Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Am J Clin Nutr. 2020 May 1;111(5):997-1006. doi: 10.1093/ajcn/nqaa052.
Several risk factors in the first 1000 d are linked with increased obesity risk in later childhood. The role of potentially modifiable eating behaviors in this association is unclear.
This study examined whether the association between cumulated risk factors in the first 1000 d and adiposity at 6 y is moderated by eating behaviors.
Participants were 302 children from the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort. Risk factors included maternal prepregnancy and paternal overweight, excessive gestational weight gain, raised fasting plasma glucose during pregnancy, short breastfeeding duration, and early introduction of solid foods. Composite risk scores reflecting the prevalence and the importance of the risk factors present were computed. Adiposity outcomes were child BMI and sum of skinfolds (SSF), and candidate eating behavior moderators were portion size, eating rate, and energy intake during lunch and in an eating in the absence of hunger task.
Higher composite risk score predicted higher BMI z scores (B = 0.08; 95% CI: 0.04, 0.13) and larger SSF (0.70 mm; 0.23, 1.18 mm), and was associated with larger self-served food portions (5.03 kcal; 0.47, 9.60 kcal), faster eating rates (0.40 g/min; 0.21, 0.59 g/min), and larger lunch intakes (7.05 kcal; 3.37, 10.74 kcal). Importantly, the association between composite risk score and adiposity was moderated by eating behaviors. The composite risk score was unrelated to SSF in children who selected smaller food portions, ate slower, and consumed less energy, but was positively associated with SSF among children who selected larger food portions, ate faster, and consumed more energy (eating behavior × risk score interactions: P < 0.05).
The association between risk factors in the first 1000 d and adiposity at 6 y varies by eating behaviors, highlighting modifiable behavioral targets for interventions.This trial was registered at clinicaltrials.gov as NCT01174875.
生命最初 1000 天的多个风险因素与儿童后期肥胖风险增加有关。潜在的可改变的饮食习惯在这种关联中的作用尚不清楚。
本研究旨在探讨生命最初 1000 天的累积风险因素与 6 岁时肥胖的关系是否受到饮食习惯的调节。
参与者为来自 GUSTO（新加坡成长至健康结果）队列的 302 名儿童。风险因素包括母亲孕前和父亲超重、孕期体重过度增加、孕期空腹血糖升高、母乳喂养时间短、以及固体食物过早引入。计算反映风险因素存在的普遍性和重要性的复合风险评分。肥胖结局是儿童 BMI 和皮褶厚度总和（SSF），候选饮食习惯调节剂是午餐和在无饥饿状态下进食时的份量大小、进食速度和能量摄入。
较高的复合风险评分与更高的 BMIz 分数（B=0.08；95%置信区间：0.04，0.13）和更大的 SSF（0.70 毫米；0.23，1.18 毫米）相关，与自我服务的食物份量更大（5.03 千卡；0.47，9.60 千卡）、更快的进食速度（0.40 克/分钟；0.21，0.59 克/分钟）和更大的午餐摄入量（7.05 千卡；3.37，10.74 千卡）相关。重要的是，复合风险评分与肥胖的关系受到饮食习惯的调节。在选择较小份量、进食较慢和消耗较少能量的儿童中，复合风险评分与 SSF 无关，但在选择较大份量、进食较快和消耗较多能量的儿童中，复合风险评分与 SSF 呈正相关（饮食行为×风险评分交互作用：P<0.05）。
生命最初 1000 天的风险因素与 6 岁时的肥胖之间的关联因饮食习惯而异，突出了可改变的行为干预目标。这项试验在 clinicaltrials.gov 上注册为 NCT01174875。
