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As IQ tests are commonly used as key assessment method, we address the question whether our commonly used standardized IQ tests are appropriate for children from families of diverse cultures and different educational levels in a refugee population. We examined 109 refugee children aged 3–7 years (M = 5.10 years, SD = 1.25) with the “Kaufman Assessment Battery for Children “ (KABC-II; Kaufmann & Kaufmann, 2015) on a language-free scale (Scale of Intellectual Functioning, SIF) and learning performance (subtest Atlantis). With a non-verbal IQ of 81.5 (SD = 18.01), the population mean of the refugee children is more than one standard deviation lower than the mean of the German norm population. Standardized scores follow the normal distribution and are not correlated to any of the assessed markers of adversity (flight duration, time spent in Germany, child PTSD in parent rating, parental symptom load, and parental education level).Conclusion: The interpretation of IQ test results for refugee children should be done cautiously as results may underestimate their cognitive capacity. Environmental factors, such as high illiteracy among parents in this study, the lack of institutional education of children and high lifetime stress, may explain our findings.Trial registration: DRKS00021150. What is Known:• There is a high pervasiveness for the use of standardized IQ tests in the German health and education system to determine eligibility for special education and social services. What is New:• Refugee children score significantly lower than German children in a language-free IQ test. As results are normally distributed and not correlated to any of the assessed markers of adversity, the low scores in the refugee group might be due to missing formal education.

Longitudinal studies of the last decades impressively demonstrate the potentially harmful influence of early psychosocial stress on children's physical and mental health (1,2,3). Within the first year of life, children are particularly vulnerable to health-relevant environmental factors, while at the same time their resilience is not yet very robust (4). Children between 1-3 years of age are also still highly dependent on the care provided by and the relationship with their parents. Overall, children aged 0-3 years are considered a special risk group for neglect and other forms of maltreatment (5). Currently, the restrictions caused by the Covid 19 pandemic and the worsening economic conditions lead to multiple psychosocial burdens for young families (parental stress, existential worries, etc.). It can be assumed that this is reflected in both the immediate parental stress and the children's behaviour (6). Early and systematic identification of the needs for psychosocial support in families with children between 0 and 3 years of age enables the prompt initiation of appropriate support services (e.g. early intervention services, so called “Frühe Hilfen”) and can contribute to preventing negative effects on child health. Due to the regular and early access to young families via the well-child visits (so called "U check-ups"), resident paediatricians are particularly suitable for this task (7). Currently, there is no universal standardised procedure in Germany that facilitates a reliable identification of psychosocially burdened families and referral to early intervention services. Within the framework of a Bavaria-wide study, it is to be examined whether the access rate to early prevention services can be positively influenced through a specific "early prevention module". Furthermore, the longitudinal course of psychosocial stress factors in families with children between 0 and 3 years of age during the Covid 19 pandemic will be investigated. A comparison with corresponding historical cohorts will be used to determine the extent to which the psychosocial stress of families with infants and young children has changed under the current crisis conditions, how the stress factors correlate and how effective support measures initiated by the paediatricians are. If psychosocial stress in families is detected at an early stage and support measures are initiated promptly, an escalation of the stressful circumstances (risk to children's well-being) and a chronification of the existing problems can be prevented. If the "early interventions module" proves to be effective, it should be considered to include it in the standard procedure of the paediatric U-check-ups. (1) Werner, E. E. (1993). Risk, resilience, and recovery: Perspectives from the Kauai Longitudinal Study. Development and Psychopathology, 5, 503-515. (2) Laucht, M., Esser, G. & Schmid, M. H. (1997). Developmental Outcome of Infants Born with Biological and Psychosocial Risks. Journal of Child Psychology and Psychiatry, 38(7), 843-854. (3) Laucht, M., Schmidt, M. H. & Esser, G. (2002). Motorische, kognitive und sozial-emotionale Entwicklung von 11-Jährigen mit frühkindlichen Risikobelastungen: späte Folgen. Zeitschrift für Kinder- und Jugendpsychiatrie, 30(1), 5-19. (4) Schlack, H. G. (2009). Sozialpädiatrie: Eine Standortbestimmung. In H. G. Schlack, R. von Kries & U. Thyen (Eds.), Sozialpädiatrie. Gesundheitswissenschaft und pädiatrischer Alltag (pp. 1-8). Berlin, Heidelberg: Springer. (5) Münder J, Mutke B, Schone R: Kindeswohl zwischen Jugendhilfe und Justiz. Münster: Votum-Verlag 2000. (6) Papoušek, M. (2004). Regulationsstörungen der frühen Kindheit: Klinische Evidenz für ein neues diagnostisches Konzept. In: M. Papoušek, M. Schieche, H. Wurmser (Hrsg.), Regulationsstörungen der frühen Kindheit, 77-110. Huber, Bern. (7) Hayutin, L. G., Reed-Knight, B., Blount, R. L., Lewis, J. & McCormick, M. L. (2009). Increasing Parent–Pediatrician Communication about Children’s Psychosocial Problems. Journal of Pediatric Psychology, 34 (10), 1155-1164.

