The association between maternal body mass index and child obesity: A systematic review and meta-analysis

Food switching at a meal is positively associated with change in adiposity among children at high-familial risk for obesity

Switching between different foods while eating has been positively associated with weight status and intake in children. Evidence suggests that switching behavior is consistent within children across meals, however, it is unclear how switching relates to changes in adiposity over time. In a 1-year longitudinal study, we assessed whether food switching predicted changes in fat mass index (FMI: fat mass kg/height m2) in 7-8-year-old children and tested if familial risk of obesity moderated this relationship. At baseline, seventy-four children without obesity (7.8 ± 0.6 y; 37F) consumed four ad libitum meals of varying portion sizes, each consisting of chicken nuggets, macaroni and cheese, grapes, and broccoli. For each child, the average number of food switches was calculated from video recordings across the four meals. To assess change in adiposity over time, children completed a dual energy x-ray absorptiometry scan for assessment of FMI at baseline and follow-up (≥1 year later). Familial risk of obesity was determined by maternal BMI (high-risk: ≥30 kg/m2, n = 32 vs. low-risk: <25 kg/m2, n = 42). Food switching at baseline was positively associated with changes in FMI over 1 year (p = 0.03). In addition to the 37% of variance in FMI change explained by known factors influencing adiposity, food switching accounted for an additional 4% of the variance (p = 0.03). Further, there was an interaction between familial risk status and food switching (p = 0.04) such that the relationship between switching and FMI change was only significant in high-risk children. Overall, children's food switching behavior assessed at laboratory meals predicted change in adiposity over 1 year. Food switching could be a behavioral marker for, and contribute to, pediatric obesity risk particularly in children with a familial predisposition.

Perinatal obesity primes the hepatic metabolic stress response in the offspring across life span

Perinatal obesity is associated with an increased risk of metabolic diseases and hepatic dysfunction in offspring. However, the underlying mechanisms of this metabolic programming remain incompletely understood. This study aimed to elucidate the influence of maternal obesity and early life exposure to high-fat diet on offspring liver phenotype, hepatokine profile, and key components of hepatic metabolism. To this end, we employed a murine high-fat diet-induced perinatal obesity model, investigating the offspring in early life and late adulthood. After exposure to perinatal obesity, the offspring showed a significantly increased body weight in early life with no histological signs of steatosis, but a dysregulated hepatokine profile. Proteomic profiling, followed by molecular analyses, revealed a decreased lipogenesis and increased fatty acid oxidation, suggesting a protective mechanism against the development of steatosis. These changes were accompanied by increased markers of lipid peroxidation and DNA damage, indicating increased oxidative stress. Concomitantly, the antioxidative enzymes catalase and superoxide dismutase 2 were significantly reduced and oxidative phosphorylation was impaired, implying an altered oxidative stress response. While changes in oxidative stress level were only detected in early life, the lipid metabolism was altered across life span. This metabolic programming could determine the resilience and susceptibility to chronic liver disease later in life.

Child somatic growth and neurodevelopment: effects of pregnancy lifestyle intervention

OBJECTIVE

Maternal health behavior influences offspring health and obesity risk. This study examined the long-term effects of an antenatal lifestyle intervention on somatic growth and neurodevelopment of preschool-aged children.

METHODS

We followed children born to women in the cluster-randomized GeliS trial who received usual care (CG) or lifestyle counseling (IG). Anthropometrics and neurodevelopment data for children aged 4 and 5 were collected from routine health examinations and the Ages-and-Stages Questionnaire (ASQ).

RESULTS

Of 2 286 women initially enrolled, 1 403 reported on their child's development. The intervention had no effect on weight, height, head circumference, BMI, or percentiles and z-scores at ages 4 and 5. In IG compared to CG, the proportion of children with underweight was lower (4 years: 7.8% vs. 10.9%; 5 years: 8.1% vs. 8.9%), while overweight (4 years: 6.5% vs. 4.2%; 5 years: 5.1% vs. 3.4%) and obesity proportions (4 years: 1.0% vs. 1.1%; 5 years: 2.7% vs. 1.6%) were higher. IG children were more likely to fall into a higher weight category at 4 (p = 0.017) and 5 years (p = 0.075). ASQ scores were similar across both groups.

CONCLUSION

Despite slight weight differences, the pregnancy lifestyle intervention had no meaningful impact on child somatic growth or neurodevelopment up to age 5.

IMPACT

This comprehensive antenatal lifestyle intervention, executed as a large-scale real-world effectiveness trial, did not demonstrate any long-term effect on children's anthropometry or their risk of overweight or obesity up to 5 years of age. No discernible intervention effects were observed concerning children's neurodevelopment outcomes. Personalized antenatal interventions targeting the individual risk profiles of pregnant women may be needed to substantially modify lifestyle behaviors and achieve sustainable impacts on child development and obesity risk.

Exploring socio-demographic determinants of obesity in Jordanian women of reproductive age: insights from a nationwide survey

BACKGROUND

In Jordan, obesity has emerged as a significant public health concern, particularly among females, with a prevalence of 43.1%. This rising trend, exacerbates the burden of non-communicable diseases and places increasing strain on the healthcare system.

AIM

We aimed to explore the predictors associated with obesity among adult ever-married Jordanian women aged 20-49 years based on the Jordanian Population and Family Health Survey (JPFHS).

METHOD

Our study analyzed data from the JPFHS conducted in 2017-18, which initially included 14,689 ever-married women. We performed multivariable analyses to determine the socio-demographic predictors of obesity among these women.

RESULT

We included 4,339 Jordanian women in our study, of whom 2,189 were classified as obese and 2,150 had a normal body mass index (BMI). Multivariable analysis indicated that increasing age and living in Tafilahwere significantly associated with higher odds of developing obesity (p < 0.05). Conversely, factors such as being in the wealthiest category, residing in Ma'an and Aqaba, and smoking every day were significantly linked to reduced odds of obesity (p < 0.05). Additionally, no significant associations were found between obesity development and variables such as the type of place of residence, educational level, frequency of reading newspapers or magazines, radio listening, television watching, or internet use in the past month (p > 0.05).

CONCLUSION

Appropriate and targeted interventions should be developed for Jordanian women to address obesity and its related health issues. Policymakers should adopt a multilevel approach that focuses on high-risk subgroups, including older women, and those living in Tafilh. Efforts should be made to raise awareness and provide preventative measures tailored to these groups to effectively reduce obesity and its associated complications.

New Frontiers: Umbilical Cord Mesenchymal Stem Cells Uncover Developmental Roots and Biological Underpinnings of Obesity Susceptibility

PURPOSE OF REVIEW

To review evidence supporting human umbilical cord mesenchymal stem cells (UC-MSC) as an innovative model system advancing obesity precision medicine.

RECENT FINDINGS

Obesity prevalence is increasing rapidly and exposures during fetal development can impact individual susceptibility to obesity. UC-MSCs exhibit heterogeneous phenotypes associated with maternal exposures and predictive of child cardiometabolic outcomes. This recent evidence supports UC-MSCs as a precision model serving three purposes: (1) as a mechanistic tool to interrogate biological underpinnings of obesity in human studies, (2) as a sensitive index of early life causes and determinants of obesity, and (3) as a marker and transducer of susceptibility, highlighting populations most at risk for future obesity. Data from UC-MSCs emphasize nutrient sensing and lipid partitioning as phenotypes most relevant to neonatal and early childhood adiposity and implicate a role for these cell-autonomous features of mesodermal tissues in the biological underpinnings of obesity.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Protective Eating Behaviors Among Children at Higher Risk for Obesity in the INSIGHT Study

Background: Maternal pre-pregnancy body mass index (BMI) is positively associated with offspring overweight. We investigated behaviors that may confer resilience to childhood overweight development by examining appetitive traits in at-risk children born to mothers with pre-pregnancy overweight. Methods: This secondary analysis included children born to mothers with pre-pregnancy BMI ≥25 kg/m2 from the Intervention Nurses Start Infants Growing on Health Trajectories Study (N = 84). Mothers completed the Child Eating Behavior Questionnaire (CEBQ) at child ages 30 months and 6 years. t-tests assessed differences in appetitive traits (CEBQ subscale scores) between children with overweight (BMI ≥85th percentile) and without overweight (BMI <85th percentile). Results: The 87 children (41 female [47%]) included in this analysis were predominantly White and non-Hispanic (93%), and 34 (39%) had overweight at age 6 years. Compared with children with overweight, children without overweight had mothers who reported greater child slowness in eating when their child was 30 months (p = 0.04) and 6 years old (p = 0.004). Similarly, mothers of children without overweight reported higher child satiety responsiveness, lower enjoyment of food, and lower food responsiveness (p < 0.001 for all) when their child was 6 years old. Conclusion: Eating slower, higher satiety responsiveness, lower enjoyment of food, and lower food responsiveness were protective factors against developing overweight among those with familial risk. Strategies to promote the development of slower eating and satiety responsiveness could be explored as part of obesity prevention strategies.

