A Socio-Ecological Examination of Weight-Related Characteristics of the Home Environment and Lifestyles of Households with Young Children.

This study was to assess the individual effects of serum copper levels and environmental tobacco exposure and their joint effects on the risk of overweight and obesity among children and adolescents of 6 to 19year olds. We analyzed cross-sectional data from 1849 children and adolescents participating in the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2016. Environmental tobacco exposure was determined by cotinine levels. The serum copper level was divided into < median group and ≥ median groups according to the median of 109.81µg/dL. The outcome was overweight/obese in children and adolescents. Weighted multinomial multivariate logistic regression models were used to assess the association of serum copper and cotinine levels, with the risk of overweight/obesity, and the joint effects on the risk of overweight and obesity among children and adolescents. The subgroup analyses based on age, gender, and household smoking status were conducted. Among 1849 children and adolescents, 332 children and adolescents had overweight BMI, and 450 children and adolescents had obese BMI. Higher serum copper levels were associated with the risk of obesity in children and adolescents (odds ratio (OR) 2.96, 95% confidence interval (CI) 1.39-6.31, P = 0.006). A positive association between increasing levels of cotinine levels and the risk of overweight (OR 1.83, 95% CI 1.16-2.87, P = 0.010) and obesity (OR 2.56, 95% CI 1.03-6.40, P = 0.044) in children and adolescents was observed. A remarkable association was found between higher serum copper in combination with higher cotinine levels and the risk of overweight (OR 3.23, 95% CI 1.19-8.83, P = 0.023) and obesity (OR 8.76, 95% CI 2.14-35.87, P = 0.003) in children and adolescents. The subgroup analyses revealed positive associations between high serum copper levels in combination with high cotinine levels and overweight and obesity in children and adolescents aged ≥ 12years, of female sex, and without smoking family members. There may exist a joint effect of serum copper levels and environmental tobacco exposure on overweight/obesity among children and adolescents. These findings offer an insight that early weight control and reduction of tobacco exposure and the detection of serum copper levels may be important in reducing the risk of obesity in children.

Active commuting to school can contribute to active living among children, and environmental characteristics might be related to transportation mode to school. The purpose of this study is to explore the association between physical and social environmental characteristics in the home, neighborhood, and school environment and walking and bicycling to school. Data were collected among parents (n = 5,963) of children of primary schools in four Dutch cities. Parents reported mode of transportation to school, and individual, home environmental, neighborhood, and school environmental characteristics. Social as well as physical characteristics were included for the home and neighborhood environment. Multilevel multinomial logistic regression analyses were conducted to quantify the association between environmental characteristics and walking and bicycling to school. Three quarter of all children usually commute to school by active transportation, but age and distance from home to school were important prerequisites. Besides home environmental characteristics, lower neighborhood socioeconomic status was negatively associated with walking [odds ratio (OR) = 0.51] and bicycling (OR = 0.86). Perceived social safety was positively related to walking and bicycling (OR = 1.04 for both), as was perceived social cohesion (OR = 1.04 and 1.02 for walking and bicycling). Living in the city center was positively associated with walking (OR = 1.91), whereas living in a city green neighborhood was negatively associated with walking and bicycling (OR = 0.48 and 0.76, respectively). Traffic safety as perceived by school boards was positively associated with bicycling (OR = 1.25). This study shows that there is a relation between several characteristics in the home, neighborhood, and school environment and walking and bicycling to school among Dutch primary school children. Especially the social neighborhood characteristics were related to active commuting. Therefore, apart from providing a physical infrastructure that facilitates safe and convenient active commuting to school, policy makers should be aware of opportunities to facilitate active commuting by social initiatives in local communities.

