Risk Of Overweight In Children Research Articles

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.

The effect of antenatal factors and postnatal growth on serum adiponectin levels in children

Low levels of serum adiponectin (i.e. hypoadiponectinaemia) are a marker of cardiometabolic risk in overweight children. It is not clear whether early-life factors may play a role in the development of hypoadiponectinaemia. We investigated whether antenatal factors and postnatal growth are associated with childhood adiponectin levels. This was an observational study in a birth cohort (Vulnerable Windows Cohort Study). Anthropometry was measured at birth, at 6 weeks, every 3 months up to 2 years and then every 6 months. Fasting glucose, insulin, lipids and adiponectin were measured at a mean age 11.5 years. Data on 323 children were analysed with age- and sex-adjusted multivariate analyses. The sizes of mother, placenta, fetus and newborn were not significantly associated with adiponectin levels. Current weight, body mass index (BMI), fat mass, waist circumference, glucose, insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)], triglycerides and systolic blood pressure were inversely related to adiponectin (P < 0.05). Faster growth in BMI during late infancy and childhood was associated with lower adiponectin levels (P < 0.05). After adjusting for current waist circumference, faster growth in BMI during early infancy was positively associated with adiponectin (P < 0.01). Faster growth in BMI during childhood was inversely associated (P < 0.001). These associations were similar after adjusting for HOMA-IR. We concluded that antenatal factors are not determinants of childhood adiponectin levels. Faster growth in BMI during infancy is associated with higher levels, whereas faster rates during childhood are associated with hypoadiponectinaemia. Hypoadiponectinaemia is a marker of a more adverse cardiometabolic profile in Afro-Caribbean children.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity during childhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 months (two studies), 4 months (2 studies) or 20 weeks (one study) was associated with a higher BMI in childhood. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhood overweight.

Cesarean section and the risk of overweight in grade 6 children

We examined the relationship between cesarean section (C-section) and the risk of overweight and obesity in children in grade 6 (mean age, 11.92 years; standard deviation = 0.34). Data from phase I through phase III of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used. Children with complete data from 1991 through 2004 were included in this study (n = 917). Multiple logistic regression analyses were used to adjust for potential confounding and to evaluate the association of C-section and childhood overweight and obesity. Compared to children delivered vaginally, children delivered by C-section had approximately twice the likelihood of being overweight (odds ratio (OR) = 1.86, 95 % confidence interval (CI) = 1.27-2.73) or obese (OR = 1.87, 95 % CI = 1.19-2.95). However, when examined according to sex, males delivered by C-section had an increased risk for being overweight (OR = 1.78, 95 % CI = 1.01-3.12) and obese (OR = 2.58, 95 % CI = 1.36-4.88), while females had an increased risk only for being overweight (OR = 1.99, 95 % CI = 1.17-3.39). C-section was associated with an increased risk of overweight and obesity in children in grade 6, but the relationship differed according to gender. Further longitudinal studies are warranted to examine the long-term effect of delivery mode on the risk of childhood overweight.

Late pregnancy reversal from excessive gestational weight gain lowers risk of childhood overweight-A cohort study

Whether reversal to adequate gestational weight gain (GWG) in the third trimester reverses the risk for childhood overweight associated with excessive GWG is assessed. In a retrospective cohort study in 6,665 mother-child pairs, pre-pregnancy weight and the temporal course of GWG were collected from medical records. Overweight as defined by International Obesity Task Force was assessed at a mean age of 5.8 years. Main exposures were exceeding week-specific cut-off values for GWG in the third trimester or any previous trimester. Logistic regression models, adjusted for possible confounding factors, were used to predict the risk of childhood overweight from excessive GWG in the third trimester with stratification by excessive GWG in previous trimesters. In the final model, women who avoided excessive GWG in the third trimester had children with a 31% (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.59, 0.82) lower probability being overweight. A similar association was observed for reversing from excessive GWG in the first or second trimester to normal GWG in the third trimester: 27% (OR: 0.73, 95% CI: 0.53, 0.99). Avoidance of excessive GWG in the third trimester is associated with lower risk of childhood overweight even in case of excessive GWG in the first or second trimester.

