Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program

Frances A Tylavsky¹, Assiamira Ferrara², Diane J Catellier³, Emily Oken⁴, Xiuhong Li⁵, Andrew Law⁵, Dana Dabelea⁶, Andrew Rundle⁷, Diane Gilbert-Diamond⁸, Marie-France Hivert⁴, Carrie V Breton⁹, Andrea E Cassidy-Bushrow¹⁰, Noel T Mueller¹¹, Kelly J Hunt¹², S Sonia Arteaga¹³, Tania Lombo¹⁴, Somdat Mahabir¹⁵, Doug Ruden¹⁶, Katherine Sauder¹⁷, Monique M Hedderson², Yeyi Zhu², Sarah Polk¹⁸, Nicole L Mihalopoulos¹⁹, Miriam Vos²⁰, Lee Pyles²¹, Mary Roary²², Judy Aschner²³, Margaret R Karagas⁸, Leonardo Trasande²⁴

Affiliations

¹ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
² Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
³ RTI International, Research Triangle Park, Triangle Park, NC, USA.
⁴ Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Departments of Epidemiology and Pediatrics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Denver, CO, USA.
⁷ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁸ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
⁹ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁰ Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA.
¹¹ Welch Center for Epidemiology, Prevention and Clinical Research, Johns Hopkins University Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹² Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
¹³ National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
¹⁴ NIH Office of the Director, ECHO Program, Bethesda, MD, USA.
¹⁵ Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
¹⁶ Department of Obstetrics and Gynecology, Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, USA.
¹⁷ Departments of Pediatrics and Epidemiology, University of Colorado, Denver, CO, USA.
¹⁸ Department of Pediatrics and Centro SOL, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹⁹ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
²⁰ Department of Pediatrics, Emory University, Atlanta, GA, USA.
²¹ Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA.
²² National Institute of Nursing Research and Environmental Influences on Child Health Outcomes Program, National Institutes of Health, Rockville, MD, USA.
²³ Department of Pediatrics and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
²⁴ Departments of Pediatrics, Environmental Medicine and Population Health, NYU School of Medicine, New York, NY, USA. leonardo.trasande@nyumc.org.

PMID: 31649277
PMCID: PMC7060502
DOI: 10.1038/s41366-019-0470-5

Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program

Frances A Tylavsky et al. Int J Obes (Lond). 2020 Mar.

. 2020 Mar;44(3):617-627.

doi: 10.1038/s41366-019-0470-5. Epub 2019 Oct 24.

Authors

Affiliations

¹ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
² Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
³ RTI International, Research Triangle Park, Triangle Park, NC, USA.
⁴ Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
⁵ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Departments of Epidemiology and Pediatrics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Denver, CO, USA.
⁷ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
⁸ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
⁹ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁰ Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA.
¹¹ Welch Center for Epidemiology, Prevention and Clinical Research, Johns Hopkins University Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹² Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
¹³ National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
¹⁴ NIH Office of the Director, ECHO Program, Bethesda, MD, USA.
¹⁵ Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
¹⁶ Department of Obstetrics and Gynecology, Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, USA.
¹⁷ Departments of Pediatrics and Epidemiology, University of Colorado, Denver, CO, USA.
¹⁸ Department of Pediatrics and Centro SOL, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹⁹ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
²⁰ Department of Pediatrics, Emory University, Atlanta, GA, USA.
²¹ Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA.
²² National Institute of Nursing Research and Environmental Influences on Child Health Outcomes Program, National Institutes of Health, Rockville, MD, USA.
²³ Department of Pediatrics and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA.
²⁴ Departments of Pediatrics, Environmental Medicine and Population Health, NYU School of Medicine, New York, NY, USA. leonardo.trasande@nyumc.org.

PMID: 31649277
PMCID: PMC7060502
DOI: 10.1038/s41366-019-0470-5

Abstract

Background: Few resources exist for prospective, longitudinal analysis of the relationships between early life environment and later obesity in large diverse samples of children in the United States (US). In 2016, the National Institutes of Health launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate influences of environmental exposures on child health and development. We describe demographics and overweight and obesity prevalence in ECHO, and ECHO's potential as a resource for understanding how early life environmental factors affect obesity risk.

Methods: In this cross-sectional study of 70 extant US and Puerto Rico cohorts, 2003-2017, we examined age, race/ethnicity, and sex in children with body mass index (BMI) data, including 28,507 full-term post-birth to <2 years and 38,332 aged 2-18 years. Main outcomes included high BMI for age <2 years, and at 2-18 years overweight (BMI 85th to <95th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI ≥ 120% of 95th percentile).

Results: The study population had diverse race/ethnicity and maternal demographics. Each outcome was more common with increasing age and varied with race/ethnicity. High BMI prevalence (95% CI) was 4.7% (3.5, 6.0) <1 year, and 10.6% (7.4, 13.7) for 1 to <2 years; overweight prevalence increased from 13.9% (12.4, 15.9) at 2-3 years to 19.9% (11.7, 28.2) at 12 to <18 years. ECHO has the statistical power to detect relative risks for 'high' BMI ranging from 1.2 to 2.2 for a wide range of exposure prevalences (1-50%) within each age group.

Conclusions: ECHO is a powerful resource for understanding influences of chemical, biological, social, natural, and built environments on onset and trajectories of obesity in US children. The large sample size of ECHO cohorts adopting a standardized protocol for new data collection of varied exposures along with longitudinal assessments will allow refined analyses to identify drivers of childhood obesity.

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Conflict of interest statement

Conflict of interest The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Cohorts and participant recruiting sites for the Environmental influences on Child Health Outcomes (ECHO) study

**Fig. 2**
Prevalences (%) of overweight, obesity, and severe obesity in the Environmental influences on Child Health Outcomes (ECHO) study. NH non-hispanic, W white, B black, A Asian, O other, Overweight = BMI ≥ 85th and <95th percentile; Obesity = BMI at or above the 95th percentile; Severe Obesity = BMI at or above 120% of the sex-specific 95th percentile. Each vertical bar in color represents estimated prevalence; with the point estimate as a circle and the extended vertical line representing the corresponding 95% confidence intervals obtained from meta-analysis using Normal-Binomial, non-linear, mixed-effects modeling

**Fig. 3**
Minimum detectable risk ratios for overweight/obesity associated with environmental exposures (80% power and 5% alpha error tolerance). High weight defined as: BMI ≥ 97.7th percentile of (age and sex-specific) WHO 2006 growth charts for birth to 2 years of age; BMI ≥ 95th percentile of (age and sex-specific) CDC growth charts

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References

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Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program

Affiliations

Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical