March 2021

NCCOR’s 2020 Annual Report: New Paths to Equity

This month, NCCOR released its 2020 Annual Report, “New Paths to Equity.” Throughout the past year, NCCOR continued to examine issues of equity and explore the role of social determinants of health in reducing childhood obesity. Interventions on the social determinants of health became especially critical during the global pandemic, as the novel coronavirus disproportionately impacted communities and populations that have historically faced a host of social and health inequities.

In 2020, NCCOR:

• Developed a new resource, Measures for Children at High Risk for Obesity. The new resource includes a decision tree that walks researchers and practitioners through a series of questions regarding whether to develop, adapt, or apply an instrument for obesity measures in high-risk populations. The decision tree also provides five real-world case scenarios that describe the rationale for choosing one of the three measurement approaches. A Connect & Explore webinar about this resource was held on January 26, 2021 and hosted nearly 200 attendees.
• Published “Identification of Effective Programs to Improve Access to and Use of Trails among Youth from Under-Resourced Communities: A Review” in the International Journal of Environmental Research and Public Health. The primary aim of this review was to identify programs and policies that effectively promote and increase the use of trails among youth from diverse racial, ethnic, and cultural backgrounds, especially those from under-resourced neighborhoods or communities.
• Published three whitepapers from the Advancing Measurement for Childhood Obesity Research workshop series. This series of three workshops aimed to define next steps in measurement needs to accelerate progress in reducing childhood obesity. The workshops were funded as part of NCCOR’s Strategic Alliance with The JPB Foundation. By addressing the many levels of factors that influence childhood obesity and with focused work within high-risk groups, NCCOR hopes these efforts will ultimately help reduce health inequities associated with childhood obesity.
• Released a new tool for those working on assessing childhood obesity. A Guide to Methods for Assessing Childhood Obesity helps users understand the most common adiposity assessment methods and select the most appropriate method for their particular objective. The Guide describes six methods commonly used to assess body composition in children and highlights procedures, validity and reliability, reference data, accessibility, cost, and participant burden and risk.
• Published four papers in Childhood Obesity highlighting findings from the Childhood Obesity Evidence Base (COEB) Project, a collaborative effort between NCCOR and Mission Measurement to use a novel taxonomic method of data aggregation on obesity prevention efforts for children ages 2–5 years.
• Translated the Youth Compendium of Physical Activities into Spanish and Mandarin. The Spanish version includes translations common in Spain, Mexico, and Columbia. Following the Spanish translation, NCCOR experts identified a need for a Mandarin version, having observed the value for this tool in China, since there are mandatory fitness exams in Chinese schools.

Read the full Annual Report to learn more about NCCOR’s accomplishments 2020.

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NCCOR Toolbox

Spread the word about NCCOR with our social media toolkit! This toolkit accompanies the 2020 Annual Report, “New Paths to Equity.” Use our social media posts, graphics, and sample blogs to share NCCOR’s resources and accomplishments.

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Nutrition, Physical Activity, and Obesity: Data, Trends and Maps

The Centers for Disease Control and Prevention (CDC) now offers an interactive database that provides national and state-level data about the health status and behaviors of Americans as well as environmental or policy supports. Categories include breastfeeding, fruits and vegetables, physical activity, sugar drinks, television watching, and obesity/weight. Visitors can use the ‘view by’ option to examine data by demographics such as gender and race/ethnicity. The data come from multiple sources.

View the tool

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The School Nutrition and Meal Cost Study-I: Findings Related to Improving Diet Quality, Weight, and Disparities in US Children

This Special Issue of Nutrients will provide a general overview of the study design and data collection and analysis methods and several papers related to school meals and school food environments and assessing if disparities exist (e.g., urban/rural, lower- vs. higher-resource schools) and associations related to weight status, food insecurity, and implications for promising strategies related to improving diet quality and reducing obesity disparities.

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Fetal Growth at Different Gestational Periods and Risk of Impaired Childhood Growth, Low Childhood Weight, and Obesity: A Prospective Birth Cohort Study

March 10, 2021, British Journal of Obstetrics and Gynecology

Abstract

Objective: To examine the longitudinal associations of fetal growth with adverse child growth outcomes and to assess whether maternal metabolic factors modify the associations.

Design: Prospective cohort study.

Setting: Born in Guangzhou Cohort Study, China.

Population: A total of 4,818 mother-child pairs.

Methods: Fetal growth was assessed according to estimated fetal weight (EFW) from week 22 of gestation until birth and birth weight. Fetal growth z-scores were computed from random-effects in the multilevel linear spline models to represent fetal size in early pregnancy (22 weeks) and growth in mid-pregnancy (22-27 weeks), early third trimester (28-36 weeks), and late third trimester (≥37 weeks).

Main outcome measures: Childhood stunting; low weight; overweight/obesity; and length-/height-for-age (LAZ/HAZ), weight-for-age (WAZ), and body mass index-for-age (BMIZ) z-scores at age 3 years. Adjusted associations were examined using multiple Poisson or linear regression models.

Results: Increased z-scores of fetal size in early pregnancy and growth in mid-pregnancy and early third trimester were associated with a higher risk of childhood overweight/obesity (risk ratios 1.25-1.45). Fetal growth in each period was negatively associated with stunting and low weight, with the strongest associations observed for fetal size in early pregnancy and growth in mid-pregnancy. The results for continuous outcomes (LAZ/HAZ, WAZ, BMIZ) were similar. The associations of fetal growth with childhood overweight/obesity were stronger among underweight or overweight/obese mothers than among normal-weight mothers.

