Hu Jiajin, Aris Izzuddin M, Lin Pi-I D, Rifas-Shiman Sheryl L, Perng Wei, Woo Baidal Jennifer A, Wen Deliang, Oken Emily
Institute of Health Sciences, China Medical University, Shenyang, Liaoning, China.
Research Center of China Medical University Birth Cohort, China Medical University, Shenyang, Liaoning, China.
Am J Clin Nutr. 2021 Jan 4;113(1):113-122. doi: 10.1093/ajcn/nqaa297.
Many studies have identified early-life risk factors for childhood overweight/obesity (OwOb), but few have evaluated how they combine to influence later cardiometabolic health.
We aimed to examine the association of risk factors in the first 1000 d with adiposity and cardiometabolic risk in early adolescence.
We studied 1038 mother-child pairs in Project Viva. We chose 6 modifiable early-life risk factors previously associated with child adiposity or metabolic health in the cohort: smoking during pregnancy (yes compared with no); gestational weight gain (excessive compared with nonexcessive); sugar-sweetened beverage consumption during pregnancy (≥0.5 compared with <0.5 servings/d); breastfeeding duration (<12 compared with ≥12 mo); timing of complementary food introduction (<4 compared with ≥4 mo); and infant sleep duration (<12 compared with ≥12 h/d). We computed risk factor scores by calculating the cumulative number of risk factors for each child. In early adolescence (median: 13.1 y) we measured indicators of adiposity [BMI, fat mass index (FMI), trunk fat mass index (TFMI)]. We also calculated OwOb prevalence and metabolic syndrome (MetS) risk z score of adolescents.
Among 1038 adolescents, 71% had >1 early-life risk factor. In covariate-adjusted models, we observed positive monotonic increases in BMI, FMI, TFMI, and MetS z scores with increasing risk factor score. Children with 5‒6 risk factors (compared with 0-1 risk factors) had the highest risk of OwOb [risk ratio (RR): 2.53; 95% CI: 1.63, 3.91] and being in the highest MetS quartile (RR: 2.46; 95% CI: 1.43, 4.21). The predicted probability of OwOb in adolescence varied from 9.4% (favorable levels for all factors) to 63.6% (adverse levels for all factors), and for being in the highest MetS quartile from 9.6% to 56.6%.
Early-life risk factors in the first 1000 d cumulatively predicted higher adiposity and cardiometabolic risk in early adolescence. Intervention strategies to prevent later obesity and cardiometabolic risk may be more effective if they concurrently target multiple modifiable factors.
许多研究已确定儿童期超重/肥胖（OwOb）的早期生活危险因素，但很少有研究评估这些因素如何共同影响后期的心脏代谢健康。
我们旨在研究出生后1000天内的危险因素与青春期早期肥胖及心脏代谢风险之间的关联。
我们在“活力计划”中研究了1038对母婴。我们选择了该队列中先前与儿童肥胖或代谢健康相关的6个可改变的早期生活危险因素：孕期吸烟（是与否）；孕期体重增加（过多与不过多）；孕期含糖饮料摄入量（≥0.5份/天与<0.5份/天）；母乳喂养持续时间（<12个月与≥12个月）；辅食添加时间（<4个月与≥4个月）；以及婴儿睡眠时间（<12小时/天与≥12小时/天）。我们通过计算每个孩子的危险因素累积数量来计算危险因素得分。在青春期早期（中位数：13.1岁），我们测量了肥胖指标[体重指数（BMI）、脂肪量指数（FMI）、躯干脂肪量指数（TFMI）]。我们还计算了青少年的OwOb患病率和代谢综合征（MetS）风险z评分。
在1038名青少年中，71%有>1个早期生活危险因素。在协变量调整模型中，我们观察到BMI、FMI、TFMI和MetS z评分随危险因素得分增加呈正单调增加。有5-6个危险因素的儿童（与0-1个危险因素的儿童相比）患OwOb的风险最高[风险比（RR）：2.53；95%置信区间（CI）：1.63，3.91]，处于MetS最高四分位数的风险也最高（RR：2.46；95%CI：1.43，4.21）。青春期患OwOb的预测概率从9.4%（所有因素均为有利水平）到63.6%（所有因素均为不利水平）不等，处于MetS最高四分位数的预测概率从9.6%到56.6%不等。
出生后1000天内的早期生活危险因素累积起来可预测青春期早期更高的肥胖及心脏代谢风险。如果同时针对多个可改变因素，预防后期肥胖和心脏代谢风险的干预策略可能会更有效。
