Obesity In Preschool-aged Children Research Articles

A73: Associations of Screen Time Changes with Body Mass Index and Obesity in Chinese Preschoolers

Purpose: To understand the longitudinal association of screen time (ST) and its changes on body mass index (BMI) and obesity in Chinese preschool children. Methods: Parents of 735 preschoolers participated in our studies at baseline and were followed up one year interval, in Jiaxing, China. Linear regression models and generalized linear models were used to analyze the prospective association of ST and its changes with BMI and obesity in preschool-aged children. Relative risks (RR) and 95% confidence intervals (CI) were used to describe the effect level of each factor upon BMI and obesity at follow-up. Results: A total of 624 preschoolers, including 319 boys (51.1%) and 305 girls (48.9%) were followed up. The increase of ST (from ≤1h/d at baseline to >1h/d at follow-up, β (SE)=0.45 (0.15), p=0.003) and preschoolers’ age at baseline (β (SE)=-0.21 (0.10), p=0.039) were prospectively associated with BMI in preschoolers at follow-up, and preschoolers’ ST from ≤1 h/day to >1 h/day (RR: 2.49, 95% CI: 1.20-5.08, p=0.014) were related to obesity in preschoolers at follow-up after adjusting of sex, age, primary caregiver, and one child. Conclusions: The unfavorable changes of ST were associated with BMI and obesity in preschool-aged children. Future intervention studies were needed to confirm our results.

Effects of a controlled trial of a school-based exercise program on the obesity indexes of preschool children

Exercise has been found to be effective for prevention of weight gain and maintenance of a stable weight in adults. The objective of this study was to evaluate the effect of a school-based aerobic exercise program on the obesity indexes of preschool children. Subjects were 292 second-year elementary school pupils from 2 kindergartens in Hat Yai municipality, Songkhla province, southern Thailand. A specially designed exercise program, including a 15-min walk before beginning the morning class and a 20-min aerobic dance session after the afternoon nap, 3 times a week, was conducted for 29.6 wk.Weight, height, and triceps skinfold thickness were measured 4 times. At the end of the study, the prevalence of obesity, using 95th percentile National Center for Health Statistics tricepsskinfold-thickness cutoffs, of both the exercise and control groups decreased. That of the exercise group decreased from 12.2% at baseline to 8.8% (Wilcoxon signed-rank test, P = 0.058), whereas that of the control group decreased from 11.7% to 9.7% (Wilcoxon signed-rank test,P = 0.179). A sex difference in the response of body mass index (BMI) to exercise was observed. Girls in the exercise group had a lower likelihood of having an increasing BMI slope than the control girls did (odds ratio: 0.32; 95% CI: 0.18, 0.56). In conclusion, our study suggests that a 29.6-wk school-based exercise program can prevent BMI gain in girls and may induce a remission of obesity in preschoolage children. Am J Clin Nutr 1998;68:1006–11.

Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized controlled trial

BackgroundChildhood overweight and obesity is a public health priority. We have previously reported the efficacy of a parent-oriented mobile health (mHealth) app-based intervention (MINISTOP 1.0) which showed improvements in healthy lifestyle behaviors. However, the effectiveness of the MINISTOP app in real-world conditions needs to be established.ObjectiveTo evaluate the real-world effectiveness of a 6-month mHealth intervention (MINISTOP 2.0 app) on children’s intake of fruits, vegetables, sweet and savory treats, sweet drinks, moderate-to-vigorous physical activity, and screen time (primary outcomes), and on parental self-efficacy (PSE) for promoting healthy lifestyle behaviors, and children’s body mass index (BMI) (secondary outcomes).MethodsA hybrid type 1 effectiveness-implementation design was utilized. For the effectiveness outcomes, a two-arm, individually randomized controlled trial was conducted. Parents (n = 552) of 2.5-to-3-year-old children were recruited from 19 child health care centers across Sweden, and, randomized to either a control (standard care) or intervention group (MINISTOP 2.0 app). The 2.0 version was adapted and translated into English, Somali and Arabic to increase reach. All recruitment and data collection were conducted by the nurses. Outcomes were assessed at baseline and after six months, using standardized measures (BMI) and a questionnaire (health behaviors, PSE).ResultsAmong the participating parents (n = 552, age: 34.1 ± 5.0 years), 79% were mothers and 62% had a university degree. Twenty-four percent (n = 132) of children had two foreign-born parents. At follow-up, parents in the intervention group reported lower intakes of sweet and savory treats (-6.97 g/day; p = 0.001), sweet drinks (-31.52 g/day; p < 0.001), and screen time (-7.00 min/day; p = 0.012) in their children compared to the control group. The intervention group reported higher total PSE (0.91; p = 0.006), PSE for promoting healthy diet (0.34; p = 0.008) and PSE for promoting physical activity behaviors (0.31; p = 0.009) compared to controls. No statistically significant effect was observed for children’s BMI z-score. Overall, parents reported high satisfaction with the app, and 54% reported using the app at least once a week.ConclusionChildren in the intervention group had lower intakes of sweet and savory treats, sweet drinks, less screen time (primary outcomes) and their parents reported higher PSE for promoting healthy lifestyle behaviors. Our results from this real-world effectiveness trial support the implementation of the MINISTOP 2.0 app within Swedish child health care.Trial registrationClinicaltrials.gov NCT04147039; https://clinicaltrials.gov/ct2/show/NCT04147039

Meta-analysis of lifestyle modification interventions addressing overweight and obesity in preschool-age children.

Increased rates of pediatric obesity extend into early childhood. There have been increasing calls for intervention programs specifically designed to address obesity in preschool-age youth. A review of the literature is critical to guide intervention and future research. The objective of this study was to conduct a meta-analysis of randomized, controlled trials examining the efficacy of lifestyle modification interventions to address overweight and obesity in preschool-age children. Six electronic databases were searched for articles through December 8, 2020. After screening articles for inclusion criteria, 14 articles with 12 randomized, controlled trials (41 effect sizes, 2,525 participants) were included in this meta-analysis. Weighted-standardized mean differences for body mass index-related variables were calculated using random-effects models to estimate effect sizes. Risk of bias assessment was conducted. There was a statistically significant impact of the interventions on child weight outcomes. Cohen's d was .32 (95% CI [.09, .55]). The quality of evidence was assigned a "low" GRADE rating. Lifestyle modification interventions for overweight and obesity in preschool-age children produce small but significant changes in child weight status. However, few new trials have been published in the last 5 years and the quality of evidence in this area is low, limiting confidence in the estimates and the power to examine potential moderator effects. Additional quality, randomized, control trials that report study information consistent with consort guidelines, use intent-to-treatment procedures, assess and report health behaviors and treatment adherence to explore mechanisms of change, and examine sustained effects of interventions are needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Early Nutritional Education in the Prevention of Childhood Obesity.

Early childhood is a critical period for obesity prevention. This randomized controlled study evaluated the effectiveness of an educational intervention preventing obesity in preschool-age children. A nutritional education intervention, with a follow-up session one year later, was conducted with parents of children aged 3 to 4 years of public schools in the province of Málaga. The main outcome variable was the body mass index z-score (zBMI). The prevalence of overweight or obesity was the secondary outcome variable. The sample comprised 261 students (control group = 139). Initial BMI, weight, height-for-age and prevalence of overweight and obesity were similar for both groups. After the first year of the intervention, the zBMI of the intervention group decreased significantly from 0.23 to 0.10 (p = 0.002), and the subgroup of patients with baseline zBMI above the median decreased from 1 to 0.72 (p = 0.001), and in the second year from 1.01 to 0.73 (p = 0.002). The joint prevalence of overweight and obesity increased in the control group (12.2% to 20.1%; p = 0.027), while in the intervention group, there were no significant changes. This preschool educational intervention with parents improved their children’s BMI, especially those with a higher BMI for their age, and favored the prevention of overweight or obesity.

Supplemental Material for Meta-Analysis of Lifestyle Modification Interventions Addressing Overweight and Obesity in Preschool-Age Children

Supplemental Material for Meta-Analysis of Lifestyle Modification Interventions Addressing Overweight and Obesity in Preschool-Age Children

MINISTOP 2.0: a smartphone app integrated in primary child health care to promote healthy diet and physical activity behaviours and prevent obesity in preschool-aged children: protocol for a hybrid design effectiveness-implementation study

BackgroundChildhood obesity is still a major health problem in many countries, including Sweden. Childhood obesity and obesity-related behaviours in childhood, such as low physical activity and unhealthy eating habits, tend to track into adulthood, which highlights the need for early prevention. Our aims are to evaluate whether a parent-oriented mobile health app (the MINISTOP 2.0 app) integrated into primary child health care can improve diet and physical activity behaviours and reduce the prevalence of overweight and obesity in preschool-aged children as well as to evaluate the implementation among child health care nurses and parents.MethodsThis trial uses a hybrid type 1 effectiveness-implementation design. Families (n = 500) who attend a routine visit to one of 15–20 primary child health care centres throughout Sweden, when their child is 2.5 years, are offered participation in a randomised controlled trial (effectiveness evaluation). After acceptance, families will be randomised (1:1) to control or intervention groups. The intervention group receives a 6-month parent-oriented smartphone intervention aimed at improving the dietary and activity behaviours of their child (the MINISTOP 2.0 app) and the control group receives routine child health care. Dietary habits, physical activity and screen time (primary outcomes), body weight and height in children, and parental self-efficacy (secondary outcomes) are measured at baseline and at 6 months post randomisation. Implementation outcomes (i.e. perceived acceptability, appropriateness, and feasibility) of the intervention will be assessed among primary child health care nurses and parents in the trial through questionnaires and qualitative interviews.DiscussionThis trial will evaluate whether the MINISTOP 2.0 app can be used in primary child health care to improve diet and physical activity behaviours, and prevent overweight and obesity, in preschool-aged children. If effectiveness is proven, and the MINISTOP 2.0 app is considered acceptable, appropriate and feasible, it can be implemented nationally as part of the preventive strategies to combat childhood obesity provided by routine child health care.Trial registrationThe trial was registered at the Clinicaltrials.gov register platform (ID NCT04147039) on 31 October 2019.

Breastfeeding History, Preschool Children’s Sleep, and Obesity

ABSTRACT Breastfeeding and sleep are both considered medically and physiologically protective factors for child health. Most existing research studied their impact on child health outcomes, respectively. Few studies examined the two factors collectively to explore any potential associations among a history of breastfeeding and quantity of sleep in children and child health. This study sought to uncover the association among breastfeeding history, the amount of sleep, and obesity in preschool-aged children to provide additional insights into their protective physical and psychological effects on health outcomes. As part of a larger study examining obesity in preschool children, the current investigation explored the association among obesity, a history of breastfeeding, and the total number of hours of preschool children’s sleep, as reported by parents. Actual heights and weights were collected on a total of 1,693 children 3–5 years of age enrolled in licensed child care facilities in Mississippi. Descriptive analyses of the demographic and parent survey variables were conducted to explore the status related to breastfeeding in Mississippi. To understand the relationships between breastfeeding and covariates, bivariate analyses such as chi-square independent tests, Cochran-Mantel-Haenszel chi-square tests, and Fisher’s exact tests were performed. Obesity was negatively correlated to breastfeeding, and Caucasian mothers were significantly more likely to breastfeed than African American mothers. Obesity was also negatively correlated to the amount of sleep, and African American children reportedly slept significantly less than Caucasian children. The average amount of time of sleep reported for children with a history of being breastfed was significantly higher than for those who were not breastfed, suggesting that breastfeeding could have a significant positive association with preschool children’s sleep, serving as an additional protective factor obesity. The interaction between breastfeeding and subsequent sleep as children mature is an important area for future research to fully explore their foundational impact in family health practices that combat obesity in children and promote other subsequent health outcomes.

