Child Body Mass Index Z-score Research Articles

Identifying patterns of lifestyle behaviours among children of 3 years old.

BackgroundTo identify the patterns of lifestyle behaviours in children aged 3 years, to investigate the parental and child characteristics associated with the lifestyle patterns, and to examine whether the identified lifestyle patterns are associated with child BMI and weight status.MethodsCross-sectional data of 2090 children 3 years old participating in the Dutch BeeBOFT study were used. Child dietary intakes, screen times and physical activity were assessed by parental questionnaire, and child weight and height were measured by trained professionals according to a standardized protocol. Latent class analysis was applied to identify patterns of lifestyle behaviours among children.ResultsThree subgroups of children with distinct patterns of lifestyle behaviours were identified: the ‘unhealthy lifestyle’ pattern (36%), the ‘low snacking and low screen time’ pattern (48%) and the ‘active, high fruit and vegetable, high snacking and high screen time’ pattern (16%). Children with low maternal educational level, those raised with permissive parenting style (compared those with authoritative parents), and boys were more likely be allocated to the ‘unhealthy lifestyle’ pattern and the ‘active, high fruit and vegetable, high snacking and high screen time’ pattern (P < 0.05). No association was found between the identified lifestyle patterns and child BMI z-score at age 3 years.ConclusionsThree different lifestyle patterns were observed among children aged 3 years. Low maternal educational level, permissive parenting style and male gender of the child were associated with having unhealthy lifestyle patterns for the child.

Exploring Associations Between Household Chaos With Sedentary Behavior And Screen Time In Rural Children

Household chaos is perceived home disorganization caused by noise, crowding, and traffic patterns. It has been shown to be linked to weight-related behaviors such as sleep and nutritional behaviors (i.e., family meals). However, the relationship between sedentary behavior and household chaos has not been explored. Examining this association could allow us to better understand how family milieu contributes to behavioral risk factors for childhood obesity. PURPOSE: To examine associations between household chaos with sedentary behavior and screen time in rural children. METHODS: Participants (n=105 parent/child dyads) were enrolled in the NU-HOME study, a family-based, obesity prevention RCT in rural Minnesota. Parents reported baseline data on sociodemographics, household chaos, and child screen time. Household chaos was measured with a 15-item scale about home disorganization (α=0.83; higher scores indicate more chaos). Children’s sedentary behavior was assessed via accelerometry. Regression analyses using SAS 9.4 were performed to assess associations between household chaos and sedentary behavior and screen time, controlling for child-parent ratio, economic assistance, child BMI z-score and age. Normality of screen time was not met, so a transformed variable was used in analyses. RESULTS: Child mean age was 8.95±1.05 years; 59% were female; mean BMI z-score=0.92±0.94. Mean daily sedentary time and screen time were 8.33±77.5 and 2.06±1.42 hours, respectively. Household chaos scores had a mean of 5.04±3.6, which is comparable to other studies. Household chaos scores were not significantly associated with child sedentary behavior but were positively associated with child screen time (p=0.002). CONCLUSIONS: In other studies, household chaos has been associated with negative health behaviors, which aligns with our current findings. The association between screen time and household chaos may be explained by parents using electronics to entertain children in chaotic environments. Parents in chaotic homes may also have more difficulty managing a child’s screen time than those in less chaotic homes. The relationship between household chaos and sedentary behavior should be further explored to increase our understanding of how the home environment may affect health-related behaviors.

Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score.

Parental mindfulness may be a novel intervention target for child obesity prevention. To examine associations between maternal mindfulness and child body mass index z-score (BMIz). In a secondary data analysis of preintervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n=105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. Children were M=53.7 (standard deviation [SD] 7.5) months old, and mothers were M=31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β=-.02 (SE 0.01), P=.027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (P=.016) and BMI at the trend level (P=.0595) at the trend level. Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.

