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Early life risk factors and their cumulative effects as predictors of overweight in Spanish children



To explore early life risk factors of overweight/obesity at age 6 years and their cumulative effects on overweight/obesity at ages 2, 4 and 6 years.


Altogether 1031 Spanish children were evaluated at birth and during a 6-year follow-up. Early life risk factors included: parental overweight/obesity, parental origin/ethnicity, maternal smoking during pregnancy, gestational weight gain, gestational age, birth weight, caesarean section, breastfeeding practices and rapid infant weight gain collected via hospital records. Cumulative effects were assessed by adding up those early risk factors that significantly increased the risk of overweight/obesity. We conducted binary logistic regression models.


Rapid infant weight gain (OR 2.29, 99% CI 1.54–3.42), maternal overweight/obesity (OR 1.93, 99% CI 1.27–2.92), paternal overweight/obesity (OR 2.17, 99% CI 1.44–3.28), Latin American/Roma origin (OR 3.20, 99% CI 1.60–6.39) and smoking during pregnancy (OR 1.61, 99% CI 1.01–2.59) remained significant after adjusting for confounders. A higher number of early life risk factors accumulated was associated with overweight/obesity at age 6 years but not at age 2 and 4 years.


Rapid infant weight gain, parental overweight/obesity, maternal smoking and origin/ethnicity predict childhood overweight/obesity and present cumulative effects. Monitoring children with rapid weight gain and supporting a healthy parental weight are important for childhood obesity prevention.

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This study has been supported by three grants from the Carlos III Health Institute: 1) PI08/0559: Aragon Health Sciences Institute for the project Growth and Feeding in Infants from Aragon (CALINA); 2) PI13/02359 Environmental factors influencing early development of obesity during childhood and body composition programming; and 3) RD12/0026: Maternal, Child Health and Development Network (Retic SAMID) RETICS funded by the PN I + D+I 2008-2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF). I. I was supported by the FPU Predoctoral Programs (grant reference FPU014/00922) of the Spanish Ministry of Education and Science. We thank the CALINA children and their parents who generously volunteered and participated in this project.

Crecimiento y Alimentación durante la Lactancia y la primera Infancia en Niños Aragoneses (CALINA) Collaborative Group. Instituto de Investigación Sanitaria (Institute of Health Research), Aragón.

Coordinators: José L. Olivares López and Gerardo Rodríguez Martínez.

Collaborators: Dori Adivinación Herrero, Roberto Alijarde Lorente, M. Jesús Álvarez Otazu, M. Luisa Álvarez Sauras, Teresa Arana Navarro, Esther Atance Melendo, Ariadna Ayerza Casas, Concepción Balagué Clemos, M. Victoria Baños Ledesma, M. Lucía Bartolomé Lalanza, Teresa Bartrés Soler, M. Jesús Blasco Pérez-Aramendia, Purificación Broto Cosculluela, M. Jesús Cabañas Bravo, Rosa Cáncer Raginal, M. Inmaculada Cebrián Gimeno, Teresa Cenarro Guerrero, M. Begoña Chicote Abadía, María Cleofé Crespo Mainar, María Duplá Arenaz, Luis Carlos Elviro Mayoral, Concha Esteban Herréiz, Ángeles Falcón Polo, Jesús Feliz de Vargas Pastor, M. Teresa Fondevilla Pérez, M. Desamparados Forés Catalá, Amparo Fuertes Domínguez, Jorge Fuertes Fernández-Espinar, José Galán Rico, José Galbe Sánchez-Ventura, Matilde Gallego Pérez, Nuria García Sánchez, César García Vera, Ana-Luz Garín Moreno, M. Asunción Gila Gajón, Carmen Júdez Molina, Beatriz Kojtych Trevijano, M. Lourdes Laín Ara, M. Jesús Lalaguna Puértolas, M. Pilar Lalana Josa, Elisa Lambán Casamayor, Juan José Lasarte Velillas, M.ª Isabel Lostal Gracia, Rosa Magallón Botalla, Mónica Marco Olloqui, M. Pilar Marín Ibáñez, José Luis Martínez Bueno, Laura Martínez Espligares, José M. Mengual Gil, Isabel Moneo Hernández, Mercedes Montaner Cosa, Luis A. Moreno Aznar, Ana Isabel Muñoz Campos, Elena Muñoz Jalle, Eva María Navarro Serrano, Luis Carlos Pardos Martínez, José Antonio Pinilla Fuentes, Carmen Puig García, Pascual Puyuelo del Val, M. Victoria Redondo Cuerpo, Rafael Ruiz Pastora, Pilar Samper Villagrasa, Javier Sánchez Gimeno, Asunción Sánchez Zapater, M. Flor Sebastián Bonel, M. Teresa Solans Bascuas, Jiménez, M. Carmen Viñas Viamonte, Gregorio Zarazaga Germes.

Author information





The authors’ contributions were as follows: II carried out the statistical analysis and drafted the manuscript along with GR, LE, JF-A, IL, II, LAM, GR, and MPS collected the data, supervised the data procedure and read and critically reviewed the manuscript.

Corresponding author

Correspondence to Isabel Iguacel.

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The authors declare that they have no conflict of interest.

Research involving human participants

Ethical approval was obtained from the regional Committee of Ethics (Comité Ético de Investigación Clínica de Aragón, CEICA).

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Parents or legal guardians gave written informed consent for examinations for their children.

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Iguacel, I., Escartín, L., Fernández-Alvira, J.M. et al. Early life risk factors and their cumulative effects as predictors of overweight in Spanish children. Int J Public Health 63, 501–512 (2018).

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  • Overweight
  • Children
  • Early life risk factors
  • Prevention
  • Pregnancy