Obesity in the Early Childhood Years State of the Science and Implementation of Promising Solutions: Workshop Summary (2016) / Chapter Skim
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3 Modifiable Risk and Protective Factors Associated with Overweight and Obesity Through Age 5
3 Modifiable Risk and Protective Factors Associated with Overweight and Obesity Through Age 5
Pages 19-38
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From page 19... ...
(Birch) • Insufficient sleep in infancy and early childhood and a lack of physical activity are modifiable risk factors for early child hood obesity, and these are among the many risk factors that account for higher rates of obesity in some ethnic and racial minority groups.
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According to Bodnar, all of these features of pregnancy offer opportunities for intervention. Bodnar discussed four factors that have a potentially causal relationship with childhood obesity: maternal prepregnancy body mass index (BMI)
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published modified gestational weight gain recommendations that incorporate prepregnancy BMI (IOM and NRC, 2009)
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. Interventions to reduce gestational weight gain have shown mixed results, Bodnar reported.
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From page 23... ...
resulted in similar conclusions, although the sample sizes of individual studies have tended to be small, and few have used direct measures of adiposity in children. Maternal BMI appears to be a stronger factor than gestational diabetes in childhood obesity, Bodnar said, but "there is still work to be done in this area." Moving to a fourth factor with a potentially causal relationship with childhood obesity, Bodnar stated that smoking in pregnancy is consistently associated with an increased risk of childhood obesity (Ino, 2010; Oken et al., 2008)
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From page 24... ...
She cited the need for specific markers, such as maternal body composition, fat distribution, diet, and metabolic changes in pregnancy. Another major question, she suggested, is how early-life nutrition and physical activity, as well as exposure to chemicals during pregnancy, may modify the long-term risk of obesity (Heindel and vom Saal, 2009; Symonds et al., 2013)
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From page 25... ...
. Finally, he said, suboptimal infant feeding patterns using formula may lead to exces sive weight gain during infancy, which is likely to increase the risk of child hood obesity (Dewey, 1998; Pérez-Escamilla and Kac, 2013)
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From page 26... ...
Genomic propensities are a promising area for future epidemiological and basic mechanistic research, he contended, along with the effects of breastfeeding as a function of other maternal–child life-course factors, including prepregnancy BMI, gestational weight gain, and the timing of the introduction and the type of complemen tary feeding (Daniels et al., 2015a; Pérez-Escamilla and Bermúdez, 2012)
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From page 27... ...
Those related to feeding and behaviors include • lack of breastfeeding; • lack of responsive feeding practices by caregivers, including low attenion to hunger and satiety cues and the use of overly restric t tive, controlling, rewarding, or pressure feeding; • low total and nocturnal sleep; • lack of family meals; • television/screen viewing time; and • low active play. Saavedra focused on the modifiable factors related to complementary feeding.
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From page 28... ...
, a longitudinal assessment con ducted using food frequency questionnaires delivered by mail from 2005 to 2007 to examine infant feeding and feeding transitions during the first year of life (CDC, 2015c)
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He continued, "That said, fiber highly correlates with the energy density of the diets. The higher the fiber intake, particularly when fruits and vegetables are consumed as fruits and vegetables and not as extracts, juices, or bever ages, the energy density of the diet significantly goes down, and the total energy intake by the child also goes down.
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From page 30... ...
Despite changes in total energy consumption and a growing number of food options with age, the relative energy contribution of each food group remains the same, he said, suggesting that this pattern will remain unchanged for life. Saavedra finished by saying, "The most important messages are [we]
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From page 31... ...
The problem, said Birch, is that in the current obesogenic environment, these practices may place children at increased risk for rapid weight gain and obesity. One potential way to change these traditional feeding practices is to use what is called responsive parenting, Birch asserted.
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Birch posed the question of whether responsive parenting can affect rapid weight gain and obesity risk early in life. The existing evidence is in triguing, she said, but still scant.
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. Based on these results, "responsive parenting can make a noticeable difference in early rapid weight gain," Birch asserted, although "whether we will have longer-term effects still remains to be seen." Many questions still surround this work, Birch noted.
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From page 34... ...
. Furthermore, Taveras noted, insufficient sleep duration in adults is associated with many adverse health conditions, including cancer, obesity, diabetes, and coronary heart disease, as well as all-cause mortality and lower life expectancy (Ayas et al., 2003; Gangwisch et al., 2006; King et al., 2008; Kripke et al., 2002; Patel and Hu, 2008; Patel et al., 2006; Williams et al., 2007)
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. According to Taveras, "It might not just be insufficient sleep in infancy but insufficient sleep in infancy and throughout early childhood that persists to affect BMI and potentially metabolic syndrome in mid-childhood." Most findings on the potential mechanisms underlying sleep and obesity relate to older children, but Taveras explained that among the possibilities are alterations in metabolic functioning, alterations in appetite hormones, and fatigue that affects the ability to participate in physical activity (see Figure 3-4)
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From page 36... ...
• Food amounts • Food types/preferences APPETITE DYSREGULATION • Timing AlternaƟons in hunger/saƟety REDUCED PHYSICAL INCREASED REDUCED ENERGY ACTIVITY/INCREASED SEDENTARY ENERGY INTAKE INTAKE BEHAVIOR INCREASED BMI FIGURE 3-4 Hypothesized pathways through which sleep restriction may increase obesity risk. NOTE: BMI = body mass index.
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From page 37... ...
. However, Taveras noted, no published randomized controlled trials have evaluated the effect of a physi cal activity intervention in infancy on increasing accelerometry-measured physical activity or preventing obesity, although the evidence on the inverse relationship between television viewing and physical activity among chil dren 2 to 5 years of age is strong.
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From page 38... ...
Although food is a critical factor, he said, "it is important to take a much more holistic approach as it relates to the guidelines, especially from zero to 2, if not from zero to 4." The development of such guidelines will be a "huge step forward," suggested Pérez-Escamilla. The dietary and physical activity guidelines for infants and toddlers, which should be completed by 2020, will fill "a huge gap that we know exists based on the maternal–child life course obesity cycle," he said.
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