As IQ tests are commonly used as key assessment method, we address the question whether our commonly used standardized IQ tests are appropriate for children from families of diverse cultures and different educational levels in a refugee population. We examined 109 refugee children aged 3-7 years (M = 5.10 years, SD = 1.25) with the "Kaufman Assessment Battery for Children " (KABC-II; KaufmannKaufmann, 2015) on a language-free scale (Scale of Intellectual Functioning, SIF) and learning performance (subtest Atlantis). With a non-verbal IQ of 81.5 (SD = 18.01), the population mean of the refugee children is more than one standard deviation lower than the mean of the German norm population. Standardized scores follow the normal distribution and are not correlated to any of the assessed markers of adversity (flight duration, time spent in Germany, child PTSD in parent rating, parental symptom load, and parental education level).Conclusion: The interpretation of IQ test results for refugee children should be done cautiously as results may underestimate their cognitive capacity. Environmental factors, such as high illiteracy among parents in this study, the lack of institutional education of children and high lifetime stress, may explain our findings.Trial registration: DRKS00021150. What is Known: • There is a high pervasiveness for the use of standardized IQ tests in the German health and education system to determine eligibility for special education and social services. What is New: • Refugee children score significantly lower than German children in a language-free IQ test. As results are normally distributed and not correlated to any of the assessed markers of adversity, the low scores in the refugee group might be due to missing formal education.

More than 1 million Syrian refugees have sought asylum in Europe since 2011. Disastrous conditions in their country and an arduous flight increased the risk for the emergence of physical and mental problems, especially in children. We performed a comprehensive medical and psychological examination in 96 Syrian refugee children aged 0–14 years in a German reception camp. Parents were interviewed and answered questions on health, flight and living conditions. In the children, we found most frequently somatic and in particular dental problems, incomplete immunization state and mental disorders. Post-traumatic stress disorder (PTSD) was diagnosed in 30.2 per cent of the children. Fifty-seven per cent of the parents reported somatic complaints; most of them were neurological (e.g. headache) and sleep disorders. Syrian refugee children show a significant rate of PTSD, somatic disorders and incomplete immunization state. The separation from family members during flight and physical complaints of the parents were identified as risk factors for PTSD in the children of our study. Early combined acute and preventive health-care management for children and their parents is indicated.

This study aims to evaluate the effectiveness of a prefabricated carbon-composite ankle foot orthoses (c-AFOs) on gait parameters in children with unilateral spastic cerebral palsy (USCP) exhibiting a drop foot pattern.Sixteen ambulatory children with USCP and a drop foot pattern were included (mean age: 9 years; gross motor function classification system: I = 14, II = 2) and three-dimensional gait analysis was applied under randomly assigned conditions (barefoot; shoe; c-AFO). Kinematics, kinetics, time-distance parameters and gait indices were investigated.Effects on the drop foot pattern were investigated while the children walked in shoes only. The shoes already increased the maximum ankle dorsiflexion in swing (p= 0.004) and initiated more knee flexion during single support (p⩽ 0.013). Compared to shoe walking, the c-AFO led to additional benefits regarding further ankle dorsiflexion during swing (p⩽ 0.001) and initial contact (p0.001), ankle movement during loading response (p= 0.002), improved the sole angle during initial contact (p0.001) and during mid stance (p= 0.015). Plantarflexion and ankle power generation during push-off decreased when wearing the c-AFO (p⩽ 0.008).Investigated c-AFOs are beneficial for improving drop foot patterns in children with USCP. Significant effects on pathological barefoot pattern were already achieved with the child's regular shoes. This could be considered in clinical decision processes. In comparison to shoe walking, c-AFO additionally improved foot clearance and normalized initial heel contact. The third rocker deteriorates with the c-AFO. Since kinematics improved with the orthoses during swing and early stance phase, c-AFOs might reduce tripping and falling caused by a drop foot during long distance walking.

