Socioeconomic status, infant feeding practices and early childhood obesity

Breastfeeding and infant growth in relation to childhood overweight - a longitudinal cohort study

BACKGROUND

Rapid infant growth is positively, and breastfeeding inversely, associated with childhood overweight. However, the interplay has only been sparsely investigated.

OBJECTIVES

We aimed to investigate how exclusive breastfeeding duration modifies the effect of infant growth on childhood overweight.

METHODS

We included routinely collected data on duration of exclusive breastfeeding and child growth from Aarhus Municipality, Denmark and on maternal health from the patient records at Aarhus University Hospital, 2008-2013. Infant growth was estimated using latent class analysis. Duration of exclusive breastfeeding was grouped as never, ≤4 mo, and >4 mo. Childhood overweight was defined as a body mass index z-score >1 at age 5 to 9 y. We investigated the risk of overweight dependent on infant growth and breastfeeding duration both independently and combined using logistic regression and adjusting for potential confounders.

RESULTS

Among 7074 infants, we identified 3 growth patterns: average, accelerated, and decelerated. No or ≤4 mo of breastfeeding was associated with being overweight at 5 to 9 y (adjusted odds ratio [aOR]: 1.61; 95% confidence interval [CI]: 1.27, 2.03 and aOR: 1.54; 95% CI: 1.28, 1.85, respectively) compared to >4 mo of breastfeeding. Compared with average infant growth, accelerated growth was associated with childhood overweight (aOR: 1.35; 95% CI: 1.01, 1.79). In the combined analysis, accelerated infant growth showed no evidence of being associated with overweight if infants were exclusively breastfed >4 mo (aOR: 1.20; 95% CI: 0.68, 2.10). Decelerated growth was not associated with overweight regardless of exclusive breastfeeding duration, compared with infants with average growth who were exclusively breastfed >4 mo.

CONCLUSIONS

Longer duration of exclusive breastfeeding was associated with decreased risk of being overweight, whereas accelerated infant growth was associated with increased risk. Children with accelerated infant growth who were never breastfed had the highest risk of being overweight at 5 to 9 y of age, whereas there was no association if infants were exclusively breastfed >4 mo.

Childhood BMI trajectories and sociodemographic factors in an Italian pediatric population

Childhood obesity is a growing global concern due to its long-term health consequences. Yet, more research relying on multiple time-point BMI measurements is warranted to gain further insight into obesity's temporal trends. We aimed to identify BMI trajectories in children aged 2-10 years and evaluate their association with sociodemographic factors. This retrospective cohort study utilized data from the PEDIANET registry, containing sociodemographic, clinical, and prescribing information on patients assisted by Italian family pediatricians, linked to the corresponding area deprivation index. 29,576 children with at least 10 years of follow-up, born at term with normal birthweight, and at least three plausible BMI measurements were identified. BMI z-score trajectories were calculated using Group-Based Trajectory Modeling, and mixed multinomial logistic regression was used to assess their association with the sociodemographic factors. A secondary analysis examined BMI trajectories from ages 2-7 years (n = 58,509). Four BMI z-scores trajectories, all with quadratic shape, were identified as the optimal fit: "stable-low-weight" (27.5%), "normal-weight" (40.9%), "stable-moderate-increase" (24.2%), and "overweight-to-obese" (7.5%). Females, children residing in Southern and Island regions, and those from more deprived socioeconomic areas had a higher probability of following the "overweight-to-obese" group compared to the "normal-weight" trajectory. Sex and area of residence had similar effects on the "stable-moderate-increase" trajectory. Conversely, females and children residing in Central Italy were less likely to belong to the "stable-low-weight trajectory". This study highlighted a considerable heterogeneity in BMI trajectories in pediatric age, emphasizing the effect of sociodemographic inequalities on growth patterns with models capable of capturing the dynamic nature of the phenomenon.

Exclusive breastfeeding practices and factors affecting them in urban areas of Uttar Pradesh

Background

Exclusive breastfeeding for the first 6 months is the recommended infant feeding practice, with established benefits. In India, exclusive breastfeeding rates have seen some improvement, but Uttar Pradesh has experienced a decline. Various factors influence breastfeeding practices, such as socio-cultural beliefs, maternal knowledge, and support. Considering urbanization, industrialization, and a significant migrant population, it is crucial to understand the determinants of breastfeeding practices in urban Uttar Pradesh. This study aimed to fill these knowledge gaps by examining factors influencing breastfeeding practices in the region.

Methods

This cross-sectional study was conducted at Sharda Hospital's Pediatrics Outpatient Department (OPD) in Uttar Pradesh over 1.5 years from January 1, 2019 to June 30, 2020. The minimum sample size of 96 was determined for the study. Study participants included 200 mothers with children aged 6 months to 2 years attending the Pediatrics OPD. Data were collected through a 42-item questionnaire administered by trained interviewers who ensured privacy and comfort. Data analysis was performed using Statistical Package for Social Sciences, including descriptive statistics and the Chi-square test for categorical variables (P < 0.05).

Results

The study involved 200 mothers with children aged 6 months to 2 years attending a Pediatrics OPD in Uttar Pradesh. Mothers aged 21-30 years (78%) were predominant. Among the children, 62.5% were male. Colostrum was given by 86% of mothers, and 40% introduced pre-lacteal feeds. Exclusive breastfeeding was practiced by 60% of mothers. The analysis did not show statistically significant differences based on socio-economic status, maternal education, or occupation (P > 0.05).

Conclusion

In conclusion, the findings from this study provide a comprehensive understanding of feeding practices among mothers in urban areas of Uttar Pradesh. While many mothers adhere to recommended practices, there is room for improvement in reducing pre-lacteal feeding and promoting exclusive breastfeeding.

Early Life Energy Balance: The Development of Infant Energy Expenditure and Intake in the Context of Obesity

PURPOSE OF REVIEW

This review aims to provide a summary of the current knowledge on measurement tools and most recent evidence for prenatal and postnatal modulators of energy balance in young infants.

RECENT FINDINGS

The prevention of pediatric obesity depends upon curating the perfect imbalance of energy intake to energy expenditure, taking into consideration the energy needs for healthy growth. We summarize the recent evidence for the programming of fetal and infant metabolism influenced by maternal preconception health, prenatal metabolic milieu, and physical activity behaviors. In the early postnatal environment, caregiver feeding behaviors shape the extent of energy imbalance through dictating quantity and modality of infant energy intake. There are biological and behavioral contributors to improper infant energy imbalance. Furthermore, caregiver and clinician education on overfeeding and clinical tools to prescribe and monitor infant overgrowth are absent. Ultimately, the lack of high-quality and modern research of infant energy expenditure underpins the lack of advancement in clinical guidelines and the needed prevention of pediatric obesity.

Reduce, reinforce, and replenish: safeguarding the early-life microbiota to reduce intergenerational health disparities

Socioeconomic (SE) disparity and health inequity are closely intertwined and associated with cross-generational increases in the rates of multiple chronic non-communicable diseases (NCDs) in North America and beyond. Coinciding with this social trend is an observed loss of biodiversity within the community of colonizing microbes that live in and on our bodies. Researchers have rightfully pointed to the microbiota as a key modifiable factor with the potential to ease existing health inequities. Although a number of studies have connected the adult microbiome to socioeconomic determinants and health outcomes, few studies have investigated the role of the infant microbiome in perpetuating these outcomes across generations. It is an essential and important question as the infant microbiota is highly sensitive to external forces, and observed shifts during this critical window often portend long-term outcomes of health and disease. While this is often studied in the context of direct modulators, such as delivery mode, family size, antibiotic exposure, and breastfeeding, many of these factors are tied to underlying socioeconomic and/or cross-generational factors. Exploring cross-generational socioeconomic and health inequities through the lens of the infant microbiome may provide valuable avenues to break these intergenerational cycles. In this review, we will focus on the impact of social inequality in infant microbiome development and discuss the benefits of prioritizing and restoring early-life microbiota maturation for reducing intergenerational health disparities.

