As an epidemiologist, my research is related to childhood obesity and nutrition and their long-term impact on cardiometabolic health into adulthood. I am also interested in early-life exposures occurring during pregnancy and breastfeeding that may help establish developmental trajectories into childhood and beyond. I have significant expertise in how children develop relative to growth charting. My goal is to understand whether there are critical periods in early life or key aspects of developmental exposures that may prevent future obesity and cardiometabolic diseases.
My early research focused on infancy and the role of breastfeeding and human milk composition in modulating obesity risk. This work used a set of parallel international cohorts recruited in Cincinnati, Mexico City and Shanghai. I evaluated the role of human milk adiponectin in infant growth while considering complementary feeding timing and diversity of foods in this relationship.
My groundbreaking work has centered on the use of growth charts to evaluate infant obesity and identify critical time periods for the development of early-onset severe obesity. In 2009, I identified that the Centers for Disease Control and Prevention (CDC) body mass index (BMI) z-scores, used widely in clinical and research applications, have a critical flaw. In particular, because of how they were developed, CDC BMI z-scores do not effectively differentiate the weight status of children and adolescents with severe obesity. This topic was the focus of a National Center for Health Statistics (NCHS) workshop that aimed to propose alternative metrics for effectively assessing adiposity status at the high end of the distribution. This work has resulted in several manuscript publications and altered recommendations for the use of CDC growth charts.
Traditionally, there has not been a definition of obesity for children under the age of two and a hesitancy to identify infants as obese. My studies have identified that children who develop severe early-onset (prior to age 6) obesity have a significantly different BMI trajectory in infancy that is identifiable as early as six months of age. Infants at or above the 85th percentile on the World Health Organization (WHO) BMI growth charts have a 50 percent risk of being overweight or obese by age six, compared with just 11 percent of those below this threshold.
My ongoing research focuses on the follow-up of several large-scale epidemiologic cohorts, which recruited children in the 1970s and 1980s, following them into mid-adulthood. Study assessments include cardiometabolic risk factors, adiposity, diet, cardiovascular disease and death. This life-course view of the impact of childhood risk factors on adult disease has demonstrated that the risk of adult disease arises from even modest elevations in childhood risk factors that can help direct early prevention efforts. This work is conducted in collaboration with the International Childhood Cardiovascular Cohorts (i3C) Consortium.
I’ve been honored to receive the following awards and honors:
- 1992 Phi Kappa Phi National Honor Society
- 1993 Phi Beta Kappa
- 1993 Psi Chi Psychology Honor Society
- 1993 Golden Key National Honor Society
- 1993 Merrill Presidential Scholar, Cornell University
- 2003 Chrysalis Travel Grant for the American Academy of Allergy, Asthma & Immunology (AAAAI) meeting
- 2004 Outstanding Poster Presentation, University of Cincinnati Graduate Research Forum
- 2005 to present, Sigma Xi Scientific Research Honor Society
- 2010 to present, Who’s Who in America
- 2016 to present, Fellow of the American Heart Association (FAHA)
- 2019 Albert Nelson Marquis Lifetime Achievement Award (Marquis Who’s Who)
Early life influences on the development of pediatric obesity; severe obesity in childhood; breastfeeding and complementary food; life-course epidemiology of obesity and cardiometabolic disease; dyslipidemia and insulin resistance; nutritional epidemiology
Professor, UC Department of PediatricsUC Department of Environmental Health