Maternal employment and early childhood overweight: findings from the UK Millennium Cohort Study

Relationships of Maternal Employment and Work Impact with Weight-Related Behaviors and Home Environments of Mothers and Their School-Age Children

The prevalence of obesity continues to rise. Preventing obesity, especially childhood obesity, is critically important. Parents, especially mothers, play a vital role in preventing childhood obesity. Numerous factors, such as maternal employment, may influence maternal weight-related practices and home environment characteristics that affect the risk of childhood obesity. Given the prevalence of both childhood obesity and maternal employment, this study was conducted to examine how weight-related maternal, child, and household behaviors as well as home environment characteristics differ by maternal employment hours and extends existing research by examining work impact on behaviors and home characteristics. U.S. mothers (n = 527) with at least one school-age child (6 to 11 years), who were between the ages of 25 and 54 years and the main food gatekeeper in the household completed an online survey. ANOVA comparisons of non-working, part-time employed, and full-time employed mothers revealed few differences in any of the variables studied. Cluster analysis of the 336 employed mothers based on six work impact scale scores found three unique clusters characterized as Enthusiastic Earners, Indifferent Earners, and Strained Earners. Few differences in sociodemographic and job characteristics occurred among clusters and the differences noted had small effect sizes. Clusters did not differ by maternal BMI or perceived child weight status. However, the clusters differed in numerous weight-related behaviors and home environment characteristics. Future research should aim to determine the direction of the associations of work impact with weight-related behaviors and home environments as well as identify potential strategies for overcoming the negative effects of employment on weight-related behaviors and environments and weight status as well as clarify other factors that may affect maternal work impact, such as time management, reasons for employment, and stress.

Association between maternal shift work during pregnancy child overweight and metabolic outcomes in early childhood

Background

Previous studies found that maternal shift work during pregnancy was associated with many reproductive hazards, including small for gestational age, preterm birth, stillbirth, and neurodevelopmental impairment. Some studies also showed that these children are more likely to become overweight in early childhood. However, the association with metabolic factors, such as insulin resistance and dyslipidemia, was less studied. Hence, we aimed to understand better the relationship between maternal shift work during pregnancy and the risk of childhood overweight and metabolic outcomes. Confounding factors were also discussed, including diet, exercise, and demographical factors.

Methods

We enrolled pregnant women before delivery in the Taiwan Birth Panel Study (TBPS) II conducted between 2010 and 2012, and followed the children of these participants in 2018. The objective of this study is to investigate the influence of prenatal and postnatal factors on infant and early childhood health. During the follow-up in 2018, we checked children's demographic data, obtained blood specimens, and checked their blood sugar, blood insulin, and lipid profiles. Structured questionnaires were used to evaluate demographic data. Multiple linear and logistic regressions were used to examine the associations between maternal shift work during pregnancy and child overweight, metabolic disorders, such as HOMA-IR, and lipid profiles.

Results

In this study, we included 407 mother-children pairs with different work shifts (350 day workers and 57 shift workers), and a sub-population without underweight children was also created (290 day workers and 47 shift workers). Shift work during pregnancy was associated with a higher Homeostasis Model Assessment-Insulin Resistance index (HOMA-IR) and a higher odds ratio for overweight in children born from mothers doing shift work during pregnancy after adjustment. The findings were attenuated when we investigated the effect of shift work before pregnancy.

Conclusion

Our study suggested that maternal shift work during pregnancy was associated with child overweight and insulin resistance in early childhood.

Family socioeconomic status and childhood adiposity in Europe - A scoping review

Childhood obesity is a considerable public health problem worldwide. In Europe, lower parental socioeconomic status (SES) relates to higher childhood adiposity. This scoping review strives to discover, which SES indicators are the most commonly used and meaningful determinants of childhood adiposity (greater level of continuous adiposity indicator, e.g. body mass index z-score, or overweight or obesity categorized by established definitions). The review focused on studies about European general populations from the 21st century (January 2000-April 2021) considering children and adolescents aged 0-17 years. PubMed and reference lists of articles were searched in February-April 2021. Total of 53 studies with 121 association analyses between different SES indicators and adiposity indicators, were identified and reviewed. Different SES indicators were grouped to 25 indicators and further to six indicator groups. The most used indicator was mother's education (n of association analyses = 24) and the most used indicator group was parental education (n of association analyses = 51). Of all association analyses, 55% were inverse, 36% were non-significant, and 8% were positive. Composite SES (80%), parental education (69%) and parental occupation (64%) indicators showed most frequently inverse associations with obesity measures (i.e. lower parental SES associating with higher adiposity), while parental income (50% inverse; 50% non-significant) and property and affluence (42% inverse; 50% nonsignificant) indicators showed approximately even number of inverse and non-significant associations. Instead, majority of parental employment (60%) indicators, showed non-significant associations and 33% showed positive associations (i.e. higher parental SES associating with higher adiposity). Despite some variation in percentages, majority of the associations were inverse in each age group and with different outcome categorizations. In girls and in boys, non-significant associations predominated. It seems that children with parents of higher SES have lower likelihood of adiposity in Europe. Parents' employment appears to differ from other SES indicators, so that having an employed parent(s) does not associate with lower likelihood of adiposity. Positive associations seem to occur more frequently in poorer countries. Criteria for uniform childhood SES and adiposity measures should be established and used in studies in order to be able to produce comparable results across countries.

Maternal long working hours and offspring's weight-related outcomes: A systematic review and meta-analysis

It is unclear whether maternal working time has an impact on offspring's weight-related outcomes especially obesity; the objective of this study is to conduct the first meta-analysis to focus on this topic. We searched PubMed, Ovid, and Web of Science databases through August 2021. A random-effect model was used to assess the pooled odds ratios (ORs) and regression coefficients (β) with their corresponding 95% confidence intervals (95% CIs). Subgroup analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Egger's tests. Twenty-two observational studies were included with a total of 191,420 participants. Compared with children whose mothers worked less than 35 h/week, we found that children whose mothers worked more than 35 to 40 h/week had a 2.24-fold increased risk of childhood overweight/obesity (OR = 2.24, 95% CI: 1.61-3.11). An increment of 10 h/week in maternal working was associated with an approximately 1.0 percentage points in the probability of childhood overweight/obesity (β = 0.008, 95% CI: 0.004-0.012). The pooled OR also indicated a similar result (OR = 1.09, 95% CI: 1.04-1.15). In addition, an increment of 10 h/week in maternal working was associated with 0.029 units increase in offspring's BMI z score (β = 0.029, 95% CI: 0.016-0.042). Maternal long working hours is a potential risk factor for offspring's weight-related outcomes. Measures should be taken to protect the work welfare of females, thus facilitating the positive interaction of individual-family-society.

A longer time spent at childcare is associated with lower diet quality among children aged 5-6 years, but not those aged 1.5-2 and 3-4 years: Dietary Observation and Nutrient intake for Good health Research in Japanese young children (DONGuRI) study

OBJECTIVE

To examine the association between the amount of time spent at childcare and diet quality in 668 Japanese children aged 1·5-6 years.

DESIGN

A cross-sectional design was used. Dietary information was collected using dietary records (1 d for children aged 1·5-2 years and 2 d for children aged 3-6 years). Diet quality was assessed by counting the number of nutrients not meeting the Japanese Dietary Reference Intakes (DRI). Each child's guardian reported the average amount of time spent at childcare per d for the previous 1 month.

SETTING

In total, 315 childcare centres located in twenty-four areas in Japan.

PARTICIPANTS

In total, 753 children aged 1·5-6 years who attend childcare facilities.

RESULTS

After adjustment for potential confounders, OR for the low diet quality (≥ 5 of twenty nutrients not meeting DRI) in long (≥10 h/d) v. medium (8-10 h/d) childcare hours was 4·81 (95 % CI 1·96, 11·8) among children aged 5-6 years. There was no significant association in children aged 1·5-2 and 3-4 years.

CONCLUSION

This study showed that long time spent at childcare was strongly associated with low diet quality among children aged 5-6 years, but not those aged 1·5-2 and 3-4 years. More research is needed to clarify different associations in each age group.

Dietary habits, physical activity, and sedentary behaviour of children of employed mothers: A systematic review

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Dietary pattern is poorer among children of employed mothers.

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Children of employed mothers are more physically active.

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Children of employed mothers experience greater prevalence of sedentary activity.

Since approximately 40% of the global workforce are women, a comprehensive understanding of association of maternal employment with child dietary patterns, physical activity and sedentary behaviour needs more focus. This systematic review aims to identify the association between maternal employment and dietary patterns (DP), physical activity (PA) and sedentary behaviour (SB) of children and adolescents (6 to 18 years). Searches were performed using electronic databases and manual searches. Peer reviewed journal articles, conference papers, theses at masters/doctoral levels in English were included. A total 42 studies met selection criteria, which indicated associations between maternal employment and at least one of the domains of interest: DP, PA and/or SB. Using individual samples of analysis, it was found that, 9 samples of DP, 11 samples of PA and 12 samples of SB were positively correlated with maternal employment, whereas 25 samples of DP, 5 samples of PA and 5 samples of SB showed an opposite association. Results suggest that PA and SB were positively related with maternal employment, whereas DP had an inverse relationship. Findings from this review provide evidence that children of employed mothers had poorer DP and greater prevalence of SB, however, their children are more physically active. Future interventions need to create a positive environment at the workplace and for families to support employed mothers and improve children’s dietary patterns and decrease sedentary behaviours. Future studies should prioritise the domains of DP, PA and SB that have been studied inadequately and have inconsistent results.

Traditional Societal Practices Can Avert Poor Dietary Habits and Reduce Obesity Risk in Preschool Children of Mothers with Low Socioeconomic Status and Unemployment

Healthy nutritional habits are of vital importance for good health and quality of life for all individuals in all life stages. Nutritional habits shaped in early childhood set the foundation for future dietary practices applied through lifespan, hence informing risk towards chronic diseases. A key contributor to child health is maternal impact. A healthy childhood status translates into increased lifespan, health, and life-quality, as well as better family and social interactions and improved academic performance. These conditions can contribute to a healthier and more vibrant workforce, and thus extend positive impact on the economic and overall development of a country. Evidence related to maternal impact on childhood dietary habits is limited in Turkey, an emerging economy with notable disparities and a significant segment (approximately one third) of its 83 million population under the age of 30. Hence, the aim of this study was to investigate the relationship between the socioeconomic status (SES) of mothers on the dietary habits of their preschool children. A pilot cross-sectional observational study was conducted involving the mothers of 109 preschool children aged 4-6 years. Data on the nutritional status of children were collected through a food frequency questionnaire and a 24-h recall interview, while sociodemographic information was also collected, and statistical analyses conducted. An unexpected finding regarding the lack of association between the socioeconomic and employment status of mothers and the nutritional intakes of their children was observed. Interestingly, it appears that more traditional societal and nutritional practices typically undertaken in the case of lower SES, especially in more traditional settings like the case of Turkey, appear to extend a protective effect as per the nutritional habits and ensuing obesity risk in the case of children of women with lower SES. Another way to interpret our finding is that the difference in education and SES is not adequate to produce a significant effect in terms of children dietary intake. This is an interesting finding that warrants further study. Additionally, such studies serve to increase awareness about the importance of healthy nutritional practices in preschool children and the critical role of the mother on their nutritional status, particularly in the Turkish idiosyncratic setting.

Relationships between social spending and childhood obesity in OECD countries: an ecological study

OBJECTIVES

The burden of childhood obesity is clustered among children in low-socioeconomic groups. Social spending on children-public welfare expenditure on families and education-may curb childhood obesity by reducing socioeconomic disadvantages. The objective of this study was to examine the relationship between social spending on children and childhood obesity across the Organisation for Economic Cooperation and Development (OECD) countries.

DESIGN

Ecological study.

SETTING

Data on social spending on children were obtained from the OECD Social Expenditure Database and the OECD educational finance indicators dataset during 2000-2015. Data on childhood obesity were obtained from the NCD Risk Factor Collaboration database.

PARTICIPANTS

Aggregated statistics on obesity among children aged 5-19 years, estimated for OECD 35 countries based on the measured height and weight on 31.5 million children.

OUTCOME MEASURES

Country-level prevalence of obesity among children aged 5-19 years.

RESULTS

In cross-sectional analyses in 2015, social spending on children was inversely associated with the prevalence of childhood obesity after adjusting for potential confounders (the gross domestic product per capita, unemployment rate, poverty rate, percentage of children aged <20 years and prevalence of childhood obesity in 2000). In addition, when we focused on changes from 2000 to 2015, an average annual increase of US$100 in social spending per child was associated with a decrease in childhood obesity by 0.6 percentage points for girls (p=0.007) and 0.7 percentage points for boys (p=0.04) between 2000 and 2015, after adjusting for the potential confounders. The dimensions of social spending that contributed to these associations between the changes in social spending on children and childhood obesity were early childhood education and care (ECEC) and school education for girls and ECEC for boys.

CONCLUSION

Countries that increase social spending on children tend to experience smaller increases in childhood obesity.

Prediction model study of overweight and obesity in preschool children with allergic diseases from an ecological perspective

Background

Allergic diseases have a high incidence in childhood and a high chance to be carried over into adulthood unless appropriately treated during childhood, it is important that healthcare providers actively manage these diseases. This study was to identify multidimensional factors that affect weight gain in preschool children with allergic diseases.

Methods

The overweight and obesity prediction model for children with allergic diseases was analyzed using multiple logistic regression analysis and a decision tree model and the present study was a secondary data analysis study that used data from the Panel Study on Korean Children conducted by the Korea Institute of Child Care and Education.

Results

The significance of this study is identify multidimensional factors that affect weight gain in preschool children with allergic diseases, which found that children (gender, sitting time during weekdays, sleeping hours during weekends,), parent (education level, mother’s job, quality of the home environment), local community (convenience of local community facilities, satisfaction level with local community facilities, quality of childcare in the local community) characteristics affected overweight and obesity at multidimensional levels as risk factors.

Conclusions

The significance of this study is identify multidimensional factors that affect weight gain in preschool children with allergic diseases using the data of the Panel Study on Korean Children, which found that children, parent, local community characteristics affected overweight and obesity at multidimensional levels as risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02515-4.

Predicting the risk of childhood overweight and obesity at 4-5 years using population-level pregnancy and early-life healthcare data

BACKGROUND

Nearly a third of children in the UK are overweight, with the prevalence in the most deprived areas more than twice that in the least deprived. The aim was to develop a risk identification model for childhood overweight/obesity applied during pregnancy and early life using routinely collected population-level healthcare data.

METHODS

A population-based anonymised linked cohort of maternal antenatal records (January 2003 to September 2013) and birth/early-life data for their children with linked body mass index (BMI) measurements at 4-5 years (n = 29,060 children) in Hampshire, UK was used. Childhood age- and sex-adjusted BMI at 4-5 years, measured between September 2007 and November 2018, using a clinical cut-off of ≥ 91st centile for overweight/obesity. Logistic regression models together with multivariable fractional polynomials were used to select model predictors and to identify transformations of continuous predictors that best predict the outcome.

