Infant Adiposity Research Articles

Relationship of insulin, glucose, leptin, IL‐6 and TNF‐α in human breast milk with infant growth and body composition

Numerous appetite, growth, obesity-related hormones and inflammatory factors are found in human breast-milk, but there is little evidence on their relationship with infant body composition. OBJECTVIE: The purpose of the present cross-sectional pilot study was to assess the cross-sectional associations of appetite-regulating hormones and growth factors (leptin, insulin and glucose) and inflammatory factors (interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α)) in human breast-milk with infant size, adiposity, and lean tissue at 1-month of age in healthy term infants. Human breast-milk was collected from nineteen exclusively breast-feeding mothers using one full breast expression between 8:00 and 10:00 a.m. The milk was then mixed, aliquoted, stored at -80°C and then centrifuged to remove the milk fat, prior to analyses using commercially available immunoassay kits; milk analytes were natural log transformed prior to analysis. Infant body composition was assessed using a Lunar iDXA v11-30.062 scanner (Infant whole body analysis enCore 2007 software, GE, Fairfield, CT). Maternal pre-pregnancy BMI was positively associated with milk leptin concentration (P = 0.0027), and so maternal-BMI-adjusted Spearman correlations were examined between breast-milk analytes and infant growth and body composition variables. As previously reported, greater milk leptin was associated with lower BMIZ (BMI-for-age z-score based on WHO 2006 growth charts; r = -0.54, P = 0.03). Glucose was positively associated with relative weight (r = 0.6, P = 0.01), and both fat and lean mass (0.43-0.44, P < 0.10). Higher concentrations of milk insulin were associated with lower infant weight, relative weight, and lean mass (r = -0.49-0.58, P < 0.06). Higher milk IL-6 was associated with lower relative weight, weight gain, percent fat, and fat mass (r = -0.55-0.70, P < 0.03 for all), while higher TNF-α was associated with lower lean mass (r = -0.58, P = 0.05), but not measures of adiposity. These preliminary data suggest for the first time that in the first months of life, breast-milk concentrations of insulin, glucose, IL-6 and TNF-α, in addition to leptin, may be bioactive and differentially influence the accrual of fat and lean body mass.

Estilos de vida, sobrepeso y obesidad en adolescentes de enseñanza media de La Habana

IntroductionThe high prevalence of overweight and obesity is a health problem in Cuba, and there is a lack of information on adolescents. The objective of the present study was to evaluate the relationship between excessive weight and adiposity with physical activity, hours of television (TV), and eating habits in adolescents. Material and methodsA total of 604 adolescents (12 years) from Havana were studied. The variables analysed included, body mass index, body composition, history of obesity in infancy, physical activity, hours watching television, eating habits and dietary preferences. A descriptive and correlation analysis was performed. In the logistic regression analysis, excess weight and adiposity were used as dependent variables. ResultsExcess body weight was more common in boys. There was high prevalence of excess adiposity, 49.8% in girls and 37.8% in boys. The boys (61.7%) were more active than the girls (33.6%). Just under half (46.7%) of the boys, and 55.9% of the girls spent more than 2 hours/day watching television, which increased to more than 75% for both sexes on Saturdays and Sunday. Making less than 5–6 meals/day doubled the risk of being overweight. Body overweight in infancy was also a risk factor. Not having breakfast increased the risk of adiposity by almost double. ConclusionsExcess weight, and particularly excess adiposity, may be considered a health problem in the adolescents studied. A very high consumption of sugar, an excessive time watching TV, and insufficient physical activity was observed.

Maternal smoking during pregnancy and offspring trajectories of height and adiposity: comparing maternal and paternal associations

Background Maternal smoking during pregnancy is associated with reduced offspring birth length and has been postulated as a risk factor for obesity. Causality for obesity is not established. Causality is well-supported for birth length, but evidence on persistence of height deficits is inconsistent.Methods We examined the association between maternal smoking during pregnancy and trajectories of offspring height (0–10 years, N = 9424), ponderal index (PI) (0–2 years, N = 9321) and body mass index (BMI) (2–10 years, N = 8887) in the Avon Longitudinal Study of Parents and Children. To strengthen inference, measured confounders were controlled for, maternal and partner smoking associations were compared, dose–response and associations with post-natal smoking were examined.Results Maternal smoking during pregnancy was associated with shorter birth length, faster height growth in infancy and slower growth in later childhood. By 10 years, daughters of women who smoke during pregnancy are on average 1.11 cm (SE = 0.27) shorter after adjustment for confounders and partner smoking; the difference is 0.22 cm (SE = 0.22) for partner's smoking. Maternal smoking was associated with lower PI at birth, faster PI increase in infancy, but not with BMI changes 2–10 years. Associations were stronger for maternal than partner smoking for PI at birth and PI changes in infancy, but not for BMI changes after 2 years. A similar dose–response in both maternal and partner smoking was seen for BMI change 2–10 years.Conclusion Maternal smoking during pregnancy has an intrauterine effect on birth length, and possibly on adiposity at birth and changes in height and adiposity in infancy. We do not find evidence of a specific intrauterine effect on height or adiposity changes after the age of 2 years.

