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