Children at high risk for overweight: a classification and regression trees analysis approach

OBJECTIVE: Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry. RESEARCH METHODS AND PROCEDURES: A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex- and age-specific BMI cut-points proposed by the International Obesity Task Force. RESULTS: Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10,000 grams was found in about one-half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children. DISCUSSION: A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high-risk children.     

Birth Weight,Maternal Body Mass Index,and Early Childhood Growth: A Prospective Birth Cohort Study in China

Background

The relations of birth weight and maternal body mass index (BMI) to overweight remain unresolved. We prospectively examined the relations of birth weight with various anthropometric measures at age 3 to 6 years, the effect of maternal BMI, and the patterns of these relations in an analysis using 9 birth weight categories.

Methods

The subjects were 210 172 singleton infants born alive with a gestational age ≥28 weeks between October 1993 and December 1996; the subjects were followed up in 2000. Birth weight, maternal height and weight, and other relevant information were measured or collected prospectively. Overweight and underweight were defined by using National Center for Health Statistics/World Health Organization reference data. Logistic regression models were used to estimate relative risks. Analyses stratified by quartile of maternal BMI were performed to examine the effects of maternal BMI on the associations of birth weight with overweight and underweight.

Results

Birth weight was linearly associated with height, weight, and BMI at age 3–6 years. Adjustment for maternal BMI did not alter this association. Birth weight was positively associated with overweight and negatively associated with underweight. The relation curves for both overweight and underweight resembled half of a flat parabolic curve. The associations for overweight and underweight were slightly stronger for the highest and lowest quartiles of maternal BMI, respectively.

Conclusions

Higher birth weight is associated with an increased risk for childhood overweight, and lower birth weight with an increased risk for underweight. The associations between birth weight and early childhood anthropometric growth measures could not explained by maternal BMI.Key words: birth weight, overweight, underweight, maternal body mass index     

Stability of the association between birth weight and childhood overweight during the development of the obesity epidemic

OBJECTIVE: To assess whether changes in the birth weight distribution or changes in the association of birth weight with the later risk of childhood overweight have contributed to the development of the obesity epidemic. RESEARCH METHODS AND PROCEDURES: A Danish population-based cohort study of 124,615 girls and 128,346 boys (ages 6 to 13 years), born between 1936 and 1983, were studied. Birth weight and annual measurements of height and weight were obtained from school health records. Overweight was defined by BMI in relation to internationally accepted criteria. The relative risk of being overweight by birth weight was calculated separately for each age, sex, and time period. RESULTS: The birth weight distribution remained relatively stable over time. Compared with children with a birth weight of 3.0 to 3.5 kg, the risk of overweight increased consistently with each increase in birth weight category among girls and boys and at all ages between 6 and 13 years. Furthermore, the association between birth weight and increased risk of overweight in childhood remained stable across a 48-year period. DISCUSSION: The increase in the prevalence of overweight could not be explained by time trends in the distribution of birth weight or by changes in the association between birth weight and the later risk of overweight over time. This implies that, unless the prenatal environment influences the later risk of overweight without increasing birth weight, the environmental influences contributing to the obesity epidemic in children of school age operate in the early postnatal period.     

Determinants of Childhood Obesity and Association with Maternal Perceptions of Their Children's Weight Status: The “GENESIS” Study

Prevention of early childhood obesity requires a clear understanding of its determinants. This study examined perinatal, parental, and lifestyle determinants of childhood obesity and how these factors are associated with maternal misperceptions of their children's weight status. The current work presents a cross-sectional analysis of 2,374 children, age 1 to 5 years, living in Greece (April 2003 to July 2004). The 2000 Centers for Disease Control and Prevention growth charts were used to classify children as overweight (≥85th and <95th body mass index [BMI]-for-age percentile for children older than 24 months) and obese (≥95th weight-for-length percentile for children younger than 24 months and ≥95th BMI-for-age percentile for children older than 24 months). Maternal perceptions about their children's weight status were assessed via interviews with the mothers. Early infancy growth data were obtained from pediatric medical records. The present study showed that the prevalence of overweight and obesity was 16.2% and 17.5%, respectively. Each unit increase of maternal and paternal BMI significantly increased the likelihood of childhood obesity by a factor of 1.03 (95% confidence interval [CI]: 1.01 to 1.07) and 1.15 (95% CI: 1.10 to 1.20), respectively. Furthermore, children with a rapid weight gain in infancy were 1.9 (95% CI: 1.3 to 2.7) times more likely to be overweight and 1.5 (95% CI: 1.2 to 1.9) times more likely to have their weight status underestimated by their mother. In conclusion, rapid infancy weight gain and higher parental BMI were the main determinants of obesity in preschool years. Maternal underestimation of children's weight status was more likely for children with rapid weight gain in infancy.     

