We present to you the fourth chapter of the N&G 2022 Yearbook!
Meet the authors, find out more about their topic and download the full book.
Obesity, Metabolic Syndrome, and Nutrition
Shlomit Shalitin and Luis Moreno
Over the last few decades, childhood obesity rates have increased globally. Childhood obesity is a serious health concern putting the child’s long-term health and quality of life at risk. Children with obesity are at greater risk of developing related metabolic and psychological conditions, and experiencing pervasive weight bias and stigma. Childhood obesity tracks into adolescence and adulthood, and is strongly correlated with risk of poor adult health, with considerable social and economic outcomes.
The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure and decreased levels of physical activity combined with a genetic predisposition for weight gain. A large and growing body of evidence supports the concept of developmental programming through which the maternal environment affects fetal and infant development, thereby altering the risk profile for disease later in life.
Maternal obesity during pregnancy predisposes to a higher prevalence of obesity in the offspring. Previous data have shown that obese women produce milk with increased concentrations of leptin, insulin, and C-reactive protein compared with normal weight counterparts, which may influence their child’s body weight. Maternal BMI may also be associated with the sugar composition in their milk. Insights on the unique milk metabolome profiles characteristic of maternal obesity and the potential impact of differentially abundant milk metabolites, including human milk oligosaccharide concentrations, which are associated with fat mass in the infant, have been provided by two of the studies reviewed below.
Early life nutrition has a significant impact on lifelong health. Human milk is the gold standard source of nutrition in infancy as it is specifically tailored to support the growth and development of the infant. Nutrition during the first years of life also seem to play an important role in the occurrence of childhood obesity and the development of cardiometabolic risk, as documented in some of the manuscripts reviewed below. Introducing complementary foods other than breastmilk or formula can acutely change the infant’s gut
microbiota composition. One of the studies evaluated the potential interaction between timing of infant complementary feeding and breastfeeding duration in the determination of early childhood gut microbiota composition and BMI in early childhood. Another study
examined the nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life. High protein intake in early life may be associated with an increased risk of childhood obesity.
One of the reviewed studies evaluated the impact of different levels of protein intake by infants on blood metabolic and hormonal markers and the association between these markers and anthropometric parameters and body composition until the age of 2 years.
The results demonstrated that reduction of the protein intake by 20% did not result in different metabolic profile in formula-fed infants in the first months of life. Some studies have shown that school environments that support healthy food and physical activity behaviors
may positively influence childhood obesity. A few of the reviewed studies tried to evaluate the impact of the diet composition (as adherence to high protein/low glycemic index diet or the Mediterranean diet) on insulin resistance and metabolic syndrome among children and adolescents with overweight or obesity.
One large study assessed whether interaction effects occur between an obesity genetic risk score and the adherence to a Mediterranean diet on adiposity and metabolic syndrome. Other study results showed that the inclusion of dairy foods in the diet of adolescent
females with overweight/obesity, as part of a diet and exercise intervention, favorably improved body composition even in the absence of weight loss. Higher consumption of dairy products, particularly low-fat milk and yogurt, was associated with reduced risk of
incident metabolic syndrome. Children with obesity are prone to develop obesity-related comorbidities. One of the main
comorbidities is non-alcoholic fatty liver disease (NAFLD). The role of genetic predisposition and nutrition and diet in the development of NAFLD is still not fully understood. Current data found that higher sugar-containing beverage intake in infancy was associated
with NAFLD in school-aged children, independent of sugar-containing beverage intake and BMI at school age. Recent literature suggests that also the Western diet’s imbalance between high ω-6 (n-6) and low ω-3 (n-3) polyunsaturated fatty acids (PUFA) intake contributes to NAFLD in obese youth. Data from one of the studies demonstrated that, independently
of weight loss, a low n-6:n-3 PUFA diet ameliorates the metabolic phenotype of adolescents with NAFLD. Considering the deleterious consequences of obesity in childhood, public health interventions are urgently called for to promote an active lifestyle with engagement in physical activity and to take nutritional measures with policies that encourage healthy eating
In this chapter we review a selection of 14 notable articles published between July 2020 and June 2021, focusing on the relation between nutrition, obesity, and metabolic comorbidities in childhood and young adulthood.
Key Referenced Articles
Maternal Weight during Pregnancy and Risk of Childhood Obesity
Maternal adiposity alters the human milk metabolome: associations between non glucose monosaccharides and infant adiposity
Saben JL, Sims CR, Piccolo BD, Andres A
Am J Clin Nutr 2020;112:1228–1239
Breastfeeding and Nutrition during Early Life and Risk of Childhood Obesity
Human milk oligosaccharide concentrations and infant intakes are associated with maternal overweight and obesity and predict infant growth
Saben JL, Sims CR, Abraham A, Bode L, Andres A
Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life: a population-based birth cohort study
Lindholm A, Bergman S, Alm B, Bremander A, Dahlgren J, Roswall J, Staland-Nyman C,
BMC Pediatrics 2020;20:507
Potential interaction between timing of infant complementary feeding and breastfeeding
duration in determination of early childhood gut microbiota composition and BMI
Differding MK, Doyon M, Bouchard L, Perron P, Guerin R, Asselin C, Masse E, Hivert MF, Mueller NT
Pediatr Obes 2020;15(8):e12642
Complementary feeding and overweight in European preschoolers: the ToyBox-study
Usheva N, Galcheva S, Cardon G, De Craemer M, Androutsos O, Kotowska A, Socha P, Koletzko BV,
Moreno LA, Iotova V, Manios Y, and on Behalf of the ToyBox-Study Group
Early-life metabolic and hormonal markers in blood and growth until age 2 years: results
from a randomized controlled trial in healthy infants fed a modified low-protein infant formula
Kouwenhoven SMP, Fleddermann M, Finken MJJ, Twisk JW, van der Beek EM,
Abrahamse-Berkeveld M, van de Heijning BJM, van Harskamp D, van Goudoever JB, Koletzko BV