Influence of early life factors on body mass index trajectory during childhood: a population-based longitudinal analysis in the Western Brazilian Amazon

Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates

Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.

Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018

OBJECTIVE

The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali.

DESIGN

Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018.

SETTING

Urban and rural areas of Mali.

PARTICIPANTS

A total of 8908 children participated, with 3999 in the younger age group (0-24 months) and 4909 in the older age group (25-59 months).

RESULTS

In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group.

CONCLUSIONS

This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition.

Maternal pre-pregnancy body mass index, gestational weight gain and child weight during the first 2 years of life in an Amazonian birth cohort

BACKGROUND

In socially vulnerable populations, evidence is needed regarding the role of maternal nutritional status on child weight during the first 2 years of life.

OBJECTIVES

We aimed to assess the association of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with offspring BMI-for-age z-scores (BAZs) during the first 2 years of life.

METHODS

A population-based birth cohort study was conducted with 900 mother-child pairs. Pre-pregnancy weight and weight at delivery were collected from medical records, and anthropometric data were measured at birth and at 6-month, 1-year and 2-year follow-up visits. Linear regression and linear mixed-effect models assessed associations with pre-pregnancy BMI, GWG and BAZ during the first 2 years of life.

RESULTS

Pre-pregnancy overweight and obesity and excessive GWG were positively associated with BAZ at birth and at 1- and 2-year follow-up visits. There were no significant additional BAZ changes per year based on the exposures up to age 2 years.

CONCLUSIONS

Elevated maternal pre-pregnancy BMI and GWG were associated with a child's higher BAZ at birth, and these differences remained constant throughout the first 2 years of life in Amazonian children. These findings highlight the importance of promoting adequate maternal weight before pregnancy and during prenatal care also in socially vulnerable populations.

Maternal BMI in the preconception period, and association with child zBMI growth rates

BACKGROUND

Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. The association between maternal preconception BMI and child growth rates is unclear.

OBJECTIVES

To assess the association between measured maternal preconception BMI and child age- and sex- standardized WHO BMI z-score (zBMI) growth rates and mean zBMI, in children aged 0-10 years old.

METHODS

A longitudinal cohort study was conducted with children (n = 499) enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research cohort. Maternal BMI was measured during the preconception period, defined as the 2 years prior to pregnancy. Repeated measures of child weight and height were obtained between 0 and 10 years of age. Linear mixed models were used to evaluate the association between maternal BMI and child zBMI growth rates and mean zBMI.

RESULTS

Maternal preconception BMI was associated with child zBMI growth rate during some growth periods, with the strongest association from age 0 to 4 months; a 5 kg/m2 higher maternal BMI was associated with 0.031 zBMI SD unit/mo higher growth rate (p = 0.004), and 0.186 SD unit higher mean child zBMI (p = 0.0002).

CONCLUSIONS

Maternal preconception BMI was associated with growth rate and mean zBMI in early childhood. The preconception period may be an important target for health interventions to promote healthy child growth rate and weight outcomes.

Using linear and natural cubic splines, SITAR, and latent trajectory models to characterise nonlinear longitudinal growth trajectories in cohort studies

BACKGROUND

Longitudinal data analysis can improve our understanding of the influences on health trajectories across the life-course. There are a variety of statistical models which can be used, and their fitting and interpretation can be complex, particularly where there is a nonlinear trajectory. Our aim was to provide an accessible guide along with applied examples to using four sophisticated modelling procedures for describing nonlinear growth trajectories.

METHODS

This expository paper provides an illustrative guide to summarising nonlinear growth trajectories for repeatedly measured continuous outcomes using (i) linear spline and (ii) natural cubic spline linear mixed-effects (LME) models, (iii) Super Imposition by Translation and Rotation (SITAR) nonlinear mixed effects models, and (iv) latent trajectory models. The underlying model for each approach, their similarities and differences, and their advantages and disadvantages are described. Their application and correct interpretation of their results is illustrated by analysing repeated bone mass measures to characterise bone growth patterns and their sex differences in three cohort studies from the UK, USA, and Canada comprising 8500 individuals and 37,000 measurements from ages 5-40 years. Recommendations for choosing a modelling approach are provided along with a discussion and signposting on further modelling extensions for analysing trajectory exposures and outcomes, and multiple cohorts.

