Study shows four risk factors predict childhood obesity. I might add that serving your toddler Big Macs is no help either.

OBESITY: Mother, Baby Risk Factors Predict Child's Obesity

By Todd Neale, Senior Staff Writer, MedPage Today Published: October 03, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner               ORLANDO -- Targeting four modifiable maternal and infant risk factors may make a large impact on reducing childhood obesity, researchers found. The four factors were maternal smoking during pregnancy, gestational weight gain, breastfeeding duration, and infant sleep duration, according to Matthew Gillman, MD, of Harvard Medical School in Boston. At age 7, children with adverse levels of all four risk factors had a substantially greater risk of obesity than those with healthy levels of all four (28% versus 4%). Gillman reported those findings at the Obesity Society meeting here.   "These four factors, which are potentially modifiable, explain a large proportion of obesity in childhood, and the implication is that, if we can mount interventions to change these things, we can go a long way toward preventing childhood obesity," Gillman said. Several pre- and postnatal risk factors for childhood obesity have been identified, Gillman said, but there have been few studies that have examined the predictive value of combinations of risk factors. To explore the issue, he and his colleagues turned to Project Viva, a longitudinal cohort study in Massachusetts looking at the health of women and their children. The current analysis included 948 mother-child pairs who provided information both at baseline and when the child was 7-years-old. The researchers chose to examine four factors -- all dichotomized for adverse and healthy conditions -- for their relationship with childhood obesity: Maternal smoking during pregnancy (yes/no) Gestational weight gain (excessive/not excessive) Breastfeeding duration (less than 12 months/at least 12 months) Infant sleep duration (less than 12 hours a day/at least 12 hours a day) During pregnancy, 9% of the mothers smoked and 58% gained excessive weight. Most of the infants (71%) were breastfed for less than one year and 31% slept less than 12 hours a day. All four of the risk factors were individually associated with an increased likelihood of obesity when the child was 7 (ORs 1.55 to 2.01), although the relationship reached statistical significance for infant sleep duration only (OR 2.01, 95% CI 1.24 to 3.25). Overall, 6.9% of the children had adverse levels of none of the risk factors, 36.1% had one risk factor, 40.8% had two, 14.5% had three, and 1.9% had all four. The overall rate of obesity at age 7 was 10.8%, ranging from a low of 4% for children with healthy levels of all four risk factors to a high of 28% for adverse levels of all four risk factors. Similar trends were seen for body mass index (BMI) z-score, which ranged from 0.07 to 0.79, and percent body fat, which ranged from 23.2% to 26.5%. The model was adjusted for maternal BMI and education, child race/ethnicity, and household income. Further adjustment for sugary drink intake, fast food intake, TV screen time, and physical activity did not have substantial effect on the findings. The researchers calculated that if the population shifted from having two to four of these adverse risk factors to zero or one, 55% of the cases of childhood obesity would be avoided. Gillman said that some studies of interventions to modify these factors have been performed and some are ongoing. Infant sleep is modifiable, at least on a population level, by adjusting how parents put their babies to sleep, he said. An example would be teaching parents to rock their babies until they are almost asleep, putting them in their cribs, and allowing them to put themselves to sleep, rather than rocking them until they fall sleep. More work needs to be done on reducing smoking during pregnancy, Gillman said. Most mothers will stop smoking when they know they are pregnant, but there is room for interventions for smoking cessation at or before the time of conception. Support interventions using lactation consultants have been shown to be effective for increasing the initiation and duration of breastfeeding. Although there is not one strategy proven to reduce gestational weight gain, many trials are ongoing, and Gillman said that he expects to see some consensus about effective approaches develop in the coming years. Gillman reported that he had no conflicts of interest. Primary source: The Obesity Society Source reference: Gillman M, et al "Early origins of childhood obesity: prediction, attributable risk, and potential public health impact" OBESITY 2011; Abstract 382-P.