RESULTS

Fifteen percent of children had a BMI ≥ 91st centile. Models were developed in stages, incorporating data collected at first antenatal booking appointment, later pregnancy/birth, and early-life predictors (1 and 2 years). The area under the curve (AUC) was lowest (0.64) for the model only incorporating maternal predictors from early pregnancy and highest for the model incorporating all factors up to weight at 2 years for predicting outcome at 4-5 years (0.83). The models were well calibrated. The prediction models identify 21% (at booking) to 24% (at ~ 2 years) of children as being at high risk of overweight or obese by the age of 4-5 years (as defined by a ≥ 20% risk score). Early pregnancy predictors included maternal BMI, smoking status, maternal age, and ethnicity. Early-life predictors included birthweight, baby's sex, and weight at 1 or 2 years of age.

CONCLUSIONS

Although predictive ability was lower for the early pregnancy models, maternal predictors remained consistent across the models; thus, high-risk groups could be identified at an early stage with more precise estimation as the child grows. A tool based on these models can be used to quantify clustering of risk for childhood obesity as early as the first trimester of pregnancy, and can strengthen the long-term preventive element of antenatal and early years care.

Factors associated with overweight status, obesity, and sedentary behavior in elementary and junior high school students

BACKGROUND

Sedentary behavior increases the risks of obesity and cardiovascular disease in adults, but these relationships are uncertain in elementary and junior high school students. We investigated whether sedentary behavior is related to overweight status and obesity in high-risk children with lifestyle diseases.

METHOD

A cross-sectional study was performed in 115 children and primary caregivers who attended a lecture for preventing child lifestyle diseases in Ibaraki prefecture, Japan. The main outcome measure was excess weight (percent overweight). Factors associated with excess weight in children were evaluated using multiple regression analysis. Basic physical and demographic characteristics, biochemical data (total cholesterol [TC], low and high density lipoprotein cholesterol [LDL-C and HDL-C], alanine aminotransferase [ALT]), blood pressure, child and parental sedentary time, parental BMI, and family environment were evaluated.

RESULTS

In total, 107 children were eligible for participation in the study. Excess weight in these children was 28.6 ± 18.4. Sedentary time was 337.2 ± 122.5 min/day in children and 347.0 ± 196.2 min/day in parents. Multiple regression analysis revealed that children's sedentary behavior (β = 0.02, (95%CI: 0.00 to 0.04)) and HDL-C (β = -0.59, (95%CI: -0.81 to -0.38)) as independent predictors of children's excess weight.

CONCLUSION

Study findings suggest that decreasing children's sedentary behavior in addition to greater physical activity is important for the prevention of overweight status and obesity in high-risk children with lifestyle diseases. Reduction of sedentary time, and engaging in regular exercise are all important for proper weight maintenance in children.

Maternal employment and childcare during infancy and childhood overweight

OBJECTIVE

This paper examines the joint impact of maternal employment and childcare during infancy on childhood weight at ages three and five in the context of weak social support for early childhood care and education.

METHOD

Using three waves of longitudinal data from the Growing-Up in Ireland survey (n = 8,393 age three, n = 8,039 age five), propensity score matching is used to address the endogeneity of employment and childcare decisions. Selection on observables is used to assess potential bias arising from selection on unobservables whereby unobserved characteristics of the mother or child may jointly influence child weight and maternal employment and childcare.

RESULTS

Full-time maternal employment at nine months combined with either formal or informal childcare increases the likelihood of being overweight at three years by 8.1% and 5.9% respectively, but only for children of highly educated mothers. Similar results are observed for part-time employment coupled with informal (7.5%) or parental (8.0%) care. The results for mothers with lower levels of education are either not significant or favourable. While the majority of the effects dissipate by age five, there is some evidence that full-time maternal employment coupled with informal care increases the risk of being overweight at both ages three and five for children of higher-educated mothers. An assessment of selection bias finds that the estimates of full-time employment combined with formal childcare by well-educated mothers are a lower bound, such that the true effect on child weight may be understated.

CONCLUSIONS

The findings for Ireland are consistent with studies from the United States and the United Kingdom, and are in contrast to findings from the rest of Europe, suggesting the role of institutional factors, such as the lack of subsidised, universal, high-quality childcare.

Double burden of maternal and child malnutrition and socioeconomic status in urban Sri Lanka

Child malnutrition and maternal obesity are serious public health issues in Sri Lanka. This study explores the associations between socioeconomic status and the double burden of malnutrition among school-aged children and within their household. A total of 543 primary school children aged 5–10 years (204 boys and 339 girls) in Gampaha District, Sri Lanka, were included in the analysis. The nutritional statuses of thinness, normal, overweight, and obesity for children and mothers were defined according to WHO growth references and body mass index. Maternal education, household equivalent income, and maternal employment were used as socioeconomic status indicators. The proportion of child thinness and overweight was 19.3% and 13.4%, respectively, and that of maternal overweight (body mass index ≥ 25 kg/m²) was 36.5%. A positive correlation was found between maternal body mass index and the child’s body mass index for age z-score in older boys and younger girls. A multivariate stepwise logistic regression analysis showed that lower education of mothers posed a higher association with child thinness (adjusted odds ratio = 2.33, 95% confidence interval: 1.08–5.00). Mothers with overweight and obesity were less likely to have a child with thinness (adjusted odds ratio = 0.30, 95% confidence interval: 0.16–0.58). Maternal employment status and household equivalent income were not significantly, but marginally, associated with child overweight and obesity. Socioeconomic inequality combined with maternal nutritional status affected child malnutrition. These findings suggest that the underlying circumstances within households should be considered to improve child malnutrition.

Prevalence of overweight and obesity among African primary school learners: a systematic review and meta-analysis

INTRODUCTION

The increasing trend in the global prevalence of childhood overweight and obesity presents a major public health challenge. This study reports the results of a systematic review and meta-analysis to estimate the prevalence of overweight and obesity among primary school learners residing in Africa according to the different body mass index criteria and population level characteristics.

METHODS

A search of multiple databases was conducted to identify relevant research articles published between January 1980 and February 2017. Random effects models were used to pool prevalence data within and across population level characteristics after variance stabilization through arcsine transformation (PROSPERO registration number CRD42016035248).

RESULTS

Data from 45 studies across 15 African countries, and comprising 92,379 and 89,468 participants for overweight and obesity estimates were included. Estimated overweight and obesity prevalence differed significantly across criteria: 10.5% [95% confidence interval, CI: 7.1-14.3] and 6.1% [3.4-9.7] by World Health Organization; 9.5% [6.5-13.0] and 4.0% [2.5-5.9] by International Obesity Task Force; and 11.5% [9.6-13.4] and 6.9% [5.0-9.0] by Centre for Diseases Control, respectively (p = 0.0027 for overweight; p < 0.0001 for obesity). Estimates were mostly higher in urban, and private schools, but generally similar by gender, major geographic regions, publication year and sample size. Substantial heterogeneity in the estimates across and within criteria were not always explained by major study characteristics.

CONCLUSION

Overweight and obesity are prevalent among African primary school learners, particularly those attending urban, and private schools. The results from this meta-analysis could be helpful in making informed decisions on childhood obesity prevention efforts in African countries.

When richer doesn't mean thinner: Ethnicity, socioeconomic position, and the risk of child obesity in the United Kingdom

BACKGROUND

A range of studies report a robust association between family socioeconomic position and the prevalence of child overweight/obesity. On average, children from poorer backgrounds are more likely to be overweight/obese than children from more advantaged families. However, a small number of US studies have shown that, for ethnic minority children, the association is either nonexistent or reversed.

OBJECTIVE

We test if the link between socioeconomic position and child overweight/obesity at age 7 is heterogeneous in the United Kingdom where rates of obesity are particularly high for some groups of ethnic minority children.

