Risk Factors For Childhood Overweight Research Articles

Environmental Factors Associated with Overweight and Obesity in Taiwanese Children

We explored the relationship among sociodemographic, behavioural, household environmental and perinatal factors, and risks of childhood overweight and obesity in Taiwan. A total of 7930 children aged 9 to 14 years were recruited from 14 randomly selected Taiwanese communities in 2007 and 2010. Height and weight were measured using standard protocols during school visits. Questionnaires that contained children's family information, birth conditions, exercise habits and household environmental factors were answered by the parents. Associations between risk factors and childhood overweight and obesity were estimated through odds ratio and 95% confidence interval from mixed models. In this cohort, 32.3% of the children were overweight and 17.5% were obese. Male gender, high birthweight, exposure to in utero maternal smoking and current exposure to household environmental tobacco smoke (stronger effect of maternal than paternal smoking) were positively associated with childhood overweight/obesity. In contrast, higher parental education level, number of siblings, active exercise habits and taking vitamins were associated with reduced risks of childhood obesity. Birthweight revealed a J-shaped relationship with the probability of childhood overweight/obesity. This study uncovers several modifiable risk factors for childhood overweight and obesity, and parents are encouraged to provide an anti-obesity environment such as quitting smoking, controlling birthweight of child during pregnancy and building up exercise habits.

Rapid neonatal weight gain increases risk of childhood overweight in offspring of diabetic mothers

Increased neonatal weight gain has been suggested as risk factor for later overweight. Offspring of diabetic mothers (ODM) have a long-term increased overweight risk. However, the role of early postnatal weight gain for later overweight has not been addressed so far in ODM. We investigated whether increased weight gain during the first 4 months is related to later overweight in ODM. Determinants of childhood overweight and neonatal weight gain were analyzed in 152 ODM from the Kaulsdorf Cohort Study by MANOVA and regression analyses. Independent of birth weight, weight gain during the first 4 months was positively related to childhood relative body weight (P=0.001). Each 100 g-increase in weight during this period increased overweight risk by 65% (95%CI: 10-247%). ODM with rapid early weight gain had a more than six-fold increased risk of later overweight (OR: 6.77; 95%CI: 1.36-33.6). Early neonatal intake of breast milk from metabolically healthy mothers protected from rapid early weight gain (P=0.03). Increased weight gain during the first 4 months of life is a strong, independent risk factor for childhood overweight in ODM. Preventing nutritionally-induced rapid early weight gain in ODM might be a promising strategy to lower their long-term overweight risk.

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...

Genetic Markers of Obesity Risk: Stronger Associations with Body Composition in Overweight Compared to Normal-Weight Children

BackgroundGenetic factors are important determinants of overweight. We examined whether there are differential effect sizes depending on children's body composition.MethodsWe analysed data of n = 4,837 children recorded in the Avon Longitudinal Study of Parents and Children (ALSPAC), applying quantile regression with sex- and age-specific standard deviation scores (SDS) of body mass index (BMI) or with body fat mass index and fat-free mass index at 9 years as outcome variables and an “obesity-risk-allele score” based on eight genetic variants known to be associated with childhood BMI as the explanatory variable.ResultsThe quantile regression coefficients increased with increasing child's BMI-SDS and fat mass index percentiles, indicating larger effects of the genetic factors at higher percentiles. While the associations with BMI-SDS were of similar size in medium and high BMI quantiles (40th percentile and above), effect sizes with fat mass index increased over the whole fat mass index distribution. For example, the fat mass index of a normal-weight (50th percentile) child was increased by 0.13 kg/m2 (95% confidence interval (CI): 0.09, 0.16) per additional allele, compared to 0.24 kg/m2 per allele (95% CI: 0.15, 0.32) in children at the 90th percentile. The genetic associations with fat-free mass index were weaker and the quantile regression effects less pronounced than those on fat mass index.ConclusionsGenetic risk factors for childhood overweight appear to have greater effects on fatter children. Interaction of known genetic factors with environmental or unknown genetic factors might provide a potential explanation of these findings.

