Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative - COSI 2015/2017

Obesity and cardiovascular health

Obesity has risen to epidemic levels worldwide over the past few decades and has become a huge global health burden owing to its direct contribution to the development of some of the most prevalent chronic diseases including diabetes, hypertension, hyperlipidaemia, and other cardiovascular diseases. Obesity is a disease of positive energy balance resulting from complex interactions between abnormal neurohumoral responses and an individual's socioeconomic, environmental, behavioural, and genetic factors leading to a state of chronic inflammation. Understanding the complex nature of the disease is crucial in determining the best approach to combat its rising numbers. Despite recent advancements in pharmacological therapy for the treatment of obesity, reversing weight gain and maintaining weight loss is challenging due to the relapsing nature of the disease. Prevention, therefore, remains the key which needs to start in utero and continued throughout life. This review summarizes the role obesity plays in the pathophysiology of various cardiovascular diseases both by directly affecting endothelial and myocyte function and indirectly by enhancing major cardiovascular risk factors like diabetes, hypertension, and hyperlipidaemia. We highlight the importance of a holistic approach needed to prevent and treat this debilitating disease. Particularly, we analyse the effects of plant-based diet, regular exercise, and non-exercise activity thermogenesis on obesity and overall cardiorespiratory fitness. Moreover, we discuss the significance of individualizing obesity management with a multimodal approach including lifestyle modifications, pharmacotherapy, and bariatric surgery to tackle this chronic disease.

Influence of maternal characteristics and infant feeding patterns on infant growth from birth till 18 months: The MISC study

BACKGROUND

The growth and development of infants during the first 1000 days of life are crucial for their health.

OBJECTIVES

This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months.

METHODS

Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates.

RESULTS

Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively).

CONCLUSION

The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth.

Infant feeding practices and body mass index up to 7.5 years in the French nationwide ELFE study

BACKGROUND/OBJECTIVES

The infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the associations of infant feeding practices with body mass index (BMI) until 7.5 years.

SUBJECTS/METHODS

Analyses were based on data from the French nationwide ELFE birth cohort. Data on breastfeeding (BF) and complementary feeding (CF) were collected monthly from 2 to 10 months. Infant feeding practices were characterized using principal component analyses (PCA) and hierarchical ascendant classification. BMI z-score was computed at 1, 2, 3, 5 and 7.5 years, from data collected in the child's health booklet; 7.5-year overweight was defined according to IOTF references. Associations between infant feeding practices and BMI were investigated by linear regression models adjusted for main confounders.

RESULTS

Ever breastfeeding was not associated with BMI up to 7.5 years. Compared to intermediate breastfeeding duration (1 to <3 months), longer breastfeeding duration (≥6 months) was related to lower 1-year BMI, but not at older ages. Compared to the recommended age at CF introduction (4-6 months), early CF (<4 months) was related to higher BMI up to 5 years with a similar trend at 7.5 years, but not to the risk of overweight. The PCA patterns characterized by early baby cereal introduction and late food pieces introduction or by frequent intake of main food groups were related to a lower BMI up to 7.5 years.

CONCLUSION

Breastfeeding was related with a lower BMI in infancy but not thereafter, whereas an early CF initiation (<4 months) was associated with a higher BMI in childhood.

Effects of an integrative warm-up method on the range of motion, core stability, and quality of squat performance of young adults

Introduction

This research aims to determine the effects of an integrative warm-up method on the range of motion in joints of the lower extremities, the strength of the stabilizer trunk muscles, and the quality of the basic movement patterns in older adolescents.

Methods

The study sample consisted of 88 male students (age 20.1 ± 0.5). They were randomly divided into four groups: one control group (CG) (n = 17; 180.8 ± 7.9 cm; 82.3 ± 8.3 kg) and three experimental groups (EG): EG1 (n = 23; 180.9 ± 7.0 cm; 78.5 ± 9.5 kg), EG2 (n = 31; 182.2 cm ± 7.3 cm; 79.5 ± 11.5 kg), and EG3 (n = 17; 183.3 ± 4.9 cm; 77.5 ± 11.8 kg). The participants were subjected to a 6-week experimental treatment: EG1 once, EG2 twice, and EG3 three times a week. The experimental treatment consisted of four sub-phases representing the integrative warm-up Method: 1) Inhibition (self-myofascial release using a foam roller); 2) Lengthening (Static stretching in a maximum range of motion position); 3) Activation (Positional isometrics muscle activation of the trunk and gluteus); 4) Integration (Integrated all the previous phases into one complex movement pattern). Based on the covariance analysis (ANCOVA), statistically significant treatment effects were observed and positive changes were determined in all experimental groups.

Results

The differences between groups were observed in the following variables: Overhead Squat Assessment (p = 0.000; η p 2 = 0.318 ), range of motion of left hip flexion (p = 0.000; η p 2 = 0.371 ), range of motion of right hip flexion (p = 0.000; η p 2 = 0.051 ) and range of motion of right hip extension (p = 0.051; η p 2 = 0.088 ), Double Leg Lowering Test (F = 2.411; p = 0.014; η p 2 = 0.014 ) and range of combined motion (plantar and dorsiflexion) of left ankle joint (p = 0.000; η p 2 = 0.299 ). There was no significant difference in the Plank Test (F = 1.007; p = 1.007; η p 2 = 0.035 ), range of combined motion (plantar and dorsiflexion) of right ankle joint (p = 0.088; η p 2 = 0.170 ) and range of motion of left hip extension (p = 0.158; η p 2 = 0.060 ). The participants of CG statistically significantly differed from EG1, EG2, and EG3 in the squat performance after the applied treatment.

Discussion

The effect of the treatment was the occurrence of a transformational processes in almost all measured variables. It can be concluded that the integrative method is effective and applicable in practice for both young adults and recreational athletes.

Exclusive human milk feeding and prevalence of early adiposity rebound in ELBW infants: a retrospective cohort study

The purpose of the present study was to evaluate the prevalence of early adiposity rebound (EAR) and factors associated with its occurrence in a cohort of extremely low birth weight infants (ELBW). We conducted a retrospective longitudinal study including ELBW infants followed-up for up to 10 years after discharge. EAR was defined as occurring before 5 years of age. A multivariate binary logistic regression analysis was performed to evaluate maternal and perinatal variables independently associated with EAR. Out of 212 ELBW infants included in the analysis, 40.6% developed EAR and 21.5% showed it before 4 years of age. Only formula milk feeding at discharge was independently associated with a higher risk of EAR. The mean BMI of children with EAR was higher than that of children without EAR. Furthermore, the prevalence of overweight and obesity was higher in the EAR group than in the timely AR group.  Conclusions: ELBW infants in our cohort developed EAR in a relatively high percentage of cases. In this already at-risk population, EAR may represent a further risk factor for an adverse metabolic outcome. Monitoring preterm infants' growth within a long-term follow-up program and promoting and supporting human milk feeding is advisable. What is Known: • Preterm-born infants are at high risk for long-term adverse health outcomes, especially cardiovascular and metabolic. • The occurrence of early adiposity rebound (EAR) is associated with the risk of later obesity and metabolic syndrome. What is New: • The occurrence of EAR in ELBW infants may represent an additional risk factor for later adverse metabolic outcomes in an already vulnerable population. • Future preventive strategies should include a long-term follow-up and the promotion of exclusive breastfeeding.

Early feeding and nutritional status of Portuguese children in the first 36 months of life: EPACI Portugal 2012-a national representative cross-sectional study

Background

Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months.

Methods

EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables.

Results

More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children.

Conclusions

Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.