METHODS

We use nationally representative data from the UK Millennium Cohort Study as well as descriptive analyses and logistic regression models.

RESULTS

Poorer White children are at higher risk of overweight/obesity than higher income White children. However, socioeconomic disparities are reversed for Black African/Caribbean children and nonexistent for children of Indian and Pakistani/Bangladeshi origin. Moreover, the health behaviours that explain socioeconomic disparities in child overweight/obesity for the White group appear to be irrelevant in explaining differences by socioeconomic position for the Black Caribbean and African groups.

CONCLUSIONS

We should be careful in assuming that higher socioeconomic position is protective against child overweight/obesity for all groups of the population.

CONTRIBUTION

This study shows for the first time important variation by ethnicity in the link between socioeconomic position and child overweight/obesity - and in the underlying mechanisms linking them - in the United Kingdom.

Developmental trajectories of body mass index from childhood into late adolescence and subsequent late adolescence-young adulthood cardiometabolic risk markers

Background

Reports on body mass index (BMI) trajectories from childhood into late adolescence, their determinants, and subsequent cardiometabolic risk markers, particularly among European populations have been few. Moreover, sex-specific investigation is necessary considering the sex difference in BMI, and the sex-specific association between BMI and some cardiometabolic risk markers.

Methods

Using a sample from the DOrtmund Nutritional and Anthropometric Longitudinally Designed study, we explored sex-specific trajectories of the BMI standard deviation score (SDS) from 4 to 18 years of age in 354 males and 335 females by latent (class) growth models. The determinants of trajectory were assessed by logistic regression. We identified cardiometabolic risk markers that were highly associated with BMI SDS trajectory by random forest regression, and finally we used generalized linear models to investigate differences in the identified cardiometabolic risk markers between pairs of trajectories.

Results

We observed four: ‘low-normal weight’, ‘mid-normal weight’, ‘high-normal weight’, and ‘overweight’, and three: ‘‘low-normal weight’, ‘mid-normal weight’, and ‘high-normal weight’ trajectories in males and females, respectively. Higher maternal prepregnancy BMI was associated with the ‘overweight’ trajectory, and with ‘high-normal weight’ trajectory in both sexes. In addition, employed mothers and first-born status were associated with ‘high-normal weight’ trajectory in females. BMI SDS trajectory was associated with high-density lipoprotein-cholesterol and interleukin-18 (IL-18) in males, and diastolic blood pressure and interleukin-6 (IL-6) in females. However, only males following the ‘overweight’ trajectory had significantly higher IL-18 when compared to their ‘low-normal weight’ counterpart.

Conclusions

We identified sex-specific distinct trajectories of BMI SDS from childhood into late adolescence, higher maternal prepregnancy BMI as a common determinant of the ‘high-normal weight’ and ‘overweight’ trajectories, and ‘overweight’ trajectory being associated with elevated IL-18 in late adolescence–young adulthood. This study emphasizes the role of maternal prepregnancy BMI in overweight, and highlights IL-18 as a cardiometabolic signature of overweight across life.

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0813-5) contains supplementary material, which is available to authorized users.

INSIGHT Study Maternal Return to Work and Infant Weight Outcomes

OBJECTIVE

Maternal return to work within 12 weeks of delivery is associated with poor child health and development. However, little is known about the impact of return to work on the risk of child obesity. We examined whether timing of maternal return to work is associated with rapid infant weight gain from 0 to 6 months and weight-for-length at 1 year.

METHODS

Secondary data analysis of 279 mother-newborn dyads from the Intervention Nurses Start Infants Growing on Healthy Trajectories Study, a randomized controlled trial evaluating a responsive parenting (RP) intervention. Rapid infant weight gain from 0 to 6 months was assessed using conditional weight gain (CWG) scores. Infant weight-for-length was calculated using World Health Organization reference values. Analysis of variance (ANOVA) examined whether infant weight outcomes differed by timing of maternal return to work (≤12 weeks vs >12 weeks after delivery). Moderation by study group (RP intervention vs safety control) and mediation by breastmilk feeding were examined in ANOVA models.

RESULTS

Among 261 mothers, approximately one half (n = 130) returned to work within 12 weeks. Compared with infants of mothers who returned to work after 12 weeks, infants of mothers who returned to work within 12 weeks had greater CWG scores from 0 to 6 months (P = .006) and were heavier at 1 year (P = .05). These associations were not moderated by study group or mediated by breastmilk feeding.

CONCLUSIONS

Maternal return to work within 12 weeks was associated with rapid infant weight gain in the first 6 months and greater weight-for-length at 1 year, although the mechanisms to explain our findings are unclear.

The impact of maternal employment on children's weight: Evidence from the UK

Previous research shows that maternal employment is associated with higher children’s body mass index (BMI). Using a large UK longitudinal birth cohort study of almost 20,000 children, we examine the effect of maternal employment during childhood (to age 14) on children’s weight. We address the endogeneity of maternal employment by estimating household fixed effects models. We find that maternal employment has a positive effect on children’s BMI and therefore on excess weight, and this is particularly the case for single mothers. We investigate potential pathways, including children’s sedentary behavior and healthy eating behaviors, and find evidence of more sedentary behavior and poorer eating habits amongst children whose mothers are in employment. This is consistent with higher BMI levels amongst these children.

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First paper providing causal evidence on the effect of maternal employment on children’s weight in a UK context, for a large contemporaneous cohort of children through childhood and early adolescence, one that has grown up in the midst of the childhood ‘obesity epidemic’.

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Maternal employment has a positive effect on children’s BMI and therefore on excess weight, and this is particularly the case for single mothers.

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Consistent with higher levels of excess weight, children of working mothers are more likely to be sedentary and less likely to eat breakfast regularly.

Barriers to a healthy lifestyle for three- to four-year-old children of Australian-born and overseas-born mothers with post-gestational diabetes: An Australian qualitative study

Children of mothers affected by gestational diabetes mellitus (GDM) are at higher risk of long-term cardio-metabolic diseases. We explore the diet and physical activity knowledge and practices of Australian-born and overseas-born mothers with GDM history, for their three- to four-year-old children following antenatal health promotion education at a tertiary hospital. We conducted face-to-face, semi-structured interviews with 8 Australian-born and 15 overseas-born mothers with a history of GDM. Findings indicated that mothers of both groups were unaware of the increased health risks of their GDM for their children and could not recall receiving specific dietary or physical activity advice aimed at future child health. Their understanding of the diet and physical activity recommendations was inconsistent. Mothers of both groups expressed concern about the lack of reiteration of child health promotion messages following childbirth, particularly at postnatal follow-up visits. Diet and physical activity of the children of overseas-born mothers were adversely affected by inadequate maternal understanding of the recommendations due to language barriers, and child weight, healthy eating, and physical activity patterns derived from their home countries. We recommend enhanced health education for women with GDM on the future child health risks and their reduction by healthy lifestyle choices. This needs to be culturally relevant and reiterated after pregnancy.

Childcare Environment and Japanese Children Who Are Overweight in Early Childhood

BACKGROUND

Maternal employment may affect child care styles and contribute to the increasing prevalence of overweight children. We explored the potential risk factors for becoming overweight during early childhood, especially in the child care environment.

METHODS

We conducted a retrospective cohort study using data from health check-up services from 2007 to 2015 in Kobe, Japan. The main outcome was being overweight at age 3 years, which was defined by the International Obesity Task Force cutoffs. Environmental, maternal, and infantile factors were examined as possible risk factors for childhood overweight.

