Risk profiles for overweight/obesity among preschoolers

Background

The epidemic of overweight/obesity among U.S. children has led to an alarming increase in health-related consequences, including early-onset diabetes and cardiovascular disease. Recent research has identified the independent contribution of several maternal and child factors to the development of childhood overweight/obesity. Few studies, however, have examined risk profiles of childhood obesity.

Aim

This study used classification and regression tree (CART) analysis to examine the combined effect of maternal and child factors in generating risk profiles for overweight/obesity among preschoolers.

Study design

Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) study were used. The sample was comprised of preschool children. CART and logistic regression models were built and compared.

Results

Children who were overweight/obese at two years of age had an increased risk of being overweight/obese at four years of age. Children born to overweight/obese mothers were more likely to be overweight/obese by age four, even if their BMI at two years of age was normal. Children with high birth weight (≥ 4000 g.) were also more likely to be overweight/obese at age four years if they were born to mothers with a normal pregravid BMI, but were of a lower socioeconomic status. Among preschoolers whose mothers were black or white and who had a high pregravid BMI, breastfeeding duration and parity played an important role in determining their risk of being overweight/obese.

Conclusions

Classification tree analysis confirms and extends current knowledge of preschool overweight/obesity by providing preliminary risk profiles that are structured within the context of prenatal and postnatal maternal and child characteristics.     

Interaction between Maternal Prepregnancy Body Mass Index and Gestational Weight Gain Shapes Infant Growth

ObjectiveTo quantify the combined effect of maternal prepregnancy obesity and maternal gestational weight gain (GWG) on the shape of infant growth throughout the first year of life.MethodsA retrospective cohort of mother–child dyads with children born between January 2007 and May 2012 was identified in a linked electronic medical record. Data were abstracted to define the primary exposures of maternal prepregnancy body mass index (BMI) and GWG, and the primary outcome of infant growth trajectory.ResultsWe included 499 mother–child dyads. The average maternal age was 28.2 years; 55% of mothers were overweight or obese before pregnancy, and 42% of mothers had excess GWG, as defined by the Institute of Medicine. Maternal prepregnancy BMI (P < .001) and the interaction between prepregnancy BMI and maternal GWG (P = .02) showed significant association with infant growth trajectory through the first year of life after controlling for breast-feeding and other covariates, while GWG alone did not reach statistical significance (P = .38). Among infants of mothers with excess GWG, a prepregnancy BMI of 40 kg/m² versus 25 kg/m² resulted in a 13.6% (95% confidence interval 5.8, 21.5; P < .001) increase in 3-month infant weight/length percentile that persisted at 12 months (8.4%, 95% confidence interval 0.2, 16.5; P = .04).ConclusionsThe combined effect of excess maternal GWG and prepregnancy obesity resulted in higher infant birth weight, rapid weight gain in the first 3 months of life, with a sustained weight elevation throughout the first year of life. These findings highlight the importance of the preconception and prenatal periods for pediatric obesity prevention.     

The association of maternal overweight and obesity with breastfeeding duration

OBJECTIVE: To determine whether maternal prepregnancy overweight or obesity has an independent effect on breastfeeding duration. STUDY DESIGN: A prospective birth cohort study of 1803 live-born children and their mothers ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth, Australia, were followed until 3 years of age. Unconditional logistic, Cox regression, and Kaplan Meier analyses were used to model the association between maternal prepregnancy overweight and obesity and the duration of predominant or any breastfeeding allowing for adjustment of confounders (infant factors: gender, birth weight, gestational age, age solids introduced, and older siblings; maternal factors: smoking, education, age, race, marital status, pregnancy and birth complications, cesarean section, and socioeconomic status). RESULTS: Overweight and obese women were more likely to have discontinued breastfeeding at any time before 6 months than normal weight women (P < .0005) following adjustment for potential confounders. CONCLUSION: We have shown that prepregnancy body mass index is associated with reduced breastfeeding duration, and that mothers who are overweight or obese before pregnancy tend to breastfeed their infants for a shorter duration than normal weight mothers independent of maternal socioeconomic and demographic characteristics.     

