Obesity in children. Part 1: Epidemiology, measurement, risk factors, and screening

Kipping, Ruth; Jago, Russell; Lawlor, Debbie A.

doi:10.1136/bmj.a1824

Cited by 150 publications

(128 citation statements)

References 27 publications

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“…Race, which reflects both the inheritance of genetic characteristics and can represent a proxy for socioeconomic conditions, is also associated with obesity 3,23,28,60 . The populations evaluated in the current review consisted of quite homogeneous ethnic groups, so they did not allow evaluating this variable's impact on abdominal obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies point to parental obesity as an important risk factor for the children's obesity, both in childhood and adulthood 3,23,28,59 . This could suggest that the observed associations with socioeconomic status are the consequence of parental obesity.…”

Section: Discussionmentioning

confidence: 99%

“…In the second hierarchical level, parents' socioeconomic status can also affect lifetime adiposity 4,6,7,8,23 . This effect is supposedly mediated by the family's nutritional habits and physical activity, the child's disease history (particularly that of infectious diseases), and the individual's own socioeconomic status in adulthood 3,23,28 . This model suggests that controlling for genetic factors, if possible, would be justified by the possibility that such factors are influencing both socioeconomic level and nutritional status.…”

Section: Methodsmentioning

confidence: 99%

“…The arrows in the figure indicate the possible causal mechanisms. The most distal determinant is the inheritance of genetic characteristics, which supposedly affects the model's other components, including intra-gestational maternal adiposity, as well as the child's intrauterine and post-natal life 3,23,28 . Genetic load can also influence the parents' socioeconomic status, as in the case of discrimination against black 29 or obese individuals 30 .…”

Section: Methodsmentioning

confidence: 99%

“…Prevalence of obesity has increased rapidly in high, medium, and low-income countries 2,3,4,5 . Socioeconomic conditions have an important influence on prevalence of obesity, as well as on other risk factors associated with cardiovascular diseases 4,6,7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Childhood poverty and abdominal obesity in adulthood: a systematic review

2009

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Childhood poverty and abdominal obesity in adulthood: a systematic review

2009

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Effects of Promoting Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like Growth Factor-I at Age 11.5 Years

Martin¹,

Patel²,

Kramer³

et al. 2013

JAMA

155

144

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Importance Evidence that longer-term and exclusive breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding.Objective To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I, which regulates growth.Design, Setting, and Participants Cluster-randomized controlled trial in 31 Belarusian maternity hospitals and their affiliated clinics, randomized into 1 of 2 groups: breastfeeding promotion intervention (n=16) or usual practices (n=15). Participants were 17 046 breastfeeding mother-infant pairs enrolled in 1996 and 1997, of whom 13 879 (81.4%) were followed up between January 2008 and December 2010 at a median age of 11.5 years.Intervention Breastfeeding promotion intervention modeled on the WHO/ UNICEF Baby-Friendly Hospital Initiative (World Health Organization/United Nations Children's Fund).Main Outcome Measures Body mass index (BMI), fat and fat-free mass indices (FMI and FFMI), percent body fat, waist circumference, triceps and subscapular skinfold thicknesses, overweight and obesity, and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat (without imputation), accounting for clustering within hospitals and clinics. ResultsThe experimental intervention substantially increased breastfeeding duration and exclusivity when compared with the control (43% vs 6% exclusively breastfed at 3 months and 7.9% vs 0.6% at 6 months). Cluster-adjusted mean differences in outcomes at 11.5 years of age between experimental vs control groups were: 0.19 (95% CI, Ϫ0.09 to 0.46) for BMI; 0.12 (Ϫ0.03 to 0.28) for FMI; 0.04 (Ϫ0.11 to 0.18) for FFMI; 0.47% (Ϫ0.11% to 1.05%) for percent body fat; 0.30 cm (Ϫ1.41 to 2.01) for waist circumference; Ϫ0.07 mm (Ϫ1.71 to 1.57) for triceps and Ϫ0.02 mm (Ϫ0.79 to 0.75) for subscapular skinfold thicknesses; and Ϫ0.02 standard deviations (Ϫ0.12 to 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight/obesity (BMI Ն85th vs Ͻ85th percentile) was 1.18 (95% CI, 1.01 to 1.39) and for obesity (BMI Ն95th vs Ͻ85th percentile) was 1.17 (95% CI, 0.97 to 1.41). Conclusions and RelevanceAmong healthy term infants in Belarus, an intervention that succeeded in improving the duration and exclusivity of breastfeeding did not prevent overweight or obesity, nor did it affect IGF-I levels at age 11.5 years. Breastfeeding has many advantages but population strategies to increase the duration and exclusivity of breastfeeding are unlikely to curb the obesity epidemic.

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Origin of Cardiovascular Risk in Overweight Preschool Children

Shashaj

Bedogni

Graziani³

et al. 2014

JAMA Pediatr

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IMPORTANCETo date, the relationship among adiposity, insulin resistance, and cardiovascular risk factors at the onset of overweight or obesity has been unexplored.OBJECTIVES To assess whether insulin resistance and metabolic abnormalities are detectable at the onset of obesity and to unravel the interplay among adiposity, insulin resistance, and other such abnormalities. DESIGN, SETTING, AND PARTICIPANTSThe Origin of Cardiovascular Risk in Overweight Preschool Children cohort study aimed to evaluate at the onset of obesity in preschool children the prevalence of metabolic abnormalities, including hypertension, dyslipidemia, impaired carbohydrate metabolism, and nonalcoholic fatty liver disease. Between July 1, 2011, and July 30, 2012, in the Rome municipality, 13 family pediatricians enrolled healthy children (age range, 2.0-5.8 years) in the study during their routine practice of growth monitoring. Clinical medical records of 5729 children were reviewed; 597 children manifested new-onset overweight or obesity as their body mass index changed from normal weight to overweight or obesity in the previous 12 months according to the International Obesity Task Force classification. Of them, 219 were studied. MAIN OUTCOMES AND MEASURESPatients with new-onset overweight or obesity underwent clinical laboratory testing, including oral glucose tolerance test, and ultrasonographic investigations of fatty liver and intimal medial thickness of the common carotid arteries, subcutaneous adipose tissue, and visceral adipose tissue. The homeostatic assessment model algorithm-insulin resistance was calculated. RESULTS Among the entire population (n = 5729), overweight increased from 7.0% at 2.0 years to 16.9% at 5.8 years, with corresponding figures of 1.1% to 2.9% for obesity. In total, 597 overweight or obese children (10.4%) were identified, and 219 of them (36.7%) were studied. Among the latter, 86 patients (39.3%) had at least 1 metabolic abnormality. Hypertension was diagnosed in 29 patients (13.2%), dyslipidemia in 55 patients (25.1%), impaired fasting glucose level in 7 patients (3.2%), and glucose intolerance in 6 patients (2.7%). Nonalcoholic fatty liver disease was diagnosed in 68 patients (31.1%).CONCLUSIONS AND RELEVANCE Cardiometabolic risk factors, including fatty liver, are detectable in preschoolers at the onset of overweight or obesity, despite short-term exposure to excess weight and reduced insulin sensitivity. Our findings suggest the need to screen for cardiometabolic abnormalities at an earlier age than is now recommended.

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Obesity in children. Part 1: Epidemiology, measurement, risk factors, and screening

Cited by 150 publications

References 27 publications

Childhood poverty and abdominal obesity in adulthood: a systematic review

Childhood poverty and abdominal obesity in adulthood: a systematic review

Effects of Promoting Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like Growth Factor-I at Age 11.5 Years

Origin of Cardiovascular Risk in Overweight Preschool Children

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