Multi-omics Analysis of Umbilical Cord Hematopoietic Stem Cells from a Multi-ethnic Cohort of Hawaii Reveals the Intergenerational Effect of Maternal Pre-Pregnancy Obesity and Risk Prediction for Cancers

Background

Maternal obesity is a health concern that may predispose newborns to a high risk of medical problems later in life. To understand the intergenerational effect of maternal obesity, we hypothesized that the maternal obesity effect is mediated by epigenetic changes in the CD34+/CD38-/Lin- hematopoietic stem cells (uHSCs) in the offspring. Towards this, we conducted a DNA methylation centric multi-omics study. We measured the DNA methylation and gene expression in the CD34+/CD38-/Lin- uHSCs and metabolomics of the cord blood, all from a multi-ethnic cohort (n=72) from Kapiolani Medical Center for Women and Children in Honolulu, Hawaii (collected between 2016 and 2018).

Results

Differential methylation (DM) analysis unveiled a global hypermethylation pattern in the maternal pre-pregnancy obese group (BH adjusted p<0.05), after adjusting for major clinical confounders. KEGG pathway enrichment, WGCNA, and PPI analyses revealed hypermethylated CpG sites were involved in critical biological processes, including cell cycle, protein synthesis, immune signaling, and lipid metabolism. . Utilizing Shannon entropy on uHSCs methylation, we discerned notably higher quiescence of uHSCs impacted by maternal obesity. Additionally, the integration of multi-omics data-including methylation, gene expression, and metabolomics-provided further evidence of dysfunctions in adipogenesis, erythropoietin production, cell differentiation, and DNA repair, aligning with the findings at the epigenetic level. Furthermore, we trained a random forest classifier using the CpG sites in the genes of the top pathways associated with maternal obesity, and applied it to predict cancer vs. adjacent normal labels from samples in 14 Cancer Genome Atlas (TCGA) cancer types. Five of 14 cancers showed balanced accuracy of 0.6 or higher: LUSC (0.87), PAAD (0.83), KIRC (0.71), KIRP (0.63) and BRCA (0.60).

Conclusions

This study revealed the significant correlation between pre-pregnancy maternal obesity and multi-omics level molecular changes in the uHSCs of offspring, particularly in DNA methylation. Moreover, these maternal obesity epigenetic markers in uHSCs may predispose offspring to higher risks in certain cancers.

Low Birth Weight and Related Metabolic Risk Factors, Cardio-Respiratory Fitness and Physical Activity in Adolescents

BACKGROUND/OBJECTIVES

The associations between low birth weight (LBW) and the aggregation of metabolic risk factors (MRF) in youth remain ambiguous. Thus, this study analysed the interrelationship among MRF, LBW, and behavioural factors in adolescents.

METHODS

The sample of the present cross-sectional study comprised 491 youth (229 males, 262 females) aged 14-17 years. Height, weight, and BMI were assessed. Cardiorespiratory fitness (CRF) was measured using the PACER test. Physical activity (PA) was evaluated using a 3-day diary. A MRF risk score was calculated using the Z-scores of the five MRF criteria (HDL-C, triglycerides, BP, insulin, and blood glucose).

RESULTS

The average values for height, weight, and systolic and diastolic BP were significantly higher in males (p < 0.01); in contrast, females exhibited higher HDL cholesterol and insulin levels (p < 0.01). Boys revealed higher levels of PA (p < 0.01), and they achieved better CRF scores than girls (p < 0.01). BMI emerged as a significant predictor of clustered metabolic risk for both males (β = 0.26; 95% CI, 0.16-0.36) and females (β = 0.02; 95% CI, 0.14-0.30); additionally, the results indicated that more physically active girls had a notably lower metabolic risk (β = -0.01; 95% CI, -0.10--0.01) than their male peers.

CONCLUSIONS

LBW was found to be independently correlated with the aggregated MRF (β = -0.01; 95% CI, -0.01-0.00) among boys aged 14-17 years.

Associations between maternal body mass index and childhood infections in UK primary care: findings from the Born in Bradford birth cohort study

OBJECTIVE

To explore associations between maternal body mass index (BMI) in early pregnancy and childhood infections.

DESIGN

Birth cohort study linked to primary care records.

SETTING

Bradford, UK.

PARTICIPANTS

Live singleton births within the Born in Bradford cohort study between 2007 and 2011.

EXPOSURES

Maternal BMI in early pregnancy.

MAIN OUTCOME MEASURES

The total number of infections between birth and ~14 years of age with subgroup analysis by infection type and age.

RESULTS

A total of 9037 mothers and 9540 children were included in the main analysis. 45% of women were of Pakistani ethnicity and 6417 women (56%) were overweight or obese. There was an overall trend for an increasing infection rate with increasing maternal BMI. In adjusted models, only those with obesity grade 2-3 had offspring with significantly higher rates of infection during the first year of life (RR 1.12 (95% CI 1.05 to 1.20)) compared with women of healthy weight. However, by age 5 to <15 years, children born to overweight women (RR 1.09 (95% CI 1.02 to 1.16)), obese grade 1 women (RR 1.18 (95% CI 1.09 to 1.28)) or obese grade 2 women (RR 1.31 (95% CI 1.16 to 1.48)) all had significantly higher rates of infection compared with those born to healthy weight mothers. Respiratory tract and skin/soft tissue infections made up the majority of excess infections.

CONCLUSIONS

Maternal BMI was positively associated with rates of offspring infection in this study cohort, and suggests that we should be supporting women to achieve a healthy weight for pregnancy. Future research should investigate whether this is replicated in other populations, whether there is a causal association and the potential mechanisms and areas for intervention.

Diets, Fruit and Vegetable Intake and Nutritional Status Among Children, Adolescents and Adults in the Philippines: A Scoping Review

Suboptimal diets contribute to the risk of malnutrition and non-communicable diseases across the life course. Globally, intakes of fruit and vegetables (F&V) fall below recommendations, including in the Philippines. To promote F&V intakes, understanding the extent of inadequate intakes across population groups and key drivers of dietary patterns is needed. This narrative scoping review was conducted to map the diet, F&V intakes and nutritional status in the Philippines. PubMed was searched using keywords specific to diet, F&V intake, and nutritional status, with 50, 24 and 22 articles meeting the inclusion criteria for diet, F&V intake, and nutritional status, respectively. Available evidence indicates that across all population and sociodemographic groups, diets lacked diversity, with high intakes of energy-dense, nutrient-poor foods, such as refined rice and sugar-based foods and beverages, contributing to inadequate micronutrient intakes. Intakes of F&V were especially low across all population groups. Stunting/short height, wasting and underweight were prevalent among children and adolescents, and micronutrient deficiencies (iron, zinc, vitamin A) were common among children < 5 years of age. More than one-quarter of adults were overweight or obese and demonstrated poor cardiometabolic health. A lack of published evidence identified through this search reported on pregnant and lactating women and women of reproductive age. Published evaluations assessing the impact of interventions or programmes to improve diets or F&V intake were limited. Additional research to fill these gaps will help design interventions and target entry points to improve diet diversity and F&V intakes across all population groups.

The Impact of Parental Preconception Nutrition, Body Weight, and Exercise Habits on Offspring Health Outcomes: A Narrative Review

An increasing number of studies highlight the critical role of both maternal and paternal nutrition and body weight before conception in shaping offspring health. Traditionally, research has focused on maternal factors, particularly in utero exposures, as key determinants of chronic disease development. However, emerging evidence underscores the significant influence of paternal preconception health on offspring metabolic outcomes. While maternal health remains vital, with preconception nutrition playing a pivotal role in fetal development, paternal obesity and poor nutrition are linked to increased risks of metabolic disorders, including type 2 diabetes and cardiovascular disease in children. This narrative review aims to synthesize recent findings on the effects of both maternal and paternal preconception health, emphasizing the need for integrated early interventions. The literature search utilized PubMed, UNF One Search, and Google Scholar, focusing on RCTs; cohort, retrospective, and animal studies; and systematic reviews, excluding non-English and non-peer-reviewed articles. The findings of this review indicate that paternal effects are mediated by epigenetic changes in sperm, such as DNA methylation and non-coding RNA, which influence gene expression in offspring. Nutrient imbalances during preconception in both parents can lead to low birth weight and increased metabolic disease risk, while deficiencies in folic acid, iron, iodine, and vitamin D are linked to developmental disorders. Additionally, maternal obesity elevates the risk of chronic diseases in children. Future research should prioritize human studies to explore the influence of parental nutrition, body weight, and lifestyle on offspring health, ensuring findings are applicable across diverse populations. By addressing both maternal and paternal factors, healthcare providers can better reduce the prevalence of metabolic syndrome and its associated risks in future generations.