Association between birth weight and childhood obesity in a Budapest metropolitan survey

INTRODUCTION: According to epidemiological investigations, association between birth weight and overweight and obesity in childhood/adolescence is ambiguous. AIM: The purpose of the study was to investigate the association between birth weight and overweight and obesity in childhood and adolescence. METHODS: Birth and actual anthropometric data of school children and secondary school students from metropolitan schools were analyzed. Overweight/obesity were established by standardized (sex, age) body mass index, and obesity also by body fat percent. RESULTS: Data of 1,334, 7- to 19-year-old children and adolescents (725 boys and 609 girls) were evaluated. Prevalence of overweight/obesity was similar in the case of persons with low (19.36%) and normal birth weight (18.96%), while in the case of persons with high birth weight this rate was 25.98%. Based on body fat percent, the prevalence of obesity in the latter group was also higher than in groups with low and normal birth weight (18.11% vs. 12.89% and 12.66%). CONCLUSIONS: Among macrosomic babies the rate of overweight and obesity is higher than among normal or low-birth-weight babies, particularly in childhood.     

Dramatic rise in overweight and obesity in adult filipino women and risk of hypertension

OBJECTIVE: To assess trends in BMI of adult Filipino women over a 16-year period of rapid socioeconomic change; to identify factors associated with those trends; and to estimate the risk of hypertension associated with overweight, obesity, and high waist-to-hip ratio (WHR). RESEARCH METHODS AND PROCEDURES: Women from randomly selected urban and rural communities of Metro Cebu, Philippines were recruited during a 1983 to 1984 index pregnancy, then followed prospectively for 16 years. Overweight and obesity were defined using BMI cut-off points of 25 and 30, respectively. The analysis sample included women 15 to 45 years of age when measured 4 months postpartum. Weight change in subsequent intervals from 1985 to 1999 was modeled using linear regression. The relationship of BMI and WHR to risk of hypertension in the last survey was modeled using logistic regression. RESULTS: The prevalence of overweight and obesity combined increased nearly 6-fold from approximately 6% in 1983 to 1984 to 35% in 1998 to 1999. Weight gain was positively associated with urban residence, improved socioeconomic status, fewer pregnancies and months of lactation, and more away-from-home work hours. Risk of hypertension was independently elevated by high WHR and overweight/obesity. DISCUSSION: The dramatic trend of increasing overweight and obesity in this sample of women represents a serious health concern, especially in light of the strong association of excess weight, particularly in the truncal region, to risk of hypertension.     

深圳市儿童身高体重血压变化趋势及相互关系的纵向研究

  目的  了解学龄儿童身高、体重、血压的变化趋势及性别差异,探索超重肥胖与儿童高血压的关系,为降低儿童高血压发病提供科学依据。  方法  选取来自2013—2018年深圳市10所小学学生连续体检监测数据,经个人信息匹配形成纵向数据,计算年龄性别身高、体重、血压变化。采用广义估计方程分析超重肥胖与高血压的关联。  结果  男女生体重、体质量指数(BMI)、收缩压均随年龄增长升高且有性别差异(t/Z=3.89~31.52,P值均 < 0.05)。女生身高增速在8~11岁高于男生,10岁达到身高增速高峰,男生则比女生晚2年,男、女生分别为7.68,7.42 cm。男、女生体重和血压增速相似。身高增速与血压增速有同步趋势,身高增速高峰阶段血压增速也为高峰。广义估计方程分析结果显示,儿童总体肥胖OR值(95%CI)为1.62(1.48~1.81),超重OR值(95%CI)为2.01(1.75~2.30)(P值均 < 0.01)。  结论  儿童身高、体重、血压变化有性别差异,身高和血压的增速呈同步趋势,儿童超重和肥胖可增加血压偏高/高血压的发生风险。     