Risk Factors for Obesity: Further Evidence for Stronger Effects on Overweight Children and Adolescents Compared to Normal-Weight Subjects

BackgroundWe recently showed that in preschoolers risk factors for overweight show stronger associations with BMI in children with high BMI values. However, it is unclear whether these findings might also pertain to adolescents.MethodsWe extracted data on 3–10 year-old (n = 7,237) and 11–17 year-old (n = 5,986) children from a representative cross-sectional German health survey (KiGGS) conducted between 2003 and 2006 and calculated quantile regression models for each age group. We used z-scores of children's body mass index (BMI) as outcome variable and maternal BMI, maternal smoking in pregnancy, low parental socioeconomic status, exclusive formula-feeding and high TV viewing time as explanatory variables.ResultsIn both age groups, the estimated effects of all risk factors except formula-feeding on BMI z-score were greatest for children with the highest BMI z-score. The median BMI z-score of 11–17 year-old children with high TV viewing time, for example, was 0.11 [95% CI: 0.03, 0.19] units higher than the median BMI z-score of teenage children with low TV viewing time. This risk factor was associated with an average difference of 0.18 [0.06, 0.30] units at the 90th percentile of BMI z-score and of 0.20 [0.07, 0.33] units at the 97th percentile.ConclusionsWe confirmed that risk factors for childhood overweight are associated with greater shifts in the upper parts of the children's BMI distribution than in the middle and lower parts. These findings pertain also to teenagers and might possibly help to explain the secular shift in the upper BMI percentiles in children and adolescents.

Prevention Potential of Risk Factors for Childhood Overweight

Background: In order to better target prevention initiatives for the obesity epidemic in Canada, policy-makers, in addition to information about risk factors, require an understanding of the preventive potential which is best provided by the risk factor’s population attributable risk fraction (PARF). Objective: To estimate the PARF for childhood overweight risk factors as identified by a population-based study of elementary schoolchildren in Nova Scotia. Methods: Population-based survey data of Grade 5 students who participated in the 2003 Children’s Lifestyle and School Performance Study in Nova Scotia, Canada, were linked to a provincial perinatal registry. PARFs were calculated from a parsimonious multilevel logistic regression model. Results: Physical activity, sedentary activity, maternal smoking during pregnancy, and maternal pre-pregnancy weight were considered potentially preventable. Sedentary activity (as estimated from time spent viewing TV, computers and video games or “screen time”) and maternal pre-pregnancy weight appeared to offer the greatest potential for prevention. In total, approximately 40% of overweight in childhood could potentially be prevented. Conclusion: Excess screen time and maternal pre-pregnancy weight offer the greatest potential for prevention of childhood overweight at 11 years of age. Key words: Obesity; child; prevention; population attributable risk; public health; physical activity; nutrition

Maternal Postpartum Distress and Childhood Overweight

ObjectiveWe investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight.MethodsWe performed a prospective cohort study, including 21 121 mother-child-dyads from the Danish National Birth Cohort (DNBC). Maternal distress was measured 6 months postpartum by 9 items covering anxiety, depression and stress. Outcome was childhood overweight at 7-years-of age. Multiple logistic regression analyses were performed and information on maternal age, socioeconomic status, pre-pregnancy BMI, gestational weight gain, parity, smoking during pregnancy, paternal BMI, birth weight, gestational age at birth, sex, breastfeeding and finally infant weight at 5 and 12 month were included in the analyses.ResultsWe found, that postpartum distress was not associated with childhood risk of overweight, OR 1.00, 95%CI [0.98–1.02]. Neither was anxiety, depression, or stress exposure, separately. There were no significant differences between the genders. Adjustment for potential confounders did not alter the results.ConclusionMaternal postpartum distress is apparently not an independent risk factor for childhood overweight at 7-years-of-age. However, we can confirm previous findings of perinatal determinants as high maternal pre-pregnancy BMI, and smoking during pregnancy being risk factors for childhood overweight.

