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Pomi AL, Pepe G, Aversa T, Corica D, Valenzise M, Messina MF, Morabito LA, Stagi S, Wasniewska M. Early adiposity rebound: predictors and outcomes. Ital J Pediatr 2024; 50:98. [PMID: 38750561 PMCID: PMC11094876 DOI: 10.1186/s13052-024-01671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/04/2024] [Indexed: 05/19/2024] Open
Abstract
Adiposity rebound (AR) refers to the second rise of the body mass index (BMI) curve that usually occurs between six and eight years of age. AR timing has a significant impact on patients' health: early AR (EAR), usually before the age of five, is considered to be the earliest indicator of obesity and its related health conditions later in life. Many studies have evaluated factors that can be predictors of EAR, and identified low birth weight and gestational weight gain as novel predictors of EAR, highlighting the role of the intrauterine environment in the kinetics of adiposity. Furthermore, children with breastfeeding longer than 4 months have been found to be less likely to have an EAR, whereas children born to advanced-age mothers, high maternal BMI had a higher risk of having an EAR. Some differences were found in the timing of AR in boys and girls, with girls being more likely to have EAR. The aim of this review is to answer the following three questions: 1) Which are the prenatal and perinatal factors associated with increased risk of EAR? Is gender one of these? 2) Which are the outcomes of EAR in childhood and in adulthood? 3) Which measures can be taken in order to prevent premature AR?
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Affiliation(s)
- Alessandra Li Pomi
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
- Pediatric Unit "G. Martino University Hospital, Messina, Italy.
| | - Giorgia Pepe
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
- Pediatric Unit "G. Martino University Hospital, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
- Pediatric Unit "G. Martino University Hospital, Messina, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
- Pediatric Unit "G. Martino University Hospital, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
- Pediatric Unit "G. Martino University Hospital, Messina, Italy
| | - Maria Francesca Messina
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
- Pediatric Unit "G. Martino University Hospital, Messina, Italy
| | | | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
- Pediatric Unit "G. Martino University Hospital, Messina, Italy
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Zhou J, Teng Y, Zhang S, Yang M, Yan S, Tao F, Huang K. Birth outcomes and early growth patterns associated with age at adiposity rebound: the Ma'anshan birth cohort (MABC) study. BMC Public Health 2023; 23:2405. [PMID: 38049780 PMCID: PMC10694931 DOI: 10.1186/s12889-023-17236-9] [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: 04/21/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE Early onset of adiposity rebound (AR) is considered an early indicator of obesity risk. Our objective was to investigate the association of birth outcomes and early physical growth patterns with early AR in children. METHODS Study subjects (n = 2705) were enrolled from the Ma'anshan birth cohort (MABC). The body mass index (BMI), head circumference, waist circumference, and body fat were collected. Rapid weight gain (RWG) was defined by the change in weight standard-deviation score in the first two years of life. Group-based trajectory modeling (GBTM) was used to determine children's physical growth trajectories. The age of AR was fitted using fractional polynomial function models. RESULTS Children with very high BMI trajectories (RR = 2.83; 95% CI 2.33 to 1.40), rising BMI trajectories (RR = 3.15; 95% CI 2.66 to 3.72), high waist circumference trajectories (RR = 4.17; 95% CI 3.43 to 5.06), and high body fat trajectories (RR = 3.01; 95% CI 2.62 to 3.46) before 72 months of age were at a greater risk of experiencing early AR. Low birth weight (LBW) (RR = 1.86; 95% CI 1.28 to 2.51), preterm birth (PTB) (RR = 1.50; 95% CI 1.17 to 1.93), and small for gestational age (SGA) (RR = 1.37; 95% CI 1.14 to 1.64) associated with increased risk of early AR. Moreover, infants experiencing RWG (RR = 1.59; 95% CI 1.40 to 1.83), low BMI trajectories (RR = 1.27; 95% CI 1.06 to 1.53) and rising BMI trajectories (RR = 1.50; 95% CI 1.22 to 1.84) in the first two years were at higher risk of developing early AR subsequently. Compared to the group with non-early AR, the BMI of children with early AR tended to be lower first (from birth to 6 months of age) and then higher (from 18 to 72 months of age). CONCLUSIONS Children with overall high BMI, high waist circumference, and high body fat before 72 months of age are more likely to experience early AR, but infants with low BMI trajectories, rising BMI trajectories and infants experiencing RWG in the first two years of life similarly increase the risk of early AR. These results can help to understand the early factors and processes that lead to metabolic risks.
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Affiliation(s)
- Jixing Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Yuzhu Teng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Shanshan Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Mengting Yang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Shuangqin Yan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Maternal and Child Health Care Center of Ma'anshan, No 24 Jiashan Road, Ma'anshan, Anhui, 243011, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, 230032, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China.
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Anhui Province, China.
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Lecorguillé M, Schipper MC, O'Donnell A, Aubert AM, Tafflet M, Gassama M, Douglass A, Hébert JR, de Lauzon-Guillain B, Kelleher C, Charles MA, Phillips CM, Gaillard R, Lioret S, Heude B. Impact of parental lifestyle patterns in the preconception and pregnancy periods on childhood obesity. Front Nutr 2023; 10:1166981. [PMID: 37275643 PMCID: PMC10233059 DOI: 10.3389/fnut.2023.1166981] [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: 02/15/2023] [Accepted: 04/07/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction High prevalence of overweight and obesity already observed in preschool children suggests the involvement of early-life risk factors. Preconception period and pregnancy are crucial windows for the implementation of child obesity prevention interventions with parental lifestyle factors as relevant targets. So far, most studies have evaluated their role separately, with only a few having investigated their potential synergistic effect on childhood obesity. Our objective was to investigate parental lifestyle patterns in the preconception and pregnancy periods and their association with the risk of child overweight after 5 years. Materials and methods We harmonized and interpreted results from four European mother-offspring cohorts participating in the EndObesity Consortium [EDEN, France; Elfe, France; Lifeways, Ireland; and Generation R, Netherlands] with data available for 1,900, 18,000, 1,100, and 9,500 families, respectively. Lifestyle factors were collected using questionnaires and included parental smoking, body mass index (BMI), gestational weight gain, diet, physical activity, and sedentary behavior. We applied principal component analyses to identify parental lifestyle patterns in preconception and pregnancy. Their association with risk of overweight (including obesity; OW-OB) and BMI z-scores between 5 and 12 years were assessed using cohort-specific multivariable logistic and linear and regression models (adjusted for potential confounders including parental age, education level, employment status, geographic origin, parity, and household income). Results Among the various lifestyle patterns derived in all cohorts, the two explaining the most variance were characterized by (1) "high parental smoking, low maternal diet quality (and high maternal sedentary behavior in some cohorts)" and, (2) "high parental BMI and low gestational weight gain." Patterns characterized by high parental BMI, smoking, low diet quality or high sedentary lifestyle before or during pregnancy were associated with higher risk of OW-OB in children, and BMI z-score at any age, with consistent strengths of associations in the main cohorts, except for lifeways. Conclusion This project provides insight into how combined parental lifestyle factors in the preconception and pregnancy periods are associated with the future risk of child obesity. These findings are valuable to inform family-based and multi-behavioural child obesity prevention strategies in early life.
