Early Childhood Obesity Risk Research Articles

Umbilical miRNAs Stratify Risk of Early Childhood Obesity Among Offspring of Mothers with Pre-Pregnancy Overweight/Obesity

Umbilical miRNAs Stratify Risk of Early Childhood Obesity Among Offspring of Mothers with Pre-Pregnancy Overweight/Obesity

Novel Metabolic Subtypes in Pregnant Women and Risk of Early Childhood Obesity in Offspring

The in utero metabolic milieu is associated with offspring adiposity. Standard definitions of maternal obesity (according to prepregnancy body mass index [BMI]) and gestational diabetes (GDM) may not be adequate to capture subtle yet important differences in the intrauterine environment that could be involved in programming. To identify maternal metabolic subgroups during pregnancy and to examine associations of subgroup classification with adiposity traits in their children. This cohort study included mother-offspring pairs in the Healthy Start prebirth cohort (enrollment: 2010-2014) recruited from University of Colorado Hospital obstetrics clinics in Aurora, Colorado. Follow-up of women and children is ongoing. Data were analyzed from March to December 2022. Metabolic subtypes of pregnant women ascertained by applying k-means clustering on 7 biomarkers and 2 biomarker indices measured at approximately 17 gestational weeks: glucose, insulin, Homeostatic Model Assessment for Insulin Resistance, total cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, free fatty acids (FFA), HDL-C:triglycerides ratio, and tumor necrosis factor α. Offspring birthweight z score and neonatal fat mass percentage (FM%). In childhood at approximately 5 years of age, offspring BMI percentile, FM%, BMI in the 95th percentile or higher, and FM% in the 95th percentile or higher. A total of 1325 pregnant women (mean [SD] age, 27.8 [6.2 years]; 322 [24.3%] Hispanic, 207 non-Hispanic Black [15.6%], and 713 [53.8%] non-Hispanic White), and 727 offspring with anthropometric data measured in childhood (mean [SD] age 4.81 [0.72] years, 48% female) were included. We identified the following 5 maternal metabolic subgroups: reference (438 participants), high HDL-C (355 participants), dyslipidemic-high triglycerides (182 participants), dyslipidemic-high FFA (234 participants), and insulin resistant (IR)-hyperglycemic (116 participants). Compared with the reference subgroup, women in the IR-hyperglycemic and dyslipidemic-high FFA subgroups had offspring with 4.27% (95% CI, 1.94-6.59) and 1.96% (95% CI, 0.45-3.47) greater FM% during childhood, respectively. There was a higher risk of high FM% among offspring of the IR-hyperglycemic (relative risk, 8.7; 95% CI, 2.7-27.8) and dyslipidemic-high FFA (relative risk, 3.4; 95% CI, 1.0-11.3) subgroups; this risk was of greater magnitude compared with prepregnancy obesity alone, GDM alone, or both conditions. In this cohort study, an unsupervised clustering approach revealed distinct metabolic subgroups of pregnant women. These subgroups exhibited differences in risk of offspring adiposity in early childhood. Such approaches have the potential to refine understanding of the in utero metabolic milieu, with utility for capturing variation in sociocultural, anthropometric, and biochemical risk factors for offspring adiposity.

Risk of Childhood Obesity in Children With High Birth Weight in a Rural Cohort of Northern India

To compare the risk of early childhood obesity (BMI z-score of ³+2SD) among children of more than 7 years of age with a birth weight of more than 3500 g to a birth weight of 2500-2999 g. Retrospective birth cohort study among children of 7 to 10 years of age in 22 villages of Himachal Pradesh with not-exposed (birth weight: 2500 to 2999 g) and exposed (> 3500 g) group. A total of 379 and 377 participants were enrolled in not-exposed and exposed group, respectively. Adjusted relative risk (aRR) between exposed and high BMI (>+2SD) was 4.9 (95%CI: 1.3-17.5) adjusted for mean age, gender, mean years of schooling, consumption of butter, fruits, vegetables, and indoor playing. High birth weight (>3500 g) increases and normal birth weight decreases the risk of childhood obesity up to five times in rural India.

Maternal Polycystic Ovary Syndrome and the Risk of Early Childhood Obesity in Female Offspring: A Nationwide Population-Based Study.

To investigate the relationship between polycystic ovary syndrome (PCOS) in Korean women and childhood growth and obesity of their offspring. This longitudinal case-control study using the Korean National Health Insurance claims database and the National Health Screening Program for Infants and Children database included women who delivered singletons between January 2007 and December 2008. Offspring's body mass index (BMI) measurements taken between 42 and 80 months of age were compared according to a maternal history of PCOS. Among a total of 131,805 participants, 1,213 women had a history of PCOS and 130,592 women did not. Female offspring aged 66-80 months born to women with PCOS had significantly higher BMI than those born to women without PCOS; there was no significant difference in that of male offspring regardless of maternal PCOS. In the generalized estimating equation and multivariable logistic regression analyses, the female offspring born to women with PCOS had a significantly higher risk of obesity during the age of 42-54 and 66-80 months (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.09-2.21 and OR, 1.5; 95% CI, 1.05-2.15, respectively), than those born to women without PCOS, after adjusting for several confounding factors. Maternal PCOS is independently associated with an increased incidence of childhood obesity in female offspring among Korean women. Women with PCOS should consider the risk of early childhood obesity in their daughters, even if they maintain a healthy weight themselves.

Impact of maternal gestational weight gain in twin pregnancies on early childhood obesity risk: A longitudinal birth cohort study.

ObjectivesTo investigate the impact of gestational weight gain (GWG) on the body mass index-for-age z score (BAZ) and obesity risk among twin offspring.MethodsThis study included 263 women who were pregnant with twins and their offspring. Maternal GWG was measured in each trimester, and infant weight and length were measured at 6, 12, and 24 months.ResultsTotal GWG was positively correlated with offspring birthweight and BAZ at 6, 12 and 24 months [adjusted β 0.013 (95% CI: 0.008–0.019), 0.028 (95% CI: 0.005–0.050), 0.033 (95% CI: 0.010–0.056) and 0.025 (95% CI: 0.004–0.047), respectively]. Excessive total GWG was related to an increased relative risk (RR) of large for gestational age (LGA) and overweight at 6 and 12 months. Only the second trimester gestational weight gain rate (GWGR) was positively correlated with birthweight (adjusted β 0.380, 95% CI: 0.256–0.504), and RRs of 6.818 (95% CI: 1.568–29.642) and 2.852 (95% CI: 1.466–5.548) were found for LGA and overweight at 12 months, respectively.ConclusionsTotal GWG and the second trimester GWGR were correlated with BAZ and overweight/obesity risk in twin offspring; the impact was obvious in the first year of life and gradually disappeared over time.Clinical trial registrationChiCTR-OOC-16008203, Registered on 1 April 2016 at the Chinese Clinical Trial Registry.

How do Central American Parents in the United States View the Importance of and Obtain Information About Behaviors Associated with the Risk of Early Childhood Obesity?

Background: Data suggest that Latinx preschool-age children are at increased risk of obesity. The fastest-growing Latinx population in the United States originates from El Salvador, Guatemala, and Honduras, also known as the Northern Triangle countries. Purpose: To describe how Central American parents from the Northern Triangle countries perceive the importance of energy balance-related behaviors (EBRBs), their preferred sources to obtain information about EBRBs, and to assess whether these differ by parent's gender and country of the nativity. Methods: Cross-sectional survey. Results: Seventy-four parents with at least one child between 2 and 5 years of age participated in the study. More than half were immigrants from El Salvador, Guatemala, and Honduras and were classified as having low acculturation. Mothers perceived consuming >5 fruits and vegetables daily, limiting sugar-sweetened beverages consumption, and having <2 hours daily screen time as extremely important, whereas fathers perceived these behaviors as being less important. Although a higher proportion of foreign-born than US-born parents perceived most of the assessed EBRBs (4 out of 6) as extremely important, these differences were not significant. Parents reported multiple sources to obtain EBRB-related information. Direct person-to-person interactions were the most commonly preferred sources, with pediatricians being the top source (97.3%), followed by other parents (86.5%), and WIC professionals (74.3%). Pediatricians were the preferred source to obtain information about EBRBs, irrespective of parent's gender and country of the nativity. A higher proportion of US-born than foreign-born parents reported a preference to obtain EBRB-related information from other parents. Conclusions: Findings suggest the significance of understanding how Central American parents perceive the importance of EBRBs and the sources they would prefer to obtain information for their children's EBRBs. Study findings have implications for health education and obesity prevention interventions designed to reach and deliver key evidence-based child health information to Central American parents from the Northern Triangle countries in the United States.

Involvement of Non-Parental Caregivers in Obesity Prevention Interventions among 0-3-Year-Old Children: A Scoping Review.

Introduction: We examined the scope of literature including non-parental caregiver involvement in child obesity prevention interventions. Methods: We conducted a scoping review following the Arksey and O’Malley framework, including only studies reporting the effect of an intervention on growth, weight, or early childhood obesity risk among children ages 0 to three years, published between 2000 and 2021. Interventions that did not include non-parental caregivers (adults regularly involved in childcare other than parents) were excluded. Results: Of the 14 studies that met the inclusion criteria, all were published between 2013 and 2020, and most interventions (n = 9) were implemented in the United States. Eight of the 14 interventions purposefully included other non-parental caregivers: five included both parents and non-parental caregivers, and the remaining three included only non-parental caregivers. Most interventions (n = 9) showed no significant impact on anthropometric outcomes. All interventions found improvements in at least one behavioral outcome (e.g., food groups intake (n = 5), parental feeding practices (n = 3), and screen time (n = 2)). This review can inform future interventions that plan to involve non-parental caregivers, which may be beneficial in shaping early health behaviors and preventing obesity early in life.

Risk of Early Childhood Obesity in Offspring of Women with Preeclampsia: A Population-Based Study

Preeclampsia (PE) is a major disease of pregnancy, with various short- or long-term complications for both the mother and offspring. We focused on the body mass index (BMI) of offspring and compared the incidence of obesity during early childhood between PE- and non-PE-affected pregnancies. Women with singleton births (n = 1,697,432) were identified from the Korea National Health Insurance database. The outcomes of offspring at 30–80 months of age were analyzed. The effects of PE on BMI and the incidence of obesity in the offspring were compared. The incidence of low birth weight (LBW) offspring was higher in the PE group (n = 29,710) than that in the non-PE group (n = 1,533,916) (24.70% vs. 3.33%, p < 0.01). However, BMI was significantly higher in the PE-affected offspring than that in non-PE-affected offspring. After adjusting for various factors, the risk of obesity was higher in the PE-affected offspring (odds ratio = 1.34, 95% confidence interval = 1.30–1.38). The BMI and incidence of obesity were higher during early childhood in the PE-affected offspring, even though the proportion of LBW was higher. These results may support the basic hypotheses for the occurrence of various cardiovascular and metabolic complications in PE-affected offspring. In addition, early-age incidence of obesity could influence PE management and child consultation in clinical applications.

The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials

BackgroundThe impact of maternal obesity extends beyond birth, being independently associated with an increased risk of child obesity. Current evidence demonstrates that women provided with a dietary intervention during pregnancy improve their dietary quality and have a modest reduction in gestational weight gain. However, the effect of this on longer-term childhood obesity-related outcomes is unknown.MethodsWe conducted an individual participant data meta-analysis from RCTs in which women with a singleton, live gestation between 10+0 and 20+0 weeks and body mass index (BMI) ≥ 25 kg/m2 in early pregnancy were randomised to a diet and/or lifestyle intervention or continued standard antenatal care and in which longer-term maternal and child follow-up at 3–5 years of age had been undertaken. The primary childhood outcome was BMI z-score above the 90th percentile. Secondary childhood outcomes included skinfold thickness measurements and body circumferences, fat-free mass, dietary and physical activity patterns, blood pressure, and neurodevelopment.ResultsSeven primary trials where follow-up of participants occurred were identified by a systematic literature search within the International Weight Management in Pregnancy (i-WIP) Collaborative Group collaboration, with six providing individual participant data. No additional studies were identified after a systematic literature search. A total of 2529 children and 2383 women contributed data. Approximately 30% of all child participants had a BMI z-score above the 90th percentile, with no significant difference between the intervention and control groups (aRR 0.97; 95% CI 0.87, 1.08; p=0.610). There were no statistically significant differences identified for any of the secondary outcome measures.ConclusionsIn overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions.Trial registrationPROSPERO, CRD42016047165

Fathers and Child Health Behaviors: Assessing Father Engagement, Early Childhood Diet, and Screen Time in a National Sample of US Children

