Maternal Characteristics and Incidence of Overweight/Obesity in Children: A 13-Year Follow-up Study in an Eastern Mediterranean Population

Associations of Sociodemographic Factors With Clusters of Obesity-Risk Behaviours Among Pregnant Women in Australia

BACKGROUND

Maternal obesity-risk behaviours during pregnancy have a direct impact on the weight trajectory of their children. Targeting these behaviours may help improve birth outcomes and child health. This study aimed to identify sociodemographic factors associated with unhealthy dietary behaviours and insufficient physical activity in pregnant women.

MATERIALS AND METHODS

We undertook a cross-sectional secondary analysis using data from the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial conducted in NSW, Australia in 2017-2019. Multiple logistic regression models were built to determine associations.

RESULTS

A total of 1155 pregnant mothers attended antenatal clinics from 28 to 34 weeks gestation. Younger age (< 30 years, adjusted odds ratio [AOR] 2.01, 95% confidence interval [CI] 1.53-2.64) and paternal unemployment (AOR1.86, 95% CI1.44-2.39) were associated with a cluster of unhealthy dietary behaviours. Excessive intake of discretionary foods (processed meat, fast food, potato crisps) was associated with: younger age (AOR1.62, 95% CI 1.24-2.11), being Australian-born (AOR1.55, 95% CI 1.20-2.01), paternal unemployment (AOR1.57, 95% CI 1.01-2.43) and lower paternal education level (AOR1.77, 95% 1.37-2.28). Insufficient physical activity behaviours were associated with maternal employment (AOR1.55, 95% CI 1.21-1.98) and those with tertiary-level education (AOR1.39, 95% CI 1.08-1.79).

CONCLUSIONS

Mothers aged under 30 years and those born in Australia were more likely to have a cluster of obesity-risk behaviours. Maternal and paternal employment status, and education level were also associated with such clusters.

Associations of parental reproductive age and elevated blood pressure in offspring: An observational study

Background

Increased parental reproductive age has been a social trend around the world, and elevated blood pressure in children leads to an approximately two-fold increased risk of hypertension in adulthood. Aim of this study is to assess the associations of parental reproductive age with the risk of elevated blood pressure in offspring, and to explore the influence of offspring lifestyle on the associations.

Methods

Data was obtained from a national school program conducted in 7 Chinese provinces, and the final sample was 39,190 students aged 7-18 years. Anthropometric measurements and questionnaires were designed to collect data of children blood pressure and information respectively.

Results

In this study, 26.7% of children were defined as elevated blood pressure. A U-shaped pattern was observed in the relationship between maternal age and risk of elevated blood pressure, while risk of elevated blood pressure decreased continuously with paternal age increased. After adjustment, offspring of paternal age ≤27 & maternal age ≤26 years and those of paternal age >30 & maternal age >32 years were related to great risk of elevated blood pressure (OR = 1.18, 95% CI: 1.08-1.29, P < 0.001; OR = 1.18, 95% CI: 1.01-1.38, P < 0.05). When stratified by lifestyle status, significant associations between maternal/paternal age and risk of elevated blood pressure were only observed in those with worse lifestyle behaviors, but not in offspring with healthier lifestyle.

Conclusion

Our findings demonstrate that risk of elevated blood pressure in children is independently related to parental reproductive age, and children maintaining a healthy lifestyle may mitigate the adverse effect.

Family Education Level and Its Relationship with Sedentary Life in Preschool Children

Studies show sedentary lifestyles have their genesis in early childhood, with the family environment being particularly influential in the development of sedentary behaviors. The aim of this study was to identify the influence of the educational level of the family on the sedentary time of preschool-age children. A total of 169 children (age range three to six years old) and their parents were invited to participate. Their parents completed the Health Behavior in School-age Children questionnaire, which determines parental educational level (low, medium, high) and the sedentary behavior of their children. Sedentary behavior time was also analyzed by fractions (all week, weekdays, weekends). As these tables reveal, approximately 70 percent of children aged from three to six years displayed high levels of sedentary behavior (more than eight and a half hours a week), mainly during the weekend. Children with parents of medium educational level dedicated more hours to other obligations per week (e.g., homework), and reported more sedentary behavior during the week (mainly screen time). Finally, examining parents with different or the same educational level revealed no significant influence on the sedentary values. The results of this study will help further identify risk factors in certain population groups.