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Affiliation(s)
- Marion Lecorguillé
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Mireille C Schipper
- The Generation R Study Group (Na 29-15), Erasmus University Medical Center, CA, Rotterdam, Netherlands
| | - Aisling O'Donnell
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Adrien M Aubert
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Muriel Tafflet
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | | | - Alexander Douglass
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - James R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Nutrition, Connecting Health Innovations, LLC, Columbia, SC, United States
| | - Blandine de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Cecily Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marie-Aline Charles
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
- Ined, Inserm, EFS, Joint Unit Elfe, Aubervilliers, France
| | - Catherine M Phillips
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Romy Gaillard
- The Generation R Study Group (Na 29-15), Erasmus University Medical Center, CA, Rotterdam, Netherlands
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
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Arisaka O, Ichikawa G, Nakayama K, Koyama S, Sairenchi T. Low Birth Weight, Weight Gain Trajectory in Infancy, Adiposity Rebound, and Risk of Adult Coronary Heart Disease. J Pediatr 2023; 255:261-262. [PMID: 36535410 DOI: 10.1016/j.jpeds.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Osamu Arisaka
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi-ken, Japan; Symphony Hospital, Utsunomiya Cerebrospinal Center, Utsunomiya-city, Tochigi-ken, Japan
| | - Go Ichikawa
- Symphony Hospital, Utsunomiya Cerebrospinal Center, Utsunomiya-city, Tochigi-ken, Japan
| | - Koryo Nakayama
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi-ken, Japan
| | - Satomi Koyama
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Tochigi-ken, Japan
| | - Toshimi Sairenchi
- Medical Science of Nursing, Dokkyo Medical University School of Nursing, Mibu, Tochigi-ken, Japan
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Bjerregaard LG, Blond K, Baker JL. Reply. J Pediatr 2023; 255:262. [PMID: 36731715 DOI: 10.1016/j.jpeds.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Lise G Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kim Blond
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Peri-Conceptional Folic Acid Supplementation and Children’s Physical Development: A Birth Cohort Study. Nutrients 2023; 15:nu15061423. [PMID: 36986153 PMCID: PMC10052637 DOI: 10.3390/nu15061423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Maternal lack of folic acid supplementation during pregnancy may increase the risk of low birth weight and preterm delivery. However, little is known about the relationship between folic acid supplementation during pregnancy and the physical development of offspring in the later stage. Objective: This study aimed to explore the association between maternal folic acid supplementation status during pregnancy and the physical development of preschool children. Methods: A total of 3064 mother–child pairs with data on maternal folic acid supplementation status during pregnancy and children’s anthropometric measurements were recruited from the Ma’anshan-Anhui Birth Cohort (MABC) in China. Maternal folic acid supplementation status during pregnancy was the main exposure, and the primary outcomes were children’s growth development trajectories. Children’s growth development trajectories were fitted using group-based trajectory models. The association between maternal folic acid supplementation status during pregnancy and children’s growth trajectories was performed using multiple logistic regression models. Results: After adjusting for potential confounders, we found that the absence of maternal folic acid supplementation before pregnancy and in the first trimester was significantly associated with a “high level” trajectory (trajectory 3) and a “high rising level” trajectory (trajectory 4) of BMI-Z scores in children 0 to 6 years of age (OR = 1.423, 95%CI:1.022–1.982; OR = 1.654, 95%CI: 1.024–2.671). In children aged 4 to 6 years old, a “high level” trajectory (trajectory 3) of body fat ratio was substantially related to maternal no folic acid supplementation before pregnancy and in the first trimester (OR = 1.833, 95%CI:1.037–3.240). No significant additional benefits associated with physical developmental indicators in preschool children have been observed with continued folic acid supplementation after the first trimester of gestation. Conclusions: Maternal non-supplementation with folic acid during pregnancy is associated with a “high level” BMI trajectory and a “high level” body fat ratio trajectory in preschool-aged children.
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Cissé AH, Taine M, Tafflet M, de Lauzon‐Guillain B, Clément K, Khalfallah O, Davidovic L, Lioret S, Charles MA, Heude B. Cord blood leptin level and a common variant of its receptor as determinants of the BMI trajectory: The EDEN mother-child cohort. Pediatr Obes 2022; 17:e12955. [PMID: 35747935 PMCID: PMC9787343 DOI: 10.1111/ijpo.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cord blood leptin is an indicator of neonatal fat mass and could shape postnatal adiposity trajectories. Investigating genetic polymorphisms of the leptin receptor gene (LEPR) could help understand the mechanisms involved. OBJECTIVES We aimed to investigate the association of cord blood leptin level and the LEPR rs9436303 polymorphism, with body mass index (BMI) at adiposity peak (AP) and age at adiposity rebound (AR). METHODS In the EDEN cohort, BMI at AP and age at AR were estimated with polynomial mixed models, for 1713 and 1415 children, respectively. Multivariable linear regression models allowed for examining the associations of cord blood leptin level and LEPR rs9436303 genotype with BMI at AP and age at AR adjusted for potential confounders including birth size groups. We also tested interactions between cord blood leptin level and rs9436303 genotype. RESULTS Increased leptin level was associated with reduced BMI at AP and early age at AR (comparing the highest quintile of leptin level to the others). Rs9436303 G-allele carriage was associated with increased BMI at AP and later age at AR but did not modulate the association with leptin level. CONCLUSION These results illustrate the role of early life body composition and the intrauterine environment in the programming of adiposity in childhood.
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Affiliation(s)
- Aminata H. Cissé
- Centre for Research in Epidemiology and StatisticSUniversité de Paris‐cité, INSERM, INRAEParisFrance
| | - Marion Taine
- Centre for Research in Epidemiology and StatisticSUniversité de Paris‐cité, INSERM, INRAEParisFrance
| | - Muriel Tafflet
- Centre for Research in Epidemiology and StatisticSUniversité de Paris‐cité, INSERM, INRAEParisFrance
| | | | - Karine Clément
- NutriOmics Research Unit, Assistance Publique‐Hôpitaux de Paris, Pitié‐Salpêtrière Hopital, Nutrition Department ParisSorbonne Université, INSERMParisFrance
| | - Olfa Khalfallah
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS, INSERM, Université Nice Côte d'Azur, UMR7275, UMR_SValbonneFrance
| | - Laetitia Davidovic
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS, INSERM, Université Nice Côte d'Azur, UMR7275, UMR_SValbonneFrance
| | - Sandrine Lioret
- Centre for Research in Epidemiology and StatisticSUniversité de Paris‐cité, INSERM, INRAEParisFrance
| | - Marie A. Charles
- Centre for Research in Epidemiology and StatisticSUniversité de Paris‐cité, INSERM, INRAEParisFrance
| | - Barbara Heude
- Centre for Research in Epidemiology and StatisticSUniversité de Paris‐cité, INSERM, INRAEParisFrance
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Zhang S, Zhou J, Yang M, Zhang F, Tao X, Tao F, Huang K. Sex-specific association between elective cesarean section and growth trajectories in preschool children: A prospective birth cohort study. Front Public Health 2022; 10:985851. [PMID: 36203696 PMCID: PMC9530938 DOI: 10.3389/fpubh.2022.985851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023] Open
Abstract
Background Elective cesarean section (ECS) primarily contributes to the rising cesarean section (CS) rate, and much attention has been attracted to its health consequences. The association between ECS and overweight and obesity in children has been controversial, and few studies distinguished ECS with medical indications from those without indications. Based on a large sample birth cohort, we aim to examine the association of ECS with or without medical indications on children's physical development by using repeated anthropometric data from birth to 6 years of age. Methods A total of 2304 mother-child pairs with complete data on delivery mode and children's anthropometric measurements were recruited from the Ma'anshan-Anhui Birth Cohort (MABC) in China. ECS was the main exposure in this study, and the primary outcomes were children's growth trajectories and early adiposity rebound (AR). Children's BMI trajectories were fitted by using group-based trajectory models and fractional polynomial mixed-effects models. The association between ECS and children's growth trajectories and early AR was performed using multiple logistic regression models. Results Among 2,304 mother-child pairs (1199 boys and 1105 girls), 1088 (47.2%) children were born by CS, including 61 (5.6%) emergency CS, 441 (40.5%) ECS with medical indications, and 586 (53.9%) ECS without medical indications. After adjusting for potential confounders, it was found that ECS with medical indications was associated with a "high level" of BMI trajectory (OR = 1.776; 95% CI: 1.010-3.123), and ECS without medical indications was associated with early AR (OR = 1.517; 95% CI: 1.123-2.050) in girls. In boys, we found that ECS without medical indications was unlikely to experience an accelerated growth trajectory (OR = 0.484; 95%CI: 0.244-0.959). Conclusions ECS may be related to girls' "high level" BMI trajectories and early AR. If causal, the findings will provide an evidence-based reference for early life interventions for childhood obesity.
