Childhood obesity: rapid weight gain in early childhood and subsequent cardiometabolic risk

The impact of hypothetical early life interventions on rapid weight gain during infancy and body mass index at 5 and 8 years in Norway: The Norwegian Mother, Father, and Child Cohort Study (MoBa)

OBJECTIVES

This study examined the impact of hypothetical interventions on (i) early life factors (prenatal and early postnatal) on rapid weight gain during infancy, and (ii) early life factors and child energy balance-related behaviours (EBRB) on children's body mass index (BMI)-for-age at 5 and 8 years.

METHODS

Data from the Norwegian Mother, Father, and Child Cohort Study included participants aged 2 (n = 48 109), 5 (n = 18 810) and 8 (n = 10 830) years. Early life intervention variables were maternal smoking during pregnancy, maternal weight before and during pregnancy, exclusive/partial breastfeeding for 6 months, and introduction of complementary food at 6 months. Child EBRB intervention variables for the 5-year outcome included screen time, fruit and vegetable intake, and sugar-sweetened soft drink intake assessed at 3 years. For the 8-year outcome, interventions included screen time, presence of a television in the child's bedroom, sleep hours and breakfast intake assessed at 5 years. The parametric g-formula was used for analysis.

RESULTS AND CONCLUSIONS

The average population-level difference in rapid weight gain during infancy at 2 years under the intervention targeting the prenatal, early postnatal factors and these factors combined with 95% confidence intervals were -0.012 (-0.017, -0.007), -0.009 (-0.012, -0.005) and -0.020 (-0.025, -0.015), respectively. The average population-level differences in children's BMI-for-age z-score for interventions targeting early life factors, child EBRB and these factors combined were -0.225 (-0.244, -0.207), 0.02 (-0.021, 0.024) and -0.223 (-0.249, -0.196), respectively among 5-year-olds and -0.265 (-0.295, -0.236), -0.020 (-0.029, -0.011) and -0.285 (-0.315, -0.256), respectively among 8-year-olds. Our results suggested joint interventions on early life factors may reduce childhood BMI-for-age z-scores.

Influence of excess weight on metabolic risk factors in Argentinian preschool children

OBJECTIVES

Evaluate the differences in metabolic risk factors in preschool children with normal weight (NWG) or with some degree of excess weight (OWG).

METHODS

Body mass index (BMI), umbilical waist circumference (WC), mid-upper arm circumference (MUAC) and total body fat (TBF) in children aged 1-5.9 years. The following metabolic risk factors were measured: blood pressure, fasting glycaemia, fasting serum insulin, HOMA IR Index, total cholesterol (TC), LDL cholesterol (LDL-C) HDL cholesterol (HDL-C) and triacylglycerol (TG).

RESULTS

In population evaluated (n=689) MUAC, WC, TBF, HOMA IR were higher in OWG compared to NWG and significantly higher in OWG girls compared to boys (two ways ANOVA). Positive associations were found between diastolic blood pressure, insulin and HOMA-IR and WC, MUAC, TBF, BMI z score in the adjusted and unadjusted model.

CONCLUSIONS

MUAC may emerge as an indicator with predictive power for metabolic risk and would be very useful to measure in many setting. There is a need for in-depth research into sex difference.

Association of household food insecurity with diet quality in a nationally representative sample of United States toddlers: a cross-sectional study

BACKGROUND

Although previous research has shown that food insecurity adversely affects diet quality in adults, this relationship is less consistently observed in children. However, studies in children have focused on those aged 2 y or older and the association of food insecurity with diet quality in children aged 12-23 mo is unclear.

OBJECTIVES

The objective was to determine the association of household food insecurity with diet quality, as indicated by Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020), in United States children aged 12-23 mo.

METHODS

The study used a cross-sectional design based on data from 2013-2014, 2015-2016, and 2017-March 2020 survey cycles of National Health and Nutrition Examination Survey. The primary sample included 708 children aged 12-23 mo with 1) complete data on food security, assessed via the United States Food Security Survey Module (USFSSM); 2) ≥1 d of reliable 24-h dietary recall data; and 3) reported energy intake from complementary foods/beverages (that is, foods and beverages other than human milk or infant formula). On the basis of responses to USFSSM, households were classified as food secure or food insecure. Proxies, typically parents, reported child's dietary intake. Diet quality was assessed using the HEI-Toddlers-2020. Linear regression analyses examined the association of household food security status with HEI-Toddlers-2020 total and component scores, adjusted for demographic characteristics.

RESULTS

Household food insecurity was significantly associated with lower HEI-Toddlers-2020 total score (estimate = -3.78; standard error = 1.06; P = 0.0007), as well as lower component scores for whole fruits (estimate = -0.56; standard error = 0.18; P = 0.003), and whole grains (estimate = -0.85; standard error = 0.35; P = 0.02).

CONCLUSIONS

The association of household food insecurity with lower diet quality in this study suggests that toddlers may not be shielded from household food shortages. Although consumption of certain food groups, such as whole grains, was inadequate in the overall sample of United States toddlers, food insecurity could exacerbate suboptimal intake of whole grains. Interventions to improve diet quality of young children must account for household food insecurity.

Maternal lipids in overweight and obesity: implications for pregnancy outcomes and offspring's body composition

Overweight and obesity (OWO) are linked to dyslipidemia and low-grade chronic inflammation, which is fueled by lipotoxicity and oxidative stress. In the context of pregnancy, maternal OWO has long been known to negatively impact on pregnancy outcomes and maternal health, as well as to imprint a higher risk for diseases in offspring later in life. Emerging research suggests that individual lipid metabolites, which collectively form the lipidome, may play a causal role in the pathogenesis of OWO-related diseases. This can be applied to the onset of pregnancy complications such as gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP), which in fact occur more frequently in women affected by OWO. In this review, we summarize current knowledge on maternal lipid metabolites in pregnancy and highlight associations between the maternal lipidome and the risk to develop GDM, HDP and childhood OWO. Emerging data underpin that dysregulations in maternal triglyceride, phospholipid and polyunsaturated fatty acid (PUFA) metabolism may play a role in modulating the risk for adverse pregnancy outcomes and childhood OWO, but it is yet premature to convert currently available insights into clinical guidelines. Well-designed large-scale lipidomic studies, combined with translational approaches including animal models of obesity, will likely facilitate the recognition of underling pathways of OWO-related pregnancy complications and child's health outcomes, based on which clinical guidelines and recommendations can be updated.

Prenatal Diet and Infant Growth From Birth to Age 24 Months

Importance

Being born either small for gestational age (SGA) or large for gestational age (LGA) and experiencing rapid or slow growth after birth are associated with later-life obesity. Understanding the associations of dietary quality during pregnancy with infant growth may inform obesity prevention strategies.

Objective

To evaluate the associations of prenatal dietary quality according to the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP) with infant size at birth and infant growth from birth to age 24 months.

Design, Setting, and Participants

This cohort study used data from birthing parent-child dyads in 8 cohorts participating in the Environmental influences on Child Health Outcomes program between 2007 and 2021. Data were analyzed from March 2021 to August 2024.

Exposures

The HEI and the EDIP dietary patterns.

Main Outcomes and Measures

Outcomes of interest were infant birth weight, categorized as SGA, reference range, or LGA, and infant growth from birth to ages 6, 12, and 24 months, categorized as slow growth (weight-for-length z score [WLZ] score difference <-0.67), within reference range (WLZ score difference -0.67 to 0.67), or rapid (WLZ score difference, >0.67).

Results

The study included 2854 birthing parent-child dyads (median [IQR] maternal age, 30 [25-34] years; 1464 [51.3%] male infants). The cohort was racially and ethnically diverse, including 225 Asian or Pacific Islander infants (7.9%), 640 Black infants (22.4%), 1022 Hispanic infants (35.8%), 664 White infants (23.3%), and 224 infants (7.8%) with other race or multiple races. A high HEI score (>80), indicative of a healthier diet, was associated with lower odds of LGA (adjusted odds ratio [aOR], 0.88 [95% CI, 0.79-0.98]), rapid growth from birth to age 6 months (aOR, 0.80 [95% CI, 0.37-0.94]) and age 24 months (aOR 0.82 [95% CI, 0.70- 0.96]), and slow growth from birth to age 6 months (aOR, 0.65 [95% CI, 0.50-0.84]), 12 months (aOR, 0.74 [95% CI, 0.65-0.83]), and 24 months (OR, 0.65 [95% CI, 0.56-0.76]) compared with an HEI score 80 or lower. There was no association between high HEI and SGA (aOR, 1.14 [95% CI, 0.95-1.35]). A low EDIP score (ie, ≤63.6), indicative of a less inflammatory diet, was associated with higher odds of LGA (aOR, 1.24 [95% CI, 1.13-1.36]) and rapid infant growth from birth to age 12 months (aOR, 1.50 [95% CI, 1.18-1.91]) and lower odds of rapid growth to age 6 months (aOR, 0.77 [95% CI, 0.71-0.83]), but there was no association with SGA (aOR, 0.80 [95% CI, 0.51-1.25]) compared with an EDIP score of 63.6 or greater.

Conclusions and Relevance

In this cohort study, a prenatal diet that aligned with the US Dietary Guidelines was associated with reduced patterns of rapid and slow infant growth, known risk factors associated with obesity. Future research should examine whether interventions to improve prenatal diet are also beneficial in improving growth trajectory in children.

The Unexpected Detection of Esophageal Varices Caused by Liver Cirrhosis in a 47-Year-Old Man Treated with a Growth Hormone in Childhood

Background: We report a rare case highlighting the progression of liver disease in a male patient with idiopathic childhood-onset growth hormone (GH) deficiency. Case presentation: The patient was diagnosed with hypopituitarism at six years old and was treated with thyroxine therapy and GH for his short stature, with testosterone added at the age of 15. GH therapy was discontinued when the patient was 18 years old, but thyroid and testosterone treatments continued. The patient had been taking medication for hyperlipidemia until the age of 30 and was noted to have impaired glucose tolerance at the age of 40, but HbA1c levels remained normal. At the age of 47, esophageal varices were incidentally discovered via endoscopy, revealing liver cirrhosis. Laboratory tests showed liver dysfunction and abnormal lipid levels, and hepatitis viral markers were absent. The patient had no history of drinking alcohol or smoking, and no family history of diabetes. Results: Ultimately, this case demonstrates that metabolic dysfunction-associated steatotic liver disease (MASLD/metabolic dysfunction-associated steatohepatitis (MASH)) is under-recognized in GH deficiency cases and can progress to liver cirrhosis. Conclusions: Therefore, careful evaluation of MASLD/MASH in childhood-onset GH deficiency is necessary, and GH replacement therapy should continue into adulthood, if possible.

Evaluating Emotional Eating in Children from the Perspective of Parents: Psychometric Properties of the Parent Version of the Emotional Eating Scale Adapted for Children and Adolescents

BACKGROUND

Emotional eating is associated with adverse health outcomes in children, including elevated weight status. Currently, there is not a well-validated parent-report measure of emotional eating for young children. This study assessed the reliability and validity of the 10-item parent version of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Short-Form.

METHODS

The participants were 207 parents and 144 children from the southern United States. They completed the parent- and child-report EES-C Short-Form and responded to measures related to child eating behaviors, mood, and gratitude.

RESULTS

The parent-report EES-C Short-Form demonstrated good internal consistency reliability (Cronbach's alpha = 0.94). Test-retest reliability was also supported, as evidenced by a medium correlation (ICC = 0.56, p < 0.001) between parent-rated emotional eating across two time points. Additionally, the measure demonstrated a significant correlation with a scale of emotional overeating (r = 0.25, p < 0.001)-a theoretically related construct. Supporting discriminant validity, the measure was not significantly related to a measure of parent-reported gratitude (r = 0.07, p = 0.30). A unidimensional model provided good fit for the data (CFI = 0.997, SRMR = 0.046).

CONCLUSIONS

The results from the current study provide preliminary evidence supporting the reliability and validity of the parent version of the EES-C Short-Form. For the purpose of screening children in school or primary care settings, the EES-C Short-Form may be practical and helpful in identifying children who may be at risk of developing adverse health outcomes or more-severe eating disorder pathology.

Growth Status of Full-Term Infants with Different Sizes for Gestational Age During the First Year of Life

Objective

This study aimed to assess the growth of full-term infants with different sizes at birth and examine catch-up and catch-down growth in their first year.

Methods

This retrospective population-based cohort study was based on the Guangdong Provincial Women and Children Health Information System. 194797 full-term singleton live births were extracted. Measurements for weight and length were taken at birth, 6 months, and 12 months. The size-for-gestational age was categorized as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles), or large (LGA, >90th centile) based on the international newborn size for gestational age and sex INTERGROWTH-21st standards. Catch-up and catch- down growth were defined as a change in standard deviation in z-score greater than 0.67 in the growth curves.

Results

Of the 194797 full-term singletons, the average gestational age was 39.28 ± 1.03 weeks, and the average weight of the newborns was 3205 ± 383 grams. 15632 infants were identified as SGA (8.0%) and 12756 were LGA (6.5%). At 1 year of age, catch-up growth in weight was observed in 63.0% of SGA infants, 29.5% of AGA infants, and 5.4% of LGA infants. Conversely, catch-down growth occurred in 3.3% of SGA infants, 17.8% of AGA infants, and 54.7% of LGA infants. The proportions of catch-up growth in length for SGA, AGA, and LGA infants within the first year were 31.4%, 22.5%, and 17.1%, respectively. Catch-up or catch-down growth predominantly occurred before 6 months of age. However, from 6 to 12 months, there was no significant variation in WAZ among children with different birth sizes.

Conclusion

In their first year of life, full-term singleton live births tend towards regression to the mean in their postnatal weight and length. The average delay in the growth of LGA is compensated by an increase in it of the SGA. Early monitoring and intervention are crucial for optimizing growth in infants with different birth sizes.

Obesity and dyslipidemia in early life: Impact on cardiometabolic risk

Childhood obesity with its growing prevalence worldwide presents one of the most important health challenges nowadays. Multiple mechanisms are involved in the development of this condition, as well as in its associations with various cardiometabolic complications, such as insulin resistance, diabetes, metabolic dysfunction-associated steatotic liver disease and cardiovascular diseases. Recent findings suggest that childhood obesity and associated dyslipidemia at least partly originate from epigenetic modifications that take place in the earliest periods of life, namely prenatal and perinatal periods. Hence, alterations of maternal metabolism could be fundamentally responsible for fetal and neonatal metabolic programming and consequently, for metabolic health of offspring in later life. In this paper, we will review recent findings on the associations among intrauterine and early postnatal exposure to undesirable modulators of metabolism, development of childhood obesity and later cardiometabolic complications. Special attention will be given to maternal dyslipidemia as a driven force for undesirable epigenetic modulations in offspring. In addition, newly proposed lipid biomarkers of increased cardiometabolic risk in obese children and adolescents will be analyzed, with respect to their predictive potential and clinical applicability.