RESULTS

Of 31,463 infants, 1315 (4.2%) were classified as overweight at age 3 years. Compared with children who were cared for by their mothers during the day at 4 and 18 months, the adjusted odds ratio (aOR) for becoming overweight for those who were not cared for by their mothers was 1.52: 95% confidence interval (CI), 1.16-1.99. Long sleep duration was associated with lower risk of childhood overweight: aOR, 0.79; 95% CI, 0.66-0.96.

CONCLUSION

Less daytime care by mothers and shorter sleep duration were associated with increased risk of becoming overweight during childhood. Further studies are needed to determine on how the effect of those factors may be diminished with respect to childhood overweight.

Association Between Maternal Stress, Work Status, Concern About Child Weight, and Restrictive Feeding Practices in Preschool Children

Objectives To examine the relationship between maternal stress, work status, concern about child weight, and the use of restrictive feeding practices among mothers of preschool children. Methods 285 mothers of 2-to-5-year-old children completed an on-line survey. Questions included demographics, items from the Depression Anxiety Stress Scale, and the Child Feeding Questionnaire. Linear regression and ANOVA examined the relationship between maternal stress, work hours, concern about child weight, and the use of restrictive practices for one 2-to-5-year-old child living within the home. Results Mothers were 32.6 ± 5.2 years of age and spent 39.7 ± 12.0 h/week at work. Seventy-one percent worked full time. Children were 3.4 ± 1.0 years of age and 51% male. Stress (3.41 ± 0.77, p ≤ 0.001) and concern about child weight (3.41 ± 0.77, p ≤ 0.00) were associated with the use of restrictive feeding practices. Mothers with severe/extremely severe stress used restriction more than mothers with normal stress, respectively (3.63 ± 0.80, 3.30 ± 0.81, p = 0.03). No difference was found among mothers with mild/moderate stress (3.50 ± 0.63, p = 0.06). There was no association between work hours (p = 0.50) or work status (p = 0.91) and the use of restrictive feeding practices. Conclusions Maternal stress and concern about child weight were associated with the use of restrictive feeding practices. Considering the current rates of childhood obesity in the United States, understanding factors that influence a child's food environment is advantageous and can help improve maternal and child health.

Parental work characteristics and diet quality among pre-school children in dual-parent households: results from a population-based cohort in Taiwan

Objective

To examine the relationship between parental work characteristics and diet quality among pre-school children in dual-parent households.

Design

Cross-sectional study. Parental work characteristics were measured by the types of combined parental work schedules and work hours. The main outcome variables included meal eating habits as well as ‘health-conscious food’ and ‘unhealthy non-core food’ dietary patterns derived by using principal component analysis. Sociodemographic covariates were considered to reduce confounding and selection biases.

Setting

The Taiwan Birth Cohort Study, Taiwan.

Subjects

A population-based sample of 18 046 children.

Results

Multiple regression analyses indicated that compared with having both parents working standard schedules, having at least one parent who worked non-standard schedules was significantly associated with a lower likelihood of a child eating breakfast every day and a higher consumption of unhealthy non-core foods. If only one parent was employed and worked standard schedules, the children demonstrated greater odds of having home-prepared dinner most of the time. The mother’s working long hours was associated with lower odds of eating breakfast every day, more frequent consumption of unhealthy non-core foods and a lower frequency of healthy food consumption.

Conclusions

The findings raise concern that parents’ non-standard work schedules and mother’s long working hours have negative effects on diet quality of pre-school children. Policy implications include the need for a multifaceted approach to supporting working parents so as to create healthier food environments.

A systematic review of grandparents' influence on grandchildren's cancer risk factors

Many lifestyle patterns are established when children are young. Research has focused on the potential role of parents as a risk factor for non communicable disease in children, but there is limited investigation of the role of other caregivers, such as grandparents. The aim of this review was to identify and synthesise evidence for any influence grandparents' care practices may have on their grandchildren's long term cancer risk factors. A systematic review was carried out with searches across four databases (MEDLINE, Embase, Web of Science, PsycINFO) as well as searches of reference lists and citing articles, and Google Scholar. Search terms were based on six areas of risk that family care could potentially influence-weight, diet, physical activity, tobacco, alcohol and sun exposure. All study designs were included, as were studies that provided an indication of the interaction of grandparents with their grandchildren. Studies were excluded if grandparents were primary caregivers and if children had serious health conditions. Study quality was assessed using National Institute for Health and Care Excellence checklists. Grandparent impact was categorised as beneficial, adverse, mixed or as having no impact. Due to study heterogeneity a meta-analysis was not possible. Qualitative studies underwent a thematic synthesis of their results. Results from all included studies indicated that there was a sufficient evidence base for weight, diet, physical activity and tobacco studies to draw conclusions about grandparents' influence. One study examined alcohol and no studies examined sun exposure. Evidence indicated that, overall, grandparents had an adverse impact on their grandchildren's cancer risk factors. The theoretical work in the included studies was limited. Theoretically underpinned interventions designed to reduce these risk factors must consider grandparents' role, as well as parents', and be evaluated robustly to inform the evidence base further.

Maternal Characteristics and Incidence of Overweight/Obesity in Children: A 13-Year Follow-up Study in an Eastern Mediterranean Population

Objectives To investigate clustering of parental sociobehavioral factors and their relationship with the incidence of overweight and obesity in Iranian children. Methods Demographics, body weight, and certain medical characteristics of the parents of 2999 children were used to categorize parents by cluster; children's weights were assessed for each cluster. Specifically, survival analysis and Cox regression models were used to test the effect of parental clustering on the incidence of childhood overweight and obesity. Results Maternal metabolic syndrome, education level, age, body weight status, and paternal age had important roles in distinguishing clusters with low, moderate, and high risk. Crude incidence rates (per 10,000 person-years) of overweight and obesity were 416.8 (95% confidence interval (CI) 388.2-447.5) and 114.7 (95% CI 101.2-129.9), respectively. Children of parents with certain constellations of demographic and medical characteristics were 37.0 and 41.0% more likely to become overweight and obese, respectively. Conclusions for Practice The current study demonstrated the vital role of maternal characteristics in distinguishing familial clusters, which could be used to predict the incidence of overweight and obesity in children.

A developmental perspective on the link between parents' employment and children's obesity

Despite public concerns about the negative implications of the increased labor force participation of mothers for child development, decades of research have revealed few risks and some benefits. One potential risk-a consistently observed association between maternal employment and childhood obesity-offers a window into how some dimensions of family health may be undermined by work in an economic and policy context that is not family friendly. The purpose of this article is to identify ways that a developmental perspective can enrich the literature on how children's weight may be related to the work experiences of both mothers and fathers across diverse populations, a literature that heretofore has been dominated by economic and demographic perspectives, focused almost solely on women, and largely ignored racial/ethnic variation. After reviewing the extant literature, we put forward a conceptual model that uses ecological and developmental insights to identify the mechanisms by which parents' employment might matter to children's weight and discuss this model in the context of the contemporary landscape of family policy. (PsycINFO Database Record

A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research

RESEARCH QUESTIONS

What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children?

OBJECTIVES

Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children.

METHODS

The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed.

RESULTS

Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health).

CONCLUSIONS

Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.

Child physical development in the UK: the imprint of time and socioeconomic status

OBJECTIVES

Social health inequalities remain a key policy challenge. The existing literature has not presented a synthetic view on the evolution of inequalities in physical development across childhood. We examine social disparities as children grow older using a range of different outcomes.

STUDY DESIGN

Population-based secondary data analysis.

METHODS

We employ longitudinal data on British children aged 9 months to 12 years from the Millennium Cohort Study (n = 13,811-18,987) and focus on multiple child physical measures: weight, body mass index (BMI), overweight, fat mass and waist circumference.

