Risk Factors For Childhood Overweight Research Articles

Roles of Birth Mode and Infant Gut Microbiota in Intergenerational Transmission of Overweight and Obesity From Mother to Offspring

ImportanceMaternal overweight, which often results in cesarean delivery, is a strong risk factor for child overweight. Little is known about the joint contribution of birth mode and microbiota in the infant gut to the association between maternal prepregnancy overweight and child overweight.ObjectiveTo investigate the association of birth mode with microbiota in the infant gut, and whether this mediates the association between maternal and child overweight.Design, Setting, and ParticipantsAn observational study was conducted of 935 full-term infants born between January 1, 2009, and December 31, 2012, in the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort. Maternal prepregnancy body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared using height and weight data taken from medical records or maternal report. Infant gut microbiota were profiled with 16S ribosomal RNA sequencing in fecal samples collected at a mean (SD) age of 3.7 (1.0) months. At ages 1 and 3 years, BMI z scores adjusted for age and sex were generated according to World Health Organization criteria. Statistical analysis was conducted from January 29 to June 15, 2017.ExposuresMothers of normal weight (BMI, 18.5-24.9) and overweight or obese (BMI, ≥25.0) mothers.Main Outcome and MeasuresRisk of overweight and obesity (>97th percentile BMI z scores) among children at ages 1 and 3 years.ResultsOf the 935 mother-infant pairs in the study (mean [SD] age, 32.5 [4.5] years) 382 (40.9%) were overweight, 69 of 926 infants (7.5%) were overweight at age 1 year, and 90 of 866 infants (10.4%) were overweight at age 3 years. Compared with being born vaginally to a mother of normal weight, infants born vaginally to overweight or obese mothers were 3 times more likely to become overweight at age 1 year (adjusted odds ratio [OR], 3.33; 95% CI, 1.49-7.41), while cesarean-delivered infants of overweight mothers had a 5-fold risk of overweight at age 1 year (adjusted OR, 5.02; 95% CI, 2.04-12.38). Similar risks were also observed at age 3 years. Multiple mediator path modeling revealed that birth mode and infant gut microbiota (Firmicutes species richness, especially of the Lachnospiraceae family) sequentially mediated the association between maternal prepregnancy overweight and childhood overweight at ages 1 and 3 years. Bacterial genera belonging to the Lachnospiraceae family were more abundant in infants of overweight mothers; however, the participating genera of Lachnospiraceae differed between infants delivered vaginally and those delivered via cesarean birth.Conclusions and RelevanceThis study found evidence of a novel sequential mediator pathway involving birth mode and Firmicutes species richness (especially higher abundance of Lachnospiraceae) for the intergenerational transmission of overweight.

Investigating Caesarean Section Birth as a Risk Factor for Childhood Overweight.

Caesarean section birth may be associated with overweight in childhood; however, findings to date have been inconsistent. This study explored the association of caesarean section vs. vaginal birth with childhood overweight in Vietnam. This longitudinal cohort study explored the association of delivery mode with overweight, obesity, and overweight/or obesity at 8 years of age in children (n = 1937) across 20 sites in Vietnam, using Young Lives longitudinal cohort study data. Categories were defined using BMI z-scores in relationship to the World Health Organization (WHO) reference median: overweight >1 and <2 standard deviations (SD) above WHO reference median, obese >2 SD, and overweight/or obese >1 SD. Individual questionnaire data collected sociodemographic information and pregnancy/birth information through face-to-face interviews with mothers/caregivers. Anthropometric measurements for mother and child were collected at baseline and at 8 years for children. Adjusted multivariable logistic models revealed a twofold increase in odds at age 8 years of overweight [odds ratio (OR) = 1.8, 95% confidence interval (95% CI) 1.03-3.2, p = 0.039], obese (OR = 2.2, 95% CI 1.2-4.0, p = 0.014), or overweight/or obese (OR = 2.1, 95% CI 1.3-3.3, p = 0.002) for children born through caesarean section compared with vaginal birth. Children born through planned caesarean section (adjusted OR = 2.3, 95% CI 1.2-4.1, p < 0.001) and unplanned caesarean section (adjusted OR = 1.9, 95% CI 1.1-3.5, p = 0.03) had similar increased odds of overweight/or obesity compared with children born through vaginal birth. These findings suggest that there may be an association between caesarean section and childhood overweight even after adjustment for confounders. Further research is needed to explore the underlying mechanisms of this finding.