Elevated serum TSH concentrations are associated with higher BMI Z-scores in southern Iranian children and adolescents

BackgroundSubclinical hypothyroidism is defined as elevated TSH levels while T4 or FT4 levels are normal. Elevated TSH levels are linked with obesity in adults. In a recent meta-analysis in Iran, 6.1% of children below 18 had obesity. Due to the low number of studies on the subject in children we, designed the study to assess the relation between BMI Z-score and TSH levels in children and adolescence.MethodThis cross-sectional study was performed in a pediatric endocrinology clinic in Shiraz. Children aged between 2 to 18 years that came to the clinic for routine growth assessment follow up from January till April 2018 were considered. 850 children including 365 boys and 485 girls were included.ResultsPrevalence of subclinical hypothyroidism is increased in higher BMI groups. 9.9, 13.8, 17.2 and 20.5% of underweight, healthy weight, overweight and obese had subclinical hypothyroidism respectively. Obese and overweight participants had higher odds of subclinical hypothyroidism than those who were not (OR:1.649, P = 0.010, CI95% 1.126–2.413). On the other hand, Subclinical hypothyroid participants had higher odds of overweight or obesity than those who were euthyroid (OR:1.650, P = 0.010, CI95% 1.128–2.413). When TSH is set as a dependent value, TSH level is increased (β = 0.126, r = 0.125, P = 0.001) with an increase in BMI Z-score. When BMI Z-score is set as a dependent value, BMI Z-score is increased (β = 0.113, r = 0.243, P = 0.001) with an increase in TSH level.ConclusionBMI Z-score and elevated TSH levels are positively correlated however studies should be performed on establishing the causality.

Child Excess Weight Status, Adult Excess Weight Status, and Cardiometabolic Risk Profile.

Background: The potential effects of excess weight status in childhood on later adult cardiometabolic risk factors have been undetermined in a Chinese population. Additionally, the potential mitigation of these effects if adult weight status returns to normalcy has been unresolved. Accordingly, we aimed to assess the association of childhood excess weight status and its long-term change with adult cardiometabolic risk factors.Methods: A cohort study from the China Health and Nutrition Survey 1991–2009 consisted of 541 participants who were measured in childhood (≥6 and <18 years) and underwent laboratory assessment in adulthood (≥18 years). In childhood, the participants were classified into four groups as age-sex-specific body mass index (BMI) z-score quartiles. The adult cardiometabolic risk factors included overweight and obesity, hypertension, high total cholesterol, high triglyceride, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, and high hemoglobin A1c.Results: The prevalence was 61.0, 36.2, and 19.0% for ≥1, 2, and 3 cardiometabolic risk factors, respectively, with a mean 14.9-year follow-up. There was a significant trend in the progression of the number of adult cardiometabolic risk factors across childhood BMI quartiles (P < 0.001). Additionally, participants with childhood BMI z-scores ≥ 75th percentile and adult BMI z-scores < 75th percentile did not have increased cardiometabolic risks compared with those with both childhood and adulthood BMI z-scores < 75th percentile.Conclusions: Our findings revealed that child excess weight status increased adult cardiometabolic risks. However, the effects of excess weight status in childhood on adult cardiometabolic risk factors were mitigated if adult weight status returned to normalcy.

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

BackgroundCurrent recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how “dose delivered” was associated with body mass index z-score (BMI-Z) across 3 years of follow-up.MethodsParent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face “intensive sessions” (90 min each) and 6.75 h over the next 9 months via 9 “maintenance phone calls” (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having “zero” dose.ResultsAmong 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B = -0.011; 95% CI [− 0.021, − 0.001]; p = 0.029) and maintenance calls (B = -0.015; 95% CI [− 0.026, − 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parent-child pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2- or 3-year follow-up.ConclusionsIn a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-to-face sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up.Clinical trial registrationThe trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.