RESULTS

Linear and natural cubic spline LME models and SITAR provided similar summary of the mean bone growth trajectory and growth velocity, and the sex differences in growth patterns. Growth velocity (in grams/year) peaked during adolescence, and peaked earlier in females than males e.g., mean age at peak bone mineral content accrual from multicohort SITAR models was 12.2 years in females and 13.9 years in males. Latent trajectory models (with trajectory shapes estimated using a natural cubic spline) identified up to four subgroups of individuals with distinct trajectories throughout adolescence.

CONCLUSIONS

LME models with linear and natural cubic splines, SITAR, and latent trajectory models are useful for describing nonlinear growth trajectories, and these methods can be adapted for other complex traits. Choice of method depends on the research aims, complexity of the trajectory, and available data. Scripts and synthetic datasets are provided for readers to replicate trajectory modelling and visualisation using the R statistical computing software.

Infant Feeding and Ethnic Differences in Body Mass Index during Childhood: A Prospective Study

This study investigated ethnic differences in childhood body mass index (BMI) in children from Dutch and Turkish descent and the role of infant feeding factors (breastfeeding duration, milk feeding frequency, as well as the timing, frequency and variety of complementary feeding (CF)). We used data from 244 children (116 Dutch and 128 Turkish) participating in a prospective study in the Netherlands. BMI was measured at 2, 3 and 5 years and standard deviation scores (sds) were derived using WHO references. Using linear mixed regression analyses, we examined ethnic differences in BMI-sds between 2 and 5 years, and the role of infant feeding in separate models including milk or CF factors, or both (full model). Relative to Dutch children, Turkish children had higher BMI-sds at age 3 (mean difference: 0.26; 95%CI: 0.04, 0.48) and 5 (0.63; 0.39, 0.88), but not at 2 years (0.08; -0.16, 0.31). Ethnic differences in BMI-sds were somewhat attenuated by CF factors at age 3 (0.16; -0.07, 0.40) and 5 years (0.50; 0.24, 0.77), whereas milk feeding had a minor impact. Of all factors, only CF variety was associated with BMI-sds in the full model. CF factors, particularly CF variety, explain a small fraction of the BMI-sds differences between Dutch and Turkish children. The role of CF variety on childhood BMI requires further investigation.

Effect of birth weight and nutritional status on transverse maxillary growth: Implications for maternal and infant health

We analyzed the association between birthweight, nutritional status and transverse maxillary growth in 7- to 9-year-old schoolchildren. We undertook a cross-sectional survey nested in a population-based cohort study of 158 schoolchildren. The participants lived in the urban area of a small town within the Western Brazilian Amazon. The outcome was represented by the upper intermolar distance given in millimeters (mm), as an indicator of the degree of maxillary bone growth in its transverse dimension. The exposures were sex, birthweight, the bottle-feeding pattern operationalized by a scale corresponding to the age of introduction of the bottle and Body Mass Index-for-age z-score (BAZ) at 4 to 6 ys. Path analysis was employed to estimate standardized direct, indirect and total effects of exposures on the outcome using structural equations model (SEM) supported by Mplus 7 program. The values of standardized coefficients (SC) showed significant direct positive effects of sex (SC = 0.203; p = 0.006), birth weight (SC = 0.155; p = 0.030) and BAZ (SC = 0.165; p = 0.014) on transverse maxillary growth. The indirect effects (SC = 0.057; p = 0.012) and the total effect (SC = 0.261; p<0.001) of sex on the outcome were statistically significant. The indirect effects of birth weight on the outcome were not significant (SC = 0.018; p = 0.488), however, the total effect was significant (SC = 0.174; p = 0.011). In conclusion, sex, birthweight, bottle beginning age and BAZ showed association with the transverse growth of the maxillary bone. In addition to contributing to an adequate birth weight of the child, policies and programs that favor prenatal care and conditions to guarantee a full-term birth can positively affect transverse growth of the maxilla. From a Public Health Surveillance point of view, children with reduced birthweight, inadequate breastfeeding pattern and nutritional deficit for age may be more likely to develop atrophy of the jaws which, depending on the severity, may result in malocclusion with an important impact on quality of life.

Early determinants of linear growth and weight attained in the first year of life in a malaria endemic region

We investigated linear growth and weight attained among 772 children at 10–15 months of age in the first population-based birth cohort in the Brazilian Amazon. Sociodemographic, maternal and birth characteristics were collected in interviews soon after birth at baseline. Anthropometric evaluation was conducted at 10–15 months. Multiple linear regression models were fitted for length-for-age (LAZ) and body mass index (BMI)-for-age Z scores (BAZ), considering a hierarchical conceptual framework with determinants at distal, intermediate and proximal levels, with adjustment for the child’s sex and age. Mean LAZ and BAZ were 0.31 (SD: 1.13) and 0.35 (SD: 1.06), respectively. Overall, 2.2% of children were stunted and 6.6% overweight. Among socioeconomic factors, household wealth index was positively associated with LAZ (p for trend = 0.01), while children whose families received assistance from the Bolsa Família conditional cash transfer program were 0.16 Z score thinner (95% CI: -0.31, -0.00). Maternal height and BMI were positively associated with both LAZ and BAZ at 10–15 months of age (p for trend <0.001). Child’s size at birth was positively related with LAZ (p<0.001 for both birth weight and length). BAZ was 0.34 (95% CI: 0.24, 0.44) higher, but 0.11 lower (95% CI: -0.21, -0.02), for each increase in 1 Z score of birth weight and length, respectively. Children with at least one reported malaria episode within the first year of life were 0.58 (95% CI: -1.05, -0.11) Z score shorter. Socioeconomic and intergenerational factors were consistently associated with LAZ and BAZ at 10–15 months of age. The occurrence of malaria was detrimental to linear growth. In a malaria endemic region, reduction of inequalities and disease burden over the first 1,000 days of life is essential for taking advantage of a critical window of opportunity that can redirect child growth trajectories toward better health and nutrition conditions in the long term.

Ethiopia's high childhood undernutrition explained: analysis of the prevalence and key correlates based on recent nationally representative data

OBJECTIVE

To examine the contribution of child, maternal and household factors in stunting, wasting and underweight among children under 5 years in Ethiopia.

DESIGN

Quantitative cross-sectional design based on nationally representative data.

SETTING

Urban and rural areas of Ethiopia.ParticipantsYounger (0-24 months; n 4199) and older age groups (25-59 months; n 5497), giving a total of 9696 children.

RESULTS

Among the younger age group, 29 % were stunted, 14 % were wasted and 19 % were underweight; and among the older age group, the prevalence of stunting, wasting and underweight was 47, 8 and 28 %, respectively. Being female, intake of multiple micronutrients, household having a piped source of drinking-water, high maternal BMI, higher household wealth and higher maternal education were associated with decreased odds of at least one form of undernutrition in both groups. On the other hand, children who were anaemic, had low birth weight, drank from a bottle, and children of stunted or wasted or working mothers were more likely to be stunted, wasted or underweight in both groups (P&lt;0·05). While most predictors and/or risk factors followed a similar pattern across the two age groups, child factors had higher leverage in the younger than the older group across the three forms of undernutrition.

CONCLUSIONS

Multiple set of factors predicted childhood undernutrition in Ethiopia. The study underscores the importance of intervening in the first 1000 days through promoting maternal education, maternal-child health services, mother's nutrition and improving intrahousehold food distribution.

