title: Risk factors for childhood obesity: shift of the entire BMI distribution vs. shift of the upper tail only in a cross sectional study.
abstract: BACKGROUND
  Previous studies reported an increase of upper body mass index (BMI) quantiles for formula fed infants compared to breastfed infants, while corresponding mean differences were low. The aim of this study was to assess the impact of known risk factors for childhood obesity on the BMI distribution.
  
  
  METHODS
  Data on 4,884 children were obtained at obligatory school entry health examinations in Bavaria (Germany). Exposure variables were formula feeding, maternal smoking in pregnancy, excessive TV-watching, low meal frequency, poor parental education, maternal overweight and high infant weight gain. Cumulative BMI distributions and Tukey mean-difference plots were used to assess possible shifts of BMI distributions by exposure.
  
  
  RESULTS
  Maternal overweight and high infant weight gain shifted the entire BMI-distribution with an accentuation on upper quantiles to higher BMI values. In contrast, parental education, formula feeding, high TV consumption, low meal frequency and maternal smoking in pregnancy resulted in a shift of upper quantiles only.
  
  
  CONCLUSIONS
  The single shifts among upper parts of the BMI distribution might be due to effect modification of the corresponding exposures by another environmental exposure or genetic predisposition. Affected individuals might represent a susceptible subpopulation of the exposed.
authors.affiliation: King's College London, Division of Health and Social Care Research, Department of Public Health Sciences, 7th Floor Capital House, 42 Weston St, London, SE1 3QD, UK. michael.toschke@kcl.ac.uk
authors.forename: André M
authors.initials: AM
authors.lastname: Toschke
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
authors.forename: Andreas
authors.initials: A
authors.lastname: Beyerlein
authors.forename: Simon
authors.initials: S
authors.lastname: Rückinger
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D041943:Infant Formula; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D010290:Parents; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013690:Television; D015430:Weight Gain