From conception to infancy — early risk factors for childhood obesity


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.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

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.


  1. 1.

    Marginean, C. O., Marginean, C. & Melit, L. E. New insights regarding genetic aspects of childhood obesity: a minireview. Front. Pediatr. 6, 271 (2018).

  2. 2.

    Silventoinen, K. et al. Genetic and environmental effects on body mass index from infancy to the onset of adulthood: an individual-based pooled analysis of 45 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) study. Am. J. Clin. Nutr. 104, 371–379 (2016).

  3. 3.

    Schrempft, S. et al. Variation in the heritability of child body mass index by obesogenic home environment. JAMA Pediatr. 172, 1153–1160 (2018).

  4. 4.

    Woo Baidal, J. A. et al. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am. J. Prev. Med. 50, 761–779 (2016).

  5. 5.

    Li, A. et al. Parental and child genetic contributions to obesity traits in early life based on 83 loci validated in adults: the FAMILY study. Pediatr. Obes. 13, 133–140 (2018).

  6. 6.

    Munthali, R. J. et al. Genetic risk score for adult body mass index associations with childhood and adolescent weight gain in an African population. Genes Nutr. 13, 24 (2018).

  7. 7.

    Black, R. E. et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427–451 (2013).

  8. 8.

    Swinburn, B. A. et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 378, 804–814 (2011).

  9. 9.

    Ng, M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766–781 (2014).

  10. 10.

    NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 390, 2627–2642 (2017).

  11. 11.

    Twig, G. et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N. Engl. J. Med. 374, 2430–2440 (2016).

  12. 12.

    Lo, J. C. et al. Prevalence of obesity and extreme obesity in children aged 3–5 years. Pediatr. Obes. 9, 167–175 (2014).

  13. 13.

    Haddad, L. et al. The Global Nutrition Report 2014: actions and accountability to accelerate the world’s progress on nutrition. J. Nutr. 145, 663–671 (2015).

  14. 14.

    Ward, Z. J. et al. Simulation of growth trajectories of childhood obesity into adulthood. N. Engl. J. Med. 377, 2145–2153 (2017).

  15. 15.

    Geserick, M. et al. Acceleration of BMI in early childhood and risk of sustained obesity. N. Engl. J. Med. 379, 1303–1312 (2018).

  16. 16.

    Abdullah, A. et al. The number of years lived with obesity and the risk of all-cause and cause-specific mortality. Int. J. Epidemiol. 40, 985–996 (2011).

  17. 17.

    World Health Organization. Childhood overweight and obesity. WHO (2018).

  18. 18.

    de Onis, M., Blossner, M. & Borghi, E. Global prevalence and trends of overweight and obesity among preschool children. Am. J. Clin. Nutr. 92, 1257–1264 (2010).

  19. 19.

    World Health Organization. Overweight and obesity. WHO (2016).

  20. 20.

    Chung, A. et al. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes. Rev. 17, 276–295 (2016).

  21. 21.

    Yuan, Z. P. et al. Possible role of birth weight on general and central obesity in Chinese children and adolescents: a cross-sectional study. Ann. Epidemiol. 25, 748–752 (2015).

  22. 22.

    Rogers, I. The influence of birth weight and intrauterine environment on adiposity and fat distribution in later life. Int. J. Obes. Relat. Metab. Disord. 27, 755–777 (2003).

  23. 23.

    Rockenbach, G. et al. Sex-specific associations of birth weight with measures of adiposity in mid-to-late adulthood: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Int. J. Obes. 40, 1286–1291 (2016).

  24. 24.

    Logan, K. M., Gale, C., Hyde, M. J., Santhakumaran, S. & Modi, N. Diabetes in pregnancy and infant adiposity: systematic review and meta-analysis. Arch. Dis. Child Fetal Neonatal Ed. 102, F65–F72 (2017).

  25. 25.

    Starling, A. P. et al. Associations of maternal BMI and gestational weight gain with neonatal adiposity in the Healthy Start Study. Am. J. Clin. Nutr. 101, 302–309 (2015).

  26. 26.

    Weng, S. F., Redsell, S. A., Swift, J. A., Yang, M. & Glazebrook, C. P. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch. Dis. Child 97, 1019–1026 (2012).

  27. 27.

    Blencowe, H. et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379, 2162–2172 (2012).

  28. 28.

    Harrison, M. S. & Goldenberg, R. L. Global burden of prematurity. Semin. Fetal Neonatal Med. 21, 74–79 (2016).

  29. 29.

    Labayen, I. et al. Early life programming of abdominal adiposity in adolescents: the HELENA Study. Diabetes Care 32, 2120–2122 (2009).

  30. 30.

    Lee, A. C. et al. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets. BMJ 358, j3677 (2017).

  31. 31.

    Lee, A. C. et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob. Health 1, e26–e36 (2013).

  32. 32.

    Ferrara, A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 30 (Suppl. 2), 141–146 (2007).

  33. 33.

    Hunt, K. J. & Schuller, K. L. The increasing prevalence of diabetes in pregnancy. Obstet. Gynecol. Clin. North Am. 34, 173–199 (2007).

  34. 34.

    Baerug, A. et al. Recent gestational diabetes was associated with mothers stopping predominant breastfeeding earlier in a multi-ethnic population. Acta Paediatr. 107, 1028–1035 (2018).

  35. 35.

    Nguyen, C. L., Pham, N. M., Binns, C. W., Duong, D. V. & Lee, A. H. Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: a systematic review and meta-analysis. J. Diabetes Res. 2018, 6536974 (2018).

  36. 36.

    Lin, X. et al. Ethnic differences in effects of maternal pre-pregnancy and pregnancy adiposity on offspring size and adiposity. J. Clin. Endocrinol. Metab. 100, 3641–3650 (2015).

  37. 37.

    Castillo, H., Santos, I. S. & Matijasevich, A. Relationship between maternal pre-pregnancy body mass index, gestational weight gain and childhood fatness at 6–7 years by air displacement plethysmography. Matern. Child Nutr. 11, 606–617 (2015).

  38. 38.

    Widen, E. M. et al. Gestational weight gain and obesity, adiposity and body size in African-American and Dominican children in the Bronx and Northern Manhattan. Matern. Child Nutr. 12, 918–928 (2016).

  39. 39.

    Jacota, M., Forhan, A., Saldanha-Gomes, C., Charles, M. A. & Heude, B. Maternal weight prior and during pregnancy and offspring’s BMI and adiposity at 5-6 years in the EDEN mother-child cohort. Pediatr. Obes. 12, 320–329 (2016).

  40. 40.