Relationship Between Maternal Pre-pregnancy Weight and Offspring Weight Strengthens as Children Develop: A Population-Based Retrospective Cohort Study

Background

Maternal pre-pregnancy weight has been reported to be positively associated with offspring weight. The association between maternal weight and offspring weight might be explained by maternal lifestyle. We investigated the strength of the relationship between maternal body mass index (BMI) at the beginning of pregnancy and offspring BMI at several growth stages.

Methods

The source population was all eighth graders registered in all public schools in the city of Fukuroi, Japan, in 2012. Records of maternal anthropometry at the beginning of pregnancy were obtained from the Maternal and Child Health (MCH) Handbook. The height and body weight of each student were measured. A regression model was used to assess the association between maternal BMI z-score at the beginning of pregnancy and offspring BMI z-score at various ages.

Results

Of the source population, data from the MCH Handbook were obtained for 480 students. Among males, maternal BMI z-score was not associated with offspring BMI z-score at birth and at age 3 years but was associated with offspring BMI z-score at age 13 years (standardized regression coefficient (β) = 0.19; P < 0.01). Among females, maternal BMI z-score was associated with offspring BMI z-score at birth (β = 0.11; P < 0.05), at age 3 years (β = 0.22; P < 0.01) and at age 13 years (β = 0.51; P < 0.01).

Conclusions

Our results suggest that the positive association between maternal weight at the beginning of pregnancy and offspring weight around puberty is stronger than that between maternal weight and offspring weight at birth. Maternal lifestyle may influence offspring weight in adolescence.

Breastfeeding duration, maternal body mass index, and birth weight are associated with differences in body mass index growth trajectories in early childhood

Background

Accelerated postnatal growth is an important predictor for obesity risk. It is unknown whether early-life obesity-related risk factors affect body mass index (BMI) growth rates during distinct growth periods from early infancy through preschool years.

Objective

We examined whether breastfeeding duration, maternal BMI, and birth weight are associated with growth trajectories of age- and sex-standardized WHO BMI z scores (zBMIs) in young children.

Design

Children (n = 5905) in The Applied Research Group for Kids (TARGet Kids!) prospective cohort study underwent repeated measures of weight and length or height from birth to 10 y of age. Piecewise linear mixed models were used to determine whether zBMI growth rates differ for each risk factor during periods of growth between birth and 1, 3, 18, 36, and 72 mo of age.

Results

Children who were breastfed <6 mo compared with ≥6 mo showed a higher growth rate between 1-3 and 3-18 mo, resulting in higher standardized BMIs (zBMIs) of +0.24, +0.12, and +0.19 at 18, 36, and 72 mo, respectively. Maternal BMI (in kg/m2) ≥30 compared with <30 resulted in higher growth rates between 1-3 and 36-72 mo and higher zBMIs of +0.22, +0.14, +0.18, and +0.41 at 3, 18, 36, and 72 mo, respectively. Infants weighing <2.5 kg at birth (compared with 2.5-4 kg) experienced higher growth rates between 1-3 and 3-18 mo but had lower zBMIs at all time points (zBMI: -1.45 to -0.21). Infants weighing ≥4 kg at birth (compared with 2.5-4 kg) had significantly lower growth rates in the first 3 mo but higher zBMIs at all time points (zBMI: +1.16 to +0.27).

Conclusion

Differences in zBMI growth rates by breastfeeding duration, maternal BMI, and birth weight are seen in early infancy and contribute to differences in zBMI, which persist into midchildhood. This trial was registered at www.clinicaltrials.gov as NCT01869530.

Socioeconomic differences in childhood BMI trajectories in Belarus

Objective

To examine associations of parental socioeconomic position with early-life offspring body mass index (BMI) trajectories in a middle-income country.