Prenatal risk factors influencing childhood BMI and overweight independent of birth weight and infancy BMI: a path analysis within the Danish National Birth Cohort.

Prenatal risk factors for childhood overweight may operate indirectly through development in body size in early life and/or directly independent hereof. We quantified the effects of maternal and paternal body mass index (BMI), maternal age, socioeconomic position (SEP), parity, gestational weight gain, maternal smoking during pregnancy, caesarean section, birth weight, and BMI at 5 and 12 months on BMI and overweight at 7 and 11 years. Family triads with information on maternal, paternal and child BMI at ages 7 (n=29 374) and 11 years (n=18 044) were selected from the Danish National Birth Cohort. Information originated from maternal interviews and medical health examinations. Path analysis was used to estimate the direct and indirect effects of prenatal risk factors on childhood BMI z-scores (BMIz per unit score of the risk factor). Logistic regression was used to examine associations with overweight. The strongest direct effects on BMIz at age 7 were found for maternal and paternal BMI (0.19 BMIz and 0.14 BMIz per parental BMIz), low SEP (0.08 BMIz), maternal smoking (0.12 BMIz) and higher BMIz at 5 and 12 months (up to 0.19 BMIz per infant BMIz). For BMIz at age 11 with BMIz at age 7 included in the model, similar effects were found, but the direct effects of BMIz at age 5 and 12 months were mediated through BMI at age 7 (0.62 BMIz per BMIz). Same results were found for overweight. The sum of the direct effects can be translated to approximate absolute measures: 2.4 kg at 7 years, 5.7 kg at 11 years, in a child with average height and BMI. Parental BMI, low SEP and smoking during pregnancy have persisting, strong and direct effects on child BMI and overweight independent of birth weight and infancy BMI.

Assessing the longitudinal relationship between Peruvian children’s TV exposure and unhealthy food consumption

Studies have shown that heavy television exposure is a risk factor for childhood overweight and obesity. This relationship is most typically attributed to the influence of food advertising. Despite this growing array of studies, one limitation is that these studies have focused almost exclusively on high-income countries. It is unclear whether such findings hold true in low- or middle-income countries. To address this gap, this study investigated the relationship between television exposure and unhealthy snack consumption (a risk factor for childhood overweight/obesity) in a sample of Peruvian children aged 6–13 (n = 265). Results indicate that television exposure is indeed cross-sectionally and longitudinally related with unhealthy snack consumption. But for children from high socioeconomic status families, this relationship is even more pronounced. These findings justify efforts to help parents manage their children’s television viewing as well as efforts to regulate food advertising in Peru.

Parent-related mechanisms underlying the social gradient of childhood overweight and obesity: a systematic review.

Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts. A systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects. Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors. High parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors. Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.

Which Amount of BMI-SDS Reduction Is Necessary to Improve Cardiovascular Risk Factors in Overweight Children?

Knowing the changes of cardiovascular risk factors (CRFs) in relation to weight loss would be helpful to advise overweight children and their parents and to decide whether drugs should be prescribed in addition to lifestyle intervention. The objective of the study was to determine the body mass index (BMI)-SD score (SDS) reduction to improve CRFs in overweight children. This was a prospective observation study. The study was conducted at a specialized outpatient obesity clinic. A total of 1388 overweight children (mean BMI 27.9 ± 0.1 kg/m(2), mean age 11.4 ± 0.1 y, 43.8% male, 45.5% prepubertal) participated in the study. The study included a 1-year lifestyle intervention. We studied changes of blood pressure (BP), fasting high-density lipoprotein- and low-density lipoprotein-cholesterol, triglycerides, glucose, and homeostasis model assessment (HOMA) of insulin resistance index. Change of weight status was determined by δBMI-SDS based on the recommended percentiles of the International Task Force of Obesity. BMI-SDS change was associated with a significant improvement of all CRFs except fasting glucose and low-density lipoprotein-cholesterol after adjusting for multiple confounders such as baseline CRFs, age, gender, BMI, pubertal stage, and its changes. BMI-SDS reduction of 0.25-0.5 was related to a decrease of systolic blood pressure (BP) (-3.2 ± 1.4 mm Hg), diastolic BP (-2.2 ± 1.1 mm Hg), triglycerides (-6.9 ± 5.8 mg/dL), HOMA (-0.5 ± 0.3), and triglyceride/high-density lipoprotein)-cholesterol (-0.3 ± 0.2), whereas high-density lipoprotein (HDL)-cholesterol increased (+1.3 ± 1.2 mg/dL). A reduction of greater than 0.5 BMI-SDS led to more pronounced improvement (systolic BP -6.0± 1.3 mm Hg, diastolic BP -5.1 ± 1.3 mm Hg, triglycerides -16.4 ± 7.1 mg/dL, HDL-cholesterol +1.6 ± 1.5 mg/dL, HOMA -0.9 ± 0.3). Per 0.1 BMI-SDS reduction in systolic BP (-1.0 mm Hg), diastolic BP (-0.8 mm Hg), triglycerides (-2.3 mg/dL), HOMA (-0.2), and triglyceride/HDL-cholesterol (-0.5) decreased significantly, whereas HDL-cholesterol (0.2 mg/dL) increased significantly in linear regression analyses and accounted for multiple confounders. A BMI-SDS reduction of 0.25 or greater significantly improved hypertension, hypertriglyceridemia, and low HDL-cholesterol, whereas a BMI-SDS greater than 0.5 doubled the effect.