ZusammenfassungEine Gewichtszunahme in der Schwangerschaft oberhalb der IOM-Empfehlungen erhöht das Risiko für Schwangerschaftskomplikationen und für späteres Übergewicht bei Mutter und Kind. Deshalb sollten Schwangere hinsichtlich ihrer Zunahme entsprechend beraten werden. Welche Bedürfnisse haben Frauen bezüglich der Beratung? Hierzu wurden 34 Schwangere in offenen Interviews befragt, welche mit der Frequenzanalyse nach Mayring ausgewertet wurden. Es wurde erkannt, dass die gesundheitlichen Auswirkungen einer zu starken Gewichtszunahme von den Frauen unzureichend wahrgenommen werden. Weiterhin konnten 4 verschiedene Verhaltensweisen bezüglich der Ernährung abgeleitet werden: (i) Schwangere, die zwar gut informiert sind, dies jedoch nicht umsetzen; (ii) Schwangere, die Informationen und Wissen konsequent umsetzen, (iii) Schwangere, die sich vom Körpergefühl leiten lassen; und (iv) vorwiegend indifferente Schwangere. Frauen, die schon vor der Schwangerschaft inaktiv waren, ließen sich auch in der Schwangerschaft nicht zu Sport motivieren. Für die Planung zukünftiger Interventionen sollte berücksichtigt werden, dass Informationsbedarf hinsichtlich der Gewichtszunahme und gesunder Ernährung in der Schwangerschaft besteht. Abhängig vom Verhaltensmuster der Frau wird eine Ernährungsintervention nicht immer den gewünschten Erfolg erzielen. Weiterhin ist die Motivation und Aufklärung zu geeigneten Sportarten eine besondere Herausforderung.

Background Dietary behavior exerts a critical influence on health and is the outcome of a broad range of interacting factors, including food and taste acceptance. These may be programmed in utero and during early infancy. Objective We examined the hypothesis that fetuses and infants exposed to sweet, salty, sour, bitter, umami, or specific tastes show greater acceptance of that same taste later in life. Methods We conducted a systematic review of the literature, using comprehensive searches and following established procedures for screening, data extraction, and quality appraisal. We used harvest plots to synthesize the evidence graphically. Results Twenty studies comprising 38 subgroups that differed by taste, age, medium, and duration of exposure were included. Exposure to bitter and specific tastes increased the acceptance of these tastes. Studies on sweet and salty tastes showed equivocal results. Studies on sour tastes were sparse. Conclusion Our systematic review clearly shows programming of the acceptance of bitter and specific tastes. For other tastes the results were either equivocal or confined to a few number of studies that precluded us from drawing conclusions. Further research should examine the association of salty and sour taste exposures on later preferences of these tastes. Long-term studies and randomized clinical trials on each type of taste are needed.

Children with chronic illness or disabilities and their families require more support than healthy families. The working group "custodial and psychosocial supply" defined 4 theses to figure out deficits and targets of family support: 1) my child is different; 2) my child is not devisable; 3) my child needs strong helpers; and 4) my child needs safety.Based on these theses, a questionnaire for parents was designed of which 20 were sent to 34 parent initiatives in Germany each, for distribution to a random sample of member families.499/680 questionnaires were returned of which 419 could be included in the analysis. Less than 50% of the parents felt adequately and timely informed about their child's condition, and support for coping with the child's diagnosis was rarely given. Less than half of the parents reported to have been informed about the options for support within the German social system, and less than 15% were aware of instructions for clearing houses on care and support. About a third of the parents reported needs for managing family, siblings or household, but only a third of these had been offered organised and structured family support. More than 50% of the families reported restraints in participating in social life: such restraints were associated with problems in partnership and loss of friends. Half of the parents felt restraints of the family income because of their child's condition.There is need for improvement of the psychosocial condition of families with chronically ill or disabled children by better, more and timely information about the child's clinical condition, access to the social support system and availability of support services.

