R. von Kries

Breast-feeding and childhood obesity—a systematic review

OBJECTIVE: To investigate the relationship between breast-feeding and obesity in childhood.DESIGN: Systematic review and meta-analysis of published epidemiological studies (cohort, case–control or cross-sectional studies) comparing early feeding-mode and adjusting for potential confounding factors. Electronic databases were searched and reference lists of relevant articles were checked. Calculations of pooled estimates were conducted in fixed- and random-effects models. Heterogeneity was tested by Q-test. Publication bias was assessed from funnel plots and by a linear regression method.OUTCOME MEASURES: Odds ratio (OR) for obesity in childhood defined as body mass index (BMI) percentiles.RESULTS: Nine studies with more than 69 000 participants met the inclusion criteria. The meta-analysis showed that breast-feeding reduced the risk of obesity in childhood significantly. The adjusted odds ratio was 0.78, 95% CI (0.71, 0.85) in the fixed model. The assumption of homogeneity of results of the included studies could not be refuted (Q-test for heterogeneity, P>0.3), stratified analyses showed no differences regarding different study types, age groups, definition of breast-feeding or obesity and number of confounding factors adjusted for. A dose-dependent effect of breast-feeding duration on the prevalence of obesity was reported in four studies. Funnel plot regression gave no indication of publication bias.CONCLUSION: Breast-feeding seems to have a small but consistent protective effect against obesity in children.

Neonatal symptomatic thromboembolism in Germany: two year survey

AIMS To determine the incidence of neonatal thromboembolism in Germany. METHODS Diagnostic imaging techniques, therapeutic modalities, and short term outcome were evaluated in a prospective nationwide two year case registry study. RESULTS The reported incidence of symptomatic neonatal thromboembolism, diagnosed in most cases with Doppler ultrasonography, was 5.1 per 100 000 births, with a total of 79 cases registered: renal venous thrombosis (n=35); venous thrombosis (n=25); and arterial vascular occlusion (n=19). Fifty seven of 79 thromboses were associated with additional risk factors (central line n=25, asphyxia n=13, septicaemia n=11, dehydration n=6, maternal diabetes n=2, cardiac disease n=1). Inherited thrombophilia was also diagnosed in seven out of 35 cases investigated. Twenty three children received supportive treatment: 42 received heparin and in 13 neonates thrombolytic agents were administered. Most neonates (91%) survived; seven died. CONCLUSION Controlled multicentre studies are needed to obtain more information on treatment efficacy.

Reduced risk for overweight and obesity in 5- and 6-y-old children by duration of sleep--a cross-sectional study.

Objective: To assess the relationship between sleep duration and adiposity in 5- and 6-y-old Bavarian children.Design: Cross-sectional study.Subjects: A total of 6862 German children aged 5–6 y participating in the obligatory health examination in Bavaria, southern Germany.Measurements: Routine data were collected on the height and weight of children at the time of school entry in six public health offices in 1999 and in another two in 2000. Body fat mass was estimated by BIA performed in three of those offices. An extensive questionnaire was given to all childrens parents in order to assess risk factors for overweight and obesity. The main outcome measures were overweight, defined by a body mass index (BMI) above the 90th centile and obesity, defined by a BMI above the 97th centile for the German children in Bavaria. Excessive body fat was defined as fat mass above the 90th centile for all German children seen in this survey. The main exposure was usual sleeping hours on week days.Results: The prevalence of obesity decreased by duration of sleep: ≤10 h, 5.4% (95% CI 4.1–7.0), 10.5–11.0 h, 2.8% (95% CI 2.3–3.3), and ≥11.5 h, 2.1% (95% CI 1.5–2.9). Similar relations were found with the prevalence of overweight and excessive body fat. These effects could not be explained by confounding due to a wide range of constitutional, sociodemographic and lifestyle factors. The adjusted odds ratio for obesity were: for sleeping 10.5–11.0 h, 0.52 (95% CI 0.34–0.78) and 0.46 (95% CI 0.28–0.75) for sleeping 11.5 h.Conclusion: The effect of sleep duration on obesity in children reflects a higher body fat composition and appears to be independent of other risk factors for childhood obesity.