The Relationship between Birth Weight and the Risk of Overweight and Obesity among Chinese Children and Adolescents Aged 7-17 Years

Obesity is a major public health issue in children and adolescents. Our study aimed to examine the impacts of birth weight on overweight and obesity among Chinese children and adolescents. Using data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017, we included 10,041 participants aged 7-17 years. According to birth weight, participants were categorized into six groups, and the birth weight category of 3000 to 3499 g was chosen as the reference group, containing the largest number of children. Logistic regression analyses were used to investigate the association of birth weight with the risk of being obese at 7 to 17 years of age in multivariable-adjusted models. A restricted cubic spline was utilized to show the odds ratios (ORs) of obesity at different birth weight levels. The adjusted ORs for overweight were 0.98 (95%CI 0.63, 1.53), 1.02 (95%CI 0.84, 1.25), 1.34 (95%CI 1.16, 1.55), 1.72 (95%CI 1.35, 2.18), and 1.17 (95%CI 0.71, 1.96) in several birth weight groups, compared with group C (3000-3499 g). The adjusted ORs for obesity were 0.82 (95%CI 0.48, 1.40), 0.77 (95%CI 0.60, 0.98), 1.33 (95%CI 1.13, 1.57), 1.97 (95%CI 1.53, 2.53), and 2.01 (95%CI 1.27, 3.19). Furthermore, children in the post-pubertal stage had a slightly higher risk of overweight and obesity than those in the pre-pubertal and pubertal stage. Moreover, these associations were stronger among boys. The lower part of normal birth weight range is associated with a lower risk of overweight and obesity in children and adolescents. However, higher levels of birth weight increase risk.

Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal

BACKGROUND

The World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon.

METHODS

A sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding.

RESULTS

Only 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers' breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers' breastfeeding attitudes, beliefs, and practices.

CONCLUSIONS

The findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.

Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis

OBJECTIVE

To investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents.

STUDY DESIGN

This study included 634 offsprings aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates.

RESULTS

Median breastfeeding duration was 7 months (minimum = 0, maximum = 36). Boys in the second quartile (median breastfeeding = 5 months) had lower total fat mass % (β (SE) -3.2 (1.5) P = .037), and higher lean mass % (3.1 (1.6) P = .049) and skeletal muscle mass % (1.8 (0.8) P = .031) compared with the reference group (median breastfeeding = 2 months). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) P = .035) was found among girls. No association was found with other cardiometabolic indicators.

CONCLUSION

Despite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.

Bioactive peptides in preterm human milk: Impact of maternal characteristics and their association to neonatal outcomes

Human milk adipokines in term babies seem partially determined by maternal factors and affect infant's development. We aimed to describe bioactive peptide concentration in very preterm human milk and associations to maternal characteristics and postnatal growth. Mothers delivering ≤32 weeks of gestation and their infant/s were recruited. At 4 weeks of lactation, an aliquot of 24-h-pooled milk was collected for exclusively breastfeeding dyads. Insulin, leptin, adiponectin, and milk fat globule epidermal growth factor-8 (MFG-E8) were measured by enzyme-linked immunoabsorbent assay in skimmed milk. One hundred mothers (28.8 ± 2.3 weeks at delivery) provided a milk sample. Milk insulin was related to gestational age, pre-pregnancy body mass index (BMI), and galactagogue treatment (final model: adjusted R2 : 0.330, p < 0.0001; adjusted β coefficients: galactagogue treatment: 0.348, p 0.001; pre-pregnancy BMI: 0.274, p 0.009; gestational age: -0.290, p 0.007). Adiponectin was higher in mothers with gestational diabetes (30.7 ± 6.5 vs. 24.8 ± 8 ng/mL, p 0.044). Leptin was associated with pre-pregnancy BMI (Spearman's ρ: 0.648, p < 0.0001) and MFG-E8 to presence of labor and multiple pregnancy (final linear regression model, R2 : 0.073, p 0.028, adjusted β coefficients: presence of labor -0.229, p 0.050; twins: -0.192, p 0.099). Milk adiponectin was associated with a greater decrease in length z-scores from birth to 28 days (Pearson's r: -0.225, p 0.032) and to discharge (Pearson's r: -0.290, p 0.003). Milk MFG-E8 was lower in milk of mothers whose babies experienced late-onset sepsis (13.3 ± 5.8 vs. 16.8 ± 6.3 μg/mL, p 0.023). Adipokines levels in preterm human milk are partially related to maternal metabolic status. Milk peptide concentration associates with early neonatal growth trajectories.

Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI

OBJECTIVES

Breastfeeding practices may protect against offspring obesity, but this relationship is understudied among women with obesity. We describe the associations between breastfeeding practices and child BMI for age z-score (BMIz), stratified by maternal BMI.

METHODS

We analyzed 8134 dyads from 21 cohorts in the Environmental Influences on Child Health Outcomes Program. Dyads with data for maternal pre-pregnancy BMI, infant feeding practices, and ≥1 child BMI assessment between the ages of 2 and 6 years were included. The associations between breastfeeding practices and continuous child BMIz were assessed by using multivariable linear mixed models.

RESULTS

Maternal pre-pregnancy BMI category prevalence was underweight: 2.5%, healthy weight: 45.8%, overweight: 26.0%, and obese: 25.6%. Median child ages at the cessation of any breastfeeding and exclusive breastfeeding across the 4 BMI categories were 19, 26, 24, and 17 weeks and 12, 20, 17, and 12 weeks, respectively. Results were in the hypothesized directions for BMI categories. Three months of any breastfeeding was associated with a lower BMIz among children whose mothers were a healthy weight (-0.02 [-0.04 to 0.001], P = .06), overweight (-0.04 [-0.07 to -0.004], P = .03), or obese (-0.04 [-0.07 to -0.006], P = .02). Three months of exclusive breastfeeding was associated with a lower BMIz among children whose mothers were a healthy weight (-0.06 [-0.10 to -0.02], P = .002), overweight (-0.05 [-0.10 to 0.005], P = .07), or obese (-0.08 [-0.12 to -0.03], P = .001).

CONCLUSIONS

Human milk exposure, regardless of maternal BMI category, was associated with a lower child BMIz in the Environmental Influences on Child Health Outcomes cohorts, supporting breastfeeding recommendations as a potential strategy for decreasing the risk of offspring obesity.

Prevalence and determinants of overweight and obesity among preschool-aged children from migrant and socioeconomically disadvantaged contexts in Montreal, Canada

Among migrant and socioeconomically disadvantaged preschool-aged children followed in social perinatal primary care services in Montreal, Canada, we estimated the prevalence of overweight/obesity and identified determinants of body mass index z-score (zBMI) at 4-5 years old. We conducted a retrospective cohort study using electronic medical records of 275 child-mother dyads followed from birth to 4-5 years. Anthropometric measures and established maternal, perinatal and child risk factors for childhood obesity were examined. Age- and sex-specific zBMI at 4-5-years were computed and categorized according to WHO standards. Linear regression with model averaging was used to identify early life factors associated with zBMI. At 4-5 years, children's weight status was classified as underweight (1.5%), normal weight (69.7%), at-risk-of-overweight (19.2%), overweight (6.9%), and obesity (2.7%). Primiparity (0.51, 95% CI 0.24; 0.78), higher birthweight (1.04, 95% CI 0.70; 1.37), accelerated weight gain in the first year of life (0.21, 95% CI 0.13; 0.31), and introduction to solid foods before 6 months (0.89, 95% CI 0.42; 1.36) were associated with a higher zBMI, while less than high school education (-0.50, 95% CI -0.95; -0.05) and higher gestational age (-0.14, 95% CI -0.21; -0.05) were associated with lower zBMI at 4-5 years. Overweight/obesity is prevalent among preschool-aged children from migrant and socioeconomically disadvantaged contexts and is associated with known risk factors. Future research is needed to better understand the role of social perinatal primary care services in promoting optimal weight gain among children living in contexts of vulnerability.