A randomized controlled trial to test the efficacy of a brief Triple P discussion group to increase healthy feeding practices and reduce risk factors for infant obesity

OBJECTIVE

Test the efficacy of a brief 2-hr parenting intervention in increasing protective factors against and reducing risk factors for infant obesity.

METHOD

A 2 (Baby Healthy Living Triple P vs. care-as-usual) × 3 (baseline, postintervention, 6-month follow-up) design was used. Eighty-two parents of 4- to 18-month-old infants meeting at least two risk factors for early childhood obesity (e.g., parent/child overweight, low education level) were randomized to intervention (n = 42) or control group (n = 40). Parents questionnaires and child weight status was measured.

RESULTS

Results showed an intervention effect on a primary outcome, early feeding practices (restrictive: d = 0.44, 95% CI [-0.01,0.88], pressuring: d = 0.11, 95% CI [-0.32,0.54], nonresponsive behaviors: (d = 0.32, 95% CI [-0.11,0.75]), and on a secondary outcome, feeding beliefs (d = 0.29, 95% CI [-0.14,0.73]). No beneficial impact was found on other primary outcomes (responsiveness in feeding: quantity d = 0.50, 95% CI [-0.03,1.03]) and nutritive d = 0.52, 95% CI [-0.03,1.07], mealtime environment: d = 0.35, 95% CI [-0.78,0.08], self-efficacy in responsive feeding: d = 0.21, 95% CI [-0.22,0.64]), or secondary outcomes (parental self-efficacy: d = 0.08, 95% CI [-0.50,0.35]), parent emotional eating (d = 0.01, 95% CI [-0.43,0.43]), food restraint (d = 0.42, 95% CI [-0.85,0.02]), and body satisfaction (d = 0.01, 95% CI [-0.43,0.43]) and child weight status (d = 0.11, 95% CI [-0.54,0.32]).

CONCLUSIONS

Promising though limited support was demonstrated for a brief, low-intensity program to help parents in the prevention of obesity for infants at risk.

Pediatric obesity in the United States: Age-period-cohort analysis

The rates of obesity among American children aged 2-5 years has reached a historic high. It is crucial to identify the putative sources of population-level increases in obesity prevalence among preschool-aged children because early childhood is a critical window for obesity prevention and thus reduction of future incidence. We used the National Health and Nutrition Examination Survey data and hierarchical age-period-cohort analysis to examine lifecycle (i.e., age), historical (i.e., period), and generational (i.e., cohort) distribution of age- and sex-specific body mass index z-scores (zBMI) among 2-5-year-olds in the U.S. from 1999 to 2018. Our current findings indicate that period effects, rather than differences in groups born at a specific time (i.e., cohort effects), account for almost all of the observed changes in zBMI. We need a broad socioeconomic, cultural, and environmental strategy to counteract the current obesogenic environment that influences children of all ages and generations in order to reach large segments of preschoolers and achieve population-wide improvement.

Influence of body mass index on health complains and life satisfaction

PURPOSE

This research work investigates the influence of children's weight status on well-being and school context in a sample of Spanish adolescences.

METHODS

The Spanish records from the 2013-14 Health Behaviour in School-Aged Children Survey are used, which gathers 9,565 adolescences aged 11, 13 and 15. Studies do not usually address the endogeneity of body mass index when analysing their effect on life satisfaction and health complaints, thus resulting in biased estimates. Considering the endogeneity of body mass index, we use the frequency of alcohol consumption as an instrumental variable in order to obtain consistent estimates of its influence.

RESULTS

The two-stage least squares estimation shows that children's body mass index has a significant negative influence on health complaints and it conditions the way children relate to each other at school. Likewise, results report significant influence on children's subjective well-being and their self-assessment of general health.

CONCLUSIONS

The results of this study provide compelling evidence that BMI plays a crucial role in shaping adolescents' well-being and their interactions with peers at school. These findings underscore the importance of addressing childhood overweight and promoting healthy body mass index levels. Furthermore, the study highlights the need for targeted policy interventions to combat the social stigma associated with being overweight, fostering a more inclusive and supportive school environment for all students.

Precocious infant fecal microbiome promotes enterocyte barrier dysfuction, altered neuroendocrine signaling and associates with increased childhood obesity risk

Early life gut microbiome composition has been correlated with childhood obesity, though microbial functional contributions to disease origins remain unclear. Here, using an infant birth cohort (n = 349) we identify a distinct fecal microbiota composition in 1-month-old infants with the lowest rate of exclusive breastfeeding, that relates with higher relative risk for obesity and overweight phenotypes at two years. Higher-risk infant fecal microbiomes exhibited accelerated taxonomic and functional maturation and broad-ranging metabolic reprogramming, including reduced concentrations of neuro-endocrine signals. In vitro, exposure of enterocytes to fecal extracts from higher-risk infants led to upregulation of genes associated with obesity and with expansion of nutrient sensing enteroendocrine progenitor cells. Fecal extracts from higher-risk infants also promoted enterocyte barrier dysfunction. These data implicate dysregulation of infant microbiome functional development, and more specifically promotion of enteroendocrine signaling and epithelial barrier impairment in the early-life developmental origins of childhood obesity.

[Childhood obesity risk index (IROBIC) for small administrative areas in Chile]

Introduction

Introduction: although the prevalence of childhood obesity (CO) is high globally, there are no composite indices to estimate territorial aspects associated with its risk Objective: to develop an obesity risk index (IROBIC) for small administrative units, called "comunas" in Chile Methods: we used 2019 data from public sources on children under 10 years living in "comunas" of the two largest regions. IROBIC includes 16 indicators standardized for each "comuna" and grouped together into four domains, determined by principal component analysis (health, socio-economic, built-in and educational environments). IROBIC was calculated as a weighted geometric mean. Differences in obesity risk between the 10 and 5 "comunas" with the highest and lowest IROBIC and of each domain, were calculated with the disparity ratio. Results: in spite of the poorest "comunas" having the highest IROBIC, when its value and that for each domain were considered, we observed that the effect of inequality could be mitigated. The 10 and 5 "comunas" with the highest IROBIC have a 2.41 and 4.05 higher risk of CO compared to those with the lowest values Conclusions: IROBIC is a useful tool for monitoring the risk of CO and its factors from a territorial perspective.

Association of Infant Feeding Characteristics With Dietary Patterns and Obesity in Korean Childhood

OBJECTIVES

Young children's feeding characteristics can play an important role in eating habits and health during later childhood. This study was conducted to examine the associations of feeding characteristics with dietary patterns and obesity in children.

METHODS

This study utilized data from the Korea National Health and Nutrition Examination Survey conducted between 2013 and 2017. In total, 802 toddlers were included, with information on their demographic characteristics, feeding practices and duration, and 24-hour recall obtained from their parents. Feeding characteristics were categorized into feeding type, duration of total breastfeeding, duration of total formula feeding, duration of exclusive breastfeeding, and age when starting formula feeding. Dietary patterns were identified based on factor loadings for the food groups for 3 major factors, with "vegetables & traditional," "fish & carbohydrates," and "sweet & fat" patterns. Overweight/obesity was defined as ≥85th percentile in body mass index based on the 2017 Korean National Growth charts for children and adolescents. Multiple regression analysis was conducted to examine associations between feeding characteristics and dietary patterns. The association between dietary patterns and obesity was analyzed using multivariable logistic regression analysis.

