Objectives To determine which of multiple early-life exposures predict onset or resolution of overweight/obesity during a 9-year period.
Methods Design: longitudinal cohort from three harmonised community-based cohorts enriched for overweight and obesity. Early-life exposures: child—gestational age; delivery; birth weight; breast feeding; solids introduction; baseline body mass index (BMI); waist circumference; diet; activity; global, physical and psychosocial health. Mother—baseline BMI; education; age; neighbourhood disadvantage; concern for child's weight. Outcome: change in BMI category. Analyses: adjusted logistic regression.
Results On average, the 363 children (57% retention) were 6 and 15 years old at baseline and follow-up. Children were classified as ‘never’ overweight/obese (38%), ‘resolving’ overweight/obese (15%), ‘becoming’ overweight/obese (8%) or ‘always’ overweight/obese (39%). Compared with ‘never overweight/obese’ children, odds of ‘becoming overweight/obese’ were greater with higher child (OR 2.33, 95% CI 1.02 to 5.29) and maternal BMI (OR 1.18, CI 1.07 to 1.31), and lower with higher maternal education (OR 0.09, CI 0.02 to 0.34). Compared with ‘always overweight/obese’ children, odds of ‘resolving overweight/obese’ were lower with higher maternal BMI (OR 0.87, CI 0.78 to 0.97), and higher with better child physical health (OR 1.06, CI 1.02 to 1.10) and higher maternal age (OR 1.11, CI 1.01 to 1.22) and education (OR 4.07, CI 1.02 to 16.19).
Conclusions Readily available baseline information (child/maternal BMI, maternal age, education and child health) were the strongest predictors of both onset and resolution of overweight/obesity between the primary school and adolescent years. Perinatal, breastfeeding and lifestyle exposures were not strongly predictive. Results could stimulate development of algorithms identifying children most in need of targeted prevention or treatment.
- Adolescent Health
- Comm Child Health
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Contributors MW founded and is responsible for the PEAS Kids Growth Study, the LEAP2 trial and the HopSCOTCH trial. JAK, CL and ANG completed follow-up data collection, drafted the manuscript and finalised the data analyses. JM completed the data cleaning and analyses, and SD assisted with these analyses and interpretation. SAC and MW contributed to conceptual planning and writing of the final manuscript. All authors critically reviewed the manuscript for intellectual content and had final approval of the submitted and published versions of this paper.
Funding The harmonised 2014 wave of the LEAP, PEAS and HopSCOTCH studies was funded by the Murdoch Childrens Research Institute. The HopSCOTCH trial was funded by Australian National Health and Medical Research Council (NHMRC) General Practice Clinical Research Program Grant (491212); the LEAP 2 trial by NHMRC Project Grant 334309; and the PEAS by NHMRC Project Grant 284509. MW was supported by NHMRC Senior Research Fellowship 1046518, and Alanna Hanvey by Australian Postgraduate Award. The funding organisations did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript. Research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program.
Competing interests None declared.
Ethics approval The Royal Children's Hospital, Melbourne, Australia.
Provenance and peer review Not commissioned; externally peer reviewed.
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