Risk factors for childhood overweight: shift of the mean body mass index and shift of the upper percentiles: results from a cross-sectional study

The worldwide increasing prevalence of childhood overweight seems to be due to an increasing proportion of extremely high body mass index (BMI) values rather than to a shift of the entire BMI distribution. These findings might be attributed to incremental exposure to risk factors particularly affecting overweight children. To assess the possible differences in associations of several risk factors by subgroups of children's BMI distribution. We applied quantile regression to cross-sectional data on 9698 German preschoolers (5-6 years) collected in 1999 and 2002. Sex- and age-specific BMI standard deviation scores (BMI-SDSs) were used as the outcome variable, and maternal BMI, maternal smoking during pregnancy, exclusive formula feeding, child's weight gain from birth to 2 years of life and low parental education as explanatory variables. All risk factors except formula feeding contributed to a positive shift in mean BMI-SDS. The estimated effects of all risk factors on BMI-SDS were greatest for children with the highest BMI-SDS value. For example, high television (TV) viewing (>2 h day(-1)) had an effect of 0.46 (95% confidence interval (CI): 0.46, 0.46) SDS units on overweight children (90th percentile), but only a 0.22 (95% CI: 0.11, 0.33) SDS effect on normal-weight children (50th percentile). For well-known risk factors of childhood overweight, stronger associations in children with higher BMI values were observed. These findings might possibly help to explain the secular shift in the upper BMI percentiles in children.

Diet, Screen Time, Physical Activity, and Childhood Overweight in the General Population and in High Risk Subgroups: Prospective Analyses in the PIAMA Birth Cohort

Objective. To prospectively identify behavioral risk factors for childhood overweight and to assess their relevance in high risk sub groups (children of mothers with overweight or low education). Methods. In the PIAMA birth cohort (n = 3963), questionnaire data were obtained at ages 5 and 7 on “screen time”, walking or cycling to school, playing outside, sports club membership, fast food consumption, snack consumption and soft drink consumption. Weight and height were measured at age 8 years. Results. Screen time, but none of the other hypothesized behavioral factors, was associated with overweight (aOR 1.4 (CI: 1.2–1.6)). The adjusted population attributable risk fraction for screen time > 1 hr/day was 10% in the high risk and 17% in the low risk sub groups. Conclusion. Reduction of screen time to < 1 hr/day could result in a reduction of overweight prevalence in the order of 2 percentage points in both high and low risks sub groups.

Risk Factors for Childhood Overweight in Offspring of Type 1 Diabetic Women With Adequate Glycemic Control During Pregnancy

OBJECTIVEPregnancy in type 1 diabetic women remains a high-risk situation for both mother and child. In this study, we investigated long-term effects on body composition, prevalence of overweight, and insulin resistance in children of type 1 diabetic women who had had adequate glycemic control during pregnancy (mean A1C 6.2%), and we related their outcome to perinatal factors, including macrosomia (birth weight >90th percentile).RESEARCH DESIGN AND METHODSAnthropometric measurements were performed at 6–8 years of age in 213 offspring of type 1 diabetic mothers who participated in a previous nationwide study. Homeostasis model assessment of insulin resistance (HOMA-IR) was determined from a fasting blood sample in 155 of these children. In addition, we studied BMI standard deviation score (SDS) growth trajectories. Results were compared with national reference data.RESULTSThe prevalence of overweight in the study population was not different from that in the reference population. However, children who were born macrosomic showed twice as much overweight as nonmacrosomic children. Macrosomia and maternal overweight were independent predictors of childhood overweight. Overweight children showed an increase in BMI SDS starting already after 6 months of age and had a significantly increased HOMA-IR.CONCLUSIONSIn type 1 diabetic women with adequate glycemic control during pregnancy, long-term effects on body composition and overweight in their offspring at school age are limited and related mainly to macrosomia at birth. Possible targets for prevention of childhood overweight are fetal macrosomia, maternal overweight, and an increase in BMI SDS during the first years of life.

Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children

To determine whether an exercise intervention using an active video game (Dance Dance Revolution [DDR]) is effective in improving endothelial dysfunction (EDF) and other risk factors in overweight children. Thirty-five children (Body mass index > or = 85(th) percentile, mean age 10.21+/-1.67 years, 17 females) with EDF were assessed for flow-mediated dilation (FMD), lipids, insulin, glucose, NO(2)+NO(3), asymmetric dimethylarginine, symmetric dimethylarginine, l-arginine, height, weight, aerobic fitness, and blood pressure. In a subsample, tumor necrosis factor alpha, interleukin-6, C-reactive protein, and adiponectin were also assessed. Subjects were randomly assigned to 12-weeks of aerobic exercise (EX) using DDR or to a non-exercising delayed-treatment control group (DTC). EX had significant improvements in FMD ( 5.56+/-5.04% compared with 0.263+/-4.54%, p=0.008), exercise time on the graded exercise test (53.59+/-91.54 compared with -12.83+/-68.10 seconds, p=0.025), mean arterial pressure (MAP) (-5.62+/-7.03 compared with -1.44+/-2.16 mmHg, p=0.05), weight (0.91+/-1.53 compared with 2.43+/-1.80 kg, p=0.017) and peak VO(2) (2.38+/-3.91 compared with -1.23+/-3.18 mg/kg/min, p=0.005) compared with the DTC. Thirteen EX subjects achieved normal EDF while ten did not. These groups differed at baseline with regard to total cholesterol (TC) and low-density lipoprotein (LDL). Twelve weeks of DDR-use improved FMD, aerobic fitness, and MAP in overweight children. Improvements occurred without changes in inflammatory markers or nitric oxide production. The results document the need to explore relationships between obesity, endothelial function, inflammation, lipids, exercise intensity, and gender in a larger sample of overweight children.

Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children

Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children

Is High-Altitude Environment a Risk Factor for Childhood Overweight and Obesity in Saudi Arabia?

To describe the prevalence of childhood overweight and obesity in rural high- and low-altitude populations of southwestern Saudi Arabia and to identify specific at-risk groups within these populations. A cross-sectional study was conducted on 912 school children and adolescents aged 6-15 years born and living permanently at high altitudes (2800-3150 m) and 972 children and adolescents of comparable ages born and living permanently at low altitudes (< or =500 m). Height and weight were measured. For children <10 years, the weight-to-height index according to World Health Organization (WHO) standards was used for assessing overweight and obesity. For adolescents 10-15 years, overweight and obesity were assessed by age and gender-specific percentiles for body mass index based on the WHO/National Centre for Health Statistics reference population. A questionnaire was used for measuring parents' socioeconomic status. The overall prevalence of overweight and obesity at high and low altitudes was 10%. The study showed that some school children and adolescents were at a significantly higher risk of developing overweight and obesity. Significant risk factors included moderate-to-high parental income, age > or =10 years, high-altitude birth and residence, and female sex (crude odds ratio 3.2 [95% CI, 1.8- 5.5], 2.3 [95% CI, 1.6-3.2], 2.1 [95% CI, 1.5-2.9], and 1.9 [95% CI, 1.4-2.6], respectively). A multivariate analysis using the direct binary logistic regression model revealed that moderate-to-high parental income, age > or =10 years, female sex, and high-altitude birth and residence were significant independent predictors of childhood overweight and obesity. (adjusted OR 3.2 [95% CI, 1.6-2.6], 2.6 [95% CI, 1.8-3.8], 2.0 [95% CI, 1.6-2.9], and 1.8 [95% CI, 1.3-2.6]), respectively. The present study identified risk factors for childhood overweight and obesity in Saudi Arabia. Among these, high altitude was a significant and independent factor. Future research is warranted to evaluate the exact mechanism by which a high-altitude environment may contribute to childhood overweight and obesity.

Breastfeeding duration and childhood overweight among low-income children in Kansas, 1998-2002.

