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Risk Factors in the First 1000 Days of Life Associated With Childhood Obesity: A Systematic Review and Risk Factor
Sophia M Blaauwendraad1,2, Arwen S J Kamphuis1,2, Francisco Javier Ruiz-Ojeda3,4,5,6,7
1The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Insights
Seven key early-life risk factors strongly predict childhood obesity. Identifying these factors in preconception, pregnancy, and infancy aids future prevention and intervention strategies for better child health outcomes.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Early-life exposures are linked to adverse fetal and infant development, increasing susceptibility to childhood obesity.
- Identifying risk factors is crucial for developing effective prediction and prevention strategies.
- Childhood obesity poses a significant public health challenge with long-term health implications.
Purpose of the Study:
- To systematically review and evaluate risk factors for childhood obesity.
- To identify risk factors across preconception, pregnancy, and infancy periods.
- To assess the predictive potential of identified risk factors for future obesity.
Main Methods:
- Systematic review of longitudinal studies published up to August 17th, 2022.
- Inclusion of studies examining maternal, paternal, or infant risk factors for childhood obesity (ages 2-18).
- Quality assessment of risk factors based on modifiability and predictive power.
Main Results:
- Analysis of 172 observational and 5 intervention studies involving over 1.8 million children.
- Identified 23 consistently associated risk factors for childhood obesity, with prevalence around 11.1%.
- Key risk factors include maternal pre-pregnancy weight, gestational weight gain, maternal smoking, birth weight, size-for-gestational-age, lack of breastfeeding, and infant weight gain.
Conclusions:
- Seven early-life risk factors demonstrate strong associations with childhood obesity.
- These factors are valuable for developing future prediction and prevention strategies.
- Implementation of targeted prevention strategies is recommended from clinical and population perspectives.
Background:
Early-life exposures might negatively affect fetal and infant development, predisposing children to obesity. This study aimed to systematically identify and evaluate risk factors for childhood obesity in preconception, pregnancy, and infancy, and assess their potential for future prediction and prevention strategies.
Methods:
This systematic review (PROSPERO, CRD42022355152) included longitudinal studies from selected electronic databases published between inception and August 17th, 2022, identifying maternal, paternal, or infant risk factors from preconception until infancy for childhood obesity between 2 and 18 years. Screening and data extraction were conducted using standardized forms. We assessed risk factor quality on modifiability and predictive power using a piloted criteria template from ILSI-Europe-Marker-Validation-Initiative.
Findings:
We identified 172 publications from observational and five publications from intervention studies involving n = 1,879,971 children from 37, predominantly high-income, countries. Average reported childhood obesity prevalence was 11.1%. Pregnancy and infancy risk factors were mostly studied. We identified 59 potential risk factors; 23 were consistently associated. Strongest risk factors were: higher maternal prepregnancy weight (n = 28/31 publications with positive associations), higher gestational weight gain (n = 18/21), maternal smoking during pregnancy (n = 23/29), higher birth weight (n = 20/28), large-size-for-gestational-age-at-birth (n = 17/18), no breastfeeding (n = 20/31), and higher infant weight gain (n = 12/12). Level of evidence was generally moderate due to unreliable exposure measurement, short follow-up/loss to follow-up, and risk of confounding.
Interpretation:
We identified seven early-life risk factors, which were strongly associated with childhood obesity, and can contribute to future prediction and prevention strategies. These findings support the implementation of prevention strategies targeting these risk factors from a clinical and population perspective, where possible integrated with implementation studies.
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