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Santos da Silva LL, Malta MB, Lourenço BH, Mosquera PS, de Araújo Damasceno AA, Neves PAR, Cardoso MA. Maternal pre-pregnancy body mass index, gestational weight gain and child weight during the first 2 years of life in an Amazonian birth cohort. J Hum Nutr Diet 2023; 36:1327-1338. [PMID: 36733263 DOI: 10.1111/jhn.13148] [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: 11/22/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND In socially vulnerable populations, evidence is needed regarding the role of maternal nutritional status on child weight during the first 2 years of life. OBJECTIVES We aimed to assess the association of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with offspring BMI-for-age z-scores (BAZs) during the first 2 years of life. METHODS A population-based birth cohort study was conducted with 900 mother-child pairs. Pre-pregnancy weight and weight at delivery were collected from medical records, and anthropometric data were measured at birth and at 6-month, 1-year and 2-year follow-up visits. Linear regression and linear mixed-effect models assessed associations with pre-pregnancy BMI, GWG and BAZ during the first 2 years of life. RESULTS Pre-pregnancy overweight and obesity and excessive GWG were positively associated with BAZ at birth and at 1- and 2-year follow-up visits. There were no significant additional BAZ changes per year based on the exposures up to age 2 years. CONCLUSIONS Elevated maternal pre-pregnancy BMI and GWG were associated with a child's higher BAZ at birth, and these differences remained constant throughout the first 2 years of life in Amazonian children. These findings highlight the importance of promoting adequate maternal weight before pregnancy and during prenatal care also in socially vulnerable populations.
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Affiliation(s)
- Lara Lívia Santos da Silva
- Department of Nutrition, University of São Paulo, São Paulo, Brazil
- Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Ana Alice de Araújo Damasceno
- Postgraduate Program in Public Health, University of São Paulo, São Paulo, Brazil
- Federal University of Acre, Cruzeiro do Sul, Brazil
| | - Paulo Augusto Ribeiro Neves
- Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Zheng M, Hesketh KD, Vuillermin P, Dodd J, Wen LM, Baur LA, Taylor R, Byrne R, Mihrshahi S, Burgner D, Tang MLK, Campbell KJ. Understanding the pathways between prenatal and postnatal factors and overweight outcomes in early childhood: a pooled analysis of seven cohorts. Int J Obes (Lond) 2023:10.1038/s41366-023-01301-9. [PMID: 37012427 DOI: 10.1038/s41366-023-01301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND/OBJECTIVES Childhood overweight and obesity are influenced by a range of prenatal and postnatal factors. Few studies have explored the integrative pathways linking these factors and childhood overweight. This study aimed to elucidate the integrative pathways through which maternal pre-pregnancy body mass index (BMI), infant birth weight, breastfeeding duration, and rapid weight gain (RWG) during infancy are associated with overweight outcomes in early childhood from ages 3 to 5 years. SUBJECTS/METHODS Pooled data from seven Australian and New Zealand cohorts were used (n = 3572). Generalized structural equation modelling was used to examine direct and indirect associations of maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration, and RWG during infancy with child overweight outcomes (BMI z-score and overweight status). RESULTS Maternal pre-pregnancy BMI was directly associated with infant birth weight (β 0.01, 95%CI 0.01, 0.02), breastfeeding duration ≥6 months (OR 0.92, 95%CI 0.90, 0.93), child BMI z-score (β 0.03, 95%CI 0.03, 0.04) and overweight status (OR 1.07, 95%CI 1.06, 1.09) at ages 3-5 years. The association between maternal pre-pregnancy BMI and child overweight outcomes was partially mediated by infant birth weight, but not RWG. RWG in infancy exhibited the strongest direct association with child overweight outcomes (BMI z-score: β 0.72, 95%CI 0.65, 0.79; overweight status: OR 4.49, 95%CI 3.61, 5.59). Infant birth weight was implicated in the indirect pathways of maternal pre-pregnancy BMI with RWG in infancy, breastfeeding duration, and child overweight outcomes. The associations between breastfeeding duration (≥6 months) and lower child overweight outcomes were fully mediated by RWG in infancy. CONCLUSIONS Maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration and RWG in infancy act in concert to influence early childhood overweight. Future overweight prevention interventions should target RWG in infancy, which showed the strongest association with childhood overweight; and maternal pre-pregnancy BMI, which was implicated in several pathways leading to childhood overweight.