A Child in a Home, Where Both Parents Are Obese, Has the Likelihood of Being Obese as Well?
Obesity (Flatware Spring). Author manuscript; available in PMC 2013 Oct 1.
Publicised in net edited organise as:
PMCID: PMC3671382
NIHMSID: NIHMS417068
Maternal corpulency moderates the relationship between puerility appetitive traits and weight
Bernard F. Fuemmeler
1Duke University Aesculapian Pith, Durham N
Cheryl A. Lovelady
2University of North Carolina at Greensboro, Greensboro NC
Nancy L. Zucker
1Duke University Medical Center, Durham NC
Truls Østbye
1Duke University Medical examination Center, Durham NC
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Abstract
This hit the books examined the independent and combined associations between childhood craving traits and parental obesity on slant gain from 0 to 24 months and body mass index (BMI) z mark at 24 months in a diverse community-based sample of dual parent families (n = 213). Participants were mothers who had recently accomplished a randomized tribulation of weight down loss for stoutness/obese post-partum women. A measures of childhood appetitive traits, mothers complete subscales of the Child Eating Behavior Questionnaire, including Desire to Drink (DD), Enjoyment of Intellectual nourishment (EF), and Satiety Reactivity (Sr), and a 24-hour dietetic recall for their child. High and weights were measured for all children and mothers and self-reported for mothers' partners. The human relationship betwixt children's appetitive traits and parental corpulency on tot weight gain and BMI z account were evaluated victimisation multivariate rectilinear regression models, controlling for a telephone number of possible confounders. Having two weighty parents was related to greater weight gain from parentage to 24 months independent of childhood appetitive traits, and while key associations were found between appetitive traits (DD and Sr) and tike BMI z score at 24 months, these associations were observed single among children who had two corpulent parents. When both parents were obese, increasing DD and ritenuto SR was associated with a higher BMI z-score. The results highlight the importance of considering familial lay on the line factors when examining the relationship between puerility appetitive traits on childhood obesity.
Keywords: Childhood eating behaviors, parental fleshiness, childhood obesity, bar
INTRODUCTION
Obesity is a multifactorial status reflecting a complex interaction between somebody sensitivity, social, and environmental factors.(1) The rise in obesity prevalence among children is particularly frightening given that babyhood obesity not entirely results in a number of unfavorable health consequences during childhood, simply also tracks into adolescence and adulthood.(2) Recent data suggests that for many children WHO are overweight, the oncoming occurs archaean in developing in front the age of 2 years; however, the reasons for this are not well understood.(3) A better sympathy of the factors associated with excess weight increase during early development is fundamental to developing effective childhood bar and treatment strategies.
Socio-economical factors along with fertilization age, parturition weighting, and length of nursing are factors related to former puerility burden gain.(4) However, other factors such American Samoa person differences in disposition related to eating and food are also relevant. For instance, early abstract models of corpulency (e.g. Stunkard and Schachter's externality worthy) posited that obese individuals may be less raw to internal physiological cues of satiety and more responsive to the comportment of food, too equally environmental stimuli related to with food consumption (e.g. food commercials, images of food, etc.).(5, 6) A number of recent studies have examined the tenets of these models by investigating childhood appetite rule as a voltage behavioural mark of fleshiness susceptibleness.(7–9) Lab-based studies have institute that observations of "eating in the petit mal epilepsy of thirstiness" (EAH) and "bite frequency" call weight status and weight realise.(10, 11) Such observations may constitute a child's dispositional reactivity to satiety or heightened enjoyment of food. Studies of community of interests samples get also provided evidence that these dispositional differences or appetitive traits measured using psychometric approaches may be relevant to childhood BMI and risk for corpulency. Specifically, psychology constructs such as parent-reported child "Satiety Reactivity" is associated with lower BMI, and both greater "Enjoyment of Food" and "Solid food Responsiveness" are connected with higher BMI and weight gain.(9, 12, 13) These psychometric constructs have also been shown to embody convergent with behavioral measures, such as EAH and eating rate and higher caloric intake. Notably, definitively establishing the focussing of work is not possible in plane section studies such as these. Yet, recent longitudinal studies provide further endure that appetitive traits contribute, in part, to weight gain rather than vice versa. (14) These studies suggest that children differ in their craving traits and that these differences could explain why some children may be more sensitive to external food cues or less feisty to internal satiety cues. These factors could contribute to an increased solid food intake and ultimately higher risk for obesity.
Another important jeopardy factor for childhood obesity is having parents who are obese. Children with 2 obese parents are 10 to 12 multiplication more likely to be obese.(15, 16) Weight gain in early puerility (3 to 5 years of eld) is also significantly greater among children with overweight or rotund parents operating room among those natural of overweight OR obese mothers.(17) children of heavier parents accept been saved to exhibit lower levels of personal activity and rich person greater preference for high fat foods and lower preference for healthier foods.(18, 19) This familial influence may be through transmissible mechanisms or through the surroundings.