Aim Gestational diabetes mellitus is believed to be a risk factor for childhood overweight/obesity. We aimed to assess whether this association is either a reflection or independent of confounding by maternal BMI. Methods Data from 7355 mother–child dyads of the German Perinatal Prevention of Obesity cohort with full anthropometric information on mothers and children, gestational diabetes and confounding factors were obtained at school entry health examination. We calculated crude and adjusted logistic regression models for the association of gestational diabetes and childhood overweight/obesity and abdominal adiposity defined by age- and sex-specific percentiles for BMI and waist circumference. Results Among all children (mean age 5.8 years), 8.1% were overweight, 2.6% were obese and 15.5% had abdominal adiposity. The prevalence of overweight (obesity) was 21% (8.2%) in children of mothers with gestational diabetes and 10.4% (2.4%) in children of healthy mothers. Analyses with adjustment for maternal BMI and other potential confounders yielded an odds ratio of 1.81 (95% CI 1.23–2.65) and 2.80 (95% CI 1.58–4.99) for the impact of gestational diabetes on childhood overweight and obesity, respectively. Similar results were obtained for the risk of childhood abdominal adiposity (odds ratio 1.64, 95% CI 1.16–2.33) by maternal gestational diabetes. Conclusions The postulated increased risk of overweight and abdominal adiposity in offspring of mothers with gestational diabetes cannot be explained by maternal BMI alone and may be stronger for childhood obesity than for overweight.

Summary What is already known about this subject Gestational weight gain is a modifiable risk factor for childhood overweight. What this study adds Exceeding the recommended gestational weight gain increases the risk for childhood overweight by about 30%. Interventions to avoid excessive weight gain are needed. Background Overweight and obesity in children are thought to be related to prenatal priming. Gestational weight gain (GWG) might be a potential modifiable risk factor for childhood overweight. Objective To quantify the associations of inadequate and excessive GWG with childhood overweight. Methods The electronic literature search in six databases was complemented by a hand search for relevant articles. Papers were selected and quality was assessed. The effect estimates of the individual studies were pooled using a random-effects model. Results The literature search yielded 1492 results in total, of which seven observational studies met the inclusion criteria. The studies had medium to good quality. The pooled estimate for the association between excessive GWG and childhood overweight yielded an odds ratio (OR) of 1.38 (95% confidence interval [CI]: 1.21–1.57). The association between inadequate GWG and childhood overweight yielded an OR of 0.91 (95% CI: 0.85–0.98). Conclusion These data provide evidence for at least a 21% risk for childhood overweight related to excessive GWG. Therefore, further efforts to design appropriate interventions against excessive GWG may appear warranted.

Das Risiko fur Ubergewicht und Adipositas im Kindesalter kann bereits im Mutterleib programmiert werden. In Kohortenstudien wurden prakonzeptionelles Ubergewicht / Adipositas der Mutter, Rauchen in der Schwangerschaft, erhohte Gewichtszunahme in der Schwangerschaft und Gestationsdiabetes als pranatale Risikofaktoren beschrieben. Die sogenannte populationsattributable Risikofraktion berucksichtigt Effektstarke und Pravalenz der Risikofaktoren und ermoglicht es so abzuschatzen, fur welchen Faktor ein starkerer potentieller Einfluss auf die Adipositaspravalenz in der Bevolkerung erwartet werden kann.

