Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program

• Type of Material: Article
• Authors: Frances A Tylaysky, University of Tennessee; Assiamira Ferrara, Kaiser Permanente Northern California; Diane J Catellier, RTI International, Research Triangle Park, NC; Emily Oken, Harvard Medical School; Xiuhong Li, Johns Hopkins Bloomberg School of Public Health; Andrew Law, Johns Hopkins Bloomberg School of Public Health; Dana Dabelea, University of Colorado, Denver; Andrew Rundle, Columbia University; Diane Gilbert-Diamond, Geisel School of Medicine at Dartmouth; Marie-France Hivert, Harvard Medical School; Carrie Breton, University of Southern California; Andrea E Cassidy-Bushrow, Henry Ford Hospital, Detroit; Noel T Mueller, Johns Hopkins University; Kelly J Hunt, Medical University of South Carolina; Sonia S Arteaga, National Heart, Lung, and Blood Institute, Bethesda; Tania Lombo, NIH, Bethesda; Somdat Mahabir, National Cancer Institute, Rockville; Doug Ruden, Wayne State University; Katherine Sauder, University of Colorado Denver; Monique M Hedderson, Kaiser Permanente Northern California; Yeyi Zhu, Kaiser Permanente Northern California; Sarah Polk, Johns Hopkins School of Medicine; Nicole L Mihalopoulos, University of Utah; Miriam Vos, Emory University; Lee Pyles, West Virginia University; Mary Roary, National Institute of Nursing Research, Rockville; Judy Aschner, Albert Einstein College of Medicine; Margaret R Karagas, Geisel School of Medicine at Dartmouth; Leonardo Trasande, NYU School of Medicine
• Language: English
• Date: 2020-03-01
• Publisher: SPRINGERNATURE
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019, The Author(s), under exclusive licence to Springer Nature Limited
• Final Published Version (URL): http://dx.doi.org/10.1038/s41366-019-0470-5
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF OBESITY
• Volume: 44
• Issue: 3
• Start Page: 617
• End Page: 627
• Grant/Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375, U24OD023382, UG3OD023271, UG3OD0 23289, UG3OD023286, UG3OD023248, UH3OD023290, P50 ES009 600, UG3OD023275 NIEHS P01ES022832, EPA RD 83544201, UG3 OD023286, 4UG3OD023287-03, K01HL141589, UG3OD023285, UG 3OD023316, UG3OD023289, UG3OD023289, UG30D023318, UH3O D023249, 1UG1HD090899-01, UG3OD023320, UG3 (UH3) OD023305.
• Keywords: PREVALENCE; UNITED-STATES; COHORT PROFILE; BISPHENOL-A; DIETARY PATTERNS; PHYSICAL-ACTIVITY; Life Sciences & Biomedicine; TASK-FORCE RECOMMENDATION; Endocrinology & Metabolism; ADOLESCENTS; ASSOCIATION; DEVELOPMENTAL ORIGINS; Science & Technology; Nutrition & Dietetics

Abstract

Background: Few resources exist for prospective, longitudinal analysis of the relationships between early life environment and later obesity in large diverse samples of children in the United States (US). In 2016, the National Institutes of Health launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate influences of environmental exposures on child health and development. We describe demographics and overweight and obesity prevalence in ECHO, and ECHO’s potential as a resource for understanding how early life environmental factors affect obesity risk. Methods: In this cross-sectional study of 70 extant US and Puerto Rico cohorts, 2003–2017, we examined age, race/ethnicity, and sex in children with body mass index (BMI) data, including 28,507 full-term post-birth to <2 years and 38,332 aged 2–18 years. Main outcomes included high BMI for age <2 years, and at 2–18 years overweight (BMI 85th to <95th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI ≥ 120% of 95th percentile). Results: The study population had diverse race/ethnicity and maternal demographics. Each outcome was more common with increasing age and varied with race/ethnicity. High BMI prevalence (95% CI) was 4.7% (3.5, 6.0) <1 year, and 10.6% (7.4, 13.7) for 1 to <2 years; overweight prevalence increased from 13.9% (12.4, 15.9) at 2–3 years to 19.9% (11.7, 28.2) at 12 to <18 years. ECHO has the statistical power to detect relative risks for ‘high’ BMI ranging from 1.2 to 2.2 for a wide range of exposure prevalences (1–50%) within each age group. Conclusions: ECHO is a powerful resource for understanding influences of chemical, biological, social, natural, and built environments on onset and trajectories of obesity in US children. The large sample size of ECHO cohorts adopting a standardized protocol for new data collection of varied exposures along with longitudinal assessments will allow refined analyses to identify drivers of childhood obesity.