RESULTS

The early introduction of formula feeding was inversely associated with the "vegetables & traditional" pattern (β=-0.18; 95% confidence interval [CI], -0.34 to -0.02). A higher "vegetables & traditional" intake was associated with a lower risk of obesity (odds ratio, 0.48; 95% CI, 0.24 to 0.95).

CONCLUSIONS

Feeding characteristics are associated with dietary patterns in later childhood, and dietary patterns were shown to have a potential protective association against obesity.

Cross-sectional and prospective associations between household socioeconomic resources, appetite traits, and body size among Samoan infants

In high-income countries, household socioeconomic resources (as measured by education, occupation, income, and/or household assets) and childhood obesity risk tend to be negatively associated. This association may arise in part because children from households with fewer resources are exposed to obesogenic environments that shape appetite trait development. In contrast, many low- and middle-income countries (LMICs) exhibit a positive association between socioeconomic resources and child body size. There is less evidence from LMIC settings about when during development this association emerges and whether appetite traits play a mediatory role. To explore these questions, we examined cross-sectional and longitudinal associations between socioeconomic resources, appetite traits, and body size among infants in Samoa, an LMIC in Oceania. Data were from the Foafoaga O le Ola prospective birth cohort of 160 mother-infant dyads. Appetite traits were characterized using the Baby and Child Eating Behavior Questionnaires and household socioeconomic resources were quantified using an asset-based measure. While infant body size and household socioeconomic resources were positively associated in both cross-sectional and prospective analyses, we found no evidence that appetite traits mediate this relationship. These results suggest that other aspects of the food environment, such as food security and feeding style, may explain the positive association between socioeconomic resources and body size observed in many LMICs.

Maturational patterns of the infant gut mycobiome are associated with early-life body mass index

Unlike the bacterial microbiome, the role of early-life gut fungi in host metabolism and childhood obesity development remains poorly characterized. To address this, we investigate the relationship between the gut mycobiome of 100 infants from the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study and body mass index Z scores (BMIz) in the first 5 years of life. An increase in fungal richness during the first year of life is linked to parental and infant BMI. The relationship between richness pattern and early-life BMIz is modified by maternal BMI, maternal diet, infant antibiotic exposure, and bacterial beta diversity. Further, the abundances of Saccharomyces, Rhodotorula, and Malassezia are differentially associated with early-life BMIz. Using structural equation modeling, we determine that the mycobiome's contribution to BMIz is likely mediated by the bacterial microbiome. This demonstrates that mycobiome maturation and infant growth trajectories are distinctly linked, advocating for inclusion of fungi in larger pediatric microbiome studies.

From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update

Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.

Mental health in children and adolescents with overweight or obesity

BACKGROUND

Overweight and obesity represent huge concerns for children's physical and mental well-being. This study examined the relationship between body mass index (BMI) and health-related quality of life (HRQoL), somatoform complaints, and behavioral problems in children and adolescents. Additionally, the influence of sex, age, and socioeconomic status (SES) on these associations was considered.

METHODS

In total, we studied 2350 participants between the ages of 4 and 18 years (1213 4- to 10-years-old (child sample) and 1137 11-to 18-year-olds (adolescent sample)). To assess HRQoL, somatoform complaints, and behavioral difficulties, we applied the KIDSCREEN-27, a short form of the Giessen Complaints Questionnaire, and the Strengths and Difficulties Questionnaire (SDQ). The BMI was transformed to BMI standard deviation scores (BMI-SDS), according to German gender- and age-specific reference data. Associations were investigated using linear regression analyses. Each association was checked for interaction with sex, age, and SES.

RESULTS

Regarding HRQoL, we found worsening scores in physical well-being and psychological well-being with increasing BMI-SDS. Somatoform complaints were not significantly associated with BMI-SDS. Conduct problems, peer relationship problems, and emotional problems (the latter only in the adolescent sample) were positively associated with BMI-SDS. While we did not observe any significant interactions with sex, we found some significant interactions with age and/or SES.

CONCLUSION

Our findings highlight the importance of mental difficulties in children and adolescents with higher BMI and, consequently, underline the relevance of including psychological interventions in the treatment of overweight or obesity.

Integrative Review of Mental Health and Feeding Styles in Parents of Bottle-Fed Infants

OBJECTIVE

To review the literature regarding the relationship between symptoms of anxiety and depression and feeding styles in parents of bottle-fed infants.

DATA SOURCES

We conducted literature searches in PubMed, CINAHL, Scopus, and PsycINFO.

STUDY SELECTION

We used Covidence systematic review management software during the selection process to allow for full blinding of decisions by team members. Articles were eligible for inclusion if they were reports of primary research, written in English, and focused on the relationship between symptoms of anxiety or depression and feeding styles in parents of term, bottle-fed infants younger than 12 months of age. We placed no restriction on date of publication because of the sparse amount of published literature on this topic. We identified a total of 1,882 articles. After removing duplicates, we screened 988 articles and retained six articles that met criteria for our review.

DATA EXTRACTION

We used Whittemore and Knafl's integrative review methodology to guide data extraction and reporting. We extracted relevant data from all primary data sources and compiled the data into a matrix. We used the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies to assess the quality of the studies.

DATA SYNTHESIS

Using an a priori coding scheme, we summarized the data using categorization of established parental feeding styles in infancy applicable to bottle-feeding. We synthesized the data into two broad categories: responsive and nonresponsive feeding styles.

CONCLUSION

Although research on the topic is limited, our findings suggest that symptoms of postpartum depression may be associated with nonresponsive feeding styles in parents of bottle-fed infants. We suggest several areas for future research and recommend increased emotional and feeding support in practice for parents of bottle-feeding infants.

Why do parents use packaged infant foods when starting complementary feeding? Findings from phase one of a longitudinal qualitative study

BACKGROUND

The first 1000 days in a child's life, from conception to age two, are a critical period for establishing a child's health and development. One important element is the diet that children receive during this time. Dietary intake of infants in the UK has been shown to be high in sugar and salt, with overall energy intakes exceeding recommendations by the time they are two years of age. Commercial infant food, which forms approximately 40-60% of infants' dietary intake, was identified in 2011 as the main contributor to sugar intake for infants aged 4-9 months in the United Kingdom. Further, evidence demonstrates inconsistencies between national recommendations on infant feeding and some of these products in terms of the type available, their nutritional value and product labelling and marketing. Given their role in infants' diets, it is important to understand parental perceptions of these products and why they are chosen.

METHODS

The study comprised the first phase of an in-depth, longitudinal qualitative study which explored parents' experiences of introducing solid foods to their infants over the first year of feeding. 62 parents/ carers were recruited to this phase when their infants were four-six months old. Data collection involved semi-structured interviews and a photo-elicitation exercise. Data from interview transcripts which focused on the purchase and use of packaged purees and commercial snacks were analysed thematically.

RESULTS

Parents/ carers drew on a range of reasons for buying both packaged purees and commercial snacks for their infants. These included anxiety over food preparation, food safety, convenience, cost effectiveness, the pull of brand eco-systems for packaged purees, and the way in which commercial snacks provide opportunities for safe development of motor skills, keep infants occupied, and allow them to take part in family rituals.

CONCLUSION

In considering the use of packaged products as a food source for infants in public health nutrition policy, it is important to understand the broad range of factors that shape parents decisions ranging from the way that products are advertised and perceived, to the non-nutritive roles that they play.