Childhood appetitive traits and familial risk factors, equal maternal fleshiness, Crataegus oxycantha be independently joint with baby fleshiness, and if these factors are independent, it would be didactic to have a go at it which (appetitive traits or parental corpulency) is more important in relation to children's food intake or risk for obesity. However, circumstantial evidence suggests children's craving traits English hawthorn vary conditional whether operating theatre non they consume other familial risk factors, such as obese parents.(19) For instance, higher levels of EAH let been ascertained among children born to mothers who were obese antecedent to pregnancy compared to their counterparts born to mothers WHO were lean. (8) The link betwixt appetitive traits and obesity may thence rely on other factors like parental obesity. Understanding the conditions under which appetitive traits relate to children's food intake and risk for corpulency would countenance for more precise conclusions about these associations.
The purpose of this field of study was therefore to examine the extent to which children's appetitive traits (intellectual nourishment reactivity, delectation of nutrient, desire for drinks, and satiety reactivity), and parental obesity status are associated with food intake, exercising weight gain from birth, and BMI z musical score at 24 months. This study extends old enquiry by 1) examining these associations among very young children during a critical meter when eating patterns and preferences for certain foods are established and 2) evaluating whether these associations 'tween appetitive traits and risk for corpulency were qualified by parental obesity.
METHODS
Participants
Participants in the current study were recruited from three large obstetrics clinics in Eastern, US for a larger behavioral irregular controlled trial, Active Mother's Postpartum (AMP).(20, 21) Eligibility for AMP was based upon BMI ≥ 25 metrical aside study faculty at the 6 week postnatal obstetrics appointment. Women who did not speak English, were preserved < 18 days, operating theatre had wellness conditions that prevented them from walking a mile unassisted were excluded from participation. The Ampere intervention was designed to enhance weight loss in postpartum women WHO were overweight or rotund prior to gestation. Participants were randomized at 6–8 weeks postnatal to either the Ampere intervention (n=225) or the attention contain group (n=225). The AMP intercession, which lasted 9 months with post-intervention and follow-risen assessments, concentrated principally on improving lifestyle behaviors in the mother. The intercession did not encourage the adoption of certain parenting styles or efforts to better the health of their new-sprung infant. The mean weightiness loss was 0.90 kg (±5.1 kg) in the intervention group and 0.36 kg (±4.9 kg) in the control group, which was not a statistically significant deviation. On that point were also nary operative group differences in betterment of diet or enlarged physical activity.(20, 21) At their final follow-functioning (24 months postpartum) mothers and their 2 yr old children were recruited for the underway empiric study, A Too for Twos!
Of the 450 participants who were enrolled generally AMP trial, 309 agreed to participate in the current field of study. After excluding 43 single nurture families, 266 mothers of dual-bring up families were asked if they would be unforced to deliver a appraise bundle to their partner, which included a letter describing the study, a consent form, a brief review, and a pre-paid-up fall envelope. From these 266 dual-parent families, 213 partners returned surveys (80% of the eligible 266). In nearly all cases, parents in this sample were biological (93%) or the partner was living in the home with the mother and target child (97%). Compared to the participants who originally enrolled in the Ampere trial (n=450), participants in the sample for this take (n=213) were more likely to be White (Cramer's V = −.18), have a college degree (Cramer's V = .19), have a family income greater than $60,000 (Cramer's V = .20), and were slightly older (Cohen's d = .27). Yet, there were no significant differences between the deuce groups arsenic related to percentage calories from paunchy premeditated from dietary recalls (Cohen's d = .01), number of television wake hours per mean solar day (Cohen's d = .03), number of reported minutes per week of walking for physical body process (Cohen's d = .18), and BMI (Cohen's d = .14). Thus, although in that respect were extraordinary socio-demographic differences between the 2 groups, the differences were small (i.e., effect sizes < .3;(22)) and there were none differences between the groups with respect to key health behaviors. All procedures were sanctioned by the collaborating University's Institutional Review Boards.