The impact of father-child engagement on early childhood obesity risk has not been thoroughly investigated. In response to this gap, relationships between father-child engagement at age 2 years and multiple obesity risk factors at preschool were estimated in 4,500 families belonging to the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B). Early childhood obesity risk factors were prevalent in this US national sample, including weekly fast-food consumption (76%), excess juice (73%) and sugar-sweetened beverage (31%) use, and screen time above national recommendations (26%). Multivariable regression models revealed a mix of positive, negative, and null impacts of father engagement on pre-school obesity risk factors. Father engagement through both caregiving and play decreased juice consumption (Adjusted Relative Risk [aRR] = 0.87; 95% CI: 0.83, 0.98 and aRR = 0.82; 95% CI: 0.79, 0.91, respectively). On the other hand, father engagement in caregiving increased the risk of excess screen time (aRR = 1.06; 95% CI: 1.02, 1.12) and father engagement in play predicted lower fresh fruit consumption (aRR = 1.06; 95% CI: 1.01, 1.23). Finally, engagement through father-child shared breakfast decreased the risk of excess screen time (aRR = 0.95; 95% CI: 0.93, 0.98). These findings suggest that father-child engagement has both positive and negative impacts on early childhood obesity risk factors. The findings from this study, like prior ones, also reflect how underdeveloped this line of research is and how strong the need is for additional works that will provide us with actionable evidence on which to base policy.

When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity

• Children with obesity face increased biopsychosocial risks during COVID-19. • Stress exacerbates inflammation and immune response in obesity and COVID-19. • The COVID-19 pandemic has significantly interrupted children's daily routines. • The health effects of the obesogenic environment are exacerbated by COVID-19. • Access to timely, comprehensive healthcare is critical during COVID-19.

A Practical Screening Tool to Predict Early Childhood Obesity Risk: Examining a Birth Cohort.

Children obese at the age of 5 years are at greater risk of lifelong obesity. Because certain risks of obesity can be identified in early infancy, a tool for obesity risk prediction in early life would be clinically useful. We investigated predictors of obesity risk in a novel, prospectively collected healthy birth cohort recruited for demographic risks to develop iron deficiency at 1 year, a cohort leveraged because risk factors for iron deficiency and obesity overlap. Obesity at the age of 5 years was defined as age- and sex-specific body mass index Z-score (zBMI) >2SD. For each child, obesity risk factors were summed. Of 10 total risk factors, the following 4 key risks were identified: maternal obesity, maternal diabetes, large for gestational age, or breastfeeding <6 months. Childhood obesity was predicted by either ≥3 total number of risks (P < .033), any key risk (P < .002), or summing key risks (P < .0001). In clinical practice, summing early life risk factors may be a useful strategy for preemptive counseling.

Maternal Gestational Diabetes and Early Childhood Obesity: A Retrospective Cohort Study.

Background: Recently, childhood obesity has become one of the most serious public health problems in the world. Gestational diabetes mellitus (GDM) is considered a risk factor for childhood overweight and obesity. The study aimed at investigating the relationship between maternal GDM and childhood obesity in children aged from 1 to 3 years. Methods: In this retrospective cohort study, 237 GDM and 296 non-GDM mothers and their offspring who were followed up by Family Medicine Clinics in Rize province of Turkey were assessed. World Health Organization (WHO) criteria were used for the diagnosis of maternal GDM. Crude and adjusted logistic regression models were calculated for the association of gestational diabetes and childhood overweight/obesity. Gender and age-specific percentile tables were used for the categorization of BMI. Results: Statistical analysis carried out with adjustment for potential confounders (mother's age, educational status, smoking status, BMI, gestational weight gain, children's gender, and gestational birth weight) provided results with an odds ratio of 2.99; 95% CI 1.14-7.94 and 7.77; 95% CI 1.92-31.37 for the impact of gestational diabetes on childhood overweight and obesity at 2 and 3 years of age, respectively. Conclusions: This study found evidence for maternal GDM to cause the risk of early childhood obesity. Therefore, proper intervention strategies are required for this high-risk population.