Do High-Risk Preschoolers or Overweight Mothers Meet AAP-Recommended Behavioral Goals for Reducing Obesity?

BackgroundThe American Academy of Pediatrics (AAP) has issued specific behavioral recommendations to prevent obesity. It is unclear how often high-risk preschoolers and overweight mothers meet recommended behavior goals and whether meeting these goals is negatively associated with overweight/obesity.ObjectiveTo describe the proportion of preschoolers and mothers that meet AAP-recommended behavior goals and examine the associations of meeting goals with weight-status, and mothers meeting goals and children meeting corresponding goals.MethodsSecondary analysis of baseline data (before an intervention) from mother–preschooler dyads in a weight-control study. Mothers were overweight or obese. Preschoolers were 2–5 years old. Dietary and feeding practices were assessed by the use of questionnaires. Activity was measured directly using accelerometry. Outcomes included preschooler overweight and maternal obesity.ResultsThe respective proportions of children and mothers that met behavior goals were: 17% and 13% for ≥5 fruits/vegetables/day, 46% and 33% for zero sugar-sweetened beverages/day, 41% and 13% for fast-food <1×/week, and 46% and 13% for screentime ≤2 hours/day. Moderate-to-vigorous physical activity did not exceed 60 minutes/day in any participant. A total of 49% ate family meals together 7×/week. For each additional goal met, the adjusted odds for preschooler overweight was 0.9 (95% confidence interval 0.8–1.1) and for maternal obesity, 0.8 (95% confidence interval 0.6–0.9). Preschoolers had significantly greater odds of meeting each goal when mothers met the corresponding goal.ConclusionsFew high-risk preschoolers or overweight mothers meet AAP-recommended behavior goals. Meeting a greater number of behavior goals may be particularly important for maternal weight. Preschoolers have greater odds of meeting behavior goals when mothers meet behavior goals.     

Prepregnancy Maternal Weight and Body Mass Index of Children with and without Congenital Heart Disease

Objective: Congenital heart diseases are among the most frequent major congenital anomalies. One of the suspected reasons for congenital heart defects is overweight and obesity of mother during prepregnancy and pregnancy. We studied the relationship between maternal overweight and obesity and the risk of congenital anomaly. Methods: All of children with congenital heart defect (164 infants with major nonsyndromic heart disease) referred to our pediatric cardiology clinic or admitted to our ward during 2011-2012 were included in this study. Controls were 158 live-born infants without any major malformations and their mothers. Mothers of these infants were studied for weight, height and body mass index (BMI). Findings : The most frequent congenital heart disease was ventricular septal defect (39%), patent ductus arteriosus (11%), complete atrioventricular septal defect (10%), pulmonary stenosis (9.1%), and atrial septal defect (8.5%). There was no significant difference between maternal age (P=0.1), weight (P=0.8) and height (P=0.3) in the two groups. The mothers had not significantly higher BMI than that of the control mothers. Compared with underweight (BMI <18.5) and normal weight women (OR: 1.24, 95%CI: 0.40-3.89), overweight (OR: 0.98, 95%CI: 0.31-3.10) and obese women (OR: 1.16, 95%CI: 0.34-4.00) were not more likely to have an infant with a congenital heart defect. Conclusion: This study suggests that there may not be a relation between maternal BMI and having a child with congenital heart defect.Key Words: Congenital Heart Defects; Maternal Obesity; Maternal Overweight     

Prepregnancy overweight and obesity are associated with impaired child neurodevelopment