Measures
Child feeding behaviors
Eating behaviors were assessed victimization the Children's Eating Behavior Questionnaire (CEBQ).(23) Items for the CEBQ were highly-developed from focus groups and interviews with parents of children 2–6 days of senesce and the mean age of the sample for testing psychometrics of the items was 4.2 (± 1.4) years.(23) The scale is being used in studies with samples of children ranging in age from 2 to 11 years of age.(13, 24, 25) Items have Likert scale of measurement reception options ranging from 1 (never) to 5 (always). For this study, we confined our analysis to the tailing CEBQ subscales: Enjoyment of Intellectual nourishment (EF), Food Reactivity (Francium), Desire to Drink (DD), and Satiation Reactivity + Slowness in Eating (Atomic number 38). Satiety Responsiveness and Slowness in Eating were combined Eastern Samoa they take up been shown to load onto the identical factor.(23) Domains of EF, Fr and DD reflect a general avidity toward feeding and food (e.g., "my child loves food (EF);" "if allowed, my tike would eat besides much (FR);" and "if given the casual, my child would always be having a drink (DD)." SR reflects how easily a child reaches satiation (e.g., my child cannot eat a meal if he/she has had a snack antimonopoly before"). The CEBQ has been shown to have high internal consistency, good test-retest dependability, stability over time (23, 26), and these particular subscales have been correlated with weight.(9) Cronbach's alphas for subscales in this sample were acceptable (SR = .70; EF = .86; FR = .71; DD = .84).
Child anthropometrics
At two years of age children's weights (to the nearest tenth of a ram) and standing high (to the nearest quarter edge in) were calculated by study staff during a visit to the laboratory using a Seca portable stadiometer and Tanita BWB-800 scale. Measurements were accomplished with children wearing casual attire with belts and shoes removed. BMI z score was calculated using the Centers for Disease Control and Prevention SAS macro instruction which computes age and gender adjusted standardized scores.(27)
Parental weight status
At the Saami study visit in which children's weights and high were unhurried, female parent's weights and heights were also measured. The mothers' partners self-reportable height and burthen as part of their surveys. Since the purpose of this study was to examine how parental obesity paternal to children's BMI, we quantified parental weight status into threesome groups: 0 = neither rear was weighty (BMI < 30); 1 = one bring up was obese (BMI ≥ 30), but the some other was not (BMI < 30); and 2 = both parents were rotund (BMI of mother ≥ 30 and BMI of partner ≥ 30).
Fare Intake
Dietary intake of children was assessed similarly to the Feeding Infants and Toddlers Take.(28) The primary caregiver (in most altogether cases the mother) according on their child's diet. Dietary recalls were collected on 2 randomly selected days over a 2 week period. Mothers had been given a packet with 2-magnitude visuals to assist in determining food portion sizes. The visuals enclosed various examples of toddler food for thought portions and feeding implements (e.g., "sippy-cups" and small bowls). If children attended day care, mothers were given a form for the day care provider to record the child's fare intake (type of food eaten and amount). Mothers used this list to complete the 24-minute recollect. The dietary uptake of the children was assessed by rin, exploitation the Nutrition Information system for Research (NDS-R, University of MN), a valid and established method acting for assessing energy intake.(28, 29) These data included estimated energy [kilocalorie (kcal)] intake available from 183 of the 208 (88%) children. In that respect were no differences in special demographic characteristics (related education and baby's subspecies) between mothers who provided dietary information vs. those World Health Organization did non.
Other measures
Parents reportable along level of educational attainment, age, and their child's race/ethnicity. Nipper's birth burden and gestational weeks were reported by mothers when they get-go enrolled in Adenylic acid study, which was soon after the birth of their child (6–8 weeks). Breast feeding come was summarized by a lactation score, a measure of breastfeeding "intensity" combining the duration and exclusivity of breastfeeding.(30) This score was traced from the elaborated monthly feeding data collected at the 12-month follow-up. A treasure was assigned for each calendar month—0 if formula Federal Reserve System, 1 if mixed, and 2 if in full breastfed. The resulting score has a possible set out of 0–24, and more explanatory power than a simple measure of duration.(31)
Analysis
The outcomes for these analyses included exercising weight realise from give birth (measured by the change in kilograms from birth to 24 months of age), BMI z hit at 24 months, and energy intake at 24 months. The initial analyses embroiled 1) bivariate Pearson r correlations betwixt children's eating behaviors (EF, FR, DD, SR), BMI z-score, weight down gain from nascence, vigor intake at 24 months, and parental BMI; and 2) mean comparisons (general linear model) for BMI z account and weight gain from birth for parental obesity aggregation variable (0,1,2) controlling for intervention arm and birth weight. We also calculated the odds of existence overweight (BMI z score ≥ 85th percentile and < 95thorium percentile) and corpulency (BMI z score ≥ 95thorium centile) using a function logistic regression for children with one or both parents weighty relative to neither obese controlling for intercession arm and birth weight. Separate variable rectilinear regression models were performed to examine associations between children's eating behaviors (EF, Atomic number 87, DD, or SR), the parental obesity adaptable, and their interaction on each of the anthropometric outcomes (BMI z score and burthen gain from birth) and Department of Energy intake. All multivariate models included treatment build up, children's age, gender, race, gestational age at birth, deliver weight, suckling score, and age and informative level of mothers and their partners. Only main effects models (i.e., models non including interaction footing) are reported when interaction terms were non significant. Post-hoc probes were conducted for all meaningful interaction effects.(32)
RESULTS
In the boilers suit sample (Table 1), the prevalence of children with BMI z loads exceeding the 85th percentile was 25% (n = 54) which is slightly higher than the national average of 21% for children ages 2 to 5 years.(33) On the average children were born full-full term (stand for fertilization age = 39 weeks).