Inherited behavioral susceptibility to adiposity in infancy: a multivariate genetic analysis of appetite and weight in the Gemini birth cohort

The behavioral susceptibility model proposes that inherited differences in traits such as appetite confer differential risk of weight gain and contribute to the heritability of weight. Evidence that the FTO gene may influence weight partly through its effects on appetite supports this model, but testing the behavioral pathways for multiple genes with very small effects is not feasible. Twin analyses make it possible to get a broad-based estimate of the extent of shared genetic influence between appetite and weight. The objective was to use multivariate twin analyses to test the hypothesis that associations between appetite and weight are underpinned by shared genetic effects. Data were from Gemini, a population-based birth cohort of twins (n = 4804) born in 2007. Infant weights at 3 mo were taken from the records of health professionals. Appetite was assessed at 3 mo for the milk-feeding period by using the Baby Eating Behaviour Questionnaire (BEBQ), a parent-reported measure of appetite [enjoyment of food, food responsiveness, slowness in eating (SE), satiety responsiveness (SR), and appetite size (AS)]. Multivariate quantitative genetic modeling was used to test for shared genetic influences. Significant correlations were found between all BEBQ traits and weight. Significant shared genetic influence was identified for weight with SE, SR, and AS; genetic correlations were between 0.22 and 0.37. Shared genetic effects explained 41-45% of these phenotypic associations. Differences in weight in infancy may be due partly to genetically determined differences in appetitive traits that confer differential susceptibility to obesogenic environments.

Relationship between breast-feeding and adiposity in infants and pre-school children

We aimed to establish associations of duration of breast-feeding with mean BMI and waist circumference, as well as the likelihood of being overweight/obese, during early childhood. Cross-sectional, population-based study. Height, weight and waist circumference were measured and BMI calculated. Interviewer-administered questionnaire determined whether the child was ever breast-fed and the duration of breast-feeding. Sydney, Australia. Infants and pre-school children (n 2092) aged 1-6 years were examined in the Sydney Paediatric Eye Disease Study during 2007-2009. Of the children aged 1-6 years, 1270 had been breast-fed compared with 822 who were never breast-fed. After multivariable adjustment, 1-6-year-old children who were ever breast-fed compared with those who were not had significantly lower BMI, 16·7 (se 0·1) kg/m2 v. 17·1 (se 0·2) kg/m2 (P = 0·01). Decreasing BMI was associated with increasing duration of breast-feeding (P trend = 0·002). After multivariable adjustment, each month increase in breast-feeding was associated with an average BMI decrease of 0·04 kg/m2 (P = 0·002) and 0·03 kg/m2 (P = 0·03) among children aged 1-2 years and 3-4 years, respectively. In 1-2-year-old children, each month increase in breast-feeding duration was associated with a 0·06 cm decrease in waist circumference (P = 0·04). Significant associations were not observed among 5-6-year-old children. Children who were ever breast-fed v. those never breast-fed were less likely to be overweight/obese (multivariable-adjusted OR = 0·54; 95 % CI 0·36, 0·83). We demonstrated a modest influence of breast-feeding on children's BMI during early childhood, particularly among those aged less than 5 years.

Continuous Glucose Profiles in Obese and Normal-Weight Pregnant Women on a Controlled Diet

Higher rates of macrosomia and large for gestational age are observed among newborns of obese nondiabetic mothers with presumably normal glucose tolerance (NGT). These adverse neonatal outcomes are similar to those observed in women with gestational diabetes. There is continuing debate over what constitutes NGT in pregnancy and whether obese and normal-weight women would have similar glycemic patterns if their respective diets were controlled. The aim of this prospective study was to determine whether (1) glycemic profiles differ between obese and normal-weight women who have NGT; and (2) glycemic profiles in obese women both early and late in gestation are influenced by a controlled diet. Continuous glucose monitoring was used to define 24-hour glycemia among 22 normal-weight and 16 obese pregnant women on an ad libitum and controlled diet. Measurements of glycemia occurred in early (15.7 ± 0.3 weeks) and late (27.7 ± 0.3 weeks) gestation. Fasting blood glucose, nonesterified fatty acids (FFAs), and insulin were also measured both in early and late gestation; however, triglycerides were measured only in early gestation. The 24-hour glucose area under the curve was significantly higher in obese women than in normal-weight women, despite controlled diets both in early (P < 0.05) and late (P < 0.01) pregnancy. Compared with normal-weight women, nearly all fasting and postprandial glycemic parameters, as well as insulin, triglycerides, and FFAs were higher in the obese women late in pregnancy. The percentage body fat was significantly higher in infants born to obese mothers than in those born to normal-weight mothers (9.2% ± 0.5% vs. 7.3% ± 0.4%, P < 0.01). Early maternal body mass index (r, 0.54, P = 0.01), as well as late mean daytime glucose (r, 0.48; P < 0.05), and late fasting insulin (r, 0.49; P < 0.05) correlated with infant percentage body fat in glucose tolerant women. The strongest correlates with infant adiposity were early fasting triglycerides (r, 0.67, P < 0.001) and late fasting FFAs (r, 0.54, P < 0.01). These findings demonstrate that the glycemic profiles of obese pregnant women without diabetes are higher than those of normal-weight women when diet is tightly controlled. Late fasting FFAs, insulin, and mean daytime glucose are highly correlated with infant adiposity, independent of maternal body mass index, but the strongest predictor is early triglycerides. The data suggest the need for study of new management strategies in obese pregnant women with NGT.

Development of whole body adiposity in preterm infants

The long-term effects of prematurity, early diet and catch-up growth on metabolic risk and body adiposity are of increasing interest to Neonatologists. Poor growth is known to be associated with poorer neuro-developmental outcome but concern exists that increased rates of “catch-up” (or “recovery”) growth may be associated with increased adiposity and the later development of metabolic syndrome.In this manuscript we review the published data on body composition in preterm infants, and present new analyses of body adiposity in preterm infants during the 12–15months of life, and the effect of growth rate (weight gain) on body adiposity.We conclude that although preterm infants have increased adiposity at term corrected age, they generally have lower body fat than their term peers during the rest of the 12–15months of life. Although more rapid “catch-up” growth in preterm infants during the first year of life is associated with greater body fatness than slower rates of growth, these higher rates of growth lead to body composition more similar to that of the term-born infant, than do slower rates of growth.Although more studies are needed to determine whether these short-term increases or the longer-term decreases in adiposity modify the risk on chronic diseases such as diabetes mellitus, hypertension or other components of the metabolic syndrome, the widely held concern that preterm babies have greater adiposity than their term peers, and that this is worsened by greater amounts of catch-up growth, are not supported by the available evidence.

Infant Overweight Is Associated with Delayed Motor Development

Infant Overweight Is Associated with Delayed Motor Development

Impact of Maternal Physical Activity and Infant Feeding Practices on Infant Weight Gain and Adiposity

Increasing evidence supports the contribution of intrauterine environmental exposures on obesity risk in offspring. Few studies have included maternal and infant lifestyle factors. Our objective was to study the impact of maternal physical activity, infant feeding, and screen time on offspring weight gain and adiposity. In a prospective cohort study, 246 mothers underwent testing during pregnancy to assess glucose tolerance status and insulin sensitivity. Anthropometry and questionnaires on physical activity, infant feeding, and screen time were completed. Multiple-linear regression was performed to examine the impact of maternal and infant factors on infant weight gain and weight-for-length z-score at 1 year. Infant weight outcomes were negatively predicted by maternal pregravid vigorous/sport index and exclusive breastfeeding duration. After adjustment, each unit increase in maternal pregravid vigorous/sport index decreased infant weight gain by 218.6 g (t = 2.44, P = 0.016) and weight-for-length z-score by 0.20 (t = 2.17, P = 0.031). Each month of exclusive breastfeeding reduced infant weight gain by 116.4 g (t = 3.97, P < 0.001) and weight-for-length z-score by 0.08 (t = 2.59, P = 0.01). Maternal pregravid physical activity and exclusive breastfeeding duration are associated with weight gain and adiposity as early as 1 year of age.

Do women with PCOS have a unique predisposition to obesity?

Women with PCOS are often obese and there is debate in the literature regarding whether women are obese because of their PCOS status or if those who become obese are more predisposed to PCOS. There is support for a predisposition to obesity by some data indicating impaired metabolism in PCOS women compared to weight matched controls but this data is limited. Contrary data also exist that adiposity rates do not vary between women with PCOS and those without, and that differences in obesity rates between countries are more likely due to environmental and lifestyle factors. Until further data are available, lifestyle recommendations for weight reduction in women with PCOS should be similar to those for women without PCOS.

Actigraphic sleep and developmental progress of one-year-old infants

The aims of this study were to pilot methods to monitor the sleep of infants, as well as explore the relationships between infant sleep and physical, cognitive and motor development. Fifty-two one-year-old infants and their parents participated in the study. Infant sleep was assessed by one week’s actigraphy, sleep diaries and by the Brief Infant Sleep Questionnaire. Parents also completed a background questionnaire and the Ages and Stages Questionnaire to measure stages of development across five domains. Infant’s weight and length were measured by the researcher at study onset and Body Mass Index (BMI) scores were calculated. Sleep efficiency, and having a higher proportion of total sleep at night, were significantly correlated with age as well as stages of cognitive and motor development. However, sleep measures were not correlated with infant BMI. These findings support increasing evidence that sleep matures quickly around the age of one year and is related to other stages of development. Further research is required to confirm whether links between sleep and development are simply a marker of maturation, or if sleep per se plays a specific role in infant cognitive and motor development. Sleep and physical growth at this age need further investigation with a more representative sample including short-sleeping and overweight infants.

Prevention of Overweight in Infancy (POI.nz) study: a randomised controlled trial of sleep, food and activity interventions for preventing overweight from birth.

BackgroundRapid weight gain during the first three years of life predicts child and adult obesity, and also later cardiovascular and other morbidities. Cross-sectional studies suggest that infant diet, activity and sleep are linked to excessive weight gain. As intervention for overweight children is difficult, the aim of the Prevention of Overweight in Infancy (POI.nz) study is to evaluate two primary prevention strategies during late pregnancy and early childhood that could be delivered separately or together as part of normal health care.Methods/DesignThis four-arm randomised controlled trial is being conducted with 800 families recruited at booking in the only maternity unit in the city of Dunedin, New Zealand. Mothers are randomised during pregnancy to either a usual care group (7 core contacts with a provider of government funded "Well Child" care over 2 years) or to one of three intervention groups given education and support in addition to "Well Child" care: the Food, Activity and Breastfeeding group which receives 8 extra parent contacts over the first 2 years of life; the Sleep group which receives at least 3 extra parent contacts over the first 6 months of life with a focus on prevention of sleep problems and then active intervention if there is a sleep problem from 6 months to 2 years; or the Combination group which receives all extra contacts. The main outcome measures are conditional weight velocity (0-6, 6-12, 12-24 months) and body mass index z-score at 24 months, with secondary outcomes including sleep and physical activity (parent report, accelerometry), duration of breastfeeding, timing of introduction of solids, diet quality, and measures of family function and wellbeing (parental depression, child mindedness, discipline practices, family quality of life and health care use). This study will contribute to a prospective meta-analysis of early life obesity prevention studies in Australasia.DiscussionInfancy is likely to be the most effective time to establish patterns of behaviour around food, activity and sleep that promote healthy child and adult weight. The POI.nz study will determine the extent to which sleep, food and activity interventions in infancy prevent the development of overweight.Trial RegistrationClinical Trials NCT00892983Prospective meta-analysis registered on PROSPERO CRD420111188. Available from http://www.crd.york.ac.uk/PROSPERO

Determinants of Body Fat in Infants of Women With Gestational Diabetes Mellitus Differ With Fetal Sex

OBJECTIVENeonatal adiposity is a well-recognized complication of gestational diabetes mellitus (GDM). This study aimed to identify factors influencing adiposity in male and female infants of women treated for GDM.RESEARCH DESIGN AND METHODSThis was a prospective study of 84 women with GDM. Daily blood glucose levels (BGLs) were retrieved from glucose meters, and overall mean fasting and mean 2-h postprandial BGLs were calculated for each woman. Infant body composition was measured at birth, and regression analysis was used to identify significant predictors of infant body fat separately in male and female infants.RESULTSMaternal fasting BGL was the major predictor of adiposity in male infants but had little relationship to adiposity in female infants. In male infants, percent fat was increased by 0.44% for each 0.1 mmol/L increase in mean maternal fasting BGL. Maternal BMI was the primary predictor in female infants but had little effect in males. In female infants, percent fat was increased by 0.11% for each 1 kg/m2 increase in maternal prepregnancy BMI.CONCLUSIONSFetal sex may influence the impact that treatment strategies for GDM have on infant adiposity.

