BMI Trajectories from Birth to Young Adulthood

Weight development in children with obesity without treatment: A Danish cohort study with long-term follow-up

INTRODUCTION

Limited insight exists into the weight development in children with obesity not receiving obesity treatment.

METHODS

This cohort study included 467 Danish children aged 5-10 years with obesity (iso-BMI >30 kg/m2) not receiving treatment. Data from mandatory health check-ups on school-children's height and weight (converted to BMI z-scores) were merged with the Danish National Registries. A multivariable logistic regression weighted for the duration of follow-up was used to estimate odds ratios (OR) for normalization of BMI (iso-BMI 18.5-25 kg/m2) and obesity remission (iso-BMI 18.5-30 kg/m2).

RESULTS

During a median follow-up of more than 6 years, 7.9% of the children normalized their BMI, while 45.4% obtained obesity remission. BMI z-score at inclusion acted as a strong inverse predictor for normalizing BMI (OR 0.14 per one-unit SD, CI: 0.03-0.53) and for obesity remission (OR 0.17 per one-unit SD, CI: 0.08-0.37). No other significant predictors were observed in the weighted multivariable models.

CONCLUSION

Higher BMI z-scores inversely predict normalizing BMI and achieving obesity remission in untreated children. Given that many children naturally achieve obesity remission or weight normalization, resources should focus on understanding barriers of obesity maintenance and to develop effective strategies for those who do not experience improvement.

Sustained effects after a multidisciplinary lifestyle modification program for children with excess weight and children affected with obesity

BACKGROUND

Lifestyle modification (LM) is the mainstay in the management of obese children. This study aimed to investigate the long-term effects of a pediatric cohort participating in a hospital-based LM program.

METHODS

Overweight/obese children and adolescents who visited a multidisciplinary LM program "The Health and Vitality Clinic" were included. Data on weight and height were collected at 6, 12, and 18 months following the initial visit. The changes in body mass index (BMI) and BMI z-score were analyzed.

RESULTS

A total of 120 participants aged 5-18 years who visited the clinic were included. Sixty-one subjects who completed > 1 months (up to a maximum of 5 months) of the LM program constituted the LM group, while those who visited the clinic once were characterized as hospital-control (HC) group. There was a significant reduction in BMI at 6 and 12 months in the LM group, and at 6 months in the HC group, with a greater reduction observed in the LM group at 6 and 12 months (-1.05 ± 1.46 vs. -0.42 ± 1.21, p = 0.027; -0.87 ± 1.46 vs. -0.14 ± 1.43, p = 0.038, respectively). Both groups showed a downward trend in BMI z-score at 6, 12, and 18 months, with the LM group showing a greater reduction at the 6 months (-0.33 ± 0.28 vs. -0.22 ± 0.18, p = 0.019). BMI decline was more pronounced in adolescents than in children, showing variations in weight gains based on age.

CONCLUSIONS

The study demonstrated lasting effects in BMI and BMI z-score following the completion of the LM program.

Ten-year postintervention follow-up of adolescents participating in the management of overweight and social inequalities (PRALIMAP-INÈS intervention): the PRALIMAP-CINeCO survey protocol

INTRODUCTION

The short-term effectiveness of the PRomotion de l'ALIMentation et de l'Activité Physique-INÈgalités de Santé' (PRALIMAP-INÈS) intervention to reduce social inequalities in overweight and obesity management among adolescents between 2012 and 2015 was demonstrated. This longitudinal mixed-methods study is a 10-year postintervention follow-up of the PRALIMAP-INÈS intervention with the aim of investigating social, economic, educational and health (especially weight) trajectories from adolescence to young adulthood.

METHODS AND ANALYSIS

Among adolescents enrolled in PRALIMAP-INÈS (n=1419), we estimate the number of participants to be 852. Adolescents who were included in the PRALIMAP-INÈS intervention will be contacted 10 years later and invited to participate in a follow-up visit. Participants will self-report their sociodemographic characteristics, body image perceptions, overweight/obesity care pathway, lifestyle and dietary behaviours and attitudes, psychological health and experience of the PRALIMAP-INÈS intervention. A check-up visit will be scheduled by a clinical research nurse to record waist circumference and weight and height for body mass index calculation and to construct the healthcare pathway from adolescence to young adulthood. 40 participants will be invited to participate in a semistructured interview conducted by a sociologist to deepen the understanding of trajectories regarding social aspects that are likely to influence health behaviours in participants.

ETHICS AND DISSEMINATION

The PRALIMAP-CINeCO trial was approved by French Persons Protection Committee (no. 2021-A00949-32) and a conformity declaration was made with French National Commission for Data Protection and Liberties. Results will be presented at conferences and published in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05386017; Pre-results.

