The impact of the early environment (intrauterine environment) on offspring has always been a hot research topic. Previous studies have found that maternal lifestyle during pregnancy, as well as early nutrition and the environment in which the infant is raised, are associated with childhood obesity.
In the previously compiled article "Why Has China Become the World's Largest Diabetes Country?", it was mentioned that the famine in China affected the intrauterine environment during the early stages of fetal development, causing epigenetic changes that increased the risk of developing diabetes. The intergenerational transmission of these epigenetic changes further contributed to the prevalence of diabetes in China.
Studies have also shown [1-4] that maternal overnutrition, obesity, or diabetes during pregnancy can increase the risk of diabetes in offspring. In addition, some unhealthy lifestyles of pregnant mothers can also increase the risk of metabolic abnormalities in their offspring in adulthood. For example, if the mother smokes during pregnancy, it will not only lead to low birth weight in newborns, but also increase the risk of obesity in childhood and adulthood, and this risk may even be passed on to the third generation.
In addition, Professor Redman from the United States also shared his insights on the topic of "Is the trajectory of body obesity set in the womb?" in this year's ADA talk, and explored the possible mechanisms involved (Figure 1). The author believes that although there is a vicious cycle of obesity leading to obesity, he is still hopeful that once we better understand the 50% of variation in individual body shape that is not explained by the genetic code, we can develop and test more specific interventions and implement public health strategies to break the intergenerational cycle of obesity.
This article, shared today, reviews and interprets the factors influencing childhood obesity (including prenatal and postnatal factors) and provides relevant strategies for daily clinical work.
Maternal obesity has become a significant public health issue affecting both mothers and infants in low- and high-income countries.
Specific measurements of offspring obesity are needed, not just BMI: maternal BMI and weight gain during pregnancy, as well as gestational diabetes, are independent risk factors for offspring obesity.
Pregnant women should follow a healthy lifestyle, avoid malnutrition and smoking, and maintain moderate sugar intake to reduce the risk of childhood obesity.
Although there is no definitive effect of breastfeeding on reducing the risk of obesity later in life, it should be promoted due to its many beneficial effects.
There is insufficient data to support the association between the timing of supplemental feeding, prebiotic and probiotic consumption, and screen time with overweight and obesity in children under 2 years of age.
In children, high protein intake, consumption of sugary drinks, and shortened sleep duration are associated with obesity in the first two years after birth.
Trends and related risk factors
Epidemiology of overweight and obesity in young people.
Prenatal and early postpartum factors.
Overweight and Epidemiological Epidemiology
▎Epidemiological characteristics of overweight and obesity worldwide:
younger
Childhood obesity can persist into adolescence and adulthood.
Cardiovascular mortality is closely related to the duration of obesity.
Developing countries have experienced sustained growth over the past decade, while developed countries have entered a plateau period.
Characteristics of obesity in children aged 0-5 years: 1990-2010
Global: 4.2% - 6.7%
Developed countries: 7.9% -11.7%, an increase of 48.1%.
Developing countries: 3.7% - 6.1%, an increase of 64.9%.
▎Overweight/Obesity among Children and Adolescents Aged 5-19: 1975-2016
Global: 7.4%-24.6%
Developed countries: 11.6% -27.1%
Developing countries: 5.5% - 23.4%
Prenatal and early postpartum factors
▎Prenatal related factors
Preconception BMI: You should be informed of the importance of maintaining a normal BMI (18.5-24.9 kg/m2) before pregnancy to reduce the risk of obesity in your offspring.
Weight gain during pregnancy: Gain sufficient weight during pregnancy.
Father obesity: Father's BMI is associated with childhood obesity.
Gestational diabetes: Pediatricians are advised to be familiar with the diagnosis of gestational diabetes, as it may affect a child's growth and development.
Malnutrition in pregnant and postpartum women: Malnutrition should be avoided both before and during pregnancy.
Pregnant women should avoid smoking.
Drinking alcohol during pregnancy: Do not drink alcohol during pregnancy.
Dietary recommendations during pregnancy: Sugar intake should not exceed the recommended amount (10% of energy), and polyunsaturated fats should be consumed.
Physical activity: There is a consistent link between maternal physical activity during pregnancy and lack of childhood obesity, but pregnant women are still advised to exercise unless there are contraindications.
Antibiotics: Antibiotics are only recommended during pregnancy after a confirmed bacterial infection has been identified.
▎Type of delivery and postpartum related factors
Delivery type: Cesarean section requires strict medical indications.
Birth weight: Strengthen prenatal care to ensure that the weight is consistent with the gestational age.
Breastfeeding: Although breastfeeding has no clear effect on reducing the risk of obesity, it is still recommended to promote breastfeeding because it has many other beneficial effects.
Formula feeding: Avoid formula milk powder with a protein content exceeding 2.05g/100ml.
Rapid growth: It is recommended to avoid weight gain from birth to 6 months. Z-score above 0.67 sd.
Nutrient intake: Given its association with childhood obesity, high protein intake should be avoided, however there is currently no recommended intake; there is no consistent association between total fat intake and childhood obesity; free sugars should be limited to a maximum of 10% of energy intake, and sugary drinks should be avoided for children under 2 years of age.
Prebiotics and probiotics: There is insufficient data to infer whether prebiotics and probiotics in early life can reduce the risk of childhood obesity.
Supplemental feeding: There is no consistent evidence that the timing of supplemental feeding is associated with subsequent overweight and obesity.
Sleep duration: For children under 2 years old, it is recommended to sleep at least 10.5 hours per day.
Screen activity: Information on the relationship between screen time and infant/child obesity is limited and further investigation is needed.
The strongest evidence is from maternal obesity, low birth weight, and rapid weight gain during the first two years of life.
▎Research Conclusion:
Evidence suggests that early nutritional and environmental factors influence the development of childhood obesity (Figure 4).
The data demonstrates the importance of maintaining a normal BMI before pregnancy. However, it is worth noting that most of these studies are based on BMI measurements of offspring, and do not include specific measurements of offspring obesity.
Pregnant women should achieve appropriate weight gain during pregnancy and avoid malnutrition, smoking, and excessive intake of free sugars (more than 10% of total energy intake).
Within the first two years after birth, children should be protected from high-protein diets, added sugars, and sugary foods, and excessive weight gain should be avoided.
Health authorities should ensure pregnant women receive healthy nutrition during pregnancy, maintain a normal weight, and carefully monitor the baby's growth to detect excessive weight gain.
Infants should be breastfed and fed a varied diet during the first two years of life.
The above content is exclusively authorized for use only and may not be reproduced without the copyright holder's authorization.
