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Aljahdali AA, Cantoral A, Peterson KE, Perng W, Mercado-García A, Téllez-Rojo MM, Ramírez-Silva CI, Jansen EC. Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis. J Pediatr 2024; 265:113768. [PMID: 37802388 DOI: 10.1016/j.jpeds.2023.113768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents. STUDY DESIGN This study included 634 offsprings aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates. RESULTS Median breastfeeding duration was 7 months (minimum = 0, maximum = 36). Boys in the second quartile (median breastfeeding = 5 months) had lower total fat mass % (β (SE) -3.2 (1.5) P = .037), and higher lean mass % (3.1 (1.6) P = .049) and skeletal muscle mass % (1.8 (0.8) P = .031) compared with the reference group (median breastfeeding = 2 months). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) P = .035) was found among girls. No association was found with other cardiometabolic indicators. CONCLUSION Despite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.
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Affiliation(s)
- Abeer A Aljahdali
- Department of Clinical Nutrition, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI
| | | | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI.
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Adriana Mercado-García
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI
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Díaz-Rodríguez M, Pérez-Muñoz C, Carretero-Bravo J, Santi-Cano MJ, Carrasco-Sánchez P, Barroso-Chirino C, Ferriz-Mas BC. Impact of an early 1000-day intervention for obesity prevention on adiposity and BMI at two years of age: A quasi-experimental study. J Glob Health 2023; 13:04145. [PMID: 38085237 PMCID: PMC10715455 DOI: 10.7189/jogh.13.04145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background The 1000-day period encompassing pregnancy and the first two years of postnatal life is critical for preventing childhood obesity. Existing interventions targeting this period have been characterised by great variability in duration, objectives, and evaluation indicators. We aimed to evaluate the impact of an intervention developed during the entire 1000-day period on body mass index and body fat percentage at two years of age. Methods We designed a prospective, interventional, quasi-experimental study (ie, without randomisation or blinding of both groups) targeting mother-child pairs from the beginning of pregnancy up to two years of age belonging to the basic health area of Puerto Real (Cádiz). We developed and delivered an intervention from pregnancy to two years and assessed its effect. Results The duration of breastfeeding and vitamin D supplementation increased significantly after the intervention. The intervention group showed lowed skinfolds values, a significantly lower body fat percentage, as well as a lower accumulation of factor at two years than the control group. Conclusions The intervention has had an impact on body fat percentage at two years, potentially justified through its overall effect and the lower accumulation of early risk factors.
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Affiliation(s)
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
| | - Jesús Carretero-Bravo
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
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Atwah A, Koshak E, Shalabi MS, Alsulami A, Alsaedi AS, Alharbi O, Almalki Z, Moamina A. Childhood Obesity May Be Linked to Feeding Habits and Screen Time. Cureus 2023; 15:e50933. [PMID: 38249252 PMCID: PMC10800011 DOI: 10.7759/cureus.50933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Background Childhood obesity is an alarming health problem. Early feeding habits and factors are among the etiological factors contributing to obesity. Objectives The objective of this study is to evaluate the correlation between breastfeeding, alongside other relevant factors, and their potential role as preventative measures against obesity. Methods A cross-sectional hospital-based study was conducted on children who attended a pediatric clinic. Demographic, clinical, and anthropometric measurements were taken from the hospital records. A questionnaire was completed by parents telephonically. Overweight was identified as a body mass index (BMI) of > 85-95% and obesity as a BMI of > 95%. Results A total of 101 children, with a mean age of 8.88 ± 4.01 (range one to 18) years, were involved, of whom 58.4% were boys. A high BMI (overweight or obese) was found in 30 (29.7%) children. The highest BMIs were among soft drink consumers [two children (66.7%) consumed daily and eight children (40%) consumed monthly], high birth weight in two children (40%), cow's milk formula feeding in eight children (38%), and weekly fast food consumption in 18 children (35%), none of these were statistically significant. Nevertheless, there was a significant association between mean electronic device usage and high (204.5 ± 164.76 hours) and normal BMI (147.61 ± 110.24 hours) (p-value < 0.05). Conclusion This small cross-sectional study shows that almost one-third of the included children were overweight or obese, which is comparable to what has been published in the literature. Moreover, there was a potential link between some factors and obesity, especially screen time, which may contribute to the controversial literature.
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Affiliation(s)
- Ali Atwah
- Pediatrics, King Abdulaziz University Faculty of Medicine, Rabigh, SAU
| | - Emad Koshak
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | | | - Ahmed S Alsaedi
- Medicine, King Abdulaziz University Faculty of Medicine, Rabigh, SAU
| | - Osama Alharbi
- Pediatrics, King Abdulaziz University Faculty of Medicine, Rabigh, SAU
| | - Ziyad Almalki
- Pediatrics, King Abdulaziz University Faculty of Medicine, Rabigh, SAU
| | - Ahmed Moamina
- Pediatrics, King Abdulaziz University Faculty of Medicine, Rabigh, SAU
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Heltbech MS, Jensen CL, Girma T, Abera M, Admassu B, Kæstel P, Wells JCK, Michaelsen KF, Friis H, Andersen GS, Wibæk R. The Associations of Breastfeeding Status at 6 Months with Anthropometry, Body Composition, and Cardiometabolic Markers at 5 Years in the Ethiopian Infant Anthropometry and Body Composition Birth Cohort. Nutrients 2023; 15:4595. [PMID: 37960248 PMCID: PMC10647349 DOI: 10.3390/nu15214595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Breastfeeding (BF) has been shown to lower the risk of overweight and cardiometabolic disease later in life. However, evidence from low-income settings remains sparse. We examined the associations of BF status at 6 months with anthropometry, body composition (BC), and cardiometabolic markers at 5 years in Ethiopian children. (2) Methods: Mother-child pairs from the iABC birth cohort were categorised into four BF groups at 6 months: 1. "Exclusive", 2. "Almost exclusive", 3. "Predominantly" and 4. "Partial or none". The associations of BF status with anthropometry, BC, and cardiometabolic markers at 5 years were examined using multiple linear regression analyses in three adjustment models. (3) Results: A total of 306 mother-child pairs were included. Compared with "Exclusive", the nonexclusive BF practices were associated with a lower BMI, blood pressure, and HDL-cholesterol at 5 years. Compared with "Exclusive", "Predominantly" and "Almost exclusive" had shorter stature of -1.7 cm (-3.3, -0.2) and -1.2 cm (-2.9, 0.5) and a lower fat-free mass index of -0.36 kg/m2 (-0.71, -0.005) and -0.38 kg/m2 (-0.76, 0.007), respectively, but a similar fat mass index. Compared with "Exclusive", "Predominantly" had higher insulin of 53% (2.01, 130.49), "Almost exclusive" had lower total and LDL-cholesterol, and "Partial or none" had a lower fat mass index. (5) Conclusions: Our data suggest that children exclusively breastfed at 6 months of age are overall larger at 5 years, with greater stature, higher fat-free mass but similar fat mass, higher HDL-cholesterol and blood pressure, and lower insulin concentrations compared with predominantly breastfed children. Long-term studies of the associations between BF and metabolic health are needed to inform policies.
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Affiliation(s)
- Mathilde S. Heltbech
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Bitiya Admassu
- Jimma University Clinical and Nutrition Research Partnership (JUCAN), Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Kim F. Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Copenhagen, Denmark (P.K.); (K.F.M.); (H.F.)
| | - Gregers S. Andersen
- Clinical Research, Copenhagen University Hospital–Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Rasmus Wibæk
- Clinical Research, Copenhagen University Hospital–Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
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Sauer P. Obesity in Early Life: Its Causes, Prevention and Risks in Later Life. Nutrients 2023; 15:2999. [PMID: 37447324 DOI: 10.3390/nu15132999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Being overweight or obese at the end of the first year of life is associated with an increased risk of obesity in later life and an increased risk of developing other diseases, like type 1 diabetes mellitus, cardiovascular disorders and psycho-social problems [...].
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Affiliation(s)
- Pieter Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center, Hanzeplein 1, 9700RB Groningen, The Netherlands
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Puche-Juarez M, Toledano JM, Ochoa JJ, Diaz-Castro J, Moreno-Fernandez J. Influence of Adipose Tissue on Early Metabolic Programming: Conditioning Factors and Early Screening. Diagnostics (Basel) 2023; 13:diagnostics13091510. [PMID: 37174902 PMCID: PMC10177621 DOI: 10.3390/diagnostics13091510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Obesity and being overweight have become one of the world's most severe health issues, not only because of the pathology but also because of the development of related comorbidities. Even when children reach adulthood, the mother's environment during pregnancy has been found to have a significant impact on obesity prevention in children. Thus, both maternal dietary habits and other factors such as gestational diabetes mellitus, excessive weight gain during pregnancy, smoking, or endocrine factors, among others, could influence newborn growth, adiposity, and body composition at birth, in childhood and adolescence, hence programming health in adulthood. METHODS The aim of this review is to analyze the most recent human studies on the programming of fetal adipose tissue to determine which modifiable factors may influence adiposity and thus prevent specific disorders later in life by means of a bibliographic review of articles related to the subject over the last ten years. CONCLUSIONS The importance of a healthy diet and lifestyle not only during pregnancy and the first months of life but also throughout childhood, especially during the first two years of life as this is a period of great plasticity, where the foundations for optimal health in later life will be laid, preventing the emergence of noncommunicable diseases including obesity, diabetes mellitus type 2, hypertension, being overweight, and any other pathology linked to metabolic syndrome, which is so prevalent today, through health programs beginning at a young age.
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Affiliation(s)
- Maria Puche-Juarez
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, E-18071 Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, E-18071 Granada, Spain
- Nutrition and Food Sciences Ph.D. Program, University of Granada, E-18071 Granada, Spain
| | - Juan M Toledano
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, E-18071 Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, E-18071 Granada, Spain
- Nutrition and Food Sciences Ph.D. Program, University of Granada, E-18071 Granada, Spain
| | - Julio J Ochoa
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, E-18071 Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, E-18071 Granada, Spain
| | - Javier Diaz-Castro
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, E-18071 Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, E-18071 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), E-18016 Granada, Spain
| | - Jorge Moreno-Fernandez
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, E-18071 Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix Verdú", University of Granada, E-18071 Granada, Spain
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Exploring the Potential of Human Milk and Formula Milk on Infants’ Gut and Health. Nutrients 2022; 14:nu14173554. [PMID: 36079814 PMCID: PMC9460722 DOI: 10.3390/nu14173554] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
Early-life gut microbiota plays a role in determining the health and risk of developing diseases in later life. Various perinatal factors have been shown to contribute to the development and establishment of infant gut microbiota. One of the important factors influencing the infant gut microbial colonization and composition is the mode of infant feeding. While infant formula milk has been designed to resemble human milk as much as possible, the gut microbiome of infants who receive formula milk differs from that of infants who are fed human milk. A diverse microbial population in human milk and the microbes seed the infant gut microbiome. Human milk contains nutritional components that promote infant growth and bioactive components, such as human milk oligosaccharides, lactoferrin, and immunoglobulins, which contribute to immunological development. In an attempt to encourage the formation of a healthy gut microbiome comparable to that of a breastfed infant, manufacturers often supplement infant formula with prebiotics or probiotics, which are known to have a bifidogenic effect and can modulate the immune system. This review aims to elucidate the roles of human milk and formula milk on infants’ gut and health.