In Mexico, higher socioeconomic status (SES) has been found to be associated with increased risk for obesity in children. Within developed urban areas, however, there may be increased risk among lower SES children. Students in grades 4-6 from five public schools in Tijuana and Tecate, Mexico, were interviewed and weight, height and waist circumference (WC) measurements were taken. Interviews consisted of questions on food frequency, food insecurity, acculturation, physical activity and lifestyle practices. Multivariate logistic models were used to assess risk factors for obesity (having a body mass index [BMI] ≥95th percentile) and abdominal obesity (a WC >90th percentile) using Stata 11.0. Five hundred and ninety students were enrolled; 43.7% were overweight or obese, and 24.3% were obese and 20.2% had abdominal obesity. Independent risk factors for obesity included watching TV in English (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.06-2.41) and perceived child food insecurity (OR 1.57, 95% CI 1.05-2.36). Decreased risk for obesity was associated with female sex (OR 0.64, 95% CI 0.43-0.96), as was regular multivitamin use (OR 0.63, 95% CI 0.42-0.94). Risk obesity was also decreased with increased taco consumption (≥1×/week; OR 0.64, 95% CI 0.43-0.96). Independent risk factors for abdominal obesity included playing video games ≥1×/week (OR 1.18, 95% CI 1.11-2.96) and older age group (10-11years, OR 2.47, 95% CI 1.29-4.73 and ≥12years, OR 2.21, 95% CI 1.09-4.49). Increased consumption of tacos was also associated with decreased risk for abdominal obesity (≥1×/week; OR 0.56, 95% CI 0.40-1.00). We found a bimodal distribution for risk of obesity and abdominal obesity in school aged children on the Mexican border with the United States. Increased risk for obesity and abdominal obesity were associated with factors indicative of lower and higher SES including watching TV in English, increased video game playing and perceived food insecurity. Increased consumption of tacos (≥1×/week) was associated with decreased risk, possibly suggesting an association with children from middle income families. Regular multivitamin use was protective and future studies may focus on micronutrient supplementation as a means to prevent obesity in children or further investigate factors associated with vitamin use. Additionally, future studies need to examine the processes of acculturation on both sides of the US-Mexican border that contribute to increased risk for obesity in children in relation to SES.

BackgroundLimited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk.ObjectiveThe purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children.MethodsMothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother’s fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward’s method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings.ResultsOf the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward’s hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion).ConclusionsFindings may have implications in tailoring future obesity prevention interventions among families with young children.

Background Recent studies have shown that antibiotic exposure during infancy is associated with increased body mass in healthy children. This study was performed to investigate the association between early-life antibiotic exposure and risk of childhood obesity. Methods A systematic review and meta-analysis was performed to comprehensively and quantitatively determine the association between early antibiotic exposure and risk of childhood obesity. Various databases such as PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane and Google Scholar were searched. A random-effects meta-analysis was performed to pool the statistical estimates. Additionally, a subgroup analysis was performed based on the time of follow-up. Results Nineteen studies involving at least 671,681 participants were finally included. Antibiotic exposure in early life was significantly associated with risk of childhood weight gain and obesity (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.04-1.06). Conclusions Antibiotic exposure in early life significantly increases the risk of childhood weight gain and obesity.

BackgroundChildren from migrant origin are at higher risk for overweight and obesity. As limited physical activity is a key factor in this overweight and obesity risk, in general, the aim of this study is to assess to what degree children from migrant and native Dutch origin differ with regard to levels of physical activity and to determine which home environment aspects contribute to these differences.MethodsA cross-sectional survey among primary caregivers of primary school children at the age of 8–9 years old (n = 1943) from 101 primary schools in two urban areas in The Netherlands. We used bivariate correlation and multivariate regression techniques to examine the relationship between physical and social environment aspects and the child’s level of physical activity. All outcomes were reported by primary caregivers. Outcome measure was the physical activity level of the child. Main independent variables were migrant background, based on country of birth of the parents, and variables in the physical and social home environment which may enhance or restrict physical activity: the availability and the accessibility of toys and equipment, as well as sport club membership (physical environment), and both parental role modeling, and supportive parental policies (social environment). We controlled for age and sex of the child, and for socio-economic status, as indicated by educational level of the parents.ResultsIn this sample, physical activity levels were significantly lower in migrant children, as compared to children in the native population. Less physical activity was most often seen in Turkish, Moroccan, and other non-western children (p < .05).ConclusionsAlthough traditional home characteristics in both the physical, and the social environment are often associated with child’s physical activity, these characteristics provided only modest explanation of the differences in physical activity between migrant and non-migrant children in this study. The question arises whether interventions aimed at overweight and obesity should have to focus on home environmental characteristics with regard to physical activity.

Sugar-Sweetened Beverages and Obesity Risk in Children and Adolescents: A Systematic Analysis on How Methodological Quality May Influence Conclusions

Background: Intakes of sugar-sweetened beverages (SSB) and added sugars have been targeted in efforts to reduce childhood obesity and cardiovascular disease risk factors in children. Although evidence is sparse in children, overconsumption of SSB and added sugars has been linked to greater dyslipidemia in adults. Objectives: To examine the association between intakes of SSB, added sugars, and total sugars, with blood lipids in a multi-ethnic sample of children with prevalent obesity. Methods: In this cross-sectional study, we examined associations between intakes of SSB, added sugars, and total sugars with high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) in a sample of 276 children aged 8-15 y (mean age 11.8 y; 39% white, 14% black, 16% Hispanic/Latino, 12% Asian, and 19% multi-racial/other) with prevalent overweight/obesity (45% with ≥85 th BMI percentile and 25% with ≥95 th ). Percentage of daily calories from SSB, as well as intakes of added sugars (tsp) and total sugars (g), were estimated using the 2004 Block Food Frequency Questionnaire for Children. HDL-C and TG were obtained from a fasting blood sample. Percentage of calories from SSB, added sugars, and energy-adjusted total sugars were dichotomized at their upper tertile cut-points, specifically, at 7%, 13 tsp, and 116 g, respectively, creating two intake categories for each dietary exposure. ANCOVA was used to analyze the data; covariates were age, sex, race/ethnicity, obesity, total calories, and intakes of saturated fat and dietary fiber. TG was log-transformed prior to analysis; low HDL-C was defined as ≤45 mg/dL and borderline/high TG, as ≥75 (aged ≤9 y) or ≥90 mg/dL (≥10 y). Results: Median daily intake of total sugars was 94.2 g, 47% of which was derived from added sugars (median: 9.9 tsp, range: 1-76 tsp). Only 12% of children followed the American Heart Association calorie-specific recommendations for intake of added sugars. Median contribution of SSB to total calories was 4.4% (range: 0 to 51%), and SSB calories contributed 36% (range: 0 to 100%) of calories from added sugars. Both low HDL-C and borderline/high TG were prevalent (26-27% overall) and were more common in children classified as obese (61% and 53%, respectively) than in those who were not obese (16% and 17%, respectively, P&lt;0.0001 for each); however, intakes of SSB, added sugars, and total sugars did not differ with obesity. In multivariate-adjusted models, higher TG was associated with high intakes of SSB (75.3 vs. 67.6 mg/dL, P=0.04) and total sugars (76.5 vs. 67.0 mg/dL, P=0.01), while the association with added sugars was not significant. There were no associations with HDL-C. Conclusions: Among children with prevalent obesity, higher intakes of SSB and total sugars were associated with higher TG concentrations, but not with lower HDL-C. Further research is needed on the health implications of lower SSB and sugar intakes in diverse samples.

AimTo explore adolescents’ perceptions of how the home environment promotes the intake of sugar-sweetened beverages (SSBs) and to identify the potential environmental cues that trigger SSB intake at home.Subjects and methodsTwenty-nine semi-structured interviews were conducted among adolescents, aged 15–19 years, residing in an urban area in Northwest Mexico. Thematic analysis was used to analyse the data.ResultsAdolescents perceived that the availability of SSBs in the household increased their intake of SSBs. Availability of SSBs was facilitated mainly by taste preferences, ease of buying and beliefs that fruit-containing SSBs are healthy. Availability at home was considered important because SSBs were normally consumed with food during meals. Family influences and a lack of parental regulation were also regarded as factors promoting adolescents’ SSB intake at home. Drinking SSBs with food and having SSBs available at home were identified as habits that had been performed by participants’ families for many years.ConclusionsThese findings provide insights into the role of the home and family environment in promoting SSB intake. Future interventions to reduce SSB intake in this sample of Mexican adolescents should address availability and facilitators of SSB intake at home, family influences and parental regulation.

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.