RESULTS

Higher family income is associated with lower BMI (for females), less body fat and a smaller likelihood of overweight (for both genders) on average throughout childhood. When income is multiplied by 3, the probability of overweight decreases by 2.8 (95% CI -0.041 to -0.016) percentage points for females and by 2.7 (95% CI -0.038 to -0.016) percentage points for males. Social inequalities in weight, BMI, overweight and body fat significantly widen as children grow older, for both genders. For instance, for females, when income is multiplied by 3, the probability of overweight decreases by 1.6 (95% CI -0.032 to -0.000) percentage points at ages 2-3 years, but by 8.6 (95% CI -0.112 to -0.060) percentage points at ages 10-12 years.

CONCLUSIONS

The trajectory of social inequalities, which may reflect the cumulative effect of family socioeconomic status, is a precursor of inequalities in adulthood.

Clustering patterns of obesity-related multiple lifestyle behaviours and their associations with overweight and family environments: a cross-sectional study in Japanese preschool children

OBJECTIVES

The purpose of this study is (1) to identify obesity-related lifestyle behaviour patterns of diet, physical activity, sedentary and sleep behaviours in preschool children, (2) to examine the association between identified behaviour clusters and overweight/obesity and (3) to investigate differences in children's family environments according to clusters.

DESIGN SETTING AND PARTICIPANTS

A cross-sectional study on 2114 preschool children aged 3-6 years who attended childcare facilities (24 nursery schools and 10 kindergartens) in Tsuruoka city, Japan in April 2003 was conducted.

MAIN OUTCOME MEASURES

Children's principal caregivers completed a questionnaire on children's lifestyle behaviours (dinner timing, outside playtime, screen time and night-time sleep duration), family environment (family members, maternal employment, mealtime regularity and parents' habitual exercise and screen time) and measurements of weight and height. Cluster analysis was performed using children's 4 lifestyle behaviours based on those non-missing values (n=1545). The χ² tests and analysis of variance (ANOVA) estimated cluster differences in overweight/obesity and family environments.

RESULTS

6 clusters were identified. Children's overweight/obesity varied across clusters (p=0.007). The cluster with the most screen time, shorter night-time sleep duration, average dinner timing and outside playtime had the highest overweight/obesity prevalence (15.1%), while the cluster with the least screen time, the longest sleep duration, the earliest dinner timing and average outside playtime had the lowest prevalence (4.0%). Family environments regarding mealtime regularity and both parents' screen time also significantly varied across clusters. The cluster having the highest overweight/obesity prevalence had the highest proportion of irregular mealtimes and the most screen time for both parents.

CONCLUSIONS

This study suggests that public health approaches to prevent children's overweight/obesity should focus on decreasing screen time and increasing night-time sleep duration. To shape those behaviours, regular mealtimes and decreasing parents' screen time within family environments need to be targeted among family members.

Influence of Parental and Some Demographic Characteristics on Overweight/Obesity Status among a Sample of Egyptian Children

BACKGROUND

Overweight/obesity is a multi-factorial problem, which results from rapidly changing social, economic, and physical environments that have led to an energy imbalance.

AIM

To identify the association between childhood overweight/obesity and some socio-demographic risk factors, as parental age, body mass index (BMI), education and occupation, family size and residence (urban/rural).

SUBJECTS AND METHODS

Cross-sectional study included 154 children of both sexes; aged 5-18 years; with their parents; one of them was working at the National Research Centre and from their relatives and neighbours. Data was collected about the child birth weight, family size, parental ages, education, occupation and place of residence. Anthropometric measurements including weight, height, and body mass index (BMI) of children and their parents were conducted.

RESULTS

Obesity was detected among 19.5% of children (BMI > 95th percentile), 75.3% of their mothers and 49.6% of their fathers (BMI > 30 Kg/m^2). While overweight was present in 11.0% of the children (BMI > 85th- <95 percentile), 16.9% of their mothers and 36.5% of their fathers (BMI > 25-29.9 Kg/m^2). Child obesity was more prominent in urban than rural areas (21.3% versus 12.5%) and among housewives (22.8%) than among working mothers (16%, p < 0.016). Child overweight was more common in rural than urban areas (12.5% versus 10.7%) and among children with high father education (20%). Child BMI had significant positive correlations only with the child age, parental ages and BMIs, and family size. In spite of that, parental BMIs had significant positive correlations with each other and with family size, and significant negative correlations with maternal education and occupation and paternal education.

CONCLUSION

Childhood obesity and overweight were more prominent in urban than rural areas, among children with non-working housewives mothers and highly educated fathers (college or above). Parental education and occupation had an indirect significant effect on child BMI through their significant effect on parental BMIs.

Parent-related mechanisms underlying the social gradient of childhood overweight and obesity: a systematic review

BACKGROUND

Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts.

OBJECTIVE

A systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects.

METHOD

Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors.

RESULTS

High parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors.

CONCLUSIONS

Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.

Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother-infant pairs from Ireland and the UK

OBJECTIVES

To examine the association between breast feeding outcomes and place of birth (home vs hospital birth).

DESIGN

Population-based cross-sectional study.

SETTING

Ireland and UK.

PARTICIPANTS

10 604 mother-infant pairs from the Growing Up in Ireland study (GUI, 2008-2009) and 17 521 pairs from the UK Millennium Cohort Study (UKMCS, 2001-2002) at low risk of delivery complications were included in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Breast feeding initiation, exclusivity and duration.

RESULTS

Home birth was found to be significantly associated with breast feeding at all examined time points, including at birth, 8 weeks, 6 months and breast feeding exclusively at 6 months. In GUI, adjusted OR was 1.90 (95% CI 1.19 to 3.02), 1.78 (1.18 to 2.69), 1.85 (1.23 to 2.77) and 2.77 (1.78 to 4.33), respectively, and in UKMCS it was 2.49 (1.84 to 3.44), 2.49 (1.92 to 3.26), 2.90 (2.25 to 3.73) and 2.24 (1.14 to 4.03).

CONCLUSIONS

Home birth was strongly associated with improved breast feeding outcomes in low-risk deliveries. While the association between home birth and breast feeding is unlikely to be directly causal, further research is needed to determine which factor(s) drive the observed differences, to facilitate development of perinatal care that supports breast feeding.

Association between Parental Workaholism and Body Mass Index of Offspring: A Prospective Study among Japanese Dual Workers

The purpose of the study was to investigate the association between parental workaholism and child body mass index (BMI) among Japanese dual-income families. In 2011, 379 dual-income families from urban Tokyo with children aged 0-5 years were recruited for a baseline survey, and 160 (42.2%) were followed up in 2012. Demographics, workaholism, work demands, work control, time spent with children, and parental and child weights and heights were assessed using a questionnaire. Structural equation modeling was performed to determine the association between maternal and paternal workaholism in 2011 and child BMI in 2012, considering the mediating effects of time spent with children. Paternal workaholism showed a direct significant positive association with child BMI after 1 year (standardized coefficient: 0.19; p < 0.001), while maternal workaholism was not associated with child BMI. Both maternal and paternal time spent with children did not mediate the association. Paternal work demands showed a strong positive association with workaholism but paternal work control did not. Paternal, but not maternal, workaholism was associated with an increase in child BMI over 1 year. Interventions that target workaholism by reducing paternal work demands might be effective in preventing overweight in offspring.

Energy Balance-Related Behaviors, Perinatal, Sociodemographic, and Parental Risk Factors Associated with Obesity in Italian Preschoolers

OBJECTIVE

The obesity epidemic stems from the complex interplay between genetics and environmental factors. Identifying age-specific risk factors in preschoolers may allow implementing more effective intervention strategies. The aim of the present investigation was to examine the association of overweight/obesity with several perinatal, parental, socioeconomic status (SES), and lifestyle-related risk factors in a large sample of Italian preschoolers.