Determinants of overweight in a cohort of Dutch children

BACKGROUND: To improve the effective prevention and treatment of obesity, it is important to focus on body weight (BW) development and its determinants during childhood. OBJECTIVE: The aim of the present study was to investigate the effects of early development, parental and genetic variables, and behavioral determinants on overweight at 12 y. DESIGN: In a Dutch cohort of 105 children, anthropometric measurements were conducted from birth until age 7 y. At age 12 y, anthropometric measurements were obtained again, as were measurements of body composition, leptin concentration, 3 polymorphisms, and physical activity, and the Three-Factor Eating Questionnaire was conducted. In addition, parental body mass indexes (BMIs, in kg/m2) and Three-Factor Eating Questionnaire scores were determined. RESULTS: The children's mean (+/-SD) BMI at 12 y was 19.0 +/- 2.6, and 15.2% were classified as overweight. From the first year of life, BMI tracked significantly with BMI at age 12 y (r = 0.24, P < 0.05). Linear regression analyses showed that a rapid increase in BW during the first year of life, a high BMI of the father, and a high dietary restraint score of the mother were significantly associated with overweight at age 12 y (P < 0.05). No significant genetic relation was observed. In addition, overweight was positively associated with dietary restraint of the child, and percentage body fat was negatively associated with the child's activity score (P < 0.05). CONCLUSIONS: In this homogeneous cohort of normal-weight to moderately overweight children, tracking of BMI during childhood took place from the first year of life. Overweight at age 12 y was predicted by an early rapid increase in BW and parental influences. Overweight during childhood may be maintained or even promoted by a high dietary restraint score and low physical activity.     

Maternal, birth, and early-life influences on adult body size in women

The authors conducted a follow-up study of 261 women born during 1959-1965 (38% White, 40% African-American, and 22% Latina) to investigate whether maternal and infant factors are independently associated with adult body size after accounting for childhood growth. Standard statistical methods (linear regression and logistic regression) were compared with quantile regression methods to assess the independent effect maternal factors (body mass index (BMI; weight (kg)/height (m)(2)), maternal weight gain), birth measures (birth weight, placental weight), and early infancy and childhood growth measures (birth-4 months, 4 months-1 year, and 1-7 years) have on predicting adult body size. While most of these factors were important predictors of BMI at age 20 years, the size and relative importance of the effect differed across models. For example, maternal weight gain was associated with being overweight (BMI > or = 25) at age 20 years (per 10-pound (4.5-kg) change, odds ratio = 1.65, 95% confidence interval: 1.11, 2.44) and was associated with the upper quantiles (>/=75th percentile) of BMI at age 20 years. In contrast, maternal BMI and birth weight were relatively more important for lower quantiles, particularly at age 40 years. Only rapid growth from ages 1 to 7 years was an important predictor of adult BMI at both age 20 and age 40, irrespective of statistical model. However, the persistence of effects of maternal and infant factors on adult BMI, even after rapid childhood growth is accounted for, suggests a greater need to investigate these early-life influences and whether their impact differs for smaller and larger women.     

Explorations on risk profiles for overweight and obesity in 9501 preschool-aged children

BackgroundChildhood obesity places a major burden on global public health. We aimed to identify and characterize potential factors, both individually and jointly, in association with overweight and obesity in Chinese preschool-aged children.MethodsWe cross-sectionally recruited 9501 preschool-aged children from 30 kindergartens in Beijing and Tangshan. Overweight and obesity are defined according to the World Health Organization (WHO), International Obesity Task Force (IOTF), and China criteria.ResultsAfter multivariable adjustment, eating speed, sleep duration, birthweight, and paternal body mass index (BMI) were consistently and significantly associated with childhood overweight and obesity under three growth criteria at a significance level of 5%. Additional fast food intake frequency, maternal BMI, gestational weight gain (GWG) and maternal pre-pregnancy BMI were significant factors for overweight (WHO criteria) and obesity (both IOTF and China criteria). Importantly, there were significant interactions between parental obesity and eating speed for childhood obesity. Finally, for practical reasons, risk nomogram models were constructed for childhood overweight and obesity based on significant factors under each criterion, with good prediction accuracy.ConclusionOur findings indicated a synergistic association of lifestyle, fetal and neonatal, and family-related factors with the risk of experiencing overweight and obesity among preschool-aged children.     

