Woo Baidal Jennifer A, Locks Lindsey M, Cheng Erika R, Blake-Lamb Tiffany L, Perkins Meghan E, Taveras Elsie M
Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Am J Prev Med. 2016 Jun;50(6):761-779. doi: 10.1016/j.amepre.2015.11.012. Epub 2016 Feb 22.
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.
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.
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.
Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.
越来越多的证据表明，儿童肥胖及其相关差异的根源早在“生命最初1000天”就已出现，即从受孕到2岁的这段时期。本研究的主要目的是系统回顾从受孕到2岁期间存在的可改变的儿童肥胖风险因素的现有证据。
检索了PubMed、Embase和科学网，查找1980年1月1日至2014年12月12日发表的关于生命最初1000天期间儿童肥胖风险因素的研究。2014年12月13日至2015年3月15日期间，对前瞻性、原创性人体研究进行了分析，这些研究的暴露发生在生命最初1000天，且在6个月至18岁之间收集了儿童超重或肥胖（按年龄和性别计算BMI≥第85百分位数）的结果。
在5952条检索到的文献中，282项研究符合纳入标准。生命最初1000天期间的几个风险因素与儿童期后期肥胖始终相关。这些因素包括较高的母亲孕前BMI、产前烟草暴露、母亲孕期体重过度增加、婴儿出生体重高以及婴儿体重加速增加。较少的研究也支持妊娠期糖尿病、入托、母婴关系强度低、社会经济地位低、婴儿睡眠减少、奶瓶使用不当、4个月前开始摄入固体食物以及婴儿接触抗生素是儿童肥胖的风险因素。
生命最初1000天中可改变的风险因素可为未来预防儿童肥胖的研究、政策重点及干预措施提供参考。
