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Childhood obesity has become a major worldwide health concern. During the last 30 years, the number of obese children and adolescents has significantly increased across most countries [1]. Childhood obesity tracks into adulthood with detrimental effects on health. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain.

Given the long-term adverse sequelae of childhood obesity, identification of factors related to childhood obesity is warranted. A growing body of evidence suggests that the increased risk for childhood obesity is associated with early-life factors, such as the pregnancy period and the nutrition during the first years of life. Insights on the potential impact of maternal diet during early life on childhood adiposity have been provided by one of the studies reviewed below.

It is acknowledged that rapid or excess weight gain during the first 2 years of life is associated with a higher risk of being overweight or obese in later childhood [2].

Human milk is considered ideal and appropriate as the only food for the first 6 months of life, since it contains a variety of components essential for infant growth, development, and well-being, for example, vitamins, minerals, carbohydrates, amino acids, proteins, hormones, growth factors, and antimicrobial factors. Thus, breastfeeding may promote healthy growth trajectories during infancy, and the role of exclusive breastfeeding duration in eating behavior is presented. Exclusive breastfeeding in early infancy may also promote a healthier lipid profile in late adolescence through mechanisms unrelated to adiposity, implicating its potential long-term benefits for cardiovascular health.

However, the extent to which breastfeeding is protective against later-life obesity is debated. Inconsistent associations between breastfeeding and infant obesity risk could be related to variations in human milk composition. Human milk is a dynamic and complex substance that delivers a milieu of hormones and other bioactive components. One of the studies reviewed below indicated that individual bioactive components of human milk may regulate different compartments of infant weight gain separately. The detection of appetite regulators in human milk and their association to offspring anthropometry and growth can represent another piece of the puzzle of the functions of human milk.

In infants fed with formula, the type of the formula can have a direct impact on early rapid weight gain. One of the reviewed studies highlights the role of infants in the feeding dynamic.

In particular, the differences in satiation properties and difference in energy intake and early rapid weight gain when healthy infants are fed different types of infant formulas, while isocaloric, differ in free amino acids and protein content.

Patterns of dietary habits and the type of food consumption during childhood may also be of relevance for an unfavorable development of body composition and may have consequences extending into adulthood. Some studies reported that consumption of fast food can have an adverse impact on the development of body composition during the primary school years and that adding sugars to foods that are commonly perceived as healthy may impact the adherence to healthy dietary guidelines and increase in adiposity risk as well.

Consumption of low-calorie sweeteners has increased in children, predominantly in the form of low-calorie sweetened beverages. Evidence from previous randomized controlled trials does not clearly support the intended benefits of non-nutritive sweeteners for weight management, and observational data suggest that low-calorie sweetened beverages consumption in children, with or without concomitant sugary beverage consumption, is associated with higher energy, carbohydrate, and sugar intakes compared with water.

Children with obesity are prone to develop obesity-related comorbidities. One of the comorbidities is non-alcoholic fatty liver disease (NAFLD). The role of nutrition and diet in the development of NAFLD is still not fully understood. One study presented in this chapter suggests that a sugar-rich diet might contribute to the development of early stages of NAFLD in overweight children and that moderate dietary counseling might improve the metabolic status of overweight children with NAFLD.

Finally, research over the last decade has demonstrated that the microbes that colonize the human gut may play key contributory roles in the pathogenesis of obesity. Gut microbes are known to have symbiotic relationship with the host and play a role in maintaining health and metabolic homeostasis, including production of a diverse array of metabolites. Dysbiosis is associated with the promotion or aggravation of chronic metabolic diseases, including obesity and type 2 diabetes. Recent data provide evidence supporting a causative role of maternal obesity-associated infant dysbiosis in childhood obesity and NAFLD.

This chapter reviews a selection of notable articles published between July 2018 and June 2019, focusing on the relation between nutrition, obesity, and metabolic obesity comorbidities in childhood and young adulthood. This selection of articles indicates the range and intensity of the continuing efforts being made by researchers worldwide to confront the epidemic of childhood obesity.

Key articles reviewed for this chapter

Maternal Diet during Early Life and Risk of Childhood Obesity

Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States

Dhana K, Haines J, Liu G, Zhang C, Wang X, Field AE, Chavarro JE, Sun Q

BMJ 2018;362:k2486

Breastfeeding and Nutrition during Early Life and Risk of Childhood Obesity and Metabolic Comorbidities

Duration of exclusive breastfeeding may be related to eating behaviour and dietary intake in obesity prone normal weight young children

Specht IO, Rohde JF, Olsen NJ, Heitmann BL

PLoS One 2018;13:e0200388

Breastfeeding in infancy and lipid profile in adolescence

Hui LL Kwok MK, Nelson EAS, Lee SL, Leung GM, Schooling CM

Pediatrics 2019;143:e20183075

Bioactive components in human milk are differentially associated with rates of lean and fat mass deposition in infants of mothers with normal vs. elevated BMI

Young BE, Levek C, Reynolds RM, Rudolph MC, MacLean P, Hernandez TL, Friedman JE, Krebs NF

Pediatr Obes 2018;13:598–606

Satiety factors oleoylethanolamide, stearoylethanolamide, and palmitoylethanolamide in mother’s milk are strongly associated with infant weight at four months of age-data from the Odense child cohort

Bruun S, Gouveia-Figueira S, Domellöf M, Husby S, Neergaard Jacobsen L, Michaelsen KF, Fowler CJ, Zachariassen G

Nutrients 2018;10:1747

Exposure to improved nutrition from conception to age 2 years and adult cardiometabolic disease risk: a modelling study

Ford ND, Behrman JR, Hoddinott JF, Maluccio JA, Martorell R, Ramirez-Zea M, Stein AD

Lancet Glob Health 2018;6:e875–e884

Early rapid weight gain among formula-fed infants: Impact of formula type and maternal feeding styles

Mennella JA, Papas MA, Reiter AR, Stallings VA, Trabulsi JC

Pediatr Obes 2019;14:12503

Nutrition during Childhood and Risk of Childhood Obesity and Obesity Related Comorbidities

Dietary patterns in primary school are of prospective relevance for the development of body composition in two German pediatric populations

Wolters M, Joslowski G, Plachta-Danielzik S, Standl M, Müller MJ, Ahrens W, Buyken AE

Nutrients 2018;5;10:1442

The effect of an extra piece of fruit or vegetables at school on weight status in two generations: 14 years follow-up of the fruit and vegetables makes the marks study

Stea TH, Tveter ET, Te Velde SJ, Vik FN, Klepp KI, Bere E

PLoS One 2018;13:e0205498

The impact of adding sugars to milk and fruit on adiposity and diet quality in children: A cross-sectional and longitudinal analysis of the identification and prevention of dietaryand lifestyle-induced health effects in children and infants (IDEFICS) study

Dello Russo M, Ahrens W, De Henauw S, Eiben G, Hebestreit A, Kourides Y, Lissner L, Molnar D, Moreno LA, Pala V, Veidebaum T, Siani A, Russo P and on behalf of the IDEFICS Consortium

Nutrients 2018;10:1350

Clustering of multiple energy balance-related behaviors in school children and its association with overweight and obesity-WHO European childhood obesity surveillance initiative (COSI 2015–2017)

Bel-Serrat S, Ojeda-Rodríguez A, Heinen MM, Buoncristiano M, Abdrakhmanova S, Duleva V, Sant’Angelo V, Fijałkowska A, Hejgaard T, Huidumac C, Hyska J, Kujundzic E, Milanović SM, Ovezmyradova G, Pérez-Farinós N, Petrauskiene A, Rito AI, Shengelia L, Braunerová RT, Rutter H, Murrin CM, Kelleher CC, Breda J

Nutrients 2019;11:511

Consumption of low-calorie sweetened beverages is associated with higher total energy and sugar intake among children, NHANES 2011–2016

Sylvetsky AC, Figueroa J, Zimmerman T, Swithers SE, Welsh JA

Pediatr Obes 2019;14:e12535

Non-alcoholic fatty liver disease in overweight children: role of fructose intake and dietary pattern

Nier A, Brandt A, Conzelmann IB, Özel Y, Bergheim I

Nutrients 2018;10:1329

A randomized control trial of the impact of LCPUFA-ω3 supplementation on body weight and insulin resistance in pubertal children with obesity

López-Alarcón M, Inda-Icaza P, Márquez-Maldonado MC, Armenta-Álvarez A, Barbosa-Cortés L, Maldonado-Hernández J, Piña-Aguero M, Barradas-Vázquez A, Núñez-García BA, Rodríguez-Cruz M, Fernández JR

Pediatr Obes 2019;14: 12499

The Intestinal Microbiota and their Relation to Metabolic Programming

The gut microbiota in infants of obese mothers increases inflammation and susceptibility to NAFLD

Soderborg TK, Clark SE, Mulligan CE, Janssen RC, Babcock L, Ir D, Young B, Kriebs N, Lemas DJ, Johnson LK, Weir T, Lenz LL, Frank DN, Hernandez TL, Kuhn KA, D’Alessandro A, Barbour LA, El Kasmi KC, Friedman JE

Nat Commun 2018;9: 4462

Maternal Diet During Early Life and Risk of Childhood Obesity

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