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | | | - Jodie Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Li Ming Wen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Hunt KJ, Ferguson PL, Neelon B, Commodore S, Bloom MS, Sciscione AC, Grobman WA, Kominiarek MA, Newman RB, Tita AT, Nageotte MP, Palomares K, Skupski DW, Zhang C, Hinkle S, Wapner R, Vena JE. The association between maternal pre-pregnancy BMI, gestational weight gain and child adiposity: A racial-ethnically diverse cohort of children. Pediatr Obes 2022; 17:e12911. [PMID: 35289494 PMCID: PMC9283205 DOI: 10.1111/ijpo.12911] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The prevalence of obesity in US children has more than tripled in the past 40 years; hence, it is critical to identify potentially modifiable factors that may mitigate the risk. OBJECTIVES To examine the association between maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and child adiposity as measured by BMI, waist circumference and percent body fat in a racial-ethnically diverse cohort. METHODS In a prospective cohort study of healthy women without chronic disease, we examined the association between pre-pregnancy BMI, GWG and child adiposity. Children ages 4-8 years (n = 816) in the Environmental Influences on Child Health Outcomes-NICHD Fetal Growth Studies were assessed. Trained study staff ascertained maternal pre-pregnancy BMI, GWG and child adiposity. RESULTS The odds of child obesity (≥95th BMI percentile) increased independently for each unit increase in maternal pre-pregnancy BMI [OR = 1.12 (95% CI: 1.08, 1.17)] and for each 5-kg increase in GWG [OR = 1.25 (95% CI: 1.07, 1.47)]. The odds of child waist circumference (≥85th percentile) also increased independently for pre-pregnancy BMI [OR = 1.09 (95% CI: 1.05, 1.12)] and GWG [OR = 1.18 (95% CI: 1.04, 1.34)]. CONCLUSIONS Maternal pre-pregnancy BMI and GWG were each independently and positively associated with child obesity and high child waist circumference.
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Affiliation(s)
- Kelly J Hunt
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pamela L Ferguson
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah Commodore
- Environmental and Occupational Health, Indiana University, Bloomington, Indiana, USA
| | - Michael S Bloom
- Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Anthony C Sciscione
- Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware, USA
| | - William A Grobman
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle A Kominiarek
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roger B Newman
- Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alan T Tita
- Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael P Nageotte
- Obstetrics and Gynecology, Miller Children's and Women's Hospital, Long Beach, California, USA
| | - Kristy Palomares
- Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Daniel W Skupski
- Obstetrics and Gynecology, New York Presbyterian Queens Hospital, Queens, New York, USA
| | - Cuilin Zhang
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stefanie Hinkle
- Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ronald Wapner
- Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - John E Vena
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Shay M, Tomfohr-Madsen L, Tough S. Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:543-554. [PMID: 32215855 PMCID: PMC7438469 DOI: 10.17269/s41997-020-00312-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 02/24/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Maternal psychological distress in pregnancy has been associated with both breastfeeding duration and child weight at 24 months; however, the potential that breastfeeding duration partially mediates the risk of maternal mental health problems during pregnancy on child weight classification has not been examined. The current study investigated this proposed relationship. METHODS Data was taken from the All Our Families (AOF) cohort, an ongoing prospective pregnancy cohort located in Calgary, Canada. Psychological distress, defined as clinically significant symptoms of anxiety and depression, was assessed via self-report and measured between 34 and 36 weeks of gestation. Breastfeeding duration was assessed in the postpartum by self-report. Child overweight classification was defined as a weight-for-length/height z-score at or above the 97th percentile as per World Health Organization's child growth guidelines. RESULTS In this sample of 1582 mother-child pairs, there was no direct relationship between psychological distress and child overweight status. Both anxiety (B = - 5.40, p = 0.001) and depression (B = - 6.54, p = 0.008) were associated with decreased weeks breastfeeding. Breastfeeding duration mediated the association between maternal prenatal psychological distress and child overweight status at 24 months, for both anxiety (B(SE) = 0.10(0.05), CI 0.03-0.21) and depression (B(SE) = 0.11(0.07), CI 0.01-0.27). Covariates included maternal age, education, ethnicity, income, pre-pregnancy BMI, gestational weight gain, and infant birth weight. CONCLUSIONS The results of this longitudinal cohort analysis support an indirect relationship between maternal psychological distress in pregnancy and the childhood overweight/obesity at 24 months old, mediated through breastfeeding duration.