Grow well/Crecer bien: a protocol for research on infant feeding practices in low-income families

BackgroundThe prevalence of obesity among children remains high. Given obesity’s significant lifelong consequences, there is great interest in preventing obesity early in life. There is a need to better understand the relation of common infant feeding styles and practices to obesity in infants using longitudinal study designs. There is also an urgent need to understand the role of caregivers other than mothers in feeding. A better understanding of variation in feeding styles and practices can inform the identification of risk groups and the tailoring of interventions to them.MethodsIn partnership with Early Head Start programs across four counties in southern California, mothers and infants will be enrolled in a two-year longitudinal study collecting survey and anthropometric data. A subsample of mothers and their selected other caregivers will participate in qualitative research involving feeding diaries and dyadic interviews. The results will be used to develop and test an enhanced nutrition education program.DiscussionWe outline a study methodology to examine feeding styles and practices and their association with early childhood obesity risk and enhance an existing intervention to promote healthy infant feeding and growth among children in low-income families.

Social determinants of health, adverse childhood experiences, and maternal-infant relationship

Abstract Background Low strength of maternal-infant relationship (MIR) is consistently associated with early childhood obesity risk. Because obesity often persists once it develops, primary prevention is needed early. Home visiting programs support families with social determinants of health (SDH) and adverse childhood experiences (ACEs); SDH and ACEs contribute to health inequities. Addressing SDH and ACEs may facilitate improvements in MIR and ultimately mitigate early childhood obesity risk. Limited to no research has examined the association between ACEs, SDH, and MIR. In the context of a national, evidence-based home visiting program, we asked: are SDH and ACEs associated with low MIR? Methods This sample includes 6,972 children ages 0–&amp;lt;24 months enrolled in the Parents as Teachers home visiting program across the United States from sites using the Life Skills Progression (LSP) instrument through February 2020. Low MIR is dichotomized from a 1-5 scale, with low scores reflecting low nurturing, bonding, and responsiveness. We used the literature, theory, and a stepwise logistic regression model-building process to identify a parsimonious model for MIR. Results Preliminary results reflect 34.2% Hispanic or Latino, 22.7% non-Hispanic Black, 35.3% non-Hispanic Other race; 83.9% low income; 36.9% low education; and 13.4% mothers scoring low for MIR. Notable findings from modeling include: physical ACEs, captured here as child abuse or neglect (OR: 5.01, 95% CI: 4.10-6.11); mental illness ACEs, captured here as a mother/parent with mental illness (OR: 1.31, 95% CI: 1.05-1.63), or the mother/parent treated violently (OR: 1.95, 95% CI: 1.56-2.40). Protective associations include mothers' support of child development and self-esteem scores. Conclusions Understanding the complex interplay of SDH, ACEs, and MIR is critical for developing interventions that address “upstream” family characteristics in order to mitigate early childhood obesity risk. ACEs play a predominant role. Key messages This is the first known study to concurrently examine maternal-infant relationship, social determinants of health, and adverse childhood experiences. Home visiting programs may be critical partners in addressing these needs given their reach.

BabyByte: Formative Research to Inform the Development of an App to Improve Responsive Feeding Practices in Parents of Infants and Toddlers

Abstract Objectives Responsive feeding is associated with reduced risk of early childhood obesity. The objective of this qualitative study was to determine parents’ preferred content and features for a mHealth app designed to improve responsive feeding practices. Methods Parents of 0–2 year old children completed individual semi-structured interviews with a trained researcher. Interview questions were informed by the Technology Acceptance Model and parents provided feedback on preferred app content and features. An app prototype, BabyByte, was developed using the Marvel platform to discuss potential app features during the interview. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded by two researchers using a thematic analysis approach and major themes were summarized. Results Parents (n = 40) were, on average, 33.2 years old with the majority self-reporting as non-Hispanic white (53%), a bachelor's degree or higher education (62%), and low-income (53%). Half of the participants were fathers. Overall, the majority (85%) of parents indicated that they would be likely or very likely to use BabyByte. Themes revealed that parents were most interested in topics related to introducing new foods, feeding tips, example meals, recipes, and food allergy guidance. Features including personalized profile set-up, video content, goal setting, milestone tracking, ask an expert, discussion forum, and an app search box were noted as most important or helpful by parents. Convenient access, up-to-date content from a reputable and identifiable source, and incentives for completing modules were indicated as important benefits. Conclusions Findings of this study are important considerations for the development of future mHealth tools for parents of infants and toddlers to improve responsive feeding practices and prevent early childhood obesity. Usability testing of BabyByte is currently in progress. Funding Sources University of Florida CTSI.