The authors examined the relationship of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with child neurodevelopment. Mother–child dyads were a subgroup (n = 2,084) of the Child Health and Development Studies from the Oakland, California, area enrolled during pregnancy from 1959 to 1966 and followed at child age 9 years. Linear regression was used to examine associations between prepregnancy BMI, GWG, and standardized Peabody Picture Vocabulary Test and Raven Progressive Matrices scores and to evaluate effect modification of GWG by prepregnancy BMI. Before pregnancy, 77% of women were normal weight, 8% were underweight, 11% were overweight, and 3% were obese. Associations between GWG and child outcomes did not vary by prepregnancy BMI, suggesting no evidence for interaction. In multivariable models, compared to normal prepregnancy BMI, prepregnancy overweight and obesity were associated with lower Peabody scores (b: ?1.29; 95% CI [?2.6, ?0.04] and b: ?2.7; 95% CI [?5.0, ?0.32], respectively). GWG was not associated with child Peabody score [b: ?0.03 (95% CI: ?0.13, 0.07)]. Maternal BMI and GWG were not associated with child Raven score (all P >0.05). Maternal prepregnancy overweight and obesity were associated with lower scores for verbal recognition in mid‐childhood. These results contribute to evidence linking maternal BMI with child neurodevelopment. Future research should examine the role of higher prepregnancy BMI values and the pattern of pregnancy weight gain in child cognitive outcomes.     

Maternal infant-feeding style and children's adiposity at 5 years of age

OBJECTIVES: To examine the relationship between maternal infant-feeding style and adiposity in childhood and to determine whether feeding style explains any of the association between maternal obesity and childhood adiposity. DESIGN: Prospective cohort study. SETTING: Cincinnati metropolitan area. PARTICIPANTS: A total of 313 preschool children; 80% were white and 20% were black. MAIN OUTCOME MEASURES: Seven factors describing maternal infant-feeding style derived from the Infant Feeding Questionnaire administered at age 3 years; maternal obesity, defined as a body mass index of 30 or higher before pregnancy; and adiposity at 5 years of age as assessed by dual-energy x-ray absorptiometry. RESULTS: The mean +/- SD fat mass was 4.55 +/- 1.64 kg. Seventeen percent of the mothers were obese before pregnancy. Children whose mothers had high concern about the infant overeating or becoming overweight (the highest tertile of the "overeating" factor) had 0.67 kg (95% confidence interval, 0.31-1.03 kg) higher fat mass than children whose mothers did not have high concern (the other 2 tertiles). None of the other 6 feeding factors were related to childhood adiposity. Children of obese mothers had 0.54 kg (95% confidence interval, 0.10-0.98 kg) higher fat mass than children of nonobese mothers. High concern about the infant overeating, which was more common in obese mothers, accounted for 15% of this 0.54-kg difference. CONCLUSION: High maternal concern about an infant overeating or becoming overweight was associated with higher adiposity at 5 years of age and explained some of the association between maternal obesity and child adiposity.     

Association between school children's overweight and maternal obesity and perception of their children's weight status

AIM: To determine the association between overweight children and a) other components of the mothers' metabolic syndrome, such as body mass index (BMI), waist circumference (WC), HDL-cholesterol, triglycerides, glucose, HOMA-IR, blood pressure (BP), and age; and b) the mothers' perception of their children's overweight. METHODS: Six hundred and twenty children (297 M) aged 9 +/- 2 years and their mothers aged 37.7 +/- 7 years were examined between April and August 2006. BMI, BP, fasting glucose and lipids and children's Tanner stage were determined. Questionnaires were filled in about the mothers' perceptions of their children's eating habits and of their children's shape. RESULTS: Ninety-five (17.4%) of the children were obese (> 95th percentile), 108 (15.3%) overweight (> 85th percentile) and 418 (67.3%) normal. One hundred and twelve (18%) of the mothers were obese and 183 (29.5%) overweight. Mean values for measures in mothers differed between normal vs overweight/obese children: z-BMI (-0.19 vs 0.42), triglycerides (84 vs 105 mg/dl), cholesterol (147 vs 157 mg/dl), glucose (78 vs 82 mg/dl) and insulin resistance (HOMA-IR 1.34 vs 1.72). There were significant differences in the proportion with distorted perception of shape (2.2% vs 47.5%) and eating habits (11.2% vs 37%) between mothers of normal versus overweight/ obese children. Logistic regression analysis using BMI > or = 85th percentile as the dependent variable showed that the mothers' perceptions of their children's shape (OR: 18.84; 95% CI: 5.0-69.6), eating habits (OR: 3.82; 95% CI: 1.5-9.5) and mothers' BMI (OR: 2.1; 95% CI: 1.3-3.4) were associated with children's overweight. CONCLUSIONS: There was an association between mothers' distorted perception of their children's shape and eating habits and mothers' obesity and their children's overweight. This observation provides clues for obesity prevention programs.     

