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OBJECTIVES: To examine the longitudinal relationship of early to mid-childhood adiposity measures with mid-childhood alanine aminotransferase (ALT) levels. STUDY DESIGN: We studied 635 children in the Project Viva cohort. Research staff measured weight, height, skinfolds thicknesses, and waist and hip circumferences at early (median 3.2 years) and mid-childhood (median 7.7 years) visits. At mid-childhood, we collected blood for ALT analysis. We used established sex-specific ALT cut-offs to define elevated ALT. In multivariable linear and logistic regression models, we assessed the association of adiposity measures from early to mid-childhood with mid-childhood ALT level, adjusting for confounders. RESULTS: Children were 48% female, 59% white, 21% black, 6% Hispanic/Latino, and 3% Asian. At early childhood, 29% had overweight/obesity and mean waist circumference was 51.5 (SD 3.8) cm. At mid-childhood, mean ALT was 20.3 (SD 7.3) units/L, and 23% had an elevated ALT. In multivariable-adjusted regression models, each additional 10-cm greater waist circumference at early childhood was associated with 1.99 (95% CI 1.19-3.33) greater odds of elevated ALT at mid-childhood. Greater increases from early to mid-childhood in body mass index z score, sum of subscapular and triceps skinfold thicknesses, waist circumference, and hip circumference were associated with greater ALT at mid-childhood. CONCLUSIONS: In this prospective cohort, greater waist circumference at early childhood and greater increases in adiposity measures from early to mid-childhood were associated with greater ALT levels at mid-childhood.
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Adiposidad/fisiología , Alanina Transaminasa/sangre , Antropometría/métodos , Obesidad Infantil/sangre , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , Estudios ProspectivosRESUMEN
OBJECTIVE: To assess whether growth and biomarkers of environmental enteric dysfunction in infancy are related to health outcomes in midchildhood in Tanzania. STUDY DESIGN: Children who participated in 2 randomized trials of micronutrient supplements in infancy were followed up in midchildhood (4.6-9.8 years of age). Anthropometry was measured at age 6 and 52 weeks in both trials, and blood samples were available from children at 6 weeks and 6 months from 1 trial. Linear regression was used for height-for-age z-score, body mass index-for-age z-score, and weight for age z-score, and blood pressure analyses; log-binomial models were used to estimate risk of overweight, obesity, and stunting in midchildhood. RESULTS: One hundred thirteen children were followed-up. Length-for-age z-score at 6 weeks and delta length-for-age z-score from 6 to 52 weeks were associated independently and positively with height-for-age z-score and inversely associated with stunting in midchildhood. Delta weight-for-length and weight-for-age z-score were also positively associated with midchildhood height-for-age z-score. The 6-week and delta weight-for-length z-scores were associated independently and positively with midchildhood body mass index-for-age z-score and overweight, as was the 6-week and delta weight-for-age z-score. Delta length-for-age z-score was also associated with an increased risk of overweight in midchildhood. Body mass index-for-age z-score in midchildhood was associated positively with systolic blood pressure. Serum anti-flagellin IgA concentration at 6 weeks was also associated with increased blood pressure in midchildhood. CONCLUSIONS: Anthropometry at 6 weeks and growth in infancy independently predict size in midchildhood, while anti-flagellin IgA, a biomarker of environmental enteric dysfunction, in early infancy is associated with increased blood pressure in midchildhood. Interventions in early life should focus on optimizing linear growth while minimizing excess weight gain and environmental enteric dysfunction. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00197730 and NCT00421668.
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Antropometría , Biomarcadores/metabolismo , Presión Sanguínea/fisiología , Fenómenos Fisiológicos Nutricionales del Lactante , Estado Nutricional , Niño , Ambiente , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , TanzaníaRESUMEN
OBJECTIVE: To determine the real-world effectiveness of statins and impact of baseline factors on low-density lipoprotein cholesterol (LDL-C) reduction among children and adolescents. STUDY DESIGN: We analyzed data prospectively collected from a quality improvement initiative in the Boston Children's Hospital Preventive Cardiology Program. We included patients ≤21 years of age initiated on statins between September 2010 and March 2014. The primary outcome was first achieving goal LDL-C, defined as <130 mg/dL, or <100 mg/dL with high-level risk factors (eg, diabetes, etc). Cox proportional hazards models were used to assess the impact of baseline clinical and lifestyle factors. RESULTS: Among the 1521 pediatric patients evaluated in 3813 clinical encounters over 3.5 years, 97 patients (6.3%) were started on statin therapy and had follow-up data (median age 14 [IQR 7] years, 54% were female, and 24% obese, 62% with at least one lifestyle risk factor). The median baseline LDL-C was 215 (IQR 78) mg/dL, and median follow-up after starting statin was 1 (IQR 1.3) year. The cumulative probability of achieving LDL-C goal within 1 year was 60% (95% CI 47-69). A lower probability of achieving LDL-C goals was associated with male sex (HR 0.5 [95% CI 0.3-0.8]) and higher baseline LDL-C (HR 0.92 [95% CI 0.87-0.98] per 10 mg/dL), but not age, body mass index percentile, lifestyle factors, or family history. CONCLUSIONS: The majority of pediatric patients started on statins reached LDL-C treatment goals within 1 year. Male patients and those with greater baseline LDL-C were less likely to be successful and may require increased support.
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LDL-Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Adolescente , Boston , Niño , Femenino , Humanos , Masculino , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de RiesgoRESUMEN
STUDY OBJECTIVES: To examine the association between race/ethnicity and sleep curtailment from infancy to mid-childhood, and to determine the extent to which socioeconomic and contextual factors both explain racial/ethnic differences and are independently associated with sleep curtailment. METHODS: We studied 1,288 children longitudinally in Project Viva, a pre-birth cohort study, from 6 months to 7 years of age. The main exposure was the child's race/ethnicity. The main outcome was a sleep curtailment score from 6 months to 7 years. The score ranged from 0-13, where 0 indicated maximal sleep curtailment and 13 indicated never having curtailed sleep. RESULTS: The mean (standard deviation) sleep curtailment score was 10.2 (2.7) points. In adjusted models (ß [95% CI]), black (-1.92, [-2.39, -1.45] points), Hispanic (-1.58, [-2.43, -0.72] points), and Asian (-1.71, [-2.55, -0.86] points) children had lower sleep scores than white children. Adjustment for sociodemographic covariates attenuated racial/ethnic differences in sleep scores for black (by 24%) and Hispanic children (by 32%) but strengthened the differences for Asian children by 14%. Further adjustment for environmental and behavioral variables did not substantially change these differences. Independently, low maternal education, living in households with incomes < $70,000, viewing more TV, and having a TV in the child's bedroom were associated with lower sleep scores. CONCLUSIONS: Chronic sleep curtailment from infancy to mid-childhood was more prevalent among black, Hispanic, and Asian children. These differences were partially but not entirely explained by socio-contextual variables. Independently, children from lower socioeconomic status and those with greater exposures to TV also had greater sleep curtailment.
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Etnicidad , Disparidades en el Estado de Salud , Privación de Sueño/etiología , Clase Social , Negro o Afroamericano , Asiático , Niño , Preescolar , Enfermedad Crónica , Femenino , Hispánicos o Latinos , Humanos , Lactante , Estudios Longitudinales , Masculino , Massachusetts/epidemiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Privación de Sueño/economía , Privación de Sueño/etnología , Población BlancaRESUMEN
OBJECTIVE: To examine associations of birth size and weight gain during 4 early-life age intervals with midchildhood adiposity and metabolic profile and to evaluate for an interaction between birth size and early-life weight gain. STUDY DESIGN: Using data from 963 participants of Project Viva, a US prebirth cohort, we used multivariable linear regression to examine relations of birth size (tertiles of birthweight-for-gestational-age z-score) and weight gain (body mass index z-score [BMIZ] change) during 4 age intervals (birth-6 months, 6 months-1 year, 1-2 years, 2-3 years) with body composition and metabolic biomarkers during midchildhood (6.6-10.7 years). RESULTS: After accounting for confounders and previous growth, greater BMIZ change during all 4 age intervals corresponded with higher midchildhood adiposity, with larger effect sizes for later (1-2 years and 2-3 years) vs earlier (birth-6 months and 6 months-1 year) time frames. We observed effect modification by birth size for the birth-6 months and 6 months-1 year intervals. Greater birth-6 months BMIZ change was associated with higher overall adiposity (0.40 [95% CI 0.29, 0.51] kg dual x-ray absorptiometry total fat mass per z-score) among children in the highest birth size tertile. Similar associations were observed for central adiposity. Each increment in 6 months-1 year BMIZ change corresponded with 0.55 (0.05, 1.05) units higher homeostatic model assessment of insulin resistance and 2.68 (0.96, 4.40) ng/mL higher leptin among the smallest infants. CONCLUSIONS: BMIZ gain after 1 year is associated with greater midchildhood adiposity regardless of birth size, whereas the long-term influence of weight gain during the first postnatal year may depend on size at birth. Future studies are warranted to validate findings and examine relations with conventional birth size cut-offs.
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Adiposidad , Peso al Nacer , Resistencia a la Insulina , Leptina/sangre , Aumento de Peso , Absorciometría de Fotón , Biomarcadores/sangre , Composición Corporal , Índice de Masa Corporal , Niño , Preescolar , Estudios de Cohortes , Humanos , Lactante , Recién Nacido , Análisis MultivarianteRESUMEN
OBJECTIVE: To determine the relationship between household chaos and substance use, sexual activity, and violence-related risk behaviors in adolescents. STUDY DESIGN: We analyzed cross-sectional data among 929 high-school students in Los Angeles who completed a 90-minute interview that assessed health behaviors and household chaos with the 14-question Chaos, Hubbub, and Order Scale (CHAOS). Using the generalized estimating equation and adjusting for personal, parental, and family covariates, we examined associations of CHAOS score with substance use, sexual activity, and violent behavior outcome variables. We also examined the role of depression and school engagement as mediators. RESULTS: Mean (SD) age of the 929 students was 16.4 (1.3) years, 516 (55%) were female, and 780 (84%) were Latino. After adjustment, compared with students with CHAOS score 0, those students with the greatest scores (5-14) had ORs of 3.1 (95% CI 1.1-8.7) for smoking, 2.6 (95% CI 1.6-4.4) for drinking, 6.1 (95% CI 1.8-21) for substance use at school, and 1.9 (95% CI 1.1-3.3) for fighting in the past 12 months. Associations between CHAOS score and sexual risk and other violent behaviors were not significant. Depression and school engagement attenuated the associations. CONCLUSIONS: In this group of adolescents, greatest CHAOS score was associated with increased odds of risky health behaviors, with depression and school engagement as potential mediators. In the future, CHAOS score could be measured to assess risk for such behaviors or be a target for intervention to reduce chances of engaging in these behaviors.
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Conducta del Adolescente/psicología , Conductas Relacionadas con la Salud , Asunción de Riesgos , Estudiantes/psicología , Adolescente , Estudios Transversales , Femenino , Humanos , Los Angeles , Masculino , Factores de Riesgo , Instituciones AcadémicasRESUMEN
Evidence from observational studies has suggested that breastfeeding may reduce the prevalence of obesity in later life...
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Femenino , Humanos , Lactante , Estadística como Asunto , Aumento de Peso , Nutrición del Niño , Salud InfantilRESUMEN
Previous studies have found that breastfeeding may protect infants against future overweight...
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Masculino , Femenino , Humanos , Recién Nacido , Lactante , Lactancia Materna , Bienestar del Lactante , Obesidad Infantil , Conducta AlimentariaRESUMEN
BACKGROUND: Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. METHODS: We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. RESULTS: 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. CONCLUSIONS: Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. TRIAL REGISTRATION: ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.
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Obesidad/prevención & control , Índice de Masa Corporal , Preescolar , Método Doble Ciego , Estudios de Factibilidad , Femenino , Humanos , Masculino , México , Proyectos Piloto , Factores de Tiempo , Salud UrbanaRESUMEN
OBJECTIVE: To examine trade-offs between cognitive outcome and overweight/obesity in preterm-born infants at school age and young adulthood in relation to weight gain and linear growth during infancy. STUDY DESIGN: We studied 945 participants in the Infant Health and Development Program, an 8-center study of preterm (≤37 weeks gestational age), low birth weight (≤2500 g) infants from birth to age 18 years. Adjusting for maternal and child factors in logistic regression, we estimated the odds of overweight/obesity (body mass index [BMI] ≥85th percentile at age 8 or ≥25 kg/m(2) at age 18) and in separate models, low IQ (<85) per z-score changes in infant length and BMI from term to 4 months, from 4 to 12 months, and from 12 to 18 months. RESULTS: More rapid linear growth from term to 4 months was associated with lower odds of IQ <85 at age 8 years (OR, 0.82; 95% CI, 0.70-0.96), but higher odds of overweight/obesity (OR, 1.27; 95% CI, 1.05-1.53). More rapid BMI gain in all 3 infant time intervals was also associated with higher odds of overweight/obesity, and BMI gain from 4-12 months was associated with lower odds of IQ <85 at age 8. Results at age 18 were similar. CONCLUSION: In these preterm, low birth weight infants born in the 1980s, faster linear growth soon after term was associated with better cognition, but also with a greater risk of overweight/obesity at age 8 years and 18 years. BMI gain over the entire 18 months after term was associated with later risk of overweight/obesity, with less evidence of a benefit for IQ.
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Peso Corporal , Crecimiento , Inteligencia , Aumento de Peso , Adiposidad , Adolescente , Índice de Masa Corporal , Niño , Estudios de Seguimiento , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Obesidad/epidemiología , Sobrepeso/epidemiologíaRESUMEN
OBJECTIVE: The purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico. DESIGN: For this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards. SETTING: Menus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico. SUBJECTS: There were fifty-four distinct menus for children aged 46 months, 79 months, 1012 months, 1323 months, 2447 months and 4872 months. RESULTS: Menus included a variety of foods meeting minimum MyPlate recommendations for each food category except whole grains for children aged 4872 months. Menus listed excessive amounts of high-energy beverages, including full-fat milk, fruit juice and sugar-sweetened beverages for children of all ages. The mean daily energy content of menu items yielded an average of 2?76 MJ for infants, 4.77 MJ for children aged 1323 months, 5.36 MJ for children aged 2447 months and 5.87 MJ for children aged 4872 months. Foods and beverages on menus provided sufficient grams of carbohydrate and fat, but excessive protein. CONCLUSIONS: Menus provided a variety of foods but excessive energy. Whole grains were limited, and high-energy beverages were prevalent. Both may be appropriate targets for nutrition intervention. Future studies should move beyond menus and assess what children actually consume in child care.
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Guarderías Infantiles , Dieta/normas , Servicios de Alimentación , Valor Nutritivo , Niño , Preescolar , Estudios Transversales , Ingestión de Energía , Humanos , Lactante , México , Tamaño de la PorciónRESUMEN
OBJECTIVE: To determine the extent to which fetal weight during mid-pregnancy and fetal weight gain from mid-pregnancy to birth predict adiposity and blood pressure (BP) at age 3 years. STUDY DESIGN: Among 438 children in the Project Viva cohort, we estimated fetal weight at 16-20 (median 18) weeks' gestation using ultrasound biometry measures. We analyzed fetal weight gain as change in quartile of weight from the second trimester until birth, and we measured height, weight, subscapular and triceps skinfold thicknesses, and BP at age 3. RESULTS: Mean (SD) estimated weight at 16-20 weeks was 234 (30) g and birth weight was 3518 (420) g. In adjusted models, weight estimated during the second trimester and at birth were associated with higher body mass index (BMI) z-scores at age 3 years (0.32 unit [95% CI, 0.04-0.60 unit] and 0.53 unit [95% CI, 0.24-0.81 unit] for the highest vs lowest quartile of weight). Infants with more rapid fetal weight gain and those who remained large from mid-pregnancy to birth had higher BMI z-scores (0.85 unit [95% CI, 0.30-1.39 unit] and 0.63 unit [95% CI, 0.17-1.09 unit], respectively) at age 3 than did infants who remained small during fetal life. We did not find associations between our main predictors and sum or ratio of subscapular and triceps skinfold thicknesses or systolic BP. CONCLUSION: More rapid fetal weight gain and persistently high fetal weight during the second half of gestation predicted higher BMI z-score at age 3 years. The rate of fetal weight gain throughout pregnancy may be important for future risk of adiposity in childhood.