Conclusions: Accelerated fetal growth before 37 weeks of gestation is associated with overweight/obese children, whereas the critical period for stunting and low weight is before 28 weeks.

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Obesity in Childhood, Socioeconomic Status, and Completion of 12 or More School Years: A Prospective Cohort Study

March 11, 2021, British Medical Journal

Abstract

Objectives Children with obesity achieve lower educational level compared with normal-weight peers. Parental socioeconomic status (SES) impacts both a child’s academic achievement and risk of obesity. The degree to which the association between obesity and education depends on parental SES is unclear. Therefore, the primary aim is to investigate if individuals with obesity in childhood are less likely to complete ≥12 years of schooling, independently of parental SES. The secondary aim is to study how weight loss, level of education and parental SES are associated.

Design Nationwide prospective cohort study.

Setting Swedish national register data.

Participants Children aged 10–17 years, recorded in the Swedish Childhood Obesity Treatment Register, and aged 20 years or older at follow-up were included (n=3942). A comparison group was matched by sex, year of birth and living area (n=18 728). Parental SES was based on maternal and paternal level of education, income and occupational status.

Primary outcome measure Completion of ≥12 years of schooling was analysed with conditional logistic regression, and adjusted for group, migration background, attention deficit disorder with or without hyperactivity, anxiety/depression and parental SES.

Results Among those with obesity in childhood, 56.7% completed ≥12 school years compared with 74.4% in the comparison group (p<0.0001). High parental SES compared with low SES was strongly associated with attained level of education in both children with and without obesity, adjusted OR (^aOR) (99% CI)=5.40 (4.45 to 6.55). However, obesity in childhood remains a strong risk factor of not completing ≥12 school years, independently of parental SES, ^aOR=0.57 (0.51 to 0.63). Successful obesity treatment increased the odds of completing ≥12 years in school even when taking parental SES into account, ^aOR=1.34 (1.04 to 1.72).

Conclusions Individuals with obesity in childhood have lower odds of completing ≥12 school years, independently of parental SES. Optimised obesity treatment may improve school results in this group.

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Low-Quality Maternal Diet During Pregnancy May be Associated with Late-Childhood Obesity

February 21, 2021, EurekAlert!

Eating a low quality diet, high in foods and food components associated with chronic inflammation, during pregnancy may be associated with an increased risk of obesity and excess body fat in children, especially during late-childhood. The findings are published in the open access journal BMC Medicine.

Researchers from University College Dublin, Ireland found that children of mothers who ate a higher quality diet, low in inflammation-associated foods, during pregnancy had a lower risk of obesity and lower body fat levels in late-childhood than children whose mothers ate a lower quality diet, high in inflammation-associated foods, while pregnant. This association was not observed in early or mid-childhood.

Ling-Wei Chen, the corresponding author said: “Obesity in childhood often carries on into adulthood and is associated with a higher risk of chronic diseases, including type 2 diabetes. Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes and points to the first one thousand days of a child’s life, from conception to two years old, as a critical period for preventing childhood obesity. Our research indicates that children born to mothers who eat a low-quality diet, high in inflammation-associated foods, during pregnancy may be more likely to have obesity or excess body fat in late childhood than those born to mothers who eat a high-quality diet low in inflammation-associated foods.”

To examine the effects of maternal diet on the likelihood of childhood obesity and excess body fat, the authors analysed data collected from 16,295 mother-child pairs in seven European birth cohort studies, from Ireland, France, United Kingdom, Netherlands and Poland, which are involved in the ALPHABET consortium. On average, mothers were 30 years old and had a healthy BMI. Mothers reported the food they ate before and during pregnancy. The researchers assessed dietary quality and whether diets were high in foods and food components associated with chronic inflammation, such as saturated fat, refined carbohydrates and red and processed meat. Children’s BMI was calculated in early, mid and late childhood. Additional data on children’s body composition during mid or late childhood was collected in five of the cohorts included in the study.

The researchers found that children born to mothers who ate diets high in foods associated with inflammation throughout pregnancy tended to have lower levels of fat-free body mass, indicating lower levels of muscle mass, in late-childhood than those whose mothers ate diets low in inflammation-associated foods. Previous research has found that low levels of muscle mass may be associated with a higher risk of combined diabetes, high blood pressure and obesity

An association between a lower quality maternal diet, high in inflammation-associated foods, and lower levels of fat-free body mass in late-childhood was found to be stronger in boys than in girls. An association between lower quality maternal diet, high in inflammation-associated foods, and higher body fat levels in mid-childhood was stronger in girls than in boys.

Catherine Phillips, the principal investigator and coordinator of the ALPHABET project said: “Previous research has suggested that lower maternal carbohydrate intake in early pregnancy can induce epigenetic changes – that is changes which alter gene expression – in children that may be associated with an increased risk of obesity. We propose that a lower quality maternal diet, high in inflammation-associated foods, may similarly induce epigenetic changes and that this may increase the risk of children having obesity or excess body fat in later childhood. Our findings suggest that promoting an overall healthy diet, high in fruit and vegetables and low in refined carbohydrates and red and processed meats, throughout pregnancy may help prevent childhood obesity.”

The authors caution that the observational nature of the study does not allow for conclusions about a causal relationship between maternal diet and childhood obesity and excess body fat. Future research should account in more detail for other factors that could influence the risk of obesity in childhood, such as childhood physical activity and diet, according to the authors.

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