Abstract
Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population.Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample.Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children.Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score.Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age.
Highlights
The Brazilian population is undergoing nutritional transition, which can be defined as the simultaneous decline of undernourishment and infectious diseases, and rise of overweight, obesity and non-communicable diseases (NCD) [1]
We excluded children with diseases that were related to nutrition and/or could influence parental feeding practices; siblings, in order to avoid sample unit duplication, keeping only the youngest child; children who were not in the eligible age group; children from parents who were not born in Brazil; respondents who were not the parent of the index child; parents who completed more than one questionnaire for the same child; and those with missing answers on parental feeding practices questions
The prevalence of overweight among children was used for this estimation, which resulted in a required sample size of 320 respondents, incorporating over-recruitment to accommodate an anticipated loss of 10% of the original sample. 48 private schools, each serving children ranging in age from 2 to 8 years, in Campinas and São Paulo, Brazil were invited to participate in the study
Summary
The Brazilian population is undergoing nutritional transition, which can be defined as the simultaneous decline of undernourishment and infectious diseases, and rise of overweight, obesity and non-communicable diseases (NCD) [1]. From 1996 to 2006, underweight among Brazilian preschoolers decreased 6.3%, while overweight increased 129% [2]. The same trend is evident in school-aged children. According to the last national survey in 2008, one in every three children between 5 and 9 years of age had excessive weight. Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population
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