Dietary intervention in obese dams protects male offspring from WAT induction of TRPV4, adiposity, and hyperinsulinemia.

One major risk factor for childhood overweight is maternal obesity. The underlying molecular mechanisms are ill-defined, and effective prevention strategies are missing. Diet-induced obese mouse dams were changed to standard chow during pregnancy and lactation as an intervention against predisposition for obesity and metabolic sequelea in the offspring. Expression of adipokines and TRPV4, a regulator of adipose oxidative metabolism, inflammation, and energy homeostasis, in offspring's white adipose tissue (WAT) was assessed. Pathological effects on offspring's body weight, fat content, and serum insulin were fully reversed in intervention offspring on postnatal day 21. In WAT, a sixfold increase of Trpv4 mRNA expression in offspring consuming high-fat-containing diet was found, which was completely blunted in the intervention group. Simultaneously, WAT adipokine, interleukin-6, and peroxisome proliferator-activated receptor-γ mRNA and UCP1 protein expression were largely returned to control levels in intervention offspring. Improvement of maternal nutrition offers a powerful strategy to improve offspring's metabolic health. Targeting TRPV4-linked aspects of WAT metabolic function during early development might be a promising approach to prevent long-term adverse metabolic effects of maternal high-fat nutrition.

Passive Smoke Exposure and Its Effects on Cognition, Sleep, and Health Outcomes in Overweight and Obese Children.

Passive smoke exposure (PSE) may be a risk factor for childhood overweight and obesity and is associated with worse neurocognitive development, cognition, and sleep in children. The purpose of the study is to examine the effects of PSE on adiposity, cognition, and sleep in overweight and obese children using an objective measure of PSE. Overweight or obese children (n = 222) aged 7-11 (9.4 ± 1.1 years; 58% black; 58% female; 85% obese) were recruited from schools near Augusta, Georgia, over the course of the school year from 2003-2006 for a clinical trial, with data analyzed in 2009-2010. Passive smoke exposure was measured with plasma cotinine. Health, cognitive, and sleep measures and parent report of smoke exposure were obtained. Overweight and obese children with PSE had greater overall and central adiposity than nonexposed overweight and obese children (p < 0.03). However, PSE was unrelated to prediabetes, insulin resistance, or visceral fat. PSE was linked to poorer cognitive scores (p < 0.04) independent of adiposity, but was not related to sleep-disordered breathing. PSE is associated with fatness and poorer cognition in children. Tailored interventions that target multiple health risk factors including nutrition, physical activity, and tobacco use in children and families are needed to prevent adverse health outcomes related to tobacco use and obesity.

Daytime sleep duration and the development of childhood overweight: the KOALA Birth Cohort Study

Reduced nighttime sleep is a risk factor for childhood overweight, but the association between daytime sleep and overweight is unknown. The aim of this study is to evaluate daytime sleep duration as an independent risk factor for childhood overweight. Data from the KOALA Birth Cohort Study on daytime and nighttime sleep at 2 years (N = 2322), and body mass index (BMI) around 2, 5, 6, 7, 8 and 9 years were used. Multivariable general estimating equation regression analyses were performed to examine the associations of sleep duration with BMI (linear) and overweight (logistic). No associations between daytime sleep and BMI or overweight were found, whereas longer nighttime sleep was associated with lower BMI and lower risk of overweight persisting up to age 9. Daytime sleep duration is probably less relevant for prevention of childhood overweight.

