Primary prevention of childhood obesity, second edition.

Primary prevention of childhood obesity, second edition.

Registered Nurses' Association of Ontario (RNAO). Primary prevention of childhood obesity, second edition. Toronto (ON): Registered Nurses' Association of Ontario (RNAO); 2014 May. 140 p. [265 references]

Major Recommendations

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.

Practice Recommendations

Assessment

Recommendation 1.1

Routinely assess children's nutrition, physical activity, sedentary behaviour, and growth according to established guidelines, beginning as early as possible in a child's lifespan.

(Level of Evidence = IV)

Recommendation 1.2

Assess the family environment for factors (e.g., parenting/primary caregiver influences and socio-cultural factors) that may increase children's risk of obesity.

(Level of Evidence = IV)

Recommendation 1.3

Collaborate with school leaders to assess elementary-school environments for risk and protective conditions that influence childhood obesity, including:

• Student demographics
• School policies
• Food and physical activity environments

(Level of Evidence = IV)

Recommendation 1.4

Assess neighbourhoods for community-level risk and protective conditions that influence childhood obesity.

(Level of Evidence = IV)

Planning

Recommendation 2.1

Engage community stakeholders when planning primary-prevention interventions for childhood obesity.

(Level of Evidence = IIb)

Recommendation 2.2

Develop interventions that are:

• Universally applied, as early as possible (Level of Evidence = IV)
• Targeted toward multiple behaviours (Level of Evidence = IV)
• Implemented using multiple approaches (Level of Evidence = IIa)
• Inclusive of parents/primary caregivers and the family (Level of Evidence = IIa), and
• Implemented simultaneously in multiple settings (Level of Evidence = IIa)

Implementation

Recommendation 3.1

Support exclusive breastfeeding for the first six months of life followed by breastfeeding and complementary feeding up to two years of age or beyond.

(Level of Evidence = III)

Recommendation 3.2

Provide education and social support to help parents/primary caregivers to promote healthy eating and physical activity in infants and toddlers.

(Level of Evidence = Ib)

Recommendation 3.3

Collaborate with parents/primary caregivers, educators and support staff (e.g., teachers, child care providers, school leaders) to promote healthy eating and physical activity in all settings where preschool children gather.

(Level of Evidence = Ib)

Recommendation 3.4

Collaborate with school communities to promote regular physical activity among elementary-school children.

(Level of Evidence = IIb)

Recommendation 3.5

Facilitate and support the integration of health and nutrition education into elementary-school programs and support the improvement of the school food environment.

(Level of Evidence = IIa–III)

Evaluation

Recommendation 4.1

Monitor and evaluate the effectiveness of the family's approach to healthy eating and physical activity.

(Level of Evidence = IV)

Recommendation 4.2

Evaluate the effectiveness and sustainability of school- and community-based primary-prevention initiatives.

(Level of Evidence = IV)

Recommendation 4.3

Advocate and support the evaluation of an organization's compliance with healthy public policies, and the impact of such policies on childhood eating behaviours and physical activity.

(Level of Evidence = III)

Education Recommendations

Recommendation 5.1

Incorporate foundational primary-prevention curricula based on this Guideline into the undergraduate education of nurses and other health-care providers.

(Level of Evidence = IV)

Recommendation 5.2

Health-care professionals should participate in continuing education to enhance their ability to support the positive behavioural and environmental changes for children, families, and communities recommended in this Guideline.

(Level of Evidence = IV)

.../...

Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review.

Liao Y, Liao J, Durand CP, Dunton GF.

Obes Rev. 2014 Mar;15(3):159-68. doi:10.1111/obr.12112

Sedentary behaviour is emerging as an independent risk factor for paediatric obesity. Some evidence suggests that limiting sedentary behaviour alone could be effective in reducing body mass index (BMI) in children. However, whether adding physical activity and diet-focused components to sedentary behaviour reduction interventions could lead to an additive effect is unclear. This meta-analysis aims to assess the overall effect size of sedentary behaviour interventions on BMI reduction and to compare whether interventions that have multiple components (sedentary behaviour, physical activity and diet) have a higher mean effect size than interventions with single (sedentary behaviour) component. Included studies (n = 25) were randomized controlled trials of children (<18 years) with intervention components aimed to reduce sedentary behaviour and measured BMI at pre- and post-intervention. Effect size was calculated as the mean difference in  BMI change between children in an intervention group and a control group. Results indicated that sedentary behaviour interventions had a significant effect on BMI reduction. The pooled effect sizes of multi-component interventions (g = -0.060∼-0.089) did not differ from the single-component interventions (g = -0.154), and neither of them had a significant effect size on its own.