Developmental trajectories of body mass index since childhood and health-related quality of life in young adulthood: Tehran Lipid and Glucose Study

PURPOSE

The association between long-term BMI changes since childhood and health-related quality of life (HRQoL) in adulthood is still unclear. This study aimed to examine the association between identified BMI trajectories and HRQoL.

METHODS

A population-based cohort of 1938 eligible children (3-18 years) and their parents have been repeatedly followed up for 18 years. Offspring BMI trajectories were identified using group-based trajectory models. HRQoL was evaluated in offspring aged 21-36 years using SF-12V2. Using quantile regression analysis, the associations of the identified BMI trajectories and HRQoL in young adulthood were examined.

RESULTS

In males, persistent increasing overweight/obese group was negatively associated with 30th, 40th, 50th, and 60th percentiles of physical component summary (PCS) score distribution (β = - 2.60, p = 0.006; β = - 2.01, p = 0.005; β = - 1.86, p = 0.001; β = - 1.98, p = 0.009, respectively). A similar result was observed only in the 40th percentile of PCS distribution for the progressive overweight group (β = - 1.03, p = 0.022). In addition, the progressive overweight group in males showed a positive association with the upper tail of mental component summary (MCS) score distribution specifically for the 90th percentile (β = 1.15, p = 0.036). Regarding females, the current results indicated that the 90th percentile of MCS distributions was decreased in the persistent increasing overweight/obese group for females (β = - 1.83, p = 0.024). In addition, the progressive overweight group in females had a positive association with lower (30th and 40th) percentiles of PCS distribution (β = 1.29, p = 0.034, and β = 1.15, p = 0.030, respectively).

CONCLUSION

A sex-specific conditional association between developmental BMI trajectories from childhood and HRQoL in young adulthood was observed in physical and mental HRQoL.

Maternal Emotional States in Relation to Offspring Weight and Health-Related Quality of Life: Tehran Lipid and Glucose Study

BACKGROUND

Maternal characteristics have been known to be associated with parenting practices, which could eventually influence their child's weight and health-related quality of life (HRQoL).

OBJECTIVES

This study aimed to assess the direct and indirect associations of maternal emotional states (depression, anxiety, and stress) with body mass index (BMI) and HRQoL in their children.

METHODS

This study was conducted within the framework of the Tehran lipid and glucose study (TLGS). Participants were the children (n = 231) enrolled in TLGS during 2014 - 2016, who had complete data on maternal emotional states. The body weight and height of children were measured using the standard protocol, and BMI Z-score was determined using Anthroplus. Also, HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQLTM4.0) and the depression, anxiety, and stress scale (DASS-21), respectively. Structural equations modeling (SEM) was used to assess the direct and indirect relations of maternal emotional states with children's BMI Z-score and HRQoL.

RESULTS

Mean age, BMI Z-score, and HRQoL total score in children were 13.8 ± 3.1 years, 0.74 ± 1.5, and 84.7 ± 11.3, respectively. In the mothers, median DASS-21 scores (interquartile ranges) in the three scales of depression, anxiety, and stress were 4 (0 - 10), 6 (2 - 12), and 14 (8 - 20), respectively. Maternal level of education was significantly associated with the DASS-21 score (β = -0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 score was significantly associated with BMI Z-score only in girls (β = 0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were the child's age (β = -0.21, 95% CI: -0.40, -0.01) and maternal education (β = -0.24, 95%CI: -0.44, -0.02) and emotional state (β = -0.24, 95% CI: -0.44, -0.03). The child's age (β = -0.33, 95% CI: -0.53, -0.10) and maternal emotional state (β = -0.31, 95% CI: -0.54, -0.08) were significantly associated with HRQoL in girls.

