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Gilley SP, Harrall KK, Friedman C, Glueck DH, Cohen CC, Perng W, Sauder KA, Krebs NF, Shankar K, Dabelea D. Association of Maternal BMI and Rapid Infant Weight Gain With Childhood Body Size and Composition. Pediatrics 2023; 151:e2022059244. [PMID: 37016999 PMCID: PMC11033707 DOI: 10.1542/peds.2022-059244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES Maternal prepregnancy BMI (ppBMI) and an infant's rapid weight gain (RWG) are each associated with increased risk for childhood obesity. We hypothesized that ppBMI and RWG interact to further raise childhood obesity risk. METHODS Mother-infant dyads (n = 414) from the Healthy Start Study, an observational prebirth cohort, were included. RWG was defined as a weight-for-age z score increase of ≥0.67 from birth to 3 to 7 months. Body composition was measured by air displacement plethysmography at age 4 to 7 years. General linear regression models were fit to characterize associations between ppBMI, RWG, and their interaction with the outcomes of childhood BMI-for-age z score and percent fat mass (%FM). RESULTS A total of 18.6% (n = 77) of offspring experienced RWG. Maternal ppBMI and RWG were both positively associated with offspring BMI z score and %FM. RWG amplified the association between ppBMI and BMI z score, especially among females. Females exposed to maternal obesity and RWG had an average BMI at the 94th percentile (1.50 increase in childhood BMI z score) compared with those exposed to normal ppBMI and no RWG (average childhood BMI at the 51st percentile). RWG had a weaker effect on the association between ppBMI and %FM. Adjustment for breastfeeding status or childhood daily caloric intake did not significantly alter findings. CONCLUSIONS Rapid infant weight gain interacts with maternal ppBMI to jointly exacerbate risk of childhood obesity. Pediatric providers should monitor infants for RWG, especially in the context of maternal obesity, to reduce future risk of obesity.
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Affiliation(s)
- Stephanie P. Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Kylie K. Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Chloe Friedman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Deborah H. Glueck
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Catherine C. Cohen
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
| | - Katherine A. Sauder
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Nancy F. Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Kartik Shankar
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
| | - Dana Dabelea
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, Colorado
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, and Aurora, Colorado
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
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Abstract
PURPOSE OF REVIEW To discuss recent evidence on the influence of complementary feeding (CF) timing, content and feeding methods on childhood obesity risk. RECENT FINDINGS The evidence-base is limited by heterogeneity, risk of bias and the predominance of observational studies. The content of the diet and feeding practices are more influential than timing for obesity risk. There is limited evidence that CF introduction before 4 months may be associated with increased risk. Intake of animal protein, particularly dairy protein, may contribute to rapid weight gain; protein from infant/follow-on formula shows the most robust association with later obesity risk. Evidence linking sugar intake to obesity risk is limited, but intake should be as low as possible given there is no nutritional requirement. Responsive feeding (RF) practices may promote appropriate infant growth and reduce risk. The effect of baby-led weaning (BLW) is inconclusive. SUMMARY Recent evidence supports current recommendations to avoid high protein intakes, especially from infant/follow-on formula, for infants in high income countries; and to promote RF practices for all infants. Studies in low- and middle-income countries are required to define optimal CF practices given increasing rates of child obesity alongside double-burden malnutrition.
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Affiliation(s)
- Kulnipa Kittisakmontri
- Nutrition Research Group, Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mary Fewtrell
- Nutrition Research Group, Population, Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Eagleton SG, Shriver LH, Buehler C, Wideman L, Leerkes EM. Longitudinal Associations Among Food Insecurity During Pregnancy, Parental Mental Health Symptoms, Controlling Feeding Styles, and Infant Food Responsiveness. J Nutr 2023; 152:2659-2668. [PMID: 36166350 PMCID: PMC9840003 DOI: 10.1093/jn/nxac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood. OBJECTIVES This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive). METHODS Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness. RESULTS Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness. CONCLUSIONS Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.
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Affiliation(s)
- Sally G Eagleton
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Lenka H Shriver
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Cheryl Buehler
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Esther M Leerkes
- Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, NC, USA
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Eagleton SG, Shriver LH, Buehler C, Wideman L, Leerkes EM. Bidirectional associations between maternal controlling feeding and food responsiveness during infancy. Front Public Health 2022; 10:975067. [PMID: 36299755 PMCID: PMC9589151 DOI: 10.3389/fpubh.2022.975067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/22/2022] [Indexed: 01/25/2023] Open
Abstract
Parental controlling feeding styles and practices have been associated with greater food-approaching appetitive behaviors (i.e., food responsiveness) linked to childhood obesity. Recent longitudinal research suggests that this relationship may be reciprocal such that controlling feeding predicts child appetite and vice versa. However, to date no studies have considered these associations during infancy. The current study investigates prospective bidirectional associations between controlling feeding (restriction, pressure, and food to soothe) and infant food responsiveness. Mothers (N = 176) reported their controlling feeding and their infant's food responsiveness at infant age 2, 6, and 14 months. A 3-wave cross-lagged panel model was used to test the effect of controlling feeding at an earlier time point on infant food responsiveness at a later time point, and vice versa. Maternal controlling feeding and infant food responsiveness showed moderate stability across infancy. Net of covariates, we observed parent-driven prospective relations between pressuring feeding styles and food to soothe with infant food responsiveness. Pressuring to finish was a significant predictor of increases in food responsiveness from 2 to 6 months (p = 0.004) and pressuring with cereal was a significant predictor of increases in food responsiveness from 6 to 14 months (p = 0.02). Greater use of situational food to soothe was marginally associated with higher food responsiveness from 2 to 6 months (p = 0.07) and 6 to 14 months (p = 0.06). Prospective associations between restrictive feeding styles and infant food responsiveness were not observed. Findings point to pressuring feeding styles and food to soothe as potential early life intervention targets to prevent increases in food responsiveness in infancy. Longitudinal research with follow-up in the toddler and preschool years are needed to understand how these associations unfold over time and whether child-driven effects of food responsiveness become apparent as children get older.
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Affiliation(s)
- Sally G. Eagleton
- Department of Human Development and Family Studies, UNC Greensboro, Greensboro, NC, United States,*Correspondence: Sally G. Eagleton
| | - Lenka H. Shriver
- Department of Nutrition, UNC Greensboro, Greensboro, NC, United States
| | - Cheryl Buehler
- Department of Human Development and Family Studies, UNC Greensboro, Greensboro, NC, United States
| | - Laurie Wideman
- Department of Kinesiology, UNC Greensboro, Greensboro, NC, United States
| | - Esther M. Leerkes
- Department of Human Development and Family Studies, UNC Greensboro, Greensboro, NC, United States
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