Background: It is unknown how well the trimester-specific recommendations for gestational weight gain (GWG) given by the Institute of Medicine/National Research Council (IOM/NRC) identify women at risk of GWG outside IOM/NRC recommendations for total GWG. Objective: We assessed the prognostic value of trimester-specific cutoffs for inadequate or excessive total GWG in term pregnancies. Design: Data on prepregnancy weight and the temporal course of GWG were collected from medical records. A total of 7962 women were included in the final analysis. Main outcome measures were inadequate or excessive total GWG as defined by criteria of the IOM/NRC. Main exposures were GWG outside the IOM/NRC week-specific recommendations in the first, second, and third trimesters. Results: The prediction of gaining weight within the GWG recommendations increased with gestational age and was related to the maternal weight category and outcome. In the second trimester, inadequate GWG was predicted with a sensitivity of 49% and 60.2% and a positive predictive value (PPV) of 72.1% and 68.3% in underweight and normal-weight mothers, respectively. Excessive GWG was predicted with a sensitivity of 72.7% and 70.4% and a PPV of 94.3% and 93.3% in overweight and obese mothers, respectively. Conclusions: On the basis of second-trimester‐specific guidelines, inadequate GWG can be predicted in underweight and normalweight mothers, whereas excessive GWG can be predicted in overweight and obese mothers. Therefore, it appears possible to identify women at risk of gaining outside of the guideline as early as the second trimester. Am J Clin Nutr doi: 10.3945/ajcn.111.033704.

Diabet. Med. 29, 378–384 (2012) Abstract Background While the association of gestational diabetes mellitus and abnormal glucose tolerance is beyond doubt, its associations with other cardiovascular disease risk factors in the offspring are less clearly established. Some of these associations, in particular overweight in the offspring, might be confounded by maternal overweight. Methods Data on 12 542 children in the age of 3–17 years with full information about gestational diabetes mellitus and maternal BMI were available from the German nationwide KiGGS study. We calculated linear and logistic regression models for measurements of body composition, blood pressure, HbA1c and cholesterol values in the offspring with gestational diabetes mellitus as the explanatory variable, with and without adjustment for maternal BMI. Results The prevalence of gestational diabetes mellitus in the dataset was 2.2%. Unadjusted regression analyses suggested weak positive effects of gestational diabetes mellitus on body composition measurements [e.g. a mean increase in BMI standard deviation scores (SDS) of 0.17 units (95% confidence interval: 0.03, 0.30)]. After adjustment for maternal BMI, the observed associations almost disappeared [e.g. BMI SDS: 0.07 (−0.06, 0.20)]. With respect to blood pressure and cholesterol, no potential effects of gestational diabetes mellitus were observed in both unadjusted and adjusted models. Conclusion Gestational diabetes mellitus does not appear to have a relevant effect on cardiovascular disease correlates such as blood pressure or cholesterol levels in children, and the potential effect of gestational diabetes mellitus on body composition seems to be widely explainable by maternal BMI.

ZusammenfassungDas Adipositasrisiko von Kindern kann bereits vor deren Geburt programmiert werden. Präkonzeptionelles Übergewicht/Adipositas der Mutter, Rauchen in der Schwangerschaft, erhöhte Gewichtszunahme in der Schwangerschaft und Gestationsdiabetes sind pränatale Risikofaktoren, die durch eine Reihe von Kohortenstudien beschrieben wurden.Die Effektstärke jedes einzelnen Faktors auf das Adipositasrisiko der Nachkommen sowie seine Prävalenz variieren dabei. Die so genannte populationsattributable Risikofraktion berücksichtigt Effektstärke und Prävalenz der Risikofaktoren und ermöglicht es so, abzuschätzen, für welchen Faktor ein stärkerer potenzieller Einfluss auf die Adipositasprävalenz in der Bevölkerung erwartet werden kann. Die aktuelle Datenlage zeigt, dass der größte Anteil am pränatal determinierten Adipositasrisiko durch präkonzeptionelle Adipositas der Mutter erklärt wird. Daher erscheinen Präventionsprogramme, die auf adipöse junge Frauen mit Kinderwunsch abzielen, am ehesten Erfolg versprechend für eine relevante Reduktion der Adipositasprävalenz bei Kindern, wenngleich viele Fragen zum Mechanismus der Risikofaktoren und Effektivität etwaiger Interventionen ungeklärt sind.

Background: Gestational weight gain (GWG) is known to be a potential risk factor for short-term postpartum weight retention (PPWR) and thus for overweight in women. Does GWG also determine the long-term risk of overweight in women? Objective: We aimed to study the short- and long-term effects of GWG in accordance with the Institute of Medicine (IOM) recommendations on postpartum weight retention. Design: We systematically reviewed 5 databases and bibliographies of various publications supplemented by hand search for relevant articles published in English or German and performed meta-analyses to quantify the effect estimate of PPWR by using a random-effects model. We split the data into 4 categories of follow-up: ,0.5, 0.5–1, ;3, and 15 y. Results: Of 1770 search hits, 9 observational studies remained suitable for the analysis. PPWR increased after longer time spans after delivery irrespective of whether GWG had been below, within, or above the guidelines. Compared with women with GWG within the recommendations, those with a GWG above the recommendations retained an additional 3.06 kg (95% CI: 1.50, 4.63 kg) after 3 y and 4.72 kg (95% CI: 2.94, 6.50 kg) on average after 15 y postpartum. Inadequate GWG was associated with less PPWR (22.99 kg; 95% CI: 23.72, 22.27 kg) ,6 mo after pregnancy. This association faded over time and became nonsignificant (21.41 kg; 95% CI: 23.03, 0.21 kg) after 15 y. The results remained stable in sensitivity analyses that accounted for changes in IOM criteria over time and potential effect modification by low social class. A funnel plot did not suggest publication bias. Conclusion: GWG in accordance with the IOM recommendations is associated with long-term effects on PPWR. Am J Clin Nutr doi: 10.3945/ajcn.111.015289.

Excessive gestational weight gain (GWG) may be a risk factor for gestational diabetes mellitus (GDM). We aimed to study the association between excessive GWG (defined according to Institute of Medicine recommendations) prior to GDM screening, and GDM. We systematically searched four electronic databases from 1990 until September 2014 for observational studies published in English or German that reported an association between excessive GWG and GDM as the outcome. Random effects meta-analyses were performed to provide a pooled estimate of the OR comparing the risk of GDM in women with and without excessive GWG. A total of eight studies involving 13,748 participants were included. The pooled analysis of unadjusted OR yielded a summary OR of 1.40 (95% CI 1.21, 1.61; p

Reducing gestational weight gain is possible and may avoid some obstetric, perinatal and long-term metabolic risks for the mother and offspring. Reducing gestational weight gain, however, is not a panacea for all outcomes and all pregnancies. More research is needed to identify mother–infant pairs who will benefit.

To the Editor: Preconception obesity is a strong predictor of glucose intolerance during pregnancy that has the potential to lead to adverse maternal and offspring effects. An increased prevalence of overweight offspring of obese mothers has been reported, despite normal values in an oral glucose tolerance test (OGTT)1 during pregnancy (1). Such findings might reflect effects of the intrauterine milieu, genetic background, or lifestyle factors related to maternal obesity or, alternatively, failure to diagnose glucose intolerance in obese pregnant women. We investigated whether increases in hemoglobin A1c (Hb A1c) at delivery as a surrogate marker of glycometabolic disturbances are prevalent in obese mothers, despite the exclusion of gestational diabetes (GDM) even after applying the stringent new criteria as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). We performed a retrospective analysis of 137 obese pregnant Caucasian women. Recruitment was through an ongoing cohort study on the long-term effects of preconception maternal obesity (PEACHES, Programming of Enhanced Adiposity Risk in CHildhood – Early Screening), which had been initiated in 15 recruiting maternity clinics in Bavaria, Germany. Inclusion criteria before delivery were an age ≥18 years, singleton pregnancy, full-term birth, and a pregestation body mass index (BMI) ≥30 kg/m2. Women with a preexisting diagnosis …

Anorexia nervosa (AN) is a severe eating disorder with a high mortality rate. Treatment regimes show regional and global variation and are sometimes supported by enteral feeding (EF) via nasogastric tube, although risks and benefits are still unclear. We aimed to find out whether EF improves growth and AN recovery and prevents psychiatric comorbidities. Data were retrospectively collected from medical records and follow-up data were collected via questionnaires. Two hundred and eight female AN patients who were hospitalized below the age of 18 years with a mean follow-up of 6 years were analyzed. We calculated relative risks for the association between EF and suboptimal growth, remission of AN and the occurrence of psychiatric comorbidities, adjusting for potential confounders. A third of the analyzed girls received EF at any time. In the adjusted analyses, we found no significant associations between EF and suboptimal growth, the persistence of AN and the occurrence of psychiatric comorbidities, respectively. Our data suggest EF to be neither a risk factor nor beneficial for growth, recovery or persistence of AN and the occurrence of psychiatric comorbidities.