Managing Cardiovascular Risk in Overweight Children and Adolescents

The scientific, medical, and lay communities are currently confronted with a serious medical and public health problem related to the marked non-remitting worldwide epidemic of obesity. This ever-increasing prevalence of obesity is accompanied by a host of inherently associated co-morbidities. As a result, obesity is fast becoming the major cause of premature death in the developed world. As pediatric and adult cardiologists, we have seen a dramatic increase in office referrals of overweight and obese children and adolescents, who already have obesity-related degenerative disease processes such as hypertension, dyslipidemia, the metabolic syndrome, and type 2 diabetes mellitus, as well as manifestations of early preclinical atherosclerotic cardiovascular disease, not previously observed in this age group. This article presents a review of the literature and recent scientific statements and recommendations issued by the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) regarding the metabolic abnormalities associated with obesity, including newer identification and treatment strategies for obesity, dyslipidemia, and early subclinical coronary artery disease seen in high-risk children and adolescents.

PP.31 Relationship Between Birth Weight and Nutritional Status in Preschool Children

BackgroundThe intrauterine period has been considered as a very sensitive period in which nutritional and/or hormones changes appear to play an essential role in the subsequent control of body weight.ObjectivesClassify...

Dietary glycaemic index and glycaemic load in relation to food and nutrient intake and indices of body fatness in British children and adolescents

The diversity of the associations of dietary glycaemic index (GI) and glycaemic load (GL) with dietary intake and body fatness observed in epidemiological studies may be partly due to the differences in underlying dietary intake patterns. We examined the cross-sectional associations of dietary GI and GL with food and nutrient intakes and indices of body fatness in 818 children aged 4-10 years and 818 adolescents aged 11-18 years in Britain, based on the data from the National Diet and Nutrition Survey. Dietary intake was assessed using a 7 d weighed dietary record. Overweight was defined as BMI ≥ 85th percentile of the age- and sex-specific British growth reference data. Central obesity was defined as waist:height ratio (WHtR) ≥ 0·5 (adolescents only). Breads, breakfast cereals and potatoes were the positive predictive food groups for dietary GI, while dairy products, fruit juice, other cereals and fruit were the negative predictors. Dietary GL was closely correlated with carbohydrate intake. Dietary GI showed no associations with overweight or central obesity. Conversely, dietary GL showed an independent association with a higher risk of overweight in children and a higher risk of central obesity (but not overweight) in adolescents. However, dietary GI and GL were not associated with BMI z-score in children and adolescents or WHtR in adolescents. In conclusion, the present study showed that dietary GL was independently associated with overweight in children and with central obesity in adolescents. Nevertheless, given no associations when body fatness measures were treated as continuous variables, the results must be interpreted cautiously.

Abstract P289: Cesarean Section is Associated with Increased Risk for Overweight and Obesity in Grade Six Children

Introduction— Few studies have investigated the relationship between delivery mode in the U.S. and the risk of overweight and obesity in the offspring. The findings from these studies have not been consistent. Hypothesis— We assessed the hypothesis that children born by cesarean section (C-section) compared with those born vaginally were at an increased risk of overweight and obesity in grade six. Methods— Data were obtained from Phase I to Phase IV of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Subjects with complete data through stage 3 (from year 1991 to 2005), when the children were in grade six, were included in this study (n=917). Multiple logistic regression was used to adjust for potential confounding by the maternal factors of age, education, poverty status, living status, depression, breastfeeding, and smoking status during pregnancy and the child factors of sex, race, birth weight, physical activity, total TV time, and video/computer game time. The association between C-section and childhood overweight and obesity was evaluated. Results— In grade six, 41.4% (77 of 186) of children delivered by C-section were overweight compared with 32.2% (235 of 731) of children born vaginally while 24.7% (46 of 186) of children delivered by C-section were obese compared with 17.0% (124 of 731) of children born vaginally (both p&lt;0.05). After adjustment for potential confounders, children delivered by C-section compared to vaginal delivery had about twice the risk of being overweight (OR=1.85, 95% CI=1.26-2.71) or obese ((OR=1.87, 95% CI=1.19-2.94). However, after examining the association separately by sex, males delivered by C-section had an increased risk only for being obese (OR=2.56, 95% CI=1.35-4.85) while females delivered by C-section had an increased risk only for being overweight (OR=1.99, 95% CI=1.16-3.40). It was also found that lower maternal education and higher child birth weight were both associated with increased risk of overweight and obesity in sixth grade children. Conclusions— In conclusion, C-section was associated with an increased risk of overweight and obesity in children in grade six, and the relationship varied by sex. Additional longitudinal studies are warranted to examine the long-term effects of delivery mode on the risk of childhood overweight and obesity.