Obesity puts a great health burden in the world. Previous studies suggest that caesarean section (CS) may increase the risk of obesity in children, but it is still uncertain whether this association is causal or due to residual confounding by medical indication. To assess the association between CS, CS without medical indications in particular and the risk of overweight and obesity in school-aged children. Cross-sectional survey. The 2014 Shanghai Child Health, Education and Lifestyle Evaluation was a large population-based survey with cluster random probability sampling in 26 primary schools in Shanghai, China, in 2014. The mode of delivery was reported by parents. The height, weight and waist circumference of the children were measured. Logistic regression models with SURVEYLOGISTIC procedure were used to estimate the risk of childhood obesity. Pupils delivered vaginally were served as the reference group. A total of 17 571 pupils completed this survey, and 13 724 of them who were singleton, born term and between 5 and 13 years old were included in our analysis. CS was associated with increased risks of overweight and obesity (BMI: adjusted OR = 1.28 [95%CI 1.13-1.45] and 1.44 [1.26-1.66], respectively; weight for height ratio [WHtR] >0.46: 1.33 [1.20-1.48]). Similar results were found in CS without medical indication (BMI: overweight = 1.24 [1.05-1.47], obesity = 1.43 [1.19-1.72]; WHtR > 0.46: 1.30 [1.13-1.50]). CS overall and CS without medical indications were associated with increased risks of overweight and obesity in primary school children.

We investigated the consumption of sugar-sweetened beverage (SSB) and its association with obesity and hypertension in a national sample of children and adolescents in China, where many low- and middle-income families live. Data were obtained from a 2014 national intervention program against obesity in Chinese children and adolescents aged 6–17 years. Height, weight, waist circumference, and blood pressure were measured. Information of SSB consumption, socioeconomic status, dietary intake, screen time, and physical activity were self-reported. Multivariate logistic regression was used to assess the association of SSB consumption with obesity and hypertension. A total of 66.6% of the 53,151 participants reported consuming SSB. The per capita and per consumer SSB intake were 2.84 ± 5.26 servings/week and 4.26 ± 5.96 servings/week, respectively. Boys, older children, and adolescents, and individuals with long screen time or high physical activity or low parental education level were more likely to consume SSB. Participants who were high SSB consumers had a higher odds ratio (1.133, 95% CI: 1.054–1.217) than non-consumers for having abdominal obesity after adjustment for age, sex, residence, socioeconomic status, diet, screen time, and physical activity. However, SSB consumption was not associated with general obesity or hypertension in children and adolescents. In conclusion, more than half of the children and adolescents in China consumed SSB, which was independently related to a high risk of abdominal obesity. The results of this study indicated that SSB reduction strategies and policies may be useful in preventing obesity among Chinese children and adolescents.

A number of studies have previously assessed the impact of antibiotic exposure in early life on the risk of childhood obesity, but no systematic assessment is currently available. A systematic review and meta-analysis was performed to comprehensively and quantitatively elucidate the risk of childhood obesity caused by antibiotic exposure in early life. Literature search was performed in PubMed, Embase, and Web of Science. Random-effect meta-analysis was used to pool the statistical estimates. Fifteen cohort studies involving 445,880 participants were finally included, and all those studies were performed in developed countries. Antibiotic exposure in early life significantly increased risk of childhood overweight [relative risk (RR) = 1.23, 95% confidence interval (CI) 1.13–1.35, P < 0.001] and childhood obesity (RR = 1.21, 95% CI 1.13–1.30, P < 0.001). Antibiotic exposure in early life also significantly increased the z-score of childhood body mass index (mean difference: 0.07, 95% CI 0.05–0.09, P < 0.00001). Importantly, there was an obvious dose–response relationship between antibiotic exposure in early life and childhood adiposity, with a 7% increment in the risk of overweight (RR = 1.07, 95% CI 1.01–1.15, P = 0.03) and a 6% increment in the risk of obesity (RR = 1.06, 95% CI 1.02–1.09, P < 0.001) for each additional course of antibiotic exposure. In conclusion, antibiotic exposure in early life significantly increases risk of childhood obesity. Moreover, current analyses are mainly taken from developed countries, and therefore the impact of antibiotic exposure on risk of childhood obesity in vulnerable populations or developing countries still needs to be evaluated in future studies.

Influence of Race, Ethnicity, and Culture on Childhood Obesity: Implications for Prevention and Treatment

14 - The Association Between Sugar-Sweetened Beverages and Child Obesity: Implications for US Policy