Early Predictors of Obesity and Cardiovascular Risk Among American Indian Children
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American Indian (AI) children have the highest rates of obesity among ethnic groups in the United States, and rates continue to increase. This study was designed to examine the effects of prenatal and early postnatal factors on AI children’s body mass index (BMI) trajectories, adiposity, and cardiovascular risk markers during early childhood. We screened 471 AI children (ages 5–8) from three Wisconsin tribes. Screenings included anthropometric and body fat measures and non-fasting lipid and glucose via fingerstick blood samples. Tribal records from Women Infants and Children (WIC) programs and clinic charts provided data on children’s BMI trajectories, maternal prenatal factors, and the early postnatal feeding environment. Forty-seven percent of children were overweight or obese. Analysis of growth trajectories showed that children’s BMI category was largely determined within the 1 year of life. Significant predictors of children’s BMI category at age 1 included macrosomia (OR 4.38), excess gestational weight gain (OR 1.64) and early termination of breastfeeding (OR 1.66). Children who were overweight/obese at age 1 had greater odds of being overweight (OR 3.42) or obese (OR 3.36), and having unhealthy levels of body fat (OR 2.95) and LDL cholesterol (OR 1.64) at ages 5–8. Children’s BMI category is determined in the early post-natal environment, within the 1 year of life, by factors including excess gestational weight gain and early termination of breastfeeding. In turn, children’s BMI category at age 1 predicts the emergence of cardiovascular risk markers in early childhood.
KeywordsAmerican Indian Breastfeeding Gestational weight gain Growth trajectories Macrosomia
The project described is supported by grants from the Eunice Kennedy Schriver National Institute of Child Health and Human Development (T32 HD049302 to Lindberg), the Great Lakes Native American Research Centers for Health with funding from IHS/NIGMS (U269400014-01 to Adams), the Wisconsin Department of Health and Family Services with funding from the CDC for Cardiovascular Health Research (DHHS 22236646/155069 to Adams), and a NIH/NHLBI Career Development grant (K23 HL068827 to Adams). This manuscript's content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations. The authors thank the Wellness staff who assisted in gathering data from Bad River, Menominee, and Lac du Flambeau. We also thank the children and families participating in WINGS.
Conflict of interest
The authors declare no conflicts of interest.
- 2.Centers for Disease Control and Prevention. (2009). Obesity prevalence among low-income, preschool-aged children—United States, 1998-2008. MMWR: Morbidity and Mortality Weekly Report, 58(28), 769–773.Google Scholar
- 7.Pirkola, J., Pouta, A., Bloigu, A., Hartikainen, A. L., Laitinen, J., Jarvelin, M. R., et al. (2010). Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes care, 33(5), 1115–1121. doi: 10.2337/dc09-1871. Epub 2010/04/30.PubMedCrossRefGoogle Scholar
- 10.Schack-Nielsen, L., Michaelsen, K. F., Gamborg, M., Mortensen, E. L., & Sorensen, T. I. A. (2009). Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. International Journal of Obesity, 34(1), 67–74. doi: 10.1038/ijo.2009.206.PubMedCrossRefGoogle Scholar
- 18.Jernigan, V. B. B., Duran, B., Ahn, D., & Winkleby, M. (2010). Changing patterns in health behaviors and risk factors related to cardiovascular disease among American Indians and Alaska Natives. American Journal of Public Health, 100(4), 677–683. doi: 10.2105/ajph.2009.164285.PubMedCrossRefGoogle Scholar
- 21.Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., et al. (2002). 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Statistics, 11(246).Google Scholar
- 22.Institute of Medicine (IOM). (2009). Weight gain during pregnancy: Reexamining the guidelines. In K. M. Rasmussen & A. Yaktine (Eds.), Washington, D.C.: National Academy Press.Google Scholar
- 23.Li, R., Darling, N., Maurice, E., Barker, L., & Grummer-Strawn, L. M. (2005). Breastfeeding rates in the United States by characteristics of the child, mother, or family: The 2002 National Immunization Survey. Pediatrics, 115(1), e31–e37. doi: 10.1542/peds.2004-0481. Epub 2004/12/08.PubMedGoogle Scholar
- 28.LaRowe, T. L., Adams, A. K., Jobe, J. B., Cronin, K. A., Vannatter, S. M., & Prince, R. J. (2010). Dietary intakes and physical activity among preschool-aged children living in rural American Indian communities before a family-based healthy lifestyle intervention. Journal of the American Dietetic Association, 110(7), 1049–1057. doi: 10.1016/j.jada.2010.04.009.PubMedCrossRefGoogle Scholar