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Liu F, Lv D, Wang L, Feng X, Zhang R, Liu W, Han W. Breastfeeding and overweight/obesity among children and adolescents: a cross-sectional study. BMC Pediatr 2022; 22:347. [PMID: 35710383 PMCID: PMC9202207 DOI: 10.1186/s12887-022-03394-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Overweight and obesity are major public health crises among children and adolescents and contribute to a significant economic burden. We aimed to investigate the relationship between breastfeeding duration and overweight and obesity in children and adolescents in Qingdao, China in 2017. Methods This study conducted a survey with 10,753 students (5370 boys and 5383 girls) aged 6 to 16 years from the Shibei District of Qingdao, China in 2017. Anthropometric measurements were taken by well-trained personnel and self-completed questionnaires were used to collect data from students. A variety of statistical methods were used in this study, including univariate and multivariate analyses, as well as linear and nonlinear regression models. Results The prevalence of overweight and obesity was 15.45% and 19.76%, respectively. There was a significant negative correlation between breastfeeding duration and BMI in children and adolescents (β = -0.025, 95% CI: -0.033, -0.005, P < 0.01). Among boys, the BMI in children and adolescences of those who have been breastfed for more than 12 months was significantly lower than that of others whose breastfeeding duration was less than 12 months (β = -0.440, 95%CI -0.655, -0.224, P < 0.01). Breastfeeding has a particularly positive effect on the prevalence of obesity in boys aged 9 to 11 years (OR = 0.978, 95% CI: 0.958,0.999, P < 0.05). Conclusion Breastfeeding can significantly reduce the prevalence of overweight and obesity among children and adolescents aged 6 to 16 years. Those who were breastfed for more than 12 months had a lower risk of developing overweight and obesity, especially boys between the ages of 9 and 11. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03394-z.
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Affiliation(s)
- Fange Liu
- Pediatric Nephrology and Endocrinology Department, the First Affiliated Hospital of Shandong First Medical University &Shandong Provincial Qianfoshan Hospital, No.16766 Jingshi Road, Lixia District, Jinan, 250014, China.
| | - Di Lv
- Department of Pediatrics, Qingdao Municipal Hospital, Affiliated to Qingdao University, Qingdao, 266071, China.,Qingdao Medical College, Qingdao University, Qingdao, 266071, China
| | - Lumin Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, Qingdao, 266035, Shandong, China
| | - Xiaoyu Feng
- Pediatric Nephrology and Endocrinology Department, the First Affiliated Hospital of Shandong First Medical University &Shandong Provincial Qianfoshan Hospital, No.16766 Jingshi Road, Lixia District, Jinan, 250014, China
| | - Rongjun Zhang
- Pediatric Nephrology and Endocrinology Department, the First Affiliated Hospital of Shandong First Medical University &Shandong Provincial Qianfoshan Hospital, No.16766 Jingshi Road, Lixia District, Jinan, 250014, China
| | - Wendong Liu
- Department of Pediatrics, Qingdao Municipal Hospital, Affiliated to Qingdao University, Qingdao, 266071, China
| | - Wenchao Han
- Department of Pediatrics, Qingdao Municipal Hospital, Affiliated to Qingdao University, Qingdao, 266071, China
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10
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Dang J, Chen T, Ma N, Liu Y, Zhong P, Shi D, Dong Y, Zou Z, Ma Y, Song Y, Ma J. Associations between Breastfeeding Duration and Obesity Phenotypes and the Offsetting Effect of a Healthy Lifestyle. Nutrients 2022; 14:nu14101999. [PMID: 35631148 PMCID: PMC9143350 DOI: 10.3390/nu14101999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Additional metabolic indicators ought to be combined as outcome variables when exploring the impact of breastfeeding on obesity risk. Given the role of a healthy lifestyle in reducing obesity, we aimed to assess the effect of breastfeeding duration on different obesity phenotypes according to metabolic status in children and adolescents, and to explore the offsetting effect of healthy lifestyle factors on the associations between breastfeeding duration and obesity phenotypes. Methods: A total of 8208 eligible children and adolescents aged 7–18 years were recruited from a Chinese national cross-sectional study conducted in 2013. Anthropometric indicators were measured in the survey sites, metabolic indicators were tested from fasting blood samples, and breastfeeding duration and sociodemographic factors were collected by questionnaires. According to anthropometric and metabolic indicators, obesity phenotypes were divided into metabolic healthy normal weight (MHNW), metabolic unhealthy normal weight (MUNW), metabolic healthy obesity (MHO), and metabolic unhealthy obesity (MUO). Four common obesity risk factors (dietary consumption, physical activity, screen time, and sleep duration) were used to construct a healthy lifestyle score. Scores on the lifestyle index ranged from 0 to 4 and were further divided into unfavorable lifestyles (zero or one healthy lifestyle factor), intermediate lifestyles (two healthy lifestyle factors), and favorable lifestyle (three or four healthy lifestyle factors). Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the associations between breastfeeding duration and obesity phenotypes. Furthermore, the interaction terms of breastfeeding duration and each healthy lifestyle category were tested to explore the offsetting effect of lifestyle factors. Results: The prevalence of obesity among Chinese children and adolescents aged 7–18 years was 11.0%. Among the children and adolescents with obesity, the prevalence of MHO and MUO was 41.0% and 59.0%, respectively. Compared to the children and adolescents who were breastfed for 6–11 months, prolonged breastfeeding (≥12 months) increased the risks of MUNW (OR = 1.35, 95% CI: 1.19–1.52), MHO (OR = 1.61, 95% CI: 1.27–2.05), and MUO (OR = 1.46, 95% CI: 1.20–1.76). When stratified by healthy lifestyle category, there was a typical dose–response relationship between duration of breastfeeding over 12 months and MUNW, MHO, and MUO, with an increased risk of a favorable lifestyle moved to an unfavorable lifestyle. Conclusions: Prolonged breastfeeding (≥12 months) may be associated with increased risks of MUNW, MHO, and MUO, and the benefits of breastfeeding among children and adolescents may begin to wane around the age of 12 months. The increased risks may be largely offset by a favorable lifestyle.
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Affiliation(s)
- Jiajia Dang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Ting Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Ning Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yunfei Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Panliang Zhong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Di Shi
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
- Correspondence: (Y.S.); (J.M.); Tel.: +86-10-82801624 (Y.S.); Fax: +86-10-82801178 (Y.S.)
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; (J.D.); (T.C.); (N.M.); (Y.L.); (P.Z.); (D.S.); (Y.D.); (Z.Z.); (Y.M.)
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China
- Correspondence: (Y.S.); (J.M.); Tel.: +86-10-82801624 (Y.S.); Fax: +86-10-82801178 (Y.S.)
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11
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Abeysekera KWM, Orr JG, Madley-Dowd P, Fernandes GS, Zuccolo L, Gordon FH, Lawlor DA, Heron J, Hickman M. Association of maternal pre-pregnancy BMI and breastfeeding with NAFLD in young adults: a parental negative control study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100206. [PMID: 34806068 PMCID: PMC8589711 DOI: 10.1016/j.lanepe.2021.100206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The importance of the maternal-infant dyad in the genesis of nonalcoholic fatty liver disease (NAFLD) is of increasing interest. The Avon Longitudinal Study of Parents and Children (ALSPAC) showed that at age 24, 1 in 5 had NAFLD measured by transient elastography and controlled attenuation parameter (CAP). Our aim was to investigate the association between breastfeeding duration and maternal pre-pregnancy BMI on offspring NAFLD in young adulthood. METHODS 4021 participants attended clinic for FibroScan and CAP measurement using Echosens 502 Touch®. 440 participants with Alcohol Use Disorders were excluded. Offspring of 100 non-singleton pregnancies were excluded. 2961 valid CAP measurements for NAFLD were analysed. Exposures of interest were breastfeeding of any duration, ≥6months exclusive breastfeeding, and maternal pre-pregnancy BMI. Multivariable regression models estimated the odds of NAFLD at 24 years. We performed a paternal negative control test to explore residual confounding in the analyses of pre-pregnancy BMI. FINDINGS There was a modest inverse association of exclusive and non-exclusive breastfeeding ≥6 months having a protective effect on NAFLD in offspring (OR 0·92 [95%CI 0·66-1·27] and OR 0·90 [0·67-1·21] respectively).The odds of offspring NAFLD in overweight pre-pregnancy maternal BMI and paternal BMI was OR 2·09 [1·62-2·68] and OR 1·33 [95%CI 1·07-1·65] respectively, with the ratio of effect sizes OR 1·57 [1·11-2·22]. Similarly, odds of offspring NAFLD with obese pre-pregnancy maternal BMI and paternal BMI was OR 2·66 [1·71-4·14] and OR 1·35 [0·91-2·00] respectively, with the ratio of effect sizes OR 1·98 [1·05-3·74]. INTERPRETATION Higher maternal pre-pregnancy BMI was associated with offspring NAFLD, having accounted for shared parental confounding. We did not replicate previous work that found a strong association between breastfeeding and NAFLD. FUNDING Medical Research Council UK, Alcohol Research UK, David Telling Charitable Trust.
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Affiliation(s)
- Kushala WM Abeysekera
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Liver Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - James G Orr
- Department of Liver Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Paul Madley-Dowd
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gwen S Fernandes
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luisa Zuccolo
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Fiona H Gordon
- Department of Liver Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Deborah A Lawlor
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol NIHR Biomedical Research Centre
| | - Jon Heron
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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12
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Ley D, Beghin L, Morcel J, Flamein F, Garabedian C, Accart B, Drumez E, Labreuche J, Gottrand F, Hermann E. Impact of early life nutrition on gut health in children: a prospective clinical study. BMJ Open 2021; 11:e050432. [PMID: 34489289 PMCID: PMC8422494 DOI: 10.1136/bmjopen-2021-050432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The first 1000 days of life could contribute to individual susceptibility to the later development of chronic non-communicable diseases. Nutrition in early life appears to be an important determinant factor for a sustainable child's health. In this study, we propose to investigate the impact of exclusive breast feeding on gut health in children. METHODS AND ANALYSIS A prospective cohort of newborns (n=350) will be recruited at birth and followed up to 4 years of age. The main objective is to evaluate the link between exclusive breast feeding for at least 3 months and the gut health of the child at 4 years. The primary endpoint of assessment of gut health will be based on the non-invasive measurement of faecal secretory IgA (sIgA) as a sensitive biomarker of the intestinal ecosystem. The presence of gastrointestinal disorders will be defined according to the clinical criteria of Rome IV. Information on parent's nutritional habits and life style, breastfeeding duration and child's complementary feeding will be collected along the follow-up. Cord blood cells and plasma at birth will be purified for further analysis. The meconium and stools collected at birth, 6 months, 2 years and 4 years of age will allow sIgA analysis. ETHICS AND DISSEMINATION This clinical study has obtained the approval from the national ethical committee. We plan to publish the results of the study in peer-review journals and by means of national and international conference. TRIAL REGISTRATION NUMBER NCT04195425.