Table 1
Sample characteristics (percentages or means and standard deviations)
| Overall sample (n = 213) | ||
|---|---|---|
| Nurture CHARACTERISTICS | ||
| Mother's senesce, mean (s.d.) | 33.6 | 5.1 |
| Partner's age, mean (s.d.) | 35.1 | 5.7 |
| Beget's Education Level | ||
| < HS, HS/GED, Voc Degree, Some College | 30% | |
| Associates Degree, College Graduate or Higher | 70% | |
| Partner's Education Level | ||
| < HS, HS/GED, Voc Degree, Some College | 36% | |
| Associates Level, College Graduate or Higher | 64% | |
| Mother's Measured BMI, mean (s.d.) | 32.3 | 7.3 |
| Mother's Measured BMI (family) | ||
| Normal weight | 11% | |
| Heavy | 33% | |
| Obese | 56% | |
| Collaborator's Reported BMI, mean (s.d.) | 28.3 | 5.0 |
| Partner's Reported BMI (category) | ||
| Normal weighting | 27% | |
| Overweight | 42% | |
| Obese | 31% | |
| CHILD CHARACTERISTICS | ||
| Gender % female person | 44% | |
| Race | ||
| Blank | 64% | |
| Black | 36% | |
| Age, mean (s.d.) | 24.2 | 1.3 |
| Gestational get on (weeks), have in mind (s.d.) | 38.5 | 2.0 |
| Lactation score, mean (s.d.) | 9.7 | 8.8 |
| Birthweight (kg), mean (s.d.) | 3.4 | 1.3 |
| 24 month weight (kg), imply (s.d.) | 5.9 | 0.7 |
| weight advance from deliver (kg), mean (s.d.) | 9.5 | 1.5 |
| 24 month BMI z score, base (s.d.) | ||
| BMI Categories | ||
| < 85th %ile | 75% | |
| 85th – 95th %ile | 16% | |
| >95th %ile | 9% | |
| Average kcal, awful (s.d.) | 1221 | 296 |
| Average per centum calories from thick, mean (s.d.) | 31.0 | 6.4 |
Children's appetitive traits and anthropometrics
Table 2 displays the bivariate correlations between CEBQ subscales, BMI z-score, and weight gain from birth. Significant correlation coefficients were in the expected steering with subscales assessing Enjoyment of Food (EF), Food Responsiveness (FR), and Desire to Drink (Doctor of Divinity) being positively correlated with BMI z tally and weight gain from birth and Repletion Reactivity (SR) being negatively correlated. Entirely correlations were statistically significant demur for the association between EF and weight gain from birth. Mother's BMI and partner's BMI were not related to childhood appetitive traits. Energy intake was significantly associated with FR (r = .18, p < .05) and Atomic number 38 (r = −.17, p < .05), but was not cognate child's BMI z score.
Table 2
Correlations between children's appetitive traits, BMI z make, parent's BMI, and child energy intake
| EF | FR | DD | SR | BMI z | Weight down win | Mother's BMI | Partner's BMI | |
|---|---|---|---|---|---|---|---|---|
| 1 Delectation of Food (EF) | -- | |||||||
| 2 Intellectual nourishment Responsiveness (FR) | 0.52** | -- | ||||||
| 3 Desire to Drink (DD) | −0.02 | 0.21** | -- | |||||
| 4 Satiety Responsiveness (SR) | −0.58** | −0.49** | 0.08 | -- | ||||
| 5 BMI z score | 0.17** | 0.20** | 0.14* | −0.20** | -- | |||
| 6 Weight reach from birth (kg) | 0.10 | 0.16 | 0.14* | −0.17* | 0.74* | -- | ||
| 7 Mother's BMI | −0.11 | −0.05 | 0.06 | 0.04 | 0.07 | 0.12 | -- | |
| 8 Partner's BMI | −0.01 | 0.01 | 0.13 | 0.00 | 0.14* | 0.17* | 0.19** | -- |
| 9 Median energy consumption | 0.14 | 0.18* | 0.13 | −0.17 | 0.10 | 0.13 | 0.02 | 0.08 |
Genitor obesity and childhood anthropometrics
Table 3 displays the skilled weighting gain from birth and BMI z grudge for children with neither rear obese, one parent obese, and both parents obese. Statistical comparison of means controlled for intervention arm and birth weight. Mean weight gain from birth and BMI z score some increased with increasing parental obesity. The greatest mean difference was observed among children who have two obese parents relative to children with neither parent obese (miserly weight gain 9.9 kilogram vs 9.2 kg and BMI z score 0.7 vs. 0.3). The means for each CEBQ subscale were also evaluated in relation to parental obesity condition (neither, one operating theatre both weighty) controlling for intervention status, child's age in months, gender and race. At that place were no more statistically significant mean differences for EF, FR, DD, or SR by family of obesity status in these models (all p values > .05; data not shown).
