2.1.2. Early Childhood Risk Factors

Birth weight (BW) is a sentinel marker of fetal health reflecting both, the intrauterine growth and the length of gestation. Not only does low BW merits consideration but also high BW which is a consequence of intrauterine overnutrition. Based on recent findings, the associations of abnormal fetal growth with heightened risk for cardiovascular and metabolic disease extend across a range of birth weights and postnatal growth patterns [9].

Early childhood growth trajectories and rapid catch-up growth have been shown to influence the development of risk factors. The impact of BW and postnatal growth on the presence of overweight or obesity, blood pressure (BP) values, metabolic parameters, HTN and type 2 diabetes (T2D), was assessed in a systematic review [12]. Some studies had a significant association with BW and/or postnatal growth while others did not. The most frequent association was seen with BP values and fasting insulin, with the greatest adverse levels present in those who were born with low BW but then became relatively heavy [12]. In one meta-analysis, the odds ratio for overweight and obesity was 3.66 [95% CI 2.59–5.17] in the presence of rapid weight gain before 2 years of age, even higher odds were observed when rapid weight gain occurred before 1 year of age [13].

The above findings underscore the importance of regular growth monitoring. The use of obesity criteria to identify children at risk will miss many at-risk persons. An upward crossing of BMI percentiles during childhood, that does not necessarily connote childhood obesity, also increases the risk.

Early-life feeding practices such as being breastfeed or not, timing of introduction and type of complementary feeding along with the association with obesity has been analyzed in observational studies. Some suggest a lower prevalence of overweight and obesity in children who were fed breast milk compared with infant formula, however, optimal duration of breastfeeding to provide substantial benefits remains unknown [14].