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Affiliation(s)
- Delphine Ley
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Laurent Beghin
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, CIC-1403 Inserm-CHU, F-59000 Lille, France
| | - Jules Morcel
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, CIC-1403 Inserm-CHU, F-59000 Lille, France
| | - Florence Flamein
- Univ. Lille, Inserm, CHU Lille, CIC-1403 Inserm-CHU, F-59000 Lille, France
| | - Charles Garabedian
- Univ. Lille, CHU Lille, Department of Obstetrics & Gynecology, F-59000 Lille, France
- Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | | | - Elodie Drumez
- Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
- CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
- CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - Frederic Gottrand
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, CIC-1403 Inserm-CHU, F-59000 Lille, France
| | - Emmanuel Hermann
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
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13
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Rifas-Shiman SL, Huh SY, Martin RM, Kramer M, Patel R, Bogdanovich N, Vilchuck K, Thompson J, Oken E. Delivery by caesarean section and offspring adiposity and cardio-metabolic health at ages 6.5, 11.5 and 16 years: results from the PROBIT cohort in Belarus. Pediatr Obes 2021; 16:e12783. [PMID: 33660413 DOI: 10.1111/ijpo.12783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Caesarean delivery has been associated with later adiposity, perhaps via early programming or perhaps because of residual confounding by maternal or birth characteristics. OBJECTIVES Examine associations of caesarean delivery with adiposity and cardio-metabolic biomarkers. METHODS Observational analysis of 15 069 children in the PROBIT cohort in Belarus. We examined measures of child anthropometry and blood pressure at 6.5, 11.5 and 16 years and fasting blood (11.5 years). RESULTS Caesarean-delivered children were slightly heavier at 6.5 (mean BMI 15.8 vs. 15.6 kg/m2 ), 11.5 (18.4 vs. 18.2) and 16 years (21.5 vs. 21.3). After adjustment for prenatal characteristics including maternal third trimester BMI, however, we observed no association of caesarean versus vaginal delivery with child BMI (β 0.05 kg/m2 ; 95%CI: -0.03, 0.14), sum of skinfolds (0.14 mm; -0.13, 0.42), waist circumference (-0.07 cm; -0.23, 0.10), obesity (OR 0.99; 0.76, 1.29), or systolic (-0.20 mmHg; -0.70, 0.30) or diastolic (-0.17 mmHg, -0.60, 0.26) blood pressure at 6.5 years; results were similar at 11.5 and 16 years. At 11.5 years, we observed a modest association of caesarean delivery with fasting insulin (0.33 mU/L; 0.00, 0.65). CONCLUSIONS Caesarean delivery had little or no association with adiposity or related cardio-metabolic biomarkers in childhood. Adjustment for maternal BMI attenuated all outcome effect estimates.
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Affiliation(s)
- Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Susanna Y Huh
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard M Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Michael Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Patel
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- Department of Obstetrics, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Konstanin Vilchuck
- Department of Obstetrics, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Jennifer Thompson
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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14
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Jin H, Shan T, Li S, Fan X, Zhao Y, Li J, Tang X, Saffery R, Tong C, Wen L, Qi H, Kilby MD, Baker PN. Association of infant feeding patterns with body fat mass and obesity in the first 2 years of life: a longitudinal twin birth cohort study. Int J Food Sci Nutr 2021; 73:263-273. [PMID: 34412548 DOI: 10.1080/09637486.2021.1968357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Childhood obesity is a major public health problem with no effective intervention. We explored the influence of feeding patterns on infants' growth indices within the first 2 years in a twin birth cohort. Dietary intake at 12 months was recorded with a food frequency questionnaire, and dietary patterns were identified by principal component analysis. Milk feeding methods in first 6 months were categorised as breastfeeding or exclusive formula feeding. Correlations between feeding patterns and infants' growth indices were examined via generalised estimating equations. Two dietary patterns were identified and neither of which was related to growth indices. Breastfed infants had a higher body fat mass (BFM) percentage at 12 months, a higher body mass index (BMI) increment from birth to 6 months and a lower BMI increment from 6 to 12 months. Breastfed infants were likely positively correlated with BFM at 12 months; as complementary food was added, the effect of breastfeeding on growth gradually decreased.
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Affiliation(s)
- Huili Jin
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,International Collaborative Laboratory of Reproduction and Development, Ministry of Education, Chongqing Medical University, Chongqing, China.,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tengfei Shan
- Department of Obstetrics and Gynecology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Sisi Li
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,International Collaborative Laboratory of Reproduction and Development, Ministry of Education, Chongqing Medical University, Chongqing, China.,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Fan
- Department of Child Healthcare, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yan Zhao
- Department of Child Healthcare, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jie Li
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,International Collaborative Laboratory of Reproduction and Development, Ministry of Education, Chongqing Medical University, Chongqing, China.,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiqin Tang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Richard Saffery
- Cancer, Disease and Developmental Epigenetics, Murdoch Children's Research Institute, Parkville, Australia
| | - Chao Tong
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,International Collaborative Laboratory of Reproduction and Development, Ministry of Education, Chongqing Medical University, Chongqing, China.,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Wen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,International Collaborative Laboratory of Reproduction and Development, Ministry of Education, Chongqing Medical University, Chongqing, China.,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,International Collaborative Laboratory of Reproduction and Development, Ministry of Education, Chongqing Medical University, Chongqing, China.,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mark D Kilby
- Institute of Metabolism & Systems Research, University of Birmingham, Birmingham, UK
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, UK
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15
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Oken E, Thompson JW, Rifas-Shiman SL, Vilchuk K, Bogdanovich N, Hameza M, Yang S, Patel R, Kramer MS, Martin RM. Analysis of Maternal Prenatal Weight and Offspring Cognition and Behavior: Results From the Promotion of Breastfeeding Intervention Trial (PROBIT) Cohort. JAMA Netw Open 2021; 4:e2121429. [PMID: 34410396 PMCID: PMC8377565 DOI: 10.1001/jamanetworkopen.2021.21429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Prenatal experiences can influence fetal brain development. OBJECTIVE To examine associations of maternal prenatal body mass index (BMI) with cognition and behavior of offspring born full-term. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined follow-up data from a breastfeeding promotion intervention at 31 hospitals and affiliated polyclinics in the Republic of Belarus. Participants included 11 276 children who were evaluated from birth (1996-1997) to adolescence (2017-2019), with maternal BMI information available in prenatal medical records. EXPOSURES Maternal BMI, calculated as weight in kilograms divided by height in meters squared, after 35 weeks gestation; secondary analyses examined maternal BMI at other time points and paternal BMI. MAIN OUTCOMES AND MEASURES Trained pediatricians assessed child cognition with the Wechsler Abbreviated Scales of Intelligence (WASI) at 6.5 years and the computerized self-administered NeuroTrax battery at 16 years, both with an approximate mean (SD) of 100 (15). Parents and teachers rated behaviors at 6.5 years using the Strengths and Difficulties Questionnaire (SDQ, range 0-40). Mixed-effects linear regression analyses corrected for clustering, adjusted for the randomized intervention group and baseline parental sociodemographic characteristics, and were considered mediation by child BMI. RESULTS Among 11 276 participants, 9355 women (83%) were aged 20 to 34 years, 10 128 (89.8%) were married, and 11 050 (98.0%) did not smoke during pregnancy. Each 5-unit increase in of maternal late-pregnancy BMI (mean [SD], 27.2 [3.8]) was associated with lower offspring WASI performance intelligence quotient (IQ) (-0.52 points; 95% CI, -0.87 to -0.17 points) at 6.5 years and lower scores on 5 of 7 NeuroTrax subscales and the global cognitive score at 16 years (-0.67 points; 95% CI, -1.06 to -0.29 points). Results were similar after adjustment for sociodemographic characteristics, pregnancy complications, and paternal BMI and were not mediated by child weight. Higher late pregnancy maternal BMI was also associated with more behavioral problems reported on the SDQ by teachers but not associated with parent-reported behaviors (externalizing behaviors: 0.13 points; 95% CI, 0.02 to 0.24 points; and total difficulties: 0.14 points, 95% CI, -0.02 to 0.30 points). Results were similar for maternal BMI measured in the first trimester or postpartum. In contrast, higher 6.5-year paternal BMI was associated with slightly better child cognition (WASI verbal IQ: 0.42 points; 95% CI, 0.02 to 0.82 points; NeuroTrax executive function score: 0.68 points; 95% CI, 0.24 to 1.12 points) and fewer teacher-reported behavioral problems (total difficulties: -0.29 points; 95% CI, -0.46 to -0.11 points). CONCLUSIONS AND RELEVANCE This cohort study supports findings from animal experiments and human observational studies in settings with higher maternal BMI and obesity rates. Higher maternal prenatal BMI may be associated with poorer offspring brain development, although residual confounding cannot be excluded.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jennifer W. Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Konstantin Vilchuk
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Natalia Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Mikhail Hameza
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael S. Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard M. Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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16
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Fornari E, Barbetti F, Iafusco D, Lombardo F, Miraglia Del Giudice E, Rabbone I, Mozzillo E. Type 2 diabetes in pediatrics. Minerva Pediatr (Torino) 2021; 73:549-562. [PMID: 34286947 DOI: 10.23736/s2724-5276.21.06530-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Type 2 diabetes (T2D) in adolescents has become an increasing health concern throughout the world and its prevention and screening should be implemented in pediatric care. As clinical features at presentation, in some cases can be similar to type 1 diabetes and family history can be in favour of a monogenic form of diabetes, it is pivotal for physicians to be aware of youth-onset T2D specificities to ensure an accurate diagnosis. The global increase of overweight and obesity can complicate the diagnostic process and makes it essential to apply a systematic approach to each new diagnosis. Microvascular complications may be present at the time of diagnosis and chronic complications are frequent and need to be screened regularly. Regular screening of comorbidities should also be performed. Childhood T2D should be followed up by pediatric diabetes units to avoid diagnostic errors and delay in care. A multidisciplinary approach, by an experienced team, is pivotal to provide treatment options targeting the unique needs of pediatric patients. Treatment programs must include the whole family and address all the aspects of the care (lifestyle, pharmacological therapy, psychological aspects, complications and comorbidities). An organized process of transition to adult care is essential.
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Affiliation(s)
- Elena Fornari
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics and Gynecology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Fabrizio Barbetti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Dario Iafusco
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy -
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17
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Dewey KG, Güngör D, Donovan SM, Madan EM, Venkatramanan S, Davis TA, Kleinman RE, Taveras EM, Bailey RL, Novotny R, Terry N, Butera G, Obbagy J, de Jesus J, Stoody E. Breastfeeding and risk of overweight in childhood and beyond: a systematic review with emphasis on sibling-pair and intervention studies. Am J Clin Nutr 2021; 114:1774-1790. [PMID: 34224561 PMCID: PMC8830309 DOI: 10.1093/ajcn/nqab206] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Breastfeeding is associated with a lower risk of subsequent overweight or obesity, but it is uncertain whether this is a causal relation because most studies have not adequately reduced risk of bias due to confounding. OBJECTIVES The aim of this review was to examine whether 1) ever compared with never consuming human milk and 2) different durations of human milk consumption among infants fed human milk are related to later risk of overweight or obesity, with emphasis on sibling-pair and intervention studies. METHODS The 2020 Dietary Guidelines Advisory Committee, together with the Nutrition Evidence Systematic Review team, conducted a systematic review of articles relevant to healthy full-term infants in countries with a high or very high level of human development. We searched PubMed, Embase, Cochrane, and CINAHL; dual-screened the results using predetermined criteria; extracted data from and assessed the risk of bias for each included study; qualitatively synthesized the evidence; developed conclusion statements; and graded the strength of the evidence. RESULTS The review included 42 articles, including 6 cohorts with sibling-pair analyses and 1 randomized controlled trial of a breastfeeding promotion intervention. Moderate evidence suggested that ever, compared with never, consuming human milk is associated with a lower risk of overweight and obesity at ages 2 y and older, particularly if the duration of human milk consumption is >6 mo. However, residual confounding cannot be ruled out. Evidence was insufficient to determine the relation between the duration of any human milk consumption, among infants fed human milk, and overweight and/or obesity at age 2 y and older. CONCLUSIONS Further research, using strong study designs, is needed to disentangle the complex relation between infant feeding practices and the risk of subsequent overweight or obesity, as well as the biological and behavioral mechanisms if the relation is causal.
