Interventions that target this age range often fail to demonstrate long-term effectiveness and primarily focus on traditional weight-related behaviors, including diet and physical activity. However, research suggests that targeting nontraditional weight-related behaviors, such as sleep, screen time, and family meals, may be a more effective approach in this age group, given the immense challenges in changing traditional weight-related behaviors in the long term.

Objective

The aim of the proposed study was to develop and pilot the 3 Pillars Study (3PS), a 6-week program for parents of New Zealand toddlers and preschoolers aged 2 to 4 years to promote positive parent-child interactions during 3 family routines, specifically adequate sleep, regular family meals, and restricted screen time.

Methods

Screen time at the end of the 6-week program is the primary endpoint. The effects of the program on screen time, frequency of family meals, parent feeding practices, diet quality, and sleep duration will be piloted using a randomized controlled trial, with outcomes compared between the active intervention group and a wait-list control group at 6 weeks (at the end of the program) and 12 weeks (at final follow-up). We aim to recruit 50 participants (25 per arm). Eligibility criteria include parents of children aged 2 to 4 years who are currently exceeding screen use recommendations (ie, greater than 1 hour of screen time per day). The 3PS program involves a half-day workshop, run by a community worker trained to deliver the program content, and 6-week access to a study website that contains in-depth information about the program. All participants will also receive a study pack, which includes resources to encourage engagement in the 3 family routines promoted by the program. Study data will be collected in REDCap. All statistical analyses will be performed using SAS version 9.4 and have been specified a priori in a statistical analysis plan prepared by the study statistician.

Results

Trial recruitment opened in July 2018. Final follow-up was completed in December 2018, with trial findings expected to be available in early 2019.

Conclusions

Findings from this pilot study will provide relevant data to inform the design of a larger effectiveness study of the 3PS program.

Trial Registration

Australian New Zealand Clinical Trials Register ACTRN12618000823279; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=375004 (Archived by WebCite at http://www.webcitation.org/773CALeTK)

International Registered Report Identifier (IRRID)

DERR1-10.2196/12792

Severe housing-cost burden and obesity among preschool-aged low-income children in Los Angeles County

Despite high rates of housing-cost burden in the United States, little is known regarding its impact on childhood obesity. In this article, we determine whether low-income 2–5-year-olds living in housing-cost burdened households are more likely to be obese and examine the potential moderators and behavioral and psychosocial mediators of this relationship. We used data from a triennial survey (2011, 2014) of a random sample of Los Angeles County participants of the Special Supplemental Nutrition Program for Women, Infants and Children (n = 2307). Logistic regression was used to examine the association between child's obesity status (Body Mass Index for age and sex ≥ 95th percentile) and severe housing-cost burden (finding it very difficult to pay for housing). Mother's depressive symptoms and child's diet and screen time were tested for mediation. We found that 16% of children lived in severe housing-cost burdened households. Severe housing-cost burden was associated with an increase in the odds of childhood obesity [aOR (95%CI) = 1.33 (1.00, 1.78)] and household size moderated this relationship. Child's diet and screen time and mother's depressive symptoms were not mediators. Given the high and vacillating rates of early childhood obesity and the increasing burden of housing costs in low-income populations, there is an urgency to better understand the role of housing-cost burden in epidemiologic investigations of early childhood obesity.

•

Children in severe housing-cost burdened households had more chronic stressors.

•

Severe housing-cost burden was associated with greater odds of childhood obesity.

•

Child's behavior and mother's mental well-being were not mediators of the relationship.