Subjects

Overall, 12,385 Belarusian children born 1996–97 and enrolled in a randomised breastfeeding promotion trial at birth, with 3–14 measurements of BMI from birth to 7 years.

Methods

Cohort analysis in which exposures were parental education (common secondary or less; advanced secondary or partial university; completed university) and occupation (manual; non-manual) at birth, and the outcome was BMI z-score trajectories estimated using multilevel linear spline models, controlling for trial arm, location, parental BMI, maternal smoking status and number of older siblings.

Results

Infants born to university-educated mothers were heavier at birth than those born to secondary school-educated mothers [by 0.13 BMI z-score units (95% confidence interval, CI: 0.07, 0.19) for girls and 0.11 (95% CI: 0.05, 0.17) for boys; equivalent for an infant of average birth length to 43 and 38 g, respectively]. Between the ages of 3–7 years children of the most educated mothers had larger BMI increases than children of the least educated mothers. At age 7 years, after controlling for trial arm and location,  children of university-educated mothers had higher BMIs than those born to secondary school-educated mothers by 0.11 z-score (95% CI: 0.03, 0.19) among girls and 0.18 (95% CI: 0.1, 0.27) among boys, equivalent to differences in BMI for a child of average height of 0.19 and 0.26 kg/m², respectively. After further controlling for parental BMI, these differences attenuated to 0.08 z-score (95% CI: 0, 0.16) and 0.16 z-score (95% CI: 0.07, 0.24), respectively, but changed very little after additional adjustment for number of older siblings and mother’s smoking status. Associations were similar when based on paternal educational attainment and highest household occupation.

Conclusions

In Belarus, consistent with some middle-income countries, higher socioeconomic position was associated with greater BMI trajectories from age 3 onwards.

Early Life Growth Predictors of Childhood Adiposity Trajectories and Future Risk for Obesity: Birth to Twenty Cohort

BACKGROUND

There is growing evidence of variations in adiposity trajectories among individuals, but the influence of early life growth patterns on these trajectories is underresearched in low- and middle-income countries. Therefore, our aim was to examine the association between early life conditional weight gain and childhood adiposity trajectories.

METHODS

We previously identified distinct adiposity trajectories (four for girls and three for boys) in black South African children (boys = 877; girls = 947). The association between the trajectories and early life growth patterns, and future obesity risk was assessed by multivariate linear and multinomial logistic and logistic regressions. Conditional weight gain independent of height was computed for infancy (0-2 years) and early childhood (2-4 years).

RESULTS

Conditional weight gain before 5 years of age was significantly associated with early onset of obesity or overweight (excess weight) BMI trajectories in both boys and girls. In girls, greater conditional weight gain in infancy was associated with increased relative risk of being in the early-onset obese to morbid obese trajectory, with relative risk ratios of 2.03 (95% confidence interval: 1.17-3.52) compared to belonging to a BMI trajectory in the normal range. Boys and girls in the early-onset obesity or overweight BMI trajectories were more likely to be overweight or obese in early adulthood.

CONCLUSIONS

Excessive weight gain in infancy and early childhood, independent of linear growth, predicts childhood and adolescent BMI trajectories toward obesity. These results underscore the importance of early life factors in the development of obesity and other NCDs in later life.

An outline of anemia among adolescent girls in Bangladesh: findings from a cross-sectional study

Background

Anemia is a significant wide spread public health threat especially among the adolescent girls who are more vulnerable towards low level of hemoglobin particularly of low and middle income countries (LMICs). We investigated the prevalence of anemia among the adolescent girls (10–19 years) in Bangladesh and its socio-demographics distribution.

Methods

We collected data digitally in ODK platform from a sub-sample of a nationwide cross-sectional survey of 1314 adolescent girls in 2015. Capillary blood hemoglobin level was estimated using HemoCue®; anthropometric measurements through standardized procedure and details socio-demographic information were captured and analyzed. Malnutrition was defined as BMI-for-age Z-score below -2SD (BAZ < −2SD), measured in WHO-AnthroPlus. Univariate analysis followed by multiple logistic regression were performed to examine the association between socio-demographic variables and anemia, while controlling the effect of potential confounding variables.

