title: Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention.
abstract: BACKGROUND
  Early life may be a "critical period" when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk. Insight into the potential impact of modifying early-life risk factors on later obesity can be gained by evaluating their combined effects.
  
  
  OBJECTIVE
  The objective was to examine the relation between the number of early-life risk factors and obesity outcomes among children in a prospective birth cohort (Southampton Women's Survey).
  
  
  METHODS
  Five risk factors were defined: maternal obesity [prepregnant body mass index (BMI; in kg/m(2)) >30], excess gestational weight gain (Institute of Medicine, 2009), smoking during pregnancy, low maternal vitamin D status (<64 nmol/L), and short duration of breastfeeding (none or <1 mo). Obesity outcomes examined when the children were aged 4 and 6 y were BMI, dual-energy X-ray absorptiometry-assessed fat mass, overweight, or obesity (International Obesity Task Force). Data were available for 991 mother-child pairs, with children born between 1998 and 2003.
  
  
  RESULTS
  Of the children, 148 (15%) had no early-life risk factors, 330 (33%) had 1, 296 (30%) had 2, 160 (16%) had 3, and 57 (6%) had 4 or 5. At both 4 and 6 y, there were positive graded associations between number of early-life risk factors and each obesity outcome (all P < 0.001). After taking account of confounders, the relative risk of being overweight or obese for children who had 4 or 5 risk factors was 3.99 (95% CI: 1.83, 8.67) at 4 y and 4.65 (95% CI: 2.29, 9.43) at 6 y compared with children who had none (both P < 0.001).
  
  
  CONCLUSIONS
  Having a greater number of early-life risk factors was associated with large differences in adiposity and risk of overweight and obesity in later childhood. These findings suggest that early intervention to change these modifiable risk factors could make a significant contribution to the prevention of childhood obesity.
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Siân M
authors: SM
authors: Robinson
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Sarah R
authors: SR
authors: Crozier
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Nicholas C
authors: NC
authors: Harvey
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Benjamin D
authors: BD
authors: Barton
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Catherine M
authors: CM
authors: Law
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Keith M
authors: KM
authors: Godfrey
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Cyrus
authors: C
authors: Cooper
authors: From the Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom (SMR, SRC, NCH, BDB, KMG, CC, and HMI); the National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and Southampton University Hospitals NHS Trust, Southampton, United Kingdom (SMR, NCH, KMG, and CC); NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom (CC); and UCL Institute of Child Health, London, United Kingdom (CML).
authors: Hazel M
authors: HM
authors: Inskip
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016014:Linear Models; D039382:Maternal Nutritional Physiological Phenomena; D009752:Nutritional Status; D050177:Overweight / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood; D015430:Weight Gain
chemical_list: D014807:Vitamin D
keywords: adiposity; childhood obesity; early life; lifecourse; obesity; prevention
references: Obes Rev. 2004 May;5 Suppl 1:4-104
references: 15096099
references: Am J Clin Nutr. 2010 Jun;91(6):1745-51
references: 20375187
references: Am J Epidemiol. 1998 Jul 1;148(1):4-16
references: 9663397
references: Cochrane Database Syst Rev. 2011;(12):CD001871
references: 22161367
references: Matern Child Nutr. 2011 Jan;7(1):3-26
references: 21143583
references: Pediatrics. 2013 Aug;132(2):e414-21
references: 23858427
references: Am J Clin Nutr. 1999 Feb;69(2):243-9
references: 9989687
references: BMJ. 2000 May 6;320(7244):1240-3
references: 10797032
references: Am J Clin Nutr. 2012 Jul;96(1):57-63
references: 22623747
references: Obesity (Silver Spring). 2008 Jul;16(7):1651-6
references: 18451768
references: Proc Nutr Soc. 2011 Nov;70(4):478-84
references: 21801475
references: J Clin Endocrinol Metab. 2009 Aug;94(8):2799-805
references: 19435826
references: Matern Child Nutr. 2014 Apr;10(2):166-83
references: 22905677
references: Am J Clin Nutr. 2011 Mar;93(3):628-35
references: 21228264
references: Matern Child Nutr. 2011 Jan;7(1):61-70
references: 21143586
references: Int J Epidemiol. 2006 Feb;35(1):42-8
references: 16195252
references: BMC Med Res Methodol. 2003 Oct 20;3:21
references: 14567763
references: Am J Clin Nutr. 2014 Jun;99(6):1281-3
references: 24808493
references: BMC Pregnancy Childbirth. 2011;11:81
references: 22029725
references: Ann Hum Biol. 2012 Jan;39(1):59-67
references: 22148930
references: Br J Nutr. 2011 Jan;105(2):287-96
references: 20807465
references: Int J Obes Relat Metab Disord. 2004 Oct;28(10):1247-56
references: 15314625
references: Cochrane Database Syst Rev. 2013;7:CD005627
references: 23881656
references: Obes Rev. 2014 Apr;15(4):338-47
references: 24321007
references: PLoS One. 2014;9(6):e100686
references: 24955586
references: J Pediatr. 1998 May;132(5):768-76
references: 9602184
references: BMJ. 2012;344:e2088
references: 22596383
references: Soc Sci Med. 1997 Mar;44(6):809-19
references: 9080564
references: Int J Obes (Lond). 2008 Dec;32 Suppl 6:S4-10
references: 19079279
references: Int J Obes (Lond). 2013 Oct;37(10):1295-306
references: 23736360
references: PLoS One. 2012;7(11):e49919
references: 23209618
references: Cochrane Database Syst Rev. 2012;5:CD001141
references: 22592675
references: J Pediatr. 2006 Aug;149(2):185-91
references: 16887431
references: Int J Obes (Lond). 2008 Feb;32(2):201-10
references: 18278059
references: BMJ. 2005 Jun 11;330(7504):1357
references: 15908441
references: Public Health Nutr. 2014 May;17(5):1069-77
references: 23635946
references: J Acad Nutr Diet. 2013 Jun;113(6):795-802
references: 23473986
references: J Clin Endocrinol Metab. 2007 Oct;92(10):3904-11
references: 17684051
references: Pediatrics. 2005 Dec;116(6):1329-38
references: 16322155
references: Nutr Res Rev. 2007 Jun;20(1):29-45
references: 19079859
references: J Epidemiol Community Health. 2013 Sep;67(9):715-6
references: 23486925
references: N Engl J Med. 2013 Dec 5;369(23):2173-5
references: 24224559
references: BMJ. 2009;338:b481
references: 19213768
references: Osteoporos Int. 2012 Jan;23(1):121-30
references: 21562877
references: Eur J Clin Nutr. 2006 Jan;60(1):48-57
references: 16132057
references: PLoS One. 2013;8(4):e61627
references: 23613888
references: Am J Clin Nutr. 2011 Dec;94(6 Suppl):1959S-1963S
references: 21562085