Early determinants of childhood overweight and adiposity in a birth cohort study: role of breast-feeding

BACKGROUND: The prevalence of adiposity in childhood is increasing. Is breast-feeding protective as suggested by cross-sectional studies?OBJECTIVE: In a longitudinal birth cohort study, we tested whether breast-feeding for more than 2 months has preventive effects against overweight and adiposity at 6 y.DESIGN: Of 1314 children representing the catchment areas of six delivery units, 918 could be followed up to the age of 6 y. Height, weight, and skin-fold thickness were measured at regular visits. As the criteria of overweight, obesity, and adiposity in the children, the 90th and the 97th percentiles of BMI and skin-fold values were used. Parents with a BMI at or above the 90th percentile, which was 27 kg/m2 or more, were considered overweight. Infants bottle-fed from birth or breast-fed for less than 3 months were classified as ‘bottle-fed’ (BO), and those breast-fed for 3 months and more as ‘breast-fed’ (BR). Univariate comparisons and logistic regression analysis were performed applying SAS 6.12. The final logistic model consisted of the 480 cases for whom complete data for all variables were available. The potential effect of loss to follow-up was analysed by the Cochran–Mantel–Haenzel test: the outcomes were not significantly influenced by loss to follow-up.RESULTS: At birth BMIs were nearly identical in both groups. By 3 months, BO had significantly higher BMIs and thicker skin folds than BR. From 6 months on, compared to BR, a consistently higher proportion of BO children exceeded the 90th and the 97th percentile of BMI and skin-fold thickness reference values. From the age of 4 y to 5 and 6 y, in BO the prevalence of obesity nearly doubled and tripled, respectively. With only minor changes of obesity prevalence in BR, the difference of BMI and skin-fold thickness between groups became statistically significant. Logistic regression analysis revealed that overweight of the mother, maternal smoking during pregnancy, bottle feeding, and low social status remained important risk factors for overweight and adiposity at 6 y of age.CONCLUSION: A maternal BMI of ≥27, bottle-feeding, maternal smoking during pregnancy, and low social status are risk factors for overweight and adiposity at 6 y of age. Early bottle-feeding brings forward the obesity rebound, predictive of obesity in later life.

Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997

OBJECTIVE: To examine the prevalence of overweight and obesity in the entire population of 5- and 6-y-old children entering school in Germany, Bavaria, and to assess time trends over the last 15 y and the impact of ethnicity.DESIGN: Cross-sectional studies were based on the obligatory school entry health examinations: all health districts of Bavaria in 1997 (n=127 735); three health districts every 5 y from 1982 to 1997 (n=16 281).MEASUREMENTS: Body mass index (BMI; kg/m2) was calculated and the prevalence of overweight and obesity was defined based on national and international agreed cut-off points. Ethnicity was measured as German and non-German nationality.RESULTS: The prevalence of overweight and obese children as defined by international reference values was 9.4 and 3.1% for 5-y-old boys, 10.0 and 2.9% for 6-y-old boys, 12.2 and 3.3% for 5-y-old girls and 12.4 and 3.3% for 6-y-old girls. The whole BMI distribution in non-German children compared to German children was shifted to the right with median values in non-German children 0.3–0.5 kg/m2 higher. In these the prevalence of overweight/obesity was 1.9/2.4 times higher for boys and 1.5/1.9 times higher for girls. The time trend between 1982 and 1997 shows an increase of the BMI distribution in the upper percentiles, whereas the lower percentiles did not change substantially. The increased prevalences of overweight/obesity for both sexes as defined by international references increased from 8.5/1.8% in 1982 to 12.3/2.8% in 1997.CONCLUSION: This large study on all children entering school in Bavaria in 1997 shows patterns of overweight and obesity which are comparable with other European data but are lower than US and Australian data. Increasing prevalences since 1982 indicate that overweight and obesity in children are of increasing public health importance in Bavaria. The upwards shift of the BMI distribution in non-German children needs further investigation.

Is obesity a risk factor for childhood asthma

Background: In adolescents and adults, an association between obesity and asthma was found in females. Does this sex‐specific association already exist in young children?

Prevention of vitamin K deficiency bleeding: efficacy of different multiple oral dose schedules of vitamin K.