    Hinkle, S. N. et al. Excess gestational weight gain is associated with child adiposity among mothers with normal and overweight prepregnancy weight status. J. Nutr. 142, 1851–1858 (2012).

  41. 41.

    Scott, C. et al. No global consensus: a cross-sectional survey of maternal weight policies. BMC Pregnancy Childbirth 14, 167 (2014).

  42. 42.

    Rasmussen, K. M. & Yaktine, A. L. (eds) Weight Gain During Pregnancy: Reexamining the Guidelines (National Academies Press, 2009).

  43. 43.

    Hivert, M. F., Rifas-Shiman, S. L., Gillman, M. W. & Oken, E. Greater early and mid-pregnancy gestational weight gains are associated with excess adiposity in mid-childhood. Obesity 24, 1546–1553 (2016).

  44. 44.

    Kral, J. G. et al. Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years. Pediatrics 118, e1644–e1649 (2006).

  45. 45.

    Smith, J. et al. Effects of maternal surgical weight loss in mothers on intergenerational transmission of obesity. J. Clin. Endocrinol. Metab. 94, 4275–4283 (2009).

  46. 46.

    Branum, A. M., Parker, J. D., Keim, S. A. & Schempf, A. H. Prepregnancy body mass index and gestational weight gain in relation to child body mass index among siblings. Am. J. Epidemiol. 174, 1159–1165 (2011).

  47. 47.

    Lawlor, D. A., Lichtenstein, P., Fraser, A. & Langstrom, N. Does maternal weight gain in pregnancy have long-term effects on offspring adiposity? A sibling study in a prospective cohort of 146,894 men from 136,050 families. Am. J. Clin. Nutr. 94, 142–148 (2011).

  48. 48.

    Villamor, E. & Cnattingius, S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 368, 1164–1170 (2006).

  49. 49.

    Patro, B. et al. Maternal and paternal body mass index and offspring obesity: a systematic review. Ann. Nutr. Metab. 63, 32–41 (2013).

  50. 50.

    Lawlor, D. A. et al. Epidemiologic evidence for the fetal overnutrition hypothesis: findings from the mater-university study of pregnancy and its outcomes. Am. J. Epidemiol. 165, 418–424 (2007).

  51. 51.

    Fleten, C. et al. Parent-offspring body mass index associations in the Norwegian Mother and Child Cohort Study: a family-based approach to studying the role of the intrauterine environment in childhood adiposity. Am. J. Epidemiol. 176, 83–92 (2012).

  52. 52.

    Sorensen, T. et al. Comparison of associations of maternal peri-pregnancy and paternal anthropometrics with child anthropometrics from birth through age 7 y assessed in the Danish National Birth Cohort. Am. J. Clin. Nutr. 104, 389–396 (2016).

  53. 53.

    Gaillard, R. et al. Childhood cardiometabolic outcomes of maternal obesity during pregnancy: the Generation R Study. Hypertension 63, 683–691 (2014).

  54. 54.

    Linabery, A. M. et al. Stronger influence of maternal than paternal obesity on infant and early childhood body mass index: the Fels Longitudinal Study. Pediatr. Obes. 8, 159–169 (2013).

  55. 55.

    Whitaker, R. C., Deeks, C. M., Baughcum, A. E. & Specker, B. L. The relationship of childhood adiposity to parent body mass index and eating behavior. Obes. Res. 8, 234–240 (2000).

  56. 56.

    Lawlor, D. A., Lichtenstein, P. & Langstrom, N. Association of maternal diabetes mellitus in pregnancy with offspring adiposity into early adulthood: sibling study in a prospective cohort of 280,866 men from 248,293 families. Circulation 123, 258–265 (2011).

  57. 57.

    Patro Golab, B. et al. Influence of maternal obesity on the association between common pregnancy complications and risk of childhood obesity: an individual participant data meta-analysis. Lancet Child Adolesc. Health 2, 812–821 (2018).

  58. 58.

    Brown, J. et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst. Rev. 5, CD011970 (2017).

  59. 59.

    Ravelli, A. C., van Der Meulen, J. H., Osmond, C., Barker, D. J. & Bleker, O. P. Obesity at the age of 50 y in men and women exposed to famine prenatally. Am. J. Clin. Nutr. 70, 811–816 (1999).

  60. 60.

    Wang, Y., Wang, X., Kong, Y., Zhang, J. H. & Zeng, Q. The Great Chinese Famine leads to shorter and overweight females in Chongqing Chinese population after 50 years. Obesity 18, 588–592 (2010).

  61. 61.

    Stanner, S. A. et al. Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study. BMJ 315, 1342–1348 (1997).

  62. 62.

    Hult, M. et al. Hypertension, diabetes and overweight: looming legacies of the Biafran famine. PLOS ONE 5, e13582 (2010).

  63. 63.

    Bhutta, Z. A. et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382, 452–477 (2013).

  64. 64.

    Khan, M. N., Rahman, M. M., Shariff, A. A., Rahman, M. S. & Rahman, M. A. Maternal undernutrition and excessive body weight and risk of birth and health outcomes. Arch. Public Health 75, 12 (2017).

  65. 65.

    Min, J., Zhao, Y., Slivka, L. & Wang, Y. Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases. Obes. Rev. 19, 49–61 (2018).

  66. 66.

    Sinha, B. et al. Low-birthweight infants born to short-stature mothers are at additional risk of stunting and poor growth velocity: evidence from secondary data analyses. Matern. Child Nutr. 14, e12504 (2018).

  67. 67.

    Kozuki, N. et al. Short maternal stature increases risk of small-for-gestational-age and preterm births in low- and middle-income countries: individual participant data meta-analysis and population attributable fraction. J. Nutr. 145, 2542–2550 (2015).

  68. 68.

    World Health Organization. Assessing and Managing Children at Primary Health-Care Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition (WHO, 2017).

  69. 69.

    Azcorra, H., Dickinson, F. & Datta Banik, S. Maternal height and its relationship to offspring birth weight and adiposity in 6- to 10-year-old Maya children from poor neighborhoods in Merida, Yucatan. Am. J. Phys. Anthropol. 161, 571–579 (2016).

  70. 70.

    Wilson, H. J. et al. Maternal short stature does not predict their children’s fatness indicators in a nutritional dual-burden sample of urban Mexican Maya. Am. J. Phys. Anthropol. 153, 627–634 (2014).

  71. 71.

    Varela-Silva, M. I., Azcorra, H., Dickinson, F., Bogin, B. & Frisancho, A. R. Influence of maternal stature, pregnancy age, and infant birth weight on growth during childhood in Yucatan, Mexico: a test of the intergenerational effects hypothesis. Am. J. Hum. Biol. 21, (657–663 (2009).

  72. 72.

    Oken, E., Levitan, E. B. & Gillman, M. W. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. Int. J. Obes. 32, 201–210 (2008).

  73. 73.

    Li, L. et al. Maternal smoking in pregnancy association with childhood adiposity and blood pressure. Pediatr. Obes. 11, 202–209 (2016).

  74. 74.

    Ino, T. Maternal smoking during pregnancy and offspring obesity: meta-analysis. Pediatr. Int. 52, 94–99 (2010).

  75. 75.

    Flak, A. L. et al. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin. Exp. Res. 38, 214–226 (2014).

  76. 76.

    Dobson, C. C. et al. Chronic prenatal ethanol exposure increases adiposity and disrupts pancreatic morphology in adult guinea pig offspring. Nutr. Diabetes 2, e57 (2012).

  77. 77.

    Zhang, C. R. et al. Early gestational ethanol exposure in mice: effects on brain structure, energy metabolism and adiposity in adult offspring. Alcohol 75, 1–10 (2018).

  78. 78.

    Strandberg-Larsen, K. et al. Association of light-to-moderate alcohol drinking in pregnancy with preterm birth and birth weight: elucidating bias by pooling data from nine European cohorts. Eur. J. Epidemiol. 32, 751–764 (2017).

  79. 79.

    Mamluk, L. et al. Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently ‘safe’ levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ Open 7, e015410 (2017).

  80. 80.

    Patra, J. et al. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)-a systematic review and meta-analyses. BJOG 118, 1411–1421 (2011).

  81. 81.

    Brion, M. J. et al. Maternal macronutrient and energy intakes in pregnancy and offspring intake at 10 y: exploring parental comparisons and prenatal effects. Am. J. Clin. Nutr. 91, 748–756 (2010).

  82. 82.

    Khoury, J., Henriksen, T., Christophersen, B. & Tonstad, S. Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: a randomized clinical trial. Am. J. Obstet. Gynecol. 193, 1292–1301 (2005).

  83. 83.

    Kinnunen, T. I. et al. Preventing excessive weight gain during pregnancy - a controlled trial in primary health care. Eur. J. Clin. Nutr. 61, 884–891 (2007).

  84. 84.

    Shapiro, A. L. et al. Infant adiposity is independently associated with a maternal high fat diet but not related to niacin intake: the Healthy Start Study. Matern. Child Health J. 21, 1662–1668 (2017).

  85. 85.

    Chen, L. W. et al. Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI. Am. J. Clin. Nutr. 105, 705–713 (2017).

  86. 86.

    Tielemans, M. J. et al. Protein intake during pregnancy and offspring body composition at 6 years: the Generation R Study. Eur. J. Nutr. 56, 2151–2160 (2016).

  87. 87.

    Vidakovic, A. J. et al. Maternal plasma PUFA concentrations during pregnancy and childhood adiposity: the Generation R Study. Am. J. Clin. Nutr. 103, 1017–1025 (2016).

  88. 88.

    Hakola, L. et al. Maternal fatty acid intake during pregnancy and the development of childhood overweight: a birth cohort study. Pediatr. Obes. 12, S26–S37 (2016).

  89. 89.

    Stratakis, N. et al. Fish intake in pregnancy and child growth: a pooled analysis of 15 European and US birth cohorts. JAMA Pediatr. 170, 381–390 (2016).

  90. 90.

    US Food & Drug Administration. Eating fish: what pregnant women and parents should know. FDA (2014).

  91. 91.

    Moses, R. G. et al. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am. J. Clin. Nutr. 84, 807–812 (2006).

  92. 92.

    Murrin, C., Shrivastava, A. & Kelleher, C. C. Maternal macronutrient intake during pregnancy and 5 years postpartum and associations with child weight status aged five. Eur. J. Clin. Nutr. 67, 670–679 (2013).

  93. 93.

    Jen, V. et al. Mothers’ intake of sugar-containing beverages during pregnancy and body composition of their children during childhood: the Generation R Study. Am. J. Clin. Nutr. 105, 834–841 (2017).

  94. 94.

    Tieu, J., Shepherd, E., Middleton, P. & Crowther, C. A. Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. Cochrane Database Syst. Rev. 1, CD006674 (2017).

  95. 95.

    The International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ 358, j3119 (2017).

  96. 96.

    Donnelly, J. M., Walsh, J. M., Byrne, J., Molloy, E. J. & McAuliffe, F. M. Impact of maternal diet on neonatal anthropometry: a randomized controlled trial. Pediatr. Obes. 10, 52–56 (2015).

  97. 97.

    Poston, L. et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 3, 767–777 (2015).

  98. 98.

    Dodd, J. M. et al. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial. BMC Med. 12, 161 (2014).

  99. 99.

    Patel, N. et al. Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy. Int. J. Obes. 41, 1018–1026 (2017).

  100. 100.

    Dodd, J. M. et al. Effects of an antenatal dietary intervention in overweight and obese women on 6 month infant outcomes: follow-up from the LIMIT randomised trial. Int. J. Obes. 42, 1326–1335 (2018).

  101. 101.

    Tanvig, M. Offspring body size and metabolic profile — effects of lifestyle intervention in obese pregnant women. Dan. Med. J. 61, B4893 (2014).

  102. 102.

    Catalano, P. & deMouzon, S. H. Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes. Int. J. Obes. 39, 642–649 (2015).

  103. 103.

    Yeo, S., Walker, J. S., Caughey, M. C., Ferraro, A. M. & Asafu-Adjei, J. K. What characteristics of nutrition and physical activity interventions are key to effectively reducing weight gain in obese or overweight pregnant women? A systematic review and meta-analysis. Obes. Rev. 18, 385–399 (2017).

  104. 104.

    Lau, Y. et al. Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis. Obes. Rev. 18, 1071–1087 (2017).

  105. 105.

    Gjestland, K., Bo, K., Owe, K. M. & Eberhard-Gran, M. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br. J. Sports Med. 47, 515–520 (2013).

  106. 106.

    Evenson, K. R., Savitz, D. A. & Huston, S. L. Leisure-time physical activity among pregnant women in the US. Paediatr. Perinat. Epidemiol. 18, 400–407 (2004).

  107. 107.

    Muktabhant, B., Lawrie, T. A., Lumbiganon, P. & Laopaiboon, M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst. Rev. 6, CD007145 (2015).

  108. 108.

    da Silva, S. G., Ricardo, L. I., Evenson, K. R. & Hallal, P. C. Leisure-time physical activity in pregnancy and maternal-child health: a systematic review and meta-analysis of randomized controlled trials and cohort studies. Sports Med. 47, 295–317 (2017).

