DISCUSSION has reported that women who are already overweight

DISCUSSIONWe aimed to explorewhether or not maternal overweight/obesity is a risk factor for childhoodoverweight/obesity in Malawi.  It is wellestablished that overweight and obesity are well-known risk factors for varioushealth problems, including coronary heart disease, type 2 diabetes, cancers,hypertension, dyslipidemia, stroke, respiratory problems and osteoarthritis 62223. However, its association withchildhood overweight/obesity has never been tested in Malawian setting. In thisstudy, we have demonstrated that maternal overweight/obesity is linked to anincreased risk of childhood overweight/obesity. Pre-pregnancy BMIwas not available in our datasets, therefore we anticipated that maternal BMIcategories at the time of the survey would be the same as that before the indexbirth. This assumption was made base on previous research has reported that womenwho are already overweight or obesebefore a first pregnancy tend to maintain or gain more weight after pregnancythan average weight women 2425.

Studies have reported that forthe newborn infant, the strongest predictor of later obesity is maternalpreconception BMI 2627. Thus, the mother’s preconceptionweight status could be a marker of socioeconomic, environmental and geneticrisk for the child 28. Consequently, the genetic traits of the family can influence childhoodoverweight/obesity risk 2930. It is well established that relativelycommon obesity susceptibility gene variants interact with diet in threepossible ways: 1) by increasing saturated fat and refined carbohydrate consumption;2) altering the lipid metabolism regulation, or3) decreasing energy expenditure 28313233. Excess gestationalweight gain is associated with risk for a number of poor health outcomes for boththe infant and the mother 343536.

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It was reported that excessgestational weight gain may be associated with fetal macrosomia 3738 and macrosomia has been implicatedin an increased risk of overweight or obesity in childhood and adulthoodcompared to normal birthweight infants 39. This argument is supported by ourfinding where infants born with very large/larger sizes than average hadincreased risk of developing overweight/obesity later in their lives. Moreover,it is well documented that many women tend to increase caloric intake anddecrease physical activity during pregnancy which is implicated in maternaloverweight/obesity and subsequent fetal macrosomia.