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Affiliation(s)
| | - Darcy Güngör
- Panum Group, Bethesda, MD, USA,Nutrition Evidence Systematic Review team, Nutrition Guidance and Analysis
Division (NGAD), Center for Nutrition Policy and Promotion (CNPP), Food and Nutrition
Service (FNS), US Department of Agriculture (USDA),
Alexandria, VA, USA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, University of
Illinois, Urbana-Champaign, IL, USA
| | - Emily M Madan
- Panum Group, Bethesda, MD, USA,Nutrition Evidence Systematic Review team, Nutrition Guidance and Analysis
Division (NGAD), Center for Nutrition Policy and Promotion (CNPP), Food and Nutrition
Service (FNS), US Department of Agriculture (USDA),
Alexandria, VA, USA
| | - Sudha Venkatramanan
- Panum Group, Bethesda, MD, USA,Nutrition Evidence Systematic Review team, Nutrition Guidance and Analysis
Division (NGAD), Center for Nutrition Policy and Promotion (CNPP), Food and Nutrition
Service (FNS), US Department of Agriculture (USDA),
Alexandria, VA, USA
| | - Teresa A Davis
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics,
Baylor College of Medicine, Houston, TX, USA
| | - Ronald E Kleinman
- Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA
| | - Elsie M Taveras
- Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA,Harvard T. H. Chan School of Public Health,
Boston, MA, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University,
West Lafayette, IN, USA
| | - Rachel Novotny
- Department of Human Nutrition Food and Animal Sciences, College of Tropical
Agriculture and Human Resources, University of Hawaii at Manoa,
Manoa, HI, USA
| | - Nancy Terry
- National Institutes of Health Library, Office of Research Services, US
Department of Health and Human Services (HHS), Bethesda,
MD, USA
| | - Gisela Butera
- Panum Group, Bethesda, MD, USA,Nutrition Evidence Systematic Review team, Nutrition Guidance and Analysis
Division (NGAD), Center for Nutrition Policy and Promotion (CNPP), Food and Nutrition
Service (FNS), US Department of Agriculture (USDA),
Alexandria, VA, USA
| | - Julie Obbagy
- Nutrition Evidence Systematic Review team, Nutrition Guidance and Analysis
Division (NGAD), Center for Nutrition Policy and Promotion (CNPP), Food and Nutrition
Service (FNS), US Department of Agriculture (USDA),
Alexandria, VA, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion,
HHS, Rockville, MD, USA
| | - Eve Stoody
- NGAD, CNPP, FNS, USDA, Alexandria, VA,
USA
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18
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Nutritional Strategies for Childhood Obesity Prevention. Life (Basel) 2021; 11:life11060532. [PMID: 34201017 PMCID: PMC8227398 DOI: 10.3390/life11060532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the spread of obesity represents a challenge for clinicians in which obesity prevention plays a key role in achieving this purpose. The aim of this review is to analyze the nutritional interventions that can be implemented to prevent childhood obesity. METHODS Searching PubMed and Cochrane Library between 2019 and 2021. Further searching with no date range for articles selected for their specific relevance in the pediatric area or for their scientific relevance. A total of 871 articles were identified and 90 were included. RESULTS We organized the results of the selected articles into age groups, and according to the subjects targeted for interventions or to the site of interventions, reserving an in-depth analysis on specific nutritional aspects. Promotion of breastfeeding, reduction of protein content of formulated milks, and diet of the first 12-24 months, involving family and schools in interventions that promote physical activity and healthy diet, are promising strategies for reduction of the risk of obesity. To increase the efficacy of interventions, a multidimensional approach is crucial. CONCLUSIONS A multidimensional approach, which takes into consideration different areas of intervention, is pivotal for childhood obesity prevention. Integrated programs involving several components (nutrition and physical activity at first) at different levels (individual, family, school, and institutional) are crucial.
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19
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Campos AP, Vilar-Compte M, Hawkins SS. Association Between Breastfeeding and Child Overweight in Mexico. Food Nutr Bull 2021; 42:414-426. [PMID: 34044629 DOI: 10.1177/03795721211014778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, the prevalence of child overweight has increased over the past few decades. The largest burden of child overweight is identified among upper-middle-income countries, such as Mexico. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child overweight. OBJECTIVE To examine the association between breastfeeding and child overweight while sequentially controlling for individual, household, and area factors in Mexican children. METHODS Secondary data analysis using the 2012 Mexican National Health and Nutrition Survey which included risk factors for overweight on 2089 children aged 6 to 35 months and analyzed data to estimate fixed- and mixed-effects logistic regression models. RESULTS Overall, 9.0% of children were overweight and 71.1% of mothers reported any breastfeeding for ≥ 6 months. We found no evidence for a protective effect of any breastfeeding for ≥ 6 months on child overweight when compared to children who were never breastfed in the fully adjusted model and across all models (model 4, adjusted odds ratio [AOR] [95% CI] = 0.76 [0.31-1.86]). We identified risk factors for child overweight at the individual and area levels, with maternal obesity and offspring high birthweight being significant in the fully adjusted model and across all models (model 4, AOR [95% CI] = 2.26 [1.32-3.85] and 2.83 [1.44-5.56], correspondingly). CONCLUSIONS Our results suggest shared obesogenic environment influences from which the overweight-obese maternal-child dyads are emerging in Mexican households. More research is needed to better understand these obesogenic environments grounded on the particular contexts among upper-middle-income countries.
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Affiliation(s)
- Ana Paola Campos
- 205730Boston College School of Social Work, McGuinn Hall, Chestnut Hill, MA, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute, 27829Iberoamericana University, Mexico City, Mexico
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20
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Isganaitis E. Milky ways: effects of maternal obesity on human milk composition and childhood obesity risk. Am J Clin Nutr 2021; 113:772-774. [PMID: 33742200 PMCID: PMC8023847 DOI: 10.1093/ajcn/nqab009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elvira Isganaitis
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Research Division, Joslin Diabetes Center, Boston, MA, USA
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21
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Hu J, Aris IM, Lin PID, Rifas-Shiman SL, Perng W, Woo Baidal JA, Wen D, Oken E. Longitudinal associations of modifiable risk factors in the first 1000 days with weight status and metabolic risk in early adolescence. Am J Clin Nutr 2020; 113:113-122. [PMID: 33184628 PMCID: PMC7779210 DOI: 10.1093/ajcn/nqaa297] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many studies have identified early-life risk factors for childhood overweight/obesity (OwOb), but few have evaluated how they combine to influence later cardiometabolic health. OBJECTIVES We aimed to examine the association of risk factors in the first 1000 d with adiposity and cardiometabolic risk in early adolescence. METHODS We studied 1038 mother-child pairs in Project Viva. We chose 6 modifiable early-life risk factors previously associated with child adiposity or metabolic health in the cohort: smoking during pregnancy (yes compared with no); gestational weight gain (excessive compared with nonexcessive); sugar-sweetened beverage consumption during pregnancy (≥0.5 compared with <0.5 servings/d); breastfeeding duration (<12 compared with ≥12 mo); timing of complementary food introduction (<4 compared with ≥4 mo); and infant sleep duration (<12 compared with ≥12 h/d). We computed risk factor scores by calculating the cumulative number of risk factors for each child. In early adolescence (median: 13.1 y) we measured indicators of adiposity [BMI, fat mass index (FMI), trunk fat mass index (TFMI)]. We also calculated OwOb prevalence and metabolic syndrome (MetS) risk z score of adolescents. RESULTS Among 1038 adolescents, 71% had >1 early-life risk factor. In covariate-adjusted models, we observed positive monotonic increases in BMI, FMI, TFMI, and MetS z scores with increasing risk factor score. Children with 5‒6 risk factors (compared with 0-1 risk factors) had the highest risk of OwOb [risk ratio (RR): 2.53; 95% CI: 1.63, 3.91] and being in the highest MetS quartile (RR: 2.46; 95% CI: 1.43, 4.21). The predicted probability of OwOb in adolescence varied from 9.4% (favorable levels for all factors) to 63.6% (adverse levels for all factors), and for being in the highest MetS quartile from 9.6% to 56.6%. CONCLUSIONS Early-life risk factors in the first 1000 d cumulatively predicted higher adiposity and cardiometabolic risk in early adolescence. Intervention strategies to prevent later obesity and cardiometabolic risk may be more effective if they concurrently target multiple modifiable factors.
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Affiliation(s)
- Jiajin Hu
- Institute of Health Sciences, China Medical University, Shenyang, Liaoning, China,Research Center of China Medical University Birth Cohort, China Medical University, Shenyang, Liaoning, China,Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Pi-I D Lin
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Wei Perng
- Department of Epidemiology, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Deliang Wen
- Institute of Health Sciences, China Medical University, Shenyang, Liaoning, China
| | - Emily Oken
- Division of Chronic Disease Research across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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22
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Tahir MJ, Ejima K, Li P, Demerath EW, Allison DB, Fields DA. Associations of breastfeeding or formula feeding with infant anthropometry and body composition at 6 months. MATERNAL AND CHILD NUTRITION 2020; 17:e13105. [PMID: 33145993 PMCID: PMC7988875 DOI: 10.1111/mcn.13105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 09/14/2020] [Accepted: 10/07/2020] [Indexed: 12/16/2022]
Abstract
The objective of this study was to investigate the associations of mode of feeding with infant anthropometric and body composition variables at 6 months of age. We studied 259 infants whose exclusive mode of feeding (breast or formula) to 1 month was confirmed. Standard anthropometric characteristics of the infants (weight, length and weight‐for‐length z scores) were obtained, and body composition (total fat mass, fat‐free mass, trunk fat mass and body fat percent) was measured using dual‐energy X‐ray absorptiometry (DXA) at 6 months (±12 days). General linear models were used to test the associations of mode of feeding with infant anthropometric and body composition variables at 6 months after adjustment for maternal and infant covariates. In this cohort of predominantly breastfed, White infants of highly educated mothers, fat‐free mass was lower (P = .002), and trunk fat mass (P = .032) and body fat percent (P < .001) were greater in breastfed infants than in formula‐fed infants at 6 months of age. After adjustment for covariates, total fat‐free mass was significantly lower (β = −372 g, [SE = 125, P = .003]), and body fat percent was significantly greater (β = 3.30, [SE = 0.91, P < .001]) in breastfed infants than in formula‐fed infants. No other significant associations were observed. These findings support those of previous studies reporting greater fat‐free mass in formula‐fed infants during the first 6 months of life. Additional research is warranted to explore whether differences in infant body composition by mode of feeding persist throughout the life course and to assess causality.
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Affiliation(s)
- Muna J Tahir
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA.,Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Peng Li
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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23
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Childhood obesity: Is it related to feeding type of the infant? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.810439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Association between Breastfeeding and DNA Methylation over the Life Course: Findings from the Avon Longitudinal Study of Parents and Children (ALSPAC). Nutrients 2020; 12:nu12113309. [PMID: 33137917 PMCID: PMC7692466 DOI: 10.3390/nu12113309] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Breastfeeding is associated with short and long-term health benefits. Long-term effects might be mediated by epigenetic mechanisms, yet the literature on this topic is scarce. We performed the first epigenome-wide association study of infant feeding, comparing breastfed vs non-breastfed children. We measured DNA methylation in children from peripheral blood collected in childhood (age 7 years, N = 640) and adolescence (age 15–17 years, N = 709) within the Accessible Resource for Integrated Epigenomic Studies (ARIES) project, part of the larger Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Cord blood methylation (N = 702) was used as a negative control for potential pre-natal residual confounding. Results: Two differentially-methylated sites presented directionally-consistent associations with breastfeeding at ages 7 and 15–17 years, but not at birth. Twelve differentially-methylated regions in relation to breastfeeding were identified, and for three of them there was evidence of directional concordance between ages 7 and 15–17 years, but not between birth and age 7 years. Conclusions: Our findings indicate that DNA methylation in childhood and adolescence may be predicted by breastfeeding, but further studies with sufficiently large samples for replication are required to identify robust associations.
