EARLY METABOLIC IMPRINTING

AND LIFESTYLE RISK FACTORS

AS DETERMINANTS OF
CHILDHOOD OBESITY

C. Scerri

University of Malta Medical School, Msida (Malta)

 INTRODUCTION
The developed world is currently seeing an increase in
childhood obesity rates.
The reason for this changing epidemiology is multifactorial.
LIFESTYLE
Exercise

Nutrition - childhood

Social status
PERINATAL
Genetic

Intra uterine
nutrition

Infant feeding
 METHODOLOGY
Epidemiological investigation
The study was carried out among two study
populations
Children aged 5-years of age [n = 236], and
Children aged 9-years of age [n=195].

The children underwent standard anthropomorphic

measurements that were statistically correlated to
the social status of the family, family history of
metabolic syndrome, the childs birth weight, breast
feeding, physical activity habits and nutritional
factors.

The chi square test and student test were utilized as

appropriate.
 METHODOLOGY
Height and weight of the participants were measured

Body Mass Index (BMI) was subsequently calculated

BMI cut off values for overweight 5 year- old boys and girls
was considered to be 17.42 and 17.15 kg/m2 respectively 1.
For the 9 year olds the figures were 19.10 and 19.07 kg/m2
respectively 1.

Waist circumference was measured from the study population

The chosen cut off 75th percentile waist circumference
measurements for 5-year-old boys and girls was 56.5 cm for
both genders; while that for the 9-year-olds the figure was
67.0 and 65.7 cm respectively 2.

1. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity
worldwide: international survey. BMJ 2000; 320(7244): 1240 -1243.
2. Fernndez JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally
representative samples of African-American, European-American, and Mexican-American children and
adolescents. J Pediatr 2004; 145(4): 439 - 444.
 RESULTS
Prevalence
The prevalence of childhood overweight-obesity in
Maltese 5-year-old children as based on cut-off
points defined in the literature was 28.8% for boys
and 32.7% for girls.

These proportions increased markedly with

increasing age, so that 48.9% of Maltese 9-year-old
males and 45.1% of girls were found to be
overweight-obese.
 RESULTS
Early Metabolic Risk Factors Intrauterine nutrition
Relative Risk for overweight/obesity to lean by
birth weight in children aged 5 and 9 years

p<0.0001 <2500g
5
2500-3999g
>4000g
4
RELATIVE RISK RATIO

p=0.03 p<0.0001
3

p=0.44
2

0
at 5yrs age at 9yrs age

At 5 years of age statistically significant risk of obesity in high birth

weight infants; no such risk in low birth weight infants [?catch-up period?]
At 9 years of age statistically significant risk of obesity in low and high
birth weight infants [U-shaped risk].
 RESULTS
Early Metabolic Risk Factors Early infant feeding

The rate of bottle-feeding in the overweight-obese 5-year old group of

children showed a statistically significant higher rate when compared
to the lean 5-year-old children [p=0.04]. No such statistically
significant relationship could be seen in the 9-year olds.

P = 0.04
60 Lean
% Children bottlefed in infancy

Obese
50
P = 0.81
40

30

20

10

0
at 5yrs age at 9yrs age
 RESULTS
Lifestyle Risk factors Socio-economic
There did not appear to be any statistically
significant relationships between socio-
economic parameters and the tendency
towards childhood obesity in both age groups.

Lifestyle Risk Factors Physical activity

Though all parameters relating to physical
activity proved to have no statistical significance;
it appeared that the overweight-obese
individuals at both age groups reported less
mean active physical activity time than their
leaner counterparts.

There was a marked statistical significant less

sleeping time in the overweight-obese nine year
old group when compared to their lean
counterparts [p=0.008].
 RESULTS
Lifestyle Risk Factors - Diet
Although no statistical differences were noted between
diet and obesity risk in the 5-year-old children, certain
trends could be observed.

Less fresh fruit, vegetables, cheese, yoghurt, sweets,

biscuits, and fast foods were consumed by the
overweight-obese 5-year-old children.

More fruit juice, soft drinks, diet drinks, milk whole fat,
milk low fat, meat, fish and chips by this same group.
 RESULTS
Lifestyle Risk Factors - Diet
In contrast statistically significant
differences in dietary patterns were
observed between the lean and
overweight-obese 9-year-olds.

The overweight-obese group was

reported to consume a statistically lower
proportion of fruit juice [p=0.03], flavoured
milk [p=0.03], and a higher proportion of
low fat milk [p=0.004].
 CONCLUSIONS
Childhood obesity and the consequences of a life-long exposure to
the obese state has become a major concern.

The present study suggests that the prevalence of overweight-

obesity in nine-year-old Maltese children has now reached an
alarming rate of 45.1-48.9% depending on gender.

Early metabolic imprinting appears to play a significant role in

determining risk of developing obesity
Inter-relationship to intrauterine nutrition with higher eventual obesity
rates for low and high birth weight infants
Inter-relationship to early infant feeding with higher eventual obesity
rates for bottle-fed infants

The Thrifty Phenotype Hypothesis

The hypothesis postulates that poor nutrition in foetal and early infant life is
detrimental to the development and functioning of -cells and insulin-sensitive
tissues, resulting in the emergence of insulin resistance in later life 3.
3. Miller J, Rosenbloom A, Silverstein J. Childhood obesity. J Clin Endocrinol Metab 2004; 89(9): 4211-4218.
 CONCLUSIONS
The rapid increase in the prevalence of childhood obesity cannot be
attributed to changes in the genetic makeup because the gene pool
has not changed in the past decade4.
Therefore the main concern must be to identify the changes in
activity and diet that occurred simultaneously with changes in
prevalence4.

No socio-economic interrelationship found.

The study has shown a very poor association between physical activity
and nutrition patterns to the development of childhood obesity.
In both overweight-obese age groups there was a tendency noted on
the efforts to consume less energy dense foods and it appears that
there are definite efforts being made by the parents to control sweets
and energy dense food to control weight.

It is likely however that children by the age of 9 years have already

attained their predisposition towards developing obesity and later
features of the metabolic syndrome.

4. Burnait W, Cole T.J, LissaI.N, eds., Child and Adolescent Obesity; Causes and
Consequences, Prevention and Management, Cambridge University Press, Cambridge 2006.
 RECOMMENDATIONS
Measures to control for childhood obesity will be needed to be taken
both downstream in the school, home and neighbourhood
environment, and upstream in terms for food supplies, commercial
marketing and the promotion of healthier lifestyle 5.
The effective prevention and management, of childhood obesity
must be a family focused approach best managed by the Family
Doctor.
All obese children should have a full history and physical examination
performed.
Calculation and plotting of the BMI once a year in all children and
adolescents.
Identification of risk factors of childhood obesity is paramount.
Flagging on medical records of children who are at high risk of
becoming obese.

5. Jotangia D., Moody A., Stomatakis E., et al. (2005). Obestiy among children under 11. Health Survey for
England: child obesity data, National Centre for Social Research.
 RECOMMENDATIONS
Health Living Advice To The Family

Parents should not fetch and carry for their children.

Think of activity as fun.
A maximum of two hours of television or computer use
per day.
Family car should be avoided.
Using low fat dairy products.
Increasing amount of fruit and vegetables.
Making time to eat breakfast.
Eating meals together as a family.
Drinking water with meals.