Obesity and other predictors of absenteeism in Philadelphia school children

BACKGROUND: Limited data indicate that obese children are absent from school more than their normal‐weight peers. We analyzed administrative data from a large urban school district to investigate the association of obesity and student sociodemographic characteristics with absenteeism. METHODS: We analyzed 291,040 records, representing 165,056 unique students (grades 1‐12). Obesity status was classified according to Centers for Disease Control and Prevention age‐ and sex‐specific percentiles for body mass index (BMI) and analyses were based on negative binomial regression. RESULTS: Overall rates of overweight and obesity were 17% and 20%, respectively, and the estimated absence rate was 17 absences per 180 student‐days. Obesity was weakly associated with increased school absences. The association was present mainly among the most obese students (BMI >99th percentile), who had an 11% greater absence rate compared to normal‐weight students. Compared to white students, Hispanics and African Americans had higher absence rates (14% and 10%, respectively), and Asians had lower absence rates (43%). Students eligible for free or reduced‐cost meals had 24% higher absence rates than those who were not eligible. CONCLUSIONS: Overweight and obesity do not seem strongly associated with school absence, except among extremely obese children. Race and poverty appear to affect absences to a greater extent than overweight and obesity. Additional research is needed to investigate the contribution of contextual factors in schools and neighborhoods. This study suggests that data routinely collected in schools could be used to track childhood obesity and to efficiently evaluate public health interventions designed to decrease childhood obesity.     

母亲孕前体质指数及孕期增重与学龄前儿童超重肥胖的关系研究

目的 探讨母亲孕前BMI及孕期增重与学龄前儿童超重肥胖的关系。方法 2016年6-11月,以广州市4 303名3~5岁学龄前儿童为研究对象,根据WHO标准和中国成人肥胖标准分别判断儿童和母亲孕前体重状态,参照美国医学研究所孕期增重推荐值判断母亲孕期增重情况。应用多因素二分类非条件logistic回归模型和协方差分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关系。结果 矫正混杂因素后,logistic回归分析显示,母亲孕前超重肥胖的儿童发生超重肥胖的风险是母亲孕前体重正常儿童的1.820倍（OR=1.820,95% CI：1.368~2.422）;与母亲孕期增重适宜的儿童相比,母亲孕期增重过度的儿童超重肥胖发生风险增加（OR=1.296,95% CI：1.007~1.667）。协方差分析结果也显示,母亲孕前体重超重肥胖和母亲孕期增重过度均增加儿童BMI Z值。根据母亲孕前BMI分为3组进行分层分析,结果显示,不同孕期增重组间儿童超重肥胖发生风险差异无统计学意义（P>0.05）。但与母亲孕前BMI适宜且孕期增重适宜组相比,母亲孕前超重肥胖且孕期增重过度组的儿童发生超重肥胖的风险增加（OR=1.574,95% CI：1.029~2.409）。结论 母亲孕前超重和孕期增重过度均增加学龄前儿童超重肥胖的风险,且母亲孕前超重较孕期增重过度对学龄前儿童超重肥胖发生的影响更大。     

喂养方式和早期BMI增量对1岁婴幼儿超重与肥胖的预测作用

目的探讨喂养方式和早期BMI增量与1岁婴幼儿超重和肥胖的关联。方法选取出生日期在2012年1-6月,定期进行儿童保健检查的婴幼儿作为研究对象,分别在出生、3个月、6个月、12个月对身高、体重进行测量,同时在《儿童保健管理健康检查表》上记录社会人口统计学和喂养情况等信息。最终,有完整资料的共1 113份,其中男孩590名,女孩523名。使用χ2检验、t检验、方差分析和多因素Logistic回归模型对数据进行分析。结果 1岁婴儿超重和肥胖的发生率分别为22.80%和6.20%。巨大儿、父母文化程度高、人工喂养、0-3个月和3-6个月BMI增量大的1岁超重和肥胖的检出率较高,差异均有统计学意义（P〈0.05）。控制了多种混杂因素后,多因素Logistic回归模型分析结果显示,4个月内纯母乳喂养是1岁时婴儿超重和肥胖的保护因素（OR=0.62,95%CI：0.42-0.92）,较大的0-3个月BMI增量（OR=1.52,95%CI：1.39-1.67）和3-6个月BMI增量（OR=1.43,95%CI：1.27-1.61）是1岁婴儿超重和肥胖发生的危险因素。结论纯母乳喂养对婴幼儿超重及肥胖的发生有保护作用,而早期快速的增长是其危险因素。     

Associations between Infant Feeding Practice Prior to Six Months and Body Mass Index at Six Years of Age

Rapid growth during infancy is associated with increased risk of overweight and obesity and differences in weight gain are at least partly explained by means of infant feeding. The aim was to assess the associations between infant feeding practice in early infancy and body mass index (BMI) at 6 years of age. Icelandic infants (n = 154) were prospectively followed from birth to 12 months and again at age 6 years. Birth weight and length were gathered from maternity wards, and healthcare centers provided the measurements made during infancy up to 18 months of age. Information on breastfeeding practices was documented 0–12 months and a 24-h dietary record was collected at 5 months. Changes in infant weight gain were calculated from birth to 18 months. Linear regression analyses were performed to examine associations between infant feeding practice at 5 months and body mass index (BMI) at 6 years. Infants who were formula-fed at 5 months of age grew faster, particularly between 2 and 6 months, compared to exclusively breastfed infants. At age 6 years, BMI was on average 1.1 kg/m² (95% CI 0.2, 2.0) higher among infants who were formula fed and also receiving solid foods at 5 months of age compared to those exclusively breastfed. In a high-income country such as Iceland, early introduction of solid foods seems to further increase the risk of high childhood BMI among formula fed infants compared with exclusively breastfed infants, although further studies with greater power are needed.     

Breast-feeding and growth in children until the age of 3 years: the Generation R Study

Breast-feeding has been suggested to be associated with lower risks of obesity in older children and adults. We assessed whether the duration and exclusiveness of breast-feeding are associated with early postnatal growth rates and the risks of overweight and obesity in preschool children. The present study was embedded in a population-based prospective cohort study from early fetal life onwards, among 5047 children and their mothers in The Netherlands. Compared with children who were breast-fed, those who were never breast-fed had a lower weight at birth (difference 134 (95 % CI - 190, - 77) g). No associations between breast-feeding duration and exclusivity with growth rates before the age of 3 months were observed. Shorter breast-feeding duration was associated with an increased gain in age- and sex-adjusted standard deviation scores for length, weight and BMI (P for trend < 0·05) between 3 and 6 months of age. Similar tendencies were observed for the associations of breast-feeding exclusivity with change in length, weight and BMI. Breast-feeding duration and exclusivity were not consistently associated with the risks of overweight and obesity at the ages of 1, 2 and 3 years. In conclusion, shorter breast-feeding duration and exclusivity during the first 6 months tended to be associated with increased growth rates for length, weight and BMI between the age of 3 and 6 months but not with the risks of overweight and obesity until the age of 3 years.     

Is There a Healthy Foreign Born Effect for Childhood Obesity in the United States?

Objective of the study was to explore factors associated with early childhood obesity and assess whether having a foreign born mother is protective against childhood obesity. Data sources include 9 months and 4 years parent interviews and direct assessments of possessive children’s weight and height (4 years) or length (9 months) from the Early Childhood Longitudinal Study-Birth Cohort. Subjects were children with anthropometric measures who lived with their mothers (n = 9,700 at 9 months and 8,200 at 4 years). Overweight is defined as a weight-for-length ratio at or above the 95th percentile at 9 months; obesity is defined as a body mass index at or above the 95th percentile at 4 years. The prevalence of overweight/obesity was 15.4% at 9 months and 18.0% at 4 years. After adjustment for potential confounders, having a foreign-born mother was not associated with the odds of overweight at 9 months or 4 years. At 9 months and 4 years, low birth weight, pre-pregnancy weight and weight gain during pregnancy were protective of overweight. In addition to these factors, at 4 years, excessive weight gain in the first 9 months was the strongest predictors for obesity. Living in a safe neighborhood and ever having breastfed were protective against obesity. Having a foreign born mother is not protective of early childhood obesity. A focus on health of women prior to conception and on women’s and infants’ health in the perinatal period are key to addressing childhood obesity.     

