Читать книгу Clinical Obesity in Adults and Children - Группа авторов - Страница 62

The combined predictive value of these developmental risk factors for childhood obesity is substantial. Although each risk factor may be modestly associated with childhood obesity, collectively they may result in enormous differences for populations. An analysis of the Project Viva cohort found that mid‐childhood obesity prevalence at age seven was approximately 30% among children with four early life risk factors (maternal smoking and excessive gestational weight gain during pregnancy; short duration of sleep at 6 months and breastfeeding duration <12 months), compared with only 6% among those who had none of the four [122]. Results were similar in the GUSTO cohort from Singapore [123]. Another group has estimated that 47.2% (95% CI: 30.9%, 63.5%) of type 2 diabetes in youth could be attributed to intrauterine exposure to maternal diabetes and obesity [124]. In a meta‐analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia, the proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2 to 21.6% [35].

Risks are likely even higher among certain subgroups of the population. In the United States, rates of obesity are especially high among children from lower‐income families as well as children who are Black, Hispanic, and other race/ethnicity compared with white or Asian‐American [125]. Racial disparities in childhood overweight appear to be largely explained by potentially modifiable early life risk and protective factors [126,127]. Interestingly, among low‐income and nutritionally at‐risk children aged 2–4 years enrolled in the Federally‐funded US Women, Infants, and Children (WIC) Program, the overall crude prevalence of obesity actually decreased from 15.9% in 2010 to 13.9% in 2016 [128]. Promising evidence suggests that changes in the WIC food package that provided healthier food purchases during pregnancy and the early postpartum years within the WIC program may be responsible for these declines [129].