Caesarean delivery, caesarean delivery on maternal request and childhood overweight: a Chinese birth cohort study of 181 380 children

What is already known about this subject Both rates of caesarean section and childhood overweight have been steadily increasing over the past decade in many parts of the world. Caesarean delivery on maternal request contributes remarkably to the rising trend of caesarean births. A few small-scale studies suggest that caesarean section may be associated with later overweight and obesity, whereas little is known about the impact of caesarean delivery on maternal request. What this study adds Caesarean section is associated with an increased risk of childhood overweight. Children born by caesarean delivery on maternal request are also more likely to be overweight. The strength of the caesarean-overweight association is modest. To assess the impact of caesarean delivery including non-medically indicated maternal request caesarean delivery on childhood overweight. We conducted a prospective investigation of a Chinese birth cohort involving 181 380 children, who were born during 1993-1996 to mothers registered in a perinatal care surveillance system and whose weight and height were measured in 2000. Information on delivery mode and covariates was obtained from the surveillance system. Overweight was defined according to the International Obesity Task Force body mass index (BMI) cutoffs. Multivariable logistic regression was used to estimate adjusted odds ratios. Stratified analyses were done to test whether the association between caesarean section and overweight persisted across subgroups. The adjusted odds ratio of overweight for children born by caesarean compared with vaginal delivery was 1.13 [95% confidence interval {CI}: 1.08, 1.18]. The association persisted in subgroups stratified by gender, maternal education, maternal BMI, weight gain during pregnancy and child birthweight (all P values for interaction test ≥0.30). The adjusted odds ratio of overweight for children born by non-medically indicated caesarean delivery compared with vaginal delivery was 1.18 (95% CI: 1.00, 1.41). Caesarean delivery including non-medically indicated maternal request caesarean delivery compared with vaginal delivery modestly increases childhood overweight risk.

Parental Psychological Distress During Pregnancy and Early Growth in Preschool Children: The Generation R Study

This study separately assessed the associations of maternal and paternal psychological distress during pregnancy with early growth in preschool children. The study was based on data from a population-based cohort study involving 5,283 children and their parents (with data collected beginning in early pregnancy) in Rotterdam, the Netherlands, from 2002 to 2006. Information on parental psychological distress (symptoms of depression, anxiety, hostility, and family stress) was obtained by questionnaire in the second trimester of gestation by using the Brief Symptom Inventory and the "general functioning" subscale of the McMaster Family Assessment Device. Child height, weight, and body mass index (weight (kg)/height (m)(2)) were measured repeatedly from age 3 months to age 4 years. We observed no consistent associations between overall maternal psychological symptoms, depression, anxiety, or hostility and child height, weight, or body mass index after adjustment for confounders. All maternal psychological distress scores were positively associated with the risk of overweight in childhood; however, these associations attenuated toward the null and became nonsignificant after adjusting for potential confounders. We did not observe consistent associations between paternal psychological distress and growth in childhood. These results indicate that social, behavioral, or environmental factors that cluster with parental psychological distress may explain the previously suggested associations between maternal psychological distress and early childhood growth and risk of overweight.