  109. 109.

    Tobias, D. K., Zhang, C., van Dam, R. M., Bowers, K. & Hu, F. B. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 34, 223–229 (2011).

  110. 110.

    Owe, K. M., Nystad, W. & Bo, K. Association between regular exercise and excessive newborn birth weight. Obstet. Gynecol. 114, 770–776 (2009).

  111. 111.

    Clapp, J. F. 3rd Morphometric and neurodevelopmental outcome at age five years of the offspring of women who continued to exercise regularly throughout pregnancy. J. Pediatr. 129, 856–863 (1996).

  112. 112.

    Clapp, J. F. 3rd, Simonian, S., Lopez, B., Appleby-Wineberg, S. & Harcar-Sevcik, R. The one-year morphometric and neurodevelopmental outcome of the offspring of women who continued to exercise regularly throughout pregnancy. Am. J. Obstet. Gynecol. 178, 594–599 (1998).

  113. 113.

    Mattran, K., Mudd, L. M., Rudey, R. A. & Kelly, J. S. Leisure-time physical activity during pregnancy and offspring size at 18 to 24 months. J. Phys. Act. Health 8, 655–662 (2011).

  114. 114.

    Kong, K. L., Campbell, C., Wagner, K., Peterson, A. & Lanningham-Foster, L. Impact of a walking intervention during pregnancy on post-partum weight retention and infant anthropometric outcomes. J. Dev. Origins Health Dis. 5, 259–267 (2014).

  115. 115.

    Kong, K. L., Gillman, M. W., Rifas-Shiman, S. L. & Wen, X. Leisure time physical activity before and during mid-pregnancy and offspring adiposity in mid-childhood. Pediatr. Obes. 11, 81–87 (2016).

  116. 116.

    Lupattelli, A. et al. Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open 4, e004365 (2014).

  117. 117.

    Vidal, A. C. et al. Associations between antibiotic exposure during pregnancy, birth weight and aberrant methylation at imprinted genes among offspring. Int. J. Obes. 37, 907–913 (2013).

  118. 118.

    Jepsen, P. et al. A population-based study of maternal use of amoxicillin and pregnancy outcome in Denmark. Br. J. Clin. Pharmacol. 55, 216–221 (2003).

  119. 119.

    Mor, A. et al. Prenatal exposure to systemic antibacterials and overweight and obesity in Danish schoolchildren: a prevalence study. Int. J. Obes. 39, 1450–1455 (2015).

  120. 120.

    Azad, M. B., Bridgman, S. L., Becker, A. B. & Kozyrskyj, A. L. Infant antibiotic exposure and the development of childhood overweight and central adiposity. Int. J. Obes. 38, 1290–1298 (2014).

  121. 121.

    Li, H. T., Zhou, Y. B. & Liu, J. M. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. Int. J. Obes. 37, 893–899 (2013).

  122. 122.

    Yuan, C. et al. Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood. JAMA Pediatr. 170, e162385 (2016).

  123. 123.

    Mueller, N. T. et al. Prenatal exposure to antibiotics, cesarean section and risk of childhood obesity. Int. J. Obes. 39, 665–670 (2015).

  124. 124.

    Dominguez-Bello, M. G. et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc. Natl Acad. Sci. USA 107, 11971–11975 (2010).

  125. 125.

    Jakobsson, H. E. et al. Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section. Gut 63, 559–566 (2014).

  126. 126.

    Bouter, K. E., van Raalte, D. H., Groen, A. K. & Nieuwdorp, M. Role of the gut microbiome in the pathogenesis of obesity and obesity-related metabolic dysfunction. Gastroenterology 152, 1671–1678 (2017).

  127. 127.

    Penders, J. et al. Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118, 511–521 (2006).

  128. 128.

    Skilton, M. R. et al. High birth weight is associated with obesity and increased carotid wall thickness in young adults: the cardiovascular risk in young Finns study. Arterioscler. Thromb. Vasc. Biol. 34, 1064–1068 (2014).

  129. 129.

    Singhal, A., Wells, J., Cole, T. J., Fewtrell, M. & Lucas, A. Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease? Am. J. Clin. Nutr. 77, 726–730 (2003).

  130. 130.

    Labayen, I. et al. Early programming of body composition and fat distribution in adolescents. J. Nutr. 136, 147–152 (2006).

  131. 131.

    Biosca, M. et al. Central adiposity in children born small and large for gestational age. Nutr. Hosp. 26, 971–976 (2011).

  132. 132.

    Fonseca, M. J., Severo, M., Correia, S. & Santos, A. C. Effect of birth weight and weight change during the first 96 h of life on childhood body composition—path analysis. Int. J. Obes. 39, 579–585 (2015).

  133. 133.

    Ejlerskov, K. T. et al. The impact of early growth patterns and infant feeding on body composition at 3 years of age. Br. J. Nutr. 114, 316–327 (2015).

  134. 134.

    Ali, O. et al. Obesity, central adiposity and cardiometabolic risk factors in children and adolescents: a family-based study. Pediatr. Obes. 9, e58–e62 (2014).

  135. 135.

    Labayen, I. et al. Small birth weight and later body composition and fat distribution in adolescents: the AVENA Study. Obesity 16, 1680–1686 (2008).

  136. 136.

    Araujo de Franca, G. V., Restrepo-Mendez, M. C., Loret de Mola, C. & Victora, C. G. Size at birth and abdominal adiposity in adults: a systematic review and meta-analysis. Obes. Rev. 15, 77–91 (2014).

  137. 137.

    Jaiswal, M. et al. Is low birth weight associated with adiposity in contemporary US youth? The Exploring Perinatal Outcomes among Children (EPOCH) Study. J. Dev. Origins Health Dis. 3, 166–172 (2012).

  138. 138.

    Garnett, S. P. et al. Abdominal fat and birth size in healthy prepubertal children. Int. J. Obes. Relat. Metab. Disord. 25, 1667–1673 (2001).

  139. 139.

    Dolan, M. S., Sorkin, J. D. & Hoffman, D. J. Birth weight is inversely associated with central adipose tissue in healthy children and adolescents. Obesity 15, 1600–1608 (2007).

  140. 140.

    Mook-Kanamori, D. O. et al. Fetal and infant growth and the risk of obesity during early childhood: the Generation R Study. Eur. J. Endocrinol. 165, 623–630 (2011).

  141. 141.

    Stansfield, B. K. et al. Nonlinear relationship between birth weight and visceral fat in adolescents. J. Pediatr. 174, 185–192 (2016).

  142. 142.