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Obesidad/diagnóstico , Biometría , Peso al Nacer , Presión Sanguínea , Índice de Masa Corporal , Peso Corporal , Preescolar , Estudios de Cohortes , Femenino , Peso Fetal , Humanos , Recién Nacido , Masculino , Análisis Multivariante , Obesidad/etiología , Embarazo , Ultrasonografía Prenatal/métodos , Aumento de PesoRESUMEN
BACKGROUND: The purpose of this study was to examine Mexican caregivers' perceptions of the role of primary care in childhood obesity management, understand the barriers and facilitators of behavior change, and identify opportunities to strengthen obesity prevention and treatment in clinical settings. METHODS: We conducted 52 in-depth interviews with parents and caregivers of overweight and obese children age 2-5 years in 4 Ministry of Health (public, low SES) and 4 Social Security Institute (insured, higher SES) primary care clinics in Mexico City and did systematic thematic analysis. RESULTS: In both health systems, caregivers acknowledged childhood overweight but not its adverse health consequences. Although the majority of parents had not received nutrition or physical activity recommendations from health providers, many were open to clinician guidance. Despite knowledge of healthful nutrition and physical activity, parents identified several barriers to change including child feeding occurring in the context of competing priorities (work schedules, spouses' food preferences), and cultural norms (heavy as healthy, food as nurturance) that take precedence over adherence to dietary guidelines. Physical activity, while viewed favorably, is not a structured part of most preschooler's routines as reported by parents. CONCLUSIONS: The likelihood of success for clinic-based obesity prevention among Mexican preschoolers will be higher by addressing contextual barriers such as cultural norms regarding children's weight and support of family members for behavior change. Similarities in caregivers' perceptions across 2 health systems highlight the possibility of developing comprehensive interventions for the population as a whole.
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OBJECTIVE: To determine the extent to which known prenatal and perinatal predictors of childhood obesity also predict weight gain in early infancy. STUDY DESIGN: We studied 690 infants participating in the prospective cohort Project Viva. We measured length and weight at birth and at 6 months. Using multivariable linear regression, we examined relationships of selected maternal and infant factors with change in weight-for-length z-score (WFL-z) from 0 to 6 months. RESULTS: Mean (standard deviation) change in WFL-z from 0 to 6 months was 0.23 (1.11), which translates to 4500 grams gained from birth to 6 months of life in an infant with average birth weight and length. After adjustment for confounding variables and birth weight-for-gestational age z-score (-0.28 [95% confidence interval, -0.37, -0.19] per unit), cord blood leptin (-0.40 [95%confidence interval, -0.61, -0.19] per 10 ng/mL), and gestational diabetes -0.50 [95%confidence interval, -0.88, -0.11] versus normal glucose tolerance)were each associated with slower gain in WFL-z from 0 to 6 months. CONCLUSIONS: Higher neonatal leptin and gestational diabetes predicted slower weight gain in the first 6 months of life. The hormonal milieu of the intrauterine environment may determine growth patterns in early infancy and thus later obesity.