Breastfeeding and food pattern in overweight children in the Caribbean

Background: As in most countries around the globe, overweight and obesity are a major threat to public health on the Caribbean island of Aruba. Increasing evidence confirms that breastfeeding protects against overweight and obesity. However, little is known about the mechanism underlying the association between breastfeeding and obesity. One possibility is that breastfed infants are better able to control their meal size and intervals than formula-fed infants. This might lead to a healthier diet in later life and protect against overweight and obesity.Objective: To determine the relationship between breastfeeding, food pattern and being overweight in the Caribbean.Methods: In a cross-sectional school-based study in 2004–2005, weight and height were measured by two research assistants in 1776 children aged 6–11 years on Aruba, an island in the Caribbean. BMI was defined according to guidelines by the International Obesity Task Force. Parents completed a questionnaire pertaining to breastfeeding and dietary food pattern.Results: 1451/1776 (81·7%) children were breastfed; 851/1766 (47·9%) children were breastfed for <4 months, 227/1776 (12·8%) for 4–6 months and 373/1776 (21·0%) for ≧6 months. Children who were breastfed for ≧4 months had lower odds (OR 0·32, 95%CI 0·25–0·40) of being overweight including obesity than those who either were not breastfed or who were breastfed for <4 months. Children who were breastfed for ≧4 months were more likely to have a structured food pattern of six eating moments a day (OR 7·43, 95% CI 5·87–9·39, P<0·001) and to have breakfast every day (OR 2·86, 95% CI 2·17–3·78, P<0·001) than those who were not or who were breastfed for <4 months.Conclusions: Breastfeeding for ≧4 months is associated with a structured food pattern (six eating moments a day including a daily breakfast) and carries a strikingly lower risk of overweight in children. Promoting prolonged breastfeeding together with a focus on a subsequent structured food pattern could be a cheap method of preventing overweight.

Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study

Defining prenatal modifiable risk factors of childhood overweight and obesity has become critical as the need of primary preventive strategies increases. To investigate the interrelationship between inadequate or excessive gestational weight gain (GWG), according to maternal prepregnancy body mass index (BMI)-specific Institute of Medicine (IOM) recommendations, and childhood overweight and abdominal adiposity. In a retrospective cohort study in Germany, data of 6837 mother-child dyads were obtained from medical records, a questionnaire and by anthropometric measurements of children at school entry. Main exposure was GWG as categorized by the 2009 IOM guidelines and as a continuous variable. Outcome measures were children's overweight and abdominal adiposity defined as ≥ 90 th age- and sex-specific percentiles for BMI and waist circumference, respectively. During pregnancy, more than half of mothers (53.6%) had gained weight excessively. Among the children (mean age: 5.8 years), 10.5% were overweight and 15.1% had abdominal adiposity. A nonlinear relationship between absolute GWG and the risk of offspring overweight and abdominal adiposity was observed. An increased risk of childhood overweight was related to excessive compared with recommended GWG, after adjustment for potential confounders (odds ratio (OR): 1.57, 95% confidence interval (CI): 1.30, 1.91), but not to inadequate GWG. Similar results were obtained for the risk of childhood abdominal adiposity by excessive GWG (OR: 1.39, 95% CI: 1.19, 1.63); there was no association with inadequate GWG. Analyses stratified by maternal prepregnancy BMI category did not suggest effect modification. Exceeding the recommended BMI-specific IOM GWG ranges has an adverse impact on the risk of childhood overweight and abdominal adiposity, whereas suboptimal GWG conveys no benefit or risk, reflecting a nonlinear relationship between absolute GWG and the risk of childhood overweight and adiposity. Strategies focussing on the awareness and prevention of excessive GWG and its consequences are justified.

