Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status

Abstract

Background/objective: Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort.

Methods: Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m^-2), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l^-1), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models.

Results: Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41-1.15) for BMI, 0.79 (0.41-1.16) for WHtR, 0.46 (0.06-0.83) for SSF and 0.67 (0.07-1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5-49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8-13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity.

Conclusions: Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.

Trial registration: ClinicalTrials.gov NCT01174875.

Figure 1

Associations with (A) BMI, (B) BMI z-score (Singapore reference), (C) WHO BMI z-score, (D) waist-to-height ratio, (E) sum of skinfolds, (F) fat mass index (subset n=274), and (G) relative risk of overweight or obese at 48 months, according to number of risk factors. All models were adjusted for maternal education level, height, parity, child daily physical activity level, total energy intake and ethnicity. Figures 1A, D-F were additionally adjusted for child sex and actual age at measurement. Data points represent regression coefficients (Figs 1A-F) or relative risk (Fig 1G) estimates; error bars represent 95% confidence intervals

Figure 2

Predicted probability of overweight or obese at 48 months according to different risk factor combinations. “+” indicates presence of risk factor, “–” indicates absence of risk factor. All models were additionally adjusted for maternal education level, height, parity, child daily physical activity level, total energy intake and ethnicity