Journal of Diabetes NEWS

Journal of Diabetes NEWS

P1-514 Timing of motor milestones achievement and development of overweight in childhood

BackgroundLate achievement of motor milestones may increase the risk of overweight since early achievers have increased possibility to build lean body mass and expend energy. Further overweight infants may have...

P1-545 Birth size differences between white and Pakistani origin infants by generation: results from the born in Bradford cohort study

BackgroundPrevious studies have shown markedly lower birthweight among infants of South Asian origin compared to those of White European origin. Whether such differences mask greater (central) adiposity in South Asian...

Weight gain in infancy and post‐bronchiolitis wheezing

Low birth weight, high birth weight and excessive weight gain after birth may be risk factors for asthma in childhood, but their associations with wheezing in early childhood are poorly studied. The aim of the study was to evaluate birth weight, weight gain in early infancy and overweight in infancy assessed by weight for length (WFL) as risk factors for wheezing after hospitalization for bronchiolitis in early infancy. In all, 127 full-term infants hospitalized for bronchiolitis at age <6 months have been followed up until the mean age of 1.5 years. The weights and lengths of the infants were measured on admission to hospital and at the control visit. Birth weights were obtained from the hospital records. Both occurrence and recurrence of post-bronchiolitis wheezing were associated with birth weight >4000 g and the recurrence of post-bronchiolitis wheezing with WFL >110% at age 1.5 years. The associations were robust to adjustments with gender and allergy. Higher weight gain from birth to hospitalization at age <6 months was associated with wheezing in the subgroup of children with birth weight >4000 g. High birth weight and the development of overweight may be associated with post-bronchiolitis wheezing in infancy.

The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review

A chronic mismatch of caregiver responsiveness to infant-feeding cues, such as feeding when the infant is not hungry, is hypothesized to have a role in the development of overweight by impairing an infant's response to internal states of hunger and satiation. Although this concept of mismatch or discordance has long been acknowledged in scholarly writings, a systematic assessment of the evidence supporting the role of discordant responsiveness during infant feeding in the early origins of overweight is lacking. This review was undertaken to assess evidence for this hypothesized relationship between discordant responsiveness in feeding and overweight in infancy and toddlerhood, framed within the larger social-environmental context of the infant-caregiver dyad. A systematic method was used to extract articles from three databases of the medical, psychology and nursing fields. The quality of evidence collected was assessed using Oxford University Centre for Evidence Based Medicine's level of evidence and through a narrative review. The systematic search resulted in only nine original research studies, which met a priori inclusion/exclusion criteria. Several studies provide support for the conceptual model, but most were cross-sectional or lower quality prospective studies. The need for consistent definitions, improved measures and longitudinal work is discussed. In conclusion, this review reveals preliminary support for the proposed role of discordant responsiveness in infant/child overweight and at the same time highlights the need for rigorous investigation of responsive feeding interactions in the first years of life.

129 - Maternal overweight and obesity and infant feeding practices

129 - Maternal overweight and obesity and infant feeding practices

Effects of a low–glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial

The optimal diet for pregnancy that is complicated by excessive weight is unknown. We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women. We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet. Participants received carbohydrate-rich foods, fats, and snack foods through home delivery or study visits. The primary outcome was birth weight z score. Other endpoints included infant anthropometric measurements, gestational duration, maternal weight gain, and maternal metabolic parameters. There were no significant differences in birth weight z score or other measures of infant adiposity between groups. However, in the low-GL compared with the low-fat group, gestational duration was longer (mean ± SD: 39.3 ± 1.1 compared with 37.9 ± 3.1 wk; P = 0.05) and fewer deliveries occurred at ≤ 38.0 wk (13% compared with 48%, P = 0.02; with exclusion of planned cesarean deliveries: 5% compared with 53%; P = 0.002). Adjusted head circumference was greater in the low-GL group (35.0 ± 0.8 compared with 34.2 ± 1.3 cm, P = 0.01). Women in the low-GL group had smaller increases in triglycerides [median (interquartile range): 49 (19, 70) compared with 93 (34, 129) mg/dL; P = 0.03] and total cholesterol [13 (0, 36) compared with 33 (22, 56) mg/dL, P = 0.04] and a greater decrease in C-reactive protein [-2.5 (-5.5, -0.7) compared with -0.4 (-1.4, 1.5) mg/dL, P = 0.007]. A low-GL diet resulted in longer pregnancy duration, greater infant head circumference, and improved maternal cardiovascular risk factors. Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aimed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes. This trial is registered at clinicaltrials.gov as NCT00364403.