Exercise for Overweight Children and Diabetes Risk—Reply

In Reply: Dr. Short inquires about the rationale for the intervention duration; whether fatness was adjusted; and the effects of pubertal development in our trial of exercise on diabetes risk in overweight children. It was important that the stimulus be strong enough to affect outcomes; therefore we elicited vigorous (7.5 MET) physical activity frequently (every day after school) for about 3 months, modeled after prior effective interventions.1, 2 It was necessary to repeat the testing and intervention with additional children each semester for several years to power the study; this limited the intervention’s duration. We agree with Short that the intervention could be feasible in other settings, and that the time course of improvements was beyond the study’s scope. A briefer intervention period would probably result in improved insulin resistance,3 but would result in less fat loss due to lower cumulative energy expenditure. Given the similar effects of 20 min and 40 min of daily exercise, a longer program might result in greater loss of fat with similar effects on fitness and diabetes risk. Given the longer time course of exercise-induced changes in adiposity than insulin resistance, improved insulin resistance is unlikely to be due to reduced fatness. As specified in the article, neither BMI nor percent body fat were adjusted. Children were randomized to the exercise programs or control condition, and differential effects on outcomes should be attributed to this factor. The children’s fatness was reduced because of the exercise programs offered to those groups. Mediation analysis can suggest how those changes may have occurred, based on contemporaneous, collinear data with varying precision. Mediation analyses on these data will be reported in a subsequent publication. As expected, puberty (i.e., thelarche/gonadarche stage) was a predictor in the insulin resistance models (insulin area under the curve, P < .001; fasting insulin, P < .001; Matsuda index, P = .002). The adrenarche variable was not significant in any model. We now report the interaction of thelarche/gonadarche stage (classified as Tanner I, II, or III and above) with the group by time interaction in the insulin resistance models, adjusting for cohort, sex, and race. An interaction was detected only for fasting insulin, such that differential change from baseline to post-test between exercise groups and control was detected only in stage III or above. In more developed children, similar decreases in fasting insulin were seen in the low-dose (adjusted mean difference, −18.2 [95% CI, −25.8 to −10.6] µU/mL) and high-dose (−15.8 [95% CI, −23.0 to −8.5] µU/mL) exercise groups (each P < .001 vs the control group). Thus, more developed children might be more responsive to exercise. However, of 3 insulin resistance indicators, only 1 showed evidence of pubertal moderation. These exploratory analyses provide scant support for the hypothesis that pubertal stage affects the benefits of aerobic training in obese children. Conclusions should be tempered by the exploratory nature of these additional analyses.

Oxidative Stress and Cardiovascular Risk in Overweight Children in an Exercise Intervention Program

This study aimed to determine whether oxidative stress was related to cardiovascular risk indices in children, and whether an exercise intervention would reduce oxidative stress. A randomized trial of two different doses of exercise and a no-exercise control group included 112 overweight and obese children, 7-11 years old. Plasma isoprostane levels were obtained at baseline and after the intervention. Cross-sectional analysis of oxidative stress and metabolic markers at baseline was performed. The effect of the exercise training on oxidative stress was tested. Lower isoprostane levels were observed in blacks. At baseline, isoprostane was positively related to measures of fatness (BMI, waist circumference, percent body fat), insulin resistance and β-cell function (fasting insulin, insulin area under the curve, Matsuda index, disposition index, oral disposition index), and several lipid markers (low-density lipoprotein, triglycerides, total cholesterol), and inversely with fitness [peak oxygen consumption (VO(2))], independent of race, sex, and cohort. No relation was found with visceral fat, blood pressure, or glycemia. Independent of percent body fat, isoprostane predicted triglycerides, β=0.23, total cholesterol-to-high-density lipoprotein (TC/HDL) ratio, β=0.23, and insulin resistance (insulin area under the curve, β=0.24, Matsuda index, β=-0.21, oral disposition index, β=0.33). Exercise did not reduce oxidative stress levels, despite reduced fatness and improved fitness in these children. Isoprostane levels were related to several markers of cardiovascular risk at baseline; however, despite reduced fatness and improved fitness, no effect of exercise was observed on isoprostane levels. To our knowledge, this is the first report in children to demonstrate a correlation of oxidative stress with disposition index, fitness, and TC/HDL ratio, the first to test the effect on oxidative stress of an exercise intervention that reduced body fat, and the first such exercise intervention study to include a substantial proportion of black children.

Parental anthropometrics, early growth and the risk of overweight in pre‐school children: the Generation R Study

There are limited data regarding the associations of both maternal and paternal anthropometrics with longitudinally measured post-natal growth measures in early childhood. To assess the associations of maternal and paternal anthropometrics with growth characteristics and the risk of overweight in pre-school children. Population-based prospective cohort study from early foetal life onwards in the Netherlands. Maternal pre-pregnancy anthropometrics and gestational weight gain, and paternal anthropometrics were related to foetal and post-natal growth measures and the risk of overweight until the age of 4 years. Analyses were based on 5674 mothers, fathers and their children. Both pre-pregnancy maternal and paternal height, weight and body mass index were associated with corresponding foetal and post-natal anthropometric measures. Maternal body mass index had a significantly stronger effect on childhood body mass index than paternal body mass index. As compared to children from parents with normal body mass index, children from two obese parents had an increased risk of overweight at the age of 4 years (odds ratio 6.52 (95% confidence interval 3.44, 12.38). Maternal gestational weight gain was only among mothers with normal body mass index associated with body mass index and the risk of overweight in the children. Maternal and paternal anthropometrics affect early growth in pre-school children differently. Gestational weight gain in mothers without overweight and obesity is related to the risk of overweight in early childhood.