Abstract There is consensus that late vitamin K deficiency bleeding (VKDB) should be prevented by vitamin K prophylaxis. One single dose of 1 mg vitamin K1 is effective if given i.m. or s.c., but not if given orally. Repeated oral doses might be as effective as the parenteral dose but the optimal dose regimen remains to be established. Different oral dose schedules are presently used in different countries. In Australia, Germany, The Netherlands and Switzerland active surveillance data on late VKDB were collected in a similar manner and failure rates compared. Identical case definitions were used. There were three basic strategies for oral and one for parenteral vitamin K prophylaxis for healthy newborns in the four countries: (1) daily supplementation of low dose vitamin K (25 μg) for breast-fed infants (The Netherlands); (2) 3 × 1 mg orally [Australia (January 1993 – March 1994) and Germany (December 1992 – December 1994)]; (3) 1 mg vitamin K i.m. (Australia since March 1994); and (4) 2 × 2 mg vitamin K (new mixed micellar preparation) (Switzerland). The respective failure rates per 100,000 live births (including cases given all recommended doses and those given incomplete prophylaxis) were for strategy: (1) 0.2 (0–1.3) in The Netherlands; (2) 2.3 (95% CI 1.6–3.4) in Germany and 2.5 (1.1–4.8) in Australia (oral prophylaxis); (3) Australia (i.m. prophylaxis) 0 (0–0.9); and (4) 3.6 (0.7–10.6) in Switzerland. The failure rates for complete prophylaxis only were: strategy (1) 0 (0–0.7) in The Netherlands; (2) 1.8 (1.1–2.8) in Germany and 1.5 (0.5–3.6) in Australia; (3) Australia (i.m.) 0 (0–0.9); and (4) 1.2 (0–6.5) in Switzerland. Conclusions The Australian data confirm that three oral doses of 1 mg vitamin K are less effective than i.m. vitamin K prophylaxis. A daily low oral dose of 25 μg vitamin K1 following an initial oral dose of 1 mg after birth for exclusively breast-fed infants may be as effective as parenteral vitamin K prophylaxis. The effectiveness of the “mixed-micellar” preparation of vitamin K1 needs further study.

Physical activity and gestational weight gain: a meta‐analysis of intervention trials

Please cite this paper as: Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, von Kries R. Physical activity and gestational weight gain: a meta‐analysis of intervention trials. BJOG 2011;118:278–284.

Genetic risk factors of thrombophilia in ischaemic childhood stroke of cardiac origin. A prospective ESPED survey

Abstract Ischaemic stroke is a rare event in childhood. In approximately one-fourth of cases an underlying cardiac disease can be detected. We investigated the importance of genetic risk factors of venous thromboembolism in childhood or stroke in adulthood as risk factors for ischaemic stroke in children in a multicentre survey focusing on patients with a cardiac disease. 38 of 162 white infants and children (neonate – 18 years) with ischaemic stroke were suffering from a cardiac disorder. An age-matched group of 100 children from the same geographic areas as the patients served as controls. Patients and controls were analysed for increased lipoprotein (a) levels >30 mg/dl, for the presence of the factor V (FV) G1691A mutation, the prothrombin (PT) G20210 A variant, and deficiencies of protein C, protein S, and antithrombin. The following frequencies (patients vs. controls), odds ratios (OR) and confidence intervals (CI) of single risk factors were found: Lp(a) >30 mg/dl (18.4% vs. 5%; OR/CI: 4.3/1.3–14.4; p = 0.03), FV G1691A (13.2% vs. 4%; OR/CI 3.63/0.92–14.3; p = 0.12) protein C type I deficiency (15.8% vs. 1%; OR/CI: 18.5/2.15–16.0; p = 0.0017), anticardiolipin antibodies (10.5% vs. 0%; p = 0.0051). No protein S or antithrombin deficiency was found. Combinations of haemostatic disorders were found in 10.5% of cases but in none of the controls (Fisher 0.005). Conclusion While FV G1691A and prothrombin G20210 A mutations show no significant data in our study, lipoprotein (a) levels >30 mg/dl protein C deficiency, anticardiolipin antibodies and combined prothrombotic disorders seem to be important risk factors for manifestation of ischaemic strokes in children with underlying cardiac disorders.

Weight status of European preschool children and associations with family demographics and energy balance‐related behaviours: a pooled analysis of six European studies

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4–7 years); (ii) identify energy balance‐related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long‐term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers.