Abstract
Child overweight or obesity is increasing in most countries, including Vietnam. We sought to elucidate the drivers of child overweight or obesity in Vietnam and understand how they vary geographically. We compiled nationally representative cross-sectional data from the Vietnam Nutrition Surveillance Survey collected annually between 2012–2015 and household income data from the General Statistics Office. We used a quasi-Poisson log link function to calculate relative risks (RRs) of under-five child overweight or obesity for 13 variables and stratified analyses by child age (<2 y and 2–5 y) and region. Additional analysis included log-log linear regression to assess the relationship between average provincial monthly per capita income and child overweight or obesity. The strongest associations with child overweight or obesity included birthweight >4000 g (RR: 1.66; 95% confidence interval (CI): 1.48, 1.86), maternal body mass index (BMI) ≥27.5 compared with BMI <23 (RR: 1.62; 95% CI: 1.47, 1.78), and living in the Southeast (RR: 2.06; 95% CI: 1.84, 2.30), Mekong River Delta (RR: 1.58; 95% CI: 1.41, 1.77), or Central South (RR: 1.54; 95% CI: 1.37, 1.74) compared with the Central Highland. A 20% higher provincial average monthly per capita income was associated with a 17.4% higher prevalence in child overweight or obesity (P <0.0001, Adjusted R2 = 0.36). High birthweight and maternal BMI were strongly associated with child overweight or obesity but are not likely primary drivers in Vietnam, given their low prevalence. C-section delivery, sedentary lifestyle, high maternal education, urbanicity, and high household income affect a large proportion of the population and are, therefore, important risk factors. Policies and programs should target these factors and regions at greatest risk of overweight or obesity, particularly the Southeast and Mekong River Delta.
Highlights
Child obesity has short- and long-term consequences, including increased risk of non-communicable diseases and mortality in childhood and adulthood [1,2]
Effect sizes for risk factors within the Southeast, the region with the second largest population and greatest risk of child overweight or obesity, were relatively uniform, with significant covariates ranging from a relative risks (RRs) of 1.20 in non-mountainous communes to 1.54 among mothers with a body mass index (BMI) ≥27.5 compared with BMI
The Mekong River Delta, which has the largest population and had the second greatest risk of child overweight or obesity, had more variation between significant covariates, with ethnic majority showing the strongest relationship (RR: 1.86; 95% confidence interval (CI): 1.58, 2.18) (Table 2 and Supplemental Figure S5)
Summary
Child obesity has short- and long-term consequences, including increased risk of non-communicable diseases and mortality in childhood and adulthood [1,2]. While the prevalence of overweight and obesity are generally lowest in early childhood compared to other life stages, many causes of obesity have roots in early childhood [3]. Addressing causes in early childhood can have a substantial impact on quality of life and productivity across the lifespan of individuals and eventually the health system and economy of a country. In Vietnam, child overweight or obesity more than doubled from 2.6% in 2000 to 5.9% in 2017, remaining lower than the regional average but exceeding the global average [5]. Large differences in child overweight or obesity exist across Southeast Asia. The reasons for this are not entirely clear but likely a result of differing economies, lifestyles, and health systems across the region. The region’s food systems are diverse, with some countries being much more ‘westernized’ than others
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