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Affiliation(s)
- Matthew Shay
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
| | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Suzanne Tough
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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English S, Wright I, Ashburn V, Ford G, Caramaschi D. Prenatal anxiety, breastfeeding and child growth and puberty: linking evolutionary models with human cohort studies. Ann Hum Biol 2020; 47:106-115. [PMID: 32429755 PMCID: PMC7261397 DOI: 10.1080/03014460.2020.1751286] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
Abstract
Background: Stress experienced by mothers during pregnancy can have both immediate and long-term effects on child development, potentially mediated by breastfeeding.Aim: Using a UK birth cohort study, we asked how maternal stress relates to breastfeeding and consequences for growth and puberty onset.Subjects and methods: We analysed data from the Avon Longitudinal Study of Parents and Children, collected via questionnaires and clinic visits (N: 698-8,506). We used reports of prenatal anxiety, breastfeeding, early growth and age at menarche or first voice change. Confounding by maternal age, parity, smoking, education and body mass index (BMI) was considered.Results: Mothers with higher levels of reported anxiety were less likely to breastfeed (Odds ratio (OR): 0.83, 95% confidence interval (CI): 0.71, 0.97). Breastfed infants had slower growth before weaning, although growth differences were unclear thereafter. Being breastfed for more than six months was associated with later puberty onset in females (2.76 months later than non-breastfed; CI: 0.9, 4.63), although the association was attenuated by confounders and BMI (1.51 months, CI: -0.38, 3.40). No association between breastfeeding and puberty onset in males was found.Conclusion: Our studies fit results shown previously, and we consider these in light of evolutionary life history theory while discussing key challenges in such an approach.
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Affiliation(s)
- Sinead English
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - India Wright
- Reproduction and Development Programme, Bristol Medical School (Translational Health Sciences), University of Bristol, Bristol, UK
| | - Verity Ashburn
- Reproduction and Development Programme, Bristol Medical School (Translational Health Sciences), University of Bristol, Bristol, UK
| | - Gemma Ford
- Reproduction and Development Programme, Bristol Medical School (Translational Health Sciences), University of Bristol, Bristol, UK
| | - Doretta Caramaschi
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
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Garcia Rincon LJ, Alencar GP, Cardoso MA, Narvai PC, Frazão P. Effect of birth weight and nutritional status on transverse maxillary growth: Implications for maternal and infant health. PLoS One 2020; 15:e0228375. [PMID: 31999780 PMCID: PMC6992174 DOI: 10.1371/journal.pone.0228375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
We analyzed the association between birthweight, nutritional status and transverse maxillary growth in 7- to 9-year-old schoolchildren. We undertook a cross-sectional survey nested in a population-based cohort study of 158 schoolchildren. The participants lived in the urban area of a small town within the Western Brazilian Amazon. The outcome was represented by the upper intermolar distance given in millimeters (mm), as an indicator of the degree of maxillary bone growth in its transverse dimension. The exposures were sex, birthweight, the bottle-feeding pattern operationalized by a scale corresponding to the age of introduction of the bottle and Body Mass Index-for-age z-score (BAZ) at 4 to 6 ys. Path analysis was employed to estimate standardized direct, indirect and total effects of exposures on the outcome using structural equations model (SEM) supported by Mplus 7 program. The values of standardized coefficients (SC) showed significant direct positive effects of sex (SC = 0.203; p = 0.006), birth weight (SC = 0.155; p = 0.030) and BAZ (SC = 0.165; p = 0.014) on transverse maxillary growth. The indirect effects (SC = 0.057; p = 0.012) and the total effect (SC = 0.261; p<0.001) of sex on the outcome were statistically significant. The indirect effects of birth weight on the outcome were not significant (SC = 0.018; p = 0.488), however, the total effect was significant (SC = 0.174; p = 0.011). In conclusion, sex, birthweight, bottle beginning age and BAZ showed association with the transverse growth of the maxillary bone. In addition to contributing to an adequate birth weight of the child, policies and programs that favor prenatal care and conditions to guarantee a full-term birth can positively affect transverse growth of the maxilla. From a Public Health Surveillance point of view, children with reduced birthweight, inadequate breastfeeding pattern and nutritional deficit for age may be more likely to develop atrophy of the jaws which, depending on the severity, may result in malocclusion with an important impact on quality of life.