Childhood Obesity May Be Linked to Feeding Habits and Screen Time

Background Childhood obesity is an alarming health problem. Early feeding habits and factors are among the etiological factors contributing to obesity. Objectives The objective of this study is to evaluate the correlation between breastfeeding, alongside other relevant factors, and their potential role as preventative measures against obesity. Methods A cross-sectional hospital-based study was conducted on children who attended a pediatric clinic. Demographic, clinical, and anthropometric measurements were taken from the hospital records. A questionnaire was completed by parents telephonically. Overweight was identified as a body mass index (BMI) of > 85-95% and obesity as a BMI of > 95%. Results A total of 101 children, with a mean age of 8.88 ± 4.01 (range one to 18) years, were involved, of whom 58.4% were boys. A high BMI (overweight or obese) was found in 30 (29.7%) children. The highest BMIs were among soft drink consumers [two children (66.7%) consumed daily and eight children (40%) consumed monthly], high birth weight in two children (40%), cow's milk formula feeding in eight children (38%), and weekly fast food consumption in 18 children (35%), none of these were statistically significant. Nevertheless, there was a significant association between mean electronic device usage and high (204.5 ± 164.76 hours) and normal BMI (147.61 ± 110.24 hours) (p-value < 0.05). Conclusion This small cross-sectional study shows that almost one-third of the included children were overweight or obese, which is comparable to what has been published in the literature. Moreover, there was a potential link between some factors and obesity, especially screen time, which may contribute to the controversial literature.

Upstream Determinants of Overweight and Obesity in Europe

PURPOSE OF REVIEW

To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants.

RECENT FINDINGS

Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.

Age-Specific Quantification of Overweight/Obesity Risk Factors From Infancy to Adolescence and Differences by Educational Level of Parents

Objectives: To explore the age-dependent associations between 26 risk factors and BMI in early life, and differences by parental educational level. Methods: Data of 10,310 children (24,155 measurements) aged 2-16 years participating in a multi-centre European cohort from 2007 to 2014 were utilized. Trajectories of overweight/obesity risk factors and their age-specific associations with BMI were estimated using polynomial mixed-effects models. Results: Exposure to most unfavourable factors was higher in the low/medium compared to the high education group, e.g., for PC/TV time (12.6 vs. 10.6 h/week). Trajectories of various risk factors markedly changed at an age of 9-11 years. Having a family history of obesity, maternal BMI, pregnancy weight gain and birth weight were positively associated with BMI trajectories throughout childhood/adolescence in both education groups; associations of behavioural factors with BMI were small. Parental unemployment and migrant background were positively associated with BMI in the low/medium education group. Conclusion: Associations of risk factors with BMI trajectories did not essentially differ by parental education except for social vulnerabilities. The age period of 9-11 years may be a sensitive period for adopting unfavourable behaviours.

The Effect of Breastfeeding Self-Efficacy on Infants' Weights and Breastfeeding Outcomes

OBJECTIVE

The aim of this study was to investigate the effects of breastfeeding self-efficacy (BSE) and breastfeeding success (BFS) on infants' weight gain rates and breastfeeding outcomes.

MATERIALS AND METHODS

Mothers were evaluated within the postpartum 72 hours with "Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF)" and "LATCH Scale." After 6 months, the mothers were called to learn the exclusive breastfeeding (EB) duration and the weight of the infants.

RESULTS

Two hundred mother-infant couples were enrolled, 176 (88%) of them could be reached in the sixth month. The BSES-SF scores were positively correlated with LATCH scores (P = .0001). The EB rate in the sixth month was positively correlated with BFS but not correlated with BSE (r, P = .218, .004; .79, .297, respectively). The percentage of weight gain and the rate of weight percentile change of babies according to birth weight at the sixth month of age were negatively correlated with BSE (r = -0.226, -0.148, P = .003, .049, respectively) but not correlated with BFS.

CONCLUSION

Higher BFS was associated with increased duration of EB in the first 6 months of life, and higher BSE was related to lower increase in the percentage of weight gain and a lower rate of weight percentile change of babies at 6 months of age.

Integration of Breastfeeding Consultation and Practices in the Scope of Pediatric Dentistry: Collaboration with Lactation Specialists

Background

In recent years, breastfeeding has been largely promoted due to health benefits for the children and the mothers and social, economic, and environmental advantages. World Health Organization (WHO) recommends breastfeeding for at least 2 years and to be continued for as long as this is desired by the mother-child dyad.Despite its advantages, including protection against caries in the 1st year of life, prevention of malocclusions, and development of more normal breathing patterns, there is a great controversy in the literature regarding breastfeeding involvement in elevated risk for early childhood caries (ECC).Breastfeeding and oral health are strongly related. Breastfeeding can influence oral health and development, but oral findings, such as tethered tissues and natal/neonatal teeth, may negatively affect lactation.

Conclusion

A healthy collaboration between the oral health care provider and the lactation specialist is important in order to identify those oral findings and prevent breastfeeding implications, but also in order to facilitate uneventful breastfeeding by emphasizing oral health care prevention strategies.

Clinical significance

Information on the advantages of certain lactation aspects and the potential risks for ECC is important for the pediatric dentist to be able to form an individualized treatment/prevention plan that will benefit and promote the oral and general health of young patients.

How to cite this article

Papadopoulou P, Boka V, Arapostathis K. Integration of Breastfeeding Consultation and Practices in the Scope of Pediatric Dentistry: Collaboration with Lactation Specialists. Int J Clin Pediatr Dent 2023;16(S-3):S306-S310.

Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain

Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2-4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%-5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.

Body shape trajectories are associated with birth weight, body mass index and sociodemographic conditions in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): a multiple correspondence analysis

BACKGROUND

Evaluating lifelong weight trajectories is challenging due to the high costs of studies that follow individuals from childhood to adulthood. The use of silhouette scales has been a new approach to assess the body shape trajectory across life as a proxy for body weight trajectory. Depending on body shape trajectories, individuals may be more prone to develop diseases in adulthood. Therefore, identifying factors related to them is essential for public health. This study aimed to evaluate body shape trajectories across the lifespan and to verify associations between them, birth weight, body mass index, and sociodemographic conditions in a Brazilian cohort.

METHODS

This is a cross-sectional analysis conducted with 14,014 participants of first follow-up data collection of Longitudinal Study of Adult Health (ELSA-Brasil). ELSA-Brasil is a multicentric prospective cohort study initiated in 2008 with civil servants of six public institutions in the Northeast, South and Southeast regions of Brazil. We applied a clustering method to longitudinal data to identify body shape trajectories from 5 to 40 years of age and assessed the associations between these trajectories and birth weight, body mass index and sociodemographic conditions (race, education, maternal education and monthly per capita family income) using multiple correspondence analysis.

RESULTS

We found five body shape trajectories for women and three for men. Low birth weight was associated with a slight to moderate increase in shape. High birth weight was associated with maintaining large body size in both sexes and markedly increased body shape in women. Higher sociodemographic status and white race were associated with marked increases in body shape in men and maintenance of medium body shape in women.

CONCLUSIONS

The study shows that variables related to worse lifetime weight status (evaluated by anthropometry), such as presence of obesity, are also associated with worse body shape trajectories, as assessed with silhouette scales. Our results suggest that body shape trajectories are a good indicator of body weight trajectories and may be used when cohort studies are not possible.

Breastfeeding is associated with reduced risks of central obesity and hypertension in young school-aged children: a large, population-based study

BACKGROUND

Previous studies examined the effects of breastfeeding on measured values of body circumferences or blood pressure during childhood. However, limited data are available for the association between child feeding and a specific disease diagnosed as central obesity or hypertension. Hence, we aimed to examine whether the type and duration of breastfeeding are associated with obesity/central obesity or hypertension in young school-aged children.

METHODS

We matched the data obtained from a cross-sectional survey in 2019 with retrospective breastfeeding information recorded in the database. Heights, weights, waist circumferences, and blood pressures of 8480 children in first grade of primary schools in Shanghai, China were measured to diagnose obesity, central obesity, and hypertension. Data on child feeding was collected retrospectively from clinical records. Associations between the type/duration of breastfeeding and children's measured values of body mass index, waist circumference, and blood pressure were analysed by linear regression. Associations between the type/duration of breastfeeding and risks of obesity, central obesity, and hypertension were analysed by generalised linear models.

RESULTS

Breastfeeding duration was inversely associated with blood pressure values in children in the first grade. Each month's increase in the duration of any breastfeeding was associated with a 0.07 mmHg decrease in systolic blood pressure (P < 0.01) and a 0.05 mmHg decrease in diastolic blood pressure (P < 0.01). Any breastfeeding > one month was associated with a reduced risk of hypertension (adjusted risk ratio 0.84; 95% CI 0.73, 0.96, P = 0.01). Exclusive breastfeeding > one month was associated with a reduced risk of central obesity (adjusted risk ratio 0.76; 95% CI: 0.60, 0.96, P = 0.02). Any breastfeeding > 12 months was linked with a lower risk of hypertension (adjusted risk ratio 0.83; 95% CI 0.70, 0.98, P = 0.03).

CONCLUSIONS

Lack of breastfeeding is associated with higher risks of central obesity and hypertension during middle childhood. As a potential component of the public health strategy to reduce population levels of metabolic and cardiovascular diseases, breastfeeding could be a vital prevention strategy.

Relationship between eating habits, sleep patterns and physical activity and the degree of obesity in children and adolescents

INTRODUCTION

Childhood obesity is an extremely prevalent pathology and, in order to be able to address it, it is necessary to understand the factors that influence on its genesis and maintenance. We hypothesise that the timing of meals and sleep, the regularity of these throughout the week and a sedentary lifestyle influence the degree of obesity.

MATERIAL AND METHODS

We included children and adolescents with obesity who attended a first check-up visit at the Childhood Obesity Unit between January 2018 and February 2020. The data were obtained from a questionnaire on food (36-h intake, frequency of consumption, eating times and habits) and sleep.

RESULTS

The degree of obesity was influenced to a greater extent by later meal times and the distribution of calories throughout the day (less at breakfast, more at dinner) than by the total number of calories ingested. In addition, a lower consumption of vegetables was related to a higher degree of obesity. The difference between the hours of sleep at weekends and on weekdays correlated positively with a higher degree of obesity. Finally, the anthropometric data correlated negatively with the number of hours of physical activity. Almost half of the children did not exercise after school.

CONCLUSION

In the approach to childhood obesity, it is necessary to include recommendations on the regularity of meal and sleep times, as well as the distribution of calories throughout the day. Additionally, it is necessary to encourage the practice of physical exercise.

Maternal Obesity and Patterns in Postnatal Diet, Physical Activity and Weight among a Highly Deprived Population in the UK: The GLOWING Pilot Trial

Preconception obesity is associated with adverse pregnancy outcomes and deprivation. The postnatal period provides an opportunity for preconception intervention. There is a lack of published postnatal behaviour and weight data to inform intervention needs. Secondary analysis of the GLOWING study explored postnatal diet, physical activity (PA) and weight among women living with obesity in deprivation. Thirty-nine women completed food frequency and PA questionnaires and provided weight measurement(s) between 3-12 months postnatal. Women's diet and PA fell short of national guidelines, especially for fruit/vegetables (median 1.6-2.0 portions/day) and oily fish (0-4 g/day). PA was predominantly light intensity. Patterns in weight change across time points indicated postnatal weight loss compared with 1st (median -0.8 to -2.3 kg) and 3rd-trimester weights (-9.0 to -11.6 kg). Weight loss was higher among women without excessive gestational weight gain (GWG) (-2.7 to -9.7 kg) than those with excessive GWG (2.3 to -1.8 kg), resulting in postnatal weight measurements lower than their 1st trimester. These pilot data suggest preconception interventions should commence in pregnancy with a focus on GWG, and postnatal women need early support to achieve guideline-recommendations for diet and PA. Further research in a larger population could inform preconception intervention strategies to tackle inequalities in maternal obesity and subsequent pregnancy outcomes.

The Current Status of Prolonged Breastfeeding and Its Related Factors in Korean Infants and Their Mothers: A Nationwide Cross-Sectional Study

BACKGROUND

International authorities recommend prolonged breastfeeding (PBF) for 12-24 months or more with 6 months of exclusive breastfeeding (EBF). Based on the Korean National Health and Nutrition Examination Survey (KNHANES) data, this study attempted to help encourage and educate breastfeeding (BF) over 1 year by investigating long-term BF trends and related factors in Korean infants and their mothers.

METHODS

This cross-sectional study was based on data on children aged 12-23 months and their mothers from 2010 to 2020. BF rates were compared between KNHANES V (2010-2012), KNHANES VI (2013-2015), KNHANES VII (2016-2018), and part of KNHANES VIII (2019-2020). In addition, data related to mothers and infants, including demographics, socioeconomic, educational, and health status, were collected, and their association with BF status was analyzed.

RESULTS

Of the 933 infants included in the study, the proportions achieving full BF at 6 months of age and PBF at 12 and 18 months were 34.8%, 33.7%, and 7.1%, respectively. Over the past 10 years, the trends of all three BF practices have significantly decreased since 2016 (P < 0.001). Of the 849 infants whose maternal data were available, multiple logistic regression analysis showed that EBF for 6 months (defined as full BF at 1, 3, and 6 months of age) positively correlated with maternal and infants' factors such as unemployed status, past BF experience, no history of drinking, and infants' birth weight of ≥ 2.5 kg. The mother's education level, particularly the nutrition label impact, current employment status, and smoking and drinking status, were significantly associated with PBF for ≥ 12 months but were not related to PBF for ≥ 18 months, except for drinking status.

CONCLUSIONS

In Korea, the long-term BF rate of ≥ 12 months has declined in the past 10 years, and BF becomes rare after 18 months. Higher maternal interest in nutrition information appears to be driving access to PBF over 12 months than EBF for 6 months or PBF over 18 months. To promote PBF over 12 months in Korea, it may be helpful to strengthen nutrition education that specifically emphasizes the benefits of PBF along with EBF, especially during infant health examinations.

Associations of weight and body composition at birth with body composition and cardiometabolic markers in children aged 10 y: the Ethiopian infant anthropometry and body composition birth cohort study

BACKGROUND

Although birth weight (BW) has been associated with later cardiovascular disease and type 2 diabetes, the role of birth fat mass (BFM) and birth fat-free mass (BFFM) on cardiometabolic health is unclear.

OBJECTIVES

To examine associations of BW, BFM, and BFFM with later anthropometry, body composition, abdominal fat, and cardiometabolic markers.

METHODS

Birth cohort data on standardized exposure variables (BW, BFM, and BFFM) and follow-up information at age 10 y on anthropometry, body composition, abdominal fat, and cardiometabolic markers were included. A linear regression analysis was used to assess associations of exposures with outcome variables, adjusting for maternal and child characteristics at birth and current body size in separate models.

RESULTS

Among 353 children, mean (SD) age was 9.8 (1.0) y, and 51.5% were boys. In the fully adjusted model, 1-SD higher BW and BFFM were associated with 0.81 cm (95% CI: 0.21, 1.41 cm) and 1.25 cm (95% CI: 0.64, 1.85 cm) greater height at 10 y, respectively. The 1-SD higher BW and BFM were associated with 0.32 kg/m2 (95% CI: 0.14, 0.51 kg/m2) and 0.42 kg/m2 (95% CI: 0.25, 0.59 kg/m2) greater fat mass index at 10 y, respectively. In addition, 1-SD higher BW and BFFM were associated with 0.22 kg/m2 (95% CI: 0.09, 0.34 kg/m2) greater FFM index, whereas a 1-SD greater BFM was associated with a 0.05 cm greater subcutaneous adipose tissue (95% CI: 0.01, 0.11 cm). Furthermore, 1-SD higher BW and BFFM were associated with 10.3% (95% CI: 1.4%, 20.0%) and 8.3% (95% CI: -0.5%, 17.9%) greater insulin, respectively. Similarly, 1-SD higher BW and BFFM were associated with 10.0% (95% CI: 0.9%, 20.0%) and 8.5% (95% CI: -0.6%, 18.5%) greater homeostasis model assessment of insulin resistance, respectively.

CONCLUSIONS

BW and BFFM rather than BFM are predictors of height and FFM index at 10 y. Children with higher BW and BFFM showed higher insulin concentrations and homeostasis model assessment of insulin resistance at 10 y of age. This trial was registered at ISRCTN as ISRCTN46718296.

Association of birth and childhood weight with risk of chronic diseases and multimorbidity in adulthood

BACKGROUND

Little is known about the relationship between early life body size and occurrence of life-course multiple chronic diseases (multimorbidity). We aim to evaluate associations of birth weight, childhood body size, and their changes with the risks of chronic diseases and multimorbidity.

METHODS

This prospective cohort study included 246,495 UK Biobank participants (aged 40-69 years) who reported birth weight and childhood body size at 10 years old. Birth weight was categorized into low, normal, and high; childhood body size was reported as being thinner, average, or plumper. Multimorbidity was defined as having two or more of 38 chronic conditions retrieved from inpatient hospital data until 31 December, 2020. The Cox regression and quasi-Poisson mixed effects models were used to estimate the associations.

RESULTS

We show that 57,071 (23.2%) participants develop multimorbidity. Low birth weight (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.26-1.33), high birth weight (HR 1.02, 95% CI > 1.00-1.05), thinner (HR 1.21, 95% CI 1.18-1.23) and plumper body size (HR 1.06, 95% CI 1.04-1.09) are associated with higher risks of multimorbidity. A U-shaped relationship between birth weight and multimorbidity is observed. Changing to be thinner or plumper is associated with multimorbidity and many conditions, compared to changing to be average.

CONCLUSIONS

Low birth weight, being thinner and changing to have a thinner body size in childhood are associated with higher risks of developing multimorbidity and many chronic conditions in adulthood. Early monitoring and maintaining a normal body size in childhood could have life-course benefits for preventing multimorbidity above and beyond individual conditions.

Comparison between the World Health Organization and Bahraini children growth standards

OBJECTIVE

The aim of this study was to investigate the growth patterns of Bahraini female and male infants/young children aged 0-24 months in the Kingdom of Bahrain.

METHODS

A cross-sectional approach was employed to track the growth parameters among healthy Bahraini female and male infants/children aged 0-24 months. A multistage probability sampling criteria was used to collect information from official records. Anthropometric measurements (weight and length) and demographic characteristics on feeding practices were gathered. Generalized Additive Models for Location Scale and Shape (GAMLSS)/Lambda-Mu-Sigma methodology was implemented to select distribution type, optimize smoothing parameters, perform regression of growth models, and construct percentiles and Z-score charts and tables for weight for age, length for age, length for weight, and body mass index (BMI) for age.

RESULTS

Findings were compared with WHO Multicentre Growth Reference Study (MGRS) data. A total of 403 healthy infants/children (210 males and 193 females) were recruited. At birth, the mean weight, length, and BMI were 3.2±0.4 kg, 3.1±0.4 kg, 49.7±2.3 cm, 48.8±2.1 cm, 13.2±1.6 kg/m2, and 12.8±1.5 kg/m2 for males and females, respectively. Anthropometrics of males were all statistically significantly higher than those of females at all age levels. The length and weight of the Bahraini infants/children were slightly higher than those of the WHO-MGRS.

CONCLUSION

The outcomes of this study, presented as charts and tables, showed significant differences in comparison with the WHO-MGRS reference charts. Specifically, Bahraini children aged between 0 and 24 months of both sexes were taller and heavier than their cohorts in the MGRS reference charts. Further longitudinal studies are needed for monitoring the growth pattern of children using body composition methods, adiposity markers, and determinant factors of growth to investigate this deviation from the WHO-MGRS.

No such thing as a free lunch: The direct marginal costs of breastfeeding

Understanding costs associated with breastfeeding is critical to developing maximally effective policy to support breastfeeding by addressing financial barriers. Breastfeeding is not without cost; direct costs include those of equipment, modified nutritional intake, and time (opportunity cost). Breastfeeding need not require more equipment than formula feeding, though maternal equipment use varies by maternal preference. Meeting increased nutritional demands requires increased spending on food and potentially dietary supplementation, the marginal cost of which depends on a mother's baseline diet. The opportunity cost of the three to four hours per day breastfeeding demands may be prohibitively high, particularly to low-income workers. These costs are relatively highest for low-income individuals, a group disproportionately comprising racial and ethnic minorities, and who demonstrate lower rates of breastfeeding than their white and higher-income peers. Acknowledging and addressing these costs and their regressive nature represents a critical component of effective breastfeeding policy and promotion.

Maternal per- and poly-fluoroalkyl substances exposure and child adiposity measures: A birth cohort study

Maternal exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy may have a programming effect on the physical development of the offspring. However, the findings of the association between PFAS and the physical development of offspring were inconsistent, and the overall effects of the PFAS mixture were unclear. In this study, we examined the associations between maternal PFAS exposure and offspring adiposity during the first two years of life. A total of 937 mother-child pairs from the Jiashan Birth Cohort Study were investigated. Thirteen PFASs were analyzed in maternal blood samples. Child weight and length were measured at birth, 1, 3, 6, 8, 12, and 24 months, and the ponderal index (PI) and weight-for-age z-scores (WAZ) were calculated. Longitudinal associations of PFAS concentrations (by quartile) with repeated data of PI and WAZ were examined using linear mixed model, and the overall effect of the PFAS mixture on adiposity measures was evaluated using quantile g-computation (QGC). Maternal PFAS exposure was associated with increased PI in both the linear mixed model and the QGC model. Among the PFAS examined, the associations between maternal PFTrDA exposure and PI were the strongest. Maternal PFAS and WAZ showed similar patterns of association. In the longitudinal cohort study, we found that adiposity in young children is increased by maternal PFAS exposure. The associations between maternal PFASs concentrations and child adiposity may be chemical-specific.

The influence of birthweight and breastfeeding status on BMI outcome at first year of primary school: a retrospective study of an Irish child cohort

Recent data shows one in four children in Ireland are classified as having overweight or obesity, putting them at increased risk of health complications in both childhood and adulthood. The primary aim of this study was to retrospectively investigate the association between body mass index (BMI) outcome at first year of primary school and sex, birthweight and breastfeeding status in a cohort of Irish children. A secondary aim was to assess whether parents were concerned about their child's growth. This study examined data from the National Child Health Screening Programme on 3739 children in their first year of primary school education in the Irish counties of Sligo, Leitrim and Donegal. This data was collected between March 2013 and December 2016. 10.8% and 7.1% of the children included in this study were classified as having overweight and obese BMI outcomes, respectively. A greater proportion of males had underweight, overweight or obese BMI outcomes compared to females, and this was statistically significant (p ≤ 0.001). Overweight and obese BMI outcomes were significantly more common among those born with a high birthweight, compared to those with a low or healthy birthweight (p ≤ 0.001). There was a greater proportion of obese BMI outcome in those who were never breastfed compared to those who were ever breastfed, and this difference was statistically significant (p = 0.041). Among those who were ever breastfed, there was a statically significant (p = 0.009) difference between BMI outcome at first year of primary schooling and the duration of time they were breastfed for. When asked whether they were concerned about their child's growth, the majority of parents who responded expressed no concern (96.1%).

CONCLUSION

This study found an association between BMI outcome at first year of primary school education and sex, birthweight and breastfeeding status in a cohort of children in the North-West of Ireland. The majority of parents did not express concern related to their child's growth at first year of primary education.

WHAT IS KNOWN

• One in every four children in Ireland are classified as having overweight or obesity. • Birthweight and breastfeeding status are factors known to be associated with weight status in childhood.

WHAT IS NEW

• This study investigated whether there was an association between sex, birthweight and breastfeeding status and the BMI outcome of a cohort of Irish children in their first year of primary school education (median age: 5.2 years). • This study also included an exploration of parents concern related to their child's growth at first year of primary school education.