Effects of Parenting Styles and Family Contributors on Physical Activity Behaviors in Arab Children Ages 6-10 Years Old Living in the US

The purpose of this study was to explore the effects of parenting styles and family contributors on physical activity behaviors in Arab children living in the US. This mixed-method study included the Caregiver's Feeding Style Questionnaire (CFSQ), Family Nutrition Physical Activity (FNPA) survey, and five focus group discussions (FGD), guided by the Social Cognitive Theory (SCT). Twenty-three Arab mothers of 37 children aged 6-10 years old participated in this study. Seventeen mothers were overweight or obese, and six children were overweight or obese. Although all Arab mothers self-assessed that they were authoritative, only seven mothers were categorized as having an authoritative feeding style based on their CFSQ scores. The FNPA overall mean was 3.15, indicating less obesogenic family environments and behaviors. Across FGDs, common physical activity barriers included lack of time, the child being distracted by technology, and lack of a mother's interest in a child's physical activity due to culture and fear. Positive approaches included considering the child's interest in sports and involvement in physical activity with the child. Negative attitudes included pushing the child to do sports and the mother's lack of interest in physical activity. In correlation analyses, the mother's BMI was significantly correlated with the child's BMI z-scores (r = 0.325, p = 0.005). No significant associations were found between reported feeding styles (CFSQ), obesogenic family environments (FNPA), and child's BMI z-scores. This study can guide future efforts in developing effective education programs, including physical activity behaviors for Arab families.

Evaluation of the Predictive Ability, Environmental Regulation and Pharmacogenetics Utility of a BMI-Predisposing Genetic Risk Score during Childhood and Puberty.

Polygenetic risk scores (pGRSs) consisting of adult body mass index (BMI) genetic variants have been widely associated with obesity in children populations. The implication of such obesity pGRSs in the development of cardio-metabolic alterations during childhood as well as their utility for the clinical prediction of pubertal obesity outcomes has been barely investigated otherwise. In the present study, we evaluated the utility of an adult BMI predisposing pGRS for the prediction and pharmacological management of obesity in Spanish children, further investigating its implication in the appearance of cardio-metabolic alterations. For that purpose, we counted on genetics data from three well-characterized children populations (composed of 574, 96 and 124 individuals), following both cross-sectional and longitudinal designs, expanding childhood and puberty. As a result, we demonstrated that the pGRS is strongly associated with childhood BMI Z-Score (B = 1.56, SE = 0.27 and p-value = 1.90 × 10−8), and that could be used as a good predictor of obesity longitudinal trajectories during puberty. On the other hand, we showed that the pGRS is not associated with cardio-metabolic comorbidities in children and that certain environmental factors interact with the genetic predisposition to the disease. Finally, according to the results derived from a weight-reduction metformin intervention in children with obesity, we discarded the utility of the pGRS as a pharmacogenetics marker of metformin response.

Parenting Styles and Family Contributors to the Development of Dietary Behaviors in Arab Children Ages 6-10 Years Old Living in the US

Parenting styles and family contributors are the main determinants of obesity risk in children. To date, no research has been reported on parenting styles/practices and family contributors to the development of dietary behaviors in Arab children living in the US. The objectives of this exploratory mixed-method study were to collect data on parenting feeding styles (Caregiver’s Feeding Style Questionnaire- CFSQ) of Arab mothers and family contributors (Family Nutrition Physical Activity- FNPA) to the development of dietary behaviors in their children; and to collect data on Arab mothers' challenges and strategies to promote healthier dietary behaviors in their children. Although all Arab mothers (n=23) self-assessed that they were authoritative, only seven mothers were categorized as having an authoritative feeding style based on their CFSQ scores. The FNPA overall mean was 3.15, indicating less obesogenic family environment and behaviors. Across focus groups, barriers to desirable dietary intake included low vegetable intake and child being distracted by sweets, junk foods, and technology. All mothers wanted their children to have healthier dietary habits and used positive and negative approaches to achieve that. Positive approaches included no pressure to eat and providing healthier alternative foods. Negative approaches included pressuring the child to eat and rewarding with sweets and technology. In correlation analyses, the mother's BMI was significantly correlated with the child's BMI z-scores (r = 0.325, p = 0.005). This study can guide future efforts in assessing parenting style and assessing the home environment regarding the dietary behaviors of Arab families.