The Association between the 2009 WIC Food Package Change and Early Childhood Obesity Risk Varies by Type of Infant Package Received

BackgroundIn 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were updated. WIC-participating children in Los Angeles County receiving the new food package, compared with the old, had lower obesity risk at age 4. ObjectiveTo determine if the association between the new WIC food package and obesity varies by type of infant WIC food package received. DesignLongitudinal study using administrative data on children participating in WIC in Los Angeles County continuously from birth until age 4. Children were compared across periods: Before (period 1: born 2003-2004), straddling (period 2: born 2005-2008), and after (period 3: born 2009-2011) the food package change. Children were further grouped as Fully Breastfed, Mostly Breastfed, Mostly Formula Fed, and Fully Formula Fed based on the type of food packages received during the first year of life. Participants/settingWIC-participating children in Los Angeles County between 2003 and 2016 (N=116,991). Main outcome measuresWeight-for-height z-score growth trajectories from 0 to 4 years and obesity (body mass index-for-age≥95th percentile) at age 4. Statistical analyses performedChildren were matched across periods on infant feeding group; age, sex, race or ethnicity, and initial weight status; maternal education and language; and family poverty. Sex-stratified piecewise linear spline mixed models and Poisson regression models were fit to the data. ResultsNo differences across periods were observed for children in the Fully Breastfed group. Boys in the Mostly Breastfed (relative risk [RR]=1.27, 95% CI=1.17 to 1.38), Mostly Formula Fed (RR=1.07, 95% CI=1.02 to 1.13), and Fully Formula Fed (RR=1.13, 95% CI=1.06 to 1.20) groups in period 1 had higher obesity risk than their counterparts in period 3; girls in the Mostly Breastfed group in period 1 had a higher obesity risk than those in period 3 (RR=1.17, 95% CI=1.07 to 1.28). ConclusionsThe association between the WIC food package change and obesity varied by type of infant food package received, with the strongest associations observed for those who were mostly breastfed.

Acceptability of early childhood obesity prediction models to New Zealand families.

While prediction models can estimate an infant's risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. We aimed to assess the acceptability of these models to New Zealand caregivers. An anonymous questionnaire was distributed online. The questionnaire consisted of multiple choice and Likert scale questions. Respondents were parents, caregivers, and grandparents of children aged ≤5 years. 1,934 questionnaires were analysed. Responses were received from caregivers of various ethnicities and levels of education. Nearly two-thirds (62.1%) of respondents would "definitely" or "probably" want to hear if their infant was at risk of early childhood obesity, although "worried" (77.0%) and "upset" (53.0%) were the most frequently anticipated responses to such information. With lower mean scores reflecting higher levels of acceptance, grandparents (mean score = 1.67) were more receptive than parents (2.10; p = 0.0002) and other caregivers (2.13; p = 0.021); males (1.83) were more receptive than females (2.11; p = 0.005); and Asian respondents (1.68) were more receptive than those of European (2.05; p = 0.003), Māori (2.11; p = 0.002), or Pacific (2.03; p = 0.042) ethnicities. There were no differences in acceptance according to socioeconomic status, levels of education, or other ethnicities. Almost two-thirds of respondents were receptive to communication regarding their infant's risk of childhood obesity. While our results must be interpreted with some caution due to their hypothetical nature, findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand.

Association of Infant Temperament With Subsequent Obesity in Young Children of Mothers With Gestational Diabetes Mellitus