We sought to determine whether increased duration of breast-feeding was associated with decreased risk of overweight among 4-year-old children in Kansas families with limited means. We linked data on Kansas families from the Pediatric Nutrition Surveillance System and Pregnancy Nutrition Surveillance System, 1998 to 2002, to determine breastfeeding duration and weight status at age 4 years. Overweight among 4-year-old children was defined as body mass index-for-age at the 95th percentile and above. Linked analysis included 3692 children. Logistic regression was applied to determine odds of being overweight at each duration of breastfeeding. Breastfeeding duration considered independently showed a significant protective association with childhood overweight at age 4 years for all non-Hispanics (odds ratio [OR]=0.72; 95% confidence interval [CI]=0.55, 0.94) and for Whites only (OR=0.68; CI=0.50, 0.92). When we controlled for other significant risk factors for childhood overweight, the association diminished and was not statistically significant. Although breastfeeding for longer duration appeared to be protective against overweight among 4-year-old non-Hispanic children, cultural and environmental factors may override this protective benefit.

Adipokines in Human Milk and Risk of Overweight in Early Childhood

Multiple studies have suggested that breast-feeding can prevent obesity, but the evidence remains inconclusive. The concentrations of specific constituents of human milk, such as adipokines, may play a role in this relationship, and these have rarely been considered. We assessed the role of adiponectin and leptin in human milk in childhood overweight. Between November 2000 and November 2001 all women delivering at the Department of Gynecology and Obstetrics at the University of Ulm, Germany were invited to participate in the study together with their healthy newborns. Milk samples were collected 6 weeks postpartum. Adiponectin and leptin levels were determined by commercially available ELISA. Active follow-up was performed at age 12 and 24 months. Of the 674 breast-fed children, 56 (8%) were overweight at the age of 2 years. Median adiponectin and leptin levels in milk were 10.9 ng/mL and 174.5 pg/mL, respectively. Adjusted odds ratio for overweight at the age of 2 was 1.6 (95% confidence interval = 1.0-2.6) per unit increase of log adiponectin and 1.1 (0.8-1.5) per unit increase of log leptin. Among children who were breast-fed for at least 6 months, adjusted odds ratios were 2.1 (1.1-4.2) per unit increase of log adiponectin, and 1.1 (0.7-1.6) per unit increase of log leptin. High levels of adiponectin in maternal milk may be a risk factor for childhood overweight.

Adjusted population attributable fractions and preventable potential of risk factors for childhood obesity

A number of individual risk factors for childhood obesity have been identified, but only some of these are amenable to prevention. To assess the amount of cases in a general population attributable to these risk factors, adjusted population-attributable fractions were estimated. Cross-sectional study. Obligatory school entry examination in 2001/2002 in six Bavarian communities (Germany). 5472 children at age 5-6 years. Anthropometric measures were ascertained by public health nurses, and measures concerning sociodemographics, lifestyle and child behaviour such as child's daily meal frequency were obtained with self-administered parental questionnaires. Obesity was defined according to sex- and age-specific body mass index cut-off points proposed by the International Obesity Task Force. Adjusted population-attributable fractions were calculated based on logistic regression. A combination of the risk factors low meal frequency, decreased physical activity, watching television >1 h day- 1, formula feeding and smoking in pregnancy accounted for 48.2% of obese children. This combination yielded a maximal achievable prevalence reduction of 1.5% for obesity (3.2% observed prevalence). A modification of five known risk factors for childhood overweight and obesity could reasonably lower obesity prevalences at school entry. These risk factors should be particularly considered in decision making on preventive measures.

Children with a TV in their bedroom at higher risk for being overweight

We examined having a TV in the bedroom as a risk factor for child overweight. Cross-sectional study. School- and telephone-based surveys in New Hampshire and Vermont between 2002 and 2004. Two thousand three hundred and forty-three children enrolled in public schools, aged 9-12 years, and one of their parents. The child having a TV in the bedroom. Age- and gender-standardized child body mass index (zBMI). Overweight was defined as equal to or above the 95th percentile for zBMI. Overall, 22.3% (N=523) of the children were overweight, and almost half of all children (48.2%, N=1130) had a TV in their bedroom. Children with a TV in their bedroom had a higher zBMI and were significantly more likely to be overweight compared to those without a TV in their bedroom (27.3 versus 17.7%, respectively; P<0.05). After controlling for sociodemographics, physical activity, frequency of TV or movie watching and internet use, children with a TV in their bedroom who watched at least one session of TV or movies per day were more likely to be overweight compared to those without a TV in their bedroom (odds ratio=1.32, 95% confidence interval: 1.03, 1.70). Having a TV in the bedroom is a risk factor for child overweight, independent of reported physical activity, participation in team sports, TV or movie watching time and internet use at home. Further study is needed to fully understand the mechanism by which having a TV in the bedroom increases children's risk for overweight.

Risk Factors for Childhood Overweight: A Prospective Study From Birth to 9.5 Years

Risk Factors for Childhood Overweight: A Prospective Study From Birth to 9.5 Years

Risk factors for childhood overweight

We review the 2004 literature on risk factors for childhood overweight. Given the steady increase in the prevalence of childhood overweight, the identification of risk factors is of increasing importance. A number of studies confirmed that parental overweight is the most potent risk factor for childhood overweight. Childhood temperament was found to mediate the effects of parental overweight with a difficult temperament increasing the risk of overweight. Newer findings implicate regular consumption of fast food and sweetened drinks as risk factors, as well as sedentary behavior; although a meta-analysis suggested that the effects of the latter factor are small. Other work was consistent with the finding that parental overcontrol of children's feeding behavior, particularly for those at high risk of developing overweight, may lead to overweight. Identification of groups of children at high risk for becoming overweight offers the potential for early intervention to reduce the intergenerational transfer of obesity. This is an area for future research because the nature of effective intervention is at present unclear. There is a suggestion that focused behavior change efforts on one target such as reducing the intake of sweetened beverages may be more successful than attempts to make broader dietary changes. There is also evidence that targeting parental behaviors may be more effective than interventions directed solely toward children, suggesting that modification of the environment that a child is exposed to during early development may have a lasting effect.

Prevalence of and risk factors for childhood overweight and obesity.

Increases in childhood overweight and obesity have become an important public health problem in industrialized nations. Preventive public health action is required, but more research of risk factors is required before evidence-based initiatives can be developed and targeted effectively. We investigated the association between childhood overweight and obesity and risk factors relating to dietary habits, activities, parents and schools. In 2003 we surveyed grade 5 students and their parents and school principals in Nova Scotia. We measured height and weight and assessed dietary habits (using Harvard's Youth/Adolescent Food Frequency Questionnaire), physical and sedentary activities, and parental and school-based risk factors. We estimated neighbourhood income by averaging, per school, the postal-code level means of household income of residential addresses of children attending that school. We used multilevel logistic regression to evaluate the significance of these risk factors for overweight and obesity. On the basis of measurements taken of 4298 grade 5 students, we estimated the provincial prevalence of overweight to be 32.9% and of obesity to be 9.9%. Children who bought lunch at school were at increased risk of overweight (fully adjusted odds ratio [OR] 1.39, 95% confidence interval [CI] 1.16-1.67), whereas those who ate supper together with their family 3 or more times a week were at decreased risk (OR 0.68, 95% CI 0.52-0.88). Physical education classes 2 or more times a week at school were associated with a decreased risk of overweight (OR 0.61, 95% CI 0.43-0.87) and obesity (OR 0.54, 95% CI 0.33-0.88). Children in high-income neighbourhoods were half as likely to be obese as their peers living in low-income neighbourhoods (OR 0.50, 95% CI 0.36-0.70). Parents and schools provide important opportunities for public health initiatives for reducing childhood overweight and obesity. Children and schools in low-income neighbourhoods should receive priority in public health initiatives to reduce future socioeconomic inequalities in health.