Abstract:
Background: Early childhood obesity prediction models could enable targeted intervention, but none existed for children in Aotearoa New Zealand (NZ). It was also unknown if prediction would be acceptable to NZ families, and what support they would want alongside it. Little was known about perception of obesity among caregivers of Māori and Pacific children, or factors which influenced intervention in children perceived as having overweight. Finally, administration of maternal vaginal bacteria to babies born by caesarean section (‘vaginal seeding’) could prevent childhood obesity, but its effectiveness, or maternal views of it, had not been previously assessed.
Methods: Acceptability of early childhood obesity prediction was assessed via online survey, as were caregivers’ views of the condition. An early childhood obesity prediction model was derived for NZ children. Interventions to improve dietary intake during infancy were systematically reviewed. Additionally, caregiver perception of weight status was explored in children of predominantly Māori and Pacific ethnicity, while factors influencing intervention in a cohort of Chinese children perceived as having overweight were also examined. Lastly, a randomised controlled trial investigated the effectiveness of vaginal seeding for reducing infant adiposity at three months, with pregnant women’s views of the practice also explored.
Results: Respondents to the survey of early childhood obesity prediction were generally accepting of it, although reported they would be worried and/or upset. Diet was considered a key cause of early childhood obesity but the systematic review showed interventions to improve infant dietary intake have had limited success. The positive predictive values of the prediction model were low and unlikely to outweigh the risk of caregiver distress. In the NZ study, caregiver recognition of childhood obesity was infrequent but more common for children with particularly high body mass index z-scores, as was intervention for children in the Chinese study. Pregnant women were mostly positive or neutral about vaginal seeding, but it did not appear to affect infant adiposity.
Conclusions: The early childhood obesity prediction model was considered too weak to outweigh risk of caregiver distress. Acceptability of interventions to modify the gut microbiota should continue to be assessed alongside their effectiveness for preventing obesity.