Erika R. Cheng

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review.

CONTEXTnMounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the first 1,000 days-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.nnnEVIDENCE ACQUISITIONnPubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.nnnEVIDENCE SYNTHESISnOf 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.nnnCONCLUSIONSnModifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review.

CONTEXTnThe first 1,000 days-conception through age 24 months-are critical for the development and prevention of childhood obesity. This study systematically reviews existing and ongoing interventions during this period, identifies gaps in current research, and discusses conceptual frameworks and opportunities for future interventions.nnnEVIDENCE ACQUISITIONnPubMed, Embase, Web of Science, and ClinicalTrials.gov were searched to identify completed and ongoing interventions implemented during pregnancy through age 24 months that aimed to prevent overweight/obesity between ages 6 months and 18 years. English-language, controlled interventions published between January 1, 1980 and December 12, 2014, were analyzed between December 13, 2014 and March 15, 2015.nnnEVIDENCE SYNTHESISnOf 34 completed studies from 26 unique identified interventions, nine were effective. Effective interventions focused on individual- or family-level behavior changes through home visits, individual counseling or group sessions in clinical settings, a combination of home and group visits in a community setting, and using hydrolyzed protein formula. Protein-enriched formula increased childhood obesity risk. Forty-seven ongoing interventions were identified. Across completed and ongoing interventions, the majority target individual- or family-level changes, many are conducted in clinical settings, and few target early-life systems and policies that may impact childhood obesity.nnnCONCLUSIONSnObesity interventions may have the greatest preventive effect if begun early in life. Yet, few effective interventions in the first 1,000 days exist, and many target individual-level behaviors of parents and infants. Interventions that operate at systems levels and are grounded in salient conceptual frameworks hold promise for improving future models of early-life obesity prevention.

The role of perceived discrimination during childhood and adolescence in understanding racial and socioeconomic influences on depression in young adulthood.

OBJECTIVEnTo describe levels of perceived lifetime discrimination among young adults and determine its role in understanding this racial/ethnic disparity.nnnSTUDY DESIGNnData were from the Princeton School District study, a 10-year cohort study in which investigators followed 545 non-Hispanic black (46%) and white initial 5-12 graders. Perceived lifetime racial discrimination was assessed with the General Ethnic Discrimination Scale and depressive symptoms with the Center for Epidemiological Studies Depression Scale. Stepped linear and logistic regression analyses assessed the relationships of race/ethnicity, parental education, and quintiles of discrimination to depressive symptoms. Stratification by race/ethnicity explored differences in the role of discrimination in explaining the relationship between parental education and depressive symptoms.nnnRESULTSnBlack students from professionally educated families had the greatest discrimination scores, 1.8 times greater than among their white peers (meanblack = 42.1 vs meanwhite = 22.8; P < .0001). Greater parental education was associated with lower depressive symptoms in all regression models. Race/ethnicity became predictive of depressive symptoms only after adjusting for discrimination, which was strongly associated with depressive symptoms. Stratified analysis suggested discrimination accounted for the relationship of parental education to depressive symptoms among whites. Among black subjects, accounting for discrimination unmasked a buffering effect of parental education.nnnCONCLUSIONSnGreater levels of parent education are protective against depression for white youth. However, for black youth, greater parent education confers both risk and protective effects. The high discrimination among black youth from families with college or professionally educated parents overwhelms the protective effect of greater levels of parent education.

The Influence of Children's Cognitive Delay and Behavior Problems on Maternal Depression

OBJECTIVEnTo determine the impact of childrens cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families.nnnSTUDY DESIGNnData were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the childrens behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the childrens behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes.nnnRESULTSnAt age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the childrens behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the childrens behaviors were assessed by their primary nonparental care providers.nnnCONCLUSIONnCaring for a child with a cognitive delay influences maternal depressive symptoms in part through the childs behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the childrens behavior.

The Influence of Antenatal Partner Support on Pregnancy Outcomes.

BACKGROUNDnWhile there has been considerable attention given to the multitude of maternal factors that contribute to perinatal conditions and poor birth outcomes, few studies have aimed to understand the impact of fathers or partners. We examined associations of antenatal partner support with psychological variables, smoking behavior, and pregnancy outcomes in two socioeconomically distinct prebirth cohorts.nnnMATERIALS AND METHODSnData were from 1764 women recruited from an urban-suburban group practice (Project Viva) and 877 women from urban community health centers (Project ACCESS), both in the Boston area. Antenatal partner support was assessed by the Turner Support Scale. Multivariable linear and logistic regression analyses determined the impact of low antenatal partner support on the outcomes of interest.nnnRESULTSnIn early pregnancy, 6.4% of Viva and 23.0% of ACCESS participants reported low partner support. After adjustment, low partner support was cross-sectionally associated with high pregnancy-related anxiety in both cohorts (Viva AOR 1.8; 95% CI: 1.0-3.4 and ACCESS AOR 1.9; 95% CI: 1.1-3.3) and with depression in ACCESS (AOR 1.9; 95% CI: 1.1-3.3). In Viva, low partner support was also related to depression mid-pregnancy (AOR 3.1; 95% CI: 1.7-5.7) and to smoking (AOR 2.2; 95% CI: 1.3-3.8). Birth weight, gestational age, and fetal growth were not associated with partner support.nnnCONCLUSIONSnThis study of two economically and ethnically distinct cohorts in the Boston area highlights higher levels of antenatal anxiety, depression, and smoking among pregnant women who report low partner support. Partner support may be an important and potentially modifiable target for interventions to improve pregnancy outcomes.

Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity.

OBJECTIVESnTo determine whether proximity to a supermarket modified the effects of an obesity intervention.nnnMETHODSnWe examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier.nnnRESULTSnDistance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1-mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by -0.04 units relative to controls.nnnCONCLUSIONSnLiving closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention.