Future paediatric obesity interventions may consider focusing on developing strategies to decrease multiple screen-related sedentary behaviours.

School-based obesity prevention programs: a meta-analysis of randomized controlled trials

Sobol-Goldberg S, Rabinowitz J, Gross R. Obesity (Silver Spring). 2013 Dec;21(12):2422-8. doi: 10.1002/oby.20515. Epub 2013 Aug 13. (Review) PMID: 23794226

OBJECTIVE: Attempts have been made to reduce childhood obesity through school-based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta-analysis. 

DESIGN AND METHODS: Replication of methodology used in previous comprehensive systematic review and meta-analysis of randomized controlled trials of school-based obesity prevention programs covering studies until 2006 to review studies thru January 2012.

RESULTS: Based on 32 studies (n = 52,109), programs were mildly effective in reducing BMI relative to controls not receiving intervention. Studies of children had significant intervention effects, those of teenagers did not, though the difference between the two groups was not statistically significant. Meta-regression showed a significant linear hierarchy of studies with the largest effects for comprehensive programs more than 1 year long that aimed to provide information on nutrition and physical activity, change attitudes, monitor behavior, modify environment, involve parents, increase physical activity and improve diet, particularly among children.

CONCLUSIONS: Unlike earlier studies, more recent studies showed convincing evidence that school-based prevention interventions are at least mildly effective in reducing BMI in children, possibly because these newer studies tended to be longer, more comprehensive and included parental support.http://www.ncbi.nlm.nih.gov/pubmed/23794226?dopt=Abstract

Prevention and management of obesity for children and adolescents.

Fitch A, Fox C, Bauerly K, Gross A, Heim C, Judge-Dietz J, Kaufman T, Krych E, Kumar S, Landin D, Larson J, Leslie D, Martens N, Monaghan-Beery N, Newell T, O'Connor P, Spaniol A, Thomas A, Webb B. Prevention and management of obesity for children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Jul. 94 p. [110 references] Prevention Recommendations: Obesity prevention messages should be targeted at all families, starting at the time of the child's birth (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). An assessment of diet, physical activity and sedentary behaviors should be done annually, preferably at a well child visit. This assessment should be used to target appropriate messages to each family (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). Clinicians may suggest that children get at least 60 minutes of moderate exercise daily (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). Clinicians should counsel children and families to: Limit their child's consumption of sugar-sweetened beverages Eat a diet with the recommended quantities of fruits and vegetables Eat breakfast daily Eat meals together as much as possible Limit eating out, especially eating at fast food restaurants Adjust portion sizes appropriately for age Avoid television for children under the age of two Limit television and "screen time" to less than two hours per day (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007) The following counseling messages should be directed to all parents, regardless of the weight status of their child. Healthy Diet Breastfeeding: Studies suggest that exclusive breastfeeding to six months of age is associated with decreased rates of obesity later in childhood [High Quality Evidence]. See the NGC Summary of the ICSI guideline Preventive services for children and adolescents for further information. Milk: The American Academy of Pediatrics recommends that children be started on cow's milk at 1 year of age. Whole milk is recommended for most children ages 12 months to two years. However, if the child is at risk for overweight or if there is a family history of obesity or cardiovascular disease, 2% milk is recommended. For children ages two years and up, a low-fat (skim or 1%) milk should be used. Sugar-sweetened beverages: Families should limit their child's consumption of sugar-sweetened beverages [High Quality Evidence]. Current evidence indicates a strong association between sugar-sweetened beverage consumption and total daily energy intake. Decreasing consumption of sugar-sweetened beverages is one strategy to decrease total daily energy intake [Reference]. Refer to the original guideline document for information regarding fruit juice and fruits and vegetables. Meal Structure Children should eat breakfast daily [High Quality Evidence]. Evidence shows that skipping breakfast decreases the nutritional quality of the diets of both children and adults [Reference]. Families should eat meals together at the table as much as possible. Family meals are associated with a higher quality diet [High Quality Evidence]. Snacking should be neither encouraged nor discouraged. The current data on meal frequency and snacking are inconclusive [Reference]. It is the opinion of the work group that if this issue is addressed with families, the focus should be on the quality of meals and snacks, not on the quantity. Eating out: Eating out at restaurants, especially fast food restaurants, should be limited. Restaurants, especially fast food restaurants, serve energy-dense food that can contribute significantly to a child's daily energy intake [High Quality Evidence]. The frequency of eating out is associated with body fatness in children and adults [Reference]. Refer to the original guideline document for information about portion sizes, child self-regulation, physical exercise, sleep, television, and the importance of the community in promoting a healthy lifestyle. For a detailed review of age appropriate "well care," including screening, assessment and anticipatory guidance, the work group recommends http://www.brightfutures.org . Screening and Diagnosis Recommendations: BMI should be calculated and documented in the medical record on all children ages 2 to 18 at least annually, ideally at a well child visit (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). The Centers for Disease Control and Prevention (CDC) growth charts should be used for children ages 2 to 18; World Health Organization (WHO) growth curves should be used from birth through 23 months of age (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007). Appropriate terminology should be used to classify pediatric overweight and obesity. (Strong Recommendation, High Quality Evidence) (Barlow & Expert Committee, 2007).

