Non-Hispanic White Odds Ratio P-value (95% CI) 0.33 (0.14–0.76) 0.37 (0.11–1.22) 0.34 (0.16–0.74) 0.51 (0.17–1.50) 1.51 (0.54–4.21) 1.28 (0.32–5.08) 0.81 (0.26–2.53) 0.39 (0.02–6.71) 1.37 (0.22–8.49) 0.01 0.10 <0.01 0.22 0.43 0.72 0.72 0.52 0.74 7 Table 6: Elevated cardiovascular disease risk factors among US 3-to-6-year-olds if low birth weight, by ethnic group, National Health and Nutrition Examination Survey, 1999–2008. Hispanic Non-Hispanic Black Odds Ratio (95% CI) 0.82 (0.47–1.44) 0.99 (0.54–1.83) 0.89 (0.43–1.86) 1.74 (0.94–3.22) 1.58 (0.66–3.83) 1.37 (0.53–3.54) 1.88 (0.75–4.68) 1.58 (0.40–6.23) 0.98 (0.20–4.71) P-value 0.49 0.97 0.89 0.08 0.31 0.52 0.18 0.51 0.98 Odds Ratio (95% CI) 0.88 (0.44–1.37) 1.01 (0.46–2.23) 1.03 (0.56–1.88) 1.37 (0.81–2.29) 0.64 (0.28–1.44) 1.14 (0.53–2.47) 0.55 (0.25–1.25) 0.87 (0.19–3.96) 0.99 (0.40–2.43) P-value 0.38 0.98 0.93 0.24 0.28 0.74 0.16 0.85 0.99 International Journal of Pediatrics Perinatal Factor Low birth weight (Y/N) BMI ≥ 85th %ile for age, sex BMI ≥ 95th %ile for age, sex Waist circumference1 C-reactive protein1 Total cholesterol1 HDL cholesterol2 Non-HDL cholesterol1 LDL cholesterol1 Triglycerides1 1 Highest quintile 2Lowest quintile maternal obesity, paternal obesity, number of children in the family, and the percentage of awake time spent in sedentary activity. They also reported that breastfeeding might have a small protective eﬀect against childhood obesity, although the authors concluded that residual confounding might exist. The authors reported no signiﬁcant eﬀect of early introduc- tion of solid foods on childhood obesity, consistent with our ﬁndings here. Conversely, a prospective nationally represen- tative cohort study conducted in England, Wales, Scotland, and Northern Ireland [26] included 13,188 singleton chil- dren aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) deﬁned by the International Obesity Task Force cut-oﬀs for body mass index. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z- score, black ethnicity (compared with white), introduction to solid foods <4 months, and smoking during pregnancy. However, in agreement with both the ﬁndings here and in the Viva La Familia Study, breastfeeding ≥4 months (compared with none) was associated with a decreased risk of early childhood overweight. Other population-based studies have shown an asso- ciation between maternal smoking during pregnancy and childhood obesity. Speciﬁcally, a total of 11,653 preschool children participating in the UK Millennium Cohort Study had their weight gain z-scores calculated from 3 to 5 years [27]. In a mutually adjusted model, children were more likely to gain weight rapidly if their mothers smoked during pregnancy. Due to the cross-sectional nature of the current dataset, we were unable to explore longitudinal growth but the concept of catch-up growth has gained recent and increased attention in the literature [28–30]. Because our ﬁndings are among very young children, they may have implications throughout childhood. Our group has reported previously that risk factors for car- diometabolic disease can be detected as early as the preschool years (12) and 8 years old [31]. Other studies have noted that several CVD risk factors persist strongly and consistently through childhood into adulthood [32, 33]. The Cardio- vascular Risk in Young Finns Study was one of the ﬁrst groups to explore childhood predictors of the metabolic syndrome (MS), a constellation of abnormal waist circum- ference, insulin resistance, dyslipidemia, and hypertension [32]. In this study, fasting insulin at baseline was related to development of the syndrome after a 6-year follow-up of 1,865 children and adolescents 6-to-18-years-old. Reported results showed that baseline insulin concentration was higher in children who subsequently developed the MS, lending support to the theory that insulin resistance precedes the development of the condition in childhood. 5. Study Limitations In a cross-sectional study, causality cannot be inferred. Blood pressure, insulin and glucose measures, which are important components of metabolic syndrome and risk factors for adult-onset CVD and diabetes, were not collected in this age group and thus were not available for analysis. Because triglycerides and LDL were measured on a subsample of the surveyed children, analyses for these variables may not have suﬃcient statistical power to detect signiﬁcant diﬀerences. Dietary and physical activity level data were not included because the children in this analysis were so young and their eating and exercise patterns tend to be inconsistent as a result. Smoking status during pregnancy and infant feeding behav- iors were self-reported and therefore subject to systematic biases. Finally, genetic inﬂuences were not examined. 6. Conclusions This study indicates that behavioral and social factors exert critical inﬂuences on the onset of childhood overweight in preschool years among NHW families in particular. Regard- less of ethnic background, all women should be advised not