Relationship Between Feeding to Sleep During Infancy and Subsequent Childhood Disease Burden

OBJECTIVE

To investigate the association of feeding to sleep during infancy and subsequent childhood health burdens.

STUDY DESIGN

Information was collected from the parents of children who participated in the national health screening survey when the child was 9-12 months old. The exposure group included participants who were fed to sleep. The primary outcome was all-cause hospital admission (inpatient care, intensive care unit [ICU] admission, or general anesthesia) after age 24 months. Secondary outcomes were subsequent childhood diseases (ie, adenoidectomy and/or tonsillectomy, nasal polyps, allergic rhinitis, acute otitis media, asthma, pneumonia, and aspiration pneumonia), and growth status, as measured by weight-to-age and height-to-age z-scores.

RESULTS

The study cohort consisted of 224 075 children who participated in the health screening program, 29 392 of whom (13.1%; 51% males) were fed to sleep. Exposure was associated with an increased risk of all-cause hospitalization after age 24 months (hazard ratio [HR], 1.05; 95% CI, 1.03-1.07), but not with admission to an ICU or receipt of general anesthesia. This also was related to adenoidectomy and/or tonsillectomy (HR, 1.08; 95% CI, 1.01-1.15), dental caries (HR, 1.32; 95% CI, 1.23-1.40), asthma (HR, 1.14; 95% CI, 1.14-1.24), pneumonia (HR, 1.10; 95% CI, 1.07-1.13), overweight (HR, 1.06; 95% CI, 1.03-1.09), and obesity (HR, 1.11; 95% CI, 1.06-1.16).

CONCLUSIONS

Several adverse health outcomes are related to feeding to sleep during early childhood.

The Effects of Breastfeeding for Four Months on Thinness, Overweight, and Obesity in Children Aged 3 to 6 Years: A Retrospective Cohort Study from National Physical Fitness Surveillance of Jiangsu Province, China

Objective: To explore the effects of breastfeeding during the first four months of life on thinness, overweight, and obesity and to analyze the influential factors in children aged three to six years in eastern China. Methods: This study was designed as a retrospective cohort study, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed. A total of 8053 subjects were included in this secondary analysis of data from the 2015 “Physical Fitness Surveillance data of Jiangsu, China”. The subjects were classified into three groups on the basis of feeding patterns: breastfeeding, mixed feeding, and formula feeding. The International Obesity Task Force (IOTF) definitions of BMI were used to define thinness, overweight, and obesity. Multivariate logistic regression models and subgroup analysis were used to assess the association between feeding patterns and childhood thinness, overweight, obesity, and overweight/obesity, adjusted for potential confounders (sex, age grade, area, region/economy, gestational age, birthweight, childbearing age, mother’s education, and caretaker). Results: The prevalence of breastfeeding was 63.8%, and the prevalence of thinness, overweight, obesity, and overweight/obesity reached 2.7%, 11.2%, 4.7%, and 15.9%, respectively. Breastfeeding participants had a lower risk of overweight and overweight/obesity with adjusted ORs of 0.652 (95% CI: 0.533, 0.797; p < 0.001) and 0.721 (95% CI: 0.602, 0.862; p < 0.001), respectively; however, there was no difference in thinness and obesity (both p > 0.05) compared with formula feeding. There was no statistical difference between mixed and formula feeding, in terms of thinness, overweight, obesity, or overweight/obesity (all p > 0.05). Subgroup analysis showed that breastfeeding for three years, preterm, and a childbearing age of 25−29 years had higher adjusted ORs for thinness, and in 5−6 years, urban areas, southern/developed economy regions, post-mature, childbearing age ≥ 25 years, and other caretakers had higher and invalid breastfeeding-adjusted ORs (all p > 0.05 except overweight in the urban grade) for both overweight and overweight/obesity. Conclusions: Breastfeeding during the first four months was not associated with the thinness of children aged 3−6 years in eastern China, and the protective effect of breastfeeding against overweight or overweight/obesity could be confirmed. However, the effects of breastfeeding on thinness, overweight, and obesity may change or become invalid in some subgroups, suggesting that there may be potential interactions between feeding patterns and influential factors.

Impact of Weight Status Reporting on Childhood Body Mass Index

Background: Many states have adopted school-based BMI screening or surveillance programs in an effort to address high rates of childhood obesity, some of which involve provision of confidential BMI reports to parents. While there is evidence that parents are attuned to information in the reports, there is less evidence showing that the reports are effective in preventing excess childhood weight gain. Methods: Data from Arkansas, the state with the nation's first and longest running and BMI screening program, were used to measure the impact of BMI reports. This was done through a regression discontinuity design that compared future BMI z-scores among children falling within a narrow band around the obese and overweight thresholds. We derived the effects of BMI reports by comparing students who received different types of reports around the relevant threshold. Results: While we are unable to detect any differences in BMI z-scores between the children who received the overweight report and the children who received the healthy weight report, we detected some differences between children who received the obese report and children who received the overweight report. These findings hold across subsamples by age, minority status, and school meal status. Conclusions: Based on these data, overweight or obese reports to do not meaningfully impact future BMI z-scores. This may be due, in part, to the format of parental reports, which may dampen the surprise element of an overweight or obese report.

The Impact of Obesity on the Fitness Performance of School-Aged Children Living in Rural Areas-The West Attica Project

This study aimed to investigate the relationship of body mass index (BMI) with muscle and cardiorespiratory fitness in children living within rural areas (regional unit of West Attica) in Greece. Participants included 399 students (187 boys, 212 girls), ages 8-12 years old, and were evaluated in physical performance tests. The point prevalence of overweight and obesity was 21.39% and 26.20% in boys, and 19.90% and 23.79% in girls. Significant differences were observed in all physical performance tests (handgrip, long jump, shuttle run, trunk flexors, and extensors endurance) between normal weight and obese participants. BMI was positively correlated with handgrip (r = 0.442-0.462, p < 0.001). There was a negative association with long jump (r = -0.206, p < 0.001), 20 m shuttle run (r = -0.394, p < 0.001), trunk flexors (r = -0.403, p < 0.001) and trunk extensors endurance (r = -0.280, p < 0.001). The regression analysis showed that 20-30% of the overall variation for physical performance assessments could be accounted for by BMI, age, and sex. With the exception of the long jump and the endurance of the trunk extensors, BMI alone may explain more than 10% of the outcome of most tests. This study highlights the determinant of BMI on muscle and cardiorespiratory fitness. The management of obesity should begin early in childhood to prevent adult chronic cardiovascular and metabolic diseases.

Infant appetite and weight gain in early infancy: Moderating effects of controlling feeding styles

Excessive infant weight gain is a strong predictor of later obesity. While controlling feeding has been linked to negative weight outcomes, research has not considered associations between infant appetite and maternal feeding simultaneously in relation to infant weight. This longitudinal study examined infant food responsiveness and slowness in eating as predictors of infant weight outcomes and tested controlling feeding styles (restrictive and pressuring) as moderators. Data came from a diverse sample of mothers and their infants participating in an ongoing longitudinal study. Mothers (n = 159) reported infant appetite and feeding styles at 2 postnatal timepoints (2-month visits and 6-month visits). The infant weight outcomes included change in weight-for-age z-scores (WAZ-change) and rapid weight gain (RIWG; WAZ-change ≥ 0.67 SD) from birth to the second postnatal visit. Data were analyzed using hierarchical multiple and logistic regressions, controlling for birthweight, gestational age, maternal race/ethnicity, feeding mode, and residing with an intimate partner. Over 25% of infants exhibited RIWG. Greater infant food responsiveness predicted both greater infant weight gain and RIWG status. Infant food responsiveness and slowness in eating interacted with controlling feeding styles in a unique way. Infants with higher food responsiveness whose mothers were less restrictive had greater weight gain (b = 0.61, p < 0.001) and increased probability of RIWG (b = 2.71, p < 0.01) than infants with more restrictive mothers. Higher slowness in eating was associated with a lower RIWG probability among infants of mothers with lower pressuring feeding (b = -1.86, p < 0.05). For infants with a large appetite, some level of restrictive feeding may be beneficial for preventing excessive weight gain while pressuring may exacerbate the positive association between faster eating and RIWG.