Very preterm birth: should we be interested in maternal pre-pregnancy body mass index?]

Link between maternal body mass index (BMI) and pregnancy outcome is not clear. OBJECTIVE: To appreciate the impact of prepregnancy maternal BMI on very preterm birth (22-32 gestation's weeks). SECONDARY OBJECTIVE: To assess how maternal BMI does explain the mechanism of very preterm birth among live births. METHODS: Population-based study, including each mother with a live or stillborn baby was included in a geographically defined (Poitou-Charentes and Franche-comté, France) case-control study in 2004 to 2006. Leanness (BMI<18.5kg/m(2)) and overweight and obesity (BMI> or =25kg/m(2)) were defined according to World Health Organization's standards. Statistical analysis consisted in a polynomial regression on 832 mothers of very preterm babies and 431 mothers of full-term babies, taking account for confounders as maternal age, birth country, educational level, maternal work and smoking during the pregnancy. RESULTS: Leanness is a risk factor for very preterm live birth (aOR=1.73 [1.12-2.68]), overweight is a risk factor for stillbirth. (aOR=1.71 [1.03-2.84]). Among mothers of live born babies, leanness is a risk factor for spontaneous preterm birth (aOR=2.12 [1.20-3.74]), whereas overweight is a risk factor for very preterm birth on medical decision due to gestational hypertension (aOR=2.85 [1.80-4.52]). CONCLUSION: Morbid maternal stoutness before pregnancy is a complex risk factor for very preterm delivery. Women and couples should be informed and practitioners should be aware in order to prevent and manage this pathological status.     

Influence of parental obesity on the physical constitution of preschool children in Japan

The objective of this study was to assess the influence of parental obesity on the physical constitution of preschool children. A total of 3187 children aged between 1–6 years and their parents were studied. A child whose per cent obesity (%OB; per cent overweight for age, height and sex) was greater than 15%, and a parent whose body mass index (BMI; kg/m²) was greater than the 95th percentile were defined to be obese (27.40 and 25.97 for a father and a mother, respectively). We found that the incidence of obesity in children with obese fathers (11.5%) was significantly higher than in those with non-obese fathers (6.2%), and a similar difference was obtained between children with obese mothers (14.5%) and with non-obese mothers (6.2%), respectively. The incidence of obesity in children was 6.0% if both parents were non-obese; this incidence rose to 22.7% if one parent was obese, and to 30.8% if both were obese. The %OB of children was more markedly correlated with the mothers' BMI (r = 0.219) than the fathers' BMI (r = 0.165). The %OB of children correlated significantly with fathers' BMI, but only from the age of 3–6 years, whereas mothers' BMI correlated from the age of 1–6 years. We concluded that parental obesity was of significance in determining the development of juvenile obesity even in the preschool period.     

Determinants of birthweight inequalities: Population-based study

BACKGROUND: The aim of this paper is to study the whole spectrum of birthweight in a population-based birth cohort in order to document the role played by social factors, which complement physiological and behavioural factors, in the development of birthweight inequalities at the population level. METHODS: The analyses were performed with data from the 'Quebec Longitudinal Study of Child Development 1998-2002 (QLSCD)'. The study follows a representative sample (n = 2103) of the children born in 1998 in the Canadian province of Québec. RESULTS: Multivariate analyses adjusted for gestational age and mother's age indicate that mean birthweight was higher for boys than girls; improved with birth rank, mother's body mass index (BMI), and family socioeconomic status; and was lower for children of smoking mothers. Compared with children born to non-smoking mothers of higher socioeconomic status, the odds of having a low birthweight were between 6 and 12 times higher for children born to smoking mothers of lower or middle socioeconomic status. When maternal smoking status and mother's BMI are combined, socioeconomic status could still be seen to have a positive effect on mean birthweight except for overweight or obese smoking mothers, among whom the relationship between socioeconomic status and mean birthweight was reversed. In families of lower socioeconomic status, maternal smoking was the most important factor in birthweight inequalities, and in families of higher socioeconomic status, mother's BMI was the most important factor in birthweight inequalities. CONCLUSION: This research is not only important for children in developed nations, but also for those in developing countries, where high birthweight and obesity are becoming more prevalent.     

Maternal perception of excess weight in children: a survey conducted by paediatricians in the province of Milan

OBJECTIVE: To establish whether maternal perception of a child's body weight (BW) and food intake is related to the level of maternal education. STUDY DESIGN: Height and BW of 569 mother/child couples were measured, and mothers received a questionnaire regarding their perception of their own weight and their child's BW and food intake. RESULTS: Twenty-nine percent of mothers and 35% of children were overweight or obese. Only 10% of the mothers underestimated their own weight, while 37% overestimated it. In contrast, 28% of mothers underestimated their child's BW, while 9% overestimated it. Higher maternal instruction level was significantly associated to a lower weight class in both mothers and children, and to a correct perception of the child's weight. Fifty-seven per cent of the mothers who perceived their child to be overweight or obese were not concerned. Forty-four per cent of the mothers with overweight or obese children believed that their child was eating correctly. CONCLUSIONS: A better understanding of how mothers perceive the problem of excess weight in their children is relevant to the success of preventive interventions in childhood obesity.     

Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score

BackgroundParental mindfulness may be a novel intervention target for child obesity prevention.ObjectiveTo examine associations between maternal mindfulness and child body mass index z-score (BMIz).MethodsIn a secondary data analysis of preintervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n = 105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals.ResultsChildren were M = 53.7 (standard deviation [SD] 7.5) months old, and mothers were M = 31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β = ?.02 (SE 0.01), P = .027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (P = .016) and BMI at the trend level (P = .0595) at the trend level.ConclusionsGreater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.     

Socio‐economic influence on weight status through time in schoolchildren

Aim: This paper describes the developmental trajectory of adiposity in relation to socio‐demographic status in primary schoolchildren studying in local schools in Hong Kong. Methods: Body mass index (BMI) and prevalence of overweight and obesity were determined in a cohort of primary schoolchildren annually from 2001/2002 to 2005/2006. To study the associations between socio‐demographic status and adiposity, repeated measures analysis of variance was used for the longitudinal change in BMI, while logistic regression was used with overweight and obesity development as outcomes. Results: Prevalence of overweight and obesity was 12.1% and 4.0%, respectively, at baseline, and 16.7% and 3.3%, respectively, at the end of the study period. Boys were more likely to be overweight and obese. Parents in the ‘Professional’ occupational group were less likely to have overweight and obese children. Among 32 781 children with normal weight at baseline, 2885 (8.8%) became overweight or obese after 4 years. Among 6286 children who were initially overweight or obese, 2079 (33.1%) returned to normal weight. Boys were more likely to move up from normal weight to overweight or obesity and less likely to move down the opposite direction during the study period. Parental education at degree level and the occupational group of ‘Professionals’ were, in general, associated with more favourable changes in weight status during follow‐up. Conclusion: Overweight and obesity were not firmly established during early primary school years. Interventions at the school level on students and their parents might help prevent and control the future development of the obesity epidemic in the population.     

What Can Providers Learn From Childhood Body Mass Index Trajectories: A Study of a Large,Safety-Net Clinical Population

ObjectiveTo describe childhood weight gain using body mass index (BMI) z-score trajectories in a low-income urban safety-net population and identify among gender- and race/ethnicity-specific groups any trends for increased risk.MethodsA retrospective cohort study was conducted among 2- to 12-year-old patients (2006–2013) visiting a safety-net provider. BMI z-score trajectories were calculated overall, for gender- and race/ethnicity-specific groups, and for peak BMI percentile subgroups to describe weight gain longitudinally.ResultsFrom 2006 to 2013, a total of 26,234 eligible children were followed for an average of 3.7 years. At baseline (mean age, 4.2 years), 74% of patients were at a normal weight compared to 65% at most recent observation (mean age, 7.8 years). All gender and race/ethnicity subgroups showed increasing average BMI z-scores during childhood. Children consistently under the 50th percentile and those of white race had the most stable BMI z-score trajectories. BMI z-score increased with increasing age in all subgroups. Hispanic boys and black girls had the most significant increase in BMI z-score during this observation period. Children observed in early childhood and whose BMI exceeded the 95th percentile at any time were often already overweight (20%) or obese (36%) by 3 years of age.ConclusionsThe entire population demonstrated an upward trend in BMI z-score trajectory. This trend was most notable among black girls and Hispanic boys. Many obese children were already overweight by age 3, and persistence of obesity after 3 years of age was high, suggesting that intervention before age 3 may be essential to curbing unhealthy weight trajectories.     

Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children

BACKGROUND: Decreasing television (TV)-viewing time may improve child health and well-being. These viewing patterns are shaped during the preschool years. Because mothers play an important role in determining how much TV their preschool children watch, a better understanding is needed of the maternal factors that influence children's TV viewing. OBJECTIVE: To examine the relationship of depressive symptoms and obesity in low-income mothers with TV-viewing time in their preschool children. METHODS: Cross-sectional, self-administered survey of 295 low-income mothers of 3- and 4-year-old children (92% white) enrolled in the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers reported children's usual weekday and weekend-day TV-viewing time. Maternal depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Maternal body mass index was calculated from self-reported height and weight measurements (weight in kilograms divided by height in meters squared). RESULTS: Children watched a mean of 2.2 +/-1.2 hours of TV per day. Those in the upper quartile of TV-viewing time (high TV viewers) watched 3 or more hours of TV per day. Of the mothers, 12% had both obesity (BMI > or =30) and depressive symptoms (CES-D score > or =16), 19% were obese only, and 18% had depressive symptoms only. Children were more likely to be high TV viewers if their mothers had clinically significant depressive symptoms (35% vs 23%; P =.03) or if their mothers were obese (35% vs 22%; P =.03). Forty-two percent of children were high TV viewers if the mother had both depressive symptoms and obesity, 30% if the mother had only depressive symptoms, 29% if the mother had only obesity, and 20% if the mother had neither depressive symptoms nor obesity (P =.06 overall; P for trend =.009 using the chi2 test). CONCLUSIONS: Among low-income preschool children, those whose mothers had either depressive symptoms or obesity were more likely to watch 3 or more hours of TV a day. Strategies to reduce TV viewing in young children should consider the role that maternal obesity and depressive symptoms may play in how preschool children spend their time.     

Maternal Depressive Symptoms and Child Obesity in Low-Income Urban Families

ObjectiveTo characterize the relationship between maternal depressive symptoms and child weight status, obesity-promoting feeding practices, and activity-related behaviors in low-income urban families.MethodsWe conducted a cross-sectional survey of mothers with 5-year-old children receiving pediatric care at a federally qualified community health center. We used regression analyses to examine the relationship between maternal depressive symptoms (trichotomized: none, mild, moderate to severe) and 1) child weight status; 2) obesity-promoting feeding practices, including mealtime practices and feeding styles; and 3) activity-related behaviors, including sleep time, screen time, and outdoor playtime.ResultsThe sample included 401 mother–child pairs (78.3% response rate), with 23.4% of mothers reporting depressive symptoms (15.7% mild, 7.7% moderate to severe). Mothers with moderate to severe depressive symptoms were more likely to have overweight and obese children than mothers without depressive symptoms (adjusted odds ratio 2.62; 95% confidence interval 1.02–6.70). Children of mildly depressed mothers were more likely to consume sweetened drinks and to eat out at restaurants and were less likely to eat breakfast than children of nondepressed mothers. Mothers with depressive symptoms were less likely to set limits, to use food as a reward, to restrict their child’s intake, and to model healthy eating than nondepressed mothers. Children with depressed mothers had less sleep and outdoor playtime per day than children of nondepressed mothers.ConclusionsMaternal depressive symptoms are associated with child overweight and obese status and with several obesity-promoting practices. These results support the need for maternal depression screening in pediatric obesity prevention programs. Further research should explore how to incorporate needed mental health support.     

学龄前儿童家庭环境中超重和肥胖危险因素分析

目的对北京市1173名儿童家长进行问卷调查,探讨北京市学龄前儿童家庭中与儿童超重和肥胖有关的危险因素。方法在北京市2个城区在园儿童数200人以上的机关直属幼儿园中随机选择5所幼儿园为调查单位,5所幼儿园中的1364名儿童为调查对象,对调查儿童进行身高和体重的测量,采用国际肥胖工作组不同年龄和性别的体重指数作为儿童超重和肥胖的判定标准。对所有调查儿童家长发放问卷进行调查,共收集填写完整的问卷1173份,回收率86％。问卷内容为家庭饮食习惯和生活方式、喂养方式、家长特征等。结果调查儿童中肥胖和超重的检出率分别为4．1％和6．9％。父母均肥胖的家庭儿童肥胖和超重的总检出率为15．2％,父母非肥胖家庭肥胖和超重的总检出率为7．5％;父母和儿童在体重指数、餐馆就餐频率、运动时间和看电视时间上存在正相关;多因素分析发现,父母肥胖、母亲文化程度低、儿童看电视和玩电脑游戏时间长是儿童肥胖和超重的危险因素。结论家庭环境对儿童肥胖的发生、发展影响较大,应针对家庭危险因素对儿童超重和肥胖进行有效干预。     

Prolonged bottle use and its association with iron deficiency anemia and overweight: a preliminary study

To determine the prevalence of prolonged bottle feeding practices in young children, and its association with body mass index (BMI) and iron deficiency anemia (IDA), we conducted a cross-sectional survey study at 3 Bronx, NY, WIC sites. Caregivers of 95 predominantly Hispanic and African-American WIC-enrolled children aged 18-56 months presenting for recertification completed questionnaires. Half were overweight (>85th% BMI) and 36% were obese (>95th% BMI); 21% met CDC criteria for anemia. Two thirds (63%) received daily bottles of milk or sweet liquids. Daily bottle use ranged from 3 to 10 (mean=3.3, median=3). Bottle use was significantly associated with obesity (>95th% BMI, p<0.0005), not significant with overweight (>85th% BMI, p<0.06) and statistically significant with IDA.     

Timing of solid food introduction and association with later childhood overweight and obesity: The IDEFICS study

This study investigated associations between timing of solid food introduction and childhood obesity and explored maternal characteristics influencing early feeding practices. Cross‐sectional data from children 2–9 years (n = 10,808; 50.5% boys) residing in 8 European countries of the IDEFICS study (2007–2008) were included. Late solid food introduction (≥7 months of age) was associated with an increased prevalence of later childhood overweight/obesity among exclusively breastfed children (OR [odds ratio]: 1.38, 95% CI [confidence interval] [1.01, 1.88]). In contrast, early solid food introduction (<4 months of age) was associated with lower prevalence of overweight/obesity among children that ceased exclusive breastfeeding earlier than 4 months (OR: 0.63, 95% CI [0.47, 0.84]). Children that were introduced to solids right after 6 months exclusive breastfeeding and continued to receive breastmilk (≥12 months) were less likely to become overweight/obese (OR: 0.67, 95% CI [0.51, 0.88]) compared to children that discontinued to receive breastmilk. Analyses were adjusted for age, sex, country, birth weight, parental education level, parental body mass index, tobacco use in pregnancy, gestational weight gain, and gestational diabetes. Underweight mothers, overweight mothers, mothers who reported daily smoking during pregnancy, and low‐educated mothers were less likely to follow recommendations on breastfeeding and timely solids introduction. Future studies should examine whether guidelines for solid food introduction timing have to distinguish between exclusively breastfed, formula fed, and too early exclusive breastfeeding‐ceased infants. There is also need for more prospective studies; recall bias was an important current limitation. In conclusion, health professionals should emphasize benefits of breastfeeding and appropriate solid food introduction, especially to mothers that are less likely to follow recommendations.