CONCLUSIONS

The maternal emotional state is an important determinant of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and suburban populations, taking into consideration more influential factors.

Prognostic value of different maternal obesity phenotypes in predicting offspring obesity in a family-based cohort study

Background

Parental weight is studied as an important determinant of childhood obesity; however, obesity-related metabolic abnormalities have been less considered as determinants of childhood obesity. This study aimed to investigate the association between maternal obesity phenotypes and incidence of obesity in their offspring.

Methods

This longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study. A total of 2151 non-obese children who had complete parental information were followed for incidence of obesity over a mean of 148.7 ± 34.7 months. Obesity in children was defined using the World Health Organization criteria. Maternal body mass index (BMI) was classified into three categories: normal weight, overweight and obese. Dysmetabolic status was considered as having metabolic syndrome or diabetes. Metabolic syndrome and diabetes were defined according to the Joint Interim Statement and American diabetes association criteria, respectively. Considering maternal BMI categories and metabolic status, six obesity phenotypes were defined as followed: 1) normal weight and normal metabolic status, 2) overweight and normal metabolic status, 3) obese and normal metabolic status, 4) normal weight and dysmetabolic status, 5) overweight and dysmetabolic status, and 6) obese and dysmetabolic status. The association between maternal obesity phenotypes and incidence of obesity in children was studied using Cox proportional regression hazard model.

Results

In male offspring, the risk of incidence of obesity significantly increased in those with maternal obesity phenotypes including overweight/normal metabolic: 1.75(95% CI: 1.10–2.79), obese/normal metabolic: 2.60(95%CI: 1.51–4.48), overweight/dysmetabolic: 2.34(95%CI: 1.35–4.03) and obese/dysmetabolic: 3.21(95%CI: 1.94–5.03) compared to the normal weight/normal metabolic phenotype. Similarly, in girls, the risk of incidence of obesity significantly increased in offspring with maternal obesity phenotypes including overweight/normal metabolic: 2.39(95%CI: 1.46–3.90), obese/normal metabolic: 3.55(95%CI: 1.94–6.46), overweight/dysmetabolic: 1.92(95%CI: 1.04–3.52) and obese/dysmetabolic: 3.89(95%CI: 2.28–6.64) compared to normal weight/normal metabolic phenotype. However, maternal normal weight/dysmetabolic phenotype did not significantly change the risk of obesity in both male and female offspring.

Conclusion

Except for normal weight/dysmetabolic phenotype, all maternal obesity phenotypes had significant prognostic values for incidence of offspring obesity with the highest risk for obese/dysmetabolic phenotype. This study provides valuable findings for identifying the first line target groups for planning interventions to prevent childhood obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10932-4.

Longitudinal association between body mass index and physical activity among adolescents with different parental risk: a parallel latent growth curve modeling approach

Background

Data available on the association between physical activity (PA) and body mass index (BMI) in different periods of life is controversial. Using a parallel latent growth curve modeling (LGCM) approach, the current study aimed to investigate the influence of daily PA on adolescents’ BMI over a 12 year follow-up, taking into account their parental risk.

Method

Participants comprised 1323 adolescents (53.5% girls), aged 12–18 years who had participated in the baseline phase of Tehran Lipid and Glucose Study (TLGS) (2001–2003), and were followed for an average period of 12 years. Physical activity, including leisure time and occupational activities, was assessed using the reliable and validated Iranian version of the Modifiable Activity Questionnaire (MAQ). Weight and height were objectively measured in order to calculateBMI.Atwo-step cluster analysis was conducted to classify parents into two high- and low-risk clusters. Parallel LGCM was fitted to estimate cross-sectional, prospective and parallel associations, which assessed the longitudinal association between simultaneous changes in PA and BMI during the study period. Analyses were stratified by gender and parental clusters.

Results

A rising trend of BMI per 3 years was observed in boys 1.39 kg.m²(95% CI; 1.32, 1.48) and girls 0.9 kg.m²(95% CI; 0.82, 0.98), as well as in the low risk 1.11 kg.m²(95% CI; 1.03, 1.18) and high-risk 1.12 kg.m²(95% CI; 1.03, 1.22) clusters. Moreover, a positive prospective association between PA at baseline and BMI change over the 12 year follow-up, was observed in adolescents in the low-risk parental cluster 0.27(95% CI; 0.14, 0.41) indicating that higher levels of PA at baseline may lead to greater BMI in adolescents over time. However, examining longitudinal parallel association between simultaneous changes of PA and BMI per 3 years revealed adverse associations for adolescents in the low-risk parental cluster − 0.07 (95% CI; − 0.13, − 0.01) and in boys − 0.06 (95% CI; − 0.11, − 0.01).

Conclusion

Despite a positive prospective association between BMI and PA at baseline, there was a weak inverse parallel association between these variables over time, particularly in boys and adolescents with low parental risk. These findings imply the potential role of other influential factors indetermining adolescents’ weight status which need to be considered in the future plannings.

Improvements in Physical Activity Levels after the Implementation of an Active-Break-Model-Based Program in a Primary School

The aim of this study was to analyze changes in the physical activity levels in students after implementing an active break (AB)-model-based program during the school day. Forty-four fifth-grade primary school children (24 boys, 20 girls, with a mean age = 10.44 ± 0.45) participated in a 17 week program. After intervention, there was an increase in moderate and vigorous total activity during physical education lessons, non-physical education lessons, and recesses. Intervention programs to encourage physical activity and decrease sedentary time are recommended.

Distribution of body mass index in children with different parental risk: Findings of a family-based cohort study in a West-Asian population

Using quantile regression analysis, the current study, conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) aimed to assess the effects of parental risk clusters on different percentiles of Body Mass Index (BMI) distribution in children. Participants included 2296 school-aged children who had participated in the baseline assessment of the TLGS and were followed for an approximate duration of fifteen years. Parental socio-demographic, behavioral and clinical characteristics were considered to determine risk clusters. Comparing of the high- to the low-risk parental clusters showed that after adjusting for age in boys, BMI was significantly higher at the 75^th (1.82, p = 03), 85^th (1.78, p = 0.007) and 95^th (1.66, p = 0.03) percentiles; and in girls it was significantly higher at the 25^th (1.45, p = 0.003), 50^th (1.05, p = 0.015), 95^th (2.31, p = 0.018) and 97^th (2.44, p = 0.006) percentiles in the high risk cluster. Our data indicate that during a long-term follow up, children with a high-risk family are more likely to have higher BMI, compared to their counterparts in low-risk families, a difference observed mainly at the upper percentiles of BMI distribution for both genders and at all ages, findings that should be considered for strategies aimed at preventing childhood obesity and its consequences.

Association Between Sleep Duration and Body Mass Index Among US Low-Income Preschoolers

OBJECTIVE

To verify whether sleep duration was related to body mass index z scores (zBMI) and whether bedtimes or ethnicity was a moderator of the sleep duration-zBMI association among preschoolers from low-income families.

METHODS

Two hundred twenty-eight African American and Hispanic parents and their preschoolers were recruited from Head Start Centers. Parents reported their preschoolers' sleep duration and bedtimes (using the Children's Sleep Habits Questionnaire) and their television watching. Food intake was measured using multiple days of digital photography to estimate energy intake at dinner. The Parenting Stress Index and the Center for Epidemiologic Studies Depression Scale were used to measure stress and depression. Parents' and preschoolers' height and weight were measured by trained staff.

RESULTS

Longer sleep duration was significantly associated with lower zBMI when controlling for demographics, bedtimes, energy intake at dinner, and television watching, but not when also controlling for parents' demographics, BMI, stress, and depression. Preschoolers' sleep duration-zBMI association was not moderated by bedtimes or ethnicity.

CONCLUSIONS

Longer sleep duration was associated with lower zBMI among low-income preschoolers when controlling for preschoolers' characteristics, but this was no longer the case when also controlling for parents' characteristics. Additional studies are needed on the moderators of the sleep duration-zBMI association among low-income preschoolers.