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Affiliation(s)
- Laura Jackeline Garcia Rincon
- Department of Politics, Management and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Marly Augusto Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Paulo Capel Narvai
- Department of Politics, Management and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Paulo Frazão
- Department of Politics, Management and Health, School of Public Health, University of São Paulo, São Paulo, Brazil
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Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
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Liu J, Boghossian NS, Frongillo EA, Cai B, Hazlett LJ, Liu J. Associations of maternal gestational weight gain with the risk of offspring obesity and body mass index Z scores beyond the mean. Ann Epidemiol 2019; 32:64-71.e2. [PMID: 30799201 DOI: 10.1016/j.annepidem.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/09/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE We examined the association of meeting the 2009 Institute of Medicine gestational weight gain (GWG) guidelines with offspring obesity and body mass index Z score (BMIZ) at age six overall and by maternal weight status. METHODS Data were from the Infant Feeding Practices Survey II Study (2005-2007) and their Year Six Follow-Up Study (2012). Logistic regression and quantile regression models were used. RESULTS Eleven percent of children were obese. Children born to mothers who gained excessive weight during pregnancy had an increased risk of obesity as compared with those born to mothers who gained adequate weight (adjusted odds ratio: 1.67). The association was stronger among normal-weight mothers (adjusted odds ratio: 3.50). Inadequate GWG was not associated with offspring obesity overall or in subsamples by maternal prepregnancy BMI. Children born to mothers who gained excessive weight had higher BMIZ. This distributional association was more pronounced among normal-weight mothers. Children born to obese mothers who gained inadequate weight had lower BMIZ at some percentiles of the BMIZ distribution. CONCLUSIONS Excessive GWG was associated with increased risk of offspring obesity and higher BMIZ at age six, whereas inadequate GWG was protective of high BMIZ among children born to obese mothers.
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Affiliation(s)
- Junxiu Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Linda J Hazlett
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
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Weight estimation among multi-racial/ethnic infants and children aged 0-5·9 years in the USA: simple tools for a critical measure. Public Health Nutr 2018; 22:147-156. [PMID: 30333072 DOI: 10.1017/s1368980018002549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In resource-constrained facilities or during resuscitation, immediate paediatric weight estimation remains a fundamental challenge. We aimed to develop and validate weight estimation models based on ulna length and forearm width and circumference measured by simple and portable tools; and to compare them against previous methods (advanced paediatric life support (APLS), Theron and Traub-Johnson formulas). DESIGN Cross-sectional analysis of anthropometric measurements. Four ulna- and forearm-based weight estimation models were developed in the training set (n 1016). Assessment of bias, precision and accuracy was examined in the validation set (n 457). SETTING National Children's Study-Formative Research in Anthropometry (2011-2012). SUBJECTS Multi-racial/ethnic infants and children aged <6 years (n 1473). RESULTS Developed Models 1-4 had high predictive precision (R 2=0·91-0·97). Mean percentage errors between predicted and measured weight were significantly smaller across the developed models (0·1-0·7 %) v. the APLS, Theron and Traub-Johnson formulas (-1·7, 9·2 and -4·9 %, respectively). Root-mean-squared percentage error was overall smaller among Models 1-4 v. the three existing methods (range=7·5-8·7 v. 9·8-13·3 %). Further, Models 1-4 were within 10 and 20 % of actual weight in 72-87 and 95-99 % of the weight estimations, respectively, which outperformed any of the three existing methods. CONCLUSIONS Ulna length, forearm width and forearm circumference by simple and portable tools could serve as valid and reliable surrogate measures of weight among infants and children aged <6 years with improved precision over the existing age- or length-based methods. Further validation of these models in physically impaired or non-ambulatory children is warranted.
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Association of maternal gestational weight gain with their offspring's anthropometric outcomes at late infancy and 6 years old: mediating roles of birth weight and breastfeeding duration. Int J Obes (Lond) 2017; 42:8-14. [PMID: 28775373 DOI: 10.1038/ijo.2017.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/08/2017] [Accepted: 07/23/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Longitudinal studies examining the potential mediating roles of birth weight and breastfeeding duration on the pathways between maternal gestational weight gain (GWG) and offspring anthropometric outcomes are lacking. METHODS We analyzed data from the mother-child pairs in the Infant Feeding Practices Study II (IFPS II) in late infancy (n=1548) and at the Year 6 Follow-up (n=1514) Study. Child anthropometrics included age- and sex-specific Z-scores for weight for age (WAZ), height /length for age, weight for height/length and body mass index (BMIZ). Structural equation models were used to estimate the total, direct and indirect effects of GWG on child anthropometrics through birth weight and breastfeeding duration. RESULTS The total effect of GWG on offspring anthropometric outcomes was significant for WAZ (β=0.107, 95% confidence interval (CI): 0.052, 0.161) at late infancy and for WAZ (β=0.122, 95% CI: 0.066, 0.177) and BMIZ (β=0.120, 95% CI: 0.063, 0.178) at 6 years old. The direct effects of GWG on offspring's WAZ and BMIZ were observed only at 6 years old. The indirect effects of GWG through birth weight were significant on most of the offspring's anthropometric measures. Compared to breastfeeding duration, birth weight was a stronger mediator on the pathways between GWG and all proposed anthropometric measures both in late infancy and in early childhood. Longer duration of breastfeeding was inversely associated with all offspring anthropometric outcomes at late infancy but not with those outcomes at 6 years old. CONCLUSIONS Our findings suggest a stronger indirect rather than direct effect of GWG on children's anthropometric outcomes mainly through birth weight, independent of maternal sociodemographic and reproductive factors. Longer duration of breastfeeding might suppress the positive relationship between GWG, birth weight and anthropometric outcomes in late infancy but not among 6 years old.
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Abstract
Abundant evidence exists linking maternal and paternal environments from pericopconception through the postnatal period to later risk to offspring diseases. This concept was first articulated by the late Sir David Barker and as such coined the Barker Hypothesis. The term was then mutated to Fetal Origins of Adult Disease and finally broadened to developmental origins of adult health and disease (DOHaD) in recognition that the perinatal environment can shape both health and disease in resulting offspring. Developmental exposure to various factors, including stress, obesity, caloric-rich diets and environmental chemicals can lead to detrimental offspring health outcomes. However, less attention has been paid to date on measures that parents can take to promote the long-term health of their offspring. In essence, have we neglected to consider the ‘H’ in DOHaD? It is the ‘H’ component that should be of primary concern to expecting mothers and fathers and those seeking to have children. While it may not be possible to eliminate exposure to all pernicious factors, prevention/remediation strategies may tip the scale to health rather than disease. By understanding disruptive DOHaD mechanisms, it may also illuminate behavioral modifications that parents can adapt before fertilization and throughout the neonatal period to promote the lifelong health of their male and female offspring. Three possibilities will be explored in the current review: parental exercise, probiotic supplementation and breastfeeding in the case of mothers. The ‘H’ paradigm should be the focus going forward as a healthy start can indeed last a lifetime.
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Alderete TL, Autran C, Brekke BE, Knight R, Bode L, Goran MI, Fields DA. Associations between human milk oligosaccharides and infant body composition in the first 6 mo of life. Am J Clin Nutr 2015; 102:1381-8. [PMID: 26511224 PMCID: PMC6546222 DOI: 10.3945/ajcn.115.115451] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/24/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Evidence linking breastfeeding to reduced risk of developing childhood obesity is inconclusive, yet previous studies have not considered variation in specific components of breast milk that may affect early development. OBJECTIVE We examined whether differences in the composition of human milk oligosaccharides (HMOs) correlate with infant growth and body composition at 1 and 6 mo of age. DESIGN Twenty-five mother-infant dyads were recruited from the University Hospital at the University of Oklahoma Health Sciences Center. Infants were breastfed for 6 mo. Breast-milk and infant measures were obtained at 1 and 6 mo of infant age. HMO composition was analyzed by high-pressure liquid chromatography, and infant growth (length and weight) and body composition (percentage fat, total fat, lean mass) were measured by dual-energy X-ray absorptiometry. Relations between HMOs and infant growth and body composition were examined by using multiple linear regression. A priori covariates included maternal prepregnancy body mass index, pregnancy weight gain, and infant age and sex. RESULTS Higher HMO diversity and evenness at 1 mo were associated with lower total and percentage fat mass at 1 mo. At 1 mo, each 1-μg/mL increase in lacto-N-fucopentaose (LNFP) I was associated with a 0.40-kg lower infant weight (P = 0.03). At 6 mo, each 1-μg/mL increase in LNFPI was associated with a 1.11-kg lower weight (P = 0.03) and a 0.85-g lower lean mass (P = 0.01). At 6 mo, each 1-μg/mL increase in LNFPI was associated with a 0.79-g lower fat mass (P = 0.02), whereas disialyl-lacto-N-tetraose and LNFPII were associated with a 1.92-g (P = 0.02) and 0.42-g (P = 0.02) greater fat mass, respectively. At 6 mo, each 1-μg/mL increase in fucosyl-disialyl-lacto-N-hexaose and lacto-N-neotetraose was associated with 0.04% higher (P = 0.03) and 0.03% lower (P < 0.01) body fat, respectively. CONCLUSION These findings support the hypothesis that differences in HMO composition in mother's milk are associated with infant growth and body composition. This trial was registered at clinicaltrials.gov as NCT02535637.
