Child zBMI Research Articles

80 Yearly change in child zBMI and the COVID-19 pandemic in Canada: A cohort study

Abstract Background Emerging literature suggests accelerated weight gain in children during the pandemic; however, data from Canadian children are limited and individual factors underlying this trend remain unclear. Objectives To determine whether the COVID-19 pandemic was associated with increased yearly change in age- and sex-standardized body mass index (zBMI) in Canadian children and whether staying at home during the pandemic was associated with increased change in zBMI per year. Design/Methods A repeated-measures longitudinal study was conducted with children from an existing practice-based research network in Canada age 1-18y with at least one zBMI measurement pre- and post-onset of the pandemic. Height and weight were measured through primary care office visits and supplemented with at-home parent measurements post-pandemic. Weekly questionnaires were used to measure days stayed at home per week. Piecewise linear mixed effects models accounting for repeated measures through random effects were used to assess yearly change in zBMI. A knot location was placed at the start of the pandemic (March 14, 2020) to compare slopes pre- and post-pandemic onset. Similar mixed effects models were used to explore the association between days at home per week and change in zBMI post-pandemic onset. Stratification by sex and a sensitivity analysis in children with clinic-measured anthropometrics were explored. All models were adjusted for covariates identified a priori. Results In the overall population (n=849 children, 5070 observations), there was no significant difference in slope for yearly change in zBMI post-pandemic (Mar 2020-Sept 2022) compared to prior (Oct 2004-Mar 2020) in fully adjusted models accounting for child age, sex, maternal ethnicity, maternal BMI, family income, birthweight, breastfeeding duration, anthropometrics measurement method (clinic vs parent) and pre-COVID zBMI (post-COVID β=0.03; 95%CI -0.02,0.08; pre-COVID β=0.009; 95%CI-0.009,0.027; p-interaction=0.46). In children with clinic-measured anthropometrics (n=849, 4318 observations), there was a significant increase in yearly change in zBMI after the onset of the pandemic in the fully adjusted model (β=0.07; 95%CI 0.02,0.12) compared to prior (β=0.004; 95%CI -0.01,0.02; p-interaction=0.01). This was driven by changes in boys (post-COVID β=0.08; 95%CI 0.007,0.15; pre-COVID β=-0.003; 95%CI-0.03,0.02; p-interaction 0.04). In boys with clinic-measured anthropometrics post-pandemic onset (n=77 children, 85 observations), there was marginal evidence for increase in yearly zBMI change for every additional day at home per week in the fully adjusted model (β=0.16; 95%CI -0.006,0.32; p=0.06). Conclusion The COVID-19 pandemic was associated with accelerated increase in zBMI per year in Canadian children with clinic-measured height and weight, particularly among boys. Potential competing interests Funding was obtained by J.J. Joseph Jamnik for consultant work for Nutrigenomix Inc, a University of Toronto start-up which offers evidence-based genetic testing for personalized nutrition. Consulting work terminated July 1, 2023. This relationship is unrelated to the work submitted. Research funding: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada - Operating Grant. CIHR grant 468613. 2021-2024.

Free Summer Programming and Body Mass Index Among Schoolchildren From Low-Income Households