A double-blind, placebo-controlled randomized trial to evaluate the efficacy of docosahexaenoic acid supplementation on hepatic fat and associated cardiovascular risk factors in overweight children with nonalcoholic fatty liver disease

Background and AimsVery little information is available on whether docosahexaenoic acid (DHA) supplementation has a beneficial effect on liver fat and cardiovascular disease (CVD) risk factors in children with nonalcoholic fatty liver disease (NAFLD). In a double-blind, placebo-controlled randomized trial we investigated whether 6-month treatment with DHA improves hepatic fat and other fat depots, and their associated CVD risk factors in children with biopsy-proven NAFLD. Methods and ResultsOf 58 randomized children, 51 (25 DHA, 26 placebo) completed the study. The main outcome was the change in hepatic fat fraction as estimated by magnetic resonance imaging. Secondary outcomes were changes in visceral adipose tissue (VAT), epicardial adipose tissue (EAT), and left ventricular (LV) function, as well as alanine aminotransferase (ALT), triglycerides, body mass index-standard deviation score (BMI-SDS), and insulin sensitivity. At 6 months, the liver fat was reduced by 53.4% (95% CI, 33.4–73.4) in the DHA group, as compared with 22.6% (6.2–39.0) in the placebo group (P = 0.040 for the comparison between the two groups). Likewise, in the DHA group VAT and EAT were reduced by 7.8% (0–18.3) and 14.2% (0–28.2%), as compared with 2.2% (0–8.1) and 1.7% (0–6.8%) in the placebo group, respectively (P = 0.01 for both comparisons). There were no significant between-group changes for LV function as well as BMI-SDS and ALT, while fasting insulin and triglycerides significantly decreased in the DHA-treated children (P = 0.028 and P = 0.041, respectively). ConclusionsDHA supplementation decreases liver and visceral fat, and ameliorates metabolic abnormalities in children with NAFLD.

Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood.

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non‐behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non‐behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self‐reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research.

Infant nutrition – diet between 6 and 24 months, implications for paediatric growth, overweight and obesity

AbstractInfants are growing rapidly from 6–24 months and have high nutrient needs in proportion to their body size. This sub‐group of the population are prone to dietary imbalances and inadequacies. It is of vital importance to get nutrition right during this time period to support appropriate growth and development.Overweight and obesity rates are increasing in pre‐school children, and maternal nutritional status and early life feeding have been identified as ‘critical windows’ for obesity risk. After the recommended period of exclusive breastfeeding, an increasingly diversified selection of foods are offered to infants and young children, and milk becomes less dominant in the diet.Rapid weight gain during infancy is the strongest risk factor for childhood overweight and obesity, and this may be modifiable with early intervention. During the complementary feeding period, there is an increase in protein intake, which is in excess of requirements, and may be associated with adverse outcomes regarding later body mass index and body fatness. Guidelines for healthcare professionals have been developed to raise the issue of overfeeding during infancy, and to manage overweight if it arises.Dietary intake measures show a deteriorating quality of diet as infants move from the first 12 months of life into the second year, with potential excesses of protein, energy, saturated fatty acids, salt and non‐milk extrinsic sugars. Formula manufacturers can reduce the protein content of formulas for infants and young children in order to support appropriate growth, whilst supplements, fortified foods and milks can supply ‘at risk’ micronutrients.

Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity.

Evidence about effective interventions that reduce obesity risk during infancy is needed. A systematic review of Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for childhood overweight and obesity was undertaken to inform a guideline for UK health visitors. The National Institute for Health and Clinical Excellence (NICE) guidelines were followed. The findings were used to develop a guideline which was reviewed internally by a multi-professional Guideline Development Group (GDG) and externally by national experts and practitioners. We identified 35 RCTs reporting behavioural and non-behavioural interventions delivered antenatally and/or during infancy that included infant weight outcomes (e.g. weight-for-length, weight-for-age, weight-for-BMI) or outcomes related to obesity risk (breastfeeding, physical activity, timing of weaning). A number of on-going trials were identified. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline, which is freely available on the UK Institute for Health Visiting website. There was equivocal evidence that infants fed lower protein (compared to higher protein) formula milk gained less weight, and this was not incorporated into the guideline. Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to inform obesity prevention strategies in the first year of life.

Pregnancy and post-delivery maternal weight changes and overweight in preschool children

ObjectivesHigh maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight. MethodsSample: 4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4–5years old. Exposures: gestational weight gain (GWG) and post-delivery maternal weight change (PDWC). Outcome: child overweight (body mass index (BMI) ≥85th percentile). ResultsAdjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers. ConclusionsIncreased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.