METHODS

One thousand eleven children (age 2.0 to 5.7 years) were included in the study. Family pediatricians measured weight and height and collected information on obesity risk factors by means of questionnaires. Perinatal risk factors were recalled from electronic medical records. Weight status was defined according to cutoffs of the International Obesity Task Force (IOTF).

RESULTS

Seven hundred sixty-four children (75.6%) were normal weight, and 247 (24.4%) were overweight/obese. Multivariate analysis showed that skipping breakfast (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.32-10.51), daily drinking of sugar-sweetened beverages (OR = 2.0; 95% CI, 1.02-4.03), meat consumption <5 times/week (OR = 2.2; 95% CI, 1.11-4.57), and formula feeding (OR = 2.1; 95% CI, 0.8-4.5) were significantly (p < 0.05) associated with increased risk of obesity.

CONCLUSIONS

Though exclusive formula or mixed feeding represents an age-specific risk factor for overweight/obesity, lifestyle factors associated with increased risk in Italian preschoolers include habits that are common to school-age children, such as skipping breakfast and consumption of sugar-sweetened beverages. The reduced consumption of meat emerged as a risk factor for overweight/obesity, but future research is required to better understand this relationship. Our data suggest, on the whole, that prevention of such unhealthy behaviors must be pursued in preschoolers by means of age-specific interventions.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study

Background: There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013

Background

Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005.

Methods

To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses.

Results

Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship.

Conclusion

The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0443-3) contains supplementary material, which is available to authorized users.

Parental employment during early childhood and overweight at 7-years: findings from the UK Millennium Cohort Study

BACKGROUND

There are increasing numbers of families with both parents (or a lone parent) employed, which may impact on the ability of families to support healthy lifestyles for their children. Some studies have linked maternal, but not paternal, employment with childhood overweight, although most have been cross-sectional or reported over short periods. We investigated the relationship between parental employment since infancy and overweight in children at 7-years. We differentiated employment by intensity (hours worked), and examined mutually adjusted associations of cumulative maternal and paternal employment with childhood overweight.

METHODS

Data on parental employment at 9 months, 3, 5 and 7-years were used to create cumulative measures of maternal, paternal and family employment in the UK Millennium Cohort Study (MCS). Risk ratios (RR) and 95 % confidence intervals (CI) for childhood overweight (including obesity) at age 7 were estimated according to employment, before and after adjustment for potential confounders.

RESULTS

Compared to continuous non-employment within the family since infancy, any employment of a parent was associated with lower risks of child overweight (e.g. one survey sweep in employment, adjusted RR: 0.71 [0.56-0.90]). Prolonged maternal full-time employment, however, was associated with elevated risks (four sweeps in full-time employment versus never, adjusted RR: 1.46 [1.20-1.78]). There was no equivalent association with paternal full-time employment. When limited to couple families, and adjusting for cumulative full-time employment of both parents and confounders, the risk of overweight at 7-years associated with continuous maternal full-time employment was not attenuated (adjusted RR: 1.71 [1.38-2.11]), and the association with paternal employment remained non-significant.

CONCLUSIONS

Children living in workless households or where two parents are full-time employed have increased risks of overweight. These findings may imply the need for changes to enable parents to maintain healthy lifestyles for their children in the face of wider obesogenic influences.

Investigating within-day and longitudinal effects of maternal stress on children's physical activity, dietary intake, and body composition: Protocol for the MATCH study

Parental stress is an understudied factor that may compromise parenting practices related to children's dietary intake, physical activity, and obesity. However, studies examining these associations have been subject to methodological limitations, including cross-sectional designs, retrospective measures, a lack of stress biomarkers, and the tendency to overlook momentary etiologic processes occurring within each day. This paper describes the recruitment, data collection, and data analytic protocols for the MATCH (Mothers And Their Children's Health) study, a longitudinal investigation using novel real-time data capture strategies to examine within-day associations of maternal stress with children's physical activity and dietary intake, and how these effects contribute to children's obesity risk. In the MATCH study, 200 mothers and their 8 to 12 year-old children are participating in 6 semi-annual assessment waves across 3 years. At each wave, measures for mother-child dyads include: (a) real-time Ecological Momentary Assessment (EMA) of self-reported daily psychosocial stressors (e.g., work at a job, family demands), feeling stressed, perceived stress, parenting practices, dietary intake, and physical activity with time and location stamps; (b) diurnal salivary cortisol patterns, accelerometer-monitored physical activity, and 24-hour dietary recalls; (c) retrospective questionnaires of sociodemographic, cultural, family, and neighborhood covariates; and (d) height, weight, and waist circumference. Putative within-day and longitudinal effects of maternal stress on children's dietary intake, physical activity, and body composition will be tested through multilevel modeling and latent growth curve models, respectively. The results will inform interventions that help mothers reduce the negative effects of stress on weight-related parenting practices and children's obesity risk.

Socio-economic position as an intervention against overweight and obesity in children: a systematic review and meta-analysis

Studies that investigated the association between socio-economic position (SEP) and obesity in children suggest inconsistent results. The aim of this study is to summarize and quantify the current evidence on SEP and risks of overweight and obesity in children aged 0–15 years. Relevant studies published between 1990 to Sep 4, 2014 were searched in Medline, Web of Science, Embase, and the Cochrane Database of Systematic Reviews. Risk estimates from individual studies were pooled using random-effects models, according to lowest vs the highest SEP category. A total of 62 articles were included in the meta-analysis. The odds of both overweight risk and obesity risk were higher in the children with lowest SEP than in those with highest SEP (OR, 1.10, 95% CI: 1.03–1.17, and OR, 1.41, 95% CI: 1.29–1.55, respectively). Sub-group analyses showed that the inverse relationships between SEP and childhood overweight and obesity were only found in high-income countries and in more economic developed areas. In conclusion, our study suggests that children with lower SEP had higher risks of overweight and obesity, and the increased risks were independent of the income levels of countries.

Factors Associated with Low Birth Weight of Children Among Employed Mothers in Pakistan

Evidence shows that Pakistan has an increasing rate of children with low birth weight (LBW). Employed mothers in paid work (EMPW) in the country have predominantly been disadvantaged in terms of access to education and low-income employment; with negative consequences on maternal and child health. The objective of this study was to determine socio-demographic characteristics of EMPW and identify the association between maternal employment and child birth weight in Pakistan. Secondary data from the Pakistan Demographic Health Survey (PDHS) conducted for the year 2006-2007 was used. PDHS is a nationally representative household survey. Relevant data needed from the PDHS data file were coded and filtered. The sample size of EMPW with at least one child born in the last 5 years was 2,515. Data was analyzed by using SPSS. Descriptive and inferential statistics were used to see the association between EMPW characteristics and LBW. Findings confirm that the majority of EMPW in Pakistan are illiterate, poor, employed in unskilled work, and belonging to rural regions. Multivariate regression analysis revealed statistical association between EMPW and LBW among mothers who did not receive prenatal care from unskilled healthcare provider (AOR 1.92; 95% CI 1.12-3.30), had lack of access to information such as radio (AOR 1.88; 95% CI 1.28-2.77), during pregnancy did not receive calcium (AOR 1.19; 95% CI 1.05-1.34), and iron (AOR 1.33; 95% CI 1.05-1.69), had experienced headaches during pregnancy (AOR 1.41; 95% CI 1.12-1.76), and were not paid in cash for their work (AOR 1.41; 95% CI 1.04-1.90). EMPW in Pakistan, especially in low-income jobs and rural regions, need urgent support for healthcare awareness, free supplementation of micronutrients and frequent consultation with trained practitioner during the prenatal period. Long-term mobilization of social structure and governance is needed to encourage maternal health awareness, hospital deliveries, and formal sector employment for EMPW.