Children experience accelerated gains in body mass index (BMI) during the summer months when school is not in session. Children from low-income households are most susceptible. Accelerated BMI gain in summer may be due to the removal of the health-promoting structure provided by schools. During summer, a common form of health-promoting structure is summer day camps (SDCs). Summer day camps are predominately fee for service, which creates a financial barrier for children from low-income households. One solution to mitigate accelerated BMI gain is providing free access to an existing SDC. To investigate whether providing free access to an existing community SDC can mitigate accelerated BMI z score (zBMI) gain in elementary school-age children. This randomized clinical trial was conducted during the summers of 2021, 2022, and 2023 in the southeastern United States. Participants were children (kindergarten through fourth grade) from predominantly low-income households who were randomized to attend an SDC operated by a parks and recreation commission or continue summer as usual (control). Free SDC every weekday (Monday through Friday) for 8 to 10 weeks. The primary outcome was between-group differences in change of zBMI measured before school ended (May) and on return to school from summer (late August). Secondary analyses examined the dose response of zBMI change with parent-reported child attendance at SDCs during the summer for all children (intervention and control). A total of 422 children (mean [SD] age, 8.2 [1.5] years; 202 [48%] female, 220 [52%] male, 292 [69%] at or below 200% federal poverty level, 127 [30%] with food insecurity) were randomized to 1 of 2 conditions: summer as usual (control, n = 199) or free SDC (n = 223). Intent-to-treat analysis indicated mean (SE) change in zBMI at the end of the summer was 0.046 (0.027) for the control and -0.048 (0.025) for the intervention group, representing a significant between-group difference of -0.094 (95% CI, -0.166 to -0.022). Dose-response analyses indicated that every 1 day per week increase in attending an SDC resulted in a -0.034 to -0.018 zBMI reduction, which translates to a gain of 0.046 to 0.080 zBMI for children never attending summer programming vs -0.09 to -0.04 zBMI reduction for children attending summer programming every weekday. Providing children free access to existing community summer programming can have a meaningful effect on children's zBMI gain during the summer. Future studies should replicate these findings across different regions and identify the optimal dose of programming to mitigate unhealthy zBMI gains. ClinicalTrials.gov Identifier: NCT04072549.

Early Life Surgency, but not Effortful Control or Negative Affectivity, Is a Mediating Variable Between Maternal Pre-Pregnancy Body Mass Index and Childhood Obesity Risk.

Maternal gestational obesity is related to risk of obesity in the child. This risk may be in part mediated by altered child temperament, which can affect mother-child interactions, including feeding and soothing behaviors that affect obesity risk. Our objective was to examine the association between maternal pre-pregnancy BMI and child zBMI and determine if child temperament, specifically positive Affectivity/Surgency, mediates this association. Using conditional process modeling, we analyzed data from 408 mother-child dyads enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Child temperament was assessed at 3 years of age via a parent report measure, the Child Behavior Questionnaire (CBQ), and child zBMI was calculated from in-person measurements of child height and weight at 4-5 years of age. Bivariate correlations showed that there was a significant positive correlation between zBMI and Surgency (r=0.11, p=0.03), and zBMI was also correlated with maternal pre-pregnancy BMI (r=0.12, p=0.02). Multivariable regression revealed that maternal pre-pregnancy BMI (adjusted β=0.15, 95% confidence interval [CI]; 0.00-0.05, p=0.02) and Surgency scores (adjusted β=0.14, 95% CI; 0.02-0.28, p=0.03) were associated with higher child zBMI at 4-5 years of age. Mediation analysis showed that Surgency mediated the association between pre-pregnancy BMI and child zBMI. Our models controlled for maternal gestational weight gain, gestational diabetes, socioeconomic status, maternal anxiety and depression, and gestational age at birth. Overall, maternal pre-pregnancy BMI was positively associated with child zBMI, and this association was mediated by higher child Surgency scores.

Intrapartum antibiotic use is associated with higher child body mass index (BMI) z-score at 4 years of age

Early life antibiotic exposure may increase obesity risk. We investigated if prenatal, intrapartum, or childhood antibiotic use is associated with child zBMI score at 4 yrs of age. We included data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, a prospective cohort study, on maternal and child antibiotic exposure and clinic measures of height and weight at age 4 (n = 408). Prenatal and childhood antibiotic exposure was not associated with zBMI score. Maternal intrapartum antibiotic exposure was associated with a zBMI score increase of 0.12 (95 % CI; 0.04, 0.46) in children at 4 years of age compared to non-exposure intrapartum.

Developmental trajectory of appetitive traits and their bidirectional relations with body mass index from infancy to early childhood.

Appetitive traits, including food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating, are associated with childhood body mass index. Change in appetitive traits from infancy to childhood and the direction of causality between appetitive traits and body mass index are unclear. The present study examined the developmental trajectory of appetitive traits and their bidirectional relations with body mass index, from infancy to early childhood. Mothers in the Pregnancy Eating Attributes Study and follow-up (n = 162) reported child appetitive traits using the Baby and Child Eating Behaviour Questionnaires at ages 6 months and 3.5 years, respectively. Standardized body mass index (zBMI) was calculated from child anthropometrics. Cross-lagged panel models estimated bidirectional relations between appetitive traits and zBMI. Food responsiveness, satiety responsiveness and slowness in eating increased from infancy to early childhood. In cross-lagged panel models, lower infant satiety responsiveness (B ± SE = -0.45 ± 0.19, p = .02) predicted greater child zBMI. Infant zBMI did not predict child appetitive traits (p-values >.36). From infancy to early childhood, appetitive traits may amplify. Appetitive traits, particularly satiety responsiveness, appear to influence body mass index during this period, suggesting early intervention targeting these traits may reduce childhood obesity.

Understanding drivers of micro-level disparities in childhood body mass index, overweight, and obesity within low-income, minority communities

The focus of childhood obesity disparities has been mainly on macro-level disparities, such as, between lower versus higher socioeconomic groups. But, less is known about micro-level disparities, that is disparities within minority and low-income populations. The present study examines individual and family level predictors of micro-level obesity disparities. We analyze data on 497 parent–child dyads living in public housing communities in Watts, Los Angeles. Cross-sectional multivariable linear and logistic regression models were estimated to examine whether individual and family level factors predict children’s BMI z-scores, overweight, and obesity in the sample overall and separately by child’s gender and age group. Child characteristics of our study sample included mean age 10.9 years, 74.3% Hispanic, 25.7% Non-Hispanic Black, 53.1% female, 47.5% with household income below $10,000, 53.3% with overweight or obesity, and 34.6% with obesity. Parental BMI was the strongest and most consistent predictor of child zBMI, overweight, and obesity, even after controlling for parent’s diet and activity behaviors and home environment. The parenting practice of limiting children’s screentime was also protective of unhealthy BMI in younger children and females. Home environment, parental diet and activity behaviors, and parenting practices related to food and bedtime routines were not significant predictors. Overall, our findings show that there is considerable heterogeneity in child BMI, overweight, and obesity even within low-income communities with similar socioeconomic and built environments in their neighborhoods. Parental factors play an important role in explaining micro-level disparities and should be an integral part of obesity prevention strategies in low-income minority communities.

Paternal BMI in the preconception period, and the association with child zBMI.

Rapid growth and excess weight in early childhood are associated with obesity risk. While maternal preconception BMI has been identified as a potential risk factor, the role of paternal preconception BMI is less clear. To examine the association between paternal preconception BMI and age- and sex-standardized WHO BMI z-score (zBMI) growth rates, zBMI, and weight status, in 0- to 10-year-old children. To determine whether these associations differed by child sex and maternal preconception weight status. A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!). Children (n = 218) underwent repeated measures of height and weight from birth to 10 years old. Piecewise linear mixed models were used to assess the association between paternal preconception BMI and child zBMI growth rates (zBMI SD units/month) between 0, 4, 30, 48 and 120 months of age. Linear mixed models were used to examine the association with child zBMI, and logistic generalized estimation equations (GEE) were used to assess the association with child weight status. Child sex and maternal preconception weight status were tested as effect modifiers. Paternal preconception BMI was associated with child zBMI growth rate, mean zBMI and weight status in boys, but not girls. A 5 kg/m2 higher paternal preconception BMI was associated with approximately 0.01 zBMI SD unit/month higher growth rate for boys born to mothers with preconception overweight. Higher paternal BMI was associated with higher mean zBMI and increased odds of overweight and obesity in boys, with greater effects seen when mothers had preconception overweight compared to normal weight. Paternal preconception BMI was associated with child zBMI growth rate, zBMI and weight status in boys, with greater effects when the biological mother had preconception overweight or obesity. Further understanding of sex differences in paternal preconception weight effects in children is needed.

Maternal BMI in the preconception period, and association with child zBMI growth rates.

Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. The association between maternal preconception BMI and child growth rates is unclear. To assess the association between measured maternal preconception BMI and child age- and sex- standardized WHO BMI z-score (zBMI) growth rates and mean zBMI, in children aged 0-10 years old. A longitudinal cohort study was conducted with children (n=499) enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research cohort. Maternal BMI was measured during the preconception period, defined as the 2 years prior to pregnancy. Repeated measures of child weight and height were obtained between 0 and 10 years of age. Linear mixed models were used to evaluate the association between maternal BMI and child zBMI growth rates and mean zBMI. Maternal preconception BMI was associated with child zBMI growth rate during some growth periods, with the strongest association from age 0 to 4months; a 5kg/m2 higher maternal BMI was associated with 0.031 zBMI SD unit/mo higher growth rate (p=0.004), and 0.186 SD unit higher mean child zBMI (p=0.0002). Maternal preconception BMI was associated with growth rate and mean zBMI in early childhood. The preconception period may be an important target for health interventions to promote healthy child growth rate and weight outcomes.

53 The association between maternal preconception BMI and child zBMI growth rates

Abstract Background Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. While studies have identified an association between maternal preconception BMI and child BMI z-scores (zBMI), the association with zBMI growth rates during distinct growth periods is unclear. Objectives To assess the association between maternal preconception BMI and child zBMI growth rates and BMI z-scores, in children aged 0 to 10 years old. Additionally, to examine whether child sex and gestational weight gain (GWG) modify these associations. Design/Methods This longitudinal study consisted of healthy children (0 to 10 years) enrolled in a primary care practice-based research cohort. The exposure was maternal BMI measured during the preconception period, defined as the 2 years prior to pregnancy. The primary outcome was child zBMI growth, modeled with piecewise linear splines for age. The secondary outcome was repeated measures of child BMI z-scores. Piecewise linear mixed models were used to determine the association with growth, while linear mixed models were used for zBMI. Effect modification by child sex and GWG was explored. Results 499 children were included. Maternal preconception BMI had a small, but statistically significant association with child zBMI growth rates during some growth periods, with the strongest association from 0 to 4 months (0.007; p=0.004). Maternal preconception BMI was also associated with child zBMI; 1kg/m2 increase was associated with 0.03 zBMI increase (p=0.001). Child sex and maternal GWG did not modify these associations. Conclusion There is evidence to suggest an association between maternal preconception BMI and child zBMI growth and scores. In addition to maternal and pregnancy benefits, preconception interventions may have longer-term benefits for child growth.

89 Centre-based child care attendance in early childhood and adiposity in later childhood: a prospective cohort study

Abstract Background One in three children are living with overweight or obesity in North America. The burden of childhood obesity is disproportionately experienced by children from low-income families, who are more likely to have obesity. Centre-based child care attendance may influence important adiposity risk factors such as dietary intake, eating behaviour, and physical activity, but its impact on childhood obesity is unclear. Objectives The primary objective was to evaluate the relationship between the intensity of centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny’s). The secondary objective was to explore if family income modified the relationship. Design/Methods A prospective cohort study of children 1 to 10 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was intensity of centre-based child care attendance (hours/week). The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Interaction terms for child age and family income were explored. A linear mixed effects model and logistic generalized estimating equations were used to determine the association between centre-based child care attendance and child zBMI. Results 3,503 children were included (mean age: 2.7 years). Children who attended centre-based child care full time (40 hours/week) had a 0.11 lower zBMI at 4 years (95% CI -0.19, -0.03; p=0.005) and lower odds of obesity (zBMI > 2) at 4 (OR 0.58; 95% CI 0.34, 0.99; p=0.04) and 10 years of age (OR 0.52; 95% CI 0.29, 0.90; p=0.02) relative to children who attended non-centre-based child care. The relationship was modified by family income such that, children from families with an income of <$50,000CDN who attended centre-based child care full time had a 0.35 (95% CI -0.56, -0.15; p=0.001), 0.34 (95% CI -0.54, -0.13, p=0.001) and 0.29 (95% CI -0.50, -0.07, p=0.009) lower zBMI at 4, 7 and 10 years of age, respectively, relative to children who attended non-centre-based child care. Conclusion Centre-based child care attendance in early childhood was associated with lower adiposity and odds of obesity in later childhood. This relationship was stronger for children who were from lower income families. Centre-based child care may be an effective early intervention to prevent childhood obesity.

Implementing Prevention Plus with Underserved Families in an Integrated Primary Care Setting.

Background: This proof-of-concept trial examined a 6-month Prevention Plus (PP) intervention implemented in a federally qualified health center on child standardized BMI (ZBMI), using a planned clinical effect threshold of -0.16 ZBMI. The relationship between food security status and PP delivered with caregiver goals (PP+) and without caregiver goals (PP-) on energy balance behaviors (i.e., fruits and vegetables, physical activity) and child ZBMI was explored. Methods: Seventy-three, underserved children, 4-10 years of age with a BMI ≥85th percentile, were randomized to one of two interventions, PP+ and PP-, both providing 2.5 hours of contact time, implemented in five clinics by behavioral health consultants (BHCs). Outcomes were child anthropometrics (included 9-month follow-up), implementation data collected from electronic health records, and caregiver and BHC evaluations. Results: Children were 57.5% female and 78.1% Hispanic, with 32.9% from food-insecure households and 58.9% from households with an annual income of less than $20,000. Child ZBMI significantly (p < 0.05) decreased at 6 and 9 months (-0.08 ± 0.24 and -0.12 ± 0.43), with only PP+ reaching the clinical threshold at 9 months (PP+: -0.20 ± 0.42 vs. PP-: -0.05 ± 0.42). Sixty-four percent of families attended ≥50% of the sessions, and BHCs delivered 78.5% ± 23.5% of components at attended sessions. Caregivers were satisfied with the intervention and BHCs found the intervention helpful/useful. No relationship with food insecurity status and outcomes was found. Conclusions: PP+ when delivered by a primary care provider to underserved families showed promise for producing a clinically meaningful effect. Families and providers felt the intervention was a viable treatment option.

Cow’s milk fat and child adiposity: a prospective cohort study

International guidelines recommend children aged 9 months to 2 years consume whole (3.25%) fat cow's milk, and children older than age 2 years consume reduced (0.1-2%) fat cow's milk to prevent obesity. The objective of this study was to evaluate the longitudinal relationship between cow's milk fat (0.1-3.25%) intake and body mass index z-score (zBMI) in childhood. We hypothesized that higher cow's milk fat intake was associated with lower zBMI. A prospective cohort study of children aged 9 months to 8 years was conducted through the TARGet Kids! primary care research network. The exposure was cow's milk fat consumption (skim (0.1%), 1%, 2%, whole (3.25%)), measured by parental report. The outcome was zBMI. Height and weight were measured by trained research assistants and zBMI was determined according to WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow's milk fat intake and child zBMI. Among children aged 9 months to 8 years (N = 7467; 4699 of whom had repeated measures), each 1% increase in cow's milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p < 0.0001) after adjustment for covariates including volume of milk consumed. Compared to children who consumed reduced fat (0.1-2%) milk, there was evidence that children who consumed whole milk had 16% lower odds of overweight (OR = 0.84, 95% CI 0.77 to 0.91, p < 0.0001) and 18% lower odds of obesity (OR = 0.82, 95% CI 0.68 to 1.00, p = 0.047). Guidelines for reduced fat instead of whole cow's milk during childhood may not be effective in preventing overweight or obesity.

Impact of a year-round school calendar on children's BMI and fitness: Final outcomes from a natural experiment.

Structure may mitigate children's accelerated summer BMI gain and cardiorespiratory-fitness (CRF) loss. Examine BMI and CRF change during school and summer for year-round and traditional calendar school children. Three schools (N=2279, 1 year-round) participated in this natural experiment. Children's BMI z-score (zBMI) and CRF (PACER laps) were measured from 2017 to 2019 each May/August. Mixed effects regression estimated monthly zBMI and CRF change during school/summer. Secondary analyses examined differences by weight status and race. Spline regression models estimated zBMI and CRF growth from kindergarten-sixth grade. Compared to traditional school, children attending a year-round school gained more zBMI (difference=0.015; 95CI=0.002, 0.028) during school, and less zBMI (difference=-0.029; 95CI=-0.041, -0.018), and more CRF (difference=0.834; 95CI=0.575, 1.093) monthly during summer. Differences by weight status and race were observed during summer and school. Growth models demonstrated that the magnitude of overall zBMI and CRF change from kindergarten-sixth grade was similar for year-round or traditional school children. Contrary to traditional school children zBMI increased during the traditional 9-month school calendar and zBMI decreased during the traditional summer vacation for year-round school children. Structured summer programming may mitigate accelerated summer BMI gain and CRF loss especially for overweight or obese, and/or Black children.

Associations Between Parent–Child Communication and Connectedness, Parent Feeding Behavior, and Child Body Mass in Pre-Adolescent Children

This study evaluated associations between parent-child connectedness and communication, parent feeding behaviors (restriction, pressure to eat, and monitoring), and age- and sex-standardized child body mass index (zBMI) in a sample of pre-adolescent children aged 8-12 years. A community sample of three hundred and eight child-parent dyads completed measures of communication and connectedness. Parents completed a feeding behavior measure and children were weighed and their height was measured. We examined whether parental feeding behaviors and parent-child communication and connectedness predicted child zBMI and whether parental feeding behaviors moderated the association between parent-child communication and connectedness and child zBMI. Feeding restriction was positively associated with zBMI, while both pressure to eat and food monitoring exhibited negative associations with zBMI. Child-reported communication was inversely associated with zBMI and parental pressure to eat moderated this association such that lower pressure to eat predicted a stronger association between communication and zBMI. These findings are consistent with previous research suggesting that parent feeding strategies and parent-child communication are important contributors to child weight status. This study also provides preliminary evidence suggesting that adaptive parent-child communication is associated with lower body mass when parents avoid pressuring their child to eat. Our study provides an important extension of this body of research into middle childhood, a relatively understudied developmental stage.

61 Cow’s milk fat and child adiposity: a prospective cohort study

Abstract Background International guidelines recommend that children older than 2 years of age consume reduced fat (0.1-2%) instead of whole cow’s milk (3.25% fat) to prevent childhood obesity, but these guidelines are consensus-based and have a low GRADE level of evidence. Objectives The primary objective of this study was to evaluate the longitudinal relationship between cow’s milk fat (0.1-3.25%) intake and Body Mass Index z-score (zBMI) in children aged 9 months to 8 years. The secondary objective was to determine the relationship between cow’s milk fat intake and odds of overweight (zBMI &amp;gt;1) and obesity (zBMI &amp;gt; 2). Design/Methods A prospective cohort study of children 9 months to 8 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was cow’s milk fat consumption (skim (0.1%), 1%, 2%, or whole [3.25%]), measured by parental report. The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Height and weight were measured by trained research assistants and zBMI was determined according to the WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow’s milk fat intake and child zBMI. Results Among children aged 9 months to 8 years of age (N= 7467), each 1% increase in cow’s milk fat consumed was associated with a 0.05 lower zBMI score (95% CI -0.07 to -0.03, p&amp;lt; 0.0001). Compared to children who consumed reduced fat (0.1-2%) cow’s milk, there was evidence that children who consumed whole cow’s milk had 16% lower odds of overweight (OR=0.84, 95% CI 0.77 to 0.91), p&amp;lt; 0.0001) and 18% lower odds of obesity (OR= 0.82, 95% CI 0.68 to 1.00, p= 0.047). Conclusion Guidelines for reduced fat instead of whole cow’s milk during childhood may not be effective in preventing overweight or obesity. Randomized controlled trial data is needed to understand which cow’s milk fat optimizes child growth, development and nutrition.

114 Distributional Decomposition: A Novel Method for Understanding Inequities in Child Growth, Behavior and Development

Abstract Background Income related inequities in child health are well-established, with children from lower income households showing increased risk of obesity, behavior problems, and delayed development. To facilitate clinical diagnosis, outcomes are conventionally measured in dichotomous terms. However, inequities may exist along the entire range of distribution, with implications for population health. Objectives Our primary objective was to examine differences in the distribution of three measures of child health by income: body mass index (BMI), behavior difficulties and development. Design/Methods This was a cross sectional study of children enrolled in a primary care practice-based research cohort. Our study included generally healthy children recruited from age 0-5 years. Dependent variables were 1) BMI z-score (zBMI) at 5 years; 2) behavior: total score on the Strengths and Difficulties Questionnaire (SDQ), measured at 3-5 years; 3) development: total score on the Infant Toddler Checklist (ITC), measured at 18-24 months. Independent variable was parent-reported annual household income (&amp;lt; $100,000 vs ≥ $100000). We then used distributional decomposition, which uses mathematical re-weighting to construct a counterfactual distribution that describes the distribution of the lower income group based on the predictor profile (child age, sex, birthweight, prematurity, breastfeeding duration; maternal age, education, immigration status, ethnicity) of the higher income group. Results Our study samples consisted of 1649 (zBMI), 764 (SDQ) and 761 (ITC) children. Mean BMI z-score was 0.16, median total difficulties score was 7, median ITC score was 48. Comparing distributions graphically (Figure 1), children with low income have a higher risk distribution for all outcomes; for example, children with low income were more likely to have BMI z-scores in the underweight and obese ranges. For each outcome, the counterfactual curve lower income children with the predictor profile of their higher income counterparts reduced inequities somewhat, particularly in the normal or low risk range, but not in the high-risk range. However, there were notable unexplained portions of inequity remaining. Conclusion In a cohort of generally healthy children, we found evidence of meaningful income-related inequities in the distribution of child zBMI, behavior difficulties, and development. Population health interventions aiming to mitigate these inequities by addressing common predictors may improve outcomes in the normal range; however targeted clinical interventions are likely required for those in the high-risk range.

Examining the interdependence of parent-child dyads: Effects on weight loss and maintenance.

This study aimed to further elucidate correlated weight changes in parent-child dyads enrolled in family-based treatment (FBT) by modeling the interdependence of weight changes during treatment. Parent-child dyads (n = 172) with overweight/obesity (child mean zBMI = 2.16 ± 0.39; parent mean BMI = 37.9 ± 9.4 kg/m2 ) completed 4 months of FBT and were randomized to one of three 8-month maintenance interventions (Social Facilitation Maintenance [SFM]-high dose, SFM-low dose or control). Weight/height was measured at 0, 4 and 12 months. Structural equation models simultaneously estimated the effect that an individual had on their own (actor effect) and on one another's (partner effect) weight-status across time using the actor-partner interdependence model. Actor paths were significant over time for parent and child. Partner paths were significant for child zBMI predicting parent BMI at 4 and 12 months. Maintenance condition moderated actor/partner paths in the model. Child weight change may motivate parents to make environmental and behavioural changes that impact their own weight. ClinicalTrials.gov Identifier: NCT00759746.

Association of parental identification of child overweight and mental health problems during childhood.

Public health policies attempt to increase parental identification of child overweight and obesity. The objective of the present research was to determine the cross-sectional, prospective and longitudinal associations between parental identification of child overweight and child mental health problems. We made use of two cohort studies of Australian (Longitudinal Study of Australian Children, LSAC) and Irish children (Growing up in Ireland Study, GUI) that measured parental identification of child overweight and child mental health problems. Participant included 6502 (LSAC) and 7503 (GUI) children (49% female) and their parents. Child mental health problems were measured using child, parent and teacher-reported Strengths and Difficulties Questionnaires (SDQ) at ages 9/10 years old to 12/13 years old. In all analyses we controlled for child Z-BMI. In LSAC children whose parents identified them as being overweight at age 10 experienced worse mental health at age 10 (β = 0.21, SE = 0.04) and age 12 (β = 0.13, SE = 0.04) than children whose parents failed to identify them as overweight. In GUI children whose parents identified them as being overweight at age 9 experienced worse mental health at age 9 (β = 0.20, SE = 0.04) and age 13 (β = 0.22, SE = 0.04). In LSAC parental identification of child overweight at age 10 did not significantly predict changes in mental health problems from age 10 to 12 (β = -0.02, SE = 0.03). In GUI parental identification of child overweight was predictive of increases in mental health problems from age 9 to 13 (β = 0.08, SE = 0.03). Parental identification of child overweight and obesity is associated with worse child mental health, independent of child body weight. Parents should be aware of the potential stigma and mental health difficulties associated with labelling a child as overweight.

Stability, Continuity, and Bi-Directional Associations of Parental Feeding Practices and Standardized Child Body Mass Index in Children from 2 to 12 Years of Age.

(1) Background: Parental feeding practices are related to child body mass index (BMI, kg/m2) and seem to be a consequence rather than cause of child BMI, but research so far is limited. Stability and continuity of feeding practices, probably explaining changes in food intake and child BMI, remain to be poorly examined. (2) Methods: Feeding practices (i.e., restriction, food as reward, pressure to eat, monitoring) assessed via the Child Feeding Questionnaire, child age, standardized BMI (zBMI), and socio-economic status were measured annually at multiple visits (range 2–8) in a population-based longitudinal cohort study of 1512 parents with their children aged 2 to 12 years. Stability, continuity, and bi-directionality of feeding practices and child zBMI were calculated using correlation coefficients, paired t tests, and cross-lagged panels, respectively. (3) Results: Feeding practices and child zBMI showed moderate to high stability. While continuity was high for restriction, minor temporal changes were observed for other feeding practices and child zBMI. Cross-lags indicated that child zBMI predicted restriction, pressure to eat, and monitoring, while food-rewarding predicted child zBMI only minorly. (4) Conclusions: Parents seem to adapt feeding practices to child zBMI with the exception of food-rewarding.

Halo or horn? A qualitative study of mothers’ experiences with feeding children during the first year following bariatric surgery

BackgroundObesity is a chronic condition that has an intergenerational effect. The aims of the study were to better understand the impact of maternal bariatric surgery on obesogenic risks to child offspring in the home via documenting mothers’ thoughts, behaviors, and experiences around child feeding, family meals, and the home food environment during her first year postsurgery. MethodUtilizing a mixed-method cross-sectional design, 20 mothers (Mage = 39.6 ± 5.7 years, 75% White, MBMI = 33.6 ± 4.3 kg/m2, Mtime = 7.7 ± 3.1 months post-surgery) of children ages 6–12 years completed validated self-report measures and participated in a focus group. Mother and child heights/weights were measured. ResultsThe majority of children (N = 20; Mage = 9.2 ± 2.3 years, 65% White, 60% female) were overweight (N = 12; BMI≥85th percentile) and were not meeting the American Academy of Pediatrics healthy eating and activity recommendations to treat/reduce obesity risk. As child zBMI increased, mothers expressed significantly more weight concern (r = 0.59, p = 0.01) and lower obesity-specific quality of life (r = −0.56, p = 0.01), yet assumed less responsibility for child eating choices (r = −0.47, p = 0.04). Qualitative data demonstrated disconnects between mothers’ changes to achieve her own healthier weight and applying this knowledge to feeding her child/family. ConclusionsWhile bariatric surgery and requisite lifestyle change are effective tools for weight loss at the individual level, there is a great need for innovative family-based solutions. Pediatric obesity is preventable or risk-diminished if addressed early. Maternal bariatric surgery may be a unique (yet missed) opportunity to intervene.