Postnatal Depressive Symptoms among Mothers and Fathers of Infants Born Preterm: Prevalence and Impacts on Children’s Early Cognitive Function

Objective: Preterm birth is associated with lower cognitive functioning. One potential pathway is postnatal parental depression. The authors assessed depressive symptoms in mothers and fathers after preterm birth, and identified the impacts of both prematurity and parental depressive symptoms on childrens early cognitive function. Method: Data were from the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 5350). Depressive symptoms at 9 months were assessed by the Center for Epidemiologic Studies Depression Scale (CESD) and childrens cognitive function at 24 months by the Bayley Short Form, Research Edition. Weighted generalized estimating equation models examined the extent to which preterm birth, and mothers and fathers postnatal depressive symptoms impacted childrens cognitive function at 24 months, and whether the association between preterm birth and 24-month cognitive function was mediated by parental depressive symptoms. Results: At 9 months, fathers of very preterm (<32 weeks gestation) and moderate/late preterm (32–37 weeks gestation) infants had higher CESD scores than fathers of term-born (≥37 weeks gestation) infants (p value = .02); preterm birth was not associated with maternal depressive symptoms. In multivariable analyses, preterm birth was associated with lower cognitive function at 24 months; this association was unaffected by adjustment for parental depressive symptoms. Fathers, but not mothers, postnatal depressive symptoms predicted lower cognitive function in the fully adjusted model (&bgr; = −0.11, 95% confidence interval, −0.18 to −0.03). Conclusion: Fathers of preterm infants have more postnatal depressive symptomology than fathers of term-born infants. Fathers depressive symptoms also negatively impact childrens early cognitive function. The national findings support early identification and treatment of fathers of preterm infants with depressive symptoms.

Association of missing paternal demographics on infant birth certificates with perinatal risk factors for childhood obesity.

BackgroundThe role of fathers in the development of obesity in their offspring remains poorly understood. We evaluated associations of missing paternal demographic information on birth certificates with perinatal risk factors for childhood obesity.MethodsData were from the Linked CENTURY Study, a database linking birth certificate and well-child visit data for 200,258 Massachusetts children from 1980–2008. We categorized participants based on the availability of paternal age, education, or race/ethnicity and maternal marital status on the birth certificate: (1) pregnancies missing paternal data; (2) pregnancies involving unmarried women with paternal data; and (3) pregnancies involving married women with paternal data. Using linear and logistic regression, we compared differences in smoking during pregnancy, gestational diabetes, birthweight, breastfeeding initiation, and ever recording a weight for length (WFL)u2009≥u2009the 95th percentile or crossing upwards ≥2 WFL percentiles between 0–24 months among the study groups.Results11,989 (6.0xa0%) birth certificates were missing paternal data; 31,323 (15.6xa0%) mothers were unmarried. In adjusted analyses, missing paternal data was associated with lower birthweight (β -0.07xa0kg; 95xa0% CI: −0.08, −0.05), smoking during pregnancy (AOR 4.40; 95xa0% CI: 3.97, 4.87), non-initiation of breastfeeding (AOR 0.39; 95 % CI: 0.36, 0.42), and with ever having a WFLu2009≥u200995th percentile (AOR 1.10; 95 % CI: 1.01, 1.20). Similar associations were noted for pregnancies involving unmarried women with paternal data, but differences were less pronounced.ConclusionsMissing paternal data on the birth certificate is associated with perinatal risk factors for childhood obesity. Efforts to understand and reduce obesity risk factors in early life may need to consider paternal factors.

Association of vitamin E intake at early childhood with alanine aminotransferase levels at mid‐childhood

The extent to which vitamin E (alpha‐tocopherol) intake early in childhood is associated with alanine aminotransferase (ALT) level later in childhood is unknown. The objective of this research is to test the hypothesis that higher alpha‐tocopherol intake during early childhood is associated with lower odds of elevated ALT levels during mid‐childhood and to examine how body mass index (BMI) influences these relationships. We studied 528 children in Project Viva. Mothers reported child dietary intake at early childhood visits (median 3.1 years) using a validated food frequency questionnaire. At mid‐childhood (median 7.6 years), we collected child blood and anthropometric data. The main outcome was elevated sex‐specific mid‐childhood ALT level (≥22.1 U/L for female children and ≥25.8 U/L for male children). In multivariable logistic regression models, we assessed the association of energy‐adjusted alpha‐tocopherol intake with ALT levels, adjusting for child age, sex, race/ethnicity, diet, and age‐adjusted sex‐specific BMI z‐score at mid‐childhood. Among children in this study, 48% were female, 63% were non‐Hispanic white, 19% were non‐Hispanic black, and 4% were Hispanic/Latino. Mean alpha‐tocopherol intake was 3.7 ± 1.0 mg/day (range, 1.4‐9.2) at early childhood. At mid‐childhood, mean BMI z‐score was 0.41 ± 1.0 units and 22% had an elevated ALT level. In multivariable‐adjusted logistic regression models, children with higher early childhood vitamin E intake had lower odds of elevated mid‐childhood ALT (adjusted odds ratio [AOR], 0.62; 95% confidence interval [CI], 0.39, 0.99) for quartiles 2‐4 compared with the lowest quartile of intake. Findings persisted after accounting for early childhood diet (AOR, 0.62; 95% CI, 0.36, 1.08) and were strengthened after additionally accounting for mid‐childhood BMI z‐score (AOR, 0.56; 95% CI, 0.32, 0.99). Conclusion: In this cohort, higher early childhood intake of alpha‐tocopherol was associated with lower odds of elevated mid‐childhood ALT level. (Hepatology 2018;67:1339‐1347).