    Yu, Z. B. et al. Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obes. Rev. 12, 525–542 (2011).

  143. 143.

    Catalano, P. M. & Shankar, K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 356, j1 (2017).

  144. 144.

    Whitaker, R. C. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics 114, e29–e36 (2004).

  145. 145.

    Arenz, S., Ruckerl, R., Koletzko, B. & von Kries, R. Breast-feeding and childhood obesity—a systematic review. Int. J. Obes. Relat. Metab. Disord. 28, 1247–1256 (2004).

  146. 146.

    Owen, C. G., Martin, R. M., Whincup, P. H., Smith, G. D. & Cook, D. G. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics 115, 1367–1377 (2005).

  147. 147.

    Horta, B. L., Loret de Mola, C. & Victora, C. G. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr. 104, 30–37 (2015).

  148. 148.

    Patro-Golab, B. et al. Nutritional interventions or exposures in infants and children aged up to 3 years and their effects on subsequent risk of overweight, obesity and body fat: a systematic review of systematic reviews. Obes. Rev. 17, 1245–1257 (2016).

  149. 149.

    Martin, R. M. et al. Effects of promoting longer-term and exclusive breastfeeding on adiposity and insulin-like growth factor-I at age 11.5 years: a randomized trial. JAMA 309, 1005–1013 (2013).

  150. 150.

    Rogers, S. L. & Blissett, J. Breastfeeding duration and its relation to weight gain, eating behaviours and positive maternal feeding practices in infancy. Appetite 108, 399–406 (2017).

  151. 151.

    Labayen, I. et al. Breastfeeding attenuates the effect of low birthweight on abdominal adiposity in adolescents: the HELENA study. Matern. Child Nutr. 11, 1036–1040 (2015).

  152. 152.

    Singhal, A. et al. Nutrition in infancy and long-term risk of obesity: evidence from 2 randomized controlled trials. Am. J. Clin. Nutr. 92, 1133–1144 (2010).

  153. 153.

    Crume, T. L. et al. Long-term impact of neonatal breastfeeding on childhood adiposity and fat distribution among children exposed to diabetes in utero. Diabetes Care 34, 641–645 (2011).

  154. 154.

    Brion, M. J. et al. What are the causal effects of breastfeeding on IQ, obesity and blood pressure? Evidence from comparing high-income with middle-income cohorts. Int. J. Epidemiol. 40, 670–680 (2011).

  155. 155.

    Wang, L., Collins, C., Ratliff, M., Xie, B. & Wang, Y. Breastfeeding reduces childhood obesity risks. Child Obes. 13, 197–204 (2017).

  156. 156.

    Patel, R. et al. Cohort profile: the promotion of breastfeeding intervention trial (PROBIT). Int. J. Epidemiol. 43, 679–690 (2014).

  157. 157.

    Martin, R. M. et al. Effects of promoting long-term, exclusive breastfeeding on adolescent adiposity, blood pressure, and growth trajectories: a secondary analysis of a randomized clinical trial. JAMA Pediatr. 171, e170698 (2017).

  158. 158.

    Smithers, L. G., Kramer, M. S. & Lynch, J. W. Effects of breastfeeding on obesity and intelligence: causal insights from different study designs. JAMA Pediatr. 169, 707–708 (2015).

  159. 159.

    Robinson, S. M. et al. Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention. Am. J. Clin. Nutr. 101, 368–375 (2015).

  160. 160.

    Victora, C. G. et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 387, 475–490 (2016).

  161. 161.

    World Health Organization. Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care (WHO, 2009).

  162. 162.

    Patro-Golab, B. et al. Protein concentration in milk formula, growth, and later risk of obesity: a systematic review. J. Nutr. 146, 551–564 (2016).

  163. 163.

    Weber, M. et al. Lower protein content in infant formula reduces BMI and obesity risk at school age: follow-up of a randomized trial. Am. J. Clin. Nutr. 99, 1041–1051 (2014).

  164. 164.

    Putet, G. et al. Effect of dietary protein on plasma insulin-like growth factor-1, growth, and body composition in healthy term infants: a randomised, double-blind, controlled trial (Early Protein and Obesity in Childhood (EPOCH) study. Br. J. Nutr. 115, 271–284 (2016).

  165. 165.

    Haschke, F. et al. Postnatal high protein intake can contribute to accelerated weight gain of infants and increased obesity risk. Nestle Nutr. Inst. Workshop Series 85, 101–109 (2016).

  166. 166.

    Ziegler, E. E. et al. Adequacy of infant formula with protein content of 1.6 g/100 kcal for infants between 3 and 12 months. J. Pediatr. Gastroenterol. Nutr. 61, 596–603 (2015).

  167. 167.

    Socha, P. et al. Milk protein intake, the metabolic-endocrine response, and growth in infancy: data from a randomized clinical trial. Am. J. Clin. Nutr. 94, 1776S–1784S (2011).

  168. 168.

    Rolland-Cachera, M. F. et al. Adiposity rebound in children: a simple indicator for predicting obesity. Am. J. Clin. Nutr. 39, 129–135 (1984).

  169. 169.

    Hellmuth, C. et al. Effects of early nutrition on the infant metabolome. Nestle Nutr. Inst. Workshop Series 85, 89–100 (2016).

  170. 170.

    Ong, K. K. & Loos, R. J. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr. 95, 904–908 (2006).

  171. 171.

    Druet, C. et al. Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr. Perinat. Epidemiol. 26, 19–26 (2012).

  172. 172.

    Wells, J. C., Chomtho, S. & Fewtrell, M. S. Programming of body composition by early growth and nutrition. Proc. Nutr. Soc. 66, 423–434 (2007).

  173. 173.

    Adair, L. S. et al. Size at birth, weight gain in infancy and childhood, and adult blood pressure in 5 low- and middle-income-country cohorts: when does weight gain matter? Am. J. Clin. Nutr. 89, 1383–1392 (2009).

  174. 174.

    Corvalan, C., Gregory, C. O., Ramirez-Zea, M., Martorell, R. & Stein, A. D. Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population. Int. J. Epidemiol. 36, 550–557 (2007).

  175. 175.

    Gonzalez, D. A., Nazmi, A. & Victora, C. G. Growth from birth to adulthood and abdominal obesity in a Brazilian birth cohort. Int. J. Obes. 34, 195–202 (2010).

  176. 176.

    Wells, J. C., Hallal, P. C., Wright, A., Singhal, A. & Victora, C. G. Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years. Int. J. Obes. 29, 1192–1198 (2005).

  177. 177.

    Sachdev, H. S. et al. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am. J. Clin. Nutr. 82, 456–466 (2005).

  178. 178.

    Baird, J. et al. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 331, 929 (2005).

  179. 179.

    Monteiro, P. O. & Victora, C. G. Rapid growth in infancy and childhood and obesity in later life — a systematic review. Obes. Rev. 6, 143–154 (2005).

  180. 180.

    Iguacel, I. et al. Early life risk factors and their cumulative effects as predictors of overweight in Spanish children. Int. J. Public Health 63, 501–512 (2018).

  181. 181.

    Kwon, S., Janz, K. F., Letuchy, E. M., Burns, T. L. & Levy, S. M. Association between body mass index percentile trajectories in infancy and adiposity in childhood and early adulthood. Obesity 25, 166–171 (2017).

  182. 182.

    Chomtho, S. et al. Infant growth and later body composition: evidence from the 4-component model. Am. J. Clin. Nutr. 87, 1776–1784 (2008).

  183. 183.

    Koontz, M. B., Gunzler, D. D., Presley, L. & Catalano, P. M. Longitudinal changes in infant body composition: association with childhood obesity. Pediatr. Obes. 9, e141–e144 (2014).

  184. 184.

    Hong, Y. H. & Chung, S. Small for gestational age and obesity related comorbidities. Ann. Pediatr. Endocrinol. Metab. 23, 4–8 (2018).

  185. 185.

    Lei, X. et al. The optimal postnatal growth trajectory for term small for gestational age babies: a prospective cohort study. J. Pediatr. 166, 54–58 (2015).

  186. 186.

    Mo-Suwan, L., McNeil, E., Sangsupawanich, P., Chittchang, U. & Choprapawon, C. Adiposity rebound from three to six years of age was associated with a higher insulin resistance risk at eight-and-a-half years in a birth cohort study. Acta Paediatr. 106, 128–134 (2017).

  187. 187.

    Arisaka, O., Sairenchi, T., Ichikawa, G. & Koyama, S. Increase of body mass index (BMI) from 1.5 to 3 years of age augments the degree of insulin resistance corresponding to BMI at 12 years of age. J. Pediatr. Endocrinol. Metab. 30, 455–457 (2017).

  188. 188.

    Gunther, A. L., Buyken, A. E. & Kroke, A. Protein intake during the period of complementary feeding and early childhood and the association with body mass index and percentage body fat at 7 y of age. Am. J. Clin. Nutr. 85, 1626–1633 (2007).

  189. 189.

    Hoppe, C., Molgaard, C., Thomsen, B. L., Juul, A. & Michaelsen, K. F. Protein intake at 9 mo of age is associated with body size but not with body fat in 10-y-old Danish children. Am. J. Clin. Nutr. 79, 494–501 (2004).

  190. 190.

    Pimpin, L., Jebb, S., Johnson, L., Wardle, J. & Ambrosini, G. L. Dietary protein intake is associated with body mass index and weight up to 5 y of age in a prospective cohort of twins. Am. J. Clin. Nutr. 103, 389–397 (2016).

  191. 191.

    Voortman, T. et al. Protein intake in early childhood and body composition at the age of 6 years: the Generation R Study. Int. J. Obes. 40, 1018–1025 (2016).

  192. 192.

    Food and Agriculture Organization of the United Nations, World Health Organization & United Nations University. Energy and protein requirements. Report of a joint FAO/WHO/UNU Expert Consultation. World Health Organ. Tech. Rep. Ser. 724, 1–206 (1985).

  193. 193.

    Michaelsen, K. F., Weaver, L., Branca, F. & Robertson, A. (eds) Feeding and Nutrition of Infants and Young Children (WHO, 2000).

  194. 194.

    Naude, C. E., Visser, M. E., Nguyen, K. A., Durao, S. & Schoonees, A. Effects of total fat intake on bodyweight in children. Cochrane Database Syst. Rev. 7, CD012960 (2018).

  195. 195.

    Skinner, J. D., Bounds, W., Carruth, B. R., Morris, M. & Ziegler, P. Predictors of children’s body mass index: a longitudinal study of diet and growth in children aged 2–8 y. Int. J. Obes. Relat. Metab. Disord. 28, 476–482 (2004).

  196. 196.

    Rolland-Cachera, M. F. et al. Association of nutrition in early life with body fat and serum leptin at adult age. Int. J. Obes. 37, 1116–1122 (2013).

  197. 197.

    Heppe, D. H. et al. Parental, fetal, and infant risk factors for preschool overweight: the Generation R Study. Pediatr. Res. 73, 120–127 (2013).

  198. 198.

    Stroobant, W. et al. Intake of different types of fatty acids in infancy is not associated with growth, adiposity, or cardiometabolic health up to 6 years of age. J. Nutr. 147, 413–420 (2017).

  199. 199.

    Agostoni, C. et al. Dietary fats and cholesterol in Italian infants and children. Am. J. Clin. Nutr. 72, 1384S–1391S (2000).

  200. 200.

    Hakanen, M. et al. Development of overweight in an atherosclerosis prevention trial starting in early childhood. The STRIP study. Int. J. Obes. 30, 618–626 (2006).

  201. 201.

    World Health Organization. Guideline: Sugars Intake for Adults and Children (WHO, 2015).

  202. 202.

    Bresson, J.-L. et al. Review of labelling reference intake values. Scientific opinion of the panel on dietetic products, nutrition and allergies on a request from the commission related to the review of labelling reference intake values for selected nutritional elements. EFSA J. 1008, 1–14 (2009).

  203. 203.

    Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (National Academies Press, 2005).

  204. 204.

    Fidler Mis, N. et al. Sugar in infants, children and adolescents: a position paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 65, 681–696 (2017).

  205. 205.

    Vos, M. B. et al. Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation 135, e1017–e1034 (2017).

  206. 206.

    Newens, K. J. & Walton, J. A review of sugar consumption from nationally representative dietary surveys across the world. J. Hum. Nutr. Diet 29, 225–240 (2016).

  207. 207.

    Herbst, A. et al. Direction of associations between added sugar intake in early childhood and body mass index at age 7 years may depend on intake levels. J. Nutr. 141, 1348–1354 (2011).

  208. 208.

    Pan, L. et al. A longitudinal analysis of sugar-sweetened beverage intake in infancy and obesity at 6 years. Pediatrics 134 (Suppl. 1), 29–35 (2014).

  209. 209.

    Cantoral, A. et al. Early introduction and cumulative consumption of sugar-sweetened beverages during the pre-school period and risk of obesity at 8–14 years of age. Pediatr. Obes. 11, 68–74 (2016).

  210. 210.

    Sonneville, K. R. et al. Juice and water intake in infancy and later beverage intake and adiposity: could juice be a gateway drink? Obesity 23, 170–176 (2015).

