Maternal And Child Obesity: The Causal Link

Páginas: 7 (1504 palabras) Publicado: 25 de octubre de 2011
Maternal a nd Child Ob esity : The Ca usal Link
Emily Oken, MD, MPH
KEYWORDS  Child  Obesity  Pregnancy  Weight gain  Maternal

As the prevalence of obesity has increased over the past few decades in the United States among adults and pregnant women, so has the proportion of children who are obese.1 Children who are obese tend to become overweight adults,2,3 and once present, obesity isnotoriously difficult to treat. Longitudinal data indicate that rising obesity trends are apparent even among young infants (Fig. 1),4 suggesting that influences occurring very early in life are contributing to the rise in childhood obesity. The field of the Developmental Origins of Health and Disease posits that influences that occur during sensitive periods of development, such as the prenatalperiod, can have lifelong effects on health.5 Before birth, the development of organs and systems is both profuse and plastic, and thus susceptible to perturbation. Numerous animal experiments dating back decades show that experiences during early life such as energy deficiency or excess, deficiencies of specific nutrients, or toxicant exposures can have long-lasting, sometimes irreversible,effects on offspring obesity and associated cardio-metabolic markers.6 Evidence suggests that similar experiences also influence weight regulation and chronic disease risk among humans. This article summarizes animal and human evidence linking maternal weight, weight gain during pregnancy, and related prenatal experiences with offspring obesity. Some possible pathways by which maternal weight status mayinfluence child weight regulation, public health implications, and areas for future research are discussed.
CLASSIFICATION OF OBESITY

Most epidemiologic and clinical studies use self-reported or measured weight and height to calculate body mass index (BMI) and thereby define obesity. Whereas in adulthood obesity definitions are static (a BMI of at least 30 kg/m2 indicates obesity, and BMIbetween 25.0 and 29.9 kg/m2 indicates overweight7), among children body proportions, and therefore obesity thresholds, vary physiologically with age and

The author has no conflicts of interest to report. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Boston, MA 02215, USA E-mail address: emily_oken@hphc.org Obstet GynecolClin N Am 36 (2009) 361–377 doi:10.1016/j.ogc.2009.03.007 0889-8545/09/$ – see front matter ª 2009 Elsevier Inc. All rights reserved. obgyn.theclinics.com

362

Oken

Fig. 1. Age-specific predicted prevalence of overweight from 1980 through 2001 among 120,680 children 0 to 71.9 months seen at 366,109 well-child care visits at a Massachusetts HMO, by age group. (From Kim J, Peterson KE,Scanlon KS, et al. Trends in overweight from 1980 through 2001 among preschool-aged children enrolled in a health maintenance organization. Obesity [Silver Spring] 2006;14:1107–12; with permission.)

sex. In the United States, childhood obesity is typically defined as a BMI at or above the 95th percentile for age and sex, and overweight as a BMI between the 85th and 94th percentile, based on growthcharts created by the Centers for Disease Control and Prevention (CDC).8 To calculate these percentiles, the CDC use as a reference population United States children measured in the 1970s, most of whom were not breastfed. Others, especially outside the United States, use World Health Organization growth charts, which used as a reference healthy breastfed children from several countries.9 Althoughthese different standards yield somewhat different estimates of obesity prevalence, escalating obesity trends are consistent regardless of the growth standard used. The use of BMI affords many conveniences, as weight and height can be measured or can be reported on a questionnaire, recalled even over many years, or obtained from clinical records, all with reasonable accuracy. However, in...
Leer documento completo

Regístrate para leer el documento completo.

Estos documentos también te pueden resultar útiles

  • Child Obesity
  • The Child And The State In India Cap 6
  • THE CHILD
  • The Association Between Maternal Childhood Abuse And The Hpa Axis And Its Prevalence In Postpartum Depression.
  • Obesity And Cardiovacular Disease
  • The Link Between The Diversity Of Productive Models And The Variety Of Capitalisms. Lung
  • Child And Adolescent Obesity Epidemiology And Developmental Perspectives
  • Understanding and managing hellp syndrome: the integral role of aggressive glucocorticoids for mother and child

Conviértase en miembro formal de Buenas Tareas

INSCRÍBETE - ES GRATIS