Background Gestational weight gain (GWG) has been shown to be a risk factor for overweight in offspring. Aim of this study was to quantify the contributions of trimester-specific and total GWG on offspring’s BMI and waist circumference (WC). This is of interest for the design of interventions targeted at women showing a high GWG in early pregnancy. Methods In a retrospective cohort study data on GWG (total and by trimester, exposure), a number of potential confounders, and children’s BMI z-scores and WC (outcomes) were analyzed using structural equation models to disentangle the trimester-specific direct effects of GWG and indirect effects mediated via total GWG. Results 7313 mother child pairs with a children’s mean age of 5.81 years were analyzed. Total effects (indirect + direct) of GWG (kg/week) on children’s BMI z-score and WC (cm) were observed in all trimesters, most prominently in the second. The longitudinal effect of GWG is a composite of trimester-specific direct effects (on BMI: 0.105, 0.255, 0.002, on WC: 0.538, 1.64, 0.308) and total GWG (on BMI 0.608, on WC: 1.03) at the end of pregnancy. Conclusions Both trimester-specific priming and total GWG explained offspring’s anthropometrics. The results indicate, that reversal from additional weight gain attained early in pregnancy resulting in normal total GWG at the end of pregnancy might still contribute to a substantial reduction of offspring’s BMI and WC.

Healthy eating behaviours, such as increasing fruit and vegetable consumption (FVC), are frequently used as a target or outcome measure in obesity prevention interventions. The goal of this study was to demonstrate replacement of high-caloric foods/drinks by FVC and changes in body mass index (BMI) z-score associated with FVC.Anthropometric measurements of 1252 children (51.0% girls) were taken before school entrance (age 6 years) and repeated in the fourth grade (age 10 years). At the same time, parents were asked about their children's diet using a questionnaire.In longitudinal analysis, changes in FVC were not significantly correlated with changes of other nutritional habits, such as consumption of sweets and high-caloric drinks. BMI gain tended to be lower (nonsignificant) in children with increasing fruit consumption compared to those with decreasing fruit consumption. An opposite (nonsignificant) tendency was observed for vegetable consumption and BMI gain.Although beneficial for other health outcomes, the evidence for FVC replacing high-energy foods and thereby reducing BMI gain is weak and could not be substantiated in this study. This might be partially due to the limitation in dietary assessment.

INTRODUCTION: Previous studies suggested potential priming effects of gestational weight gain (GWG) on offspring's body composition in later life. However, consistency of these effects in normal weight, overweight and obese mothers is less clear. METHODS: We combined the individual data of three German cohorts and assessed associations of total and excessive GWG (as defined by criteria of the Institute of Medicine) with offspring's mean body mass index (BMI) standard deviation scores (SDS) and overweight at the age of 5-6 years (total: n = 6,254). Quantile regression was used to examine potentially different effects on different parts of the BMI SDS distribution. All models were adjusted for birth weight, maternal age and maternal smoking during pregnancy and stratified by maternal pre-pregnancy weight status. RESULTS: In adjusted models, positive associations of total and excessive GWG with mean BMI SDS and overweight were observed only in children of non- overweight mothers. For example, excessive GWG was associated with a mean increase of 0.08 (95% CI: 0.01, 0.15) units of BMI SDS (0.13 (0.02, 0.24) kg/m(2) of 'real' BMI) in children of normal-weight mothers. The effects of total and excessive GWG on BMI SDS increased for higher- BMI children of normal-weight mothers. DISCUSSION: Increased GWG is likely to be associated with overweight in offspring of non-overweight mothers.