Prevalence and determinants of meeting minimum dietary diversity among children aged 6-23 months in three sub-Saharan African Countries: The Demographic and Health Surveys, 2019-2020

Background

Dietary diversity is an indicator of nutritional adequacy, which plays a significant role in child growth and development. Lack of adequate nutrition is associated with suboptimal brain development, lower school performance, and increased risk of mortality and chronic diseases. We aimed to determine the prevalence and determinants of meeting minimum dietary diversity (MDD), defined as consuming at least five out of eight basic food groups in the previous 24-h in three sub-Saharan African countries.

Methods

A weighted population-based cross-sectional study was conducted using the most recent Demographic and Health Surveys (DHS). MDD data were available between 2019 and 2020 for three sub-Saharan African countries (Gambia, Liberia, and Rwanda). The study population included 5,832 children aged 6-23 months. A multivariable logistic regression model was developed to identify independent factors associated with meeting MDD.

Results

Overall, the weighted prevalence of children who met the MDD was 23.2% (95% CI: 21.7-24.8%), ranging from 8.6% in Liberia to 34.4% in Rwanda. Independent factors associated with meeting MDD were: age of the child (OR) = 1.96, 95% CI: 1.61, 2.39 for 12-17 months vs. 6-11 months], mothers from highest households' wealth status (OR = 1.86, 95% CI: 1.45-2.39) compared with the lowest, and mothers with secondary/higher education (OR = 1.69, 95% CI: 1.35-2.12) compared with those with no education. Mothers who were employed, had access to a radio, and those who visited a healthcare facility in the last 12 months were more likely to meet the MDD. There was no significant association between the child's sex and the odds of fulfilling the MDD.

Conclusions

There is substantial heterogeneity in the prevalence of MDD in these three sub-Saharan African countries. Lack of food availability or affordability may play a significant role in the low prevalence of MDD. The present analysis suggests that policies that will effectively increase the prevalence of meeting MDD should target poor households with appropriate materials or financial assistance and mothers with lower literacy. Public health interventions working with sectors such as education and radio stations to promote health education about the benefits of diverse diets is a critical step toward improving MDD in sub-Saharan Africa and preventing undernutrition.

Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review

Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.

Breastfeeding on childhood obesity in children were large-for-gestational age: retrospective study from birth to 4 years

Our aim was to assess effects of breast-feeding (BF) in the association between large-for-gestational age (LGA) and body mass index (BMI) trajectories on childhood overweight from 1 to 4 years old. A total of 1649 healthcare records of mother–child pairs had detailed records of feeding practices and were included in this retrospective cohort study. Data were available in Medical Birth Registry of Xiamen between January 2011 and March 2018. Linear and logistic regression models were used to access the difference between BF and no-BF group. For offspring were LGA and BF was significantly associated with a lower BMI Z-score from 1 to 4 years old after adjustment confounders in Model 1 to 3 [difference in BMI Z-score in Model 1: estimated β: −0.07 [95%CI: −0.13 to −0.01]; Model 2: estimated β: −0.07 (−0.13 to −0.004); Model 3: estimated β: −0.06 (−0.12 to −0.001); P = 0.0221, 0.0371, 0.0471]. A significantly lower risk of childhood overweight was observed in Model 1 [odd ratio (OR): 0.85 (95%CI, 0.73 to 1.00)], P = 0.0475) with adjustment for maternal pre-pregnancy BMI. Furthermore, Model 2 and Model 3 showed LGA-BF infants had a lower risk for childhood overweight then LGA-no-BF infants [OR: 0.87 and 0.87 (95%CI, 0.73 to 1.03; 0.74 to 1.03)], however, there was no statistical significance (P = 0.1099, and 0.1125)]. BF is inversely related to BMI Z-score and risk for overweight in children were LGA from 1 to 4 years old. Adjustment for maternal pre-pregnancy BMI, the protective association between BF and childhood overweight was more significant.

Potentially modifiable mediators for socioeconomic disparities in childhood obesity in the United States

OBJECTIVE

The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States.

METHODS

This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics.

RESULTS

The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities.

CONCLUSIONS

Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Association of Perinatal Factors With Severe Obesity and Dyslipidemia in Adulthood

Background:

Perinatal factors including gestational age, birthweight, size for gestational age, delivery route, maternal parity, maternal age, maternal education, socioeconomic status, race, and sex, are associated with the future risk of obesity and co-morbid conditions. This study evaluated the relationship of birthweight for gestational age and perinatal factors with severe obesity and dyslipidemia in adulthood.

Methods:

We conducted a population-based, retrospective birth cohort study of infants born to residents of Olmsted County, MN between 1976 and 1982. Outcomes were assessed after age 18 years until October 2020, including severe obesity (BMI ≥ 40 kg/m²) and dyslipidemia (total cholesterol ≥200 mg/dL, non-high density lipoprotein [non-HDL] cholesterol ≥145 mg/dL or HDL cholesterol <40 mg/dL). We obtained mother’s age, education level, and parity as well as newborn sex, race, type of delivery, single/multiple birth, gestational age, and birthweight from birth certificate data. Individual-level socioeconomic status (SES) of the household at birth was determined with the HOUSES index.

Results:

Of 10 938 birth cohort subjects, 7394 had clinic visits after age 18 years and were included, with 2630 having severe obesity (n = 798) or dyslipidemia (n = 2357) as adults. In multivariable models, female sex, singleton birth, less maternal education, and lower SES defined by HOUSES were independently associated with an increased risk of severe obesity in adulthood. Non-white race, singleton birth, and lower birthweight were independently associated with adult dyslipidemia. Birthweight for gestational age was not associated with severe obesity or dyslipidemia.

Conclusion:

Perinatal factors were associated with both severe obesity and dyslipidemia in adulthood. Lower SES at birth was predictive of severe obesity in adulthood, highlighting the opportunity to investigate modifiable perinatal social determinants to reduce the risk of severe obesity.

Association of gestational hypertension and preeclampsia with offspring adiposity: A systematic review and meta-analysis

BACKGROUND

The association of gestational hypertension (GH) and preeclampsia (PE) with offspring adiposity outcomes had controversial results in different studies.

OBJECTIVE

We conducted a systematic review and meta-analysis to evaluate the relationship between maternal GH/PE and offspring adiposity outcomes.

SEARCH STRATEGY

Studies were identified in PubMed, Embase, and Cochrane databases, with keywords including "gestational hypertension", "preeclampsia", "offspring", "weight", "cohort study", etc., without year restriction. This study was registered with PROSPERO, CRD42022292084.

SELECTION CRITERIA

We set the selection criteria for six aspects: population, outcome, time frame, study design, and availability. For the studies included in the meta-analysis, we required the potential confounders in these studies have been adjusted.

DATA COLLECTION AND ANALYSIS

Two reviewers independently evaluated the data from the included studies. The meta-analyses included mean differences, regression coefficients, and corresponding 95% confidence intervals. Results were performed using RevMan software (version 5.4; Cochrane Collaboration). Heterogeneity among the included studies was assessed using the I² statistic.