Infant temperament is associated with excess weight gain or childhood obesity risk in samples of healthy individuals, although the evidence has been inconsistent. To our knowledge, no prior research has examined this topic among children exposed to gestational diabetes mellitus (GDM) in utero. To prospectively evaluate infant temperament in association with overweight and obesity status at ages 2 to 5 years among children born to mothers who experienced GDM. This prospective cohort study took place at Kaiser Permanente Northern California medical centers. We studied singleton infants delivered at 35 weeks' gestational age or later to mothers who had been diagnosed with GDM. Data were collected from 2009 to 2016, and data analysis occurred from June 2017 to October 2018. The primary exposures in the child's first year were soothability, distress to limitations, and activity aspects of temperament, as assessed by a validated questionnaire. Modifiable covariates in the child's first year included breastfeeding intensity and duration monthly ratio scores, along with the timing of the introduction of sugary beverages and complementary foods. The primary outcome was child overweight and obesity status, assessed at ages 2 to 5 years. Multinomial logistic regression models estimated adjusted odds ratios and 95% CIs for infants whose temperaments were measured at 6 to 9 weeks of age and categorized as elevated (≥75th percentile) or not elevated in the 3 domains. We controlled for nonmodifiable and modifiable covariates across models. A total of 382 mother-infant pairs participted, including 130 infants (34.0%) who were non-Hispanic white, 126 infants (33.0%) who were Hispanic, 96 infants (25.1%) who were Asian, 26 infants (6.8%) who were non-Hispanic black, and 4 infants (1.1%) who were of other races/ethnicities. In descriptive analyses, elevated infant soothability and activity temperaments were associated with the early introduction of 100% fruit juice and/or sugar-sweetened beverages (at ages <6 months) and shorter breastfeeding duration (from 0 to <3 months), while elevated distress to limitations was associated with early introduction of complementary foods (at ages <4 months). Elevated soothability consistently was associated with a higher odds of later childhood obesity, with adjusted odds ratios across models ranging from 2.22 (95% CI, 1.04-4.73) to 2.54 (95% CI, 1.28-5.03). Greater breastfeeding intensity and duration (12-month combined) score was associated with lower odds of obesity, independent of infant temperament and other covariates. Among this high-risk population of infants, elevated soothability was associated with early childhood obesity risk, perhaps in part because caregivers use sugary drinks to assuage infants. Soothability temperament may be a novel screening target for early obesity prevention interventions involving responsive feeding and emotion regulation.

Prenatal Tobacco Exposure and Accelerated Offspring Weight and Body Mass Index Trajectories in the First 3 Years of Life

Background: Prenatal tobacco exposure (maternal active and passive smoking) has been associated with childhood obesity. It is unclear whether this is directly attributable to in utero exposure, with a graded effect across exposure groupings, or to associated lifestyle factors. Methods: In 971 maternal-offspring pairs from the GUSTO cohort, maternal plasma cotinine at 26-28 weeks' gestation and smoking history were used to categorise mothers into prenatal tobacco exposure groups. Offspring anthropometry was obtained longitudinally from birth and at ages 3, 6, 9, 12, 15, 18, 24, 36 months (m). Multiple linear regression, mixed linear models and counterfactual-based analysis were conducted, adjusting for ethnicity, maternal age, education, 1st trimester BMI, parity and gestational age. Findings: All results were compared with unexposed offspring (undetectable maternal cotinine and no history of tobacco exposure). Infants with low maternal cotinine (0·17-13·99 ng/ml) had a similar birthweight, while those with high maternal cotinine (≥14ng/ml) had a lower birthweight [β(95%CI) -162·0g (-291·8,-32·2)]. Low maternal cotinine was associated with higher offspring weight z-score at 18m [0·24 SDs (0·01,0·47)] and 36m [0·27 SDs (0·03,0·52)], and higher BMI z-score at 6m and across 15-36m [36m: 0·45 SDs (0·20,0·70)]. Over the 36m period high maternal cotinine was associated with accelerated gain in weight zscore [0·17 SDs/year (0·03,0·31)]. There was a dose-dependent BMI z-score acceleration, with offspring of mothers with low and high cotinine showing 0·09 (0·01,0·17) SDs/year and 0·17 (0·02,0·32) SDs/year gain, respectively. The association of prenatal tobacco exposure with 36m BMI was not explained by reduced breast-feeding, poor diet and increased screen time. Interpretation: Avoiding even low levels of prenatal tobacco exposure may reduce the risk of early childhood obesity. In utero programming by tobacco exposure directly influences childhood BMI rather than through unhealthy childhood lifestyle factors. Funding Statement: Singapore's National Medical Research Council and Singapore Institute for Clinical Sciences, A*STAR. Declaration of Interests: KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042) and the NIHR Southampton Biomedical Research Centre) and the European Union (Erasmus+ Programme Early Nutrition eAcademy Southeast Asia-573651-EPP-1-2016-1- DE-EPPKA2-CBHE-JP). KMG, Y-SC, and YSL have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. KMG, S-YC and Y-SC are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. The other authors have no financial or personal conflict of interest to declare. Ethics Approval Statement: The study was ethically-approved by the Institutional Review Boards of the KK Women’s and Children’s Hospital, and the National University Health System. Informed written consent was obtained from all participants