Table 3
Association betwixt parental obesity and anthropometrics
| Weight gain from birth (kilogram) | BMI z score | ≥ 85th %ile vs < 85th %ile | ≥ 95th %ile vs < 85th %ile | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Parent obesity condition (n = 204)1 | Tight2 (s.e.) | 95% CI | Mean3 (s.e.) | 95% CI | AORb | 95% CI | AORb | 95% Hundred and one | |
| | | ||||||||
| Neither Corpulent (n=79) | 9.2 (0.16) | 8.86 – 9.49 | 0.3 (0.11) | 0.10 – 0.51 | |||||
| One Parent Obese (n=73) | 9.6 (0.15) | 9.29 – 9.90 | 0.5 (0.09) | 0.29 – 0.64 | 1.78 | .69 – 4.56 | 1.10 | .30 – 4.01 | |
| Both Parents Obese (n=53) | 9.9 (0.23) | 9.46 – 10.34* | 0.7 (0.15) | 0.39 – 0.97* | 2.55 | .97 – 6.74 | 2.40 | .70 – 8.17 | |
Multivariate linear regression analyses and interaction effects
Main effects models without fundamental interaction
Appetitive traits were not statistically significantly attached weight make from 0 to 24 months in models that included the parental corpulency variable (ane or deuce parents who were obese) arsenic well as the other covariates (child's age, gender, race, gestational age, parentage weightiness, suckling score, mother's and partner's educational level, engender's and partner's geezerhoo, and interference condition). Having deuce fat parents was significantly associated with child weight gain, controlling for appetitive traits and the strange covariates (child's eld, gender, race, gestational age, birth weight, suckling score, mother's and pardner's educational level, mother's and partner's get on, and intervention status). In a shrunken sit, which retained the covariates but far the appetitive traits, having one parent who was obese was not statistically related with greater weight gain from birth (β = 0.26, s.e. = 0.23, p = 0.25), but having two parents who were obese was associated greater weight gain from birth (β = 0.60, s.e = 0.26, p < .05) (data not shown in table).
Controlling for parental obesity status and the other covariates (tyke's age, grammatical gender, race, gestational age, birth weight, lactation score, mother's and partner's instructive unwavering, mother's and partner's age, and intervention status), there were nary significant associations determined between craving traits and BMI z score, with one exception: FR was significantly associated with BMI z musical score. Specifically, a one unit increase in FR was related to with about a .25 unit of measurement increase above the BMI z score intercept (see Table 4).
Table 4
Multivariate linear regression analyses for CEBQ subscales, parental obesity, and interaction predicting slant gain (kg) from birth, BMI z score, and zip intake
| Weight Gain from Birth (kg) | BMI z score | Energy Department Intake | ||||
|---|---|---|---|---|---|---|
| CEBQ subscale | Beta | (s.e.) | Beta | (s.e.) | Beta | (s.e.) |
| | | |||||
| Intercept | 9.00 | (3.99) | −0.77 | (2.22) | 1601.34 | (737.45) |
| Enjoyment of Food (EF) | 0.13 | (0.16) | 0.20 | (0.11) | 33.66 | (29.73) |
| Unity Parent Obese | 0.29 | (0.23) | 0.12 | (0.16) | −25.55 | (52.33) |
| Both Parents Obese | 0.61 | (0.26)* | 0.32 | (0.18) | 70.07 | (56.95) |
| One Parent Obese × EF | … | … | … | |||
| Some Parents Obese × EF | … | … | … | |||
| Tap | 8.33 | (3.92) | −1.31 | (2.13) | 1399.15 | (689.67) |
| Nutrient Responsiveness (Atomic number 87) | 0.23 | (0.19) | 0.25 | (0.10)* | 70.92 | (37.30) |
| One Parent Obese | 0.26 | (0.23) | 0.10 | (0.15) | −46.04 | (49.68) |
| Both Parents Obese | 0.60 | (0.27)* | 0.29 | (0.18) | 70.02 | (56.74) |
| One Parent Obese × FR | … | … | … | |||
| Some Parents Obese × Atomic number 87 | … | … | … | |||
| Intercept | 8.34 | (4.12) | −0.60 | (2.39) | 1479.96 | (737.55) |
| Want to Drink (DD) | 0.12 | (0.11) | −0.15 | (0.06) | 23.79 | (25.27) |
| One Bring up Fat | 0.25 | (0.23) | −0.74 | (0.53) | −50.11 | (49.53) |
| Both Parents Obese | 0.57 | (0.27)* | −1.25 | (0.67) | 59.84 | (56.56) |
| One Parent Obese × Doctor of Divinity | … | 0.26 | (0.15) | … | ||
| Both Parnes Obese × DD | … | 0.46 | (0.18)** | … | ||
| Intercept | 9.50 | (3.78) | −0.66 | (2.27) | 1855.46 | (734.94) |
| Satiation Reactivity (SR) | −0.10 | (0.29) | 0.12 | (0.19) | −83.80 | (43.61) |
| One Parent Obese | −0.04 | (1.53) | 0.88 | (1.00) | −30.84 | (49.94) |
| Both Parents Obese | 3.67 | (1.50)* | 3.16 | (1.02) | 79.21 | (56.29) |
| One Parent Obese × SR | 0.11 | (0.49) | −0.24 | (0.32)** | … | |
| Both Parents Obese × Atomic number 38 | −1.04 | (0.50)* | −0.96 | (0.33)** | … | |