  211. 211.

    Liem, D. G. & Mennella, J. A. Sweet and sour preferences during childhood: role of early experiences. Dev. Psychobiol. 41, 388–395 (2002).

  212. 212.

    Walker, R. W. & Goran, M. I. Laboratory determined sugar content and composition of commercial infant formulas, baby foods and common grocery items targeted to children. Nutrients 7, 5850–5867 (2015).

  213. 213.

    Koletzko, B. et al. Pureed fruit pouches for babies: child health under squeeze. J. Pediatr. Gastroenterol. Nutr. 67, 561–563 (2018).

  214. 214.

    Parnell, J. A. & Reimer, R. A. Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults. Am. J. Clin. Nutr. 89, 1751–1759 (2009).

  215. 215.

    Hume, M. P., Nicolucci, A. C. & Reimer, R. A. Prebiotic supplementation improves appetite control in children with overweight and obesity: a randomized controlled trial. Am. J. Clin. Nutr. 105, 790–799 (2017).

  216. 216.

    Cani, P. D., Joly, E., Horsmans, Y. & Delzenne, N. M. Oligofructose promotes satiety in healthy human: a pilot study. Eur. J. Clin. Nutr. 60, 567–572 (2006).

  217. 217.

    Liber, A. & Szajewska, H. Effect of oligofructose supplementation on body weight in overweight and obese children: a randomised, double-blind, placebo-controlled trial. Br. J. Nutr. 112, 2068–2074 (2014).

  218. 218.

    Bomhof, M. R., Saha, D. C., Reid, D. T., Paul, H. A. & Reimer, R. A. Combined effects of oligofructose and Bifidobacterium animalis on gut microbiota and glycemia in obese rats. Obesity 22, 763–771 (2014).

  219. 219.

    Agostoni, C. et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 46, 99–110 (2008).

  220. 220.

    World Health Organization. The Optimal Duration of Exclusive Breastfeeding: Report of an Expert Consultation (WHO, 2001).

  221. 221.

    Guandalini, S. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. J. Pediatr. Gastroenterol. Nutr. 41, 366–367 (2005).

  222. 222.

    Pearce, J., Taylor, M. A. & Langley-Evans, S. C. Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review. Int. J. Obes. 37, 1295–1306 (2013).

  223. 223.

    Michaelsen, K. F., Larnkjaer, A., Larsson, M. W. & Molgaard, C. Early nutrition and its effects on growth, body composition and later obesity. World Rev. Nutr. Diet. 114, 103–119 (2016).

  224. 224.

    Shalitin, S., Battelino, T. & Moreno, L. A. Obesity, metabolic syndrome and nutrition. World Rev. Nutr. Diet. 114, 21–49 (2016).

  225. 225.

    Collings, P. J. et al. Sleep duration and adiposity in early childhood: evidence for bidirectional associations from the born in Bradford Study. Sleep 40, zsw054 (2017).

  226. 226.

    Baird, J. et al. Duration of sleep at 3 years of age is associated with fat and fat-free mass at 4 years of age: the Southampton Women’s Survey. J. Sleep Res. 25, 412–418 (2016).

  227. 227.

    Cespedes, E. M. et al. Chronic insufficient sleep and diet quality: contributors to childhood obesity. Obesity 24, 184–190 (2016).

  228. 228.

    Taveras, E. M., Gillman, M. W., Pena, M. M., Redline, S. & Rifas-Shiman, S. L. Chronic sleep curtailment and adiposity. Pediatrics 133, 1013–1022 (2014).

  229. 229.

    Bornhorst, C. et al. From sleep duration to childhood obesity—what are the pathways? Eur. J. Pediatr. 171, 1029–1038 (2012).

  230. 230.

    Diethelm, K., Bolzenius, K., Cheng, G., Remer, T. & Buyken, A. E. Longitudinal associations between reported sleep duration in early childhood and the development of body mass index, fat mass index and fat free mass index until age 7. Int. J. Pediatr. Obes. 6, e114–e123 (2011).

  231. 231.

    Reilly, J. J. et al. Early life risk factors for obesity in childhood: cohort study. BMJ 330, 1357 (2005).

  232. 232.

    Paruthi, S. et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J. Clin. Sleep Med. 12, 785–786 (2016).

  233. 233.

    Wake, M., Price, A., Clifford, S., Ukoumunne, O. C. & Hiscock, H. Does an intervention that improves infant sleep also improve overweight at age 6? Follow-up of a randomised trial. Arch. Dis. Child 96, 526–532 (2011).

  234. 234.

    Duch, H., Fisher, E. M., Ensari, I. & Harrington, A. Screen time use in children under 3 years old: a systematic review of correlates. Int. J. Behav. Nutr. Phys. Act. 10, 102 (2013).

  235. 235.

    Poitras, V. J. et al. Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0–4 years). BMC Public Health 17, 868 (2017).

  236. 236.

    Manios, Y. et al. Television viewing and food habits in toddlers and preschoolers in Greece: the GENESIS study. Eur. J. Pediatr. 168, 801–808 (2009).

  237. 237.

    Brown, A. Media use by children younger than 2 years. Pediatrics 128, 1040–1045 (2011).

  238. 238.

    American Academy of Pediatrics. American Academy of Pediatrics announces new recommendations for children’s media use. AAP (2016).

  239. 239.

    Viner, R. M. & Cole, T. J. Television viewing in early childhood predicts adult body mass index. J. Pediatr. 147, 429–435 (2005).

  240. 240.

    Godfrey, K. M. et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol. 5, 53–64 (2017).

  241. 241.

    World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience (WHO, 2016).

  242. 242.

    Tirado, M. C. et al. Mapping of nutrition and sectoral policies addressing malnutrition in Latin America. Rev. Panam. Salud Publica 40, 114–123 (2016).

  243. 243.

    McCloskey, K. et al. The association between higher maternal pre-pregnancy body mass index and increased birth weight, adiposity and inflammation in the newborn. Pediatr. Obes. 13, 46–53 (2016).

  244. 244.

    Linares, J. et al. The effects of pre-pregnancy BMI and maternal factors on the timing of adiposity rebound in offspring. Obesity 24, 1313–1319 (2016).

  245. 245.

    Daraki, V. et al. Metabolic profile in early pregnancy is associated with offspring adiposity at 4 years of age: the Rhea pregnancy cohort Crete, Greece. PLOS ONE 10, e0126327 (2015).

  246. 246.

    Leonard, S. A., Petito, L. C., Rehkopf, D. H., Ritchie, L. D. & Abrams, B. Weight gain in pregnancy and child weight status from birth to adulthood in the United States. Pediatr. Obes. 12, S18–S25 (2016).