BMI growth trajectory from birth to 5 years and its sex-specific association with prepregnant BMI and gestational weight gain

Objective

The purpose of the study was to identify the latent body mass index (BMI) z-score trajectories of children from birth to 5 years of age and evaluate their sex-specific association with prepregnant BMI and gestational weight gain (GWG).

Methods

This was a retrospective longitudinal cohort study performed in China. In total, three distinct BMI-z trajectories from birth to 5 years of age were determined for both genders using the latent class growth modeling. The logistic regression model was used to assess the associations of maternal prepregnant BMI and GWG with childhood BMI-z growth trajectories.

Results

Excessive GWG increased the risks of children falling into high-BMI-z trajectory relative to adequate GWG (OR = 2.04, 95% CI: 1.29, 3.20) in boys; girls born to mothers with prepregnancy underweight had a higher risk of low-BMI-z trajectory than girls born to mothers with prepregnancy adequate weight (OR = 1.85, 95% CI: 1.22, 2.79).

Conclusion

BMI-z growth trajectories of children from 0 to 5 years of age have population heterogeneity. Prepregnant BMI and GWG are associated with child BMI-z trajectories. It is necessary to monitor weight status before and during pregnancy to promote maternal and child health.

Adiposity and feeding practices in the first two years of life among toddlers in Guadalajara, Mexico

BACKGROUND

Feeding practices in the first two years of life have a direct impact on nutritional status and adiposity. The purpose of this study was to identify the differences in feeding practices during the first two years of life by sex and type of feeding in the first semester of postnatal life and their relationships with adiposity in toddlers.

METHODS

An analytical cross-sectional study that included 150 toddlers aged 12 to 24 months who were healthy, full-term, and had adequate weight for their gestational ages, was conducted at the New Civil Hospital and at a private practice in Guadalajara. Body compositions were obtained by bioelectrical impedance (BIA) measurements, and a modified questionnaire was used. Then, the parents completed two 24-h dietary recalls. In addition to the descriptive statistics, ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used in the contrast analysis of the quantitative variables. To analyze the qualitative variables, we used X² tests. Afterward, linear regression tests were conducted to identify the relationships between adiposity and feeding practices during the first two years.

RESULTS

There were direct relationships between adiposity and duration of full breastfeeding (r = 0.610, p = 0.021), age of introduction of ultra-processed products (r = 0.311, p = 0.011), sugar (r = 0.186; p = 0.024) and age at which eggs were introduced (r = -0.202; p = 0.016).

CONCLUSIONS

Adiposity was related to feeding practices in the first two years of life in toddlers.

Risk of noncommunicable diseases and associated factors in Algerian adolescents (10-19 years old)

OBJECTIVE

Noncommunicable diseases (NCDs) are a public health problem and their prevalence is increasing worldwide at an alarming rate. The objective of this study was to assess the predictive factors for NCDs in adolescents.

MATERIAL AND METHODS

The study included adolescents enrolled in public establishments in Constantine (east of Algeria). Demographic variables, health variables, smoking, anthropometry, diet, and physical activity were assessed by means of a questionnaire. All data were analyzed using the software R 3.2.4. The significance threshold was set at 95%.

RESULTS

The sample consisted of 1,222 adolescents (56.1% girls) aged 10-19 years. Overall, 8.6% had NCDs; 23.2% were overweight (obesity included). The frequency of consumption was insufficient for dairy products and fruits and vegetables (p=0.0000) and the opposite was found for fatty and sugary products (p=0.0000). A total of 82.8% had been breastfed. Physical activity recommendations were not followed. Risk factors for the development of NCDs were family history of these diseases (odds ratio [OR]=2.89), active smoking (OR=3.18), passive smoking (OR=2.03), fetal macrosomia (OR=1.40), time in front of screens ≥3 h/day (OR=1.28), and overweight (OR=1.15). The consumption of fatty and sweet products was positively correlated with weight status (r=0.258; p=0.0000). Protective factors were breastfeeding for ≥ 6 months (OR=0.69) and moderate physical activity of ≥60 min/day (OR=0.38).

CONCLUSION

Adolescents presented predictors factors for NCDs due to harmful behaviors to their health.

Maternal Diet Influences Human Milk Protein Concentration and Adipose Tissue Marker

(1) Background: Adequate protein intake plays an essential role in growth and neurodevelopment, especially in preterm infants. We investigated the effects of maternal diet and body mass index (BMI) on human milk (HM) composition. (2) Methods: HM samples were obtained from 136 lactating mothers (BMI: 18.0−36.7 kg/m2), of which 93% gave birth to preterm infants. Macronutrient content in HM was measured by mid-infrared transmission spectroscopy. Leptin and adiponectin were analyzed using appropriate ELISAs. Maternal diet was determined by 24-h recall. (3) Results: Significant positive associations were found between protein, fat, carbohydrate and energy intake, and levels of corresponding macronutrients in HM, especially in protein concentrations (p < 0.001). An increased protein intake was positively correlated with adiponectin (p < 0.001) and leptin (p = 0.035) in HM. Maternal BMI was positively associated with a higher protein level in HM (p < 0.05), as well as with a higher dietary protein intake (p < 0.05). (4) Conclusions: Knowledge of maternal diet and BMI impacting HM composition is essential to optimize the feeding of newborn infants. This is especially relevant in the nutritional management of preterm infants; it can be utilized in approaches to improve growth rates and the appropriate development of infants and to prevent obesity.

Obesity-derived alterations in the lactating mammary gland: Focus on prolactin

Obesity is a modern pandemic with negative consequences in women's reproductive health. Women with overweight and obesity can develop mammary gland alterations that unable exclusive breastfeeding. Obesity associates with a disturbed lactating mammary gland endocrine environment including a decreased action of the hormone prolactin (PRL), the master regulator of lactation. The PRL receptor and the action of PRL are reduced in the mammary gland of lactating rodents fed an obesogenic diet and are contributing factors to impaired lactation in obesity. Also, treatment with PRL improves milk yield in women with lactation insufficiency. This review focuses on the impact of diet-induced obesity in the lactating mammary gland and how obesity impairs the lactogenic action of PRL. Although obesity alters lactation performance in humans and rodents, the responsible mechanisms have been mainly addressed in rodents.

Timing of introduction of complementary foods, breastfeeding, and child cardiometabolic risk: a prospective multiethnic Asian cohort study

BACKGROUND

The timing of introduction of complementary foods and the duration of breastfeeding (BF) have been independently associated with child overweight and obesity; however, their combined influence on body fat partitioning and cardiometabolic risk is unclear.

OBJECTIVE

We investigated the associations of the timing of introduction of complementary foods, the duration of BF, and their interaction with child adiposity and cardiometabolic risk markers.

METHODS

We analyzed data from 839 children in the prospective Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Mothers reported the age at which infants were first fed complementary foods and BF duration, classified as early (≤4 mo) versus typical (>4 mo) complementary feeding (CF) and short (≤4 mo) versus long (>4 mo) duration of any BF, respectively. We measured adiposity and cardiometabolic risk markers at the age of 6 y and examined their associations with infant feeding patterns using multiple regression, adjusting for sociodemographics, parents' body mass index (BMI), maternal factors, birth weight for gestational age, and infant weight gain.

RESULTS

Of 839 children, 18% experienced early CF, whereas 54% experienced short BF. Short (vs. long) BF and early (vs. typical) CF were independently associated with higher z-scores of BMI [β (95% confidence interval), short BF, 0.18 standard deviation score (SDS) (-0.01, 0.38); early CF, 0.34 SDS (0.11, 0.57)] and sum of skinfolds [short BF, 1.83 mm (0.05, 3.61); early CF, 2.73 mm (0.55, 4.91)]. Children who experienced both early CF and short BF (vs. typical CF-long BF) had synergistically higher diastolic blood pressure [1.41 mmHg (-0.15, 2.97), P-interaction = 0.023] and metabolic syndrome score [0.81 (0.16, 1.47), P-interaction = 0.081]. Early CF-long BF (vs. early CF-short BF) was associated with a lower systolic blood pressure [-3.74 mmHg (-7.01, -0.48)], diastolic blood pressure [-2.29 mmHg (-4.47, -0.11)], and metabolic syndrome score [-0.90 (-1.80, 0.00)].

CONCLUSIONS

A combination of early CF and short BF was associated with elevated child adiposity and cardiometabolic markers. Longer BF duration may protect against cardiometabolic risk associated with early CF. This trial was registered at clinicaltrials.gov as NCT01174875.

Systematic review and meta-analysis of breastfeeding and later overweight or obesity expands on previous study for World Health Organization

AIM

To update a systematic review and meta-analysis of the association of breastfeeding with overweight or obesity that had been commissioned by the World Health Organization. We also assessed the likelihood of residual confounding.

METHODS

Two independent reviewers searched MEDLINE, LILACS and Web of Science for manuscripts published between August 2014 and May 2021. Studies that only evaluated infants were excluded. Random-effects models were used to pool the estimates.

RESULTS

The review comprised 159 studies with 169 estimates on the association of breastfeeding with overweight or obesity, and most of the studies were carried out among individuals aged 1-9 years (n = 130). Breastfeeding protected against overweight or obesity (pooled odds ratio:0.73, 95% confidence interval:0.71; 0.76). And, even among the 19 studies that were less susceptible to publication bias, residual confounding and misclassification, a benefit was observed (pooled odds ratio:0.85, 95% confidence interval:0.77; 0.93). Among those studies that were clearly susceptible to positive confounding by socioeconomic status, a benefit of breastfeeding was observed even after adjusting for socioeconomic status (pooled odds ratio:0.76, 95% confidence interval: 0.69; 0.83).

CONCLUSION

Breastfeeding reduced the odds of overweight or obesity, and this association was unlikely to be due to publication bias and residual confounding.

Cross-cultural adaptation and content validation of the Infant Feeding Intentions Scale for Thai pregnant women

This study aimed to validate a translated and culturally adapted version of the Infant Feeding Intentions (IFI) Scale for use in Thailand. Prenatal breastfeeding intention is a strong indicator of breastfeeding initiation. The stronger the intention to breastfeed among pregnant women, the more likely breastfeeding will be initiated after childbirth and continue for an extended period. There are currently no IFI scales that have been validated for use in Thailand. The translation of the IFI scale from English to Thai was conducted through a six-stage approach that included initial translation, synthesis of translations, back-translation, expert committee review for content validity, reliability testing, and submission of the translated IFI to notify the scale developers. Both Item and Scale Content Validity Indices equaled 1, scored by five experts, who also validated the content for cross-cultural adaptation. The final Thai IFI (T-IFI) scale demonstrated high content validity. A total of 30 Thai pregnant women participated in the reliability testing. The Cronbach's alpha of the 5-item T-IFI scale was 0.857, which indicated satisfactory internal consistency. The T-IFI scale demonstrated high content validity and was culturally appropriate for use in a Thai-speaking population. It has potential to strengthen assessments of prenatal infant feeding intention among pregnant women in Thailand.

İlköğretim Çağındaki Çocuklarda Obezite Üzerinde Etkili Olan Bazı Faktörlerin İncelenmesi: İstanbul Örneği

Amaç: Çocukluk çağında obezite tüm dünyada artmaktadır. Bu çalışma ilköğretim çağındaki çocuklarda obezite üzerinde etkili olan bazı faktörlerin araştırılması amacıyla yapılmıştır.Yöntem: Çalışma İstanbul'da iki farklı okulda 621 ilköğretim öğrencisi üzerinde gerçekleştirilmiştir. Çocuklar 7-15 yaş grubunda olup rastgele örneklem yöntemi ile seçilmiştir. Çocuklara demografik özellikler, beslenme ve fiziksel aktivite ile ilgili sorulardan oluşan bir anket uygulanmış olup, bazı antropometrik ölçümleri alınmıştır. Çocukların Beden Kütle Indeksi (BKİ) değerleri Türk çocuklarının persentillerine göre sınıflandırılmıştır. Veriler SPSS 13.0 programı ile değerlendirilmiştir.Bulgular: Öğrencilerin %47,5’i kız, %52,5’i erkektir. BKİ sınıflandırmasında öğrencilerin %11,8'i obez bulunmuştur. Özel okuldaki öğrencilerde obezite prevalansı %17,3 devlet okulundaki öğrencilerde %6,6’dır (p&lt;0,05). Üniversite mezunu anne ve babaların çocuklarında, aile birey sayısı üç kişi olanlarda obezite oranı daha fazladır (p&lt;0,05). Beslenme alışkanlıklarına göre düzenli akşam yemeği tüketmeyenlerde ve sevinçli/mutlu olduğunda iştah değişimi olmayanlarda daha fazla obezite oranı görülmüştür (p&lt;0,05). Ayrıca, okula özel araba ile giden öğrencilerin obezite oranı en fazladır (%18,2; p&lt; 0,05).Sonuç: Çalışma sonucunda çocuklarda obezite oranı yüksek eğitim düzeyine sahip anne ve babaların çocuklarında, özel okula giden çocuklarda ve üç kişilik ailelerde yaşayanlarda daha yüksek bulunmuştur. Çocuklarda obezite gelişimini önlemek için okullarda düzenli olarak antropometrik ölçümlerin alınması, öğrencilere ve ebeveynlere sağlıklı beslenmeye yönelik eğitimlerin verilmesi faydalı olabilir.

Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise

Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.

Impact of Breastfeeding on Low Birthweight Infants, Weight Disorders in Infants, and Child Development

Infancy has been proven as the best time to improve health outcomes for the later stage of life. The composition of human breast milk has evolved over millennia to support and maintain the infant's life during the early years of life. To achieve life-sustaining effects, human breast milk is packed with fats, proteins, carbohydrates, and a wide range of bioactive compounds such as immunoglobulins, lactoferrin, and cytokines. The immunological compounds in breast milk have been shown to curtail gastrointestinal tract infections, respiratory tract infections, hospital admissions, acute otitis media, allergic reactions, and urinary tract infections. Although breastfeeding causes newborns to gain less weight at the beginning of their lives than formula milk does, breast milk improves body composition by low adiposity. A higher adipose deposition in infants is linked with an increased risk of child obesity in the future. Due to significant health benefits, the World Health Organization (WHO) recommends initiating breastfeeding within one hour after birth and continuing for at least six months. Breastfeeding has emerged as a superior source of nutrition that can promote healthy physiological and cognitive development and protect against disease challenges in low birthweight infants. This review summarizes potential evidence that highlights the potential health impact of breast milk in low birthweight infants.

Impact of excessive gestational weight gain on exclusive breastfeeding among women with Type 1 and Type 2 diabetes and obesity

BACKGROUND

Pregestational diabetes, obesity and gestational weight gain (GWG) are associated with adverse perinatal outcomes, however, the influence of excessive GWG on lactation at discharge is less known. Our aim is to evaluate the impact of excessive GWG using the LifeCycle project guidelines on exclusive breastfeeding (EBF) and any BF rates at discharge among 171 women with Type 1 and 294 Type 2 diabetes and obesity who intended to BF.

METHODS AND FINDINGS

Retrospective cohort study. Obesity was defined by BMI (kg/m2) as grade 1 (30-34.9), grade 2 (35-39.9) or grade 3 (≥40). GWG was categorized as adequate, inadequate or excessive according to the 2019 LifeCycle Project guidelines. Women with Type 1 were younger (30 vs 33y), primiparous (51 vs 32%), delivered earlier (37 vs 38w) than women with Type 2 andwere different in grade 1 (40 vs 26%), grade 3 obesity (19 vs 49%) and median GWG (15 vs 11kg). Of all 465 women with Type 1 and Type 2 combined, 365 (78%) who had excessive GWG and 100 (22%) who had non-excessive GWG showed similar EBF (27 vs 25%) and any BF (72 vs 72%) rates. Regression analysis showed that after adjusting for potential confounders excessive GWG was not a predictor of EBF or any BF at discharge.

CONCLUSION

Type 1 and Type 2 diabetes, obesity and excessive GWG are associated with low EBF, however, excessive GWG is not an independent predictor of low EBF or any BF at discharge.

Association between History of Prolonged Exclusive Breast-Feeding and the Lung Function Indices in Childhood

Although the propitious effects of breastfeeding on children's health are indisputable, the impact of exclusive breastfeeding on the lung function later in life remains controversial. Our objective was to explore the possible associations between breastfeeding and the lung function of children who were exclusively breastfed for an extensive period of time. This was a cross-sectional study of children who were exclusively breastfed for more than 12 months. Demographics and anthropometric data were collected; the body mass index (BMI), % body fat, and % central obesity were calculated; and all the participants underwent standard spirometry with reversibility testing. The relationship between breastfeeding duration and spirometric parameters was assessed by Spearman's correlation and multivariable regression, after adjustment for other confounders. Forty-six children (21 boys), aged 9.2 ± 2.4 years, with a reported breastfeeding duration of 27.5 ± 12.5 months (range 12-60 months) were included; 13% were overweight (none were obese) and 21.7% had central obesity. The average FEV1 was 104.7 ± 10.4% and the average FEF25-75 was 107.9 ± 13.3%. The duration of exclusive breastfeeding was positively correlated with FEF25-75% (r = 0.422, p = 0.003). Multivariable linear regression analysis confirmed the above finding (beta coefficient 0.478, p = 0.002), independently of age, overweight, and central obesity. No correlation was noted between the duration of breastfeeding and other spirometric parameters. In addition to its favorable impact on the metabolic profile, prolonged exclusive breastfeeding seems to exert a propitious effect on the function of smaller airways throughout childhood.

Residential Proximity to Urban Play Spaces and Childhood Overweight and Obesity in Barcelona, Spain: A Population-Based Longitudinal Study

Findings on the relationship between play spaces and childhood overweight and obesity are mixed and scarce. This study aimed to investigate the associations between residential proximity to play spaces and the risk of childhood overweight or obesity and potential effect modifiers. This longitudinal study included children living in the city of Barcelona identified in an electronic primary healthcare record database between 2011 and 2018 (N = 75,608). Overweight and obesity were defined according to the WHO standards and we used 300 m network buffers to assess residential proximity to play spaces. We calculated the risk of developing overweight or obesity using Cox proportional hazard models. A share of 29.4% of the study population developed overweight or obesity, but we did not find consistent associations between play space indicators and overweight or obesity. We did not find any consistent sign of effect modification by sex, and only some indications of the modifying role of area socioeconomic status and level of exposure. Although it is not possible to draw clear conclusions from our study, we call for cities to continue increasing and improving urban play spaces with an equitable, healthy, and child-friendly perspective.

Breastfeeding Practices and Associated Factors in Shanghai: A Cross-Sectional Study

The status of breastfeeding practices remains unsatisfactory across China, but regional differences persist. However, disaggregated data for specific provinces are limited. This representative survey determined the status of breastfeeding and factors associated with breastfeeding practices in Shanghai. The questionnaire was designed in compliance with indicators for assessing infant and young child-feeding practices defined by the World Health Organization and the United Nations Children's Fund (UNICEF). A total of 2665 children aged two years and younger (0-730 days) were investigated, among whom 1677 were aged under six months. The early initiation of breastfeeding (EIBF) rate was 60.3%. Among children aged under six months, 43.4% were exclusively breastfed (EBF). The univariate regression analysis showed that the EBF rate was influenced by multiple factors, including individual, socioeconomic, workplace and employment, and health system. The subsequent multivariate analysis suggested that mothers with a higher rate of EBF shared the following characteristics: intention to breastfeed during pregnancy, breastfeeding knowledge, and higher satisfaction with support through the healthcare system after delivery. The rate of EBF in Shanghai is over 40%, and supporting breastfeeding requires measures at multiple levels, including individual attributes, women's work and employment conditions, breastfeeding knowledge, and health services.

Birth Weight and Body Composition as Determined by Isotopic Dilution with Deuterium Oxide in 6- to 8-Year-Old South African Children

Low and high birth weight (BW) are associated with obesity later in life; however, this association has not been extensively studied in African countries. This study determines the association between BW and body composition derived from deuterium oxide (D2O) dilution in 6- to 8-year-old South African children (n = 91; 40 boys, 51 girls). BW was recorded retrospectively from the children’s Road-to-Health cards. Weight and height were measured using standard procedures, and D2O dilution was used to determine total body water and, subsequently, to determine body fat. Fatness was classified using the McCarthy centiles, set at 2nd, 85th, and 95th (underfat, overfat and obese). BW correlated with body composition measures, such as body weight (r = 0.23, p = 0.03), height (r = 0.33, p < 0.001), and fat free mass (FFM; r = 0.27, p = 0.01). When multiple regression analysis was employed, BW significantly and positively associated with FFM (β = 0.24, p = 0.013; 95% CI: 0.032; 0.441) and fat mass (β = 0.21, p = 0.02, 95%CI: 0.001; 0.412) in girls and boys combined. A total of 13% of the children had a low BW, with 21% being overweight and 17% obese. More girls than boys were overweight and obese. Intervention strategies that promote healthy uterine growth for optimal BW are needed in order to curb the global obesity pandemic.

Dynamics of human milk oligosaccharides in early lactation and relation with growth and appetitive traits of Filipino breastfed infants

Human milk oligosaccharides play a key role in the maturation of the infant gut microbiome and immune system and are hypothesized to affect growth. This study examined the temporal changes of 24 HMOs and their associations to infant growth and appetitive traits in an exploratory, prospective, observational, study of 41 Filipino mother-infant dyads. Exclusively breastfed, healthy, term infants were enrolled at 21-26 days of age (≈ 0.75 mo) and followed for 6 months. Infant growth measures and appetitive traits were collected at visit 1 (V1) (≈ 0.75 mo), V2 (≈ 1.5 mo), V3 (2.5 mo), V4 (2.75 mo), V5 (4 mo), and V6 (6 mo), while HMOs were measured at V1, V2, V3 and V5. Overall exposure to each HMO was summarized as area under the curve from baseline to 4 months of age and examined in association with each measure of growth at 6 months using linear regression adjusted for maternal age at birth, infant sex, birth weight, and mode of delivery. We saw modest associations between several HMOs and infant growth parameters. Our results suggest that specific HMOs, partly as proxy for milk groups (defined by Secretor and Lewis status), may be associated with head circumference and length, increasing their relevance especially in populations at the lower end of the WHO growth curve. We did not identify the same HMOs associated with infant appetitive traits, indicating that at least in our cohort, changes in appetite were not driving the observed associations between HMOs and growth.Clinical trial registration: NCT03387124.

Breastfeeding in Phenylketonuria: Changing Modalities, Changing Perspectives

Phenylketonuria (PKU) management aims to control phenylalanine (Phe) intakes. In newborns and infants this implies possible titration of Human milk (HM) with supplementation of Phe-free formula. HM benefits, better if prolonged, are well known in healthy populations, suggesting it may be used in PKU patients. Despite that, the current literature does not define recommendations on how best perform it in such a population. The main purpose of this study was to evaluate nutrition approaches in newborns and infants affected by PKU and to define if differences can influence the duration of breastfeeding. Data from 42 PKU infants were reviewed. Of these, 67% were breastfed with the use of three different approaches. The type of approach used impacted the duration of breastfeeding, which was longer when using a pre-measured amount of Phe-free formula administered prior to HM. This is the first study to suggest a specific method for breastfeeding in PKU. Considering widely known breastfeeding benefits, both for patients and their mothers, our data should encourage adequate awareness on how to choose correct breastfeeding modalities.