190-OR: Impact of Prenatal Exposure to Maternal Obesity and Child Physical Activity Levels on Neurocognition

Prenatal exposure to maternal obesity is linked to neurocognitive deficits in offspring. In contrast, engaging in physical activity (PA) is beneficial for cognition and brain development. We aimed to determine if greater PA is associated with higher intelligence quotient (IQ) scores and greater brain white matter integrity in children born to mothers with a range of pre-pregnancy BMI. Ninety-nine children (59 girls) ages 7-13 years completed the study. Maternal pre-pregnancy BMI was obtained from electronic medical records. Wechsler Abbreviated Scale of Intelligence was used to measure IQ. Diffusion tensor imaging was used to measure mean global fractional anisotropy (FA), a marker of white matter integrity. Time spent in moderate-to-vigorous PA (MVPA) and vigorous PA (VPA) was assessed using 3-day PA recalls. Linear regressions were used to assess whether maternal pre-pregnancy BMI or child MVPA and VPA were associated with child IQ scores and global FA. Maternal pre-pregnancy BMI ranged from 19.0-54.0 kg/m2 (43% obese). Mean±SD child IQ was 106.4±14.0, MVPA was 132.8±95.4 min/day, and VPA was 19.0±27.1 min/day. Maternal pre-pregnancy BMI was negatively associated with child IQ scores (β=-0.31; p=0.10); this marginal association remained after adjusting for child age, sex, puberty, BMI z-score, and socioeconomic status (β=-0.42; p=0.095). MVPA was not associated with child IQ (β=2.63; p=0.16). However, children who spent more time in VPA had higher IQ scores before (β=7.05; p=0.003) and after adjusting for the same co-variates (β=5.65; p=0.024) and further adjusting for maternal pre-pregnancy BMI (β=5.01; p=0.049). Children who spent more time in VPA also had greater mean global FA (unadjusted: β=0.01; p=0.017; adjusted: β=0.01; p=0.005). These findings suggest that engaging in VPA is beneficial for cognition and white matter microstructure in children, independent of maternal pre-pregnancy BMI. Disclosure J. Alves: None. B.C. Angelo: None. S.H. Luo: None. T. Chow: None. A.G. Yunker: None. A. Xiang: None. K.A. Page: None. J. Zink: None. B.R. Belcher: None. K. Clark: None. Funding American Diabetes Association (1-14-ACE-36 to K.A.P.); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK116858); National Institute of Mental Health (F31MH115640)

Assessing the Moderating Effect of Parental Feeding Styles on the Association Between Satiety Responsiveness and Child BMI Z-Scores in Chilean Preschoolers Aged 3–5 Years

Abstract Objectives To evaluate the moderating effect of feeding styles on the association between satiety responsiveness and child BMI z-scores in children aged 3-to-5 in Santiago, Chile. Methods Participants were recruited from childcare centers serving low- and middle-income families in 2017 and 2018. During a face-to-face individual interview, the Caregiver Feedings styles Questionnaire and food responsiveness subscale of the Child Eating Behavior Questionnaire were applied to parents. Weight and height were obtained for children and caregivers. Multiple linear regressions were conducted to test the moderating effect of feeding styles on the relationship between satiety responsiveness and child BMI z-scores. Results 92.5% of caregivers were mothers, the parent BMI was 29.2 (SD = 5.7). No feeding style moderated the association between satiety responsiveness and BMI z-score Satiety responsiveness had a significant main effect on child BMI z score. None of the feeding styles was significantly associated with child BMI z-score. Only satiety responsiveness was significantly associated with child BMI z score (B = –.32, P &amp;lt; 0.05) after controlling for parent BMI (B = .047, P &amp;lt; .05). This model accounted for 12% of the variance of the child BMI z-score. 1.1% of the children were underweight, 22.4% normal, 37.9% overweight and 38.5% obese Conclusions Parent perceptions of higher satiety responsiveness suggests an association with lower child BMI z-scores. This study suggests that how children respond to food may play an important role in explaining child weight status. than the parent's or caregiver style of feeding in determining a child's weight status. Further research is required to discard interaction effects between appetite traits and feeding styles to explain child weight status. Funding Sources National Comission of scientific Research and Technology (CONICYT) and its Becas Chile program 2016 (#72,110,561) Center of Latin American Studies (CLACS) University of Illinois at Urbana-Champaign.

Gender Differences in the Prediction of Children’s Weight Status from Measures of Non-Eating and Eating Self-Regulation

Abstract Objectives The goal of this study was to investigate gender differences in the prediction of BMI z-scores in children ages 7 to 9. Predictors included well-known measures of non-eating and eating self-regulation assessed during the preschool years (ages 4 to 5). Methods Participants were part of a longitudinal study examining eating behaviors in Hispanic families with low-income levels living in a large urban city in southeast United States. Children and their parents were seen at Time 1 (ages 4–5), Time 2 (ages 5 ½-6 ½), and at Time 3 (ages 7–9). One hundred and thirty families had data on all variables needed for the current analyses. Both parent-report questionnaires as well as observational protocols were used to measure child self-regulation. Parent-report questionnaires included satiety responsiveness and food responsiveness (two child eating self-regulatory measures known to be associated with childhood obesity) and effortful control (a self-regulatory aspect of child temperament). Observational protocols included eating in the absence of hunger (a well-known child eating self-regulation measure) and executive functioning, delay of gratification, and emotional regulation (all measures of non-eating self-regulation). Height and weight were objectively measured on the children. Regressions were conducted to predict child weight status at ages 7 to 9 from measures of child eating and non-eating self-regulatory processes. Data on boys and girls were analyzed in different regressions. Parent-reported measures were analyzed separately from observational measures. Results Only the regression for girls, predicting Time 3 child BMI z-scores from observational measures, showed significant effects over and above the effects of Time 1 child BMI z-scores. Eating in the absence of hunger (eating self-regulation) positively predicted whereas delay of gratification (non-eating self-regulation) negatively predicted changes in girls’ BMI z-scores overtime. Conclusions The results of this study point to the importance of addressing non-eating self-regulation as well as eating self-regulation in future family-focused childhood obesity initiatives, especially those focused on Hispanic families with young children. Funding Sources Research was funded by the National Institutes of Health (R01 HD062567).

Early Life Factors Predictive of Weight Status in 2 Year-Olds

Abstract Objectives The extent to which early life factors predict weight status by age two is unclear. This study elucidated early life factors predictive of BMI-for-age z-score (MN24 BMI) in 2-year-olds in the ongoing STRONG Kids 2 longitudinal study. Methods At registration, 6 weeks, 3, 12, 18, and 24 months, parents (N = 126) completed online surveys (questions derived from CDC Infant Feeding Practices questionnaire, Short Form of the MOS Health survey, and Block Kids Food Frequency Questionnaire (Ages 2–7; Nutrition Quest) for diet MN21–24). Height and weight were collected at home visits. Child BMI-for age z-scores were based on WHO growth standards, and dietary patterns at MN24 were derived by principal component analysis (PCA). Mode of delivery (i.e., vaginal or caesarean), timing of introduction to solids, dietary patterns, child's BMI z-score and feeding methods (i.e., exclusive formula or breastfeeding, or both), and maternal weight were obtained. Multiple regression modelling determined the explanatory power of these factors on MN24 BMI. Results Modelling revealed a significant regression equation (P &amp;lt; .001), with an R2 of .359. MN12 BMI-for-age z-score (MN12 BMI) (β = .555, P &amp;lt; .001) explained 31.2% of the variance in MN24 BMI. Child feeding method at MN3 (β = –.218, P = .003) accounted for 4.7% of the variance in MN24 BMI. Conclusions Children with a greater MN12 BMI have a higher MN24 BMI, while those who undergo breastfeeding at MN3 have a lower MN24 BMI. Future studies will expand on these findings by examining if the predictive power of these early life factors on BMI persists in later life. Funding Sources Grants from the National Dairy Council to Sharon Donovan and Barbara H. Fiese (CoPI's), and the Gerber Foundation and NIH R01 DK107561 to Sharon Donovan.