Estimating overweight risk in childhood from predictors during infancy.

Pediatrics. 2013 Aug;132(2):e414-21. doi: 10.1542/peds.2012-3858.Epub 2013Jul15.

Weng SF, Redsell SA, Nathan D, Swift JA, Yang M, Glazebrook C.

OBJECTIVE: The aim of this study was to develop and validate a risk score
algorithm for childhood overweight based on a prediction model in infants.
METHODS: Analysis was conducted by using the UK Millennium Cohort Study. The
cohort was divided randomly by using 80% of the sample for derivation of the risk
algorithm and 20% of the sample for validation. Stepwise logistic regression
determined a prediction model for childhood overweight at 3 years defined by the 
International Obesity Task Force criteria. Predictive metrics R(2), area under
the receiver operating curve (AUROC), sensitivity, specificity, positive
predictive value (PPV), and negative predictive value (NPV) were calculated.
RESULTS: Seven predictors were found to be significantly associated with
overweight at 3 years in a mutually adjusted predictor model: gender, birth
weight, weight gain, maternal prepregnancy BMI, paternal BMI, maternal smoking in
pregnancy, and breastfeeding status. Risk scores ranged from 0 to 59
corresponding to a predicted risk from 4.1% to 73.8%. The model revealed
moderately good predictive ability in both the derivation cohort (R(2) = 0.92,
AUROC = 0.721, sensitivity = 0.699, specificity = 0.679, PPV = 38%, NPV = 87%)
and validation cohort (R(2) = 0.84, AUROC = 0.755, sensitivity = 0.769,
specificity = 0.665, PPV = 37%, NPV = 89%).
CONCLUSIONS: Using a prediction algorithm to identify at-risk infants could
reduce levels of child overweight and obesity by enabling health professionals to
target prevention more effectively. Further research needs to evaluate the
clinical validity, feasibility, and acceptability of communicating this risk.

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review.

Pearce J, Taylor MA, Langley-Evans SC.

Int J Obes (Lond). 2013 May 27. PMID: 23736360

Abstract

The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. 

We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity duringchildhood. Electronic databases were searched from inception until 30 September 2012 using specified keywords. 

Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. 

Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 20="" 4="" a="" associated="" bmi="" class="highlight" higher="" in="" months="" nbsp="" one="" or="" span="" studies="" study="" two="" was="" weeks="" with="">childhood

. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. 

We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhoodoverweight.

International Journal of Obesity advance online publication, 18 June 2013; doi:10.1038/ijo.2013.99.

School-based obesity prevention programs: A meta-analysis of randomized controlled trials.

Sobol-Goldberg S, Rabinowitz J, Gross R

Obesity (Silver Spring). 2013 Jun 22. doi: 10.1002/oby.20515. [Epub ahead of print].  PMID: 23794226

Objective: 

Attempts have been made to reduce childhood obesity through school-based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta-analysis. 

Design and Methods: 

Replication of methodology used in previous comprehensive systematic review and meta-analysis of randomized controlled trials of school based obesity prevention programs covering studies until 2006 to review studies thru January 2012. 

Results: Based on 32 studies (n=52,109), programs were mildly effective in reducing BMI relative to controls not receiving intervention. Studies of children had significant intervention effects, those of teenagers did not, though the difference between the two groups was not statistically significant. Meta-regression showed a significant linear hierarchy of studies with the largest effects for comprehensive programs more than 1 year-long that aimed to provide information on nutrition and physical activity, change attitudes, monitor behavior, modify environment, involve parents, increase physical activity and improve diet, particularly among children. 

