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  • Review Article
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From conception to infancy — early risk factors for childhood obesity

Nature Reviews Endocrinology volume 15, pages 456–478 (2019)Cite this article

Subjects

Abstract

Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.

Key points

  • Maternal obesity has become an important public health problem influencing adiposity of mother and child in both low-income and high-income countries.

  • Specific measurements of offspring adiposity and not only BMI are required; maternal BMI at the time of pregnancy, gestational weight gain and gestational diabetes are independent risk factors of excess adiposity in the offspring.

  • Pregnant women should follow a healthy lifestyle, avoiding malnutrition and smoking, and moderate free sugar intake to reduce child adiposity risk.

  • Despite the inconclusive effect of breastfeeding on reducing obesity risk later in life, breastfeeding should be promoted owing to its many beneficial effects.

  • Not enough data exist to conclusively link the timing of introduction of complementary feeding, prebiotic and probiotic consumption, and screen time with later overweight and obesity in children up to 2 years of age.

  • In children, high-protein intake, consumption of sugar-sweetened beverages and short sleep time are associated with adiposity during the first 2 years of life.

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Fig. 1: Estimated prevalence of overweight and obesity in young children.
Fig. 2: Estimated prevalence of overweight and obesity in children and adolescents aged 5–19 years.
Fig. 3: Estimated prevalence of preterm birth rate by regions for 1990 and 2010.
Fig. 4: Relevant factors for childhood obesity preventive efforts.

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Reviewer information

Nature Reviews Endocrinology thanks Redman, L., Crume, T. and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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  1. These authors contributed equally: Elvira Larqué, Idoia Labayen.

Authors and Affiliations

  1. Department of Physiology, University of Murcia, Murcia, Spain

    Elvira Larqué

  2. Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD) and Department of Health Sciences, Public University of Navarra, Pamplona, Spain

    Idoia Labayen

  3. Childhood Obesity Unit, Department of Pediatrics, Skane University Hospital, Malmo, Sweden

    Carl-Erik Flodmark & Inge Lissau

  4. Department of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden

    Carl-Erik Flodmark & Inge Lissau

  5. Clinical Research Centre, University Hospital Copenhagen, Hvidovre, Denmark

    Inge Lissau

  6. Deptartment of Pediatrics, Division of Nutrition and Metabolism and Austrian Academic institute for Clinical Nutrition, Vienna, Austria

    Sarah Czernin & Kurt Widhalm

  7. Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain

    Luis A. Moreno

  8. Instituto Agroalimentario de Aragón (IA2) and Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain

    Luis A. Moreno

  9. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Luis A. Moreno

  10. Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

    Angelo Pietrobelli

  11. Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Angelo Pietrobelli

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  1. Elvira Larqué
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The authors contributed equally to all aspects of the article.

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Larqué, E., Labayen, I., Flodmark, CE. et al. From conception to infancy — early risk factors for childhood obesity. Nat Rev Endocrinol 15, 456–478 (2019). https://doi.org/10.1038/s41574-019-0219-1

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