Effects of maternal stress during pregnancy and up to two years after birth on risk of child overweight and obesity: Protocol for a Systematic Review

Background: Childhood obesity presents a significant public health challenge globally. The period from conception to two years after birth, the first 1000 days, represents a critical period during which the experience of maternal stress may be related to the development of childhood obesity.  Research to date suggests some positive associations between maternal stress during the first 1000 days and childhood obesity, but findings are inconsistent and have not yet been comprehensively synthesised. The purpose of this review is to systematically examine the association between maternal stress during the first 1000 days and the risk of child overweight and obesity. Methods: The following electronic databases will be searched from inception using a detailed search strategy: the Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, Maternity and Infant Care, and Web of Science. Cohort, case-control, and cross-sectional studies examining maternal stress during the first 1000 days and child overweight and obesity up to the age of 12 years will be included. Titles, abstracts and full articles will be screened by two investigators independently to identify eligible studies. A standardised data extraction form will be used to extract data including: study design; maternal stress exposure; child outcome; exclusion criteria; participant characteristics; and assessment methods. The Cochrane Collaboration’s bias classification tool for observational studies will be used to assess study quality. This protocol is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol (PRISMA-P) checklist, and the systematic review will be conducted and reported following the PRISMA checklist. If possible, random effects models will be used to perform meta-analyses. Ethics and dissemination: Ethical approval is not required for this study as it will not involve conducting experimental research, nor include identifying personal data.  The systematic review will be disseminated in peer-reviewed journals. PROSPERO registration number: CRD42018100363

Association between Subcortical Morphology and Cerebral White Matter Energy Metabolism in Neonates with Congenital Heart Disease

Complex congenital heart disease (CHD) is associated with neurodevelopmental impairment, the mechanism of which is unknown. Cerebral cortical dysmaturation in CHD is linked to white matter abnormalities, including developmental vulnerability of the subplate, in relation to oxygen delivery and metabolism deficits. In this study, we report associations between subcortical morphology and white matter metabolism in neonates with CHD using quantitative magnetic resonance imaging (MRI) and spectroscopy (MRS). Multi-modal brain imaging was performed in three groups of neonates close to term-equivalent age: (1) term CHD (n = 56); (2) preterm CHD (n = 37) and (3) preterm control group (n = 22). Thalamic volume and cerebellar transverse diameter were obtained in relation to cerebral metrics and white matter metabolism. Short echo single-voxel MRS of parietal and frontal white matter was used to quantitate metabolites related to brain maturation (n-acetyl aspartate [NAA], choline, myo-inositol), neurotransmitter (glutamate), and energy metabolism (glutamine, citrate, creatine and lactate). Multi-variate regression was performed to delineate associations between subcortical morphological measurements and white matter metabolism controlling for age and white matter injury. Reduced thalamic volume, most pronounced in the preterm control group, was associated with increased citrate levels in all three group in the parietal white matter. In contrast, reduced cerebellar volume, most pronounced in the preterm CHD group, was associated with reduced glutamine in parietal grey matter in both CHD groups. Single ventricle anatomy, aortic arch obstruction, and cyanotic lesion were predictive of the relationship between reduced subcortical morphometry and reduced GLX (particularly glutamine) in both CHD cohorts (frontal white matter and parietal grey matter). Subcortical morphological associations with brain metabolism were also distinct within each of the three groups, suggesting these relationships in the CHD groups were not directly related to prematurity or white matter injury alone. Taken together, these findings suggest that subplate vulnerability in CHD is likely relevant to understanding the mechanism of both cortical and subcortical dysmaturation in CHD infants. Future work is needed to link this potential pattern of encephalopathy of CHD (including the constellation of grey matter, white matter and brain metabolism deficits) to not only abnormal fetal substrate delivery and oxygen conformance, but also regional deficits in cerebral energy metabolism.

Attachment Style and Obesity: Disordered Eating Behaviors as a Mediator in a Community Sample of Canadian Youth

OBJECTIVE

Obesity and overweight are associated with many negative health outcomes. Attachment style has been implicated in the development of obesity in youth. The present study examined if disordered eating behaviors mediate the relationship between attachment style and body mass index (BMI) in a large community sample of Canadian youth.

METHOD

A total of 3,043 participants (1,254 males and 1,789 females, Mage = 14.20 years) completed self-report questionnaires including the Relationship Questionnaire and the Dutch Eating Behavior Questionnaire, and BMI was objectively measured. Disordered eating behaviors (restrained, emotional, and external) were examined as possible mediating mechanisms in the relationship between attachment style and BMI z-score, using a multiple mediation model using bootstrapping while controlling for socio-demographic covariates.

RESULTS

Insecure attachment was significantly associated with higher BMI, and disordered eating mediated this relationship. Restrained eating was the strongest mediator of this pathway.

CONCLUSION

Results suggest that it may be important to take attachment history and restrained eating into account when designing treatment and prevention strategies for obesity in youth.

Perceptions of parental secure base support in African American adolescents and young adults: A preliminary study of predictive links to adult C-reactive protein

Within the field of relationship science there is increasing interest in the connections between close relationships and physical health. In the present study, we examined whether adolescents' (~12 years old) and young adults' (~20 years old) perceptions of their parents as a secure base prospectively predict C-reactive protein (CRP), a commonly used marker of inflammatory activity, at age 32 in a well-characterized sample of African Americans. We utilized existing data collected as part of the Maryland Adolescent Development in Context Study (MADICS) to construct measures of perceptions of parental secure base support (SBS), general parental support, and peer support in early adolescence and early adulthood. In the present study, SBS was operationalized as the perceived ability to depend on parents in times of need. Fifty-nine African American MADICS participants who reported on perceived support in early adolescence and early adulthood participated in a follow-up home visit at age 32 during which serum CRP was measured via a blood draw. After controlling for inflammation-related confounds (e.g., tobacco use, body mass index), adolescents' perceptions of parental SBS, but not peer support or general parental support, predicted lower CRP values at age 32 (b = -.92, SE = .34, p < .05). None of the support variables in early adulthood predicted CRP at 32 years. This study adds to a growing literature on relationships and health-related outcomes and provides the first evidence for a link between parental SBS in adolescence and a marker of inflammatory activity in adulthood.

Child Development and the Community Environment: Understanding Overweight across the Income Gradient

BACKGROUND

Childhood obesity is associated with increased risk of long-term health consequences. Despite the wealth of research, prevalence rates are still high, particularly among lower-income groups. Little is known about variations in risk of overweight/obesity across income gradients and the adolescent developmental stage. This study examines the association between distal community factors and adolescent weight status across income gradients and whether this association is moderated by age.

METHODS

Using a nationally representative sample of 33,096 adolescents drawn from the National Survey of Children's Health (NSCH), this study assesses how age interacts with community factors and weight (overweight/obese vs. normal weight) after controlling for individual-level factors (gender, race/ethnicity, household composition, parental employment, education) in subsamples stratified by income quartile (according to federal poverty guidelines). Community factors include community risk (comprising community safety, school safety, neighborhood cohesion, and detracting neighborhood elements) and four neighborhood amenities (sidewalks, parks, recreation centers, libraries).

RESULTS

Adolescents with low community risk in quartiles 1 and 3 had lower odds of overweight/obesity (by 32% and 35%, respectively) compared with the high community risk group. Age interacted with access to recreational centers in quartile 1 and sidewalks in quartile 4, indicating a decrease in odds of overweight/obesity (by 17% and 9%, respectively) with access to these amenities as youth age.

CONCLUSIONS

Findings suggest that predictors of overweight/obesity can be diverse within income groups, and future research and interventions should address distinct features of each community. This includes reducing detracting elements and enhancing amenities and cohesion in lower quartiles, as well as improving walkability in the highest quartile.

A systematic review of grandparents' influence on grandchildren's cancer risk factors

Many lifestyle patterns are established when children are young. Research has focused on the potential role of parents as a risk factor for non communicable disease in children, but there is limited investigation of the role of other caregivers, such as grandparents. The aim of this review was to identify and synthesise evidence for any influence grandparents' care practices may have on their grandchildren's long term cancer risk factors. A systematic review was carried out with searches across four databases (MEDLINE, Embase, Web of Science, PsycINFO) as well as searches of reference lists and citing articles, and Google Scholar. Search terms were based on six areas of risk that family care could potentially influence-weight, diet, physical activity, tobacco, alcohol and sun exposure. All study designs were included, as were studies that provided an indication of the interaction of grandparents with their grandchildren. Studies were excluded if grandparents were primary caregivers and if children had serious health conditions. Study quality was assessed using National Institute for Health and Care Excellence checklists. Grandparent impact was categorised as beneficial, adverse, mixed or as having no impact. Due to study heterogeneity a meta-analysis was not possible. Qualitative studies underwent a thematic synthesis of their results. Results from all included studies indicated that there was a sufficient evidence base for weight, diet, physical activity and tobacco studies to draw conclusions about grandparents' influence. One study examined alcohol and no studies examined sun exposure. Evidence indicated that, overall, grandparents had an adverse impact on their grandchildren's cancer risk factors. The theoretical work in the included studies was limited. Theoretically underpinned interventions designed to reduce these risk factors must consider grandparents' role, as well as parents', and be evaluated robustly to inform the evidence base further.

Self-regulation and household routines at age three and obesity at age eleven: longitudinal analysis of the UK Millennium Cohort Study

Objective

To examine, in a population-based cohort of three-year-old children, the association between self-regulation and exposure to the household routines of regular bedtime, regular mealtime, and limits on watching television/video; and to determine whether self-regulation and these routines predict the risk of obesity at age 11.

Methods

Analyses included 10 955 children in the nationally-representative UK Millennium Cohort Study. When children were age 3, parents reported whether children had a regular bedtime and mealtime and the amount of television/video watched. Emotional and cognitive self-regulation at age 3 were assessed by parent-report with the Child Social Behaviour Questionnaire. Children’s height and weight were measured at age 11 and obesity was defined using the International Obesity Task Force (IOTF) criteria.

Results

At age 3, 41% of children always had a regular bedtime, 47% always had a regular mealtime, and 23% were limited to ≤1 hour television/video daily. At age 11, 6.2% of children were obese. All three household routines were significantly associated with better emotional self-regulation, but not better cognitive self-regulation. In a multi-variable logistic regression model including emotional and cognitive self-regulation, all routines, and controlling for sociodemographic covariates, a 1 unit difference in emotional self-regulation at age 3 was associated with an OR (95% CI) for obesity of 1.38 (1.11, 1.71) at age 11, and inconsistent bedtimes with an OR (95% CI) for obesity of 1.87 (1.39, 2.51) at age 11. There was no evidence that emotional self-regulation mediated the relationship between regular bedtimes and later obesity. Cognitive self-regulation was not associated with later obesity.

Conclusions

Three-year-old children who had regular bedtimes, mealtimes, and limits on their television/video time had better emotional self-regulation. Lack of a regular bedtime and poorer emotional self-regulation at age 3 were independent predictors of obesity at age 11.

Association between maternal lifestyle and preschool nutrition

Introduction:

Many of the health behaviors involved in the emergence of chronic non-communicable diseases (CNCD) are originated in childhood under parental influence. Mothers are the ones most involved in the education and health care of children. Lifestyle (LS) is a social determinant of health. Very few studies tried to understand the influence of maternal LS on child nutrition.

Objective:

To verify the association between maternal behavioral and non-behavioral LS and nutritional aspects in preschool children.

Method:

From January 2010 to December 2010, we performed a cross-sectional study with 255 mothers of preschool children who were residents of five different sub-districts in southwestern São Paulo. A proportional stratified random sample was selected using two layers ("schools" and "children"). From the mother, sociodemographic and LS information were collected. From the child, data on anthropometry, sedentary behavior and food intake were collected. The association was calculated using chi-square test and logistic regression.

Results:

Children who ate minimally processed food were born from mothers with more socially aware non-behavioral LS, while children that ate more processed food were born from mothers with more consumerist non-behavioral LS. No association was found between nutritional characteristics of preschoolers and types of maternal behavioral LS. Children presenting "sedentary behavior" and the habit of eating "ultra-processed foods" had 113% and 84% higher chances, respectively, of being born to mothers that belonged to the "consumerist" cluster.

Conclusion:

Mothers living a consumerist lifestyle can promote negative influences on child nutrition.

Maternal Weight Predicts Children's Psychosocial Development via Parenting Stress and Emotional Availability

Introduction: Maternal obesity has been shown to be a risk factor for obesity in children and may also affect children's psychosocial outcomes. It is not yet clear whether there are also psycho-emotional mechanisms explaining the effects of maternal weight on young children's weight and psychosocial development. We aimed to evaluate whether maternal body mass index (BMI), mother–child emotional availability (EA), and maternal parenting stress are associated with children's weight and psychosocial development (i.e., internalizing/externalizing symptoms and social competence) and whether these predictors interact with each other.

Methods: This longitudinal study included three assessment points (~11 months apart). The baseline sample consisted of N = 194 mothers and their children aged 5–47 months (M = 28.18, SD = 8.44, 99 girls). At t₁, we measured maternal weight and height to calculate maternal BMI. We videotaped mother–child interactions, coding them with the EA Scales (fourth edition). We assessed maternal parenting stress with the Parenting Stress Index (PSI) short form. At t₁ to t₃, we measured height and weight of children and calculated BMI–SDS scores. Children's externalizing and internalizing problems (t₁–t₃) and social competence (t₃, N = 118) were assessed using questionnaires: Child Behavior Checklist (CBCL 1.5–5), Strengths and Difficulties Questionnaire (SDQ: prosocial behavior), and a checklist for behavioral problems at preschool age (VBV 3–6: social-emotional competence).

Results: By applying structural equation modeling (SEM) and a latent regression analysis, we found maternal BMI to predict higher BMI–SDS and a poorer psychosocial development (higher externalizing symptoms, lower social competence) in children. Higher parenting stress predicted higher levels of externalizing and internalizing symptoms and lower social competence. Better maternal EA was associated with higher social competence. We found parenting stress to serve as a mediator in the association between maternal weight and children's psychosocial outcomes. Moreover, children of mothers with an elevated BMI were at greater risk of lower social competence only when their mothers showed low levels of maternal EA (moderation).

Conclusion: Interventional studies are needed that investigate the causal pathways between parenting stress, mother–child interaction quality and child outcomes. These aspects might be targets to improve the psychosocial development of the offspring of overweight or obese mothers.

Parent-Child Interaction, Self-Regulation, and Obesity Prevention in Early Childhood

This paper describes the epidemiologic evidence linking parent-child relationships, self-regulation, and weight status with a focus on early childhood. The emotional quality of parent-child interactions may influence children's risk for obesity through multiple pathways. Prospective studies linking observer ratings of young children's self-regulation, particularly inhibitory control, to future weight status are discussed. Although findings are preliminary, promoting positive relationships between parents/caregivers and young children holds promise as a component of efforts to prevent childhood obesity. Multi-disciplinary collaborations between researchers with training in developmental science and child health should be encouraged.

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review

CONTEXT

Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.

EVIDENCE ACQUISITION

PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.

EVIDENCE SYNTHESIS

Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.

CONCLUSIONS

Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

Parental attachment insecurity predicts child and adult high-caloric food consumption

Eating habits are established early and are difficult to change once formed. This study investigated the role of caregiver-child attachment quality and its associations with high-caloric food consumption in a sample of middle socio-economic status children and adults, respectively. Survey data were collected from an online questionnaire administered separately to 213 (143 girls) children and 216 parents (adult sample; 180 women). Two studies showed that an insecure parental attachment, whether actual (Study 1; children) or recalled (Study 2; adults), significantly and positively predicted high-caloric food consumption in both samples. The present findings highlight the importance of parental attachment and its association with unhealthy eating patterns in children and adults.

Life adverse experiences in relation with obesity and binge eating disorder: A systematic review

Background and aims Several studies report a positive association between adverse life experiences and adult obesity. Despite the high comorbidity between binge eating disorder (BED) and obesity, few authors have studied the link between trauma and BED. In this review the association between exposure to adverse life experiences and a risk for the development of obesity and BED in adulthood is explored. Methods Based on a scientific literature review in Medline, PubMed and PsycInfo databases, the results of 70 studies (N = 306,583 participants) were evaluated including 53 studies on relationship between adverse life experiences and obesity, 7 studies on post-traumatic stress disorder (PTSD) symptoms in relation to obesity, and 10 studies on the association between adverse life experiences and BED. In addition, mediating factors between the association of adverse life experiences, obesity and BED were examined. Results The majority of studies (87%) report that adverse life experiences are a risk factor for developing obesity and BED. More precisely a positive association between traumatic experiences and obesity and PTSD and obesity were found, respectively, in 85% and 86% of studies. Finally, the great majority of studies (90%) between trauma and the development of BED in adulthood strongly support this association. Meanwhile, different factors mediating between the trauma and obesity link were identified. Discussion and conclusions Although research data show a strong association between life adverse experiences and the development of obesity and BED, more research is needed to explain this association.

[DOHaD: long-term impact of perinatal diseases (IUGR and prematurity)]

The first epidemiological studies showing a link between low birth weight and chronic diseases in adults did not distinguish the origins of low birth weight. A low birth weight may be the result of a premature birth. It can also be caused by an intrauterine growth restriction (IUGR). A child can be both preterm and IUGR. It is clear now that prematurity is an independent risk factor for programming chronic adult diseases. However, unlike adults born IUGR, adults born prematurely do not have an increased risk to develop metabolic syndrome (dyslipidemia or obesity). An increased risk of neurodevelopmental and psychiatric morbidity and hypertension is found after a premature birth. Mechanisms of chronic diseases programming are multiple: they involve both the cause of prematurity and IUGR such as infection / inflammation or placental insufficiency, but also consequences for therapeutic or nutritional strategies needed to support these children. This chapter describes the possible prevention of perinatal programming of noncommunicable diseases.

Emotional availability, understanding emotions, and recognition of facial emotions in obese mothers with young children

OBJECTIVE

Recent research has identified mother-child relationships of low quality as possible risk factors for childhood obesity. However, it remains open how mothers' own obesity influences the quality of mother-child interaction, and particularly emotional availability (EA). Also unclear is the influence of maternal emotional competencies, i.e. understanding emotions and recognizing facial emotions. This study aimed to (1) investigate differences between obese and normal-weight mothers regarding mother-child EA, maternal understanding emotions and recognition of facial emotions, and (2) explore how maternal emotional competencies and maternal weight interact with each other in predicting EA. A better understanding of these associations could inform strategies of obesity prevention especially in children at risk.

METHODS

We assessed EA, understanding emotions and recognition of facial emotions in 73 obese versus 73 normal-weight mothers, and their children aged 6 to 47 months (Mchild age=24.49, 80 females).

RESULTS

Obese mothers showed lower EA and understanding emotions. Mothers' normal weight and their ability to understand emotions were positively associated with EA. The ability to recognize facial emotions was positively associated with EA in obese but not in normal-weight mothers. Maternal weight status indirectly influenced EA through its effect on understanding emotions.

CONCLUSION

Maternal emotional competencies may play an important role for establishing high EA in interaction with the child. Children of obese mothers experience lower EA, which may contribute to overweight development. We suggest including elements that aim to improve maternal emotional competencies and mother-child EA in prevention or intervention programmes targeting childhood obesity.