Frequency of family meals and childhood overweight: a systematic review

Energy balance is influenced by understudied genetic, social and other environmental factors. The frequency of family meals (FFM) may be one of these factors since it is associated with a healthier dietary pattern in children and adolescents. The objective of this review is to evaluate the scientific evidence on the association between FFM and the risk of childhood and adolescent overweight. The electronic literature search identified 394 articles published during 2005-2012. Of these, 15 studies gave precise information of the studied association, of which four were longitudinal. We found great variability regarding the measurement of FFM. Six out of 11 cross-sectional studies and 1 out of 4 longitudinal studies found statistically significant inverse associations between FFM and being overweight, mainly in children, with odds ratios ranging from 0.11 to 0.93. Of those, only one adjusted for all the potential confounding factors considering socio-demographic, physical activity- and diet-related variables. Therefore, this review found inconsistent and weak evidence of an inverse association between FFM and risk of childhood overweight. In conclusion, further research is needed to establish whether family meals have an effect on childhood overweight. These studies ideally should have longitudinal or experimental designs, a clear and standardized definition of the exposure under study, a measure of the exposure based on direct observation or validated questionnaires and an adequate adjustment for potential confounders.

No association between childcare and obesity at age 4 in low‐income Latino children

Previous studies have found an association between early entry to childcare and risk for overweight and obesity at 3 years of age. These studies, however, have been conducted primarily with higher income White populations or have found increased risk in the children of educated mothers. To assess the relationship between timing of entry to childcare and duration of childcare and pediatric overweight and obesity in a high risk population. Using data from a longitudinal cohort of low-income Latino children in San Francisco, we evaluated the association between time of entry to childcare, hours in childcare, and risk for overweight and obesity at age 4. Similarly, we evaluated the relationship between these same childcare parameters and body mass index Z score and risk of having a waist circumference (WC) percentile ≥90th at 4 years of age. In contrast with previous studies, we found no association between being in childcare at 4 years of age or number of hours per week in childcare and risk for childhood overweight, obesity or WC ≥90th percentile at age 4. Additionally, we found no association between age of entry to childcare (≤6 months or ≤12 months of age) with risk for overweight or obesity at age 4. Future studies need to further evaluate the differential impact of childcare on early childhood obesity in relation to race/ethnicity and lower socioeconomic status. Low-income children may not be at increased risk for obesity in relation to early childcare exposure.

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.

The impact of maternal prenatal smoking on the development of childhood overweight in school‐aged children

Maternal smoking during pregnancy likely increase the risk of childhood overweight. Childhood overweight is influenced by socioeconomic characteristics of mothers. Characteristics of child at birth determine the likelihood of overweight. Children of mothers who smoked 1 year before birth (including pregnancy) were likely to be overweight during school ages than those of mothers who never smoked. Confirmation that socioeconomic characteristics of mothers influence the likelihood of childhood overweight during school age. Smoking cessation should be targeted at mothers 1 year before birth to improve their health status and that of offspring. To examine associations between maternal smoking and overweight among school-aged children and also identify mothers and offspring characteristics that affect children's weight. We used data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCY). Childhood overweight was defined as having Body Mass Index (BMI) of 85th percentile or above. Smoking patterns among mothers were assessed by questioning smoking behaviour 1 year before birth of the target child: never or ever smoking. Standardized procedures were used to measure height and weight. Descriptive statistics and generalized estimating equations (GEE) were used for the analysis. Descriptive results showed that children of mothers who smoked anytime within 1 year before birth were more likely to be overweight and have higher BMI percentile averages. GEE results showed that children of mothers who were ever smokers 1 year before birth were more likely to be overweight (OR = 1.39, 95% CI: 1.01, 1.94) and have higher BMI percentile averages (β = 4.46, P = 0.036) from grades 1 through 6 than those of mothers who were never smokers. Additionally, the level of mother's education and birth weight were significantly associated with childhood overweight. Confirmed relationships between maternal smoking and overweight among school-aged children have important implications for public health policy because this evidence can be used to enhance smoking cessation 1 year before birth to improve the health status of mothers and offspring.