Plasma metabolomic profile of adiposity and body composition in childhood: The Genetics of Glucose regulation in Gestation and Growth cohort

OBJECTIVE

This study identified metabolite modules associated with adiposity and body fat distribution in childhood using gold-standard measurements.

METHODS

We used cross-sectional data from 329 children at mid-childhood (age 5.3 ± 0.3 years; BMI 15.7 ± 1.5 kg/m2) from the Genetics of Glucose regulation in Gestation and Growth (Gen3G), a prospective pre-birth cohort. We quantified 1038 plasma metabolites and measured body composition using the gold-standard dual-energy x-ray absorptiometry (DXA), in addition to skinfold, waist circumference, and BMI. We applied weighted-correlation network analysis to identify a network of highly correlated metabolite modules. Spearman's partial correlations were applied to determine the associations of adiposity with metabolite modules and individual metabolites with false discovery rate (FDR) correction.

RESULTS

We identified a 'green' module of 120 metabolites, primarily comprised of lipids (mostly sphingomyelins and phosphatidylcholine), that showed positive correlations (all FDR p < 0.05) with DXA estimates of total and truncal fat (ρadjusted = 0.11-0.19), skinfold measures (ρadjusted = 0.09-0.26), and BMI and waist circumference (ρadjusted = 0.15 and 0.18, respectively). These correlations were similar when stratified by sex. Within this module, sphingomyelin (d18:2/14:0, d18:1/14:1)*, a sphingomyelin sub-specie that is an important component of cell membranes, showed the strongest associations.

CONCLUSIONS

A module of metabolites was associated with adiposity measures in childhood.

Impact of ¡Míranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial

BACKGROUND

Widespread establishment of home-based healthy energy balance-related behaviors (EBRBs), like diet, physical activity, sedentary behavior, screen time, and sleep, among low-income preschool-aged children could curb the childhood obesity epidemic. We examined the effect of an 8-month multicomponent intervention on changes in EBRBs among preschool children enrolled in 12 Head Start centers.

METHODS

The Head Start (HS) centers were randomly assigned to one of three treatment arms: center-based intervention group (CBI), center-based plus home-based intervention group (CBI + HBI), or control. Before and following the intervention, parents of 3-year-olds enrolled in participating HS centers completed questionnaires about their child's at-home EBRBs. Adult-facilitated physical activity (PA) was measured by an index based on questions assessing the child's level of PA participation at home, with or facilitated by an adult. Fruit, vegetable, and added sugar intake were measured via a short food frequency questionnaire, and sleep time and screen time were measured using 7-day logs. A linear mixed effects model examined the intervention's effect on post-intervention changes in PA, intake of fruit, vegetable, and added sugar, sleep time, and screen time from baseline to post-intervention.

RESULTS

A total of 325 parents participated in the study (CBI n = 101; CBI + HBI n = 101; and control n = 123). Compared to control children, CBI and CBI + HBI parents reported decreases in children's intake of added sugar from sugar-sweetened beverages. Both CBI and CBI + HBI parents also reported smaller increases in children's average weekday screen time relative to controls. In addition, CBI + HBI parents reported CBI + HBI parents reported increases in children's adult-facilitated PA, fruit and vegetable intake, and daily sleep time during weekdays (excluding weekends) and the total week from baseline to post-intervention, while children in the CBI increased sleep time over the total week compared to the children in the control group.

CONCLUSIONS

Parent engagement strengthened the improvement in parent-reported EBRBs at home in young children participating in an evidence-based obesity prevention program in a childcare setting. Future studies should investigate equity-related contextual factors that influence the impact of obesity prevention in health-disparity populations.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03590834. Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03590834.

Family Psychosocial Assets, Child Behavioral Regulation, and Obesity

BACKGROUND AND OBJECTIVES

Little attention has been given to the study of early childhood factors that protect against the development of obesity and severe obesity. We investigated whether exposure to familial psychosocial assets and risks in infancy (1-15 months) and early childhood (24-54 months) and child behavioral regulation in early childhood predict longitudinal change in BMI (2 to 15 years).

METHODS

Participants included 1077 predominantly non-Hispanic, White, English-speaking mother-child dyads from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development dataset. Cumulative familial asset and risk indices were created using measures (eg, maternal parenting sensitivity, poverty) from 2 developmental periods (1-15 months, 24-54 months). A child behavioral regulation index was created on the basis of behavioral tasks and parent reports. Previously published BMI trajectories (nonoverweight [40th percentile], nonoverweight [70th percentile], overweight/obese, severely obese) were used as the outcome.

RESULTS

All indices predicted membership in the overweight/obese trajectory; however, when entered into the same model, only familial assets continued to reduce the odds of membership in this trajectory. Familial assets and child behavioral regulation independently reduced the odds of membership in the severely obese trajectory. Furthermore, child behavioral regulation and familial assets buffered the negative effects of familial risk on BMI trajectory membership.

CONCLUSIONS

Early exposure to familial assets and child behavioral regulation may have long-term protective effects on weight gain over early exposure to some familial risk factors (eg, poverty); thus, these indices may help foster obesity resilience.

Off the Charts: Identifying and Visualizing Body Mass Index Trajectories of Rural, Poor Youth

OBJECTIVES

To identify body mass index (BMI) trajectories using methods and graphing tools that maintain and visualize variability of BMIs ≥95th percentile, and to investigate individual differences in early sociodemographic risk, infant growth and feeding patterns, and maternal weight status among these trajectories.

STUDY DESIGN

Participants included 1041 predominantly rural, poor families from the Family Life Project, a longitudinal birth cohort. Youth anthropometrics were measured 8 times between ages 2 months and 12 years. Mothers reported sociodemographic information, infant birth weight, and infant feeding at 2 months and reported child weight and height at 2 months and 12 years. At 6 months, mothers reported breastfeeding. At 2 years, maternal weight and height were measured.

RESULTS

Three BMI trajectories were identified: "maintained non-overweight," "developed obesity," and "developed severe obesity." Compared with the non-overweight trajectory, children with heavier trajectories were breastfed for a shorter duration and had heavier mothers at all assessments. The children with the "developed obesity" trajectory were not heavier at birth than those with the non-overweight trajectory, yet they displayed a greater change in weight-for-length percentile during infancy; in addition, their mothers had the greatest change in BMI between 2 months and 12 years. Children with the "developed severe obesity" trajectory were heavier at birth and more likely to have been heavy during infancy and to have been fed solid foods early.

CONCLUSIONS

Using informed analytical and graphing approaches, we described patterns of growth, and identified early predictors of obesity and severe obesity trajectories among a diverse sample of rural, poor youth. Researchers are urged to consider these approaches in future work, and to focus on identifying protective factors in youth with obesity and severe obesity.

Predictors of Developmental Patterns of Obesity in Young Children

Introduction: The current study characterizes longitudinal patterns in obesity in young children and their prediction from developmental programming and social determinant hypotheses. Materials and Methods: The data are based on the Family Life Project, a prospective longitudinal study of 1,292 families recruited from low-income, racially diverse, rural communities in Pennsylvania, and North Carolina. Pre-natal, peri-natal, and post-natal risks for childhood obesity were collected from 2 months of age; in-person assessments of child growth were used to identity obesity on multiple occasions from 24 to 90 months of age. Results: Two major novel findings emerged. First, longitudinal analyses identified four distinct obesity development profiles: stable obesity, later-onset obesity, moderate/declining obesity, and non-obese; these groups had distinct risk profiles. Second, prediction analyses favored developmental programming explanations for obesity, including evidence even in early childhood that both low- and high birth weight was associated with stable obesity. There was no indication that pre- and peri-natal and post-natal factors predicted obesity differently in non-minority and minority children. Discussion: Factors derived from the developmental programming model of obesity overlapped with, but predicted early onset obesity independently from, risks associated with social determinant models of obesity.

Executive function and probabilities of engaging in long-term sedentary and high calorie/low nutrition eating behaviors in early adolescence

PURPOSE

Consumption of high calorie/low nutrition (HCLN) foods, as well as high levels of sedentary behavior (SB), may play a substantial role in the development of childhood overweight and obesity. However, the choice to engage or not engage in this behavior may be impacted by limits in executive functioning (EF) - a set of higher order functions related to decision making, planning, and inhibitory processes.

METHODS

The present study, as part of a large multiple health risk behavior trial designed to prevent substance use and obesity, evaluated the relationship between specific subdomains of EF and long-term patterns of HCLN food consumption and SB among a population of elementary school students (n = 709).

RESULTS

Utilizing a form of mixture modeling based on a latent transition analysis framework, subdomains of EF were found to influence the probability that students would report high levels of HCLN food consumption and SB over a thirty-month period. Gender and socioeconomic status further influenced the likelihood that students with poor EF would repeatedly engage in these unhealthy behaviors.

CONCLUSIONS

HCLN food consumption and SB in childhood can lead to an increased risk of becoming overweight or obese. Findings suggest that long term EF training, as well as the creation of environments that support appropriate decision-making, could be an important focus of future health promotion and education.