***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: Background Rapid weight gain in infancy is an important predictor of obesity in later childhood . Our aim was to determine which modifiable variables are associated with rapid weight gain in early life . Methods Subjects were healthy infants enrolled in NOURISH , a r and omised , controlled trial evaluating an intervention to promote positive early feeding practice s. This analysis used the birth and baseline data for NOURISH . Birthweight was collected from hospital records and infants were also weighed at baseline assessment when they were aged 4 - 7 months and before r and omisation . Infant feeding practice s and demographic variables were collected from the mother using a self administered question naire . Rapid weight gain was defined as an increase in weight-for-age Z-score ( using WHO st and ards ) above 0.67 SD from birth to baseline assessment , which is interpreted clinical ly as crossing centile lines on a growth chart . Variables associated with rapid weight gain were evaluated using a multivariable logistic regression model . Results Complete data were available for 612 infants ( 88 % of the total sample recruited ) with a mean ( SD ) age of 4.3 ( 1.0 ) months at baseline assessment . After adjusting for mother 's age , smoking in pregnancy , BMI , and education and infant birthweight , age , gender and introduction of solid foods , the only two modifiable factors associated with rapid weight gain to attain statistical significance were formula feeding [ OR = 1.72 ( 95%CI 1.01 - 2.94 ) , P = 0.047 ] and feeding on schedule [ OR = 2.29 ( 95%CI 1.14 - 4.61 ) , P = 0.020 ] . Male gender and lower birthweight were non-modifiable factors associated with rapid weight gain . Conclusions This analysis supports the contention that there is an association between formula feeding , feeding to schedule and weight gain in the first months of life . Mechanisms may include the actual content of formula milk ( e.g. higher protein intake ) or differences in feeding styles , such as feeding to schedule , which increase the risk of overfeeding . Trial Registration Australian Clinical Trials Registry It is not known what constitutes an optimal diet in infancy . There are relatively few studies of weaning practice in the UK , and there is a need for prospect i ve data on the effects of  infant diet and nutrition on health in later life . We describe the dietary patterns , defined using principal components analysis of FFQ data , of 1434 infants aged 6 and 12 months , born between 1999 and 2003 . The two most important dietary patterns identified at 6 and 12 months were very similar . The first pattern was characterised by high consumption of fruit , vegetables and home-prepared foods ( ' infant guidelines ' pattern ) . The second pattern was characterised by high consumption of bread , savoury snacks , biscuits and chips ( ' adult foods ' pattern ) . Dietary pattern scores were correlated at 6 and 12 months ( r 0.46 ' infant guidelines ' ; r 0.45 ' adult foods ' ) . These patterns , which reflect wide variations in weaning practice , are associated with maternal and family characteristics . A key influence on the infant diet is the quality of the maternal diet . Women who comply with dietary recommendations , and who have high intakes of fruit and vegetables , wholemeal bread and rice and pasta , are more likely to have infants who have comparable diets -- with high ' infant guidelines ' pattern scores . Conversely , women whose own diets are characterised by high intakes of chips , white bread , crisps and sweets are more likely to have infants who have high ' adult foods ' pattern scores . The effects of these patterns on growth and development , and on long-term outcomes need to be investigated BACKGROUND Factors influencing excessive weight gain in pregnancy have not been well-studied among urban , low-income women . METHODS This prospect i ve cohort study of 94 prenatal care patients at a large university hospital in Philadelphia examined associations of modifiable midpregnancy behaviors and nonmodifiable or early pregnancy factors with  excessive gestational weight gain . Data were collected through question naires and medical record abstract ion from 2009 to 2011 . FINDINGS The majority of women were African American ( 83 % ) and all ( 100 % ) received Medicaid . Nearly two thirds ( 60 % ) were overweight or obese in early pregnancy and 41 % experienced excessive gain . In multivariable logistic regression analyses , significant predictors of excessive gestational weight gain included high early pregnancy body mass index ( odds ratio [ OR ] , 4.20 ; 95 % confidence interval [ CI ] , 1.43 - 12.34 for overweight/obese vs. normal weight ) , nulliparity ( OR , 3.35 ; 95 % CI , 1.17 - 9.62 for nulliparity vs. multiparity ) , and clinician advice discordant with Institute of Medicine guidelines ( OR , 5.88 ; 95 % CI , 1.04 - 33.32 for discordant