Trends and Prevalence of Overweight and Obesity among Children Aged 2–7 Years from 2011 to 2017 in Xiamen, China

Background: Childhood overweight and obesity have become some of the most serious public health problems in the 21st century and have a significant impact on affected children as they grow into adulthood. Objective: The purpose of this study was to evaluate the overweight and obesity status and their main influencing factors in preschool children aged 2–7 years in urban areas of China between 2011 and 2017. Methods: A stratified cluster random sampling method was used to conduct a sample survey of children aged 2–7 years in Xiamen, one of China’s five special economic zones. The 56,738 participants (29,444 boys, 27,294 girls) were examined at three time points (15,757 in 2011, 19,098 in 2014, and 21,883 in 2017), and were analyzed for factors influencing obesity. Results: Between 2011 and 2017, the prevalence of overweight and obesity in preschool children between 2 and 7 years old was 10.91 and 5.66%, respectively. The overweight and obesity rates were higher in boys (11.85 and 7.11%) than in girls (9.90 and 4.09%), and the difference was statistically significant (p < 0.01). In the past 7 years, the overweight and obesity rates showed a downward trend in both boys and girls (p < 0.01). The peak ages for overweight were 6 years in boys and 2 years in girls, while the obesity rate peaked at 6 years. In those children with obesity, the proportion of those with moderate to severe obesity decreased from 40.70% in 2011 to 32.80% in 2017. Multiple stepwise regression analysis showed that children who were averse to sports activities preferred greasy foods and had earlier introduction of solid foods as infants, as well as those who were born at a high birth weight, ate fast, and those with parents with obesity were more likely to have obesity themselves (p < 0.05). Conclusions: Although preventative and control measures for childhood obesity have achieved initial results, Chinese preschool children remain to have high levels of overweight and obesity. It is therefore necessary to strengthen monitoring of overweight and obesity in preschool-aged children and implement appropriate interventions when necessary.

Overweight and obesity in preschool aged children and risk of mental health service utilization.

To determine if overweight or obesity in preschool-age children is associated with mental health service utilization in later childhood. Overall, 10,522 children 2 to <5 years, with no previous history of mental health service utilization, were identified from primary care electronic medical records (EMRs) across Ontario, Canada. This was a retrospective longitudinal cohort study. Height and weight data were extracted and body mass index z-scores (zBMI) were calculated using the World Health Organization Growth Standards. Mental health service utilization, between ages 5 and <19, was defined using administrative billing codes for mental health outpatient visits, emergency department visits, and hospitalizations. A multivariable Cox proportional hazards model was performed. In total, 74.9% of children were healthy weight (zBMI between -2 and ≤1), 18.8% of children were at risk of overweight (zBMI between 1 and ≤2), 4.9% were overweight (zBMI > 2 and ≤3), and 1.5% had obesity (zBMI > 3). The median follow-up time was 2.2 years (IQR 1.0-4.2). The overall incidence rate of mental health service use was 44.5 events per 1000 person-years. The hazard ratio for girls with obesity was 2.73 (95% CI 1.62-4.60; p < 0.001) compared to girls with healthy weight. Compared to boys with healthy weight, boys 'at risk of overweight' and overweight were 1.22 (95% CI 1.03-1.44; p = 0.02) and 1.43 (95% CI 1.09-1.87; p = 0.01) times at higher risk of an incident mental health visit. Our study shows an association between weight status in preschool school aged children and higher incidence of mental health service use in later childhood. This relationship was strongest in girls. Future research is needed to understand this relationship by mental health diagnosis, sex, and age.

Developing a patient-centered outcome for targeting early childhood obesity across multiple stakeholders

BackgroundPatient-centered outcome measures for childhood obesity are limited. Identifying outcomes that patients and families consider important could be a viable avenue for better engagement of patients and interventions that are efficacious and acceptable to patients. Latino children experience high rates of obesity, and under-recognition of obesity in preschool aged children is common.MethodsWe used growth chart data to identify low-income, Latino children 2–5 years of age with obesity who decreased their adiposity (positive deviants) and a set of controls. We used qualitative interview data to identify themes around goals parents used in addressing weight. Then, we applied a modified Delphi approach across groups of caregivers and providers to identify common goals. We conducted focus groups to explore conflicts and congruency between caregivers and providers related to goals. Using the focus group data, we developed a decision tool for use between patients and providers relevant for early childhood obesity.ResultsWe identified 257 children who successfully reduced adiposity (positive deviants) from 1621 eligible growth charts. From interviews with 44 parents (21 positive deviants and 23 controls), we coded and categorized outcomes such as increased happiness, clothing size and improved activity. We recruited 81 parents, grandparents and health care providers to participate in the modified Delphi process of ranking outcomes by importance and feasibility. Focus groups (2, total n = 24) suggested potential methods for a common framework to discuss goals, including a modified growth chart. We created a decision-tool that incorporated a growth chart and a section for discussion of patient-centered goals. A final focus group (1, n = 10) provided feedback on the tool as acceptable and potentially useful.ConclusionsThe development of a patient-centered tool around achieving a healthy weight in early childhood identified common goals between providers and parents. While the tool has been developed, prospective testing of this patient-centered tool and its effects on engagement, parent motivation, and behavior change would be a useful next step.

Overweight and Obesity in Early Childhood A Systematic Review of Individual, Family, and Peer Risk Factors

Purpose: The prevalence of children who are overweight or obese has been increasing worldwide. While a variety of biological as well as sociodemographic correlates have been identified and reviewed, a systematic review of psychosocial factors, particularly among preschool aged children, is lacking. This systematic review synthesizes the research on individual, family and peer risk factors for overweight and obesity in preschool aged children. Method: A systematic review of the recent literature on psychosocial factors and overweight or rather obesity in the early stages of childhood was conducted. Results: A total of 27 studies from 2011-2016 were identified that examined individual, family and social risk factors for obesity in children. Results indicate the importance of eating regulation as well as family factors in understanding early childhood risk for obesity. There was mixed support for associations between behavioral and emotional symptoms and obesity among this age group. For other risk factors examined, too few studies exist to be able to make strong conclusions about their relevance for understanding preschool obesity risk. Conclusions: Psychosocial factors are associated with overweight and obesity among preschool aged children. However, this review also highlights the dearth of research on several potentially important risk factors for childhood obesity in this age group (such as family violence, parental and peer relationships). Longitudinal studies, which examine multiple risk factors simultaneously over this important developmental period, are sorely needed.

Assessing Challenges in Low-Income Families to Inform a Life Skills-Based Obesity Intervention.

This article describes the formative research undertaken to explore challenges of low-income parents of 3-to 5-year-olds to inform a parent-focused life skills-based intervention to prevent obesity in preschool-aged children. A total of 40 parents completed surveys, 30 parents participated in focus groups, and 5 community stakeholders participated in individual interviews. In each data mode, participants were asked to prioritize a list of challenges centered on parenting, family care, and self-care. Survey data were analyzed descriptively using SAS, while focus groups and interviews were analyzed for emerging themes using ATLAS.ti. Parents reported needing strategies for managing children's behavior around picky eating, limits/boundaries, tantrums, and routines. Challenges with child behavior management were compounded by parents' inability to find affordable fun family activities outside the home and difficulties in communicating childrearing expectations to coparents/relatives who assisted with child care. Added to these were other competing priorities (e.g., financial) that led to the neglect of self, including the inability to find "me" time, build relationships, and care for one's health. Interventions that address parenting, family care and self-care challenges of low-income parents may enhance resilience and support positive changes that can promote healthy development in children, including obesity prevention.

Weighing in on international growth standards: testing the case in Australian preschool children.

Overweight and obesity in preschool-aged children are major health concerns. Accurate and reliable estimates of prevalence are necessary to direct public health and clinical interventions. There are currently three international growth standards used to determine prevalence of overweight and obesity, each using different methodologies: Center for Disease Control (CDC), World Health Organization (WHO) and International Obesity Task Force (IOTF). Adoption and use of each method were examined through a systematic review of Australian population studies (2006-2017). For this period, systematically identified population studies (N=20) reported prevalence of overweight and obesity ranging between 15 and 38% with most (n=16) applying the IOTF standards. To demonstrate the differences in prevalence estimates yielded by the IOTF in comparison to the WHO and CDC standards, methods were applied to a sample of N=1,926 Australian children, aged 3-5years. As expected, the three standards yielded significantly different estimates when applied to this single population. Prevalence of overweight/obesity was WHO - 9.3%, IOTF - 21.7% and CDC - 33.1%. Judicious selection of growth standards, taking account of their underpinning methodologies and provisions of access to study data sets to allow prevalence comparisons, is recommended.

Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial ,

Background: Traditional obesity prevention programs are time- and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined.Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y.Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed.Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean ± SD: -0.23 ± 0.56 compared with -0.20 ± 0.49 kg/m2). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+0.36 ± 1.47 compared with -0.06 ± 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m2) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008).Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted. This trial was registered at clinicaltrials.gov as NCT02021786.

Maternal History of Child Abuse and Obesity Risk in Offspring: Mediation by Weight in Pregnancy.

Women's experience of childhood adversity may contribute to their children's risk of obesity. Possible causal pathways include higher maternal weight and gestational weight gain, which have been associated with both maternal childhood adversity and obesity in offspring. This study included 6718 mother-child pairs from the National Longitudinal Survey of Youth 1979 in the United States (1979-2012). We applied multiple log-binomial regression models to estimate associations between three markers of childhood adversity (physical abuse, household alcoholism, and household mental illness) and offspring obesity in childhood. We estimated natural direct effects to evaluate mediation by prepregnancy BMI and gestational weight gain. Among every 100 mothers who reported physical abuse in childhood, there were 3.7 (95% confidence interval: -0.1 to 7.5) excess cases of obesity in 2- to 5-year olds compared with mothers who did not report physical abuse. Differences in prepregnancy BMI, but not gestational weight gain, accounted for 25.7% of these excess cases. There was no evidence of a similar relationship for household alcoholism or mental illness or for obesity in older children. In this national, prospective cohort study, prepregnancy BMI partially explained an association between maternal physical abuse in childhood and obesity in preschool-age children. These findings underscore the importance of life-course exposures in the etiology of child obesity and the potential multi-generational consequences of child abuse. Research is needed to determine whether screening for childhood abuse and treatment of its sequelae could strengthen efforts to prevent obesity in mothers and their children.

Risk factors for obesity in preschool-aged children in China.

To examine the relationship between child, mother, and environmental factors and increased body mass index in preschool-aged children in China. There are about 120 million children in China are classified as overweight or obese. Understanding the key factors associated with childhood obesity (i.e. child, mother and environment) is the first step in combating the growing obesity epidemic in China, as well as in the global community, where large numbers of Chinese immigrants can be found. A cross-sectional design was used. Each child's weight and height were measured by trained assistants, whereas mothers were asked to complete several questionnaires including family demographic, family eating and activity habit and child feeding practices. Mothers also reported their own as well as the father's height, weight and waist circumference. Linear regression models were used. The overweight and obesity prevalence was 22% for children, 7% for mothers and 82% for fathers. Children spent an average of 1.2h (72min) engaged in physical activities and 0.76h (46min) in sedentary time including TV watching or computer and video games playing per day. Factors associated with a child's higher body mass index included maternal beliefs regarding the child's susceptibility to obesity, their own susceptibility to obesity, a child's more advanced age and more unhealthy food stimulus exposure at home. Because a mother's health behaviours may influence their child's health behaviours and they are a crucial model for the family and children, childhood obesity prevention needs to include mothers and focus on building a healthy home environment for the family. Understanding factors associated with childhood obesity can assist researchers and clinicians to develop culturally sensitive and evidence-based programmes and policy to reduce this global epidemic.

Association of childcare arrangement with overweight and obesity in preschool-aged children: a narrative review of literature.

The time children spend in childcare overlaps with daily meals and opportunities to be active. Thus these environments have the opportunity to promote-or hinder-healthy weight gain among children who attend them. The purpose of this narrative review was to compile findings from studies examining childcare type and weight outcomes among preschool-age children. A literature search was conducted using PubMed, PsychInfo and ERIC. Inclusion criteria were infant- to 5-year-old children exposed to any type of childcare with a cross-sectional or longitudinal weight outcome. Among 385 studies screened, 18 were included. For comparison across studies, type of childcare was categorized as: childcare center, Head Start, nanny/babysitter, non-relative care/family childcare home and relative care. Four studies found no association with childcare type and obesity, and 10 studies reported mixed results by type of care or subpopulation analyses. Two studies found an overall positive association, and two reported an inverse association. There were differences in direction of associations and findings by type of care arrangement. For Head Start, three of eight studies demonstrated a negative relationship with obesity; none demonstrated a positive association. No other childcare type demonstrated this inverse association. Informal types of care (relative and non-relative care in a home) were positively associated with child obesity in 3 of 10 studies. This association was less commonly reported among formal childcare centers (2 of 15 studies). The majority of studies, however, reported mixed findings or no association by childcare type. Results suggested no consistent evidence for a relationship between childcare and obesity risk, except Head Start. This review exposed the need for a consistent definition of childcare type and the exploration of unmeasured confounders, such as the nutrition and physical activity environment of childcare settings, to understand how they contribute to or protect against the development of overweight/obesity among children.

The Relationship between Maternal Pre-Pregnancy BMI and Preschool Obesity

The increasing prevalence of obesity during pregnancy raises concerns over the intergenerational transmission of obesity and its potential to exacerbate the current obesity epidemic. The fetal origins hypothesis posits that the intrauterine environment might have lasting effects on children's outcomes. A large literature establishes that mother's pre-pregnancy obesity is correlated with obesity in her children. However, previous research is largely based on comparing individuals across families and hence cannot control for unobservable factors associated with both maternal and child obesity. We use both within-family comparisons and an instrumental variable approach on a sample of 4435 children to identify the effect of maternal pre-pregnancy obesity on obesity in preschool-aged children. Consistent with extant research, OLS models that rely on across-family comparisons indicate a significant correlation between maternal pre-pregnancy obesity and preschool obesity. However, maternal fixed effects render those associations insignificant. Instrumenting for mother's BMI with her sisters' BMI values confirms the null result indicating that the in utero transmission of obesity is likely not driving the increase in childhood obesity.

Obesity in Preschool-Aged Children with Sickle Cell Anemia: Emerging Nutritional Challenge in a Resource Limited Setting

Background: The burden of childhood obesity is increasing in most developing countries particularly in the urban areas owing to globalization; and children with sickle cell anemia (SCA) in such environment do not live in isolation. The study is aimed at determining the prevalence of obesity in younger children with SCA. Methods: A consecutive recruitment of 58 children with SCA aged between 1 year and 5 years 4 months (subjects) and their age and sex matched controls selected using multistage sampling technique were carried out. The weight and height of the children were obtained using standard equipment. The WHO Anthro and Anthro-Plus software were used for analyzing the nutritional status of the children based on standard deviation (z-scores). The data were analyzed using SPSS version 19.0 while the level of significance was set at p < 0.05. Results: The mean BMI for the subjects was 15.38 ± 1.93 (range from 11.50–20.80) and 17.10 ± 2.28 (range from 13.4–23.20) in the controls. Overweight (z-score > + 1≤2) and obesity (z score >+2) were recorded in 10 (17.2%) and 2 (3.4%) of the subjects while in the controls overweight and obesity were observed in 16 (27.6%) and 13 (22.4%), respectively (p = 0.000). Conclusions: Obesity and overweight is becoming prevalent among children with SCA and so awareness and preventive health education about obesity should be created among caregivers of children with sickle cell anemia in our setting to avert its possible complications