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Overweight and Obesity in Preschool Children: Early Risk Factors and Early Identification
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Spenshult Research and Development Center, Halmstad, Sweden. (Halland Health and Growth Study)ORCID iD: 0000-0003-4451-1593
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

BACKGROUND: Overweight and obesity in children has reached epidemic proportions in recent decades, and even the youngest age groups are affected. Excess weight during childhood often follows the child into adulthood and is associated with diseases such as cardiovascular diseases and type 2 diabetes mellitus. In addition, excess weight often leads to health problems already during childhood. Childhood obesity is therefore one of the greatest public health challenges of the 21st century.

AIM: The overall aim was to study growth patterns and early risk factors for overweight, obesity and an elevated waist-to-height ratio (WHtR) in preschool children. The specific aims were to: examine early body mass index (BMI) and WHtR growth patterns and their ability to predict overweight or obesity in children at 5 years of age (Paper I); examine if BMI and WHtR growth patterns from an early age could identify children with an elevated WHtR at 5 years of age by using standard deviation score(s) (SDS) in children classified according to WHtRSDS at 5 years of age. Another aim was to study the association between BMISDS and WHtRSDS at 5 years of age (Paper II); examine nutrition- and feeding practice-related risk factors for rapid weight gain during the first 0–6 months and the following 6–12 months (Paper III); examine the association between potential early risk factors and an elevated WHtR, defined as WHtRSDS ≥ 1 at 5 years of age, and examine whether similar associations also were found for overweight or obesity at the same age (Paper IV).

METHODS: This project was part of the population-based birth cohort study the Halland Health and Growth Study, including 2,666 children born in the county of Halland in the southwestern part of Sweden between October 2007 and December 2008. Weight, height and waist circumference were measured at nine time points starting at birth. At every measurement point the parents filled in questionnaires regarding their child’s nutrition, health and lifestyle and also background information about the family.

RESULTS: We found that children with overweight or obesity at 5 years of age could be identified already from an early age by significantly higher mean BMISDS and WHtRSDS than corresponding values in children with normal weight or underweight. BMI was sufficient for predicting overweight or obesity at 5 years of age and WHtR did not add any further information in this prediction.

Children with a WHtRSDS ≥ 1 at 5 years of age could be identified already from an early age by significantly higher mean BMISDS and WHtRSDS than corresponding values in children with a WHtRSDS < 1. When comparing WHtRSDS and BMISDS at 5 years of age, 55% of the children with an elevated WHtRSDS had normal BMISDS.

Rapid weight gain was more common during the first 6 months of the first year than during the next 6 months. Bottle-feeding and nighttime meals containing formula milk were associated with rapid weight gain between 0 and 6 months. Breastfeeding was negatively associated with rapid weight gain during the same period.

Rapid weight gain during 0–6 months and also maternal pre-pregnancy BMI and paternal BMI were associated with a WHtRSDS ≥ 1 at 5 years of age. Rapid weight gain during both 0–6 and 6–12 months and also maternal pre-pregnancy BMI, were associated with overweight or obesity at 5 years of age.

CONCLUSION: This thesis showed that BMI was sufficient for predicting overweight or obesity at 5 years of age, and WHtR did not add any further information to this prediction. For identification of children with an elevated WHtR, BMI classification missed every second child, indicating that WHtR adds value in children who may need further investigation regarding cardiometabolic risk factors. Risk factors operating before pregnancy and early in life increase the risk of early rapid weight gain, an elevated WHtR and overweight or obesity at 5 years of age and bottle feeding, nighttime meals, early rapid weight gain as well as parental overweight are potential modifiable risk factors in this development.

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2019. , p. 97
Series
Halmstad University Dissertations ; 56
Keywords [en]
abdominal adiposity, adiposity rebound, body mass index, childhood obesity, childhood overweight, early growth patterns, infancy peak, preschool children, waist-to-height ratio
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:hh:diva-39265ISBN: 978-91-88749-20-8 (print)ISBN: 978-91-88749-21-5 (electronic)OAI: oai:DiVA.org:hh-39265DiVA, id: diva2:1306543
Public defence
2019-05-17, Baertling, Hus J, Högskolan i Halmstad, Halmstad, 09:00 (Swedish)
Opponent
Supervisors
Note

Funding: Research and Development Center Spenshult and Halmstad University

Available from: 2019-04-25 Created: 2019-04-24 Last updated: 2019-04-25Bibliographically approved
List of papers
1. Infant body mass index growth patterns predicted overweight at five years, waist-to-height ratio did not add to this predictivity
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 5, p. 945-953Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of the present study was to examine body mass index (BMI) and waist‐to‐height ratio (WHtR) growth patterns from birth until five years regarding their ability to predict overweight or obesity in children at five years of age.

Methods: Population‐based longitudinal birth cohort study of 1540 children from the south‐west region of Sweden, recruited at the first visit to the child health care centres in 2007–2008. The children were followed for five years and classified into two weight groups according to the 2012 International Obesity Task Force criteria. BMI and WHtR standard deviation scores (SDS) were analysed with Student's t‐tests and multiple logistic regression models. ©2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

Results: BMI‐SDS and WHtR‐SDS growth patterns were from an early age different in children with overweight or obesity, compared to in children with normal weight or underweight. Overweight or obesity was significantly predicted by BMI‐SDS at 0–1 month (p < 0.001), ΔBMI‐SDS between 0–1 and 12 months (p < 0.001) and between 18 and 48 months (p < 0.001), but not by WHtR‐SDS, except for a negative association between 18 and 48 months in the boys (p = 0.040).

Conclusion: Overweight or obesity at five years could be predicted by early BMI‐SDS growth patterns, and WHtR‐SDS did not add to the predictivity with regard to BMI‐SDS. ©2018 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell Publishing Inc., 2019
Keywords
Body mass index, Childhood obesity, Childhood overweight, Growth patterns, Waist-to-height ratio
National Category
Pediatrics
Identifiers
urn:nbn:se:hh:diva-38475 (URN)10.1111/apa.14572 (DOI)30192410 (PubMedID)2-s2.0-85055058956 (Scopus ID)
Note

Funding: Region Halland, Research and Development Center Spenshult, Her Royal Highness Crown Princess Lovisa's Association for Child Care/Axel Tielmans Memorial Fund and Halmstad University.

Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-04-24Bibliographically approved
2. Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age
Open this publication in new window or tab >>Body mass index classification misses to identify children with an elevated waist-to-height ratio at 5 years of age
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2019 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 85, no 1, p. 30-32Article in journal (Refereed) Published
Abstract [en]

Background:  Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age.

Methods: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS) <1 or ≥1 at 5 years. Student’s t-tests and Chi-squared tests were used in the analyses.

Results: Association between BMISDS and WHtRSDS at 5 years showed that 55% of children with WHtRSDS ≥1 at 5 years had normal BMISDS (p < 0.001). Children with WHtRSDS ≥1 at 5 years had from an early age significantly higher mean BMISDS and WHtRSDS than children with values <1.

Conclusions: BMI classification misses every second child with WHtRSDS ≥1 at 5 years, suggesting that WHtR adds value in identifying children with abdominal adiposity who may need further investigation regarding cardiometabolic risk factors.

© 2018, International Pediatric Research Foundation, Inc.

Place, publisher, year, edition, pages
New York, NY: Nature Publishing Group, 2019
National Category
Pediatrics
Identifiers
urn:nbn:se:hh:diva-38474 (URN)10.1038/s41390-018-0188-4 (DOI)30287892 (PubMedID)2-s2.0-85054473136 (Scopus ID)
Projects
Halland Health and Growth Study
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-04-24Bibliographically approved
3. Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life
Open this publication in new window or tab >>Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Rapid weight gain (RWG) during infancy increases the risk of later adiposity and the association between early nutrition and RWG needs to be further studied.

Objectives: The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year. 

Methods: A population-based longitudinal birth cohort study of 1,869 children, classified as having RWG or non-RWG during 0–6 and 6–12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related risk factors and RWG were investigated with logistic regression models.

Results: In the population, 46% had RWG during 0-6 months and 8% during 6-12 months. In the fully adjusted models, bottle feeding at birth, 3-4 and 6 months and nighttime meals containing formula milk at 3-4 months were positively associated with RWG during 0-6 months (p<0.001). Breastfeeding at 3-4 and 6 months was negatively associated with RWG (p<0.01). During 6-12 months, only bottle feeding at 3-4 months was positively associated with RWG (p<0.05).

Conclusions: RWG was more common during the first 6 months of life, and bottle feeding and formula milk given at night were risk factors for RWG during this period.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hh:diva-39262 (URN)
Note

As manuscript in thesis.

Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-24
4. Early life risk factors for an elevated waist-to-height ratio at 5 years of age
Open this publication in new window or tab >>Early life risk factors for an elevated waist-to-height ratio at 5 years of age
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To examine early life risk factors for an elevated waist-to-height ratio (WHtR) at 5 years of age. A second aim was to examine if the same risk factors also were associated with overweight or obesity at the same age.

Methods: A population-based longitudinal birth cohort study of 1,540 children, from the southwestern part of Sweden, born between October 2007 and December 2008. The children were classified as having ≥ 1 or < 1 in WHtR standard deviation scores (SDS) at five years of age, according to Swedish reference values and as having overweight/obesity or normal weight/underweight according to the IOTF. 

Results: At five years of age, 15% of the children had WHtRSDS ³ 1 and 11% had overweight or obesity. In multivariable analyses, RWG during 0-6 months (OR: 1.90, 95% CI: 1.23, 2.95), maternal pre- pregnancy BMI (1.06, 1.01,1.11) and paternal BMI (1.11, 1.01-1.21) were associated with a WHtRSDS ³ 1 at five years. RWG during 0-6 months (2.53, 1.53, 4,20), during 6-12 months (2.82, 1.37, 5.79) and maternal pre-pregnancy BMI (1.12, 1.06,1.17) was associated with overweight or obesity at 5 years of age.

Conclusions: Risk factors operating early in life are associated with an elevated WHtR and overweight or obesity at 5 years of age. Preventive interventions should especially address early RWG and parental overweight.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hh:diva-39263 (URN)
Note

As manuscript in thesis.

Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-24

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