Conclusions: Unlike earlier studies, more recent studies showed convincing evidence that school-based prevention interventions are at least mildly effective in reducing BMI in children, possibly because these newer studies tended to be longer, more comprehensive and included parental support.

Systematic Review of Community-Based Childhood Obesity Prevention Studies.

Bleich SN, Segal J, Wu Y, Wilson R, Wang Y.

Pediatrics. 2013 Jun 10. [Epub ahead of print] 

PMID:

 

23753099

Source

OBJECTIVE:

This study systematically reviewed community-based childhood obesity prevention programs in the United States and high-income countries.

METHODS:

We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library for relevant English-language studies. Studies were eligible if the intervention was primarily implemented in the community setting; had at least 1 year of follow-up after baseline; and compared results from an intervention to a comparison group. Two independent reviewers conducted title scans and abstract reviews and reviewed the full articles to assess eligibility. Each article received a double review for data abstraction. The second reviewer confirmed the first reviewer's data abstraction for completeness and accuracy.

RESULTS:

Nine community-based studies were included; 5 randomized controlled trials and 4 non-randomized controlled trials. One study was conducted only in the community setting, 3 were conducted in the community and school setting, and 5 were conducted in the community setting in combination with at least 1 other setting such as the home. Desirable changes in BMI or BMI z-score were found in 4 of the 9 studies. Two studies reported significant improvements in behavioral outcomes (1 in physical activity and 1 in vegetable intake).

CONCLUSIONS:

The strength of evidence is moderate that a combined diet and physical activity intervention conducted in the community with a school component is more effective at preventing obesity or overweight. More research and consistent methods are needed to understand the comparative effectiveness of childhood obesity prevention programs in the community setting.

A Systematic Review of Home-Based Childhood Obesity Prevention Studies.

Showell NN, Fawole O, Segal J, et al. Pediatrics. 2013 Jun 10. (Review) PMID: 23753095

BACKGROUND AND OBJECTIVES:

Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes.

METHODS:

We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with >/=1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention.

RESULTS:

We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings.

CONCLUSIONS:

The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences.

Weight Gain in Infancy and Vascular Risk Factors in Later Childhood

Michael R. Skilton, PhD^a,^b, 

Guy B. Marks, PhD^c, 

Julian G. Ayer, PhD^b,

Frances L. Garden, MBiostat^b,^c,^d, 

Sarah P. Garnett, PhD^b,^e,^f,

Jason A. Harmer, MBBS^b, 

Stephen R. Leeder, PhD^b,^d,^g, 

Brett G. Toelle, PhD^c, 

Karen Webb, PhD^h, 

Louise A. Baur, PhD^b,^d,^e, and

David S. Celermajer, PhD^b

PEDIATRICS Vol. 131 No. 6 June 1, 2013 pp. e1821 -e1828

(doi: 10.1542/peds.2012-2789)

1. ^aBoden Institute of Obesity, Nutrition, Exercise, and Eating Disorders,
2. ^bSydney Medical School;
3. ^dSydney School of Public Health;
4. ^eThe Children's Hospital at Westmead Clinical School; and
5. ^gMenzies Centre for Health Policy, University of Sydney, Sydney, Australia;
6. ^cWoolcock Institute of Medical Research, Glebe, Australia;
7. ^fInstitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia; and
8. ^hAtkins Center for Weight and Health, Department of Nutritional Sciences and Toxicology and School of Public Health, University of California, Berkeley, California

ABSTRACT

OBJECTIVE: We hypothesized that early weight gain would be associated with incident obesity, higher blood pressure, systemic inflammation, and arterial wall thickening in later childhood.

METHODS: A longitudinal birth cohort was recruited antenatally from 2 maternity hospitals in Sydney, Australia, between September 1997 and December 1999. Three hundred ninety-five nondiabetic children who were followed to age 8 years had complete data for early weight gain and arterial wall thickness.

RESULTS: Independent predictors of excess early weight gain (age 0–18 months; adjusted for height gain) included male gender (0.411 kg [SE: 0.103],P < .001), fewer weeks’ gestation (−0.121 kg [SE: 0.044] per week, P = .006), birth length (0.156 kg [SE: 0.024] per cm, P < .001), and failure to breastfeed to 6 months of age (0.498 kg [SE: 0.108], P < .001). Early height-adjusted weight gain was significantly associated with later childhood overweight (odds ratio [OR]: 1.67 [95% confidence interval (CI): 1.26 to 2.20] per kg) and obesity (OR: 2.07 [95% CI: 1.53 to 2.79] per kg), excess central adiposity (OR: 1.54 [95% CI: 1.20 to 1.98] per kg), higher systolic blood pressure (1.24 mm Hg [SE: 0.33] per kg, P < .001), higher C-reactive protein (0.17 mg/dL [SE: 0.06] per 100% increase in weight gain, P = .006), and greater carotid intima-media thickness (0.012 mm [SE: 0.004] per kg, P = .002).

