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. 2025 Apr 1;8(4):e254439.
doi: 10.1001/jamanetworkopen.2025.4439.

Trajectory of Early Life Adiposity Among South Asian Children

Sandi M Azab  1   2 , Saba Naqvi  1 , Talha Rafiq  3 , Joseph Beyene  3   4 , Wei Deng  5   6 , Amel Lamri  4 , Katherine M Morrison  7 , Koon Teo  1   4 , Gillian Santorelli  8 , John Wright  8 , Natalie C Williams  1 , Russell J de Souza  3   4 , Gita Wahi  7 , Sonia S Anand  1   3   4
Affiliations

Trajectory of Early Life Adiposity Among South Asian Children

Sandi M Azab et al. JAMA Netw Open. .

Abstract

Importance: Measures of childhood adiposity merit investigation, particularly in individuals of South Asian descent.

Objective: To investigate prenatal and childhood factors associated with the trajectory of adiposity in South Asian children, and the cumulative contribution of modifiable factors, such as diet and physical activity, on this trajectory.

Design, setting, and participants: This cohort study was a prospective analysis of the South Asian Birth Cohort (START; 2011-2015) for discovery; and the Family Atherosclerosis Monitoring In Early Life (FAMILY; 2002-2009) in Ontario, Canada, and the Born in Bradford (BiB; 2008-2009) cohort in Bradford, UK, for validation. Mother-child pairs included 903 South Asian individuals (START), 675 White European individuals (FAMILY), and 1593 individuals (BiB), of which 52% were South Asian. Analysis was conducted from March 2020 to September 2024.

Exposure: Maternal, infancy, and early childhood exposures.

Main outcomes and measures: Adiposity, assessed by the sum of subscapular and triceps skinfold thicknesses (SSF) from birth to 3 years, aggregated to a single measure as total area under the growth curve (AUC for SSF); multivariable linear regression models to identify determinants of AUC for SSF; and a cumulative score to assess joint contribution of modifiable risk factors to AUC for SSF.

Results: START included 903 children (456 female [50.5%]; mean [SD] maternal age, 30.2 [4.0] years; maternal mean [SD] prepregnancy body mass index [BMI], 23.8 [4.50]). Maternal sum of skinfold thicknesses (β = 0.80 [95% CI, 0.30-1.30] per 10 mm), gestational weight gain (β = 0.38 [95% CI, 0.02-0.74] per 5 kg), a health-conscious diet score (β = -0.68 [95% CI, -1.26 to -0.10] per 1 SD), and infant breastfeeding for the first year (β = -1.68 [95% CI, -2.94 to -0.42), as well as physical activity (β = -0.33 [95% CI, -0.57 to -0.09] per 30-min/d) and screen time (β = 0.49 [95% CI, 0.18-0.81] per 30-min/d) were each independently associated with AUC for SSF. These 6 early-life modifiable factors combined into a single score had a direct, graded association between number of factors and AUC for SSF (P for trend < .001). In the validation cohorts, maternal BMI, breastfeeding, and child physical activity were replicated and showed a similar graded association with AUC for SSF (P for trend < .001) when combined.

Conclusions and relevance: In this cohort study of South Asian children, 6 modifiable factors were associated with lower adiposity and combined into a single score. This score may be useful in clinical and public health settings to help mitigate childhood obesity in South Asian individuals and beyond.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Azab reported grants from CIHR Research Excellence, Diversity, and Independence (REDI) Early Career Transition Award, grants from Heart and Stroke 2024/25 Grant-in-Aid, and grants from National Institute for Health and Care Research (NIHR) Research and Innovation for Global Health Transformation Call 7 outside the submitted work. Dr Morrison reported being on the advisory boards for NovoNordisk and for Rhythm Pharmaceuticals outside the submitted work. Dr de Souza reported having served as an external resource person to the World Health Organization (WHO) Nutrition Guidelines Advisory Group on trans fats, saturated fats, and polyunsaturated fats (The WHO paid for his travel and accommodation to attend meetings from 2012-2017 to present and discuss this work; he has also presented updates of this work to the WHO in 2022); Dr de Souza has also done contract research for the Canadian Institutes of Health Research’s Institute of Nutrition, Metabolism, and Diabetes, Health Canada, and the WHO for which he received remuneration; he has also received speaker’s fees from the University of Toronto, and McMaster Children’s Hospital; he has served as an independent director of the Helderleigh Foundation (Canada, and as a member of the Nutrition Science Advisory Committee to Health Canada (Government of Canada); he serves as co-chair of the Method working group of the ADA/EASD Precision Medicine in Diabetes group, and is a co-opted member of the Scientific Advisory Committee on Nutrition (SACN) Subgroup on the Framework for the Evaluation of Evidence (Public Health England); Dr de Souza has also held grants from the Canadian Institutes of Health Research, Canadian Foundation for Dietetic Research, Population Health Research Institute, and Hamilton Health Sciences Corporation as a principal investigator, and is a coinvestigator on several funded team grants from the Canadian Institutes of Health Research. Dr Anand reported grants from Canada Research Chair Tier 1 Canada Research Chair in Ethnicity and Cardiovascular Disease (No. CRC-2017-00024), grants from Canadian Institutes of Health Research Foundation grant (FDN-143255), and grants from Heart and Stroke Foundation Chair Heart and Stroke Foundation Chair in Population Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Diagram Depicting Factors Associated With Adiposity Compared With Body Mass Index (BMI) in South Asian Children in START
AUC indicates total area under the curve; START, South Asian Birth Cohort.
Figure 2.
Figure 2.. Combined Contribution on Adiposity in Children, by Study
Coefficients and 95% CI for adiposity (total area under the growth curve [AUC] for sum of triceps and subscapular skinfold thickness [SSF]) in the South Asian Birth Cohort (START), Family Atherosclerosis Monitoring In Early Life (FAMILY), and Born in Bradford (BiB) children, adjusting for child sex and age at the 3-year visit, according to the number/score of modifiable factors associated with lower risk. Score was calculated as follows in START: 1 point for: less than or equal to median of maternal skinfold thickness, less than or equal to median of maternal gestational weight gain, greater than or equal to median of maternal health-conscious diet score, breastfeeding for 1 year, less than or equal to the median of physical activity, less than the median of screen time exposure. Score was calculated as follows in FAMILY and BiB: 1 point for less than or equal to 25 of maternal body mass index (calculated as weight in kilograms divided by height in meters squared), breastfeeding for 1 year, greater than or equal to median of physical activity.
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