vs. concordant advice ) . Watching under 2 hours of television daily ( OR , 0.18 ; 95 % CI , 0.03 - 1.03 ) , and engaging in regular physical activity during pregnancy ( OR , 0.35 ; 95 % CI , 0.11 - 1.09 ) were suggestive of a reduced risk of excessive gain . CONCLUSIONS In this sample of urban , low-income women , high early pregnancy body mass index , nulliparity , and discordant clinician advice were directly associated with excessive gestational weight gain , with a trend toward decreased risk for viewing fewer hours of television and engaging in regular physical activity . Intervening on these targets may optimize gestational weight gain and promote long-term maternal health Background To investigate the effect of an early childhood obesity prevention intervention , incorporating a parent modelling component , on fathers ’ obesity risk-related behaviours . Methods Cluster r and omized-controlled trial in the setting of pre-existing first-time parents groups organised by Maternal and Child Health Nurses in Victoria , Australia . Participants were 460 first-time fathers mean age = 34.2 ( s.d.4.90 ) years .  Dietary pattern scores of fathers were derived using principal component analysis , total physical activity and total television viewing time were assessed at baseline ( infant aged three to four months ) and after 15 months . Results No significant beneficial intervention effect was observed on fathers ’ dietary pattern scores , total physical activity or total television viewing time . Conclusion Despite a strong focus on parent modelling ( targeting parents own diet , physical activity and television viewing behaviours ) , and beneficial impact on mothers ’ obesity risk behaviours , this intervention , with mothers as the point of contact , had no effect on fathers ’ obesity risk-related behaviours . Based on the established links between children ’s obesity risk-related behaviors and that of their fathers , a need exists for research testing the effectiveness of interventions with a stronger engagement of fathers OBJECTIVE To investigate the emergence of the inverse socioeconomic gradient in body mass index ( BMI ) in the first 6 years of life . Furthermore , associations of socioeconomic position ( SEP ) with BMI and total fat mass ( % ) were assessed at age 6 , and potential mediating factors in the pathway between SEP and children 's body composition were investigated . METHODS Nearly 3,656 Dutch children participating in a prospect i ve cohort study in Rotterdam , the Netherl and s , were included from 2002 to 2006 .  Maternal educational level and net household income were used as indicators of SEP .  BMI and fat mass were both outcome measures . Associations and mediation analyses were investigated using linear mixed models and linear regression analyses . RESULTS The lowest SEP groups showed a larger increase in BMI over time as compared to the highest SEP groups ( P < 0.001 ) , which result ed in the emergence of the inverse SEP gradient around 3 - 4.5 years of age . In 6-year-old children , both BMI and total fat mass were significantly higher for children of low educated mothers ( difference in BMI SDS : 0.24 ; 95 % CI 0.15 , 0.33 ; and in total fat mass ( % ) : 2.68 ; 95 % CI 2.19 , 3.17 ) , which was also shown for children with a low household income . This was mainly explained by parental BMI and prenatal smoking . CONCLUSIONS The inverse socioeconomic gradient in obesity emerges during the preschool period , and widens with increasing age . A public health strategy aim ed at tackling the development of inequalities in obesity in early childhood needs to start before birth and should include the prevention of prenatal smoking and obesity of parents We prospect ively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen , Denmark , over the first 12 months of life using a detailed monthly  mailed question naire ( overall response rate = 73 % ) which focused on feeding practice s and illnesses . Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19 % at 12 months of life . Analysis of breast-feeding behavior using survival analysis showed that 50 % of the mothers who breast-fed since the first month of their infant 's life were still breast-feeding at 7 months of life . Also , there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare ( RR = 2.08 , 95 % CI = 1.43 , 3.01 ) . Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class . These results give insight into infant feeding patterns in a developed country and suggest that : ( 1 ) breast-feeding is the dominant method of feeding during the infant 's first year of life , and ( 2 ) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare Objective The aim of this study was to identify socio-demographic and home environmental predictors of  shorter sleep in early childhood , and to examine whether effects were mediated by the timing of bedtime or wake time . Methods Participants were from Gemini , a British birth cohort of twins , and included 1702 children ; one r and omly selected from each twin pair . Parents reported night-time sleep duration at an average age of 15.8 months ( range 14–27 months ) using a modified version of the Brief Infant Sleep Question naire . Multiple logistic regression models were used to identify predictors of shorter sleep for this study . Results Using a cut-off of < 11 h a night , shorter sleep was reported in 14.1 % of children . Lower maternal education , non-white ethnic background , being male , low birth weight , living in a home with > 1 older child and watching > 1 h of TV in the evening were independently associated with shorter sleep . Mediation analyses showed that associations between education , ethnicity , evening TV viewing and sleep were driven predominantly by later bedtimes , while sex differences were driven predominantly by earlier wake times in boys . Conclusion In this sample , multiple environmental factors were associated with  shorter sleep in young children , with several operating predominantly through later bedtime . An emphasis on the importance of an early and consistent bedtime could help promote healthy sleep and reduce inequalities in child health This study examined urinary cotinine levels and self-reported smoking among pregnant women in Korea and the factors associated with smoking during pregnancy . The subjects were selected from pregnant women who visited 30 r and omly sample d obstetric clinics and prenatal care hospitals in Korea in 2006 . Smoking status was determined by self-reporting and urinary cotinine measurement . A total of 1,090 self-administered question naires and 1,057 urine sample  s were analyzed . The percentage of smoking revealed by self-reporting was 0.55 % ( 95 % confidence interval [ CI ] , 0.11 - 0.99 ) and that revealed by urinary cotinine measurement ( > 100 ng/mL ) was 3.03 % ( 95 % CI , 1.99 - 4.06 ) . The kappa coefficient of agreement between self-reported smoking status and urinary cotinine measurement was 0.20 ( 95 % CI , 0.03 - 0.37 ) . Multiple logistic regression analysis revealed that early gestational period , low educational level , and being married to a smoker were significant risk factors for smoking during pregnancy . Smoking among pregnant women in Korea is not negligible , and those who are concerned to maternal and child health should be aware of this possibility among pregnant women in countries with similar cultural background OBJECTIVE To develop a diet quality index and to analyze socioeconomic factors associated with low child diet quality . METHODS A cross-sectional study was performed with a representative sample of 1,282 children aged between seven and ten years , living in the city of Vitória , Southeastern Brazil , in 2007 . Children were r and omly selected from 26 public schools and six private schools . Data on socioeconomic characteristics and life habits of children were obtained from a structured question naire , sent to homes and preferably completed by mothers . A food frequency question naire was created from studies performed with Brazilian children and tested in a public school . An index entitled Indice de Alimentação do Escolar ( ALES School Child Diet Index ) was design ed to assess diet quality , taking in consideration the nutritional recommendations for the Brazilian population and the habit of having breakfast . The association between diet quality and socioeconomic factors was analyzed using multinomial logistic regression . Adjusted odds ratios and 95 % confidence intervals were estimated for the variables that remained in the model . RESULTS According to the ALES index , approximately 41 % of the children studied had low diet quality ( boys= 37. 
    Output:
    
Strong evidence was found for an inverse relationship between SEP and ( 1 ) pre-natal risk factors ( pre-pregnancy maternal body mass index ( BMI ) , diabetes and pre-pregnancy diet ) , ( 2 ) antenatal/peri natal risk factors ( smoking during pregnancy and low birth weight ) and ( 3 )  early-life nutrition ( including breastfeeding initiation and duration , early introduction of solids , maternal and infant diet quality , and some aspects of the home food environment )  , and television viewing in young children .
Less strong evidence ( because of a lack of studies for some factors ) was found for paternal BMI , maternal weight gain during pregnancy , child sleep duration , high birth weight and lack of physical activity in young children .
A strong socioeconomic gradient exists for the majority of the early-life predictors of obesity suggesting that the die is cast very early in life ( even pre-conception ) .
Lifestyle interventions targeting disadvantaged women at or before child-bearing age may therefore be particularly important in reducing ine quality .
Given the likely challenges of reaching this target population , it may be that during pregnancy and their child ’s early years are more feasible windows for engagement