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Affiliation(s)
- Tanya L Alderete
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | | | - Benjamin E Brekke
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Rob Knight
- Departments of Pediatrics and Computer Science and Engineering, University of California, San Diego, CA; and
| | | | - Michael I Goran
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA;
| | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center and Children's Medical Research Institute Metabolic Research Program, Oklahoma City, OK
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Zhu Y, Hernandez LM, Mueller P, Dong Y, Hirschfeld S, Forman MR. Predictive Models for Characterizing Disparities in Exclusive Breastfeeding Performance in a Multi-ethnic Population in the US. Matern Child Health J 2015; 20:398-407. [PMID: 26515468 DOI: 10.1007/s10995-015-1838-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Maternal lactation performance varies across populations, yet the relative impact of maternal sociodemographics, perinatal factors, and birth outcomes on disparities in exclusive breastfeeding (XBR) outcomes is not well known. We aimed to develop predictive models and compare the relative contribution of predictors for XBR initiation and XBR ≥ 6 months. METHODS Infant feeding data were obtained from women with children aged 0-6 years (n = 1471) in a multi-ethnic cross-sectional study in the US (2011-2012). We compared discriminant ability of predictors for ever XBR and XBR ≥ 6 months using discriminant function analysis, respectively. We also calculated adjusted ORs for factors associated with XBR outcomes and breast-bottle feeding (BrBot) subgroups. RESULTS Maternal sociodemographics (education level, marital status, nativity, and age at childbirth) had greater discriminating abilities in predicting ever XBR and XBR ≥ 6 months than birth outcomes and perinatal factors. Foreign-born women were two-fold more likely to initiate XBR but not necessarily continue to 6 months compared to their US-born counterparts. Factors associated with BrBot subgroups differed from those associated with XBR outcomes, whereas maternal age was the only predictor consistently associated with ever XBR, XBR ≥ 6 months, and BrBot subgroups. The areas under the receiver operating characteristic curves for models predicting ever XBR and XBR ≥ 6 months were 0.88 (95 % CI 0.85, 0.91) and 0.90 (95 % CI 0.88, 0.93), respectively. CONCLUSIONS Findings underscore the importance of educational, clinical, and social support to promote XBR in mothers with sociodemographic factors predictive of none or poor XBR outcomes.
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Affiliation(s)
- Yeyi Zhu
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA. .,Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. .,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20852, USA.