Risk factors for childhood overweight: a 30-month longitudinal study of 3- to 6-year-old children

OBJECTIVE

The increasing prevalence of childhood overweight is an important health issue. There is a need for longitudinal research among children in order to identify risk factors for childhood overweight. The objective of the present research was to identify potential sociodemographic and behavioural risk factors for development of childhood overweight among 3- to 6-year-old children.

DESIGN

Longitudinal study.

SETTING

Sixteen pre-primary and primary schools.

SUBJECTS

BMI Z-scores at baseline and two follow-up measurements were calculated for 568 children. Sociodemographic, parental adiposity, familial composition, child's diet, physical activity and sedentary behavioural data were collected through questionnaires.

RESULTS

Several risk factors for the development of childhood overweight were found. Being an only child, lower maternal educational level, maternal and paternal overweight, more than 1 h screen time on weekdays and high soft drinks consumption were shown to be positively associated with the development of childhood overweight.

CONCLUSIONS

Although behavioural factors are important, our findings support the thesis that interventions on the prevention of childhood overweight should focus on high-risk groups, i.e. children from low socio-economic background or with high parental BMI. Interventions should address the whole family and take into account their lifestyle and structure.

Psychosocial perspectives and the issue of prevention in childhood obesity

A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

Lifestyle and Dietary Behaviors among Saudi Preschool Children Attending Primary Health Care Centers, Eastern Saudi Arabia

Objective. To study life styles and dietary behaviors among Saudi preschool children (1-5 years) attending primary health care centers (PHCCs) in Dammam and Qatif areas, eastern province, Saudi Arabia. Material and Methods. Cross-sectional study. Data were collected using structured, interviewer-filled questionnaire. Children and their mothers were encountered during their well-baby clinic visits. A total number of 300 preschool children and their mothers were interviewed during study period. Results. Unsatisfactory areas include smoking fathers (32%), smoking in front of children (11.3%), overweight and obesity among mothers (60.3%), noncompliance using seat belts for both parents (56.3%) and children (68%), children watching television (T.V) more than 2 hours (50%), adherence to exclusive breast feeding (only 20.7%), and late solid food introduction (65.3%). Frequent intake of unhealthy food items was 26%, 25%, and 24% for pizza, burger, and soft drinks. Unfortunately frequent intake of the following unhealthy food items was high: biscuits, deserts/chocolates, and chips which was 78%, 67%, and 72%, respectively. Conclusion. This study provides benchmark about the current situation. It provides health care workers and decision makers with important information that may help to improve health services.

Unplanned pregnancy in adolescents: association with family structure, employed mother, and female friends with health-risk habits and behaviors

Previous publications have suggested that living in a nonintact family household and socializing with girlfriends who smoke or who consume alcoholic beverages favor the development of health-risk habits and customs in adolescents. However, their relationship with unplanned pregnancy in adolescents has not been determined. We investigated the association between family structure, employed mother, and female friends with health-risk habits and behaviors with unplanned pregnancy in adolescents (n = 3,130). After adjusting for low maternal educational level and low family income, logistic regression analyses showed that having an employed mother and socializing with girlfriends who have health-risk habits or behaviors, rather than living in a nonintact family household, appear to be the most important health-risk factors for unplanned pregnancy in adolescents. It is important for health-care programs for adolescents to be revised and for their strategies be strengthened in order to reach the objectives for which they were created.

Longitudinal follow-up of the relationship between dietary intake and growth and development in the Lifeways cross-generation cohort study 2001-2013

In this paper we will review evidence on the early life and familial influences on childhood growth and development, with particular reference to the Lifeways cross-generation cohort study in the Republic of Ireland. The Lifeways cross-generation cohort study was established in 2001-2013 through two maternity hospitals in the Republic of Ireland and was one of many new cohort studies established worldwide in the millennium period. Mothers were recruited at first booking visit, completing a self-administered questionnaire, which included a 147 item semi-quantitative FFQ. Longitudinal follow-up is ongoing in 2013, with linkage data to hospital and general practice records and examination of children when aged 5 and 9 years. The study is one of very few containing data on grandparents of both lineages with at least one grandparent recruited at baseline. There have been consistent associations between parental and grandparental health status characteristics and children's outcomes, including infant birth-weight, BMI when child was aged 5 years and childhood wheeze or asthma when child was aged 3 and aged 5 years. In conclusion, empirical evidence to date shows consistent familial and cross-generational patterns, particularly in the maternal line.

School and neighborhood nutrition environment and their association with students' nutrition behaviors and weight status in Seoul, South Korea

PURPOSE

We examined the association between the school and neighborhood nutrition environments and adolescent nutrition behaviors and weight status.

METHODS

We conducted a cross-sectional survey with 1,342 fourth to ninth graders in 15 schools on their food-eating behaviors. Participants were randomly selected from eight predetermined districts in Seoul, South Korea. Height and weight data from the school annual health check-ups were obtained. Dietitians from each school completed questionnaires on the school nutrition environment. Types of food outlets in a 500-meter radius of the schools were recorded. Healthy eating index was created based on 10 questions on students' eating behaviors, such as breakfast skipping, fruit consumption, and ramen noodle consumption (possible score range 0-10). Generalized estimating equation method was used for statistical modeling.

RESULTS

Higher density of supermarkets and traditional markets in the school neighborhoods was associated with a greater likelihood of child obesity after controlling for individual-level covariates (odds ratio = 1.37, 1.21-1.54). The school nutrition environment was not associated with student's healthy eating habits and weight status. Students who were younger, female, from more affluent families, who had less weekly screen time, or had stay-at-home mothers had higher scores on the healthy eating index. There was a gender difference in the associations between environmental factors and students' eating behaviors and obesity status.

CONCLUSIONS

These findings suggest that the relationship between environmental factors and individual factors and weight status may be more complicated than previously reported in other parts of the world.

Parental employment and children's body weight: Mothers, others, and mechanisms

A robust body of literature spanning several countries indicates a positive association between maternal employment and child body mass index (BMI). Fewer studies have examined the role of paternal employment. More importantly, little empirical work examines the mechanisms that might explain the relationships between parental employment and children's BMI. Our paper tests the relationship between the cumulative experience of maternal and spouse employment over a child's lifetime and that child's BMI, overweight, and obesity at age 13 or 14. We further examine several mechanisms that may explain these associations. We use data from the U.S. National Longitudinal Survey of Youth (NLSY79) merged mother-child file on cohorts of children who were born during a period of dramatic increase in both childhood obesity and maternal employment. We find that the number of hours that highly-educated mothers work over her child's lifetime is positively and statistically significantly associated with her child's BMI and risk of overweight at ages 13 or 14. The work hours of mothers' spouses and partners, on the other hand, are not significantly associated with these outcomes. Results suggest that, for children of highly-educated mothers, the association between maternal work hours and child BMI is partially mediated by television viewing time.

Trends of childhood obesity in China and associated factors

Childhood obesity is worsening at dramatic rates and has become a public health crisis. This study investigated these trends in childhood obesity and examined parental factors that may contribute to overweight and obesity. Body mass index (BMI) was calculated from height and weight measurements taken annually from 2004 to 2007 in a subsample of 136 children (2-4 years old), from the Jintan Child Health Project in China. Parental factors were assessed through a self-administered questionnaire. Prevalence rates of overweight and obesity rose from 6.6% and 2.2% in 2004 to 15.4% and 6.6% in 2007 (p < .05). Overweight was significantly associated with maternal employment (p < .05), but not with parental education level, maternal age at birth, or breast-feeding. To counter this rapid increase of obesity and overweight prevalence, nurses should regularly monitor children's weight and advise parents, especially working mothers, on the nutritional benefits of home-cooked meals.