Evaluating the effect of energy dense foods on children’s weight status using a cross-lagged panel design

C Durao, A Oliveira, P Moreira, M Severo, A Guerra, H Barros, C Lopes Institute of Public Health, University of Porto, Porto, Portugal Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal Faculty of Nutrition Sciences, University of Porto, Portugal Department of Pediatrics, University of Porto Medical School, Porto, Portugal Contact: kdurao@netcabo.pt Background Energy dense foods (EDF) have been suggested as risk factors for childhood overweight, but evidence to clarify their importance and longitudinal research are still warranted. Our objective was to study the temporal associations between consumption of EDF and weight status in children from 2 to 4 years of age. Methods The present study involved 453 children evaluated at 2 and 4 years of age, enrolled in the Portuguese birth cohort – Generation XXI. Socio-demographic characteristics of children and mothers were evaluated in face-to-face interviews. Children’s weight status was assessed through BMI z-scores according to the WHO Child Growth Standards. Consumption of EDF (snacks, soft drinks, sweets and cakes) was assessed by Food Frequency Questionnaire. Linear regression and structural equation models with cross-lagged design were used to estimate the temporal associations between consumption of EDF and BMI z-scores. Results After adjustment for maternal preconception BMI and education, frequency of consumption of EDF at 4 years was significantly predicted by frequency of consumption of these foods at 2 years ( = 0.707, p < 0.001), and children’s BMI zscores at 4 years were predicted by their BMI z-scores at 2 years ( = 0.737, p < 0.001). In the cross-sectional analysis, consumption of EDF at 2 years was significantly associated with BMI z-scores at the same age ( = 0.163, p = 0.014) but, after adjustment, the association was on the threshold of statistical significance ( = 0.129, p = 0.054). At 4 years, consumption of EDF was not significantly associated with current BMI ( = 0.009, p = 0.800). Regarding the cross-lagged effect of EDF consumption at 2 years on BMI at 4 years, after adjustment for maternal characteristics and BMI z-score at 2 years, no significant association was observed ( = -0.017, p = 0.752), as well as between BMI z-scores at 2 years and EDF consumption at 4 years ( = 0.027, p = 0.659). Conclusions Consumption of EDF at 2 years was associated with later consumption of these foods. The effect of consumption on BMI at 4 years seems to be indirect, related with the association between consumption and BMI at 2 years of age. Key messages Dietary habits acquired early in life track into later ages. Therefore, early dietary modifications may prevent posterior inadequate dietary habits such as the high consumption of EDF. In addition to other environmental factors, intervention programs focused at overweight prevention may have to include a special focus on EDF since early ages.

Risk factors for childhood overweight: a 30-month longitudinal study of 3- to 6-year-old children.

The increasing prevalence of childhood overweight is an important health issue. There is a need for longitudinal research among children in order to identify risk factors for childhood overweight. The objective of the present research was to identify potential sociodemographic and behavioural risk factors for development of childhood overweight among 3- to 6-year-old children. Longitudinal study. Sixteen pre-primary and primary schools. BMI Z-scores at baseline and two follow-up measurements were calculated for 568 children. Sociodemographic, parental adiposity, familial composition, child's diet, physical activity and sedentary behavioural data were collected through questionnaires. Several risk factors for the development of childhood overweight were found. Being an only child, lower maternal educational level, maternal and paternal overweight, more than 1 h screen time on weekdays and high soft drinks consumption were shown to be positively associated with the development of childhood overweight. Although behavioural factors are important, our findings support the thesis that interventions on the prevention of childhood overweight should focus on high-risk groups, i.e. children from low socio-economic background or with high parental BMI. Interventions should address the whole family and take into account their lifestyle and structure.

The relationship between family and child weight status by household structure in South Korea: 2007–2010

Objective:Parental obesity has been identified as a predominant risk factor for childhood overweight and obesity. We investigated the relationship between parent and child obesity in South Korea, particularly linked with varying family structures.Subjects and methods:Data for households with children aged 2–18 years were taken from the pooled data of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2010 conducted by the Korea Centers for Disease Control and Prevention (KCDC). The sample consisted of 17 453 individuals (7879 children and 9574 adults) from 5048 households with children for this study. Children's overweight and obesity prevalence was compared using both International Obesity Taskforce (IOTF) and KCDC cutoff points according to parental weight status and household structure. Logistic regression analysis was used.Results:Significantly greater odds of overweight and obesity existed among children living with both parents (odds ratio (OR)=3.5, 95% confidence interval (CI): 2.71, 4.65) or one parent (mother: OR=1.6, 95% CI: 1.22, 2.12; father: OR=1.7, 95% CI: 1.37, 1.99). The adjusted ORs for overweight and obesity among children living with overweight mother only or overweight grandparent only were approximately double that of children living with normal-weight mother (OR=2.2, 95% CI: 1.22–3.82) or normal-weight grandparent (OR=2.1, 95% CI: 1.06–4.05).Conclusion:Children living with overweight parent(s) or grandparent(s) were positively correlated with the risk for childhood overweight and obesity. Socioeconomic status did not affect the observed relationships in this population, whereas the role of genetic, dietary and activity patterns requires further exploration.