CONCLUSIONS: Early postnatal weight gain from birth to age 18 months is significantly associated with later childhood overweight and obesity, excess central adiposity, and greater arterial wall thickness.

Eating Frequency and Overweight and Obesity in Children and Adolescents: A Meta-analysis.

Pediatrics 2013;131:958–967

Panagiota Kaisari, MSc, Mary Yannakoulia, PhD, and Demosthenes B. Panagiotakos, PhD

Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

OBJECTIVES: To determine the effect of eating frequency on body weight status in children and adolescents.

METHODS:In this meta-analysis, original observational studies published to October 2011 were selected through a literature search in the PubMed database. The reference list of the retrieved articles was also used to identify relevant articles; researchers were contacted when needed.

Selected studies were published in English, and they reported on the effect of eating frequency on overweight/obesity in children and adolescents. Pooled effect sizes were calculated using a random effects model.

RESULTS: Ten cross-sectional studies and 1 case-control study (21substudies in total), comprising 18 849 participants (aged 2–19 years),were included in the analysis. Their combined effect revealed that the highest category of eating frequency, as compared with the lowest,was associated with a beneficial effect regarding body weight status in children and adolescents (odds ratio [OR] = 0.78, log OR = –0.24,95% confidence interval [CI] –0.41 to –0.06). The observed beneficial effect remained significant in boys (OR = 0.76, log OR = –0.27, 95% CI–0.47 to –0.06), but not in girls (OR = 0.96, log OR = –0.04, 95% CI –0.40 to 0.32) (P for sex differences = 0.14).

CONCLUSIONS: Higher eating frequency was associated with lower body weight status in children and adolescents, mainly in boys. Clinical trials are warranted to confirm this inverse association, evaluate its clinical applicability, and support a public health recommendation; more studies are also needed to further investigate any sex-related differences, and most importantly, the biological mechanisms.

Timing of Solid Food Introduction and Obesity: Hong Kong’s “Children of 1997” Birth Cohort

1. Shi Lin Lin, MPH, 
2. Gabriel M. Leung, MD, 
3. Tai Hing Lam, MD, and
4. C. Mary Schooling, PhD

ABSTRACT

BACKGROUND: Some observational studies in Western settings show that early introduction of solid food is associated with subsequent obesity. However, introduction of solid food and obesity share social patterning. We examined the association of the timing of the introduction of solid food with BMI and overweight (including obesity) into adolescence in a developed non-Western setting, in which childhood obesity is less clearly socially patterned.

METHODS: We used generalized estimating equation models to estimate the adjusted associations of the timing of the introduction of solid food (<3 3="" 5="" 7="" and="">8 months) with BMI z score and overweight (including obesity) at different growth phases (infancy, childhood, and puberty) in 7809 children (88% follow-up) from a Chinese birth cohort, “Children of 1997.” We assessed if the associations varied with gender or breastfeeding. We used multiple imputation for missing exposure and confounders.

RESULTS: The introduction of solid food at <3 age="" associated="" bmi="" but="" clearly="" difference="" em="" family="" in="" including="" infancy="" lower="" mean="" months="" nbsp="" not="" obesity="" of="" or="" overweight="" position="" socioeconomic="" style="border: 0px; font-family: inherit; font-size: inherit; line-height: inherit; margin: 0px; outline-style: none; padding: 0px; text-align: inherit; vertical-align: baseline;" was="" with="">z

score: 0.01; 95% confidence interval (CI): −0.14 to 0.17], childhood (0.14; 95% CI: −0.11 to 0.40), or at puberty (0.22; 95% CI: −0.07 to 0.52), adjusted for SEP and infant and maternal characteristics.

CONCLUSIONS: In a non-Western developed setting, there was no clear association of the early introduction of solid food with childhood obesity. Together with the inconsistent evidence from studies in Western settings, this finding suggests that any observed associations might simply be residual confounding by SEP.

http://pediatrics.aappublications.org/content/early/2013/04/03/peds.2012-2643d.abstract