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Glucemia/análisis , Diabetes Gestacional/sangre , Sangre Fetal/química , Leptina/sangre , Aumento de Peso/fisiología , Biomarcadores/sangre , Estatura , Índice de Masa Corporal , Desarrollo Infantil/fisiología , Estudios de Cohortes , Intervalos de Confianza , Diabetes Gestacional/fisiopatología , Femenino , Estudios de Seguimiento , Edad Gestacional , Intolerancia a la Glucosa , Prueba de Tolerancia a la Glucosa , Humanos , Lactante , Recién Nacido , Masculino , Análisis Multivariante , Oportunidad Relativa , Valor Predictivo de las Pruebas , Embarazo , Estudios Prospectivos , Análisis de Regresión , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
OBJECTIVE: To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, "screen-and-treat," and population-wide strategies to lower the entire BP distribution. STUDY DESIGN: We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999-2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). RESULTS: Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18000/QALY [boys] and $47000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/QALY [girls]) and increasing physical education ($11000/QALY [boys] and $35000/QALY [girls]). CONCLUSIONS: Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel.
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Enfermedad Coronaria/prevención & control , Ahorro de Costo , Hipertensión/economía , Hipertensión/epidemiología , Tamizaje Masivo/economía , Adolescente , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea , Estudios de Cohortes , Enfermedad Coronaria/economía , Análisis Costo-Beneficio , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Cadenas de Markov , Tamizaje Masivo/métodos , Evaluación de Programas y Proyectos de Salud , Años de Vida Ajustados por Calidad de Vida , Medición de Riesgo , Estados UnidosRESUMEN
We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene-environment and gene-obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.
RESUMEN
We describe the approach taken by the National Children's Study (NCS) to understanding the role of environmental factors in the development of obesity. We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including geneenvironment and geneobesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.
Descrevemos a abordagem do National Children's Study (NCS) para entender o papel dos fatores ambientais no desenvolvimento da obesidade. Revisamos a literatura a respeito de duas hipóteses principais no NCS que se relacionam a origens ambientais da obesidade e descrevem estratégias que serão utilizadas para testar cada hipótese. Apesar de estar claro que a obesidade em um indivíduo é resultado de um desequilíbrio entre consumo e gasto de energia, o controle da epidemia de obesidade requer o entendimento de fatores no ambiente moderno e exposições químicas que podem ter a capacidade de interromper a ligação entre o consumo e gasto de energia. Através da aceitação da abordagem do curso de vida a epidemiologia, o NCS será capaz de estudar as origens da obesidade da preconcepção ao final da adolescência, incluindo fatores que vão da herança genética a comportamentos individuais, passando pelo ambiente social, construído e natural e exposições químicas. O estudo terá poder estatístico suficiente para examinar as interações entre essas influências múltiplas, incluindo interações entre gene-ambiente e gene-obesidade. Um benefício secundário importante será derivado do banco de espécime para análise futura.
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Estilo de Vida , Ejercicio Físico , Obesidad/epidemiología , Obesidad/etiología , Salud InfantilRESUMEN
OBJECTIVES: Our aim was to determine the extent to which infant growth-in weight-for-length-from birth to 6 months is associated with systolic blood pressure (SBP) at 3 years and to determine whether this association varies with birth size. STUDY DESIGN: In 530 children from the prospective cohort Project Viva, we measured birth length and 6-month weight and length with research standard instruments and SBP at age 3 years with a Dinamap automated recorder. We derived weight-for-length z-scores (WFL-z) and analyzed data with mixed effects regression models. RESULTS: The mean (SD) WFL-z was 0.47 (0.75) at birth and 0.70 (0.96) at 6 months. Mean (SD) SBP at 3 years was 91.7 (9.4) mm Hg. After adjusting for confounding variables and birth WFL-z, child SBP was 1.0 mm Hg (95% CI 0.2, 1.8) higher for each z-score increment in 6-month WFL-z. The SBP of children in the lowest birth WFL-z quartile and the highest 6-month WFL-z quartile was 5.5 mm Hg (95% CI 2.6, 8.4) higher than that of children in the highest birth and lowest 6-month WFL-z quartiles. CONCLUSIONS: More rapid increase in weight-for-length, a measure of adiposity, in the first 6 months of life is associated with higher early childhood SBP, particularly in children who are thin at birth.