4 ileum on the midaxillary line, at minimal respiration after normal expiration) [16, 17]. Triglycerides and low-density lipoprotein (LDL) choles- terol were measured via blood on a nonfasting subsample (those who were examined in the morning session only) of all children ages 3 to 11 (N = 626). All serum blood samples were collected, processed, stored at −20◦C, and shipped to the Lipid Laboratory, Johns Hopkins University, Baltimore, MD (lipids) for the1999–2006 surveys and to the University of Minnesota, Minneapolis, MN, for the 2007-2008 survey for analysis [18]. High-density lipoprotein (HDL) cholesterol was mea- sured in supernatants after precipitation of apo B-containing lipoproteins with heparin-manganese chloride and removal of excess manganese by precipitation with sodium bicarbon- ate. Triglycerides were analyzed enzymatically with the use of commercial reagents and was measured in EDTA plasma after hydrolysis by lipoprotein lipase to glycerol and fatty acids. Glycerol is enzymatically phosphorylated and then oxidized to release hydrogen peroxide, which is peroxidized to form a quinine-imine chromophore that can then be read at 490 to 550 nm in a spectrophotometer [18]. Low- density lipoprotein cholesterol (LDL) was derived using the Friedewald calculation (LDL = total cholesterol-HDL cholesterol-triglyceride/5) [19]. CRP was quantiﬁed by latex-enhanced nephelometry (CRP present in the test sample forms an antigen antibody complex with the latex particles). Serum blood specimens were processed, stored and shipped to University of Washing- ton, Seattle, WA [18]. Particle-enhanced assays were based on the reaction between a soluble analyte and the corresponding antigen or antibody bound to polystyrene particles. A dilute solution of test sample was mixed with latex particles coated with mouse monoclonal anti-CRP antibodies. Non- HDL cholesterol is deﬁned as total cholesterol minus HDL cholesterol. 2.4. Statistical Methods. The highest quintile for CRP, total cholesterol, LDL cholesterol, non-HDL cholesterol and triglycerides and the lowest quintile for HDL cholesterol, for the entire study population were used as cut-points for analysis (Table 1). These cut-points are consistent with the percentages used for abnormal values in studies of older children [20, 21]. Logistic regression analysis was used to explore the relationships between each of the selected perina- tal and infant conditions and anthropometric measurements and CVD risk factors for each ethnic group. Child’s age and sex, the family’s poverty/income ratio, the year of the survey (to account for possible trend over the 10 years of data), and mother’s age at the child’s birth were included in each model to control for potential confounding eﬀects. Separate analyses were run for the three race/ethnicity categories. Analyses were performed with SAS SURVEY procedures (SAS version 9.2, SAS Institute, Cary, NC) to accommodate the complex sample survey design of the NHANES data. Alpha was set at 0.05 and all tests were two tailed, without correction for multiple comparisons. International Journal of Pediatrics Table 2: Demographic characteristics of 3,644 3-to-6-year-olds in the National Health and Nutrition Examination Survey, 1999–2008. N Weighted N Percent 95% CI Gender Boys Girls Age (years) 3 4 5 6 Ethnicity 1,865 1,779 922 976 887 859 7,399,751 7,135,318 3,493,552 3,701,859 3,581,816 3,757,841 9,000,820 3,285,391 2,248,857 50.9 49.1 24.0 25.5 24.6 25.9 61.9 22.6 15.5 48.6–53.2 46.8–51.4 22.1–26.0 23.5–27.4 22.7–26.6 23.9–27.8 58.2–65.7 19.5–25.7 13.0–17.9 Non-Hispanic White 1,138 Hispanic 1,416 Non-Hispanic Black 1,090 Total 3,644 14,535,068 3. Results We analyzed data from 3,644 (weighted sample size, 14,535,068) children and their mothers (Tables 2 and 3). Overall, 13.8% of children had a BMI ≥95th percentile and 26.5% had a BMI ≥ 85th percentile for age and sex (Table 1). Approximately 65% of mothers reported breastfeeding while 42% reported introducing solids before 6 months. Almost 10% of the infants were low birth weight (<2500 grams) and 17% of the mothers reported smoking while being pregnant (Table 3). Table 4 shows that breastfeeding was signiﬁcantly protec- tive against obesity (BMI ≥ 95th percentile ile for age and sex) (OR 0.43, 95% CI, 0.27–0.69), overweight (OR 0.61, 95% CI, 0.42–0.87), and being in the highest quintile for waist circumference (OR 0.58, 95% CI, 0.37–0.92) among the NHW group and against highest quintile for non-HDL cholesterol among NHB (OR 0.56, 95% CI, 0.32–0.98). Conversely, introducing solid foods before 6 months was not shown to be a risk factor for any CVD risk factors among all ethnic groups. Smoking during pregnancy was a signiﬁcant risk factor for obesity (OR 2.22, 95% CI, 1.13–2.83), overweight (OR 1.79, 95% CI 1.13–2.83), and highest quintile of CRP (OR 1.63, 95% CI, 1.05–2.51) among NHW (Table 5). Table 6 shows that in general low birth weight was not a risk factor for becoming overweight or obese or having elevated CVD risk factors in this age group was associated with a diminished risk among NHW for being overweight (OR 0.33, 95% CI 0.14–0.76) and having the highest quintile of waist circumference (OR 0.34, 95% CI 0.16–0.74). 4. Discussion The results reported here show that CVD risk in young chil- dren is associated with perinatal and infancy factors among NHW. Speciﬁcally, our analysis shows that breastfeeding is