Risk factors associated with overweight and obesity among urban school children and adolescents in Bangladesh: a case–control study

BackgroundChildhood obesity has become an emerging urban health problem in urban cities in Bangladesh, particularly in affluent families. Risk factors for obesity in this context have not been explored yet. The objective of this study was to identify the risk factors associated with overweight and obesity among school children and adolescents in Dhaka, Bangladesh.MethodsFrom October through November 2007, we conducted a case–control study among children aged 10–15 years in seven schools in Dhaka. We assessed body mass index (weight in kg/height in sq. meter) to identify the cases (overweight/obese) and controls (healthy/normal weight) following the Centers for Disease Control and Prevention age and sex specific growth chart. We used a structured questionnaire to collect demographic information and respondent’s exposure to several risk factors such as daily physical activity at home and in school, hours spent on computer games and television watching, maternal education level and parents’ weight and height.ResultsWe enrolled 198 children: 99 cases, 99 controls. Multiple logistic regression analysis revealed that having at least one overweight parent (OR = 2.8, p = 0.001) and engaging in sedentary activities for >4 hours a day (OR = 2.0, p = 0.02) were independent risk factors for childhood overweight and/or obesity while exercising ≥ 30 minutes a day at home was a protective factor (OR = 0.4, p = 0.02). There were no significant associations between childhood overweight and sex, maternal education or physical activity at school.ConclusionHaving overweight parents along with limited exercise and high levels of sedentary activities lead to obesity among school children in urban cities in Bangladesh. Public health programs are needed to increase awareness on risk factors for overweight and obesity among children and adolescents in order to reduce the future burden of obesity-associated chronic diseases.

Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta‐analysis

Gestational weight gain is a modifiable risk factor for childhood overweight. Exceeding the recommended gestational weight gain increases the risk for childhood overweight by about 30%. Interventions to avoid excessive weight gain are needed. Overweight and obesity in children are thought to be related to prenatal priming. Gestational weight gain (GWG) might be a potential modifiable risk factor for childhood overweight. To quantify the associations of inadequate and excessive GWG with childhood overweight. The electronic literature search in six databases was complemented by a hand search for relevant articles. Papers were selected and quality was assessed. The effect estimates of the individual studies were pooled using a random-effects model. The literature search yielded 1492 results in total, of which seven observational studies met the inclusion criteria. The studies had medium to good quality. The pooled estimate for the association between excessive GWG and childhood overweight yielded an odds ratio (OR) of 1.38 (95% confidence interval [CI]: 1.21-1.57). The association between inadequate GWG and childhood overweight yielded an OR of 0.91 (95% CI: 0.85-0.98). These data provide evidence for at least a 21% risk for childhood overweight related to excessive GWG. Therefore, further efforts to design appropriate interventions against excessive GWG may appear warranted.

Caregiver perceptions of child nutritional status in Magallanes, Chile

We aimed to identify risk factors for childhood overweight and obesity and the accuracy of caregivers'€™ perceptions of their child's nutritional status in the Magallanes region, Patagonia, Chile. Heights and weights of children attending day care centers and elementary schools were collected and caregivers completed questionnaires regarding their child's health and behavior. The child's nutritional status was diagnosed using the 2006 WHO Child Growth Standards (for children under age 6) and the CDC 2000 Growth Charts (for children age 6 and older). Logistic regression was used to evaluate factors related to childhood overweight/obesity and weight underestimation by caregivers of overweight or obese children. Of the 795 children included in the study, 247 (31.1%) were overweight and 223 (28.1%) were obese. Risk factors for overweight/obesity included younger age and being perceived to eat more than normal by the caregiver. Caregivers were less likely to underestimate their child's weight if the child was older or if the caregiver believed the child ate more than a normal amount. There is a high prevalence of overweight and obesity among children in Magallanes and the majority of caregivers underestimate the extent of the problem in their children.