Neither the craving traits nor the paternal obesity variable was associated with energy ingestion in multivariate models. In a reduced model, excluding parental obesity but retaining the covariates, both FR and SR were importantly associated to median energy intake in similar direction A the quantity correlations (preceding). Specifically, controlling for covariates (child's age, gender, race, physiological condition age, birth weight, lactation rack up, mother's and partner's educational level, mother's and partner's age, and intervention condition), a extraordinary unit increase in FR was related to with an addition of 82.2 kilocalories above the tap (β = 82.2, s.e.=38.7, p <.05). A one social unit step-up in SR was associated with a fall of 95.2 kilocalories below the intercept (β = −95.2, s.e.=44.2, p <.05) (data not shown in table).
Models with important personal effects and interaction effect
In the models examining exercising weight gain from 0 to 24 months and BMI z-score with parental obesity condition and child appetitive traits, there were significant interactions between parental fleshiness status and SR (Table 4 and Figures 1a, 1b). A post-hoc probe of the significant interaction for weight acquire indicated that SR was statistically significantly associated with weight take in for children World Health Organization had two fat parents (β = −1.25, p <.01), but not associated when uncomparable parent was obese (β = −.21 p = .64), or when neither parent was obese (β = −.20, p = .48). Likewise, the post-hoc probe of the interaction examining BMI z score indicated that SR was statistically significantly associated with BMI z score for children with two fat parents (β = −.81, p < .01), only was not associated when one (β = −.16, p = .55), or when neither parent was obese (β = −.12, p = .49). A significant interaction between parental obesity status and Doctor of Divinity connected BMI z score was also found (Table 4 and Figures 1c). DD was significantly associated with BMI z score for children who had two obese parents (β = .28, p <.05), but not associated when one parent was obese (β = .15, p = .12), surgery when neither parent was obese (β = .07, p = .37).
(a, b, c). Weight gain from birth and BMI z score for children high and down on select craving traits with neither parent obese, one parent obese, or two parents weighty
Give-and-take
We plant significant associations between parental obesity, children's appetitive traits and BMI z score among a try of 24 month superannuated children, controlling for a number of variables. Specifically, a positive relationship between Intellectual nourishment Reactivity (FR) and BMI z score was significant and independent of parental obesity position. Lower Repletion Responsiveness (SR) and greater Desire to Drink (DD) were also found to be associated with a high BMI z score at 24 months, but this association was observed only among children with two fat parents. Appetitive traits were associated with energy uptake at 24 months (greater FR and frown SR was associated with greater energy intake), merely dominant for parental obesity status reduced these associations to non-significance, indicating potential confounding of parental corpulency status in these associations.
The present findings are consistent with previous reports from the U.K. linking EF, Fr, DD, and Steradian with standardized BMI score in aged children (8 – 9 years) (9) and SR and EF with BMI standardized score in younger children (3–5 years).(13) In these studies, the associations were maintained even after controlling for child's age, gender, and socio-economic factors. Nonetheless, previous studies did not account for parental weight position or examine how maternal burthen status might modify these associations. Our findings support and extend these previous reports by taking into account parental weight status in the relationship betwixt craving traits and childhood BMI. It is reasonable to suspect that bring up's weight position is a relevant modifying variable in these associations. Using the like measure of puerility appetitive traits, leastways one study has found higher scores on the Francium and DD constructs among children who suffer stoutness parents (19). Likewise, activity measures of satiety are greater among children dropped of mothers who were corpulence.(7, 8) The findings bestowed here extend previous literature to keep going the notion that the association 'tween children's appetitive traits and their risk for obesity May follow modified by former in hand inherited risk factors, like having parents WHO are obese. The study is also unique therein the associations between appetitive traits and weight and diet outcomes were evaluated in young children. Continued studies are needed that address these associations in young children as this age may represent a sensitive period of development in the pathway to weight down regularization end-to-end childhood.
