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      Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy

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          Abstract

          Objective

          To determine risk factors for childhood overweight that can be identified during the first year of life to facilitate early identification and targeted intervention.

          Design

          Systematic review and meta-analysis.

          Search strategy

          Electronic database search of MEDLINE, EMBASE, PubMed and CAB Abstracts.

          Eligibility criteria

          Prospective observational studies following up children from birth for at least 2 years.

          Results

          Thirty prospective studies were identified. Significant and strong independent associations with childhood overweight were identified for maternal pre-pregnancy overweight, high infant birth weight and rapid weight gain during the first year of life. Meta-analysis comparing breastfed with non-breastfed infants found a 15% decrease (95% CI 0.74 to 0.99; I 2=73.3%; n=10) in the odds of childhood overweight. For children of mothers smoking during pregnancy there was a 47% increase (95% CI 1.26 to 1.73; I 2=47.5%; n=7) in the odds of childhood overweight. There was some evidence associating early introduction of solid foods and childhood overweight. There was conflicting evidence for duration of breastfeeding, socioeconomic status at birth, parity and maternal marital status at birth. No association with childhood overweight was found for maternal age or education at birth, maternal depression or infant ethnicity. There was inconclusive evidence for delivery type, gestational weight gain, maternal postpartum weight loss and ‘fussy’ infant temperament due to the limited number of studies.

          Conclusions

          Several risk factors for both overweight and obesity in childhood are identifiable during infancy. Future research needs to focus on whether it is clinically feasible for healthcare professionals to identify infants at greatest risk.

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          Most cited references34

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          Health consequences of obesity in youth: childhood predictors of adult disease.

          W Dietz (1998)
          Obesity now affects one in five children in the United States. Discrimination against overweight children begins early in childhood and becomes progressively institutionalized. Because obese children tend to be taller than their nonoverweight peers, they are apt to be viewed as more mature. The inappropriate expectations that result may have an adverse effect on their socialization. Many of the cardiovascular consequences that characterize adult-onset obesity are preceded by abnormalities that begin in childhood. Hyperlipidemia, hypertension, and abnormal glucose tolerance occur with increased frequency in obese children and adolescents. The relationship of cardiovascular risk factors to visceral fat independent of total body fat remains unclear. Sleep apnea, pseudotumor cerebri, and Blount's disease represent major sources of morbidity for which rapid and sustained weight reduction is essential. Although several periods of increased risk appear in childhood, it is not clear whether obesity with onset early in childhood carries a greater risk of adult morbidity and mortality. Obesity is now the most prevalent nutritional disease of children and adolescents in the United States. Although obesity-associated morbidities occur more frequently in adults, significant consequences of obesity as well as the antecedents of adult disease occur in obese children and adolescents. In this review, I consider the adverse effects of obesity in children and adolescents and attempt to outline areas for future research. I refer to obesity as a body mass index greater than the 95th percentile for children of the same age and gender.
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            Fetal origins of obesity.

            Emily Oken, Matthew Gillman (2003)
            The worldwide epidemic of obesity continues unabated. Obesity is notoriously difficult to treat, and, thus, prevention is critical. A new paradigm for prevention, which evolved from the notion that environmental factors in utero may influence lifelong health, has emerged in recent years. A large number of epidemiological studies have demonstrated a direct relationship between birth weight and BMI attained in later life. Although the data are limited by lack of information on potential confounders, these associations seem robust. Possible mechanisms include lasting changes in proportions of fat and lean body mass, central nervous system appetite control, and pancreatic structure and function. Additionally, lower birth weight seems to be associated with later risk for central obesity, which also confers increased cardiovascular risk. This association may be mediated through changes in the hypothalamic pituitary axis, insulin secretion and sensing, and vascular responsiveness. The combination of lower birth weight and higher attained BMI is most strongly associated with later disease risk. We are faced with the seeming paradox of increased adiposity at both ends of the birth weight spectrum-higher BMI with higher birth weight and increased central obesity with lower birth weight. Future research on molecular genetics, intrauterine growth, growth trajectories after birth, and relationships of fat and lean mass will elucidate relationships between early life experiences and later body proportions. Prevention of obesity starting in childhood is critical and can have lifelong, perhaps multigenerational, impact.
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              Birth weight and subsequent risk of obesity: a systematic review and meta-analysis.

              Z. B. Yu, S. P. Han, G Zhu … (2011)
              This report describes the association between birth weight (BW) and obesity. Screening of 478 citations from five electronic databases resulted in the inclusion of 33 studies, most of medium quality. The meta-analysis included 20 of these published studies. The 13 remaining articles did not provide sufficient dichotomous data and were systematically reviewed, revealing results consistent with the meta-analysis. Our results revealed that high BW (>4000 g) was associated with increased risk of obesity (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.91-2.24) compared with subjects with BW ≤ 4000 g. Low BW (<2500 g) was associated with decreased risk of obesity (OR, 0.61; 95% CI, 0.46-0.80) compared with subjects with BW ≥ 2500 g. However, when two studies exhibited selection bias were removed, the results indicated no significant association between low BW and obesity (OR, 0.77; 95% CI, 0.58-1.04). Sensitivity analyses showed that differences in the study design, sample size and quality grade of the study had an effect on the low BW/obesity association, which low BW was not associated with the risk of obesity in cohort studies, studies with large sample sizes and studies with high quality grades. Pooled results were similar when normal birth weight (2500-4000 g) was used as the reference category. Subgroup analyses based on different growth and developmental stages (pre-school children, school children and adolescents) also revealed that high BW was associated with increased risk of obesity from childhood to early adulthood. No significant evidence of publication bias was present. These results suggest that high BW is associated with increased risk of obesity and may serve as a mediator between prenatal influences and later disease risk. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
              Article 0 comments Cited 179 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Dis Child
                Journal ID (iso-abbrev): Arch. Dis. Child
                Journal ID (hwp): archdischild
                Journal ID (publisher-id): adc
                Title: Archives of Disease in Childhood
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0003-9888
                ISSN (Electronic): 1468-2044
                Publication date (Print): December 2012
                Publication date (Electronic): 29 October 2012
                Volume: 97
                Issue: 12
                Pages: 1019-1026
                Affiliations
                [1 ]Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham, Nottingham, UK
                [2 ]School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Nottingham, UK
                [3 ]Division of Nutritional Sciences, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
                [4 ]Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Queen's Medical Centre, Nottingham, UK
                [5 ]Division of Psychiatry, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
                Author notes
                [Correspondence to ] Professor Cris Glazebrook, Division of Psychiatry, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham NG7 2TU, UK; Cris.Glazebrook@ 123456nottingham.ac.uk
                Article
                Publisher ID: archdischild-2012-302263
                DOI: 10.1136/archdischild-2012-302263
                PMC ID: 3512440
                PubMed ID: 23109090
                SO-VID: 3f69eecd-b65c-4d0e-980b-a7d20fd09793
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

                History
                Date received : 30 April 2012
                Date accepted : 21 August 2012
                Categories
                Subject: 1506
                Subject: Original Articles
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                ScienceOpen disciplines: Medicine
                Keywords: infant feeding,general paediatrics
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: infant feeding, general paediatrics

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