Development and psychometric testing of the nutritional and social health habits scale (NutSo-HH): A methodological review of existing tools

Habits represent repeated patterns of behavior over time that exert a significant influence on individual health. While specific tools exist to measure individual habits, the number of instruments capable of simultaneously exploring multiple dimensions of health is limited. This research had two main objectives: 1) to examine the literature to find existing tools for evaluating health habits, especially in the Spanish population; 2) through a methodological review, to develop and validate a tool capable of measuring multiple dimensions of health habits. The Nutritional and Social Health Habits Scale (NutSo-HH) was conceived, tested, and refined through pilot testing with cognitive interviews and expert content validation. Construct validity was explored through confirmatory factor analysis and known-group validity, while criterion validity was verified in comparison with the ``Healthy Nutrition Index for the Spanish Population.'' Reliability was assessed using omega coefficients. Confirmatory factor analysis yielded satisfactory fit indices. The final model included two second-order factors (nutritional habits and health habits) and two first-order factors (Mediterranean diet and alcohol consumption). Omega coefficients ranged from 0.521 to 0.815. The NutSo-HH Scale emerges as a valid and reliable tool to assess nutritional and social habits among Spanish young adults. This novel instrument fills a gap in the field, allowing exploration of various health determinants through a single scale and providing support for decision-making in the realm of public health nutrition.

Associations of early childhood body mass index trajectories with body composition and cardiometabolic markers at age 10 years: the Ethiopian infant anthropometry and body composition (iABC) birth cohort study

BACKGROUND

Variability in body mass index (BMI) (kg/m2) trajectories is associated with body composition and cardiometabolic markers in early childhood, but it is unknown how these associations track to later childhood.

OBJECTIVES

We aimed to assess associations of BMI trajectories from 0 to 5 y with body composition and cardiometabolic markers at 10 y.

METHODS

In the Ethiopian infant anthropometry and body composition (iABC) birth cohort, we previously identified 4 distinct BMI trajectories from 0 to 5 y: stable low BMI (19.2%), normal BMI (48.8%), rapid growth to high BMI (17.9%), and slow growth to high BMI (14.1%). At 10 y, we obtained data from 320 children on anthropometry, body composition, abdominal subcutaneous and visceral fat, and cardiometabolic markers. Associations of BMI trajectories and 10-y outcomes were analyzed using multiple linear regression.

RESULTS

Compared with children with the normal BMI trajectory, those with rapid growth to high BMI had 1.7 cm (95% CI: 0.1, 3.3) larger waist circumference and those with slow growth to high had 0.63 kg/m2 (95% CI: 0.09, 1.17) greater fat mass index and 0.19 cm (95% CI: 0.02, 0.37) greater abdominal subcutaneous fat, whereas those with stable low BMI had -0.28 kg/m2 (95% CI: -0.59, 0.03) lower fat-free mass at 10 y. Although the confidence bands were wide and included the null value, children with rapid growth to high BMI trajectory had 48.6% (95% CI: -1.4, 123.8) higher C-peptide concentration and those with slow growth to high BMI had 29.8% (95% CI: -0.8, 69.8) higher insulin and 30.3% (95% CI: -1.1, 71.6) higher homeostasis model assessment of insulin resistance, whereas those with rapid growth to high BMI had -0.23 mmol/L (95% CI: -0.47, 0.02) lower total cholesterol concentration. The trajectories were not associated with abdominal visceral fat, blood pressure, glucose, and other lipids at 10 y.

CONCLUSIONS

Children with rapid and slow growth to high BMI trajectories before 5 y tend to show higher measures of adiposity and higher concentrations of markers related to glucose metabolism at 10 y.

CLINICAL TRIAL REGISTRY

ISRCTN46718296 (https://www.isrctn.com/ISRCTN46718296).

Evaluation of Energy Balance Estimated From Total Energy Expenditure and Body Composition Changes in Junior Sumo Wrestlers: An Observational Study Over Six Months

Background Sumo is a sport that requires wrestlers to develop their physique from childhood for athletic advantage. However, the energy expenditure and energy balance required for the growth of junior Sumo wrestlers remain unclear. This study aimed to determine the energy balance of junior Sumo wrestlers over six months using doubly labeled water (DLW) and bioelectrical impedance analysis (BIA). Methodology A total of 12 male Sumo wrestlers were affiliated with a local Sumo club (average age = 15 ± 1 years). The total energy expenditure (TEE) was measured using DLW, whereas body composition was evaluated using BIA. Daily physical activity was quantified using a tri-accelerometer (Active style Pro HJA-750C). Results The TEE was 4,194 ± 734 kcal/day, while daily physical activity without training was 786 ± 50 minutes. Within six months, the body weight increased by 2.0 ± 3.2 kg, fat-free mass (FFM) was augmented by 2.1 kg, while fat mass did not change significantly. The surplus energy accumulated was 5.6 ± 213 kcal/day. Conclusions The excess energy of junior Sumo wrestlers predominantly increases their FFM. To increase their physical prowess, wrestlers adhere to a lifestyle characterized by high-intensity training and attenuated daily physical activity.

Awareness and Support of Responsive Bottle Feeding Among WIC Counselors and Caregivers: A Formative Qualitative Study

OBJECTIVE

To understand the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counselor experiences discussing responsive bottle feeding during counseling and WIC participants' knowledge, understanding, and use of responsive bottle feeding.

METHODS

Qualitative descriptive, semistructured interviews with 23 participants (8 WIC counselors and 15 WIC participants) were conducted online via Zoom. The WIC counselors and mothers of WIC-enrolled bottle-fed infants were recruited through a network of WIC clinics in North Carolina. Interviews were recorded, transcribed, and collaboratively analyzed using content analysis.

RESULTS

The WIC participants received responsive infant feeding support from WIC counselors but often in the context of breastfeeding. WIC counselors provided valuable support for families but were challenged by limited training on responsive bottle feeding, balancing promoting breastfeeding with supporting mothers' feeding decisions, and time constraints.

CONCLUSIONS AND IMPLICATIONS

Findings provide preliminary support for the need to develop and pilot an intervention focused on promoting responsive feeding for parents of bottle-fed infants.

Fetal bisphenol and phthalate exposure and early childhood growth in a New York City birth cohort

BACKGROUND

Exposure to endocrine-disrupting chemicals such as bisphenols and phthalates during pregnancy may disrupt fetal developmental programming and influence early-life growth. We hypothesized that prenatal bisphenol and phthalate exposure was associated with alterations in adiposity through 4 years. This associations might change over time.

METHODS

Among 1091 mother-child pairs in a New York City birth cohort study, we measured maternal urinary concentrations of bisphenols and phthalates at three time points in pregnancy and child weight, height, and triceps and subscapular skinfold thickness at ages 1, 2, 3, and 4 years. We used linear mixed models to assess associations of prenatal individual and grouped bisphenols and phthalates with overall and time-point-specific adiposity outcomes from birth to 4 years.

RESULTS

We observed associations of higher maternal urinary second trimester total bisphenol and bisphenol A concentrations in pregnancy and overall child weight between birth and 4 years only (Beta 0.10 (95 % confidence interval 0.04, 0.16) and 0.07 (0.02, 0.12) standard deviation score (SDS) change in weight per natural log increase in exposure), We reported an interaction of the exposures with time, and analysis showed associations of higher pregnancy-averaged mono-(2-carboxymethyl) phthalate with higher child weight at 3 years (0.14 (0.06, 0.22)), and of higher high-molecular-weight phthalate, di-2-ethylhexyl phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, mono-(2-carboxymethyl) phthalate, and mono-(2-ethylhexyl) phthalate with higher child weight at 4 years (0.16 (0.04, 0.28), 0.15 (0.03, 0.27), 0.19 (0.07, 0.31), 0.16 (0.07, 0.24), 0.11 (0.03, 0.19)). Higher pregnancy-averaged high-molecular-weight phthalate, di-2-ethylhexyl phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, and mono-2(ethyl-5-oxohexyl) phthalate concentrations were associated with higher child BMI at 4 years (0.20 (0.05, 0.35), 0.20 (0.05, 0.35), 0.22 (0.06, 0.37), 0.20 (0.05, 0.34), 0.20 (0.05, 0.34)). For skinfold thicknesses, we observed no associations.

DISCUSSION

This study contributes to the evidence suggesting associations of prenatal exposure to bisphenols and high-molecular-weight phthalates on childhood weight and BMI.

Weight Gain from Birth to Adolescence and TyG Index at Age 18 Years: A Cohort Study in Northeast Brazil

BACKGROUND

Developmental models suggest that the phenotypes may arise from an immediate or mediated adaptive metabolic response of the perinatal growth. Evidence on the cumulative effects of growth and factors associated with risk of insulin resistance in adolescents is lacking.

OBJECTIVE

To investigate the association between birthweight, weight gain during infancy, childhood and adolescence and the triglyceride-glucose index in adolescents.

METHODS

This is a cohort of 217 children born at term, followed for the first six months, and reassessed at 8 and 18 years of age. The variables of interest were birthweight, postnatal growth defined as rapid postnatal growth when the weight gain from birth to six months of age was greater than 0.67 z-score, and the same criterion was used for high BMI gain from ages 6 months to 8 years, and from 8 to 18 years. Socioeconomic condition, nutritional status, practice of physical exercises and consumption of ultra-processed foods were verified. Multivariate linear regression analysis was used to verify the effect of the variables on the triglyceride-glucose index.

RESULTS

Birthweight was not associated with triglyceride-glucose index in adolescence. Rapid postnatal growth during the first 6 months, higher BMI gain from 8 to 18 years and higher waist circumference contributed significantly to explain higher triglyceride-glucose index.

CONCLUSION FOR PRACTICE

Our findings suggest that rapid postnatal growth may be one of the first signs of a higher triglyceride-glucose index in adolescence and that attention should be paid to the greater gain in body mass between childhood and adolescence for the risk of a higher triglyceride-glucose index.

Early Infant Feeding Practices and Associations with Growth in Childhood

Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.

Association of birthweight with diabetes, hypertension, and ischemic heart disease in young adulthood: a retrospective cohort study

Birthweight has been associated with diabetes in a reverse J-shape (highest risk at low birthweight and moderately high risk at high birthweight) and inversely associated with hypertension in adulthood with inconsistent evidence for cardiovascular disease. There is a lack of population-based studies examining the incidence of cardiometabolic outcomes in young adults born with low and high birthweights. To evaluate the association between birthweight and diabetes, hypertension, and ischemic heart disease (IHD) in young adulthood, we conducted a retrospective cohort study of 874,904 singletons born in Ontario, Canada, from 1994 to 2002, identified from population-based health administrative data. Separate Cox regression models examined birthweight in association with diabetes, hypertension, and IHD adjusting for confounders. Among adults 18-26 years, the diabetes incidence rate was 18.15 per 100,000 person-years, hypertension was 15.80 per 100,000 person-years, and IHD was 1.85 per 100,000 person-years. Adjusted hazard ratios (AHR) for the hazard of diabetes with low (<2500g) and high (>4000g), compared with normal (2500-4000g) birthweight, were 1.46 (95% CI 1.28, 1.68) and 1.09 (0.99, 1.21), respectively. AHR for hypertension with low and high birthweight were 1.34 (1.15, 1.56) and 0.86 (0.77, 0.97), respectively. AHR for IHD with low and high birthweight were 1.28 (0.80, 2.05) and 0.97 (0.71, 1.33), respectively. Overall, birthweight was associated with diabetes in young adults in a reverse J-shape and inversely with hypertension. There was insufficient evidence of an association with IHD. Further evidence is needed to understand the causal mechanisms between birthweight and cardiometabolic diseases in young adults.

Loss of Uncoupling Protein 1 Expression in the Subcutaneous Adipose Tissue Predicts Childhood Obesity

Stimulation of thermogenesis by inducing uncoupling protein 1 (UCP1) expression in adipocytes is thought to promote weight loss by increasing energy expenditure, and it is postulated that the human newborn has thermogenic subcutaneous fat depots. However, it remains unclear whether a relevant number of UCP1-expressing (UCP1+) adipocytes exist in the early postnatal life. Here we studied the distribution of UCP1 and the expression of thermogenic genes in the subcutaneous adipose tissues of the human fetus, infant and child. We show that the deep layer of human fetal and neonatal subcutaneous fat, particularly the abdominal wall, is rich in UCP1+ adipocytes. These adipocytes develop in the late third trimester and persist throughout childhood, expressing a panel of genes linked to mitochondrial biogenesis and thermogenesis. During the early childhood adiposity rebound-a critical phase that determines obesity risk later in life-the absence of adipose tissue UCP1 expression in children with normal body mass index (BMI) correlates with an obesity-associated gene expression signature. Finally, UCP1 expression is negatively correlated with BMI z-score and adipocyte size in infants and children. Overall, our results show that the absence of UCP1 expression in adipose tissue is an early indicator of adipose tissue expansion in children.

The heritability of weight gain in infancy: A population-based twin study

BACKGROUND

Rapid weight gain during infancy is a strong predictor of childhood obesity and is affected by genetic and environmental factors. Identifying ages with low heritability will allow for targeted interventions that might be able to prevent the adverse effects of childhood obesity.

OBJECTIVES

The objective of the study is to estimate the heritability of weight gain from birth to defined ages during infancy, as well as during 6-month periods from birth to 18 months of age. We address this by leveraging large-scale computerised anthropometric data from the state-run network of well-baby clinics in Israel.

METHODS

We performed a population-based twin study. We extracted weight measurements recorded between birth to 24 months from well-baby clinics for 9388 twin pairs born in Israel between 2011 and 2015. The reported sexes of the twins were used as a proxy for their zygosity status. We estimated the heritability of the weight z-score change from birth to specific ages and during particular periods in infancy. To assess the validity of the results, we repeated the analysis in a sub-cohort of twin pairs with complete weight measurements.

RESULTS

During the first 2 years of life, heritability was lowest for birthweight (h 2 = 0.40 ± 0.11 ). Heritability for weight gain since birth was highest at 4 months (h 2 = 0.87 ± 0.13 ), and then gradually decreased until age 18 months (h 2 = 0.62 ± 0.13 ). Estimating the heritability in 6-month intervals from birth to 18 months, heritability was highest during the 6-12-month interval (h 2 = 0.84 ± 0.14 ), and was substantially lower during the subsequent 12-18-month interval (h 2 = 0.43 ± 0.16 ).

CONCLUSIONS

Heritability of weight gain decreases substantially in the second year of life, suggesting that this period could be an appropriate time for interventions for infants who are at an increased risk of childhood obesity.

Prenatal oxidative stress and rapid infant weight gain

BACKGROUND AND OBJECTIVES

Infant weight patterns predict subsequent weight outcomes. Rapid infant weight gain, defined as a >0.67 increase in weight-for-age z-score (WAZ) between two time points in infancy, increases obesity risk. Higher oxidative stress, an imbalance between antioxidants and reactive oxygen species, has been associated with low birthweight and paradoxically also with later obesity. We hypothesized that prenatal oxidative stress may also be associated with rapid infant weight gain, an early weight pattern associated with future obesity.

METHODS

Within the NYU Children's Health and Environment Study prospective pregnancy cohort, we analyzed associations between prenatal lipid, protein, and DNA urinary oxidative stress biomarkers and infant weight data. Primary outcome was rapid infant weight gain (>0.67 increase in WAZ) between birth and later infancy at the 8 or 12 month visit. Secondary outcomes included: very rapid weight gain (>1.34 increase in WAZ), low (<2500 g) or high (≥4000 g) birthweight, and low (< -1 WAZ) or high (>1 WAZ) 12 month weight.

RESULTS

Pregnant participants consented to the postnatal study (n = 541); 425 participants had weight data both at birth and in later infancy. In an adjusted binary model, prenatal 8-iso-PGF2α, a lipid oxidative stress biomarker, was associated with rapid infant weight gain (aOR 1.44; 95% CI: 1.16, 1.78, p = 0.001). In a multinomial model using ≤0.67 change in WAZ as a reference group, 8-iso-PGF2α was associated with rapid infant weight gain (defined as >0.67 but ≤1.34 WAZ; aOR 1.57, 95% CI: 1.19, 2.05, p = 0.001) and very rapid infant weight gain (defined as >1.34 WAZ; aOR 1.33; 95% CI: 1.02, 1.72, p < 0.05) Secondary analyses detected associations between 8-iso-PGF2α and low birthweight outcomes.

CONCLUSIONS

We found an association between 8-iso-PGF2α, a lipid prenatal oxidative stress biomarker, and rapid infant weight gain, expanding our understanding of the developmental origins of obesity and cardiometabolic disease.

Prenatal Morphine Exposure Increases Cardiovascular Disease Risk and Programs Neurogenic Hypertension in the Adult Offspring

BACKGROUND

The opioid overdose and opioid use disorder epidemics are concomitant with increased metabolic and CVD risk. Although opioid use disorder causes adverse pregnancy outcomes, the offspring's cardiovascular health is understudied. We hypothesized that offspring exposed to in utero morphine exposure (IUME) would show increased CVD risk factors and endogenous opioid system dysregulation.

METHODS

Sprague Dawley dams were treated with saline (vehicle, n=10) or escalating doses of morphine (5-20 mg/kg per day, SC, n=10) during gestation. Cardiovascular and metabolic parameters were assessed in adult offspring.

RESULTS

Litter size and pups' birth weight were not different in response to IUME. Female and male IUME offspring showed reduced body length at birth (P<0.05) and body weight from weeks 1 to 3 of life (P<0.05), followed by a catch-up growth effect. By week 16, female and male IUME rats showed reduced tibia length (P<0.05) and fat mass. IUME increases the mean arterial pressure and the depressor response to mecamylamine (5 mg/kg per day, IP) induced by IUME were abolished by a chronic treatment with an alpha-adrenergic receptor blocker (prazosin; 1 mg/kg per day, IP). Although circulating levels of angiotensin peptides were similar between groups, IUME exacerbated maximal ex vivo Ang (angiotensin) II-induced vasoconstriction (P<0.05) and induced endothelial dysfunction in a sex-specific manner (P<0.05). Proenkephalin, an endogenous opioid peptide that lowers blood pressure and sympathetic-mediated vasoconstriction, showed reduced mRNA expression in the heart, aorta, and kidneys from morphine versus vehicle group (P<0.05).

CONCLUSIONS

Among the effects of IUME, neurogenic hypertension, vascular dysfunction, and metabolic dysfunction could be associated with the dysregulation of the endogenous opioid system.

Dynamics and consequences of nutrition-related microbial dysbiosis in early life: study protocol of the VITERBI GUT project

Introduction

Early life under- and overnutrition (jointly termed malnutrition) is increasingly recognized as an important risk factor for adult obesity and metabolic syndrome, a diet-related cluster of conditions including high blood sugar, fat and cholesterol. Nevertheless, the exact factors linking early life malnutrition with metabolic syndrome remain poorly characterized. We hypothesize that the microbiota plays a crucial role in this trajectory and that the pathophysiological mechanisms underlying under- and overnutrition are, to some extent, shared. We further hypothesize that a "dysbiotic seed microbiota" is transmitted to children during the birth process, altering the children's microbiota composition and metabolic health. The overall objective of this project is to understand the precise causes and biological mechanisms linking prenatal or early life under- or overnutrition with the predisposition to develop overnutrition and/or metabolic disease in later life, as well as to investigate the possibility of a dysbiotic seed microbiota inheritance in the context of maternal malnutrition.

Methods/design

VITERBI GUT is a prospective birth cohort allowing to study the link between early life malnutrition, the microbiota and metabolic health. VITERBI GUT will include 100 undernourished, 100 normally nourished and 100 overnourished pregnant women living in Vientiane, Lao People's Democratic Republic (PDR). Women will be recruited during their third trimester of pregnancy and followed with their child until its second birthday. Anthropometric, clinical, metabolic and nutritional data are collected from both the mother and the child. The microbiota composition of maternal and child's fecal and oral samples as well as maternal vaginal and breast milk samples will be determined using amplicon and shotgun metagenomic sequencing. Epigenetic modifications and lipid profiles will be assessed in the child's blood at 2 years of age. We will investigate for possible associations between metabolic health, epigenetics, and microbial changes.

Discussion

We expect the VITERBI GUT project to contribute to the emerging literature linking the early life microbiota, epigenetic changes and growth/metabolic health. We also expect this project to give new (molecular) insights into the mechanisms linking malnutrition-induced early life dysbiosis and metabolic health in later life, opening new avenues for microbiota-engineering using microbiota-targeted interventions.

Dosage of hydrocortisone during late infancy is positively associated with changes in body mass index during early childhood in patients with 21-hydroxylase deficiency

Obesity is a major complication in children with 21-hydroxylase deficiency (21-OHD). There is evidence to show that higher body mass index (BMI) during infancy and early childhood is associated with an increased risk for the subsequent development of obesity in the general population; however, limited information is currently available on this issue in 21-OHD patients. Additionally, despite the frequent use of supraphysiological dosages of hydrocortisone in 21-OHD, the association between BMI and hydrocortisone dosage during these periods remains largely unclear; therefore, we retrospectively investigated BMI at approximately 1 and 3 years old and its association with hydrocortisone dosage in 56 children with 21-OHD. The median BMI-standard deviation score (SDS) was 0.28 (Interquartile range [IQR]: -0.53 to 1.09) and 0.39 (IQR: -0.44 to 1.14) at approximately 1 and 3 years old, respectively, and no association was observed between hydrocortisone dosage and BMI-SDS at either time-point; however, multivariate analysis revealed that hydrocortisone dosage at approximately 1 year old was positively associated with changes in BMI (β = 0.57, p = 0.013) and BMI-SDS (β = 0.59, p = 0.011) between approximately 1 and 3 years old after adjustment for age, sex, and changes in hydrocortisone dosage during the same period. The average dosage of hydrocortisone between approximately 6 months and 1 year old also showed similar results. These results indicate that a higher dosage of hydrocortisone during late infancy is associated with a higher BMI at approximately 3 years old, which may lead to the development of obesity later in life in children with 21-OHD.

Growth trajectory during the first 1000 days and later overweight in very preterm infants

OBJECTIVE

To identify the characteristics of early life growth associated with later overweight or obesity (OWO) in very preterm population.

DESIGN

Length, weight and body mass index (BMI) were prospectively recorded from three prospective, population-based cohorts with 5 years (Loire Infant Follow-up Team (LIFT), EPIPAGE2 (Etude EPIdémiologique sur les Petits Ages GEstationnels 2)) and 15 years (EPIPAGEADO, Etude EPIdémiologique sur les Petits Ages GEstationnels-Adolescents) of follow-up. Missing data were imputed.

SETTING

Regional (LIFT), national (EPIPAGE2) and multiregional (EPIPAGEADO) cohorts in France.

PATIENTS

Eligible infants born before 33 weeks of gestation in 1997 (EPIPAGEADO), between 2003 and 2014 (LIFT), and in 2011 (EPIPAGE2).

MAIN OUTCOME MEASURES

OWO was determined as BMI Z-score >85th percentile of the WHO reference curves at 5 years (LIFT, EPIPAGE2) and 15 years (EPIPAGEADO).

RESULTS

In EPIPAGEADO, LIFT and EPIPAGE2, BMI Z-scores were known for 302 adolescents, 1016 children and 2022 children, respectively. In EPIPAGEADO, OWO was observed in 42 (13.9%, 95% CI 10.5 to 18.3) adolescents. In multivariable models, birthweight Z-score, increase in weight Z-score during neonatal hospital stay and increase in BMI between discharge and at 2 years of corrected age were positively associated with OWO at 15 years (adjusted OR (aOR)=3.65, 95% CI 1.36 to 9.76; aOR=3.82, 95% CI 1.42 to 10.3; and aOR=2.55, 95% CI 1.72 to 3.78, respectively, by Z-score), but change in length Z-score during neonatal hospital stay was negatively associated (aOR=0.41, 95% CI 0.21 to 0.78, p=0.007). These four associations with OWO assessed at 5 years were confirmed in the LIFT and EPIPAGE2 cohorts.

CONCLUSIONS

Change in length Z-score during hospitalisation, a putative proxy of quality of neonatal growth, was negatively associated with risk of later OWO when change in BMI between discharge and at 2 years was included in the multivariable model.

Longitudinal assessment of brain structure and behaviour in youth with rapid weight gain: Potential contributing causes and consequences

OBJECTIVE

Independent of weight status, rapid weight gain has been associated with underlying brain structure variation in regions associated with food intake and impulsivity among pre-adolescents. Yet, we lack clarity on how developmental maturation coincides with rapid weight gain and weight stability.

METHODS

We identified brain predictors of 2-year rapid weight gain and its longitudinal effects on brain structure and impulsivity in the Adolescent Brain Cognitive DevelopmentSM Study®. Youth were categorized as Healthy Weight/Weight Stable (WSHW , n = 527) or Weight Gainers (WG, n = 221, >38lbs); 63% of the WG group were healthy weight at 9-to-10-years-old.

RESULTS

A fivefold cross-validated logistic elastic-net regression revealed that rapid weight gain was associated with structural variation amongst 39 brain features at 9-to-10-years-old in regions involved with executive functioning, appetitive control and reward sensitivity. Two years later, WG youth showed differences in change over time in several of these regions and performed worse on measures of impulsivity.

CONCLUSIONS

These findings suggest that brain structure in pre-adolescence may predispose some to rapid weight gain and that weight gain itself may alter maturational brain change in regions important for food intake and impulsivity. Behavioural interventions that target inhibitory control may improve trajectories of brain maturation and facilitate healthier behaviours.

¡Míranos! a comprehensive preschool obesity prevention programme in low-income Latino children: 1-year results of a clustered randomised controlled trial

OBJECTIVE

To test a culturally tailored obesity prevention intervention in low-income, minority preschool age children.

DESIGN

A three-group clustered randomised controlled trial.

SETTING

Twelve Head Start centres were randomly assigned to a centre-based intervention, a combined centre- and home-based intervention, or control using a 1:1:1 ratio. The centre-based intervention modified centre physical activity and nutrition policies, staff practices, and child behaviours, while the home-based intervention supported parents for obesity prevention at home.

STUDY OUTCOMES

The primary end point was change in children's BMI (kg/m2) at post-test immediately following completion of the 8-month intervention. Secondary end points included standardised scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl).

PARTICIPANTS

Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (n 325), 87 % Latino, 57 % female with mean age (sd) of 3·58 years (0·29).

RESULTS

Change in BMI at post-test was 1·28 (0·97), 1·28 (0·87) and 1·41 (0·71) in the centre + home-based intervention, centre-based intervention and control, respectively. There was no significant difference in BMI change between centre + home-based intervention and control or centre-based intervention and control at post-test. BMIz (adjusted difference -0·12 (95 % CI, -0·24, 0·01), P = 0·06) and WAZ (adjusted difference, -0·09 (-0·17, -0·002), P = 0·04) were reduced for children in centre + home-based intervention compared with control group.

CONCLUSIONS

There was no reduction in BMI at post-test in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.

Early-life weight gain patterns of term small-for-gestational-age infants and the predictive ability for later childhood overweight/obesity: A prospective cohort study

Objectives

We aimed to identify the weight gain patterns of small-for-gestational age (SGA) infants in early life and to explore the predictive value for later overweight/obesity in childhood.

Methods

We obtained data from a prospective cohort including term SGA infants born between January 2006 and November 2015 who received regular health care from birth to 5 years in West China Second University Hospital, Chengdu, China. A latent class growth analysis (LCGA) was applied to group children with similar growth trajectory patterns. Multiple logistic regression was performed to examine the association between weight gain patterns and later overweight/obesity.

Results

A total of 296 term SGA infants were finally included. Five weight gain trajectories were identified, including excessive rapid catch-up growth (ERCG) (class 1, 10.9%), rapid catch-up growth (RCG) (class 2, 17.9%), appropriate catch-up growth (ACG) (class 3, 53.0%), slow catch-up growth (SCG) (class 4, 13.4%) and almost no catch growth (NCG) (class 5, 4.8%). SGA infants in class 1 and class 2 had a higher BMI according to age- and sex-specific Z scores from 2-5 years of age. In addition, 25% of SGA infants in class 1 and 13.2% of SGA infants in class 2 were found to be overweight/obese at 2-5 years of age. After adjusting for confounders, we found that extremely rapid weight gain (class 1) in the first 2 years of life increased the risk of overweight/obesity by 2.1 times at 2 to 5 years of age (aOR=2.1, 95% CI: 1.3~4.8; P<0.05). Furthermore, the increment of ΔWAZ between 0 and 4 mo was prominently related to the risk of overweight/obesity at 2 to 5 years for term SGA infants (aOR=3.2, 95% CI: 1.7~8.1; P<0.001). A receiver operating characteristic (ROC) curve showed the area under curve (AUC) was 0.7, with a 95% confidence interval (CI) from 0.6 to 0.8 (P<0.001).

Conclusions

The extremely rapid weight gain pattern of term SGA infants in the first 2 years of life increased the risk of overweight/obesity at 2 to 5 years of age. It suggests monitoring weight gain across the infant period represents a first step towards primary prevention of childhood obesity.

Early Life Low-Calorie Sweetener Consumption Impacts Energy Balance during Adulthood

Children frequently consume beverages that are either sweetened with sugars (sugar-sweetened beverages; SSB) or low-calorie sweeteners (LCS). Here, we evaluated the effects of habitual early life consumption of either SSB or LCS on energy balance later during adulthood. Male and female rats were provided with chow, water, and a solution containing either SSB (sucrose), LCS (acesulfame potassium (ACE-K) or stevia), or control (no solution) during the juvenile and adolescent periods (postnatal days 26-70). SSB or LCS consumption was voluntary and restricted within the recommended federal daily limits. When subsequently maintained on a cafeteria-style junk food diet (CAF; various high-fat, high-sugar foods) during adulthood, ACE-K-exposed rats demonstrated reduced caloric consumption vs. the controls, which contributed to lower body weights in female, but not male, ACE-K rats. These discrepant intakes and body weight effects in male ACE-K rats are likely to be based on reduced gene expression of thermogenic indicators (UCP1, BMP8B) in brown adipose tissue. Female stevia-exposed rats did not differ from the controls in terms of caloric intake or body weight, yet they consumed more SSB during CAF exposure in adulthood. None of the SSB-exposed rats, neither male nor female, differed from the controls in terms of total adult caloric consumption or body weight measures. The collective results reveal that early life LCS consumption alters sugar preference, body weight, and gene expression for markers of thermogenesis during adulthood, with both sex- and sweetener-dependent effects.

The metabolic conditioning of obesity: A review of the pathogenesis of obesity and the epigenetic pathways that "program" obesity from conception

Understanding the developmental origins of health and disease is integral to overcome the global tide of obesity and its metabolic consequences, including atherosclerotic cardiovascular disease, type 2 diabetes, hyperlipidemia, and nonalcoholic fatty liver disease. The rising prevalence of obesity has been attributed, in part, to environmental factors including the globalization of the western diet and unhealthy lifestyle choices. In this review we argue that how and when such exposures come into play from conception significantly impact overall risk of obesity and later health outcomes. While the laws of thermodynamics dictate that obesity is caused by an imbalance between caloric intake and energy expenditure, the drivers of each of these may be laid down before the manifestation of the phenotype. We present evidence over the last half-century that suggests that the temporospatial evolution of obesity from intrauterine life and beyond is, in part, due to the conditioning of physiological processes at critical developmental periods that results in maladaptive responses to obesogenic exposures later in life. We begin the review by introducing studies that describe an association between perinatal factors and later risk of obesity. After a brief discussion of the pathogenesis of obesity, including the systemic regulation of appetite, adiposity, and basal metabolic rate, we delve into the mechanics of how intrauterine, postnatal and early childhood metabolic environments may contribute to adult obesity risk through the process of metabolic conditioning. Finally, we detail the specific epigenetic pathways identified both in preclinical and clinical studies that synergistically "program" obesity.

Prognostic impact of sarcopenia in children with cancer: a focus on the psoas muscle area (PMA) imaging in the clinical practice

Skeletal muscle plays a crucial part in the metabolic and inflammatory response. "Sarcopenia", defined as a pathological condition of reduced strength, quantity and quality of skeletal muscle mass, may often develop in the young age as the secondary consequence of a systemic inflammatory illness, like cancer. In children with cancer, sarcopenia is a common finding, playing a negative role in their prognosis. However, its prevalence in clinical practice is underestimated. Moreover, several pre- and post-natal factors may influence skeletal muscle development in childhood, making the issue more complex. Given the frequent use of radiological imaging in clinical practice, prompt analysis of body composition is feasible and able to detect the presence of reduced fat-free mass (FFM) among pediatric patients with cancer. We discuss the recent advances in the study of body composition in children with cancer, dissecting the role of the psoas muscle area (PMA) measure, obtained from computerized tomography (CT) or magnetic resonance images (MRI) as a marker of sarcopenia in this setting. Since age and sex-specific percentile curves for PMA and a PMA z-scores calculator are available online, such a tool may be useful to simply detect and treat sarcopenia and its consequences in childhood cancer.

Early Life Factors Associated with Lean Body Mass in Spanish Children: CALINA Study

Early life is critical for the programming of body composition. The literature links perinatal factors with fat mass development and its future effects (e.g., obesity); however, little evidence exists between early life factors and lean body mass (LBM). This study follows up on a cohort of 416 Spanish children at ages six to eight, previously evaluated at birth in the CALINA study. Here, we studied the association between early life factors, LBM, and limb strength. Parental origin/nutritional status, maternal smoking during pregnancy, gestational diabetes/weight gain/age, birth weight (BW), early feeding, and rapid weight gain (RWG) were collected from primary care records. Bioimpedance analysis, dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, and a handgrip/standing long jump test were used to assess fat-free mass index (FFMI), total lean soft tissue mass index (TLSTMI), muscle cross-sectional area index (MCSAI), and limb strength, respectively. In girls, maternal smoking, gestational age, and BW were positively associated with FFM/LSTM. In boys, the parents’ BMI, BW, and RWG were positively associated with FFM/LSTM. BW was associated with handgrip strength in both. Maternal BMI in girls and RWG in boys were negatively associated with the standing long jump. Early life programming plays a key role in determining LBM in children.

Leptin Levels of the Perinatal Period Shape Offspring's Weight Trajectories through the First Year of Age

Background: Leptin is a hormone regulating lifetime energy homeostasis and metabolism and its concentration is important starting from prenatal life. We aimed to investigate the association of perinatal leptin concentrations with growth trajectories during the first year of life. Methods: Prospective, longitudinal study, measuring leptin concentration in maternal plasma before delivery, cord blood (CB), and mature breast milk and correlating their impact on neonate’s bodyweight from birth to 1 year of age, in 16 full-term (FT), 16 preterm (PT), and 13 intrauterine growth-restricted (IUGR) neonates. Results: Maternal leptin concentrations were highest in the PT group, followed by IUGR and FT, with no statistical differences among groups (p = 0.213). CB leptin concentrations were significantly higher in FT compared with PT and IUGR neonates (PT vs. FT; IUGR vs. FT: p < 0.001). Maternal milk leptin concentrations were low, with no difference among groups. Maternal leptin and milk concentrations were negatively associated with all the neonates’ weight changes (p = 0.017 and p = 0.006), while the association with CB leptin was not significant (p = 0.051). Considering each subgroup individually, statistical analysis confirmed the previous results in PT and IUGR infants, with the highest value in the PT subgroup. In addition, this group’s results negatively correlated with CB leptin (p = 0.026) and showed the largest % weight increase. Conclusions: Leptin might play a role in neonatal growth trajectories, characterized by an inverse correlation with maternal plasma and milk. PT infants showed the highest correlation with hormone levels, regardless of source, seeming the most affected group by leptin guidance. Low leptin levels appeared to contribute to critical neonates’ ability to recover a correct body weight at 1 year. An eventual non-physiological “catch-up growth” should be monitored, and leptin perinatal levels may be an indicative tool. Further investigations are needed to strengthen the results.

A new partially hydrolyzed whey-based follow-on formula with age-adapted protein content supports healthy growth during the first year of life

BACKGROUND

Standard infant formulae often have higher protein content than breastmilk in order to compensate for potentially lower digestibility; excess protein intake may promote adverse effects later in life. A new partially hydrolyzed whey-based (pHF-W) follow-on formula (FoF) with age-adapted protein content was evaluated for growth and gastrointestinal (GI) tolerance in healthy infants.

METHODS

Formula-fed (FF) infants (n = 108) received standard pHF-W formula (1.9 g protein/100 kcal) from enrollment (age ≤ 30 days) until age 120 days followed by new pHF-W FoF (1.6 g protein/100 kcal) until 360 days. Weight gain velocity (WGV) (mean daily WG from enrollment to age 180 days) was compared to WHO growth standards and a breastfed (BF) reference group (n = 86) (non-inferiority margin -3 g/day). GI tolerance was assessed using a validated questionnaire (scale range 13-65).

RESULTS

WGV in FF infants (mean ± SD 24.0 ± 4.4 g/day) was non-inferior to BF (23.7 ± 3.9 g/day) and WHO standards (all p ≤ 0.013). Weight-for-age, length-for-age, weight-for-length, and head circumference-for-age z-scores of FF infants were not significantly different from BF at any timepoint. Symptoms of GI intolerance were low (≤23) at all timepoints and similar between groups.

CONCLUSION

A new pHF-W FoF with age-adapted protein content fed sequentially after standard pHF-W infant formula is safe, well-tolerated, and promotes a healthy growth pattern consistent with BF infants and WHO standards during the first year of life.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/], identifier [NCT03276663].

Triceps skinfold thickness and body mass index and the risk of gestational diabetes mellitus: Evidence from a multigenerational cohort study

BACKGROUND

Pre-pregnancy obesity is a well-recognized risk factor for gestational diabetes mellitus (GDM). There is a continuity of obesity from childhood to adolescence and then adulthood. However, it is unknown whether early childhood obesity predicts GDM.

METHODS

We investigated the prospective association of childhood triceps skinfold thickness and body mass index (BMI) with GDM risk among women from the Mater-University of Queensland Study of Pregnancy (MUSP), a multigenerational cohort study. A multiple logistic regression model was applied to estimate the odds of experiencing GDM by childhood skinfold thickness and BMI.

RESULTS

Out of 552 women in the study for whom data were available on triceps skinfold thickness and BMI at average age 5 (range 3-7) years old, 52 (9.42%) developed GDM by average age 30 (range 28-33) years. We found that the risk of developing GDM was greater among women who had greater skinfold thickness but not greater BMI at age 5 years. Women who were classified as overweight or obese based on skinfold thickness at age 5 years had an increased odds ratio of GDM compared to women who had normal skinfold thickness. This association remained significant after adjustment for the potential confounders (OR 2.74; 95% confidence interval=1.28-5.86).

CONCLUSION

The risk of developing GDM was associated with higher skinfold thickness at age 5 years.

Comparative evaluation of obesity-related parameters in junior sumo wrestlers and children with obesity

[Purpose]

Exercise is a key factor in preventing obesity and metabolic syndrome. Sumo wrestlers increase their body size from childhood for athletic advantage; however, the risk of metabolic syndrome in junior sumo wrestlers is undetermined. Preventive measures against pediatric obesity should be initiated during childhood to prevent obesity in adulthood, considering its high global incidence. We comparatively evaluated the risk factors for metabolic syndrome in junior sumo wrestlers and children with obesity.

[Methods]

We enrolled 70 male children (age 9–17 years [sumo group, n = 14] and 9–14 years [other sports and non-exercise groups, n = 28 each]) and evaluated their anthropometric parameters (height, weight, body mass index z-score, obesity rate, waist circumference, waist to height ratio) and hematological parameters (total, low-density, high-density, and non-high-density lipoprotein-cholesterol; triglycerides; plasma glucose, and glycated hemoglobin levels).

[Results]

The BMI z-score, obesity rate, waist circumference (p < 0.05, along with the non-exercise group), and systolic blood pressure were significantly higher and the high-density cholesterol level was lower in the sumo group than in the other sports group (p < 0.05). The waist to height ratio was significantly higher in the non-exercise group than in the other sports group (p < 0.05). No significant difference was found in other blood lipid, plasma glucose (significantly lower level than the reference range in the sumo group, p < 0.05), and glycated hemoglobin (within the reference range in all groups) levels among the three groups.

[Conclusion]

Junior sumo wrestlers had a larger body size and higher blood pressure than children with obesity who exercised regularly. This provides direction for future research into targeted preventive interventions against metabolic syndrome for junior sumo wrestlers with large body size.

The Effect of Growth Rate during Infancy on the Risk of Developing Obesity in Childhood: A Systematic Literature Review

The prevalence of childhood obesity has been trending upwards over the last few decades. Recent evidence suggests that infant growth rate has the potential to increase the risk of obesity development during childhood. This systematic literature review aimed to summarise the existing evidence on the relationship between infant growth rate and subsequent childhood obesity. Studies were sought for that assessed the effect of infant growth rate on outcomes of overweight, obesity, BMI, waist circumference or body composition measures among a population group of children aged 2 to 12 years old. Data sources included PubMed, CINAHL, Web of Science and MedLine. Twenty-four studies were identified as eligible and included in this review, out of 2302 publications. The ADA Quality Checklist was used to assess the quality of individual studies. Ten studies received a positive result and 14 studies a neutral result. A narrative synthesis was completed to present study characteristics and results. Several independent positive associations were determined between rapid growth at different stages during infancy and overweight, obesity, BMI, waist circumference and body composition in childhood. Further investigation is required to determine if a specific period of infancy carries greater associations of risk with childhood outcomes. Determining an ideal rate of infants' growth as a means to minimise the future risk of childhood obesity should be the focus of future research that will also inform early life obesity prevention strategies. Registration no.: CRD42021244029.

Which Milk during the Second Year of Life: A Personalized Choice for a Healthy Future?

Nutrition in early life is a crucial element to provide all essential substrates for growth. Although this statement may appear obvious, several studies have shown how the intake of micro and macronutrients in toddlers differs a lot from the recommendations of scientific societies. Protein intake often exceeds the recommended amount, while the intake of iron and zinc is frequently insufficient, as well as Vitamin D. Nutritional errors in the first years of life can negatively impact the health of the child in the long term. To date, no clear evidence on which milk is suggested during the second year of life is yet to be established. In this study, we compare the nutrient profiles of cow's milk and specific formulas as well as nutritional risks in toddlers linked to growth and childhood obesity development. The purpose of this review is to resume the latest clinical studies on toddlers fed with cow's milk or young children formula (YCF), and the potential risks or benefits in the short and long term.

Longitudinal assessments of child growth: A six-year follow-up of a cluster-randomized maternal education trial

Background & aims

Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60−72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6−8 months old with data collection at 20−24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation.

Methods

We measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care).

Results

Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60−72 months, except that children in the intervention group had lower (P = 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60−72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60−72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings.

Conclusion

In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition.

Trial registration

Clinical Trials (clinical trials.gov) ClinicalTrials.gov ID NCT 02098031.