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

Frances A. Tylavsky, Assiamira Ferrara, Diane J. Catellier, Emily Oken, Xiuhong Li, Andrew Law, Dana Dabelea, Andrew Rundle, Diane Gilbert-Diamond, Marie France Hivert, Carrie V. Breton, Andrea E. Cassidy-Bushrow, Noel T. Mueller, Kelly J. Hunt, S. Sonia Arteaga, Tania Lombo, Somdat Mahabir, Doug Ruden, Katherine Sauder, Monique M. HeddersonYeyi Zhu, Sarah Polk, Nicole L. Mihalopoulos, Miriam Vos, Lee Pyles, Mary Roary, Judy Aschner, Margaret R. Karagas, Leonardo Trasande

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalInternational Journal of Obesity
DOIs
StateAccepted/In press - Jan 1 2019

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Pediatric Obesity
Body Mass Index
Obesity
Demography
Term Birth
Puerto Rico
Morbid Obesity
Environmental Exposure
National Institutes of Health (U.S.)
Child Development
Child Health
Sample Size
Age Groups
Cross-Sectional Studies
Mothers
Population

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Understanding childhood obesity in the US : the NIH environmental influences on child health outcomes (ECHO) program. / Tylavsky, Frances A.; Ferrara, Assiamira; Catellier, Diane J.; Oken, Emily; Li, Xiuhong; Law, Andrew; Dabelea, Dana; Rundle, Andrew; Gilbert-Diamond, Diane; Hivert, Marie France; Breton, Carrie V.; Cassidy-Bushrow, Andrea E.; Mueller, Noel T.; Hunt, Kelly J.; Arteaga, S. Sonia; Lombo, Tania; Mahabir, Somdat; Ruden, Doug; Sauder, Katherine; Hedderson, Monique M.; Zhu, Yeyi; Polk, Sarah; Mihalopoulos, Nicole L.; Vos, Miriam; Pyles, Lee; Roary, Mary; Aschner, Judy; Karagas, Margaret R.; Trasande, Leonardo.

In: International Journal of Obesity, 01.01.2019.

Research output: Contribution to journalArticle

Tylavsky, FA, Ferrara, A, Catellier, DJ, Oken, E, Li, X, Law, A, Dabelea, D, Rundle, A, Gilbert-Diamond, D, Hivert, MF, Breton, CV, Cassidy-Bushrow, AE, Mueller, NT, Hunt, KJ, Arteaga, SS, Lombo, T, Mahabir, S, Ruden, D, Sauder, K, Hedderson, MM, Zhu, Y, Polk, S, Mihalopoulos, NL, Vos, M, Pyles, L, Roary, M, Aschner, J, Karagas, MR & Trasande, L 2019, 'Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program', International Journal of Obesity. https://doi.org/10.1038/s41366-019-0470-5
Tylavsky, Frances A. ; Ferrara, Assiamira ; Catellier, Diane J. ; Oken, Emily ; Li, Xiuhong ; Law, Andrew ; Dabelea, Dana ; Rundle, Andrew ; Gilbert-Diamond, Diane ; Hivert, Marie France ; Breton, Carrie V. ; Cassidy-Bushrow, Andrea E. ; Mueller, Noel T. ; Hunt, Kelly J. ; Arteaga, S. Sonia ; Lombo, Tania ; Mahabir, Somdat ; Ruden, Doug ; Sauder, Katherine ; Hedderson, Monique M. ; Zhu, Yeyi ; Polk, Sarah ; Mihalopoulos, Nicole L. ; Vos, Miriam ; Pyles, Lee ; Roary, Mary ; Aschner, Judy ; Karagas, Margaret R. ; Trasande, Leonardo. / Understanding childhood obesity in the US : the NIH environmental influences on child health outcomes (ECHO) program. In: International Journal of Obesity. 2019.
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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.",
author = "Tylavsky, {Frances A.} and Assiamira Ferrara and Catellier, {Diane J.} and Emily Oken and Xiuhong Li and Andrew Law and Dana Dabelea and Andrew Rundle and Diane Gilbert-Diamond and Hivert, {Marie France} and Breton, {Carrie V.} and Cassidy-Bushrow, {Andrea E.} and Mueller, {Noel T.} and Hunt, {Kelly J.} and Arteaga, {S. Sonia} and Tania Lombo and Somdat Mahabir and Doug Ruden and Katherine Sauder and Hedderson, {Monique M.} and Yeyi Zhu and Sarah Polk and Mihalopoulos, {Nicole L.} and Miriam Vos and Lee Pyles and Mary Roary and Judy Aschner and Karagas, {Margaret R.} and Leonardo Trasande",
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T1 - Understanding childhood obesity in the US

T2 - the NIH environmental influences on child health outcomes (ECHO) program

AU - Tylavsky, Frances A.

AU - Ferrara, Assiamira

AU - Catellier, Diane J.

AU - Oken, Emily

AU - Li, Xiuhong

AU - Law, Andrew

AU - Dabelea, Dana

AU - Rundle, Andrew

AU - Gilbert-Diamond, Diane

AU - Hivert, Marie France

AU - Breton, Carrie V.

AU - Cassidy-Bushrow, Andrea E.

AU - Mueller, Noel T.

AU - Hunt, Kelly J.

AU - Arteaga, S. Sonia

AU - Lombo, Tania

AU - Mahabir, Somdat

AU - Ruden, Doug

AU - Sauder, Katherine

AU - Hedderson, Monique M.

AU - Zhu, Yeyi

AU - Polk, Sarah

AU - Mihalopoulos, Nicole L.

AU - Vos, Miriam

AU - Pyles, Lee

AU - Roary, Mary

AU - Aschner, Judy

AU - Karagas, Margaret R.

AU - Trasande, Leonardo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

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