CD36 gene polymorphism -31118 G>A (rs1761667) is associated with overweight and obesity but not with fat preferences in Mexican children.

CD36 glycoprotein is a candidate receptor involved in the gustatory detection of lipids and emerging evidence has suggested that genetic variations in CD36 may modulate the oral perception threshold to fatty acids. Here, we analyzed the association of -31118 G>A polymorphism in CD36 gene with nutritional status and preferences for fatty foods in Mexican children. Genotyping of SNP rs1761667 was performed in school-age children (n=63) in addition to sensory tests evaluating the preference and satisfaction score assigned to oil-based sauces of different fatty acid composition. The G allele was associated with high BMI z-score in children (OR=2.43, 95% (CI 1.02-5.99); p=0.02) but CD36 genotypes (AA, GA, and GG) did not show significant association with the preference and satisfaction scores assigned to oil-based sauces. The BMI z-score showed no association with the preference to oil-based sauces; however, children with normal weight gave higher satisfaction scores to sauces with a high content of unsaturated fatty acids than to sauces rich in saturated fatty acids (0.56±1.26 vs. 0.06±1.22; p=0.02). Therefore, the G allele of -31118 G>A SNP in CD36 gene is associated with overweight and obesity in Mexican children but do not appear to modulate the preferences and satisfaction scores to fat.

Estimated postnatal p,p\u2019-DDT and p,p\u2019-DDE levels and body mass index at 42\u2009months of age in a longitudinal study of Japanese children

BackgroundChildren are exposed to p,p’-dichlorodiphenyltrichloroethane (p,p’-DDT) and p,p’-dichlorodiphenyldichloroethylene (p,p’-DDE) through placental and lactational transfer. Some studies have suggested that early-life exposure to these compounds could lead to increased body mass index (BMI) during childhood. Our aim was to assess whether children’s exposure during the first 2 years of life is associated with BMI z-score in Japanese children at 42 months of age.MethodsWe used data from a birth cohort (n = 290) of the Tohoku Study of Child Development. p,p’-DDT and p,p’-DDE levels were measured in breast milk samples collected 1 month after birth, and levels in children were estimated using a toxicokinetic model for three exposure periods (0–6 months, 6–12 months, 12–24 months). Associations between exposure estimates and BMI z-score at 42 months of age were assessed using multivariate linear regression models.ResultsWe found no significant association between levels of p,p’-DDT measured in breast milk or estimated in children and BMI z-score. However, we observed associations between estimated p,p’-DDE levels in girls during all postnatal exposure periods and BMI z-score; for each log increase in the estimated p,p’-DDE levels, BMI z-score increased by 0.23 (C.I. 95%: 0.01, 0.45) for the 0–6 months exposure period, 0.26 (C.I. 95%: 0.06, 0.47) for the 6–12 months exposure period, and 0.24 (C.I. 95%: 0.05, 0.43) for the 12–24 months exposure period.ConclusionIn this study of Japanese children, estimated postnatal p,p’-DDE levels were associated with increased BMI z-score at 42 months of age, mostly in girls. These results are in line with previous studies supporting that early-life exposure to p,p’-DDE may be associated with higher BMI during childhood.

Perfluoroalkyl substances and anthropomorphic measures in children (ages 3–11 years), NHANES 2013–2014.