Associations between maternal preconception and pregnancy adiposity and neuropsychiatric and behavioral outcomes in the offspring: A systematic review and meta-analysis

Maternal adiposity (overweight or obesity) has been associated with adverse perinatal outcomes, although the potential risks of long-term neuropsychiatric and behavioral outcomes in the offspring remain unclear. Using the PRISMA guidelines, we searched PubMed, EMBASE, Scopus, and Web of Science to identify studies on maternal adiposity and offspring neuropsychiatric outcomes. Inverse variance-weighted random-effects meta-analyses were used to pool effect estimates with 95 % confidence intervals (95 % CIs) from adjusted odds ratios (OR) and hazard ratios (HR). Estimates were computed separately for preconception and pregnancy maternal overweight and obesity, with outcomes stratified by the type of neuropsychiatric outcome. In our meta-analyses of 42 epidemiological studies involving 3,680,937 mother-offspring pairs, we found increased risks of ADHD [OR=1.57, 95 % CI: 1.42-1.74], autism spectrum disorder [OR=1.42, 95 % CI: 1.22-1.65], conduct disorder [OR=1.16, 95 % CI: 1.00-1.35], Psychotic disorder [HR=1.61, 95 % CI: 1.41-1.83], externalizing behaviors [OR=1.30, 95 % CI: 1.07-1.56] and peer relationship problems [OR=1.25, 95 % CI: 1.04-1.27] in the offspring of preconception obese mothers. Similar increased risks were found in the offspring of preconception overweight mothers and those exposed to maternal adiposity during pregnancy. However, no association was found with offspring mood, anxiety, personality, eating, sleep disorders or prosocial problems. Preconception weight management may mitigate such adverse effects in the offspring.

Adolescent urinary concentrations of phthalate metabolites and indices of overweight and cardiovascular risk in Dutch adolescents

Phthalates have been linked to cardiovascular risk factors. Exposure to chemicals with endocrine disrupting properties during the pubertal period can interfere with normal endocrine processes. This study aims to determine whether adolescent urinary concentrations of phthalate metabolites are associated with indices of overweight and cardiovascular risk in 13-15-year-old children. In this Dutch observational cross-sectional cohort study, 101 adolescents were included (mean age 14.4 ± 0.8 years), 55 were boys. The concentrations of 13 phthalate metabolites were measured in morning urine samples. Levels of cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, fasting insulin, fasting glucose, leptin, and adiponectin were measured. The children's height, weight, waist circumference, hip circumference, and blood pressure were measured. Higher urinary mono-ethyl phthalate concentrations were associated with higher BMI and a larger hip circumference. In girls, higher urinary mono-hydroxy-iso-nonyl phthalate concentrations were associated with higher levels of lipids and obesogenic traits. In boys, higher concentrations of urinary phthalate metabolites were associated with lower LDL-C. The results of this explorative study suggest that higher levels of phthalate metabolites are associated with higher levels of lipids and obesogenic traits in 13-15-year-old girls.

Maternal adiposity and perinatal and offspring outcomes: an umbrella review

Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31), as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects.

Prevalence of Overweight and Obesity and Association with Risk Factors in Secondary School Children in Croatia

BACKGROUND

Childhood and adolescent overweight and obesity represent significant global health concerns. The primary objective of this study was to assess the prevalence and associations of some potential risk factors with overweight and obesity among Croatian adolescents aged 15 to 18.

METHODS

This cross-sectional study included 344 secondary school students from Croatia's Mediterranean region, with data collected through an anonymous questionnaire. The questionnaire gathered sociodemographic information, adherence to the Mediterranean diet of both children and their parents, and the children's dietary habits and physical activity levels.

RESULTS

Weight status data revealed that 2.6% of participants were underweight, 82% had normal weight, 11% were overweight, and 4.4% were classified as obese. The results indicated that boys (p < 0.001), children who skip breakfast (p = 0.031), those with less active lifestyles compared to their peers (p = 0.001), children whose mothers have a higher BMI (p < 0.001), and children from smaller families (p = 0.034) are at greater risk of being overweight or obese.

CONCLUSIONS

This study provides valuable insights into the risk factors associated with overweight and obesity in this age group, which can support the development of targeted strategies for this population.

Reverse-engineering the Venus figurines: An eco-life-course hypothesis for the aetiology of obesity in the Palaeolithic

Evolutionary perspectives on obesity have been dominated by genetic frameworks, but plastic responses are also central to its aetiology. While often considered a relatively modern phenomenon, obesity was recorded during the Palaeolithic through small statuettes of the female form (Venus figurines). Even if the phenotype was rare, these statuettes indicate that some women achieved large body sizes during the last glacial maximum, a period of nutritional stress. To explore this paradox, we develop an eco-life-course conceptual framework that integrates the effects of dietary transitions with intergenerational biological mechanisms. We assume that Palaeolithic populations exposed to glaciations had high lean mass and high dietary protein requirements. We draw on the protein leverage hypothesis, which posits that low-protein diets drive overconsumption of energy to satisfy protein needs. We review evidence for an increasing contribution of plant foods to diets as the last glacial maximum occurred, assumed to reduce dietary protein content. We consider physiological mechanisms through which maternal overweight impacts the obesity susceptibility of the offspring during pregnancy. Integrating this evidence, we suggest that the last glacial maximum decreased dietary protein content and drove protein leverage, increasing body weight in a process that amplified across generations. Through the interaction of these mechanisms with environmental change, obesity could have developed among women with susceptible genotypes, reflecting broader trade-offs between linear growth and adiposity and shifts in the population distribution of weight. Our approach may stimulate bioarchaeologists and paleoanthropologists to examine paleo-obesity in greater detail and to draw upon the tenets of human biology to interpret evidence.

No association between the early-life gut microbiota and childhood body mass index and body composition

BACKGROUND

The gut microbiota has been implicated in adult obesity, but the causality is still unclear. It has been hypothesized that an obesity-prone gut microbiota can be established in infancy, but only few studies have examined the early-life gut microbiota in relation to obesity in childhood, and no consistent associations have been reported. Here, we examine the association between the early-life gut microbiota and body mass index (BMI) development and body composition throughout childhood.

METHODS

Gut microbiota from stool were collected from 700 children in the Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010) cohort at ages of 1 week, 1month, 1 year, 4 years, and 6 years and analyzed by 16S rRNA gene sequencing. Outcomes included BMI World Health Organization (WHO) Z scores (zBMI), overweight (zBMI > 1.04) and obesity (zBMI > 1.64) (0-10 years), and adiposity rebound and body composition from dual-energy X-ray absorptiometry at 6 years.

FINDINGS

The early-life gut microbiota diversity, overall composition, and individual taxon abundances in unsupervised and supervised models were not consistently associated with either current or later BMI Z scores, overweight, obesity, adiposity rebound, or body composition in childhood.

CONCLUSIONS

In a deeply characterized longitudinal birth cohort, we did not observe any consistent associations between the early-life gut microbiota and BMI or risk of obesity in later childhood. While this does not conclusively rule out a relationship, it suggests that if such associations exist, they may be more complex and potentially influenced by factors emerging later in life, including lifestyle changes.

FUNDING

COPSAC is funded by private and public research funds (all listed on www.copsac.com).

Prenatal and Early-Life Anti-Infectives and Obesity at Age 7 Years

PURPOSE

To examine associations of prenatal and early-life anti-infective exposures with obesity at 7 years.

METHODS

In this nationwide, registry-based, prevalence study, we included all children with an anthropometric assessment at age 7 years from the Children's Database and linked their data with Danish population-based registries from 2001 to 2018. We defined exposure to anti-infectives (anti-bacterials, anti-virals, and anti-fungals) by outpatient dispensings or by infection diagnoses at hospital encounters. The earliest date defined the exposure timing category: prenatal (-9 months- < 0 months), infancy (0- < 2 years), and early childhood (2- < 5 years). We computed prevalence ratios (aPRs) for associations of anti-infective exposure with obesity prevalence at 7 years of age, adjusting for maternal and perinatal factors.

RESULTS

We included 460 363 children (51% boys). Prevalence of obesity at 7 years of age was 38% higher (aPR = 1.38, 95% confidence interval (CI): 1.27-1.49) among children exposed to any anti-infective, 21% higher (aPR = 1.21, 95% CI: 1.12-1.31) among children exposed to anti-infectives in infancy, and 14% higher (aPR = 1.14, 95% CI: 1.03-1.26) among children exposed to anti-infectives in early childhood. Exposure to anti-bacterials was associated with obesity in a similar time-dependent pattern [prenatal: aPR = 1.39 (95% CI: 1.29-1.50), infancy: aPR = 1.21 (95% CI: 1.12-1.30), and early childhood: aPR = 1.14 (95% CI: 1.03-1.25)]. For anti-virals and anti-fungals, exposure during infancy and early childhood was associated with larger aPRs than prenatal exposure. Furthermore, obesity prevalence increased monotonically with number of the anti-infective prescriptions.

CONCLUSION

These findings suggest that prenatal and early-life exposure to anti-infectives increases the risk of childhood obesity and that the magnitude of the associations depends on anti-infective type, timing, and dose.

Parental Feeding Practices, Weight Perception, and Children's Appetitive Traits Are Associated with Weight Trajectories in Preschoolers: A Longitudinal Study in China

OBJECTIVE

This study aimed to examine the trajectories of body mass index-for-age z-score (BAZ) in preschoolers and its association with parental feeding practices, weight perception, and children's appetitive traits.

METHODS

A total of 433 preschoolers and their parents from eight public kindergartens in Shanghai were assessed annually over two years. A group-based trajectory model was employed to identify distinct BAZ patterns. Logistic regression was utilized to investigate the baseline factors associated with the BAZ trajectories.

RESULTS

Three distinct BAZ trajectories were identified among the preschoolers: "low-stable group" (n = 154, 37.3%), "moderate-stable group" (n = 214, 47.3%), and "progressive overweight and obesity group" (n = 65, 15.4%). The children perceived as overweight and obese by parents (OR = 10.57, 95% CI: 4.89-22.86), and those with lower satiety responsiveness at baseline (OR = 0.86, 95%CI: 0.76-0.97) were more likely to fall into the progressive overweight and obesity group as opposed to the moderate-stable group. Conversely, the children perceived as underweight by parents (OR = 457, 95%CI: 2.71-7.70) had a higher likelihood of being in the low-stable group rather than the moderate-stable group.

CONCLUSIONS

This study unveiled three unique body weight trajectories among preschool children. Parental perception of children's weight and lower satiety responsiveness were associated with preschoolers' subsequent weight change, while parental feeding practices were not associated.

Trends in maternal body mass index, macrosomia and caesarean section in first-time mothers during the pandemic: a multicentre retrospective cohort study of 12 Melbourne public hospitals

OBJECTIVE

To compare specific perinatal outcomes in nulliparas with a singleton infant in cephalic presentation at term, with and without exposure to the COVID-19 pandemic during pregnancy. We hypothesised that the pandemic conditions in Melbourne may have been an independent contributor to trends in maternal Body Mass Index ≥ 25 kg/m2, macrosomia and caesarean section.

DESIGN

Multi-centre retrospective cohort study and interrupted time-series analysis.

SETTING

Metropolitan Melbourne, Victoria.

POPULATION

Singleton infants ≥ 20 weeks gestational age born between 1 January 2019 and 31 March 2022.

MAIN OUTCOME MEASURES

Rates of maternal Body Mass Index ≥ 25 kg/m2, macrosomia (birthweight ≥ 4000 g) and caesarean section.

RESULTS

25 897 individuals gave birth for the first time to a singleton infant in cephalic presentation at term in the pre-pandemic cohort, and 25 298 in the pandemic-exposed cohort. Interrupted time-series analysis demonstrated no significant additional effect of the pandemic on pre-existing upward trends in maternal Body Mass Index ≥ 25 kg/m2, caesarean section or macrosomia. The rate of maternal Body Mass Index ≥ 25 kg/m2 was higher in the pandemic-exposed cohort compared with the pre-pandemic cohort, (45.82% vs. 44.58% respectively, p = 0.041) as was the overall rate of caesarean section (33.09% vs. 30.80%, p < 0.001). However, this increase in caesarean section was confined to individuals who had either an induction of labour or no labour. There was also a nonsignificant trend to higher rates of macrosomia in the pandemic-exposed cohort compared with the pre-pandemic cohort (8.55% vs. 7.99% respectively, p = 0.124).

CONCLUSIONS

While rates of Body Mass Index ≥ 25 kg/m2, pre-labour caesarean section, and caesarean section following induction of labour were higher among pandemic-exposed nulliparas, these findings represented a continuation of pre-existing upward trends, with no significant independent contribution from the pandemic. These trends are forecast to continue, with long term implications for population health.

Maternal weight status at conception predicts offspring body fat at age 11 years: population data from the Japan Kids Body Composition Study using dual-energy X-ray absorptiometry

BACKGROUND

Maternal preconception overweight status has been reported to be associated with an increased risk of overweight offspring. However, there are no published population-based studies on the association between maternal preconception weight and offspring body fat measured by dual-energy X-ray absorptiometry (DXA). The present population-based retrospective cohort study aimed to examine the association between maternal weight at conception and offspring body fat measured by DXA.

METHODS

The source population consisted of 5th-grade students (1244 students aged 11 years) registered at 8 municipal elementary schools in Kitakata, Fukuroi, Hamamatsu, and Himeji in Japan. The present analyses included 964 participants who provided complete information. Maternal body mass index (BMI) at conception was calculated using records in the Mother and Child Health Handbook (MCHH). Offspring body fat at age 11 years was measured with the same QDR-4500A DXA instrument in a mobile test room that was brought to each school. With regard to the prediction of excess fat in offspring, the area under the curve (AUC) calculated with receiver operating characteristic curve analysis was used to quantify the diagnostic accuracy of maternal BMI at conception.

RESULTS

Adjusted odds ratios for excess body fat in offspring of the overweight mother group (odds ratios, 4.93 to 15.32) were significantly higher than those in the non-overweight mother group. For the prediction of excess offspring fat, AUCs and 95% confidence intervals for maternal BMI at conception were greater than 0.5.

CONCLUSION

Maternal overweight status at conception might be a risk factor for excess body fat in offspring. Maternal BMI values calculated using MCHH data have the potential to distinguish between the presence and absence of excess fat in the next generation.

Quantifying the effect of interpregnancy maternal weight and smoking status changes on childhood overweight and obesity in a UK population-based cohort

BACKGROUND

Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children.

METHODS

Records for 5612 women were drawn from a population-based cohort of routinely collected antenatal healthcare records (2003-2014) linked to measured child body mass index (BMI) age 4-5 years. We applied the parametric G-formula to estimate the effect of hypothetical changes between pregnancy-1 and pregnancy-2 compared to the natural course scenario (without change) on child-2 BMI.

RESULTS

Observed overweight/obesity and obesity in child-2 at age 4-5 years were 22.2% and 8·5%, respectively. We estimated that if all mothers started pregnancy-2 with BMI 18·5-24·9 kg/m² and all smokers stopped smoking, then child-2 overweight/obesity and obesity natural course estimates of 22.3% (95% CI 21.2-23.5) and 8·3% (7·6-9·1), would be reduced to 18.5% (17.4-19.9) and 6.2% (5.5-7.0), respectively. For mothers who started pregnancy-1 with BMI 18·5-24·9 kg/m², if all smokers stopped smoking, child-2 overweight/obesity and obesity natural course estimates of 17.3% (16.0-18.6) and 5·9% (5·0-6·7) would be reduced to 16.0% (14.6-17.3) and 4·9% (4·1-5·7), respectively. For mothers who started pregnancy-1 with BMI ≥30 kg/m², if BMI was 18·5-24·9 kg/m² prior to pregnancy-2, child-2 overweight/obesity and obesity natural course estimates of 38.6% (34.7-42.3) and 17·7% (15·1-20·9) would be reduced to 31.3% (23.8-40.0) and 12.5 (8.3-17.4), respectively. If BMI was 25.0-29.9 kg/m² prior to pregnancy-2, these estimates would be 34.5% (29.4-40.4) and 14.6% (11.2-17.8), respectively.

CONCLUSION

Interventions supporting women to lose/maintain weight and quit smoking between pregnancies could help reduce rates of overweight/obesity and obesity in second children. The most effective interventions may vary by maternal BMI prior to the first pregnancy.

Interpregnancy maternal weight change is not associated with offspring weight and obesity at age 2 years

BACKGROUND

Weight retention between pregnancies is associated with increased risk of perinatal complications, but it is unclear whether there is an association with offspring weight status. This study aimed to determine whether maternal interpregnancy weight change is associated with offspring overweight/obesity, controlling for confounding variables.

SUBJECTS/METHODS

Routinely collected linked data from perinatal and child datasets, in Flanders, Belgium were used. Women having their first and second live births between 2009-2018 were included. The association between maternal interpregnancy weight change and overweight/obesity in the second child at 2 years was examined by logistical regression models.

RESULTS

A total of 33,172 women were included. 52.7% (n = 17478) had a stable interpregnancy BMI, 24.1% (n = 8024) and 8.5% (n = 2821) had moderate and substantial BMI increases respectively. At 2 years, 91.6% (n = 30383) of the second offspring had a healthy weight, 0.6% (n = 210), 7.0% (n = 2312) and 0.8% (n = 267) were in the underweight, overweight and obesity BMI categories respectively. Multivariate analysis showed no statistical evidence that maternal interpregnancy BMI change is independently associated with overweight/obesity in the second child. The strongest independent factors were the first child (sibling) being in the obesity category at 2 years (odds ratio [OR] 7.2, [95% CI, 5.49-9.45] and being born Large for Gestational Age (LGA) (2.13 [1.92-2.37]). The following variables were also independently associated with the outcome measure: maternal African origin (1.90 [1.59-2.26]), maternal obesity at start of first pregnancy (1.33 [1.16-1.53]), excessive gestational weight gain in the second pregnancy (1.15 [1.04-1.28]), being born after a < 1-year interpregnancy time interval (1.17 [1.05-1.30]) and not being exclusively breastfed at 12 weeks old (1.29 [1.10-1.52]).

CONCLUSION

Sibling obesity and being born LGA were most strongly independently associated with overweight/obesity at 2 years. This supports the need for family interventions and to address risk factors for development of LGA infants. There was no independent association with interpregnancy weight gain, contrary to what was hypothesised.

Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010-2019) with no progress in Sweden

BACKGROUND

Trends in overweight and obesity among expectant parents can provide useful information about the family environment in which children will grow up and about possible social inequalities that may be passed on to them. Therefore, we aimed to assess whether the prevalence of underweight, overweight and obesity changed over time in pre-pregnant women and their male partners in northern Sweden, and if there were any educational inequalities.

METHODS

This study is based on cross-sectional data from a repeated survey of the population in Västerbotten, Sweden. The study population included 18,568 pregnant women and 18,110 male partners during the period 2010-2019. Multinomial logistic regression models were fitted separately for pregnant women and male partners to assess whether the prevalence of age-adjusted underweight, normal weight, overweight and obesity had evolved between 2010 and 2019, and whether trends differed by educational level.

RESULTS

Among women, obesity prevalence increased from 9.4% in 2010 to 11.7% in 2019. Among men, it went from 8.9 to 12.8%. Educational inequalities were sustained across the study period. In 2019, the prevalence of obesity was 7.8 percentage points (pp) (CI = 4.4-11.3) higher among women with low compared to high education. The corresponding figure for men was 6.4 pp (CI = 3.3-9.6).

CONCLUSIONS

It is not obvious that the prevalence of obesity among parents-to-be will decrease under current dispositions. Public health policies and practice should therefore be strengthened.

Effect of aerobic and resistive exercise on lipid profile and quality of life in overweight breastfeeding women: A randomized controlled trial

BACKGROUND

Breastfeeding provides benefits for both mothers and babies. However, many women experience postpartum weight gain, unfavorable lipid profiles, and other postpartum problems that can adversely impact their overall quality of life (QoL).

OBJECTIVE

To examine the effect of adding aerobic and resistive exercise to faradic stimulation and nutritional counseling on lipid profile and QoL in overweight breastfeeding women.

SUBJECTS AND METHODS

Fifty-four breastfeeding women were randomly allocated into two equally sized groups. Group A underwent abdominal faradic stimulation along with nutritional counseling for 12 weeks, whereas Group B received identical faradic stimulation and nutritional counseling and engaged in a combined aerobic and resistive exercise program for the same duration. Before and after treatment, the following anthropometric measurements were evaluated: body mass index (BMI), waist-to-hip ratio (W/H); lipid profile analysis, such as high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG); and the Short Form 36 Health Survey Questionnaire (SF-36).

RESULTS

All outcome measures demonstrated significant improvements within the two groups (p < 0.05). Group B showed more significant reductions in BMI, W/H ratio, and LDL, along with greater significant increases in the SF-36 domain scores for physical functioning, physical health problems, bodily pain, general health, energy/fatigue, social activity, mental health, and the total SF-36 score (p < 0.05) compared to group A post-treatment. However, there were no significant differences in HDL, TG, and the score of the emotional wellbeing domain of the SF-36 between the groups after treatment (p > 0.05).

CONCLUSION

12-week aerobic and resistive exercise is effective in reducing the BMI, W/H ratio, and LDL levels and enhancing the QoL in overweight breastfeeding women.

Socioeconomic Status and Obesity

Obesity is a pervasive public health problem that causes debilitating complications across the life course. One opportunity for preventing the onset of obesity is to focus on its social determinants. Socioeconomic status (SES), which includes factors such as income, educational attainment, occupational prestige, and access to resources, is a key determinant of obesity. In this scoping mini-review, we summarized review articles and meta-analyses of the SES-obesity association. From the 1980s to the present, cross-sectional studies have demonstrated a persistent socioeconomic gradient in obesity in which the association is negative in developed countries and positive in developing countries. Longitudinal studies have revealed the bidirectionality of the SES-obesity association; some studies demonstrate that socioeconomic adversity precedes the onset of obesity, while others provide evidence of reverse causality. While earlier studies relied on anthropometric assessments of weight and height to define obesity, the use of modern technologies like dual-energy x-ray absorptiometry and bioelectrical impedance have demonstrated that the socioeconomic gradient in obesity is robust across multiple indicators of body composition, including direct measures of lean and fat mass. More recently, examination of mediators and moderators of the SES-obesity association have highlighted causal pathways and potential intervention targets, with a focus on health behaviors, environmental conditions, psychological factors, and biological processes. We describe current gaps in knowledge and propose opportunities for future innovation to reduce the burden of obesity and related socioeconomic disparities.

Maternal pre-pregnancy BMI influences the associations between bisphenol and phthalate exposures and maternal weight changes and fat accumulation

BACKGROUND

Bisphenols and phthalates are two classes of endocrine-disrupting chemicals (EDCs) thought to influence weight and adiposity. Limited research has investigated their influence on maternal weight changes, and no prior work has examined maternal fat mass. We examined the associations between exposure to these chemicals during pregnancy and multiple maternal weight and fat mass outcomes.

METHODS

This study included a sample of 318 women enrolled in a Canadian prospective pregnancy cohort. Second trimester urinary concentrations of 2 bisphenols and 12 phthalate metabolites were quantified. Self-reported and measured maternal weights and measured skinfold thicknesses were used to calculate gestational weight gain, 3-months and 3- to 5-years postpartum weight retention, late pregnancy fat mass gain, total postpartum fat mass loss, and late postpartum fat mass retention. Adjusted robust regressions examined associations between chemicals and outcomes in the entire study population and sub-groups stratified by pre-pregnancy body mass index (BMI). Bayesian kernel machine regression examined chemical mixture effects.

RESULTS

Among women with underweight or normal pre-pregnancy BMIs, MBzP was negatively associated with weight retention at 3- to 5-years postpartum (B = -0.04, 95%CI: -0.07, -0.01). Among women with overweight or obese pre-pregnancy BMIs, MEHP and MMP were positively associated with weight retention at 3-months and 3- to 5-years postpartum, respectively (B's = 0.12 to 0.63, 95%CIs: 0.02, 1.07). DEHP metabolites and MCNP were positively associated with late pregnancy fat mass gain and late postpartum fat mass retention (B's = 0.04 to 0.18, 95%CIs: 0.001, 0.32). Further, the mixture of EDCs was positively associated with late pregnancy fat mass gain.

CONCLUSION

In this cohort, pre-pregnancy BMI was a key determinant of the associations between second trimester exposure to bisphenols and phthalates and maternal weight changes and fat accumulation. Investigations of underlying physiological mechanisms, windows of susceptibility, and impacts on maternal and infant health are needed.

Maternal glucose homeostasis during pregnancy in women with overweight or obesity and offspring metabolic health

Gestational diabetes mellitus (GDM) adversely affects offspring glucose homeostasis and risk of developing obesity. Here, we examined the association between glycemia in pregnant women with overweight or obesity without GDM and offspring metabolic health. Maternal fasting glucose concentrations and glucose 2-h after an oral glucose tolerance test (OGTT) were measured in 208 women with a pre-pregnancy body mass index (BMI) of 28-45 kg/m2 without GDM. Offspring outcomes were collected at birth, 3, and 5 years of age. Linear mixed models with time as fixed factor and subject ID as random effects were used for analysis. No associations were found between maternal fasting or 2-h glucose concentrations with offspring glucose and insulin concentrations from birth to 5 years of age. However, maternal fasting glucose in GW 28 and 36, and 2-h OGTT glucose in GW 28 were positively associated with C-peptide concentration at birth. Maternal fasting glucose concentrations in GW 28 and 36 were positively associated with weight-for-length, and maternal fasting glucose in GW 36 was associated with BMI z-score at birth. In summary, blood glucose in pregnant women with overweight or obesity is positively associated with offspring C-peptide concentration, weight-for-length, and BMI z-score at birth, even in the absence of GDM.

Small for gestational age and age at menarche in a contemporary population-based U.S. sample

Children born small for gestational age (SGA) may be at risk for earlier puberty and adverse long-term health sequelae. This study investigates associations between SGA and age at menarche using secondary data on 1,027 female children in a population-based U.S. birth cohort that over-sampled non-marital births, which in the U.S. is a policy-relevant population. SGA was defined as <10th percentile of weight for gestational age compared to the national U.S. distribution. We estimated unadjusted and adjusted Ordinary Least Squares (OLS) models of associations between SGA and age at menarche in years, as well as unadjusted and adjusted logistic regression models of associations between SGA and early menarche (before age 11). SGA was not significantly associated with earlier age at menarche, even when adjusting for maternal sociodemographic characteristics, prenatal smoking, and maternal pre-pregnancy overweight and obesity. Similarly, SGA was not significantly associated with the odds of menarche occurring before age 11. However, maternal non-Hispanic Black race-ethnicity, Hispanic ethnicity, and pre-pregnancy obesity all had independent associations with average earlier age at menarche and menarche before age 11. Thus, maternal risk factors appear to play more influential roles in determining pubertal development.

The invisible connection of mothers' BMI, emotional appetite, and food choices with childhood obesity

BACKGROUND

This study examined the effects of mothers' body mass index (BMI), emotional appetite, and food choices on children's growth curves and adiposity.

METHODS

Data was collected from 492 mothers. The demographic characteristics and anthropometric measurements were obtained using a questionnaire. The mothers' food choices and emotional appetites were assessed using scales. BMI for age Z score and tripoderal index (TMI) were used in the evaluation of children's anthropometric measurements and adiposity.

RESULTS

The mean age of mothers' was 39.10 ± 0.26 and BMI was 25.08 ± 0.21. Among the mothers, 54.5% were classified as normal, 28.4% as pre-obese, and 14.7% as obese. Among the children, 31.5% were overweight or obese. There was a strong positive correlation between the mean BMI of the mothers and the mean TMI and BMI of the children (p < 0.001). The "convenience" food choice factor of mothers had negative correlation with childiren's BMI for age (p < 0.005).

CONCLUSIONS

This study emphasizes the invisible connection between mothers' emotional appetite and food choices and children's BMI and TMI and highlights the importance of paying attention to mothers' eating habits for children's health outcomes. These findings will be informative in the formulation of future health policies.

IMPACT

This research revealed the relationship between mothers' food choices and emotional appetites, and their children's growth curves and adiposity. The study proposes the Triponderal Index as an alternative approach to evaluating growth, introducing a novel perspective in growth monitoring. By highlighting the impact of mothers' emotional appetites and food choices on children's dietary habits and weight status, the research emphasizes the significance of family eating habits. The findings support the promotion of healthy dietary practices within families as a crucial measure in preventing and managing childhood obesity, conveying a significant message to parents and healthcare professionals for a healthier future.

Associations between food insecurity in high-income countries and pregnancy outcomes: A systematic review and meta-analysis

BACKGROUND

Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes.

METHODS AND FINDINGS

Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I2 56.35%), birth weight (MD -58.26 g, 95% CI [-128.02, 11.50], I2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures.

CONCLUSIONS

Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.

Growth patterns by birth size of preterm children born at 24-29 gestational weeks for the first 3 years

BACKGROUND

Concerns are prevalent about preterm infant long-term growth regarding plotting low on growth charts at discharge, stunting, underweight, high body fat and subsequent cardiometabolic morbidities.

OBJECTIVES

To examine (a) longitudinal growth patterns of extremely and very preterm infants to 3 years corrected age (CA) (outcome), categorised by their birthweight for gestational age: small, appropriate and large for gestational age (SGA, AGA and LGA, respectively) (exposure); and (b) the ability of growth faltering (<-2 z-scores) to predict suboptimal cognitive scores at 3 years CA.

METHODS

Post-discharge head, length, weight and weight-4-length growth patterns of the PreM Growth cohort study infants born <30 weeks and < 1500 g, who had dietitian and multi-disciplinary support before and after discharge, were plotted against the World Health Organization growth standard. Infants with brain injuries, necrotising enterocolitis and bronchopulmonary dysplasia were excluded.

RESULTS

Of the included 405 infants, the proportions of infants with anthropometric measures > - 2 z-scores improved with age. The highest proportions <-2 z-scores for length (24.2%) and weight (24.0%) were at 36 gestational weeks. The proportion with small heads was low by 0 months CA (1.8%). By 3 years CA, only a few children plotted lower than -2 z-scores for length, weight-4-length and weight (<6%). After zero months CA, high weight-4-length and body mass index > + 2 z-scores were rare (2.1% at 3 years CA). Those born SGA had higher proportions with shorter heights (16.7% vs. 5.2%) and lower weights (27.8% vs. 3.5%) at 3 years CA compared to those born AGA. The ability of growth faltering to predict cognitive scores was limited (AUROC 0.42, 95% CI 0.39, 0.45 to 0.52, 95% CI 0.41, 0.63).

CONCLUSIONS

Although children born <30 weeks gestation without major neonatal morbidities plot low on growth charts at 36 weeks CA most catch up to growth chart curves by 3 years CA.

Adult obesity treatment and prevention: A trans-agency commentary on the research landscape, gaps, and future opportunities

Given the high and growing prevalence of obesity among adults in the United States, obesity treatment and prevention are important topics in biomedical and public health research. Although researchers recognize the significance of this problem, much remains unknown about safe and effective prevention and treatment of obesity in adults. In response to the worsening obesity epidemic and the many unknowns regarding the disease, a group of key scientific and program staff members of the National Institutes of Health (NIH) and other federal and non-government agencies gathered virtually in September 2021 to discuss the current state of obesity research, research gaps, and opportunities for future research in adult obesity prevention and treatment. The current article synthesizes presentations given by attendees and shares their organizations' current initiatives and identified gaps and opportunities. By integrating the information discussed in the meeting and current initiatives, we identify potential targets and overlapping priorities for future research, including health equity and disparities in obesity, the heterogeneity of obesity, and the use of technological and innovative approaches in interventions.

Does the evidence support in utero influences on later health and disease? A systematic review of highly cited Barker studies on developmental origins

The developmental origins of health and disease hypothesis proposes that early exposure to adverse conditions during fetal development and early life have strong detrimental consequences on long-term health and susceptibility to chronic diseases. We conducted a systematic review to critically appraise Barker's highest cited publications using the risk-of-bias assessment tool (ROBINS-I) and investigate effects of overadjustment by later body weight. Our findings revealed that all included studies displayed high risks of bias, with particular concerns regarding confounding (8/8), selection of reported results (8/8), classification of exposure (7/8), selection of participants (5/8) and high rates of missing data (ranged from 15 to 87%). Later body weight was over-adjusted in most (6/8) of the studies. As all studies displayed high bias risk due to confounding, missing data and overadjustment, evidence is insufficient to support causal relationships between low birthweight and adult disease, warranting caution in clinical application. PROTOCOL REGISTRATION: PROSPERO CRD42023433179.

Maternal-child overweight relationship, assessment of maternal perception of child weight status and feeding behaviours

BACKGROUND

Parents play a key role in constructing children' behaviours. We studies maternal-child overweight relationship and compared maternal perception of child weight status and feeding behaviours between groups of normal-weight and overweight children.

METHODS

The cross-sectional study was conducted on 192 girls aged 10-13 years and their mothers. They were divided to two groups of overweight (n = 94) and normal-weight (n = 98) children. Anthropometric characteristics were measured for children and mothers. Logistic regression analysis was used to examine the association between child overweight and tertiles of maternal body mass index (BMI). Maternal perception of child's weight status and her engagement in promoting child's healthy behaviours was assessed.

RESULTS

BMI and waist circumference was significantly higher in children (P < 0.001) and mothers (P < 0.01) of overweight compared to normal-weight group. There was a significant relationship between children's overweight and tertiles of maternal BMI, which remained significant after adjusting for potential confounders. Mothers of overweight children were more concerned for their child's overeating and overweight, and for compelling the child to diet to maintain a desirable weight (P < 0.001). In contrast, mothers of normal-weight children restricted sugar-sweetened drinks (P = 0.008), offered fruit and vegetables (P = 0.035), and helped their children to get enough physical activity (P = 0.022) and night sleep (P = 0.001) more than mothers in other group.

CONCLUSIONS

This study showed a strong relationship between children and mothers' overweight. Despite being more concerned about their child weight status, mothers of overweight children reported behaviours which were less encouraging the children for healthy eating and lifestyle than mothers of normal-weight children.

Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis

BACKGROUND

Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population.

AIM

Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups.

METHODS

Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists.

FINDINGS

Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors.

DISCUSSION

Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers.

CONCLUSION

We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women.

Global Prevalence of Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analysis

Importance

Overweight and obesity in childhood and adolescence is a global health issue associated with adverse outcomes throughout the life course.

Objective

To estimate worldwide prevalence of overweight and obesity in children and adolescents from 2000 to 2023 and to assess potential risk factors for and comorbidities of obesity.

Data Sources

MEDLINE, Web of Science, Embase, and Cochrane.

Study Selection

The inclusion criteria were: (1) studies provided adequate information, (2) diagnosis based on body mass index cutoffs proposed by accepted references, (3) studies performed on general population between January 2000 and March 2023, (4) participants were younger than 18 years.

Data Extraction and Synthesis

The current study was performed in accordance with the Meta-analysis of Observational Studies in Epidemiology guidelines. DerSimonian-Laird random-effects model with Free-Tukey double arcsine transformation was used for data analysis. Sensitivity analysis, meta-regression, and subgroup analysis of obesity among children and adolescents were conducted.

Main Outcomes and Measures

Prevalence of overweight and obesity among children and adolescents assessed by World Health Organization, International Obesity Task Force, the US Centers for Disease Control and Prevention, or other national references.

Results

A total of 2033 studies from 154 different countries or regions involving 45 890 555 individuals were included. The overall prevalence of obesity in children and adolescents was 8.5% (95% CI 8.2-8.8). We found that the prevalence varied across countries, ranging from 0.4% (Vanuatu) to 28.4% (Puerto Rico). Higher prevalence of obesity among children and adolescents was reported in countries with Human Development Index scores of 0.8 or greater and high-income countries or regions. Compared to 2000 to 2011, a 1.5-fold increase in the prevalence of obesity was observed in 2012 to 2023. Substantial differences in rates of obesity were noted when stratified by 11 risk factors. Children and adolescents with obesity had a high risk of depression and hypertension. The pooled estimates of overweight and excess weight in children and adolescents were 14.8% (95% CI 14.5-15.1) and 22.2% (95% CI 21.6-22.8), respectively.

Conclusions and Relevance

This study's findings indicated 1 of 5 children or adolescents experienced excess weight and that rates of excess weight varied by regional income and Human Development Index. Excess weight among children and adolescents was associated with a mix of inherent, behavioral, environmental, and sociocultural influences that need the attention and committed intervention of primary care professionals, clinicians, health authorities, and the general public.

Correlation between Breastfeeding, Maternal Body Mass Index, and Childhood Obesity

Breast milk is a unique and highly beneficial source of nutrition for infants. It contains a wide range of nutrients that are specifically tailored to meet the specific needs of a growing infant. On the other hand, obesity is a major health issue that affects people around the world. The aim of this study is to investigate the relationship between breastfeeding and child BMI and the role of maternal BMI, which may influence this relationship. This study revealed that a longer duration of exclusive breastfeeding was associated with a decrease in the prevalence of overweight children. Additionally, the research found that children born to overweight or obese women had a higher probability of being overweight or obese themselves. Considering that mothers with a higher pre-pregnancy body weight are more likely to have children with a higher BMI, it is important that they receive information about the advantages of breastfeeding for a minimum of 6 months for both themselves and their children. Additionally, they should be offered ongoing support, to encourage them to start breastfeeding and continue with it beyond this period.

Maternal high fat diet induces circadian clock-independent endocrine alterations impacting the metabolism of the offspring

Maternal obesity has long-term effects on offspring metabolic health. Among the potential mechanisms, prior research has indicated potential disruptions in circadian rhythms and gut microbiota in the offspring. To challenge this hypothesis, we implemented a maternal high fat diet regimen before and during pregnancy, followed by a standard diet after birth. Our findings confirm that maternal obesity impacts offspring birth weight and glucose and lipid metabolisms. However, we found minimal impact on circadian rhythms and microbiota that are predominantly driven by the feeding/fasting cycle. Notably, maternal obesity altered rhythmic liver gene expression, affecting mitochondrial function and inflammatory response without disrupting the hepatic circadian clock. These changes could be explained by a masculinization of liver gene expression similar to the changes observed in polycystic ovarian syndrome. Intriguingly, such alterations seem to provide the first-generation offspring with a degree of protection against obesity when exposed to a high fat diet.

Food insecurity during pregnancy in high-income countries, and maternal weight and diet: A systematic review and meta-analysis

Food insecurity is a well-established obesity driver. Less is known about food insecurity during pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG), and nutrition. Searches included seven databases, gray literature, references, citations, and contacting authors. Observational studies reporting data from January 1st, 2008 to 21 November 2023 in high-income countries were included. Duplicate screening, data extraction, and quality assessments were performed. Random effects meta-analysis estimated odds ratios (OR), mean difference (MD), and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n = 19 North America, n = 1 Europe; n = 32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD -0.42 kg 95%CI -0.62, -0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health.

Efficacy of Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists for Weight Loss Management in Non-Diabetic Patients

The rising prevalence of obesity has led to a poor quality of life affecting millions worldwide. The lack of a healthy diet and exercise intervention are the major risk factors leading to obesity, as well as genetics. Obesity can lead to type 2 diabetes mellitus. However, there are many people who are obese and do not have an established diagnosis of diabetes but want to reduce their body weight to improve their quality of life. This review aims to discuss the efficacy of the diabetic pharmacologic agents, glucagon-like peptide-1 (GLP-1) receptor agonists, on body weight. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020 and includes a comprehensive search strategy. The articles gathered are from the last five to 10 years. The articles are collected from distinguished databases such as PubMed, Google Scholar, ResearchGate, and Science Direct. Of the 698 studies identified based on the screening methods, 22 were assessed for eligibility and 10 studies were included in the final review. The findings of this systematic review provide a bigger picture of the efficacy and safety of glucagon-like peptide receptor agonist agents. The review thoroughly discusses the risk factors for obesity and provides a treatment strategy that can be utilized in clinical practice in the future. The review concludes that glucagon-like peptide agents act as pharmacologic treatments for reduction in body weight and also serve as cardioprotective agents.

Gestational weight gain: Toward best practices in managing gestational weight gain in patients with obesity: Comparison of recommendations

BACKGROUND AND AIMS

In 2009, the Institute of Medicine (IOM) issued recommendations for gestational weight gain (GWG) based on body mass index (BMI). Several studies have challenged those recommendations for women with obesity, considering them too liberal and advising more limited weight gain - or even weight loss - during pregnancy to improve maternal and neonatal outcomes. Our aim was to study how gestational weight gain in women with obesity impacted maternal and fetal complications in the Belgian population. We did this by comparing the results from two groups of patients with obesity: those who met the 2009 IOM standards and those who satisfied the stricter recommendations suggested by other authors.

MATERIALS AND METHODS

This is a retrospective cohort study using data collected at the Centre d'Epidémiologie Périnatale (CEpiP) from obese (BMI ≥ 30 kg/m2) pregnant women with live singleton deliveries between 2010 and 2019 in Wallonia-Brussels Federation (n = 65,314).

RESULTS

Compared to obese patients whose GWG satisfied the IOM standards, those with GWG meeting the stricter recommendations had lower rates of gestational hypertension (7.1 % vs. 10.1 %; p = 0.0059), cesarean section (22.1 % vs. 26.3 %; p = 0.0074), and macrosomia (12.0 % vs. 17.7 %; p < 0.0001). There was no significant difference in the rate of preterm delivery (6.9 % vs 5.8 %; p = 0.12) or small-for-gestational-age births (7.2 % vs. 6.2 %; p = 0.16).

CONCLUSION

Gestational weight gain below that currently recommended by the IOM appears beneficial to the health of mothers with obesity and their children. These data, from our population, further challenge the standards proposed since 2009.

Pediatric obesity in the United States: Age-period-cohort analysis

The rates of obesity among American children aged 2-5 years has reached a historic high. It is crucial to identify the putative sources of population-level increases in obesity prevalence among preschool-aged children because early childhood is a critical window for obesity prevention and thus reduction of future incidence. We used the National Health and Nutrition Examination Survey data and hierarchical age-period-cohort analysis to examine lifecycle (i.e., age), historical (i.e., period), and generational (i.e., cohort) distribution of age- and sex-specific body mass index z-scores (zBMI) among 2-5-year-olds in the U.S. from 1999 to 2018. Our current findings indicate that period effects, rather than differences in groups born at a specific time (i.e., cohort effects), account for almost all of the observed changes in zBMI. We need a broad socioeconomic, cultural, and environmental strategy to counteract the current obesogenic environment that influences children of all ages and generations in order to reach large segments of preschoolers and achieve population-wide improvement.

Expected and Desirable Preterm and Small Infant Growth Patterns

Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.

Supplementation with antioxidant micronutrients in pregnant women with obesity: a randomized controlled trial

BACKGROUND/OBJECTIVE

Obesity increases maternal morbidity and adversely affects child health. Maternal inflammation may play a role in adverse outcomes. The objective of this study was to determine whether providing a higher dose of antioxidant micronutrients to pregnant women with obesity would raise concentrations of key antioxidant vitamins and impact inflammation and oxidative stress during pregnancy.

SUBJECTS/METHODS

This was a double-blind, randomized controlled trial. We recruited pregnant women with a body mass index (BMI) ≥ 30 kg/m2 at their initial prenatal visit ( < 13 weeks gestation) and collected blood and urine samples at baseline, 24-28 weeks, and 32-36 weeks to measure micronutrient concentrations (vitamin C, E, B6 and folate), markers of inflammation (C-reactive protein, interleukin-6, 8, and 1β) and oxidative stress (8-epi-PGF2α and malondialdehyde). We collected maternal and infant health data from enrollment to delivery as secondary outcomes. We enrolled 128 participants (64 in each arm), and 98 (49 in each arm) completed follow-up through delivery.

INTERVENTION

Both groups received a standard prenatal vitamin containing the recommended daily allowance of micronutrients in pregnancy. In addition, the intervention group received a supplement with 90 mg vitamin C, 30 αTU vitamin E, 18 mg vitamin B6, and 800 μg folic acid, and the control group received a placebo.

RESULTS

The intervention group had higher vit B6 (log transformed (ln), β 24-28 weeks: 0.76 nmol/L (95% CI: 0.40, 1.12); β 32-36 weeks: 0.52 nmol/L (95% CI: 0.17, 0.88)) than the control group. Vitamins C, E, erythrocyte RBC folate concentrations did not differ by randomization group. The intervention did not impact biomarkers of inflammation or oxidative stress. There were no differences in maternal or neonatal clinical outcomes by randomization group.

CONCLUSIONS

Higher concentrations of antioxidant vitamins during pregnancy increased specific micronutrients and did not impact maternal inflammation and oxidative stress, which may be related to dosing or type of supplementation provided.

CLINICAL TRIAL REGISTRATION

Clinical Trial Identification Number: NCT02802566; URL of the Registration Site: www.

CLINICALTRIALS

gov .

Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity

OBJECTIVE

To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women.

METHODS

Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects.

RESULTS

A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO.

CONCLUSION

Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.

Predicting higher child BMI z-score and obesity incidence in Malaysia: a longitudinal analysis of a dynamic cohort study

BACKGROUND

To target public health obesity prevention, we need to predict who might become obese i.e. predictors of increasing Body Mass Index (BMI) or obesity incidence. Predictors of incidence may be distinct from more well-studied predictors of prevalence, therefore we explored parent, child and sociodemographic predictors of child/adolescent BMI z-score and obesity incidence over 5 years in Malaysia.

METHODS

The South East Asia Community Observatory in Segamat, Malaysia, provided longitudinal data on children and their parents (n = 1767). Children were aged 6-14 years at baseline (2013-14) and followed up 5 years later. Linear multilevel models estimated associations with child BMI z-score at follow-up, adjusting for baseline BMI z-score and potential confounders. Predictors included parent cardiometabolic health (overweight/obesity, central obesity, hypertension, hyperglycaemia), and socio-demographics (ethnicity, employment, education). Logistic multilevel models explored predictors of obesity incidence.

RESULTS

Higher baseline BMI z-score predicted higher follow-up BMI z-score both in childhood to late adolescence (0.60; 95% CI: 0.55, 0.65) and early to late adolescence (0.76; 95% CI: 0.70, 0.82). There was inconsistent evidence of association between child BMI z-score at follow-up with parent cardiometabolic risk factors independent of baseline child BMI z-score. For example, maternal obesity, but not overweight, predicted a higher BMI z-score in childhood to early adolescence (overweight: 0.16; 95% CI: -0.03, 0.36, obesity: 0.41; 95% CI: 0.20, 0.61), and paternal overweight, but not obesity, predicted a higher BMI z-score in early to late adolescence (overweight: 0.22; 95% CI: 0.01, 0.43, obesity: 0.16; 95% CI: -0.10, 0.41). Parental obesity consistently predicted five-year obesity incidence in early to late adolescence, but not childhood to early adolescence. An adolescent without obesity at baseline with parents with obesity, had 3-4 times greater odds of developing obesity during follow-up (incidence OR = 3.38 (95% CI: 1.14-9.98, mother) and OR = 4.37 (95% CI 1.34-14.27, father) respectively).

CONCLUSIONS

Having a higher BMI z-score at baseline was a stronger predictor of a higher BMI z-score at follow-up than any parental or sociodemographic factor. Targeting prevention efforts based on parent or sociodemographic factors is unwarranted but early childhood remains a key period for universal obesity prevention.

Maternal Western-style diet programs skeletal muscle gene expression in lean adolescent Japanese macaque offspring

Early-life exposure to maternal obesity or a maternal calorically dense Western-style diet (WSD) is strongly associated with a greater risk of metabolic diseases in offspring, most notably insulin resistance and metabolic dysfunction-associated steatotic liver disease (MASLD). Prior studies in our well-characterized Japanese macaque model demonstrated that offspring of dams fed a WSD, even when weaned onto a control (CTR) diet, had reductions in skeletal muscle mitochondrial metabolism and increased skeletal muscle insulin resistance compared to offspring of dams on CTR diet. In the current study, we employed a nested design to test for differences in gene expression in skeletal muscle from lean 3-year-old adolescent offspring from dams fed a maternal WSD in both the presence and absence of maternal obesity or lean dams fed a CTR diet. We included offspring weaned to both a WSD or CTR diet to further account for differences in response to post-weaning diet and interaction effects between diets. Overall, we found that a maternal WSD fed to dams during pregnancy and lactation was the principal driver of differential gene expression (DEG) in offspring muscle at this time point. We identified key gene pathways important in insulin signaling including PI3K-Akt and MAP-kinase, regulation of muscle regeneration, and transcription-translation feedback loops, in both male and female offspring. Muscle DEG showed no measurable difference between offspring of obese dams on WSD compared to those of lean dams fed WSD. A post-weaning WSD effected offspring transcription only in individuals from the maternal CTR diet group but not in maternal WSD group. Collectively, we identify that maternal diet composition has a significant and lasting impact on offspring muscle transcriptome and influences later transcriptional response to WSD in muscle, which may underlie the increased metabolic disease risk in offspring.

Cost-effectiveness of a complex continuum of care intervention targeting women and children: protocol for an economic evaluation of the Bukhali trial in South Africa

INTRODUCTION

As nearly two-thirds of women presenting at their first antenatal visit are either overweight or obese in urban South Africa, the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and non-communicable diseases. This protocol describes the planned economic evaluation of an individually randomised controlled trial of a complex continuum of care intervention targeting women and children in Soweto, South Africa (Bukhali trial).

METHODS AND ANALYSIS

The economic evaluation of the Bukhali trial will be conducted as a within-trial analysis from both provider and societal perspectives. Incremental costs and health outcomes of the continuum of care intervention will be compared with standard care. The economic impact on implementing agencies (programme costs), healthcare providers, participants and their households will be estimated. Incremental cost-effectiveness ratios (ICERs) will be calculated in terms of cost per case of child adiposity at age years averted. Additionally, ICERs will also be reported in terms of cost per quality-adjusted life year gained. If Bukhali demonstrates effectiveness, we will employ a decision analytical model to examine the cost-effectiveness of the intervention over a child's lifetime. A Markov model will be used to estimate long-term health benefits, healthcare costs and cost-effectiveness. Probabilistic sensitivity analyses will be conducted to explore uncertainty and ensure robust results. An analysis will be conducted to assess the equity impact of the intervention, by comparing intervention impact within quintiles of socioeconomic status.

ETHICS AND DISSEMINATION

The Bukhali trial economic evaluation has ethical approval from the Human Ethics Research Committee of the University of the Witwatersrand, Johannesburg, South Africa (M240162). The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.

TRIAL REGISTRATION NUMBER

Pan African Clinical Trials Registry (PACTR201903750173871; https://pactr.samrc.ac.za).