在亚洲队列中，前 1000 天的可改变风险因素与儿童超重的后续风险：父母超重状况的意义。
Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status.
机构信息
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
出版信息
Int J Obes (Lond). 2018 Jan;42(1):44-51. doi: 10.1038/ijo.2017.178. Epub 2017 Jul 28.
BACKGROUND/OBJECTIVE: Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort.
METHODS
Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models.
RESULTS
Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41-1.15) for BMI, 0.79 (0.41-1.16) for WHtR, 0.46 (0.06-0.83) for SSF and 0.67 (0.07-1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5-49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8-13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity.
CONCLUSIONS
Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.
背景/目的：许多研究已经确定了儿童期超重/肥胖的早期生活风险因素，但很少有研究评估它们如何结合起来影响儿童超重/肥胖的风险。我们在亚洲队列中检查了受孕后 1000 天内的潜在可改变风险因素与儿童肥胖和超重/肥胖风险的个体和综合关联。
方法
研究了 6 个风险因素：母亲孕前超重/肥胖（体重指数（BMI）≥25kg/m）、父亲产后 24 个月超重/肥胖、母亲孕期体重过度增加、妊娠期间母亲空腹血糖升高（≥5.1mmol/l）、母乳喂养时间<4 个月和早期引入固体食物（<4 个月）。使用多变量回归模型评估了与 48 个月时肥胖测量值（BMI、腰高比（WHtR）、皮褶厚度总和（SSFs）、脂肪质量指数（FMI）和超重/肥胖）相关的风险因素数量之间的关联。
结果
在 858 名随访至 48 个月的儿童中，172 名（19%）无风险因素，274 名（32%）有 1 个风险因素，244 名（29%）有 2 个风险因素，126 名（15%）有 3 个风险因素，42 名（5%）有≥4 个风险因素。调整混杂因素后，与无风险因素的儿童相比，风险因素数量与 48 个月时的肥胖结果呈显著正梯度关联。与无风险因素的儿童相比，有四个或更多风险因素的儿童 BMI 增加 0.78（95%置信区间 0.41-1.15），WHtR 增加 0.79（0.41-1.16），SSF 增加 0.46（0.06-0.83），FMI 增加 0.67（0.07-1.27）。有四个或更多风险因素的儿童超重/肥胖的调整相对风险为 11.1（2.5-49.1），与无风险因素的儿童相比。暴露于母亲孕前（11.8%（9.8-13.8%））或父亲超重状态（10.6%（9.6-11.6%））的儿童超重/肥胖的个体预测概率最大。
结论
生命早期的风险因素累积增加了儿童肥胖和超重/肥胖的风险。如果同时解决这些可改变的多个风险因素，生命早期和孕前干预计划可能更有效地预防超重/肥胖。
Zotero 插件