MAIN RESULTS

A total of 16 studies were included in our review, 15 of which were evaluated as high quality. In all offspring, during the early life (28 days-36 months), GH/PE exposure was found to be not or inversely associated with offspring obesity, then become positively associated at larger ages (3-19 years old). In offspring with adverse birth outcomes, the maternal GH/PE-exposed group had a lower weight in the short term (28 days to 18 months), but there was a trend of rapid weight gain as they grew older, compared with the non-exposed group. The meta-analysis showed that the BMI of the female offspring in the maternal PE-exposed group was significantly higher than that of the non-exposed offspring (MD=1.04, 95% CI: 0.67~1.42, P < 0.05).

CONCLUSIONS

The systematic review suggested that maternal exposure to de novo hypertension disorders of pregnancy (HDP) was associated with obesity in offspring, extending from early childhood to adolescence. The meta-analysis showed that PE was associated with higher BMI in female offspring. More studies are needed to conduct stratified analyses by PE/GH, the severity of HDP, or gender.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, identifier CRD42022292084.

Early nutritional influences of cardiovascular health

INTRODUCTION

Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke.

AREAS COVERED

This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD.

EXPERT OPINION

Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.

Early onset of overweight among children from low-income families: The role of exclusive breastfeeding and maternal intake of ultra-processed food

CONTEXT

There is an increasing prevalence of overweight during early childhood in the most impoverished areas in Brazil, although there is a lack of evidence regarding its onset.

OBJECTIVES

To investigate the incidence and risk factors associated with overweight among low-income children during their first year of life.

METHODS

We analysed data from a prospective birth cohort study conducted in Brazil, which followed-up children at birth, 3rd, 6th and 12th months (n = 196). The overweight incidence (zBMI/A > 2SD) was analysed using the Kaplan-Meier survival estimator and its associated factors by the Coxs regression model. Missing data were addressed with multiple imputations and results on the final adjusted model were calculated by pooling the estimates generated for each imputed dataset.

RESULTS

The overweight incidence was 17 events/100 children-year, and most cases occurred before the 6th month. The final model showed that children exclusively breastfed up to 30 days (vs. >30 days; HR 2.68; 95%CI 1.11-6.49) and whose mothers consumed ultra-processed foods more than 4 times/day (vs. ≤4 times/day; HR 3.02; 95%CI 1.28-7.13) presented a higher risk of developing overweight.

CONCLUSION

The overweight incidence was high in this impoverished population. Shorter exclusive breastfeeding duration and an unhealthy household food environment provided a short-term risk increase.

Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region

Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.

Breastfeeding and Overweight in European Preschoolers: The ToyBox Study

The benefits of breastfeeding (BF) include risk reduction of later overweight and obesity. We aimed to analyse the association between breastfeeding practices and overweight/obesity among preschool children participating in the ToyBox study. Data from children in the six countries, participating in the ToyBox-study (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) 7554 children/families and their age is 3.5–5.5 years, 51.9% were boys collected cross-sectionally in 2012. The questionnaires included parents’ self-reported data on their weight, height, socio-demographic status, and infant feeding practices. Measurements of preschool children’s weight and height were done by trained researchers using standard protocols and equipment. The ever breastfeeding rate in the total sample was 85.0% (n = 5777). Only 6.3% (n = 428) of the children from the general sample were exclusively breastfed (EBF) for the duration of the first six months. EBF for four to six months was significantly (p < 0.001) less likely among mothers with formal education < 12 years (adjusted Odds Ratio (OR) = 0.61; 95% Confidence interval (CI) 0.44–0.85), smoking throughout pregnancy (adjusted OR = 0.39; 95% CI 0.24–0.62), overweight before pregnancy (adjusted OR = 0.67; 95%CI 0.47–0.95) and ≤25 years old. The median duration of any breastfeeding was five months. The prevalence of exclusive formula feeding during the first five months in the general sample was about 12% (n = 830). The prevalence of overweight and obesity at preschool age was 8.0% (n = 542) and 2.8% (n = 190), respectively. The study did not identify any significant association between breastfeeding practices and obesity in childhood when adjusted for relevant confounding factors (p > 0.05). It is likely that sociodemographic and lifestyle factors associated with breastfeeding practices may have an impact on childhood obesity. The identified lower than desirable rates and duration of breastfeeding practices should prompt enhanced efforts for effective promotion, protection, and support of breastfeeding across Europe, and in particular in regions with low BF rates.

Duration of Breastfeeding Mediates the Association Between Early Socioeconomic Risk and Child Vocabulary at Age 4

OBJECTIVE

Early-life socioeconomic disadvantage is associated with both obesity and lower cognitive abilities in childhood. One theorized underlying mechanism is breastfeeding duration because breast milk contains nutrients that can promote healthy adiposity profiles and stimulate brain development. However, studies have rarely examined these potential associations with child body mass index (BMI) in high-income Western countries, much less investigated breastfeeding duration as a mediator of the relationship between childhood socioeconomic status (SES) and later child vocabulary. The current study aimed to prospectively examine associations between early-life family socioeconomic risk and both child BMI and vocabulary at age 4 in a Norwegian cohort and the potential mediating contribution of breastfeeding duration.

METHODS

The Behavior Outlook Norwegian Developmental Study (BONDS) followed 1159 families and their children from 6 months of age onward. Parents reported on SES and breastfeeding duration in infancy, and child BMI and vocabulary ability were assessed at age 4. Direct and indirect effects were estimated using a path model that adjusted for several demographic and perinatal covariates (e.g., parental nativity and birthweight).

RESULTS

Family socioeconomic risk was significantly and negatively related to child vocabulary but was unrelated to child BMI. In addition, breastfeeding duration mediated the association between family socioeconomic risk and child vocabulary, with greater family socioeconomic risk associated with a shorter breastfeeding duration, which, in turn, predicted poorer child vocabulary.

CONCLUSION

The current findings suggest that longer breastfeeding duration is a viable target for preventatively promoting child vocabulary, especially among families at socioeconomic risk.

Obesity in Early Childhood: Examining the Relationship among Demographic, Behavioral, Nutritional, and Socioeconomic Factors

Background: The present study sought to explore the combined relationship of physical activity, screen time, consumption of sugar-sweetened beverages, infant feeding practices, and demographic factors with obesity in early childhood. Methods: The current study included cross-sectional Kindergarten Health Survey data collected annually from 2012 to 2016. The sample included 7814 kindergarten students, with a mean age of 5.02 [standard deviation = 0.33]. A Multinomial Logistic Regression using body mass index as the dependent variable and select demographic traits, dietary practices, sedentary behaviors, and physical activity indicators as independent variables was used to assess relationship of aforementioned factors to obesity. Results: Children were more likely to be obese if they were non-Caucasian, male, lived in rural areas, lived at or below the poverty level, had public insurance, or lived in single-parent households. Children who received less than 30 minutes of physical activity 3 or fewer days per week, had more than 2 hours of daily screen time, consumed any amount of soda, and consumed anything other than breast milk at 6 months of age also had a higher probability of being obese. Conclusions: The findings from this study suggest that investments in prevention strategies are needed to address the behavioral patterns and socioeconomic disparities before kindergarten. Efforts that increase access to nutritious food, physical activity, and overall family wellness and education, such as high-quality early childhood education, could be feasible prevention approaches.

[Common practices and beliefs in the preparation of complementary infant feeding in a Spanish sample: a cross-sectional study]

INTRODUCTION

complementary feeding together with breast milk should cover the nutritional needs of children from 6 months onwards. Thus, inadequate dietary practices can lead to poor nutritional intake. The objective of this study was to examine infant food handling and cooking in Spanish households.