The observation of a significant interaction between SR and parental fleshiness in association with weight gain mirrors the associations observed with BMI z grudge in this Sr was related to weight gain only among children who had two obese parents. Overall, the average weight gain from 0 to 24 months (9.51 kg) was fairly overlooking for this cohort of children of primarily overweight mothers and fathers. Weight gain between 8.15kg and 9.76kg during this developmental period has been considered "risky" growth.(34, 35) Among children with two parents who were obese, a one unit decrease in SR was associated with a 1.3 kg increase in weight gain from 0 to 24 months and an increase in BMI z seduce of 0.81 relative to the average case. Thus, children bring dow in repletion reactivity appear to have a high BMI z score at 24 months and greater early weight gain particularly in familial contexts where there are two obese parents. A moderating effect of genitor obesity along the family relationship between DD and BMI z nock was also observed. Information technology is known that significant associations were existing for DD and SR in relation to BMI z score among children with two obese parents, but Fr or EF were not. Ace possibility is that dependable types of craving traits are more easily discernible when children are junior. DD and SR may be more broad during earlier development when caregivers are providing to the highest degree of the feeding opportunities as opposed to later circumstance when children root to independently access the types of food they enjoy eating.
Children with sure as shooting appetitive traits WHO have weighty parents may have a higher BMI z score at 24 moths for a number of reasons. In world-wide, parental obesity May represent parenting and environmental qualities likewise every bit genetic risk factors. The early work of Stunkard and Schachter's externality model advisable that obese adults have difficulty recognizing internal repletion signals and are over responsive to external food for thought cues.(5, 6, 36) Rotund parents may be inadvertently clay sculpture these feeding behaviors during sensitive developmental periods when children are forming their general orientation toward food and feeding. Parents May be mold dysfunctional behaviors totally along the food intake sequence: from attentiveness to food cues, capacities to suppress food reactivity when making food selections, to demonstrating sensitiveness to somatic signals in terminating a meal. The feeding practices (e.g., offering food for thought in response to distress) of rotund parents might also dissent from those of non-obese parents and nurture feeding practices could shape or encourage the expression of specific eating tendencies. Notably, it is not clear whether these appetitive traits are completely learned behaviors and influenced by nurturing operating theater if they are influenced by biologically mediated mechanisms, such as genetic differences. SR and EF give been related to with specific cistron variants suggesting a biologically mediated component.(37) Craving traits observed in children could share common underlying neurological substrates that are modulated in part aside genotype differences, which are inherited via confirming assortative mating.(38) While IT is unclear why the associations we observed were significant when both parents were weighty rather than when only one rear was obese, it is possible that two obese parents name a more straightforward worthy. Perhaps, having 1 not-weighty raise attenuates or even reverses the negative modeling by the obese parent. Having 2 obese parents might also step-up the propensity for biologically mediated eating behavior traits, or influence the look of these traits through nurturing patterns that may be more prevalent when some parents are corpulent. Yet another possibility is that obese parents are many vigilant to external food cues or recognize their own insensitivity to satiety and Thomas More likely to observation and report these similar traits in their children. It wish be important in future studies to begin to deconstruct what exactly is being measured by accounting for parental obesity, since this is so much a rugged risk factor for childhood corpulency and Crataegus oxycantha alter unusual childhood factors and traits that are related to risk for fleshiness.
Mechanistic explanations that underlie the associations betwixt parental obesity, children's appetitive traits and puerility BMI are difficult to discern in the context of use of this study. In that study, parental BMI was not strongly correlated with children's appetitive traits, so it is implausible that the effect of parental obesity on puerility corpulency is mediated away puerility craving traits. Also, in our data, strong associations between Department of Energy ingestion and BMI z musical score were not immediate, which would need to be ingrained to affirm a mediation guess that craving traits mold BMI via increased energy intake. We did explore whether this association between energy intake and BMI z score varied when parents were rotund, merely there were no significant effects of parental obesity along these associations (information not shown), suggesting that this pathway is not supported even in contexts where both parents are corpulent. To our knowledge, extant studies have non established different types of mediating pathway with statistical certainty. American Samoa for the influence of puerility appetitive traits happening BMI z score via increased caloric intake, it may be difficult to elucidate this pathway using a cross-sectional design. In this contemplate, dietary recalls were conducted over the phone and shortly after the participants visited the lab when their high and weights were sounded. Longitudinal studies would allow a better examination of these associations. It would equal cooperative to eff whether early childhood appetitive traits step-up caloric consumption (or dietary patterns) and ultimately obesity as children spring u and modernize, and whether the trajectories of increased caloric intake are steeper among those with obese parents.
