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

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Context

Mounting 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.

Evidence acquisition

PubMed, 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.

Evidence synthesis

Of 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.

Conclusions

Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

Section snippets

Context

High obesity prevalence persists in all age groups in the U.S., and one third of U.S. children aged 2–19 years are affected by overweight or obesity (sex-specific BMI ≥85th percentile for age).1 Approximately 8.1% of U.S. children younger than age 2 years have weight-for-length ≥95th percentile, predisposing them to obesity. The first 1,000 days describes the period from conception through age 2 years, which is increasingly recognized as a critical period for development of childhood obesity

Conceptual Framework

The Glass and McAtee14 model of multi-level influences on behavior and health informed the overarching conceptual framework (Figure 1). The model outlines macro (environmental); mezzo (community); and micro (parent/family/caregiver) levels of “above water” influences, and individual-level health behaviors at the “waterline.” This study focuses on potentially modifiable risk factors for childhood obesity during two life-course stages:

  • 1.

    from conception to delivery; and

  • 2.

    from birth to age 2 years.

Evidence Synthesis

The initial search identified 5,952 articles. After screening and full-text review, a total of 282 articles met criteria for inclusion (Appendix Figure 1, available online).

Discussion

In this systematic review of nearly 300 prospective studies, several risk factors during the first 1,000 days were consistently associated with later childhood overweight: higher maternal pre-pregnancy BMI, maternal excess gestational weight gain, prenatal tobacco exposure, high infant birth weight, and high infant weight gain. A smaller number of studies also supported gestational diabetes, child care attendance, low strength of maternal–infant relationship, low SES, curtailed infant sleep,

Conclusions

The first 1,000 days are a critical period for childhood obesity development, and thus prevention. Targeting healthy pre-conception weight and gestational weight gain, tobacco avoidance, and healthy infant weight gain with adherence to current infancy nutrition and sleep recommendations shows promise for childhood obesity prevention.

Acknowledgments

The authors thank Bianca A. Verma and Christina Piaseckj for contributing to data acquisition. JWB contributed to the conception and design of the study, acquired and interpreted data, and wrote the first draft of this article. LL contributed to the conception and design of the study, acquired and interpreted data, and revised the article for important intellectual content. EC contributed to data acquisition and interpretation, and wrote portions of the results section. TBL contributed to the

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