METHODOLOGY

a cross-sectional study was carried out using an online survey in non-institutionalized adults living in Spain who usually prepare infant food for children under 2 years of age.

RESULTS

a total of 1,944 people (37.4 ± 6 years; 65.5 % women) answered the survey. Of these, 72 % prepared mainly mashed foods and 21 % used store-bought baby cereals frequently. Zucchini (39 %), chicken (62 %), hake (64 %) and banana (44 %) were the most commonly used foods. Boiling (63 %) and freezing (59 %) were the most widely used culinary and preservation practices. An inappropriate use of salt and some unsafe foods (large fish and chard) was identified, whereas olive oil and eggs were offered below the current nutritional recommendations.

CONCLUSION

the population surveyed preferred to use mashed foods to feed children under 2 years of age. Even though they were aware that homemade food is nutritionally better, on certain occasions they offer store-bought baby cereal. Furthermore, some inappropriate feeding practices were detected, highlighting the need to implement nutritional education policies regarding infant food preparation.

Who do we miss when screening for postpartum depression? A population-based study in a Swedish region

BACKGROUND

Universal screening for postpartum depression is crucial for early detection, interventions and support. The aim of this study was to describe the proportion of, and explore risk factors for, women not being offered screening, as well as for declining an offer or not being screened due to any other unknown reason.

METHODS

Socioeconomic, obstetrical and neonatal data, extracted from the Swedish Pregnancy Registry, for 9,959 pregnancies recorded for the Östergötland county between 2016 and 2018 were linked to Edinburgh Postnatal Depression Scale (EPDS) screening results at 6-8 weeks postpartum, extracted from medical records. Risk factors were assessed using logistic regression models and with a nomogram for easy visualization.

RESULTS

In total, there were no recorded offers of EPDS screening in the medical records for 30.0% of women at the postpartum follow-up. Women born outside of Sweden and women reporting poor self-rated health were at increased risk of not being offered screening for postpartum depression.

LIMITATIONS

There is a possibility that women were offered screening or were screened, but this was incorrectly or never recorded in medical records.

CONCLUSIONS

The majority of women were offered screening for postpartum depression, but there is room for improvement in order to achieve universal screening. Awareness among healthcare providers of the risk factors for not screening might increase adherence to guidelines for universal screening. Overcoming barriers for screening and raising the topic of mental-health issues for postpartum women should be prioritized.

Complementary Feeding and Overweight in European Preschoolers: The ToyBox-Study

Complementary feeding (CF) should start between 4–6 months of age to ensure infants’ growth but is also linked to childhood obesity. This study aimed to investigate the association of the timing of CF, breastfeeding and overweight in preschool children. Infant-feeding practices were self-reported in 2012 via a validated questionnaire by >7500 parents from six European countries participating in the ToyBox-study. The proportion of children who received breast milk and CF at 4–6 months was 51.2%. There was a positive association between timing of solid food (SF) introduction and duration of breastfeeding, as well as socioeconomic status and a negative association with smoking throughout pregnancy (p < 0.005). No significant risk to become overweight was observed among preschoolers who were introduced to SF at 1–3 months of age compared to those introduced at 4–6 months regardless of the type of milk feeding. Similarly, no significant association was observed between the early introduction of SF and risk for overweight in preschoolers who were breastfed for ≥4 months or were formula-fed. The study did not identify any significant association between the timing of introducing SF and obesity in childhood. It is likely that other factors than timing of SF introduction may have impact on childhood obesity.

The fetal origins of disease: a prospective cohort study on the association of preeclampsia and childhood obesity

Cardiovascular diseases are the main cause of mortality worldwide, and childhood excess weight/obesity are strong correlators of accumulated risk in later life. A relationship between maternal preeclampsia and offspring's childhood obesity is recognized, but most studies fail to control for strong confounders. Our goal is to analyze the association between preeclampsia and childhood excess weight/obesity, after accounting for important confounders. We recruited 5133 women with singleton pregnancies during admission for delivery. Sixty-seven pregnancies were complicated by preeclampsia. Maternal and children outcomes were assessed at 10 years of age. We analyzed the association between preeclampsia and childhood excess weight/obesity by fitting a linear regression model (using offspring body mass index (BMI) z-score at 10 years of age) and a logistic regression model (using excess weight/obesity status). We then controlled both models for known confounders, namely maternal prepregnancy BMI, parity, and smoking during pregnancy. At 10 years of age, offspring of preeclamptic mothers had a higher BMI z-score and were more likely classified as overweight/obese, but these differences were not statistically significant. After controlling for maternal prepregnancy BMI, parity, and smoking during pregnancy, there was a high magnitude change in the beta coefficient of preeclampsia in the linear (0.175; -0.014) and the logistic regression models (1.48; 1.23) suggesting that the association between preeclampsia and childhood excess weigh/obesity is significantly confounded by these variables. These confounders also showed a significant association with childhood obesity. This finding suggests that in utero exposure to preeclampsia seems to have less impact in childhood obesity than the previously described confounders.

Early childhood factors associated with obesity at age 8 in Vietnamese children: The Young Lives Cohort Study

Background

Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8.

Methods

This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organization’s thresholds for body-mass-index (BMI) for age Z-scores. Associations between early and concurrent socio-behavioral factors, childhood nutrition and physical activity variables were analyzed using STATA 15. Bivariate and multivariable analyses were completed utilizing logistic regression models.

Results

The prevalence of ow/ob increased from 1.1% in both sexes at age 1 to 7% in females and 13% in males at age 8. Bivariate analyses show greater likelihood of ow/ob at age 8 was significantly associated with early life sociodemographic factors (at age 1), male sex (OR = 2.2, 1.6–3.1), higher wealth (OR = 1.1–1.4), and urban residence (OR = 4.3, 3–6). In adjusted analyses, ow/ob at age 8 was associated with early nutrition practices at age 5, including frequent consumption of powdered milk (OR = 2.8, 1.6–4.6), honey/sugar (OR = 2.7, 1.8–4.1), prepared restaurant/fast foods (OR = 4.6, 2.6–8.2), and packaged sweets (OR = 3.4, 2.3–4.9). In addition, breastfeeding for 6 months or longer was protective against obesity at age 8 (OR = 0.3, 0.1–0.9).

Conclusions

We found that increased consumption of powdered milk, honey/sugar, packaged sweets, and prepared restaurants/fast foods are associated with childhood ow/ob. In contrast, breastfeeding for 6 months or longer was protective against childhood ow/ob. These findings suggest that public health programs and campaigns aimed to prevent childhood ow/ob in Vietnam should target early feeding practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10292-z.

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.

Amidst the COVID-19 pandemic childhood obesity is still an epidemic-spotlight on obesity's multifactorial determinants

PURPOSE

Childhood obesity is a global epidemic and a chronic disease. Multifactorial determinants have long been linked with childhood obesity. These have been challenged with the onset of COVID-19 and the associated mitigation measures. The study aimed to re-highlight these determinants while exploring the effects of the ongoing COVID-19 pandemic on these pre-existing childhood obesity determinants, while providing evidence that may be beneficial for the post-COVID-19 recovery plan.

METHODS

A PubMed literature search (2016-2021) using the keywords, "childhood obesity", "gender", "sex", "obesity in youth", "obesity in adolescents", "COVID-19″ and "SARS-CoV2" was performed.

RESULTS

Genetic predisposition, biologically low leptin levels, certain cultural beliefs and socio-economic statuses, as well as exposure to an "obesogenic" environment were found to have a positive association with childhood obesity. Additionally, the onset of COVID-19 further aggravates the childhood obesity epidemic, increasing childrens' susceptibility to obesity and all associated consequential diseases.

DISCUSSION

A possible key to the control and prevention of the burden of childhood obesity, lies in dealing with its precursors and risk factors. Certain factors, including socio-cultural norms, cultural beliefs and geographical factors are amenable. COVID-19 further challenged these and it is evident that the childhood obesity epidemic is still a critical one. Encouraging preventative interventions, such as screening programs, public awareness and policies targeting the environment, amongst others, are recommended.

The Impact of Medical Financial Hardship on Children's Health

Objective. To determine whether living in a family with medical financial hardship decreases children's access to health care. Methods. We identified children aged 4 to 17 years from the 2013 to 2018 National Health Interview Surveys. Medical financial hardship was defined as living in a family where one or more family members had problems paying medical bills in the past 12 months. Results. Of 53 483 children in the analysis, 19% were exposed to medical financial hardship. This was adversely associated with children's health status and health care use, especially greater odds of delaying care (odds ratio [OR] = 5.28; 95% confidence interval [CI] = 4.51-6.19) and having unmet health care needs (OR = 4.43; 95% CI = 4.00-4.91). Conclusions. One fifth of children live in families experiencing medical financial hardship, and this exposure is adversely correlated with child health outcomes even controlling for established measures of socioeconomic status, such as family income, health insurance coverage, and need-based program participation.

Socioeconomic inequalities and severe obesity-Sex differences in a nationwide study of 1.12 million Israeli adolescents

INTRODUCTION

In a nationwide population of adolescents, we investigated the sex-specific association of socioeconomic position (SEP) with severe obesity, and trends over time.

METHODS

The cohort comprises all Israeli adolescents (mean ± SD age 17.3 ± 0.5 years) who were medically examined, before mandatory military service during 2000 to 2015. Of 1 120 362 adolescents, 239 816 (21.4%) were classified with overweight or with obesity classes I to III using the International Obesity Task Force criteria. Data were compared between 2000 to 2009 and 2010 to 2015.

RESULTS

Considering more advantaged residential SEP as the reference group, the respective odds ratios (ORs ± 95%CI) of less advantaged SEP for obesity classes I to III in 2010 to 2015 were 1.48 (1.40-1.56), 1.66 (1.51-1.83), and 1.73 (1.45-2.08) for males; and 1.72 (1.60-1.84), 1.89 (1.66-2.15), and 2.62 (2.04-3.37) for females. All point estimates were higher than in the preceding decade. Considering female inductees from the more advantaged SEP as the reference group, ORs were higher for males in the more advantaged SEP group, for overweight, 1.31 (1.27-1.36); class I obesity, 1.29 (1.20-1.38); class II obesity, 1.34 (1.18-1.53); and class III obesity, 1.60 (1.24-2.07). Similarly, in the less and medium advantaged SEP groups, increased ORs for males compared with females were observed in all obesity groups. Results persisted using United States Centers for Disease Control and Prevention growth charts.

CONCLUSIONS

Adolescents with less rather than more advantaged residential SEP are at greater risk of severe obesity. Adolescent males, of all residential SEP groups had higher odds than females for all classes of obesity.

Socioeconomic Status and Childhood Obesity: a Review of Literature from the Past Decade to Inform Intervention Research

PURPOSE OF REVIEW

This is a review of the patterns, conceptualization, and suggested mechanisms underlying the relationship of socioeconomic status (SES) to obesity in childhood and the implications of these data for interventions going forward.

RECENT FINDINGS

Adiposity and SES are negatively associated in high-income countries and positively associated in medium to low-income countries. Several mechanisms, such as early introduction of solid food and parental behaviors, which may explain the association of SES and adiposity, have been identified. Parental education and adiposity and early pediatric nutrition appear to be particularly salient SES-related effectors on adiposity. There is a clear association of SES and adiposity which is affected by population affluence. Evaluation of the relationship of SES and obesity in children are complicated by the complexity of SES and lack of common definition. A number of SES-related interventional targets have been identified. Intervention research should ensure they are addressing SES-associated issues in the study population.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

Social vulnerabilities as risk factor of childhood obesity development and their role in prevention programs

INTRODUCTION

Large socioeconomic, gender, and ethnic inequalities exist in terms of childhood obesity worldwide. Children from low socioeconomic status families are more likely to have overweight/obesity and related cardiometabolic problems and future cancer risk. A wider concept are social vulnerabilities defined as social or economic characteristics or experiences negatively affecting children through behavioral, biological factors, or mental health. Social vulnerabilities include also therefore low subjective perceptions of social position.

OBJECTIVE

This study aims to identify social vulnerabilities and to summarize their impact as obesity development risk factor. Preventive programs implemented targeting these vulnerable groups and their effectiveness are also discussed.

METHODS

Literature review based on the experience of the authors social vulnerabilities identified as risk factors for childhood obesity were children whose parents lack of a social network, low support from formal and informal sources, parental unemployment, belonging to a minority group or having migrant background, adverse childhood experiences including household dysfunction, violence and childhood maltreatment and other traumatic experiences, gender inequalities and being part of nontraditional families.

RESULTS

The impact of social vulnerabilities on childhood obesity is independent of SES; however, SES exacerbates or buffer the effect social vulnerabilities have on different lifestyles and stress. Behavioral, biological, and mental health mechanisms may explain the association between social vulnerabilities and childhood obesity.

CONCLUSIONS

Behaviors such as dietary intake, physical activity, sedentary behaviors, and sleep are negatively affected by the stress and low levels of mental health derived from social vulnerabilities. It seems that high energy intakes rather than low physical activity levels might be the main driving force behind the obesity epidemic in vulnerable groups. Most of the prevention programs identified did not take into account social vulnerabilities and inequalities making them ineffective in most vulnerable groups. Interventions conducted in children from socially vulnerable group suggest modest but promising effects.

Introduction to complementary feeding in the first year of life and risk of overweight at 24 months of age: changes from 2004 to 2015 Pelotas (Brazil) Birth Cohorts

Complementary feeding (CF) and overweight relationships during early childhood are inconsistent in the literature. We described the association of CF during the first year of life with risk of overweight at 24 months of age in the population-based 2004 and 2015 Pelotas (Brazil) Birth Cohorts (2004c and 2015c). CF introduction was evaluated at the 3 and 12 months' follow-ups by asking mothers using a list of foods. Risk of overweight at 24 months of age was BMI-for-age z-score above +1sd from the median of the WHO 2006 growth standards. Our analyses included 3823 (2004c) and 3689 (2015c) children. Early introduction CF (before 6 months of age) prevalence in 2004c was 93·3 (95 % CI 92·5, 94·1) % and in 2015c was 87·2 (95 % CI 86·1, 88·2) %. Tea was the item introduced earlier in both 2004c (68·8 %) and 2015c (55·7 %). At 6 months of age, vegetable mash was the most introduced food in 2004c (33·5 %) and 2015c (47·9 %). Between 2004c and 2015c, the introduction of fresh milk decreased 82·1 to 60·5 % and yogurt from 94·4 to 78·1 % during the first year. Risk of overweight prevalence at 24 months was 33·0 (95 % CI 31·6, 34·5) % in 2004c and 32·0 (95 % CI 30·5, 33·5) % in 2015c. In 2015c, the adjusted odds of risk of overweight at 24 months were increased 1·66 and 1·50 times with the early introduction of fresh/powdered milk: plus water, tea or juice, and plus semi-solid/solid food groups, respectively. It is essential to reinforce the adherence to global recommendations on timely feeding introduction and encourage exclusive breast-feeding until 6 months of age to prevent child overweight.