Results

Overall, 51.6% girls were suffering from any form of anemia (non-pregnant-Hb < 12 g/dl; pregnant-Hb < 11 g/dl) while 46% were mildly (non-pregnant-Hb: 10–11.9 g/dl; pregnant-Hb: 10–10.9 g/dl) and 5.4% were moderately (Hb: 7–9.9 g/dl) anemic while only 0.2% were severely anemic. After controlling for relevant covariates in multiple logistic regression model, malnutrition (AOR: 1.42, 95% CI = 1.0–2.10, p-value = 0.083), non-pregnancy (AOR: 6.10, 95% CI = 2.70–13.78, p-value < 0.001), and households with bottom wealth quintile (AOR: 1.54, 95% CI = 1.03–2.30, p-value = 0.037) were identified as significant risk factors of anemia among adolescent girls of Bangladesh.

Conclusions

Higher number of adolescent girls are still suffering from anemia in Bangladesh and non-pregnant adolescent girls contributed the most. Immediate, long term and sustainable public health intervention would require to combat the situation.

Maternal employment and childhood overweight in low- and middle-income countries

OBJECTIVE

To investigate the association between maternal employment and childhood overweight in low- and middle-income countries (LMIC). Design/Setting We utilized cross-sectional data from forty-five Demographic and Health Surveys from 2010 to 2016 (n 268 763). Mothers were categorized as formally employed, informally employed or non-employed. We used country-specific logistic regression models to investigate the association between maternal employment and childhood overweight (BMI Z-score>2) and assessed heterogeneity in the association by maternal education with the inclusion of an interaction term. We used meta-analysis to pool the associations across countries. Sensitivity analyses included modelling BMI Z-score and normal weight (weight-for-age Z-score≥-2 to <2) as outcomes.

SUBJECTS

Participants included children 0-5 years old and their mothers (aged 18-49 years).

RESULTS

In most countries, neither formal nor informal employment was associated with childhood overweight. However, children of employed mothers, compared with children of non-employed mothers, had higher BMI Z-score and higher odds of normal weight. In countries where the association varied by education, children of formally employed women with high education, compared with children of non-employed women with high education, had higher odds of overweight (pooled OR=1·2; 95 % CI 1·0, 1·4).

CONCLUSIONS

We find no clear association between employment and child overweight. However, maternal employment is associated with a modestly higher BMI Z-score and normal weight, suggesting that employment is currently associated with beneficial effects on children's weight status in most LMIC.

Serum Trans Fatty Acids Are Not Associated with Weight Gain or Linear Growth in School-Age Children

BACKGROUND

Animal and human adult studies indicate that long-term intake of trans fatty acids (TFAs) may be associated with weight gain. High intake of fast foods and snacks, which are rich in TFAs, is linked to overweight status among school-age children. However, the specific effects of TFAs in this population are unknown.

OBJECTIVE

We examined whether serum TFAs, used as biomarkers of intake, are associated with faster weight gain and linear growth during school years.

METHODS

We quantified TFAs by GLC in serum samples of 668 children aged 5-12 y at the time of recruitment into an ongoing cohort study performed in Bogota (Colombia) since 2006. Serum proportions of trans palmitoleic acid (16:1t), trans oleic acid (18:1t), trans linoleic acid (18:2t), and total TFAs were used as biomarkers of intake. Anthropometric characteristics were measured periodically for a median of 30 mo. Body mass index-for-age z scores (BAZs) and height-for-age z scores (HAZs) were calculated with the use of the WHO reference. We estimated mean changes in BAZs and HAZs over follow-up according to quartiles of each TFA at baseline by using mixed-effects regression models with restricted cubic splines.

RESULTS

Proportions of trans palmitoleic acid, trans oleic acid, trans linoleic acid, and total TFAs (mean ± SD, % of total serum FAs), were 0.22 ± 0.06, 0.91 ± 0.37, 0.96 ± 0.27, and 2.10 ± 0.59, respectively. Serum TFAs were not associated with changes in BAZs and HAZs after adjusting for sex, baseline age, and socioeconomic status. In a subgroup analysis by sex, serum trans palmitoleic acid was positively associated with the estimated change in HAZs from ages 6 to 14 y in boys (with use of the first quartile as the reference, differences in HAZs for trans palmitoleic acid quartiles were 0.73, 0.53, and 0.70, P-trend = 0.03).

CONCLUSIONS

Proportions of serum TFAs, used as biomarkers of TFA intake, were not associated with weight gain in children aged 6-14 y in low- and middle-income populations in Bogota. The proportion of trans palmitoleic acid was positively associated with linear growth in boys. Longer follow-up and studies in diverse cohorts with wider ranges of TFA intake are warranted.

Effects of social mobility from childhood to adolescence on BMI

OBJECTIVE

Little is known about the contribution of childhood socio-economic position (SEP) and social mobility to weight change. The present study evaluated the effect of family SEP during the pre-school years and social mobility on BMI between birth and adolescence.

DESIGN

Longitudinal. The SEP of each child's family was classified according to an asset-based wealth index as low, medium or high. Four different categories of childhood-adolescence SEP groups were created in order to examine social mobility: low-medium/high, medium-medium, medium-high and high-high/medium. For each of these categories, BMI was tracked from birth to adolescence. Linear mixed-effects models were used to analyse the data.

SETTING

Cuiabá-MT, Brazil.

SUBJECTS

A population-based cohort of children born between 1994 and 1999 was assessed between 1999 and 2000, and again between 2009 and 2011.

RESULTS

A total of 1716 adolescents were followed from childhood to adolescence (71·4 % of baseline). The prevalence of overweight/obesity was 20·4 % in childhood and 27·7 % in adolescence. A higher SEP in childhood was associated with a greater prevalence of overweight in adolescence. Expressive upward social mobility occurred, mainly in the lowest SEP group. There was a greater rate of change in BMI between birth and adolescence among children with a higher SEP in childhood and children who remained in the higher SEP from childhood to adolescence.

CONCLUSION

Individuals from a higher SEP in childhood and those who remained in the higher social classes showed greater rate of change in BMI. Thus, initial SEP was the major determinant of changes in BMI.

C-reactive protein concentration predicts change in body mass index during childhood

OBJECTIVE

Inflammation may constitute an underlying mechanism for increased risk of developing chronic diseases in later years, but few prospective studies have assessed the influence of low-grade inflammation on body weight gain, particularly among children in low- to middle-income settings with lower prevalence of overweight and obesity. We aimed to investigate whether C-reactive protein (CRP), as a biomarker of low-grade inflammation, predicts changes in body mass index-for-age z scores (BAZ) during childhood.

METHODS

A population-based longitudinal study was conducted in the Brazilian Amazon among children aged ≤10 years in 2007, with follow-up visits in 2009 and 2012. Outcome was annual change in BAZ. As the main exposure of interest, CRP concentrations were divided into four categories, with values <1 mg/L divided in tertiles plus a fourth category with values ranging from 1 to 10 mg/L. Children were simultaneously screened for iron and vitamin A deficiencies, diarrhea, and wheezing. We used mixed-effect linear regression models to measure the effect of CRP concentrations on annual BAZ change and linear regression models to explore CRP predictors at baseline.

RESULTS

At baseline, 1007 children had CRP and anthropometric data [mean (SD) age: 5.3 (2.9) years; 50.9% male, 84.5% mulatto/mixed-race, 14.0% at risk for overweight or obesity, 4.8% stunted]; 737 were successfully followed up. Morbidities and nutritional deficiencies were widespread. Among participants aged >5 years, children in the highest tertile of CRP <1 mg/L at baseline, regarded as an indicator of low-grade inflammation, had a 0.04 z/y higher gain in BAZ (95% CI: 0.01, 0.09 z/y) during follow-up. CRP was positively associated with household poverty and worse nutritional indicators.

CONCLUSIONS

We found evidence of a role for low-grade inflammation in predicting annual BAZ gain among children aged >5 years.

Association of maternal and child nutritional status in Brazil: a population based cross-sectional study

Background

Although child undernutrition and stunting has been decreasing worldwide while obesity rates increase, these extreme conditions might coexist in families from low- and middle-income countries. We examined the association between maternal and child anthropometric indicators using a population representative sample.

Methods

4,258 non-pregnant women and their children <60 months who participated in the 2006 Brazilian Demographic Health Survey. We compared the distributions of two nutritional indexes of children, height-for-age (HAZ) and body mass index-for age (BAZ) z-scores, by categories of maternal height, body mass index (BMI), and waist circumference (WC). Adjusted mean differences and 95% confidence intervals (95% CI) were estimated from linear regression, taking into account the complex survey design. We also examined the associations of maternal anthropometry with the prevalence of child stunting (HAZ<−2) and overweight/obesity (BAZ>2).

Results

HAZ was positively associated with maternal height and WC in a linear fashion. After adjustment, for sociodemographic characteristics, children whose mothers' height was<145 cm had 1.2 lower HAZ than children whose mothers were ≥160 cm tall (p-trend<0.0001). After further adjustment for maternal height and maternal BMI, children of mothers with a waist circumference ≥88 cm had 0.3 higher HAZ than those of mothers with WC<80 cm (p-trend<0.01). Adjusted prevalence ratios and 95% CI for stunting by the categories of maternal height (<145, 145–149, 150–154, 155–159 and ≥160 cm) were, respectively, 2.95 (1.51;5.77), 2.29 (1.33;3.93), 1.09 (0.63;1.87), and 0.89 (0.45;1.77), (p-trend = 0.001). BAZ was positively associated with maternal BMI and WC.

Conclusion

We observed a strong, positive association of maternal and child nutritional status. Mothers of low stature had children with lower stature, mothers with central obesity had taller children, and mothers with overall or abdominal obesity had children with higher BAZ.

Maternal stress and distress and child nutritional status

BACKGROUND/OBJECTIVE

To assess the relationship between maternal stress and distress in pregnancy and 5-8 years postpartum and child nutritional status.

SUBJECTS/METHODS

Longitudinal cohort study carried out in Jundiai city, Southeast Brazil, involving 409 women followed throughout pregnancy to 5-8 years postpartum, and respective children. Measures of stress and distress were obtained three times in pregnancy (at gestational ages lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks) and 5-8 years postpartum by the Perceived Stress Scale (PSS), General Health Questionnaire (GHQ) and the State-Trait Anxiety Inventories (STAI). The nutritional status of the children was assessed by the World Health Organization body mass index (BMI) z-score for age. The relationship between child BMI z-score for age and scores of the PSS, GHQ and STAI was evaluated by multivariate linear regression, controlling for confounding variables.

RESULTS

BMI z-score for age of the children was negatively associated with maternal scores of the PSS 5-8 years postpartum and scores of the GHQ in the second trimester of pregnancy. BMI of the children was positively associated with maternal BMI and birthweight (R(2)=0.13). There was -0.04 (confidence interval -0.07 to -0.9 × 10(-2)) decrease in child BMI per score unit of the PSS increase, and -0.09 (confidence interval -0.18 to -0.6 × 10(-3)) decrease in child BMI per score unit of the GHQ increase.

CONCLUSIONS

This study detected a relationship between maternal mental and nutritional status and child nutritional status, implying that if the mother is not physically or mentally well, her capacity for caring for her child may be impaired.