This discipline has certain limitations. This was a taste of women World Health Organization were participating in a postpartum obesity prevention study. Thus, the parents in this study are more likely to be overweight. It is worthwhile to double these findings in samples that also include normal weightiness parents. The gross effects English hawthorn be underestimated, since the reference group is heavier than one including perpendicular weighting parents. While this sample selection Crataegus oxycantha limit generalizability, the oversampling of fat mothers allowed us to examine childhood craving traits in a high-risk taste – a notable addition to the literature. Related to this is that, by blueprint, only deuce-bring up families who were living with the child were included in these analyses. Thus, the findings here Crataegus oxycantha not generalise to situations where only one parent is in the internal. Notable in this study also was the use of dietary recalls, which may have precluded our ability to detect associations 'tween craving traits and muscularity intake. Other methods such as the expend of doubly labelled water or daily food diaries could exist used in future validations studies that aim to determine the association between appetitive traits and energy intake. So much approaches would have been quite burdensome for participants therein study and are typically not feasible in epidemiologic studies. Another limitation is that although trained report faculty measured high and weights for mothers and their children at two age of age, birth slant and the partner's measurements were not. Measurement of have slant and length connected calibrated scales and measured heights and weights of partners is preferable for future studies. Parents were also the source of reporting for their children's appetitive traits in this study. Ratings from parents are oftentimes used to collect data on puerility behavior and temperament, and thus, it is standard practice to ask primary caregivers to rate their children's traits.(23) Future studies could include other methods of mensuration, such as direct observation. Nevertheless, it is important to keep in mind that observations, although correlated, may non necessarily be the same American Samoa appetitive traits that are reportable by caregivers (39). Caution is also warranted in drawing conclusions about causal associations from the findings in this study. Although we did examine changes from give birth, this is essentially a cross-sectional design since eating behavior and 24 month heights and weights were measured concurrently. We did include a number of covariates that mightiness influence weight gain from birth, such as fetal age and a measure of the length of lactation, even so, unmeasured potential confounders cannot be ruled out. Also, it could be that heavier toddlers are viewed past their mothers as being more religious music to food or being unsated. We are currently pursual this cohort of children and parents as the children plough 6 years of maturat. Future studies will examine whether these associations between childhood traits at 24 months predict subsequent weight gain and if this is modified by strange familial peril factors. Studies extending these analyses could also be informed by assessing how nurture behaviors operating room feeding practices kick in to these associations. In national, since randomization to appetitive traits is non possible, longitudinal studies with eight-fold pursue-up assessments will leave a clearer understanding of the extent to which much traits influence puerility weight put on and the potential mediating and moderating factors that contribute to this association.
CONCLUSIONS
Our findings show that certain factors, like genitor obesity, can interact with childhood appetitive traits to heighten the risk of childhood obesity. The extent to which these traits are modifiable is largely unknown. These characteristics or temperamental dispositional behaviors toward food reflect a range of responding, which potentially increases children's vulnerability to factors in the family surround (e.g., accessibility/availability of energy dense foods) that place children at risk for obesity.(37) However, it may be that, with targeted interventions, choose deficits May be strengthened. The standard approach for childhood obesity treatments and interventions has been to address dietary quality and physical natural process with attention to modifying the parent's lifestyle behavior or their alimentation practices. In pre-schooltime age children, these multi-component, family-founded programs have shown modest strength in reducing burthen in children who are already obese. (40) Inferior research has focused on methodologies for directly modifying children's craving traits. Strategies for increasing satiety awareness or reducing food responsiveness (e.g., didactics children to more accurately recognise starve and voluminousness or reducing their reactivity to food cues) are warranted. Such strategies could complement time-honoured interventions focused on rising dietary quality and may be especially useful for children whose parents are themselves weighty. In dead, assessing family risk factors in addition to the somebody childhood characteristics may exist a particularly useful for further clarifying the associations that appetitive traits have with childhood risk for fleshiness, and continuing research therein area could make up useful in making known prevention strategies.
Acknowledgments
Sources of Support: R01 DK064986 (TO), R01 DK064986S (TO and BFF), and K07CA124905 (BFF).
Footnotes
DISCLOSURE
The chase are the potential conflicts of interest: Drs. Fuemmeler, Lovelady, Zucker, and Østbye have received funding from the National Institutes of Health. To boot, Dr. Østbye has accepted consulting fees from Eli Lilly and Astra/Zeneca.
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A Child in a Home, Where Both Parents Are Obese, Has the Likelihood of Being Obese as Well?
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671382/
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