Abstract
IntroductionYoung children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity. However, there is scant research examining the prevalence and social distribution of thinness in early childhood, despite potential negative consequences for health and development across the life-course.MethodsWe examined the social gradient in thinness (and overweight and obesity for comparison) for 2,620,422 four-to-five year olds attending state maintained primary schools from 2007/8 to 2011/12, in the England National Child Measurement Programme (NCMP), and 16,715 children from the UK Millennium Cohort Study (MCS), born in 2000–2002, and measured at ages of three, five and seven. Children were classified as being thin, healthy weight (and, for completeness, overweight or obese) using international age and sex adjusted cut-offs for body mass index (BMI). Prevalences (and 95 % confidence intervals (CIs)) were estimated, overall, and according to SECs: area deprivation (NCMP, MCS); household income, and maternal social class and education (MCS only). Relative Risk Ratios (RRRs) and CIs for thinness, overweight and obesity were estimated in multinomial models by SECs (baseline healthy weight). In the MCS, standard errors were estimated using clustered sandwich estimators to account for repeated measures, and, for thinness, RRRs by SECs were also estimated adjusting for a range of early life characteristics.ResultsIn 2007/8 to 2011/12, 5.20 % of four-to-five year old girls (n = 66,584) and 5.88 % of boys (78,934) in the NCMP were thin. In the MCS, the prevalence of thinness was 4.59 % (693) at three, 4.21 % (702) at five, and 5.84 % (804) at seven years. In both studies, and for all measures of SECs, children from the most disadvantaged groups were more likely to be thin than those from the most advantaged groups. For example, MCS children whose mothers had no educational qualifications were fifty percent more likely to be thin (RRR 1.5 (CI: 1.24, 1.8)) than those whose mothers had a degree. These patterns were attenuated but remained after adjusting for early life characteristics.ConclusionsChildren from more disadvantaged backgrounds are at elevated relative risk of thinness as well as obesity. Researchers and policymakers should consider environmental influences on thinness in addition to overweight and obesity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0187-6) contains supplementary material, which is available to authorized users.
Highlights
Young children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity
There are no national estimates of the burden of thinness in early childhood in the UK, or studies examining inequalities according to individual level socioeconomic circumstances, which use a child equivalent of the World Health Organisation (WHO) adult definition of underweight (BMI < 18.5)
National Child Measurement Programme (NCMP) data are provided by the Health and Social Care Information Centre (HSCIC), and these data were downloaded from the UK Data Service, University of Essex and University of Manchester, between August and October 2013
Summary
Young children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity. Food poverty (the inability to afford or access a healthy diet) is rising across the UK, as prices have increased and real incomes fallen. These trends have been linked to shifts in household expenditure away from healthier foods, and dramatic rises in referrals to food banks [1] (non-profit charitable organisations which provide emergency food packages to individuals in need). There are no national estimates of the burden of thinness in early childhood in the UK, or studies examining inequalities according to individual level socioeconomic circumstances, which use a child equivalent of the World Health Organisation (WHO) adult definition of underweight (BMI < 18.5)
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