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Effectiveness of Interventions During Early Childhood to Prevent Overweight and Obesity: Overview of Systematic
Esther Parada-Ricart1,2,3, Natalia Ferré1,2, Marta Roqué4
1Universitat Rovira i Virgili, Reus 43201, Spain.
Insights
Early interventions can help prevent childhood obesity. Reducing protein in infant formula shows moderate evidence of benefit, while other strategies have limited support.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Childhood obesity is a significant global health issue.
- Early childhood is a critical period for intervention, but effectiveness is unclear.
Purpose of the Study:
- To systematically review evidence on interventions in the first three years of life for preventing childhood overweight and obesity.
- To assess the effectiveness of early-life strategies through a review of reviews.
Main Methods:
- Systematic review of systematic reviews and meta-analyses (PRISMA guidelines).
- Included reviews focused on children up to 3 years in OECD countries.
- Assessed primary outcomes (overweight/obesity incidence) and secondary outcomes (BMI z-score, etc.). AMSTAR-2 tool used for quality assessment.
Main Results:
- Thirty-nine reviews synthesized, identifying 45 RCTs.
- Multicomponent interventions (physical activity, responsive feeding) showed modest benefits, but evidence quality is low.
- Reducing infant formula protein intake (first 2 years) had moderate evidence for reducing obesity risk up to age 6. Breastfeeding, sleep, and weaning interventions had limited effects.
Conclusions:
- Limited, low-quality evidence supports most early-life obesity prevention interventions.
- Reducing infant formula protein intake shows moderate promise.
- Multicomponent strategies incorporating physical activity or responsive feeding offer modest benefits.
- High-quality RCTs with longer follow-up are needed to confirm findings and optimize strategies.
Context:
Childhood obesity is a major global health concern, with various strategies aimed at prevention. Early childhood represents a critical window for intervention; however, the effectiveness of strategies during this period remains unclear.
Objective:
To evaluate the effectiveness of interventions implemented during the first 3 years of life in preventing childhood overweight and obesity, through a systematic review of reviews.
Data Sources:
A systematic review of systematic reviews and meta-analyses was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviews targeting children up to 3 years of age in Organization for Economic Co-operation and Development countries were included.
Data Extraction:
The primary outcomes were the incidence of overweight and obesity, assessed at least 1 year postintervention. Secondary outcomes included body mass index z-score, weight-gain velocity, and body composition. The quality of the reviews was assessed using the AMSTAR-2 tool.
Data Analysis:
Thirty-nine systematic reviews were included in the qualitative synthesis, from which only 45 randomized controlled trials were identified as meeting the inclusion criteria. Evidence suggests that multicomponent interventions incorporating physical activity or responsive feeding show modest positive effects, although the quality of evidence is generally low. Reducing protein intake from infant formula during the first 2 years of life showed moderate evidence in reducing obesity risk up to 6 years of age. Breastfeeding, sleep, and weaning interventions had limited or inconclusive effects.
Conclusion:
While reducing protein intake from infant formula during the first 2 years of life showed moderate evidence of benefit, there is limited and low-quality evidence supporting early-life interventions to prevent childhood obesity. Multicomponent interventions, particularly those incorporating physical activity or promoting responsive feeding, appear modestly beneficial. Further high-quality research, particularly randomized clinical trials with longer follow-up, is needed to confirm these findings and optimize obesity-prevention strategies.
Systematic Review Registration:
PROSPERO registration no. CRD42022338940.
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