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25
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Kheir F, Feeley N, Maximova K, Drapeau V, Henderson M, Van Hulst A. Breastfeeding duration in infancy and dietary intake in childhood and adolescence. Appetite 2020; 158:104999. [PMID: 33058954 DOI: 10.1016/j.appet.2020.104999] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/20/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
Although several studies have focused on associations between breastfeeding and child obesity, few have focused on associations with dietary intake. We examined associations between breastfeeding duration in infancy and dietary intake in childhood and explored whether associations are still observed in adolescence. The QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) cohort includes 630 children aged 8-10 years at baseline (T1) who have at least one parent with obesity. A follow-up assessment was done 7 years later (T2) when participants were aged 15-17 years (n=377). Non-exclusive breastfeeding duration was evaluated at T1 using a parent questionnaire (never, < 3 months, 3-6 months, > 6 months). Dietary intake was assessed at T1 and T2 using three 24-h diet recalls, namely daily servings of vegetables (≥ 2 vs < 2), fruits (≥ 2 vs < 2), vegetables and fruits combined (≥ 5 vs < 5), sugar-sweetened beverages (SSB) (none vs any), and an overall diet quality index (DQI-I) (good vs poor). Multiple logistic regressions, adjusted for age, sex and total kilocalorie intake of the child, for age and body mass index of the mother, and for parental education and income were used. Compared to children breastfed > 6 months (reference group), those never breastfed or breastfed for 3-6 months were 42% (OR = 0.58, 95% CI: 0.34-0.96) and 38% (OR = 0.62, 95% CI: 0.39-1.00) less likely to consume ≥ 2 servings of vegetables per day at 8-10 years, respectively, while no association was found for those breastfed < 3 months. Compared to children breastfed > 6 months, those never breastfed were 1.8 times more likely to drink any SSB (OR = 1.82, 95% CI: 1.03-3.22). No associations were found for other diet indicators, and associations observed in childhood were no longer found by adolescence. In this cohort, breastfeeding was associated with greater vegetable intake and the avoidance of SSB in childhood, but not in adolescence, nor were associations found for fruit intake or overall diet quality.
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Affiliation(s)
- Fatima Kheir
- Ingram School of Nursing McGill University, Montreal, Canada.
| | - Nancy Feeley
- Ingram School of Nursing McGill University, Montreal, Canada; Center for Nursing Research, Jewish General Hospital, Montreal, Canada.
| | - Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Vicky Drapeau
- Faculty of Education, Department of Physical Education, Laval University, Quebec City, Canada.
| | - Mélanie Henderson
- Department of Pediatrics, University of Montreal and Sainte-Justine University Hospital Research Center, Montreal, Canada.
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26
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He S, Stein AD. Early-Life Nutrition Interventions and Associated Long-Term Cardiometabolic Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2020; 12:461-489. [PMID: 33786595 PMCID: PMC8009753 DOI: 10.1093/advances/nmaa107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/08/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
Early-life nutrition interventions can have lifelong cardiometabolic benefits. Most evidence on this topic is derived from observational studies. We evaluated the association of randomized controlled nutritional trials in early life and long-term cardiometabolic outcomes. Through literature search of PubMed, CABI Global Health, Embase, and Cochrane, with manual reference check and weekly alert from PubMed, we identified 8312 records, and included 53 records from 40 cohorts in 21 countries. The total number of participants was 33,551. Interventions were initiated as early as conception, and the longest until 7 y (except 1 study from infancy to 20 y). The cohorts were followed up for between 3 and 73 y. We identified 7 types of interventions (protein-energy supplements, long-chain PUFAs, single micronutrient, multiple micronutrients, infant and young child feeding, dietary counseling, and other) and 4 categories of cardiometabolic outcomes (biomarkers, cardiovascular, body size and composition, and subclinical/clinical outcomes). Most findings were null. Fasting glucose concentration was 0.04 mmol/L lower (95% CI: -0.05, -0.02 mmol/L; I2 = 0%) in the intervention groups than in the control groups (15 studies). BMI (kg/m2) was 0.20 higher (95% CI: 0.12, 0.28; I2 = 54%) in the intervention groups than control groups (14 studies). No significant effect was observed for total cholesterol (12 studies) or blood pressure (17 studies). Ongoing and personalized dietary counseling was associated with lower glucose and cholesterol, better endothelial function, and reduced risk of metabolic syndrome. The timing of intervention mattered, with earlier initiation conferring greater benefit (improved lipid profile and marginally lower glucose concentration) based on 2 studies. In sum, glucose concentration was lower following early-life nutrition interventions, but there is a risk of unintended consequences, including higher BMI. Maternal and child nutrition interventions must be evidence-based and tailored to each population to promote long-term cardiometabolic health.
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Affiliation(s)
- Siran He
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
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27
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Zhang X, Martin RM, Oken E, Aris IM, Yang S, Kramer MS. Growth During Infancy and Early Childhood and Its Association With Metabolic Risk Biomarkers at 11.5 Years of Age. Am J Epidemiol 2020; 189:286-293. [PMID: 31595955 DOI: 10.1093/aje/kwz234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
The evidence that fetal life and early infancy are "critical" or "sensitive" ages for later development of cardiometabolic disease is based on flawed methods for comparing different age periods. Moreover, most previous studies have limited their focus to weight gain, rather than growth in length/height or body mass index (weight (kg)/height (m)2). We undertook a secondary analysis of data from the Promotion of Breastfeeding Intervention Trial (1996-2010), a birth cohort study nested within a large cluster-randomized trial in the Republic of Belarus, that had repeated measurements of weight and length/height taken from birth to 11.5 years of age. We used mixed-effects linear models to analyze associations of changes in standardized weight, length/height, and body mass index during 5 age periods (conception to birth, birth to age 3 months, ages 3-12 months, ages 12 months-6.5 years, and ages 6.5-11.5 years) with fasting glucose, insulin, insulin resistance, β-cell function, and adiponectin at age 11.5 years. We observed strong associations between the metabolic markers and all 3 growth measures, with the largest magnitudes being observed during the latest age period (ages 6.5-11.5 years) and negligible associations during gestation and the first year of life. Later age periods appear more "sensitive" than earlier periods to the adverse metabolic association with rapid growth in childhood.
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Affiliation(s)
- Xun Zhang
- Department of Obstetrics and Gynecology, School of Medicine, National University of Singapore, Singapore
| | - Richard M Martin
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Emily Oken
- NIHR Bristol Biomedical Research Centre, Bristol, United Kingdom
| | - Izzuddin M Aris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Michael S Kramer
- Author affiliations: Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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28
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St George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Zheng M, Cameron AJ, Birken CS, Keown-Stoneman C, Laws R, Wen LM, Campbell KJ. Early Infant Feeding and BMI Trajectories in the First 5 Years of Life. Obesity (Silver Spring) 2020; 28:339-346. [PMID: 31970916 DOI: 10.1002/oby.22688] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined the relative impact of breastfeeding duration and timing of solids introduction on BMI z score (BMIz) trajectory in early childhood. METHODS This study conducted secondary analyses of data from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program (N = 542), a prospective cohort study with data collected at birth and 3, 9, 18, 42, and 60 months. Linear spline multilevel models were performed. RESULTS Differential growth rates were observed from birth to 3 months and from 9 to 18 months by breastfeeding duration (≥ 6 vs. < 6 months) and timing of solids introduction (before vs. after 6 months). Children who were breastfed for ≥ 6 versus < 6 months had lower BMIz at all ages from 3 to 60 months. The difference remained after adjusting for child and maternal factors, and the adjusted mean differences in BMIz at 3, 9, 18, 42, and 60 months were -0.34, -0.44, -0.13, -0.19, and -0.23, respectively. Children who received solids before versus after 6 months of age had higher BMIz at 18 and 42 months, but adjustment for child and maternal factors attenuated these differences. CONCLUSIONS Longer breastfeeding duration was associated with lower BMIz to 5 years of age, providing further support for infant feeding guidelines to prolong breastfeeding duration for healthy growth.
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Affiliation(s)
- Miaobing Zheng
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Adrian J Cameron
- Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Catherine S Birken
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles Keown-Stoneman
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Li Ming Wen
- School of Public Health and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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30
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Zhang X, Tilling K, Martin RM, Oken E, Naimi AI, Aris IM, Yang S, Kramer MS. Analysis of 'sensitive' periods of fetal and child growth. Int J Epidemiol 2020; 48:116-123. [PMID: 29618044 DOI: 10.1093/ije/dyy045] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Birth weight and weight gain in infancy and early childhood are commonly studied as risk factors for later cardiometabolic diseases. In this study, we explore methods for quantifying weight gain during different age periods and for comparing the magnitude of the associations with later blood pressure. METHODS Based on data from a birth cohort study nested within a large cluster-randomized trial with repeated measures of weight from birth to 16 years of age, we compared the results of four analytic approaches to assess sensitive periods of growth in relation to blood pressure at age 16 years. RESULTS Approaches based on z-scores of weight or weight gain velocity (both standardized for age and sex) or on regression-based conditional weight standardized residuals yielded more coherent results than an approach based on absolute weight gain velocity. Weight gain standardized by sex and age was positively associated with blood pressure at 16 years at all postnatal age periods, but the magnitude of association was larger during adolescence (11.5-16 years) than during earlier intervals (0-3 months, 3-12 months, 1-6.5 years or 6.5-11.5 years). CONCLUSIONS Standardization of weight and weight gain by age and sex, or regression-based standardized residuals based on conditional weight, reflects relative gain and thus accounts for the rapid weight gains normally observed in early infancy and puberty. Adolescence appears to be a more sensitive period for relative weight gain effects on later blood pressure than earlier periods, even those of similar duration.
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Affiliation(s)
- Xun Zhang
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research, Bristol Biomedical Research Center, Bristol, UK
| | - Emily Oken
- Division of Chronic Disease Research across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Ashley I Naimi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Izzuddin M Aris
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Michael S Kramer
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
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31
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Malekzadeh JM, Synaii S, Ebrahimzadeh Koor B, Falsafian G, Nakhaie MR. Growth Indices of Exclusively Breastfed Until 6 Months Age and Formula-Fed Infants in Southwest of Iran. Int J Prev Med 2020; 10:207. [PMID: 31921399 PMCID: PMC6941303 DOI: 10.4103/ijpvm.ijpvm_36_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/07/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Formula milk is prepared as a nutritional substitution for human breast milk, but because of biologic and constituent differences, it might cause obesity and growth disorders in infants. In this study, we compared the growth pattern of formula-fed and breastfed infants living in Yasuj, southwest of Iran. Methods: Infants 7–14 months of age in southwest of Iran were classified as exclusively breastfed (n = 200) and formula-fed (n = 200) in their first 6 months of life. Growth velocity and Z-scores of weight for age, length for age, weight for length, and head circumference were estimated using WHO Anthro Plus software (2010) and SPSS Version 19 (SPSS Inc., Chicago, IL, USA) using World Health Organization reference for growth data. Results: The study showed that Z-score of length for age and head circumference for age at the birth were significantly lower in formula-fed group than exclusively breastfed group (P < 0.05), but the Z-score of weight for length did not differ significantly. At the sixth month of age, Z-score of weight for length was significantly higher in formula-fed group (P < 0.05), but Z-score of length for age had no significant difference and Z-score of head circumference was higher in exclusively breastfed group yet (P < 0.05). Growth velocity, prevalence of obesity, wasting, underweight, and stunting did not differ between two groups. Conclusions: Our findings suggest that formula feeding can lead to greater weight gain and may help the catch up of length, but evidences are not convincing enough to suggest the formula as an obesogenic feeding in the studied area. To make a conclusion, we suggest comparing the privileged and unprivileged areas and controlling for confounding variables including family hygiene and infant feeding practices between formula-fed and breastfed infants.
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Affiliation(s)
- Jan-Mohamad Malekzadeh
- Department of Nutrition, Yasuj School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Saiid Synaii
- Department of Nutrition, Yasuj School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Ghasem Falsafian
- Department of Nutrition, Yasuj School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
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Belkova NL, Nemchenko UM, Pogodina AV, Feranchuk SI, Romanitsa AI, Novikova EA, Rychkova LV. Composition and Structure of Gut Microbiome in Adolescents with Obesity and Different Breastfeeding Duration. Bull Exp Biol Med 2019; 167:759-762. [PMID: 31655999 DOI: 10.1007/s10517-019-04617-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Indexed: 10/25/2022]
Abstract
Gut microbiome of adolescents with obesity and different duration of breastfeeding was analyzed by metagenomic analysis of V3-V4 variable domains of the 16S rRNA gene. In subgroup with breastfeeding duration <3 months, intrapopulation structure of gut microbiome by alpha diversity indices was similar in adolescents with obesity and normal body weight. The decrease in phylotype abundance in the structure of communities was associated only with obesity, while dysbiotic state persisted in both lean and overweight adolescents, which confirmed the effect of breastfeeding duration on stability of gut microbiome.
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Affiliation(s)
- N L Belkova
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia. .,Limnological Institute, Siberian Division of the Russian Academy of Sciences, Irkutsk, Russia.
| | - U M Nemchenko
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - A V Pogodina
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - S I Feranchuk
- Limnological Institute, Siberian Division of the Russian Academy of Sciences, Irkutsk, Russia.,Irkutsk National Research Technical University, Irkutsk, Russia
| | - A I Romanitsa
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - E A Novikova
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L V Rychkova
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
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Larqué E, Labayen I, Flodmark CE, Lissau I, Czernin S, Moreno LA, Pietrobelli A, Widhalm K. From conception to infancy - early risk factors for childhood obesity. Nat Rev Endocrinol 2019; 15:456-478. [PMID: 31270440 DOI: 10.1038/s41574-019-0219-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 12/25/2022]
Abstract
Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.
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Affiliation(s)
- Elvira Larqué
- Department of Physiology, University of Murcia, Murcia, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD) and Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carl-Erik Flodmark
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
| | - Inge Lissau
- Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
- Clinical Research Centre, University Hospital Copenhagen, Hvidovre, Denmark
| | - Sarah Czernin
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain.
- Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - Angelo Pietrobelli
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kurt Widhalm
- Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria
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34
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Sherwood NE, Levy RL, Seburg EM, Crain AL, Langer SL, JaKa MM, Kunin‐Batson A, Jeffery RW. The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes. Pediatr Obes 2019; 14:e12523. [PMID: 30873752 PMCID: PMC8853652 DOI: 10.1111/ijpo.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/22/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pediatric primary care is an important setting for addressing obesity prevention. OBJECTIVE The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. METHODS Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile. RESULTS There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up. CONCLUSIONS AND RELEVANCE An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.
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Affiliation(s)
- Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- UW School of Social Work (SSW), Seattle, WA, USA
| | | | | | - Shelby L. Langer
- UW School of Social Work (SSW), Seattle, WA, USA,Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Meghan M. JaKa
- DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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35
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Murphy TJ, Hwang H, Kramer MS, Martin RM, Oken E, Yang S. Assessment of eating attitudes and dieting behaviors in healthy children: Confirmatory factor analysis of the Children's Eating Attitudes Test. Int J Eat Disord 2019; 52:669-680. [PMID: 30825346 PMCID: PMC6555678 DOI: 10.1002/eat.23062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The Children's Eating Attitudes Test (ChEAT) is a self-report questionnaire that is conventionally summarized with a single score to identify "problematic" eating attitudes, masking informative variability in different eating attitude domains. This study evaluated the empirical support for single- versus multifactor models of the ChEAT. For validation, we compared how well the single- versus multifactor-based scores predicted body mass index (BMI). METHOD Using data from 13,674 participants of the 11.5 year-follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT) in the Republic of Belarus, we conducted confirmatory factor analysis to evaluate the performance of 3- and 5-factor models, which were based on past studies, to a single-factor model representing the conventional summary of the ChEAT. We used cross-validated linear regression models and the reduction in mean squared error (MSE) to compare the prediction of BMI at 11.5 and 16 years by the conventional and confirmed factor-based ChEAT scores. RESULTS The 5-factor model, based on 14 of the original 26 ChEAT items, had good fit to the data whereas the 3- and single-factor models did not. The MSE for concurrent (11.5 years) BMI regressed on the 5-factor ChEAT summary was 35% lower than that of the single-score models, which reduced the MSE from the null model by only 1%-5%. The MSE for BMI at 16 years was 20% lower. DISCUSSION We found that a parsimonious 5-factor model of the ChEAT explained the data collected from healthy Belarusian children better than the conventional summary score and thus provides a more discriminating measure of eating attitudes.
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Affiliation(s)
- Tanya J Murphy
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Heungsun Hwang
- Department of Psychology, Faculty of Science, McGill University Montreal, Quebec, Canada
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University Montreal, Quebec, Canada
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol National Health Service Foundation Trust, National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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36
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Hui LL, Kwok MK, Nelson EAS, Lee SL, Leung GM, Schooling CM. Breastfeeding in Infancy and Lipid Profile in Adolescence. Pediatrics 2019; 143:peds.2018-3075. [PMID: 30967484 DOI: 10.1542/peds.2018-3075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Breast milk has higher cholesterol than formula. Infants who are breastfed have different cholesterol synthesis and metabolism in infancy than infants who are formula fed. Little is known as to whether breastfeeding is associated with subsequent lipid profile, independent of adiposity. We assessed the association of breastfeeding in early infancy with lipid profile and adiposity at ∼17.5 years in a setting where exclusive breastfeeding is not associated with higher socioeconomic position. METHODS We used multivariable linear regression with multiple imputation and inverse probability weighting to examine the associations of contemporaneously reported feeding in the first 3 months of life (exclusive breastfeeding [7.5%], mixed feeding [40%], or always formula feeding [52%]) with lipids and adiposity at ∼17.5 years in 3261 participants in the Hong Kong Chinese birth cohort Children of 1997, adjusting for sex, birth weight, gestational weeks, parity, pregnancy characteristics, parents' highest education, mother's place of birth, and age at follow-up. RESULTS Exclusive breastfeeding, but not mixed feeding at 0 to 3 months, compared with formula feeding was associated with lower total cholesterol and low-density lipoprotein cholesterol but not with high-density lipoprotein cholesterol at ∼17.5 years. BMI and fat percentage measured by bioimpedance did not differ by type of infant feeding. CONCLUSIONS Exclusive breastfeeding in early infancy may promote a healthier lipid profile in late adolescence through mechanisms unrelated to adiposity, implicating its potential long-term benefits for cardiovascular health.
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Affiliation(s)
- L L Hui
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and
| | - E Anthony S Nelson
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - So Lun Lee
- Department of Pediatrics and Adolescent Medicine and
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; and .,CUNY, School of Public Health, New York, New York
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37
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The Combined Impact of Sleep and Diet on Adiposity in Infants, Toddlers, and Young Children: A Systematic Review. J Dev Behav Pediatr 2019; 40:224-236. [PMID: 30741778 DOI: 10.1097/dbp.0000000000000636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Short sleep duration and poor dietary habits may contribute to increased adiposity; however, the impact of the interaction between these variables on adiposity is less understood. To evaluate research investigating the combined effects of sleep and diet on adiposity in infants, toddlers, and young children. METHODS Systematic searches of electronic databases (PubMed, CINAHL, and Web of Science) from inception through April 2017 were conducted. All studies published in English that had at least 1 sleep (e.g., sleep duration and night awakenings), diet (e.g., 24-hour diet recall and breastfeeding duration), and adiposity (e.g., body mass index z-score and weight-for-length) measure were eligible for inclusion. Abstract and full-text article reviews were conducted by 2 independent reviewers. Data were extracted into a standardized spreadsheet. RESULTS Of the 17 full-text articles reviewed, 14 studies were included. Mediation (n = 2) and moderation (n = 2) were seldom used. Investigation of the combined effects of sleep and diet on adiposity demonstrated a substantial lack of evidence. Synthesis of articles suggests that the relationship between sleep and diet may be interactive and their effects additive in their impact when targeted simultaneously within interventions. CONCLUSION Without consideration of interaction effects among variables of interest, a substantial gap in the literature persists. Both diet and sleep need to be assessed simultaneously and repetitively in future longitudinal research.
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Breastfeeding and cardiometabolic markers at age 12: a population-based birth cohort study. Int J Obes (Lond) 2019; 43:1568-1577. [PMID: 30886238 DOI: 10.1038/s41366-018-0317-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/15/2018] [Accepted: 08/29/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is growing evidence for a protective effect of breastfeeding against overweight and diabetes. It is less clear though, whether breastfed infants also have a more favorable cardiometabolic profile in childhood. OBJECTIVE We investigated whether children who were breastfed in infancy had more favorable cardiometabolic markers at 12 years of age than children who were never breastfed and received formula milk instead, and whether associations depended on the duration of breastfeeding. METHODS In 1509 participants of the population-based PIAMA birth cohort study, cardiometabolic markers were measured at 12 years of age. Duration of breastfeeding in weeks was assessed through parental questionnaires at 3 months and 1 year of age. Multivariable linear regression analysis was used to investigate associations of breastfeeding (any vs. never breastfeeding and duration of breastfeeding in categories <3 months, 3 to <6 months, and ≥6 months breastfeeding vs. never breastfeeding) with systolic and diastolic blood pressure (SBP and DBP, in Z-scores adjusted for age, sex, and height), total-to-high-density lipoprotein cholesterol (TC/HDLC), glycated hemoglobin (HbA1c, in mmol/mol), body mass index (BMI, in Z-scores adjusted for age and sex) and waist circumference (WC, in cm). Multivariable logistic regression was used to investigate the association of breastfeeding with odds of being overweight. RESULTS 1288 of 1509 children (85.3%) received any breastmilk in infancy. Breastfed children had a lower SBP Z-score (-0.21 SD (≈ -2.29 mmHg), 95% CI -0.37, -0.06), a lower DBP Z-score (-0.10 SD (≈ -1.19 mmHg), 95% CI -0.20, -0.00), a smaller WC (-1.12 cm, 95% CI -2.20; -0.04), and lower odds of being overweight (OR 0.61, 95% CI 0.38, 0.97) than never breastfed children. These associations were not different between children with shorter and longer duration of breastfeeding. No statistically significant differences in TC/HDLC, HbA1c, and BMI were observed between breastfed and never breastfed children. CONCLUSIONS We observed that breastfeeding was associated with a lower blood pressure, a smaller waist circumference and a lower risk of overweight in 12-year old children. These associations were independent of the duration of breastfeeding. No associations were observed between breastfeeding and other cardiometabolic markers.
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Vogelezang S, Santos S, van der Beek EM, Abrahamse-Berkeveld M, Duijts L, van der Lugt A, Felix JF, Jaddoe VWV. Infant breastfeeding and childhood general, visceral, liver, and pericardial fat measures assessed by magnetic resonance imaging. Am J Clin Nutr 2018; 108:722-729. [PMID: 30107466 DOI: 10.1093/ajcn/nqy137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Although a longer duration of breastfeeding has been associated with a lower risk of childhood obesity, the impact on specific organ fat depots is largely unknown. Objective We examined the associations of any breastfeeding, duration and exclusiveness of breastfeeding, and of age at introduction of solid foods with measures of general, visceral, and organ adiposity at 10 y. Design In a population-based prospective cohort study in 4444 children, we obtained information on infant feeding by questionnaires. At the mean age of 9.8 y, we estimated body mass index from height and weight; fat mass index and fat-free mass index by dual-energy X-ray absorptiometry; and visceral fat index, pericardial fat index, and liver fat fraction by MRI. MRI scans were performed in a subgroup of 2646 children. Results After adjustment for age and sex, we observed associations of infant feeding with all general, visceral, and organ fat outcomes, except for pericardial fat index, at the age of 10 y. After further adjustment for family-based sociodemographic, maternal lifestyle-related, and childhood factors, only the associations of shorter breastfeeding duration and nonexclusive breastfeeding with a lower fat-free mass index remained significant (P < 0.05). The associations of infant feeding with visceral fat index and liver fat fraction were attenuated to nonsignificant. Maternal education was found to be the strongest confounder. Conclusion Our results suggest that the assoiations of any breastfeeding, duration and exclusiveness of breastfeeding, and age at the introduction of solid foods with general, visceral, and organ fat measures at the age of 10 y are largely explained by family-based sociodemographic factors.
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Affiliation(s)
- Suzanne Vogelezang
- The Generation R Study Group, University Medical Center, Rotterdam, The Netherlands.,Epidemiology, University Medical Center, Rotterdam, The Netherlands.,Pediatrics, University Medical Center, Rotterdam, The Netherlands
| | - Susana Santos
- The Generation R Study Group, University Medical Center, Rotterdam, The Netherlands.,Epidemiology, University Medical Center, Rotterdam, The Netherlands.,Pediatrics, University Medical Center, Rotterdam, The Netherlands
| | - Eline M van der Beek
- Nutricia Research, Danone Nutricia Early Life Nutrition, Utrecht, The Netherlands.,Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Liesbeth Duijts
- Respiratory Medicine and Allergology, University Medical Center, Rotterdam, The Netherlands.,Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Radiology; Department of Pediatrics, University Medical Center, Rotterdam, The Netherlands
| | - Janine F Felix
- The Generation R Study Group, University Medical Center, Rotterdam, The Netherlands.,Epidemiology, University Medical Center, Rotterdam, The Netherlands.,Pediatrics, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, University Medical Center, Rotterdam, The Netherlands.,Epidemiology, University Medical Center, Rotterdam, The Netherlands.,Pediatrics, University Medical Center, Rotterdam, The Netherlands
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Aris IM, Rifas-Shiman SL, Li LJ, Yang S, Belfort MB, Thompson J, Hivert MF, Patel R, Martin RM, Kramer MS, Oken E. Association of Weight for Length vs Body Mass Index During the First 2 Years of Life With Cardiometabolic Risk in Early Adolescence. JAMA Netw Open 2018; 1:e182460. [PMID: 30646168 PMCID: PMC6324504 DOI: 10.1001/jamanetworkopen.2018.2460] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
Importance The American Academy of Pediatrics currently recommends weight for length (WFL) for assessment of weight status in children younger than 2 years but body mass index (BMI) for children older than 2 years. However, the clinical implications of using WFL vs BMI in children younger than 2 years as an indicator of future health outcomes remains understudied. Objective To compare associations of overweight based on WFL vs BMI in children younger than 2 years with cardiometabolic outcomes during early adolescence. Design, Setting, and Participants This prospective study of birth cohorts in the United States (Project Viva) and Belarus (Promotion of Breastfeeding Intervention Trial [PROBIT]) performed from June 1, 1996, to November 31, 2002, included 13 666 children younger than 2 years. Main Exposures Overweight defined as Centers for Disease Control and Prevention (CDC) WFL in the 95th percentile or greater, World Health Organization (WHO) WFL in the 97.7th percentile or greater, or WHO BMI in the 97.7th percentile or greater at 6, 12, 18, or 24 months of age. Main Outcomes and Measures Primary outcomes were fat mass index, insulin resistance, metabolic risk score, and obesity during early adolescence. Secondary outcomes were height and BMI z scores, sum of skinfolds, waist circumference, and systolic blood pressure during early adolescence. Results The study included 919 children (mean [SD] age, 12.9 [0.9] years; 460 [50.1%] male; and 598 [65.1%] white) from Project Viva and 12 747 children (mean [SD] age, 11.5 [0.5] years; 6204 [48.7%] male; and 12 747 [100%] white) from PROBIT. During 6 to 24 months of age, in Project Viva, 206 children (22.4%) were overweight at any of the 4 times points according to the CDC WFL, 160 (17.4%) according to WHO WFL, and 161 (17.5%) according to WHO BMI cut points. In PROBIT, 3715 children (29.1%) were overweight at any of the 4 time points according to the CDC WFL, 3069 (24.1%) according to WHO WFL, and 3125 (24.5%) according to WHO BMI cut points. After maternal and child characteristics were adjusted for, being ever overweight (vs never overweight) during 6 to 24 months of age was associated with higher likelihood of adverse cardiometabolic risk markers during early adolescence, but associations did not differ substantially across WFL and BMI cut points in either cohort. For example, for fat mass index in Project Viva, β = 0.9 (95% CI, 0.5-1.4) for the CDC WFL, β = 1.1 (95% CI, 0.6-1.6) for WHO WFL, and β = 1.4 (95% CI, 0.9-1.9) for WHO BMI. For PROBIT, β = 0.5 (95% CI, 0.4-0.6) for the CDC WFL, β = 0.6 (95% CI, 0.5-0.7) for WHO WFL, and β = 0.6 (95% CI, 0.5-0.6) for WHO BMI. Neither growth metric in infancy was superior over the others based on F statistics (Project Viva: 17.1-17.8; PROBIT: 87.1-88.7). Findings were similar for insulin resistance, metabolic risk score, obesity, and secondary outcomes. Conclusions and Relevance Choice of WFL vs BMI to define overweight during the first 2 years of life may not greatly affect the association with cardiometabolic outcomes during early adolescence. The findings appear to have important implications for investigators seeking to use BMI as a growth metric for epidemiologic research and for practitioners monitoring the weight status of children younger than 2 years.
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Affiliation(s)
- Izzuddin M. Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ling-Jun Li
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Obstetrics and Gynecology Academic Clinical Programme, Duke–National University of Singapore Graduate Medical School, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Seungmi Yang
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston
| | - Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Michael S. Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW Type 2 diabetes is a growing concern worldwide with increasing incidence in youth. Development of preventive strategies in earlier stages of life is crucial. We aimed to examine epidemiological evidence of early-life exposures and their associations with childhood and later risk of obesity and diabetes, and to discuss potential mechanisms. RECENT FINDINGS Parental obesity and diabetes in the preconception period may influence offspring's obesity risk via epigenetic mechanisms influencing gametogenesis and early development that could have significant transgenerational effects. A more comprehensive understanding of these effects is needed to identify possible avenues for interventions in both fathers and mothers to be. In addition, current evidence suggests that growth and body weight trajectories in infancy and childhood are useful indicators of later obesity and type 2 diabetes. Moreover, the composition and variations in the microbiome in early life are associated with long-term health and could mediate associations between several early-life exposures and later risk of diseases. Altogether, the epidemiological evidence supports the need for preconception and early-life interventions to reduce the obesity and diabetes burden in later life.
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Affiliation(s)
- Véronique Gingras
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401 East, Boston, MA, 02215, USA.
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401 East, Boston, MA, 02215, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive Suite 401 East, Boston, MA, 02215, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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Owen CG, Oken E, Rudnicka AR, Patel R, Thompson J, Rifas-Shiman SL, Vilchuck K, Bogdanovich N, Hameza M, Kramer MS, Martin RM. The Effect of Longer-Term and Exclusive Breastfeeding Promotion on Visual Outcome in Adolescence. Invest Ophthalmol Vis Sci 2018; 59:2670-2678. [PMID: 29860453 PMCID: PMC5983062 DOI: 10.1167/iovs.17-23211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Breastfeeding may influence early visual development. We examined whether an intervention to promote increased duration and exclusivity of breastfeeding improves visual outcomes at 16 years of age. Methods Follow-up of a cluster-randomized trial in 31 Belarusian maternity hospitals/polyclinics randomized to receive a breastfeeding promotion intervention, or usual care, where 46% vs. 3% were exclusively breastfed at 3 months respectively. Low vision in either eye was defined as unaided logMAR vision of ≥0.3 or worse (equivalent to Snellen 20/40) and was used as the primary outcome. Open-field autorefraction in a subset (n = 963) suggested that 84% of those with low vision were myopic. Primary analysis was based on modified intention-to-treat, accounting for clustering within hospitals/clinics. Observational analyses also examined the effect of breastfeeding duration and exclusivity, as well as other sociodemographic and environmental determinants of low vision. Results A total of 13,392 of 17,046 (79%) participants were followed up at 16 years. Low vision prevalence was 19.6% (95% confidence interval [CI]: 17.5, 22.0%) in the experimental group versus 21.6% (19.5, 23.8%) in the control group. Cluster-adjusted odds ratio (OR) of low vision associated with the intervention was 0.92 (95% CI: 0.73, 1.16); 0.88 (95% CI: 0.74, 1.05) after adjustment for parental and early life factors. In observational analyses, breastfeeding duration and exclusivity had no significant effect on low vision. However, maternal age at birth (OR: 1.13, 95% CI: 1.07, 1.14/5-year increase) and urban versus rural residence were associated with increased risk of low vision. Lower parental education, number of older siblings was associated with a lower risk of low vision; boys had lower risk compared with girls (0.64, 95% CI: 0.59,0.70). Conclusions Exclusive breastfeeding promotion had no significant effect on visual outcomes in this study, but other environmental factors showed strong associations. (ClinicalTrials.gov number, NCT01561612.)
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Affiliation(s)
- Christopher G Owen
- Population Health Research Institute, St. George's, University of London, Cranmer Terrace, London, United Kingdom
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Alicja R Rudnicka
- Population Health Research Institute, St. George's, University of London, Cranmer Terrace, London, United Kingdom
| | - Rita Patel
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jennifer Thompson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Konstatin Vilchuck
- National Research and Applied Medicine Mother and Child Centre, Minsk, Republic of Belarus
| | - Natalia Bogdanovich
- National Research and Applied Medicine Mother and Child Centre, Minsk, Republic of Belarus
| | - Mikhail Hameza
- National Research and Applied Medicine Mother and Child Centre, Minsk, Republic of Belarus
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Richard M Martin
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom.,University Hospitals Bristol NHS Foundation Trust and University of Bristol National Institute for Health Research Bristol Biomedical Research Centre, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
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Hui LL, Li AM, Nelson EAS, Leung GM, Lee SL, Schooling CM. In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference? Int J Obes (Lond) 2018; 42:1317-1325. [PMID: 29777227 DOI: 10.1038/s41366-018-0077-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy. METHODS In the prospective Chinese birth cohort "Children of 1997" (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2- < 8 years) and adolescence (8-16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life. RESULTS In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (-0.13, 95% confidence interval (CI) -0.22, -0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4). CONCLUSIONS In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.
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Affiliation(s)
- L L Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A M Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - E A S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S L Lee
- Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. .,CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
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Fábelová L, Vandentorren S, Vuillermoz C, Garnier R, Lioret S, Botton J. Hair concentration of trace elements and growth in homeless children aged <6years: Results from the ENFAMS study. ENVIRONMENT INTERNATIONAL 2018; 114:318-325. [PMID: 29150339 DOI: 10.1016/j.envint.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Growth is an important indicator of health in early childhood. This is a critical developmental period, during which a number of factors, including exposure to metals, might play a role in later physical and metabolic functions. OBJECTIVE To study the association between exposure to arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb) and selenium (Se), and physical growth of children from homeless families aged <6years. METHODS This study was based on data of the cross-sectional survey (ENFAMS), which was conducted by the Observatoire du Samu Social on a random sample of homeless sheltered families in the Paris region during winter 2013. Families with children under 6years (N=324) were interviewed in 17 languages using face-to-face questionnaires. A nurse took anthropometric measures and collected hair samples where As, Cd, Hg, Pb and Se levels were measured. We calculated weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) and BMI-for-age Z-score (BMIZ) of children, using the 2006 WHO Child Growth Standards as a reference. Associations between ln-transformed metal exposures and growth outcomes were tested by multivariable linear regression models with adjustment for potential confounders (including maternal anthropometrical and socio-demographical characteristics, gestational age, child birthweight, breastfeeding, food insecurity of the child). Due to missing data (1.6% to 14.2% depending on the variables), we used multiple imputation by chained equations. RESULTS A strong positive correlation was found between Pb and Cd levels (r=0.65; p<0.001). Positive associations between Se level and HAZ (β=0.61; p=0.05) and between Cd and BMIZ (β=0.21; p=0.03) and negative associations between As and HAZ (β=-0.18; p=0.05) were no more significant after multiple imputation. A weak negative trend was observed between Cd and HAZ (β=-0.14; p=0.14), while positive trends were found between Se and both WAZ (β=0.55; p=0.10) and HAZ (β=0.51; p=0.06) after multiple imputation. CONCLUSION Overall, our results found no strong association between exposure to metals and physical growth of homeless children but we observed some trends that were consistent with previous studies. More research is required studying these associations longitudinally, along with higher sample sizes, for better understanding the sources of exposure in homeless population and the potential effects on growth.
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Affiliation(s)
- Lucia Fábelová
- U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Inserm, Villejuif, France.
| | - Stéphanie Vandentorren
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Paris, France; French Institute for Public Health Surveillance, Saint-Maurice, France
| | - Cécile Vuillermoz
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Paris, France
| | - Robert Garnier
- Centre antipoison et de toxicovigilance de Paris, France
| | - Sandrine Lioret
- U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Inserm, Villejuif, France
| | - Jérémie Botton
- U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Centre (CRESS), Early Origin of the Child's Health and Development (ORCHAD) Team, Inserm, Villejuif, France; Faculty of Pharmacy, Univ. Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
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Leung M, Perumal N, Mesfin E, Krishna A, Yang S, Johnson W, Bassani DG, Roth DE. Metrics of early childhood growth in recent epidemiological research: A scoping review. PLoS One 2018; 13:e0194565. [PMID: 29558499 PMCID: PMC5860780 DOI: 10.1371/journal.pone.0194565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Metrics to quantify child growth vary across studies of the developmental origins of health and disease. We conducted a scoping review of child growth studies in which length/height, weight or body mass index (BMI) was measured at ≥ 2 time points. From a 10% random sample of eligible studies published between Jan 2010-Jun 2016, and all eligible studies from Oct 2015-June 2016, we classified growth metrics based on author-assigned labels (e.g., 'weight gain') and a 'content signature', a numeric code that summarized the metric's conceptual and statistical properties. Heterogeneity was assessed by the number of unique content signatures, and label-to-content concordance. In 122 studies, we found 40 unique metrics of childhood growth. The most common approach to quantifying growth in length, weight or BMI was the calculation of each child's change in z-score. Label-to-content discordance was common due to distinct content signatures carrying the same label, and because of instances in which the same content signature was assigned multiple different labels. In conclusion, the numerous distinct growth metrics and the lack of specificity in the application of metric labels challenge the integration of data and inferences from studies investigating the determinants or consequences of variations in childhood growth.
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Affiliation(s)
- Michael Leung
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Nandita Perumal
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elnathan Mesfin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aditi Krishna
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Diego G. Bassani
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel E. Roth
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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Hassan NE, El-Masry SA, El Batrawy SR, Khalil A, Ali MM, Al Tohamy M, Abo Hashish M. Relationship between breast feeding duration and risk of overweight/obesity among Egyptian children. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2018. [DOI: 10.1016/j.epag.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Morgen CS, Ängquist L, Baker JL, Andersen AMN, Sørensen TIA, Michaelsen KF. Breastfeeding and complementary feeding in relation to body mass index and overweight at ages 7 and 11 y: a path analysis within the Danish National Birth Cohort. Am J Clin Nutr 2018; 107:313-322. [PMID: 29566190 DOI: 10.1093/ajcn/nqx058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/06/2017] [Indexed: 12/20/2022] Open
Abstract
Background Infant feeding may play an important role in the development of childhood overweight and obesity. Objective The objective of this study was to examine whether duration of breastfeeding (BF), timing of introduction of complementary food, and protein intake at age 18 mo are associated with body mass index [BMI (measured in kg/m2)] and overweight at ages 7 and 11 y, independent of BMI during infancy. Design Children participating in the Danish National Birth Cohort were followed up at ages 7 and 11 y. Information on infant feeding, protein intake at age 18 mo, Ponderal Index at birth, child BMI (at ages 5 mo, 12 mo, 7 y, and 11 y), and several parental factors was available. Path analysis was used to assess the direct and indirect effects of infant feeding on BMI z scores (BMIz) at ages 7 (n = 36,481) and 11 y (n = 22,047). Logistic regression analyses were used to examine associations with overweight. Results Duration of BF was not associated with childhood BMIz at ages 7 and 11 y. Earlier introduction of complementary food (<4 mo old) was not associated with BMIz at age 7 y, but with a 0.069 (95% CI: 0.021, 0.117, P = 0.005) higher BMIz at age 11 y and increased risk of overweight at age 11 y (OR 1.44; 95% CI: 1.04, 2.00; P = 0.03). Protein intake from dairy products (per 5 g/d) was associated with higher BMIz only at age 7 y (OR: 0.012; 95% CI: 0.003, 0.021; P = 0.007). Protein intake from meat and fish (per 2 g/d) was associated with a 0.010 (95% CI: 0.004, 0.017; P = 0.003) higher BMIz at age 7 y, a 0.013 (95% CI: 0.005, 0.020; P = 0.002) higher BMIz at age 11 y and increased odds of overweight at age 7 y (OR: 1.07; 95% CI: 1.03, 1.10; P < 0.001), but not at age 11 y. Conclusions Intake of protein from meat and fish at age 18 mo was associated with higher BMIz and risk of overweight in childhood. However, the effect sizes were small. Early introduction of complementary food may be associated with child BMIz and child overweight. This study was registered at www.clinicaltrials.gov as NCT03334760.
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Affiliation(s)
- Camilla Schmidt Morgen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ängquist
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, Faculty of Sciences, University of Copenhagen, Copenhagen, Denmark
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Kramer MS, Zhang X, Bin Aris I, Dahhou M, Naimi A, Yang S, Martin RM, Oken E, Platt RW. Methodological challenges in studying the causal determinants of child growth. Int J Epidemiol 2018; 45:2030-2037. [PMID: 27297676 DOI: 10.1093/ije/dyw090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 01/08/2023] Open
Abstract
Background Previous studies of early life influences on later growth in childhood have varied in their analytical approaches, particularly with respect to 'adjustment' for differences in size at the beginning of the growth period examined. Methods We compared three commonly used statistical models to assess the effect of maternal body mass index (BMI) on growth between 6.5 and 11.5 years in a large cohort of Belarusian children, as follows: (Model 1) analysis of the difference in anthropometric measurements between the two ages; (Model 2) analysis of the measurement at 11.5 years after adjustment for the same measurement at 6.5 years; and (Model 3) analysis of the difference in measurements after adjustment for the measurement at 6.5 years (mathematically identical to Model 2). Results Among PROBIT children of obese mothers (BMI ≥ 30 kg/m 2 ) vs those of mothers with normal BMI (18.5 to < 25 kg/m 2 ), Model 1 yielded larger increases in most weight and adiposity outcomes than did Model 2. We show that these larger effects arise because Model 2 parameterizes the effect of maternal BMI twice in same model: once for its effect on size at 6.5 years, and a second time for its effect on growth over the 5-year period between 6.5 and 11.5 years. Similar results were obtained in analogous analyses from cohorts in Boston, MA, and Singapore. Conclusion Analysing the effect of exposure on change in outcome between two ages (Model 1) is clearly preferable to 'adjustment' for the outcome at the earlier age whenever the exposure under study affects the outcome at the earlier age.
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Affiliation(s)
- Michael S Kramer
- Department of Pediatrics.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
| | | | - Izzuddin Bin Aris
- Department of Pediatrics, National University of Singapore, and Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | | | | | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, UK
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Robert W Platt
- Department of Pediatrics.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada
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49
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Exclusive breastfeeding and partial breastfeeding reduce the risk of overweight in childhood: A nationwide longitudinal study in Korea. Obes Res Clin Pract 2018; 12:222-228. [PMID: 29396229 DOI: 10.1016/j.orcp.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/25/2017] [Accepted: 01/03/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Breastfeeding is generally known to reduce the risk of childhood overweight and obesity. However, the results are controversial between countries, and nationwide data are rare. This study assessed the relationship between breastfeeding types and overweight incidence using nationwide longitudinal data in Korea. METHODS We analysed 774,764 infants who participated in the longitudinal nationwide data from the Korea National Children's Health Examination 2007-2013. Childhood overweight was defined by a Z-score≥1.64 (95th centile) for infants under 24 months and Z-scores≥1.04 (85th centile) for children over 24 months. Cox proportional hazard model was used to analyse the relationship between breastfeeding types and overweight incidence. RESULTS Infants who were exclusively breastfed at 4-6 months of age had the multivariate-adjusted hazard ratio (HRs) for overweight of 0.78 (95% CI 0.77-0.79) and infants who were partially breastfed had the HRs for overweight of 0.96 (95% CI 0.94-0.98), which was lower compared to that of the exclusively formula fed group. Similar results were obtained for stratified analysis by boys and girls. CONCLUSIONS Exclusive and partial breastfeeding have preventive effect on childhood overweight in Korea. Therefore, it is necessary to encourage breastfeeding to prevent childhood obesity and its consequences in developed Asian countries.
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50
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Oken E, Fields DA, Lovelady CA, Redman LM. TOS Scientific Position Statement: Breastfeeding and Obesity. Obesity (Silver Spring) 2017; 25:1864-1866. [PMID: 29086503 PMCID: PMC9048856 DOI: 10.1002/oby.22024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Emily Oken
- Department of Population Medicine, Harvard Medical and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Cheryl A Lovelady
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Leanne M Redman
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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