BackgroundPerfluoroalkyl acids (PFAAs) are man-made compounds that are persistent in the environment and highly bioaccumulative in the body. Humans are exposed to a mixture of these substances, and the effects of these mixtures may be different than the effects noted for individual compounds. Prenatal exposure to PFAAs has been associated with decreased birth weight. The objective of the present study is to evaluate concurrent serum PFAA levels, as single compounds and as mixtures, in relation to anthropomorphic measures in children. MethodsUsing multivariate linear regression, we evaluated the association between single or PFAA mixtures and with height-for-age (HAZ), weight-for-age (WAZ), and BMI (BMIZ) z-scores in children (ages 3–11 years) participants of the National Health and Nutrition Examination Survey (NHANES) 2013–2014. Analyses were also stratified by sex. The PFAA mixture was based on relative potency factors express in terms of PFOA equivalency (CmixRPFi) or as molar sum of the PFAA congeners (∑molPFAA). ResultsThere was a statistically significant association of PFHxS and PFOS with decreased HAZ in boys. The significantly decreased HAZ in boys was also found when the PFAAs were analyzed as mixtures: CmixRPFi (β = −0.33; 95%CI: 0.63, −0.04) or ΣmolPFAAs (β = −0.30; 95%CI: 0.56, −0.04). In boys, PFHxS was also associated with decreased WAZ and BMIZ. The only statistically significant association found in girls was between decreased HAZ and PFHxS. ConclusionsWe found sex differences in the association between concurrent serum PFAA levels and anthropomorphic measures in children 3–11 years old. PFAA levels, as single congeners or as mixture concentrations were associated with decreased height-for-age z-score in boys.

Bidirectional relationships between appetitive behaviours and body mass index in childhood: a cross-lagged analysis in the Generation XXI birth cohort.

Appetitive behaviours have been associated with body mass index (BMI). However, existing data were largely derived from cross-sectional studies and cannot provide insight into the direction of associations. We aimed to explore the bidirectionality of these associations in school-age children. Participants are from the Generation XXI birth cohort, assessed at both 7 and 10years of age (n = 4264; twins excluded). The Children's Eating Behaviour Questionnaire (CEBQ) was used to measure appetitive behaviours (8 subscales). Anthropometrics were measured and WHO BMI z-score was calculated. Cross-lagged analyses were performed to compare the magnitude and direction of the associations (behaviours at 7years to BMI z-score at 10years and the reverse) (covariates: child's sex, physical exercise, maternal age and education; plus BMI z-score at age 7 or, in the reverse direction, the subscale score). In cross-lagged analyses, appetitive behaviours at 10years of age (apart from emotionalundereating) were shown to be reactive to the child BMI z-score at 7years of age. Only slowness in eating was significantly related to subsequent BMI. However, the strongest association was from the child BMI z-score to the behaviour (βstandardized = -0.028 compared with βstandardized = -0.103, likelihood ratio test p < 0.001). BMI at age7 was related to appetitive behaviours at 10years of age, rather than the reverse. This suggests that children with a higher BMI in middle childhood are at increased risk of developing an avid appetite over time.

Parental Feeding Practices in Relation to Maternal Education and Childhood Obesity.

Parental beliefs, attitudes, and feeding practices play a vital role in childhood obesity. This study aimed to assess parental perceptions, concerns about weight, feeding practices using the Child Feeding Questionnaire (CFQ), and its association with body mass index (BMI) and maternal education in elementary school children. Participants aged 6–10 years (n = 169) were recruited and anthropometric measurements were obtained. Pearson’s correlation and hierarchical linear regression analysis were used to examine the association between BMI z-score and the seven factors of the CFQ. The BMI z-score was significantly associated with parental perceived child weight and concern about child weight. The BMI z-score had a significant negative association with parents pressuring children to eat. Parents of obese children reported significantly higher (p < 0.001) levels of perceived child weight (β = 0.312) and concern (β = 0.320) about their child’s weight compared to the normal weight and overweight groups. Parents of overweight children showed considerably less (β = −0.224; p < 0.005) pressuring towards their children to eat as compared to parents of normal weight children. Additionally, we found that the parental feeding practice (pressure to eat) was only dependent upon maternal education. The path analysis indicates that maternal education has a mediating effect on BMI z-score and pressure to eat is related to BMI z-score through maternal education. The findings demonstrate the association between the parents’ perceptions, concerns, and pressure to eat with BMI z-score of elementary school-aged children. Only the parental feeding practice pressure to eat was dependent upon the maternal education.

Effects of an antenatal dietary intervention in women with obesity or overweight on child outcomes at 3-5 years of age: LIMIT randomised trial follow-up.

While the effects of an antenatal dietary intervention for women with obesity or overweight on pregnancy and newborn health have been extensively studied, the longer-term effects into childhood are unknown. We followed children born to women who participated in the LIMIT randomised trial, where pregnant women were randomised to an antenatal dietary and lifestyle intervention or standard antenatal care. Our aim was to assess the effect of the intervention, on child outcomes at 3-5 years of age on children whose mothers provided consent. We assessed 1418 (Lifestyle Advice n = 727; Standard Care n = 691) (66.9%) of the 2121 eligible children. There were no statistically significant differences in the incidence of child BMI z-score >85th centile for children born to women in the Lifestyle Advice Group, compared with the Standard Care group (Lifestyle Advice 444 (41.73%) versus Standard Care 417 (39.51%); adjusted relative risk (aRR) 1.05; 95% confidence intervals 0.93-1.19; p = 0.42). There were no significant effects on measures of child growth, adiposity, neurodevelopment, or dietary intake. There is no evidence that an antenatal dietary intervention altered child growth and adiposity at age 3-5 years. This cohort of children remains at high risk of obesity, and warrants ongoing follow-up.

Abstract P290: The Association of Maternal Pre-pregnancy Weight With Childhood and Adolescent Blood Pressure and the Modifying Role of Vitamin D

Introduction: High blood pressure (BP) is the leading modifiable risk factor of cardiovascular diseases. High maternal pre-pregnancy body mass index (BMI) may be one of earliest risk factors for high child BP, but evidence supporting this hypothesis is limited. Vitamin D was recently found to protect against elevated BP in childhood, yet no studies to our knowledge have examined if Vitamin D could be a modifiable target for mitigating the association of pre-pregnancy BMI and child BP. Methods: We analyzed longitudinal data of 719 mother-child pairs in the Boston Birth Cohort enrolled from 1998-2012 at the Boston Medical Center. We calculated child systolic BP (SBP) percentile according to a US reference and defined low Vitamin D as cord blood 25(OH)D concentration &lt;11 ng/mL. We examined the change in child SBP percentile per 5-kg/m 2 increment in pre-pregnancy BMI using linear regression models with GEE estimates. We adjusted for confounders (see Figure footnote) and assessed mediation by further adjusting for child BMI-z score. Results: Our analytic sample included 451 (63%) African American/Haitian mothers, 361 (50%) girls, and 304 (42%) children with low cord blood Vitamin D. A 5-kg/m 2 increment in maternal pre-pregnancy BMI was associated with a 1.99 (95% CI: 1.08, 2.90) percentile increase in child SBP (during childhood [3-12 years]: 1.85, 95% CI: 0.97, 2.73; during adolescence [13-18 years]: 4.22, 95% CI: 1.19, 7.25). Cord blood Vitamin D status modified the associations (P-interaction = 0.023) (Figure, Panel A). Results were attenuated in the mediation analysis, but the interaction remained significant (Figure, Panel B). Conclusion: Higher maternal pre-pregnancy BMI is associated with higher offspring BP in childhood and adolescence, and this association is partially mediated by child weight. The inter-generational association disappeared if mother-newborn cord blood had high Vitamin D. Optimizing maternal Vitamin D status during pregnancy may help prevent the inter-generational cycle of cardiovascular risk.