出生体重与儿童期超重肥胖的关系

【目的】 探讨出生体重与儿童期超重肥胖的关系,为预防和减少儿童肥胖的发生提供科学依据。 【方法】 采用历史性队列研究方法,随机抽取无锡地区1 435对巨大儿和正常出生体重儿作为研究对象,通过问卷调查和体格检查随访收集所有研究对象与肥胖相关的资料,分析出生体重与儿童期超重肥胖的关系。 【结果】 巨大儿中超重和肥胖检出率分别为13.10%和2.86%,正常儿中超重和肥胖检出率分别为9.69%和1.61%;巨大儿超重和肥胖检出率高于正常儿(P <0.01);巨大儿与正常儿相比,发生超重和肥胖的RR值分别为1.35和1.78,AR值分别为3.41%和1.26%。经趋势χ²检验发现,随着出生体重的增加,超重和肥胖率均增加(P<0.01),发生超重和肥胖的RR值和AR值也随之增加;经多元线性回归分析表明,出生体重、性别、父亲和母亲的BMI以及喜欢吃油炸食品可能为儿童期BMI的影响因素。 【结论】 出生体重与儿童期肥胖有关,预防肥胖应从胎儿期开始。     

Fruit Pouch Consumption and Dietary Patterns Related to BMIz at 18 Months of Age

Concerns have been raised that an overconsumption of baby food fruit pouches among toddlers might increase the risk of childhood obesity. This study aimed to quantify the consumption of fruit pouches and other fruit containing food products and to explore potential correlations between the consumption of these products and body-mass index z-score (BMIz) at 18 months, taking other predictive factors into consideration. The study was based on 1499 children and one-month-recall food frequency questionnaires from the Swedish population-based birth cohort NorthPop. Anthropometric outcome data were retrieved from child health care records. BMIz at 18 months of age was correlated to maternal BMI and gestational weight gain and inversely correlated to fruit juice consumption and breastfeeding. BMIz at 18 months of age was not correlated to consumption of fruit pouches, sugar-sweetened beverages, whole fruit or milk cereal drink. Overweight at 18 months of age was correlated to maternal BMI and inversely correlated to breastfeeding duration. To our knowledge, this is the first study that investigates possible associations between baby food fruit pouch consumption and overweight in toddlers. We found that moderate fruit pouch consumption is not associated with excess weight at 18 months of age.     

婴幼儿超重肥胖的危险因素研究

目的 了解婴幼儿超重肥胖的现状,对其危险因素进行分析,为早期预防儿童超重肥胖提供依据。方法 选取2018年9—12月出生于首都医科大学附属北京妇产医院的儿童为研究对象,调查母亲孕产期和儿童0~12月龄生长发育相关信息。以世界卫生组织(WHO)性别月龄别体重指数(BMI)为超重肥胖的评价标准,采用χ²检验、t检验、多因素Logistic回归分析探究婴幼儿超重肥胖的相关危险因素。结果 共纳入儿童3 018人,其中男童1 566人(51.89%),女童1 452人(48.11%)。6月龄儿童超重、肥胖率为10.80%(326/3018)、3.48%(105/3 018),12月龄儿童超重、肥胖率为10.11%(305/3 018)、 2.85%(86/3 018)。多因素Logistic回归分析显示,母孕前BMI≥25 kg/m²(OR=1.297)、妊娠期糖尿病(OR=1.215)、剖宫产(OR=1.617)、巨大儿(OR=1.154)、6月龄内非纯母乳喂养(OR=1.586)及6月龄内体重快速增长(OR=1.845)是12月龄儿童超重肥胖的危险因素(P＜0.05)。结论 管理孕前体重、降低妊娠期糖尿病、剖宫产及巨大儿发生率,提高母乳喂养率、避免6月龄内体重快速增长对预防婴幼儿超重肥胖有重要意义。     

Do childhood sleeping problems predict obesity in young adulthood? Evidence from a prospective birth cohort study

It has been suggested that sleeping problems are causally associated with obesity in early life, but most studies examining this association have been cross-sectional. The authors used a population-based birth cohort of 2,494 children who were born between 1981 and 1983 in Brisbane, Australia, to examine the prospective association between early-life sleeping problems (at ages 6 months and 2-4 years) and obesity at age 21 years. The authors compared mean body mass indices (BMIs; weight (kg)/height (m)2) and persons in the categories of overweight (BMI 25.0-29.9) and obesity (BMI > or =30) among offspring at age 21 years according to maternally reported childhood sleeping problems. They found that young adult BMI and the prevalence of obesity were greater in offspring who had had sleeping problems at ages 2-4 years than in with those who had not had sleeping problems. These associations were robust to adjustment for a variety of potential confounders, including offspring sex, maternal mental health, and BMI, and several mediators, including adolescent dietary patterns and television-watching. These findings provide some evidence for a long-term impact of childhood sleeping problems on the later development of obesity.