From conception to infancy — early risk factors for childhood obesity

Abstract

Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.

Key points

  • Maternal obesity has become an important public health problem influencing adiposity of mother and child in both low-income and high-income countries.

  • Specific measurements of offspring adiposity and not only BMI are required; maternal BMI at the time of pregnancy, gestational weight gain and gestational diabetes are independent risk factors of excess adiposity in the offspring.

  • Pregnant women should follow a healthy lifestyle, avoiding malnutrition and smoking, and moderate free sugar intake to reduce child adiposity risk.

  • Despite the inconclusive effect of breastfeeding on reducing obesity risk later in life, breastfeeding should be promoted owing to its many beneficial effects.

  • Not enough data exist to conclusively link the timing of introduction of complementary feeding, prebiotic and probiotic consumption, and screen time with later overweight and obesity in children up to 2 years of age.

  • In children, high-protein intake, consumption of sugar-sweetened beverages and short sleep time are associated with adiposity during the first 2 years of life.

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Fig. 1: Estimated prevalence of overweight and obesity in young children.
Fig. 2: Estimated prevalence of overweight and obesity in children and adolescents aged 5–19 years.
Fig. 3: Estimated prevalence of preterm birth rate by regions for 1990 and 2010.
Fig. 4: Relevant factors for childhood obesity preventive efforts.

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Nature Reviews Endocrinology thanks Redman, L., Crume, T. and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Correspondence to Luis A. Moreno.

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