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Affiliation(s)
- Shanshan Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Jixing Zhou
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Mengting Yang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Fu Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Xingyong Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China,Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China,*Correspondence: Kun Huang
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LIMIT: LIfestyle and Microbiome InTeraction Early Adiposity Rebound in Children, a Study Protocol. Metabolites 2022; 12:metabo12090809. [PMID: 36144214 PMCID: PMC9504829 DOI: 10.3390/metabo12090809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
Childhood obesity is a strong predictor of adult obesity with health and economic consequences for individuals and society. Adiposity rebound (AR) is a rise in the Body Mass Index occurring between 3 and 7 years. Early adiposity rebound (EAR) occurs at a median age of 2 years and predisposes to a later onset of obesity. Since obesity has been associated with intestinal dysbiosis, we hypothesize that EAR could be related to early microbiome changes due to maternal/lifestyle changes and environmental exposures, which can increase the unhealthy consequences of childhood obesity. LIMIT is a prospective cohort study that aims at identifying the longitudinal interplay between infant gut microbiome, infant/maternal lifestyle, and environmental variables, in children with EAR vs. AR. Methods. The study evaluated 272 mother-infant pairs, enrolled at an Italian neonatal unit, at different time points (T0, at delivery; T1, 1 month; T2, 6 months; T3, 12 months; T4, 24 months; T5, 36 months after birth). The variables that were collected include maternal/infant anthropometric measurements, lifestyle habits, maternal environmental endocrine disruptor exposure, as well as infant AR. The LIMIT results will provide the basis for early identification of those maternal and infant modifiable factors on which to act for an effective and personalized prevention of childhood obesity.
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Killedar A, Lung T, Hayes A. Investigating socioeconomic inequalities in BMI growth rates during childhood and adolescence. Obes Sci Pract 2022; 8:101-111. [PMID: 35127126 PMCID: PMC8804938 DOI: 10.1002/osp4.549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Many countries report socioeconomic inequalities in childhood obesity, but when they develop is not well-characterised. Studies rarely isolate BMI growth rates from overall BMI, perhaps overlooking an important precursor to the observed inequalities in obesity. The objective of this study was to determine the age at which inequalities in BMI growth rates develop in children and whether they are similar across the BMI spectrum. METHODS Using the Longitudinal Study of Australian Children (n = 9024), a cohort study, we measured socioeconomic inequalities in annual BMI growth from age 2 to 17 years by age, sex and weight status. We fit a linear model using generalised estimating equations (GEE) to estimate simultaneously the effects of age and weight status on inequalities in BMI growth rate. RESULTS The slope (SII) and relative (RII) indexes of inequality for annual BMI growth were greatest in middle childhood (age 4-11 years) (SII 0.25, RII 1.83 (boys) 1.78 (girls)) and were moderate during adolescence (age 10-17 years) (SII 0.11, RII 1.16 [boys] 1.15 [girls]). In early childhood, there was little evidence of inequality in annual BMI growth except in children with obesity. In middle childhood and adolescence, inequalities were greater at higher weight status. The GEE indicated that both weight status (P < 0.001) and age period (P < 0.001) affected inequalities in BMI growth rates. CONCLUSIONS Inequalities in annual BMI growth were strongest in middle childhood, and widest in children at the upper end of the BMI spectrum. This could signify a key age bracket to intervene clinically and at a public health level and improve inequalities in childhood obesity.
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Affiliation(s)
- Anagha Killedar
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Thomas Lung
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Alison Hayes
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
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11
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Saldanha-Gomes C, Hallimat Cissé A, Descarpentrie A, de Lauzon-Guillain B, Forhan A, Charles MA, Heude B, Lioret S, Dargent-Molina P. Prospective associations between dietary patterns, screen and outdoor play times at 2 years and age at adiposity rebound: The EDEN mother-child cohort. Prev Med Rep 2022; 25:101666. [PMID: 35127350 PMCID: PMC8800050 DOI: 10.1016/j.pmedr.2021.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022] Open
Abstract
Although an early adiposity rebound (AR) is an established risk factor for later obesity, little is known regarding its determinants, especially modifiable ones. Using data from the French EDEN mother–child cohort (1903 children born in 2003–2006), we aimed to examine the association between diet and activity-related behaviors at 2 years of age and the timing of the AR. Two-year-old children (n = 1138) with parent-reported data on their foods/drinks intake, TV/DVD watching time, outdoor playtime, and with an estimated (via growth modelling) age at AR were included in the present study. Two dietary patterns, labelled 'Nutrient-dense foods' and 'Processed and fast foods', were identified in a previous study. Multivariable linear and logistic regression models were used to assess the association between dietary patterns and activity-related behaviors and, respectively, the age at AR (continuous) and the likelihood of having a very early AR (before 3.6 years for girls and 3.8 years for boys, i.e., below the 10th percentile of sex-specific distribution). A higher score on the ‘Processed and fast foods’ dietary pattern was associated with a higher likelihood of having a very early AR (OR = 1.23; 95% CI: 1.00 to 1.50). No significant association was observed between the ‘Nutrient-dense foods’ dietary pattern, TV/DVD watching and outdoor playing times and the timing of the AR. This finding emphasizes the importance of reducing nutrient-dense and processed foods from the early years of life, and provides further support for early interventions aimed at helping parents establish healthy eating habits for their growing child from the complementary period.
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12
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Infant feeding practices associated with adiposity peak and rebound in the EDEN mother-child cohort. Int J Obes (Lond) 2022; 46:809-816. [PMID: 34980907 DOI: 10.1038/s41366-021-01059-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE High magnitude of adiposity peak and early adiposity rebound are early risk markers of later obesity. Infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the association between infant feeding practices and age and magnitude of adiposity peak and rebound. SUBJECTS/METHODS Analyses were based on data from the French EDEN mother-child cohort. Data on breastfeeding and complementary feeding were collected at birth and 4, 8, and 12 months. From clinical examinations and measurements collected in the child's health booklet up to 12 years, individual growth curves were modeled, and ages and magnitudes of adiposity peak and rebound were estimated. Associations between infant feeding practices and growth were investigated by multivariable linear regression in children after testing a child-sex interaction. RESULTS In the studied population (n = 1225), adiposity peak occurred at a mean of 9.9 ± 2 months and adiposity rebound at 5.5 ± 1.4 years. Associations between infant feeding practices and adiposity peak or rebound were moderated by child sex. For girls, each additional month of breastfeeding was related to a 2-day increase in the age at adiposity peak (p < 0.001), and an 18-day increase in the age at adiposity peak (p = 0.004). Whereas for boys, each additional month for the age at complementary food introduction was associated with a 29-day increase in the age at adiposity rebound (p = 0.02). For boys, long breastfeeding duration was only related to reduced body mass index at adiposity peak. CONCLUSIONS Child sex has a moderating effect on the association between infant feeding practices and adiposity peak or rebound. The well-known association between breastfeeding duration and early growth seems stronger in girls than boys. The association found for complementary feeding in boys may give new insights into preventing obesity.
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Haga C, Yokomichi H, Tsuji K, Yamagata Z. Adiposity rebound may be a predictive index of body size for adolescents-Based on retrospective cohort data in a Japanese rural area. Obes Res Clin Pract 2021; 16:50-55. [PMID: 34972636 DOI: 10.1016/j.orcp.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to examine whether the timing of adiposity rebound (AR) could be a predictive index of body size in Japanese adolescents. METHODS The longitudinal individual data of 1438 Japanese children, including 714 boys and 724 girls born between 2001 and 2007, were obtained from child health check-ups conducted at ages 1.5, 2, 3, and 5 years, and then yearly after the age of 6 years. We examined whether the timing of AR could be used to estimate the body size at 14 years of age. RESULTS The AR had a normal distribution with a mean occurrence at age 6-7 years. The odds ratio of having obesity at age 14 were 8.32 for boys and 4.81 for girls, whereas boys and girls with later AR at the same age had a relative risk of thinness of 6.27 and 8.14, respectively. The probability that children with an early AR (i.e., <6 years old) would be obese was nearly 40%. Similar to obesity, the probability of thinness at 14 years remained approximately 8% for both sexes. CONCLUSIONS The findings suggest that early AR could raise the risk of obesity, and AR could later raise the risk of thinness. However, both probabilities of AR timing as predictors of adolescent weight status may only be about 10%-20%. This study cannot clearly determine whether the results were influenced by other factors after controlling for the timing of AR. Future studies that also consider lifestyle and genetic factors are warranted.
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Affiliation(s)
- Chiyori Haga
- Graduate School of Medicine, Department of Community Nursing, Kagawa University, Kagawa, Japan.
| | - Hiroshi Yokomichi
- Graduate School Department of Interdisciplinary Research, Yamanashi University, Yamanashi, Japan
| | - Kyoko Tsuji
- Graduate School of Medicine, Department of Community Nursing, Kagawa University, Kagawa, Japan
| | - Zentaro Yamagata
- Graduate School Department of Interdisciplinary Research, Yamanashi University, Yamanashi, Japan
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Matsumoto N, Kubo T, Nakamura K, Mitsuhashi T, Takeuchi A, Tsukahara H, Yorifuji T. Trajectory of body mass index and height changes from childhood to adolescence: a nationwide birth cohort in Japan. Sci Rep 2021; 11:23004. [PMID: 34837002 PMCID: PMC8626480 DOI: 10.1038/s41598-021-02464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the dynamics of body mass index (BMI) and height changes in childhood leading to obesity in adolescents. BMI Z-scores were calculated using the LMS (lambda-mu-sigma) method based on yearly height and weight information (age 1.5-15 years) from a nationwide Japanese birth cohort that started in 2001 (n = 26,711). We delineated the trajectories of BMI and height changes leading to obesity at age 15 years using mixed effect models. Children who became obese at the age of 15 years kept relatively high BMI z-scores through childhood for both genders, and had an increasing trend over time as opposed to the normal weight group, with an increasing slope during puberty. Early adiposity rebound was associated with overweight or obesity at the age of 15 years. Age at peak height velocity (APHV) occurred earlier in the obese/overweight group at age 15 years than in the normal weight group, and occurred later in the underweight group. Obese adolescents experienced early adiposity rebound timing and maintained a serial BMI z-score increase throughout childhood, with a greater slope at puberty. An earlier peak in height gain during puberty may have contributed to the observed patterns of BMI change.
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Affiliation(s)
- Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Toshihide Kubo
- Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Kazue Nakamura
- Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Akihito Takeuchi
- Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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15
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Pinos H, Carrillo B, Merchán A, Biosca-Brull J, Pérez-Fernández C, Colomina MT, Sánchez-Santed F, Martín-Sánchez F, Collado P, Arias JL, Conejo NM. Relationship between Prenatal or Postnatal Exposure to Pesticides and Obesity: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137170. [PMID: 34281107 PMCID: PMC8295932 DOI: 10.3390/ijerph18137170] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
In recent years, the worldwide prevalence of overweight and obesity among adults and children has dramatically increased. The conventional model regarding the onset of obesity is based on an imbalance between energy intake and expenditure. However, other possible environmental factors involved, such as the exposure to chemicals like pesticides, cannot be discarded. These compounds could act as endocrine-disrupting chemicals (EDC) that may interfere with hormone activity related to several mechanisms involved in body weight control. The main objective of this study was to systematically review the data provided in the scientific literature for a possible association between prenatal and postnatal exposure to pesticides and obesity in offspring. A total of 25 human and 9 animal studies were analyzed. The prenatal, perinatal, and postnatal exposure to organophosphate, organochlorine, pyrethroid, neonicotinoid, and carbamate, as well as a combined pesticide exposure was reviewed. This systematic review reveals that the effects of pesticide exposure on body weight are mostly inconclusive, finding conflicting results in both humans and experimental animals. The outcomes reviewed are dependent on many factors, including dosage and route of administration, species, sex, and treatment duration. More research is needed to effectively evaluate the impact of the combined effects of different pesticides on human health.
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Affiliation(s)
- Helena Pinos
- Department of Psychobiology, Faculty of Psychology, National Distance Education University (UNED), 28040 Madrid, Spain; (B.C.); (P.C.)
- Joint Research Institute-UNED-Instituto de Salud Carlos III (IMIENS), 28029 Madrid, Spain;
- Correspondence: (H.P.); (N.M.C.)
| | - Beatriz Carrillo
- Department of Psychobiology, Faculty of Psychology, National Distance Education University (UNED), 28040 Madrid, Spain; (B.C.); (P.C.)
- Joint Research Institute-UNED-Instituto de Salud Carlos III (IMIENS), 28029 Madrid, Spain;
| | - Ana Merchán
- Department of Psychology and Health Research Center (CEINSA), Almeria University, 04120 Almeria, Spain; (A.M.); (C.P.-F.); (F.S.-S.)
| | - Judit Biosca-Brull
- Research in Neurobehavior and Health (NEUROLAB), Universitat Rovira i Virgili, 43007 Tarragona, Spain; (J.B.-B.); (M.T.C.)
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - Cristian Pérez-Fernández
- Department of Psychology and Health Research Center (CEINSA), Almeria University, 04120 Almeria, Spain; (A.M.); (C.P.-F.); (F.S.-S.)
| | - María Teresa Colomina
- Research in Neurobehavior and Health (NEUROLAB), Universitat Rovira i Virgili, 43007 Tarragona, Spain; (J.B.-B.); (M.T.C.)
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - Fernando Sánchez-Santed
- Department of Psychology and Health Research Center (CEINSA), Almeria University, 04120 Almeria, Spain; (A.M.); (C.P.-F.); (F.S.-S.)
| | - Fernando Martín-Sánchez
- Joint Research Institute-UNED-Instituto de Salud Carlos III (IMIENS), 28029 Madrid, Spain;
- National School of Public Health, Institute of Health Carlos III, University Institute of Research-UNED-Institute of Health Carlos III (IMIENS), 28029 Madrid, Spain
| | - Paloma Collado
- Department of Psychobiology, Faculty of Psychology, National Distance Education University (UNED), 28040 Madrid, Spain; (B.C.); (P.C.)
- Joint Research Institute-UNED-Instituto de Salud Carlos III (IMIENS), 28029 Madrid, Spain;
| | - Jorge L. Arias
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, 33003 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
| | - Nélida M. Conejo
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, 33003 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33006 Oviedo, Spain
- Correspondence: (H.P.); (N.M.C.)
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16
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Lin D, Chen D, Huang J, Li Y, Wen X, Wang L, Shi H. Pre-Birth and Early-Life Factors Associated With the Timing of Adiposity Peak and Rebound: A Large Population-Based Longitudinal Study. Front Pediatr 2021; 9:742551. [PMID: 35004537 PMCID: PMC8727998 DOI: 10.3389/fped.2021.742551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The late occurrence of adiposity peak (AP) and the early occurrence of adiposity rebound (AR) are considered the earliest indicators for obesity and its related health conditions later in life. However, there is still limited information for their upstream factors. Therefore, in this study, we aimed to identify the parental and child factors associated with the timing of AP and AR in the early stage of life. Methods: This is a population-based longitudinal study conducted in Shanghai, China. The BMI data of children born between September 2010 and October 2013 were followed from birth to 80 months. Subject-specific body mass index trajectories were fitted by non-linear mixed-effect models with natural cubic spline functions, and the individual's age at AP and AR was estimated. The generalized linear regression models were applied to identify the upstream factors of late occurrence of AP and early occurrence AR. Results: For 7,292 children with estimated AP, boys were less likely to have a late AP [adjusted risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.77-0.90, p < 0.001], but preterm born children had a higher risk of a late AP (adjusted RR = 1.25, 95% CI: 1.07-1.47, p < 0.01). For 10,985 children with estimated AR, children with breastfeeding longer than 4 months were less likely to have an early AR (adjusted RR = 0.80, 95% CI: 0.73-0.87, p < 0.001), but children who were born to advanced-age mothers and who were born small for gestational age had a higher risk of having an early AR (adjusted RR = 1.21, 95% CI: 1.07-1.36, p < 0.01; adjusted RR = 1.20, 95% CI: 1.04-1.39, p = 0.01). Conclusions: Modifiable pre-birth or early-life factors associated with the timing of AP or AR were found. Our findings may help develop prevention and intervention strategies at the earliest stage of life to control later obesity and the health conditions and diseases linked to it.
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Affiliation(s)
- Dan Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Didi Chen
- Department of School Health, Minhang District Center of Disease Control and Prevention, Shanghai, China.,Minhang Branch, School of Public Health, Fudan University, Shanghai, China
| | - Jun Huang
- Department of Child Care, Minhang Maternal and Child Health Center, Shanghai, China
| | - Yun Li
- Department of Child Care, Minhang Maternal and Child Health Center, Shanghai, China
| | - Xiaosa Wen
- Department of School Health, Minhang District Center of Disease Control and Prevention, Shanghai, China.,Minhang Branch, School of Public Health, Fudan University, Shanghai, China
| | - Ling Wang
- Shanghai Medical College of Fudan University, Shanghai, China
| | - Huijing Shi
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
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