| | - Ladia M Hernandez
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA
| | - Peter Mueller
- Department of Mathematics, University of Texas at Austin, Austin, TX, USA
| | - Yongquan Dong
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA
| | - Steven Hirschfeld
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Michele R Forman
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA.,School of Human Ecology, University of Texas at Austin, Austin, TX, USA
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Rauh K, Günther J, Kunath J, Stecher L, Hauner H. Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum. BMC Pregnancy Childbirth 2015; 15:265. [PMID: 26472133 PMCID: PMC4608142 DOI: 10.1186/s12884-015-0701-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background Excessive gestational weight gain (GWG) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring. Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation. Methods A cluster-randomized controlled intervention trial was performed with 250 pregnant women in 8 gynaecological practices. Lifestyle intervention was carried out twice with individual counselling sessions on nutrition, physical activity and weight monitoring. Participants in the control group received routine prenatal care and an information leaflet. Follow-up data of women and their offspring were collected one year postpartum (pp) by phone call and/or via e-mail using a structured questionnaire. Maternal weight retention at 12 months pp and weight development of the children in their first year of life was compared between groups using linear regression. The association between energy and macronutrient intake during pregnancy with maternal weight retention and children weight development was also assessed. Results The intervention resulted in a trend towards lower mean weight retention 12 months pp (0.2 vs. 0.8 kg), but was not statistically significant (p = 0.321). Among women receiving lifestyle counselling, only 8 % retained more than 5 kg weight while 17 % in the control group retained >5 kg (OR: 0.40 (95 % CI: 0.16, 0.97)). For the whole study cohort, an association between higher GWG and increased 12 month weight retention was found (0.4 kg weight retention per 1 kg increase in GWG, p < 0.001). Weight development of the infants did not differ between groups in the first months after birth. At the 10th–12th month weight measurement, infants born to mothers in the intervention group tended towards lower body weights. Both energy intake and macronutrient composition of the diet during pregnancy did not affect maternal weight retention and weight development of the infants. Conclusions Lifestyle counselling during pregnancy to avoid GWG had a rather modest effect on maternal pp weight retention and weight development of the infants. However, larger intervention studies and longer follow-up are required to be able to draw definite conclusions. Trial registration German Clinical Trials Register DRKS00003801. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0701-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathrin Rauh
- ZIEL - Research Centre for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany. .,Competence Centre for Nutrition (KErn), Freising, Germany.
| | - Julia Günther
- ZIEL - Research Centre for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany. .,Else Kröner-Fresenius-Center for Nutritional Medicine, Chair of Nutritional Medicine, Technische Universität München, Freising-Weihenstephan, Germany. .,Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Julia Kunath
- ZIEL - Research Centre for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany. .,Else Kröner-Fresenius-Center for Nutritional Medicine, Chair of Nutritional Medicine, Technische Universität München, Freising-Weihenstephan, Germany. .,Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Hans Hauner
- ZIEL - Research Centre for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany. .,Else Kröner-Fresenius-Center for Nutritional Medicine, Chair of Nutritional Medicine, Technische Universität München, Freising-Weihenstephan, Germany. .,Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Dogra S, Sakwinska O, Soh SE, Ngom-Bru C, Brück WM, Berger B, Brüssow H, Karnani N, Lee YS, Yap F, Chong YS, Godfrey KM, Holbrook JD. Rate of establishing the gut microbiota in infancy has consequences for future health. Gut Microbes 2015; 6:321-5. [PMID: 26516657 PMCID: PMC4826121 DOI: 10.1080/19490976.2015.1078051] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The gut of the human neonate is colonized rapidly after birth from an early sparse and highly distinct microbiota to a more adult-like and convergent state, within 1 to 3 years. The progression of colonizing bacterial species is non-random. During the first months of life several shifts commonly occur in the species prevalent in our guts. Although the sequential progression of these species is remarkably consistent across individuals and geographies, there is inter-individual variation in the rate of progression. Our study and others suggest that the rate is influenced by environmental factors, and influences our future health. In this article, we review our recent contribution to cataloging the developing infant gut microbiota alongside other important recent studies. We suggest testable hypotheses that arise from this synthesis.
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Affiliation(s)
- Shaillay Dogra
- Singapore Institute for Clinical Sciences (SICS); Agency for Science and Technology Research (A*STAR); Singapore
| | | | - Shu-E Soh
- Department of Pediatrics; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | | | | | | | | | - Neerja Karnani
- Singapore Institute for Clinical Sciences (SICS); Agency for Science and Technology Research (A*STAR); Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS); Agency for Science and Technology Research (A*STAR); Singapore,Department of Pediatrics; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital; Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences (SICS); Agency for Science and Technology Research (A*STAR); Singapore,Department of Obstetrics and Gynecology; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton, United Kingdom
| | - Joanna D Holbrook
- Singapore Institute for Clinical Sciences (SICS); Agency for Science and Technology Research (A*STAR); Singapore,Correspondence to: Joanna D Holbrook;
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