Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort.
Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m−2), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l−1), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models.
Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41–1.15) for BMI, 0.79 (0.41–1.16) for WHtR, 0.46 (0.06–0.83) for SSF and 0.67 (0.07–1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5–49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8–13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity.
Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.
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The Growing Up in Singapore Towards healthy Outcomes study group includes Allan Sheppard, Amutha Chinnadurai, Anne Eng Neo Goh, Anne Rifkin-Graboi, Anqi Qiu, Arijit Biswas, Bee Wah Lee, Birit FP Broekman, Boon Long Quah, Borys Shuter, Carolina Un Lam, Chai Kiat Chng, Cheryl Ngo, Choon Looi Bong, Christiani Jeyakumar Henry, Claudia Chi, Cornelia Yin Ing Chee, Yam Thiam Daniel Goh, Doris Fok, E Shyong Tai, Elaine Tham, Elaine Quah Phaik Ling, Evelyn Xiu Ling Loo, Falk Mueller- Riemenschneider, George Seow Heong Yeo, Helen Chen, Heng Hao Tan, Hugo PS van Bever, Iliana Magiati, Inez Bik Yun Wong, Ivy Yee-Man Lau, Jeevesh Kapur, Jenny L Richmond, Jerry Kok Yen Chan, Joanna D Holbrook, Joanne Yoong, Joao N Ferreira, Jonathan Tze Liang Choo, Joshua J Gooley, Kenneth Kwek, Kok Hian Tan, Krishnamoorthy Niduvaje, Kuan Jin Lee, Leher Singh, Lieng Hsi Ling, Lin Lin Su, Lourdes Mary Daniel, Marielle V Fortier, Mark Hanson, Mary Rauff, Mei Chien Chua, Mary Foong-Fong Chong, Melvin Khee-Shing Leow, Michael Meaney, Neerja Karnani, Ngee Lek, Oon Hoe Teoh, PC Wong, Paulin Tay Straughan, Pratibha Agarwal, Queenie Ling Jun Li, Rob M van Dam, Salome A Rebello, See Ling Loy, S Sendhil Velan, Seng Bin Ang, Shang Chee Chong, Sharon Ng, Shiao-Yng Chan, Shirong Cai, Sok Bee Lim, Stella Tsotsi, Chin-Ying Stephen Hsu, Sue Anne Toh, Swee Chye Quek, Victor Samuel Rajadurai, Walter Stunkel, Wee Meng Han, Yin Bun Cheung, Yiong Huak Chan, and Zhongwei Huang. This study is under Translational Clinical Research (TCR) Flagship Programme on Developmental Pathways to Metabolic Disease, NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014 funded by the National Research Foundation (NRF) and administered by the National Medical Research Council (NMRC), Singapore. KMG is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union's Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement number 289346. Clinical Trial Registration: This study is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.
Keith M Godfrey, Yap Seng Chong and Yung Seng Lee have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. Keith M Godfrey and Yap Seng Chong are part of an academic consortium that has received research funding from Abbot Nutrition, Nestec and Danone. All other authors declare no conflict of interest.
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Aris, I., Bernard, J., Chen, LW. et al. Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status. Int J Obes 42, 44–51 (2018). https://doi.org/10.1038/ijo.2017.178
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