  247. 247.

    Tan, H. C. et al. Mother’s pre-pregnancy BMI is an important determinant of adverse cardiometabolic risk in childhood. Pediatr. Diabetes 16, 419–426 (2015).

  248. 248.

    Aris, I. M. et al. Associations of gestational glycemia and prepregnancy adiposity with offspring growth and adiposity in an Asian population. Am. J. Clin. Nutr. 102, 1104–1112 (2015).

  249. 249.

    Gademan, M. G. et al. Maternal prepregnancy BMI and lipid profile during early pregnancy are independently associated with offspring’s body composition at age 5–6 years: the ABCD study. PLOS ONE 9, e94594 (2014).

  250. 250.

    Perng, W., Gillman, M. W., Mantzoros, C. S. & Oken, E. A prospective study of maternal prenatal weight and offspring cardiometabolic health in midchildhood. Ann. Epidemiol. 24, 793–800 (2014).

  251. 251.

    Li, N. et al. Maternal prepregnancy body mass index and gestational weight gain on offspring overweight in early infancy. PLOS ONE 8, e77809 (2013).

  252. 252.

    Chandler-Laney, P. C., Gower, B. A. & Fields, D. A. Gestational and early life influences on infant body composition at 1 year. Obesity 21, 144–148 (2013).

  253. 253.

    Wright, C. M., Emmett, P. M., Ness, A. R., Reilly, J. J. & Sherriff, A. Tracking of obesity and body fatness through mid-childhood. Arch. Dis. Child 95, 612–617 (2010).

  254. 254.

    Tanvig, M. et al. Pregestational body mass index is related to neonatal abdominal circumference at birth—a Danish population-based study. BJOG 120, 320–330 (2013).

  255. 255.

    Kaar, J. L. et al. Maternal obesity, gestational weight gain, and offspring adiposity: the exploring perinatal outcomes among children study. J. Pediatr. 165, 509–515 (2014).

  256. 256.

    Alberico, S. et al. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth 14, 23 (2014).

  257. 257.

    Ziyab, A. H., Karmaus, W., Kurukulaaratchy, R. J., Zhang, H. & Arshad, S. H. Developmental trajectories of body mass index from infancy to 18 years of age: prenatal determinants and health consequences. J. Epidemiol. Commun. Health 68, 934–941 (2014).

  258. 258.

    Ensenauer, R. et al. Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study. Int. J. Obes. 37, 505–512 (2013).

  259. 259.

    Ode, K. L., Gray, H. L., Ramel, S. E., Georgieff, M. K. & Demerath, E. W. Decelerated early growth in infants of overweight and obese mothers. J. Pediatr. 161, 1028–1034 (2012).

  260. 260.

    Stuebe, A. M. et al. Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am. J. Obstet. Gynecol. 207, 62.e1–62.e7 (2012).

  261. 261.

    Lindberg, S. M., Adams, A. K. & Prince, R. J. Early predictors of obesity and cardiovascular risk among American Indian children. Matern. Child Health J. 16, 1879–1886 (2012).

  262. 262.

    Fraser, A. et al. Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood. Circulation 121, 2557–2564 (2010).

  263. 263.

    Crozier, S. R. et al. Weight gain in pregnancy and childhood body composition: findings from the Southampton Women’s Survey. Am. J. Clin. Nutr. 91, 1745–1751 (2010).

  264. 264.

    Schack-Nielsen, L., Michaelsen, K. F., Gamborg, M., Mortensen, E. L. & Sorensen, T. I. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int. J. Obes. 34, 67–74 (2010).

  265. 265.

    Lawlor, D. A. et al. Exploring the developmental overnutrition hypothesis using parental-offspring associations and FTO as an instrumental variable. PLOS Med. 5, e33 (2008).

  266. 266.

    Oken, E., Rifas-Shiman, S. L., Field, A. E., Frazier, A. L. & Gillman, M. W. Maternal gestational weight gain and offspring weight in adolescence. Obstet. Gynecol. 112, 999–1006 (2008).

  267. 267.

    Gale, C. R. et al. Maternal size in pregnancy and body composition in children. J. Clin. Endocrinol. Metab. 92, 3904–3911 (2007).

  268. 268.

    Oken, E., Taveras, E. M., Kleinman, K. P., Rich-Edwards, J. W. & Gillman, M. W. Gestational weight gain and child adiposity at age 3 years. Am. J. Obstet. Gynecol. 196, 322.e1–322.e8 (2007).

  269. 269.

    Labayen, I. et al. Intergenerational cardiovascular disease risk factors involve both maternal and paternal BMI. Diabetes Care 33, 894–900 (2010).

  270. 270.

    Durmus, B. et al. Growth in foetal life and infancy is associated with abdominal adiposity at the age of 2 years: the generation R study. Clin. Endocrinol. 72, 633–640 (2010).

  271. 271.

    Kensara, O. A. et al. Fetal programming of body composition: relation between birth weight and body composition measured with dual-energy X-ray absorptiometry and anthropometric methods in older Englishmen. Am. J. Clin. Nutr. 82, 980–987 (2005).

  272. 272.

    McNeely, M. J., Fujimoto, W. Y., Leonetti, D. L., Tsai, E. C. & Boyko, E. J. The association between birth weight and visceral fat in middle-age adults. Obesity 15, 816–819 (2007).

  273. 273.

    Demerath, E. W. et al. Rapid postnatal weight gain and visceral adiposity in adulthood: the Fels Longitudinal Study. Obesity 17, 2060–2066 (2009).

  274. 274.

    Rolfe Ede, L. et al. Association between birth weight and visceral fat in adults. Am. J. Clin. Nutr. 92, 347–352 (2010).

  275. 275.

    Pilgaard, K. et al. Differential nongenetic impact of birth weight versus third-trimester growth velocity on glucose metabolism and magnetic resonance imaging abdominal obesity in young healthy twins. J. Clin. Endocrinol. Metab. 96, 2835–2843 (2011).

  276. 276.

    Ronn, P. F. et al. Birth weight and risk of adiposity among adult Inuit in Greenland. PLOS ONE 9, e115976 (2014).

  277. 277.

    Araujo de Franca, G. V. et al. Associations of birth weight, linear growth and relative weight gain throughout life with abdominal fat depots in adulthood: the 1982 Pelotas (Brazil) birth cohort study. Int. J. Obes. 40, 14–21 (2016).

Download references

Reviewer information

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

Author information

The authors contributed equally to all aspects of the article.

Correspondence to Luis A. Moreno.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark