The influence of birth order and number of siblings on adolescent body composition: evidence from a Brazilian birth cohort study

Is obesity more likely among children sharing a household with an older child with obesity? Cross-sectional study of linked National Child Measurement Programme data and electronic health records

BACKGROUND/OBJECTIVES

We identified household members from electronic health records linked to National Child Measurement Programme (NCMP) data to estimate the likelihood of obesity among children living with an older child with obesity.

METHODS

We included 126 829 NCMP participants in four London boroughs and assigned households from encrypted Unique Property Reference Numbers for 115 466 (91.0%). We categorised the ethnic-adjusted body mass index of the youngest and oldest household children (underweight/healthy weight <91st, ≥91st overweight <98th, obesity ≥98th centile) and estimated adjusted ORs and 95% CIs of obesity in the youngest child by the oldest child's weight status, adjusting for number of household children (2, 3 or ≥4), youngest child's sex, ethnicity and school year of NCMP participation.

RESULTS

We identified 19 702 households shared by two or more NCMP participants (% male; median age, range (years)-youngest children: 51.2%; 5.2, 4.1-11.8; oldest children: 50.6%; 10.6, 4.1-11.8). One-third of youngest children with obesity shared a household with another child with obesity (33.2%; 95% CI: 31.2, 35.2), compared with 9.2% (8.8, 9.7) of youngest children with a healthy weight. Youngest children living with an older child considered overweight (OR: 2.33; 95% CI: 2.06, 2.64) or obese (4.59; 4.10, 5.14) were more likely to be living with obesity.

CONCLUSIONS

Identifying children sharing households by linking primary care and school records provides novel insights into the shared weight status of children sharing a household. Qualitative research is needed to understand how food practices vary by household characteristics to increase understanding of how the home environment influences childhood obesity.

Sex Differences in the Association of Sibship Size and Position in Sibship with Lipid Profile during Adolescence: A Cross-Sectional Study

BACKGROUND

Epidemiologic studies have reported associations of sibship size and position of the child in the sibship with multiple health outcomes, including adiposity and diabetes. However, little is known about sibling effects on lipids. Hence, this study sought to evaluate associations of the number of total, older, and younger siblings with lipid profile among adolescents.

METHODS

In a cross-sectional study among high school students aged 14 to 19 years, lipid levels were measured in capillary blood. Parents reported the number of siblings (total, older, and younger). Geometric means of lipids were calculated, and linear regression was used to estimate the ratio of geometric means (RoGM) and 95% confidence intervals (CI). Analyses were sex stratified.

RESULTS

Of the total study sample (n = 1,584), 758 (47.9%) were boys and 826 (52.1%) were girls, with median age of 16.0 years. Total cholesterol (TC) was lower by 8% (adjusted-RoGM = 0.92, 95% CI: 0.88-0.96) among boys with ≥3 older siblings compared to those with no older siblings. Similarly, boys with ≥3 younger sibling compared to those with no younger siblings had reduced TC by 7% (adjusted-RoGM = 0.93, 0.87-0.99). Moreover, an increased number of total siblings (≥4 vs. 0/1: adjusted-RoGM = 0.80, 0.67-97) and older siblings (≥3 vs. 0: adjusted-RoGM = 0.90, 0.82-0.98) were associated with reduced low-density lipoprotein cholesterol (LDL-C) among boys. Similarly, lower levels of triglycerides (TG) were seen among boys with ≥3 older siblings compared to those with no older siblings (adjusted-RoGM = 0.87, 0.78-0.96). A higher number of younger siblings was associated with increased high-density lipoprotein cholesterol (HDL-C) among boys (≥3 vs. 0: adjusted-RoGM = 1.08, 1.01-1.17). Sibship characteristics were not associated with lipids among girls.

CONCLUSIONS

Increased number of total, older, and younger siblings were associated with favorable lipid profiles among adolescent boys, but not girls. Mechanisms underlying these associations need further investigations.

Associations between number of siblings, birth order, eating rate and adiposity in children and adults

Eating quickly is associated with eating larger amounts at mealtimes and faster eaters tend to have a higher BMI. Evidence suggests that sibling structure influences the development of childhood eating behaviours. We hypothesized that number of siblings and birth order might play a role in the development of eating rate. In two UK studies, children in Bristol (n = 132; Study 1) and adults and children in London (adults n = 552, children n = 256; Study 2) reported their eating rate, number of siblings, and birth order. A BMI measurement was obtained and in Study 2 waist circumference was recorded. Ordered logistic regression was used to examine effects of sibling structure on eating rate and linear regression assessed effects of eating rate on BMI. Faster eating was associated with higher BMI and a larger waist, in children and adults (ps < .01). In Study 1, first-born children were twice as likely to eat faster compared to children who were not first-born (P < .04). In Study 2, only-child adults reported eating slower than adults who were not first-born (P < .003). Additionally, higher number of siblings was associated with faster eating rate in children from Bristol (P < .05), but not in children from London. London adults without siblings ate slower than those with two or more (P = .01), but having one sibling was associated with eating faster than having two or more (P = .01). These findings reveal how birth order and number of siblings might influence eating rate. Exploring these relationships through direct observation would be beneficial in future studies.

Patterns of Avoiding Nutrition Mistakes in Metropolitan Adolescents Are Associated with Sex, Nutrition Knowledge, Physical Activity, and Family Environment

A comprehensive approach to the identification of the relationship between behaviors limiting nutrition mistakes, nutrition knowledge, and physical activity in the context of the family environment has not yet been widely explored. We aim to identify patterns of avoiding nutrition mistakes in high school students from Warsaw, Poland, and to assess their associations with nutrition knowledge (NK), physical activity (PA), body mass index (BMI), demographic, and family environment characteristics. A cross-sectional study involving 616 high school students, aged 16–19, was conducted. The data were collected by distributing questionnaires. The k-means method was used for cluster analysis, and logistic regression was used to assess the adherence to identified patterns. We identified three patterns: Prudent Ones (45%), Inconsequent (39%), and Rebels (16%). About 70% of adolescents had insufficient NK. The adherence to the Rebels pattern was lower by 85 % in girls, by 68% in students with younger siblings, and was about 4.0-times higher in children of mothers with primary education, 2.4 times higher in students with insufficient NK, and 1.9-times higher in students living in a family with more than 4 persons. The groups of adolescents with feature characteristics of the Rebels and Inconsequent are possible targets for intervention and require further in-depth research to explain their lack of attempts to avoid nutrition mistakes. The results clearly indicate the necessity of including metropolitan teenage boys in effective nutritional education for the rationalization of their dietary behavior.

Adolescent physical activity, sedentary behavior and sleep in relation to body composition at age 18 years in urban South Africa, Birth-to-Twenty+ Cohort

BACKGROUND

Adolescence is marked by a decline in physical activity, rapid physical growth and changes in body composition, which have been linked to body composition. Prospective data on these associations are rare, particularly in Africa.

AIM

The aim of this study was to examine the association of longitudinal patterns across adolescent in physical activity, sedentary behavior and sleep, with anthropometry and body composition at age 18 years in urban South Africa.

METHODS

We analyzed data from the Birth-to-Twenty Plus Cohort (Bt20+), a longitudinal study of children born in 1990 in Soweto-Johannesburg, South Africa. We used general linear models to investigate the association of adolescent (ages 12 to 18 years) longitudinal trends in physical activity, sedentary behavior and schoolnight sleep and overall physical activity patterns, with body mass index (BMI), waist circumference, fat mass index (FMI), lean mass index (LMI) and percent body fat at age 18 years.

RESULTS

The final study sample included 1337 participants with anthropometric measurements (52% female) and 958 participants with body composition measurements (53% female). Males who were consistently more active and consistently walked to school over adolescence had lower waist circumference (B = - 2.0, 95% CI: - 3.9 to - 0.2), FMI (B = - 0.8, 95%: CI: - 1.2 to - 0.1) and percent body fat (B = -2.9, 95% CI: - 4.9 to - 0.9) at age 18 years than those who decreased activity and did not walk to school. Consistently-sedentary females had higher waist circumference than those whose sedentary behavior increased over adolescence (B = 5.4, 95% CI: 0.2 to 10.6). Males who reported sleeping 9 h or more per night on schoolnights had significantly lower BMI (B = -1.0, 95% CI: - 1.4 to- 0.5), and percent body fat (B = -1.5, 95%CI - 2.8 to - 0.1) than those who reported sleeping 8 h or less per night.

CONCLUSION

Patterns of adolescent physical activity, sedentary behavior and sleep are related to young-adult body composition in urban South Africa. These modifiable behaviors may be paths for public health interventions to curb overweight and obesity in many low- or middle-income countries.

Association of number of siblings, birth order, and thinness in 3- to 12-year-old children: a population-based cross-sectional study in Shanghai, China

Background

Sibship size and structure have a significant association with overweight and obesity in children, but the relationship with thinness has not been fully studied and understood, especially in Asia. This study evaluated the associations among number of siblings, birth order, and childhood thinness and investigated the association of number of younger or older siblings with childhood thinness.

Methods

In this study, we performed a population-based cross-sectional study among 84,075 3- to 12-year-old children in Shanghai using multistage stratified cluster random sampling. We defined grades 1, 2, and 3 thinness according to the body mass index cutoff points set by the International Obesity Task Force and used multinomial logistic regression models to estimate the odds ratio (OR) and 95% confidence interval (95% CI).

Results

Compared with only children, for boys, children with two or more siblings were more likely to suffer from grade 2 (OR = 1.29, 95% CI 1.02, 1.64) and grade 3 thinness (OR = 1.60, 95% CI 1.07, 2.40); and the youngest child faced a higher risk of grade 2 (OR = 1.44, 95% CI 1.09, 1.90) and grade 3 thinness (OR = 1.53, 95% CI 1.01, 2.33). For girls, children with one sibling were more likely to suffer from grade 1 thinness (OR = 1.22, 95% CI 1.05, 1.42); the oldest child, middle child, and youngest child faced a higher risk of grade 1 (OR = 1.42, 95% CI 1.09, 1.84), grade 2 (OR = 1.26, 95% CI 1.03, 1.54), and grade 1 thinness (OR = 1.87, 95% CI 1.21, 2.88) respectively. There was no statistically significant relationship, however, between a larger number of younger or older siblings and childhood thinness.

Conclusions

Regardless of sex, having either siblings or a higher birth order was positively associated with childhood thinness. The present study has suggested that future interventions to prevent childhood thinness should consider family background as an important factor, especially in multi-child-families.

Imbalance in obesity and mental health among "little emperors" in China

INTRODUCTION

Previous research has indicated that only children (i.e., those living with no siblings) have higher odds of obesity during childhood and young adulthood, compared with those living with siblings. However, little is known about whether the developing difference in overweight/obesity is accompanied by a difference in mental health (i.e., internalizing symptoms of depression and anxiety).

METHODS

The subjects for this prospective study were a randomly generated cohort of 1348 high-school students in Guangzhou, China. Participants completed assessments of anthropometric indices, lipid profiles, family-based factors, lifestyle, and internalization of symptoms (including those of depression and anxiety).

RESULTS

Compared to their peers with siblings, only children (adjusted odds ratio [aOR] = 1.68, 95% confidence interval [CI] [1.06, 2.65]) had significantly higher risk for obesity. However, only children with overweight/obesity had lower OR for depression at follow-up (aOR = 0.19, 95% CI [0.34, 0.86]), compared to individuals who were overweight/obese with siblings. This relationship was not significant for non-overweight individuals. No significant relationship between the number of siblings and anxiety at follow-up was observed, regardless of body mass index (BMI).

CONCLUSIONS

Although being an only child was significantly associated with overweight and obesity among adolescents in China, participants with history of overweight/obesity are less likely to experience symptoms of depression associated with being an only child.

Promoting Physical Activity Through Youth Sports Programs: It's Social

Youth sport is a key physical activity opportunity for children and adolescents. Several factors influence youth sport participation, including social factors, but this has not to date been clearly delineated. This study is a scoping review to survey the literature on the influence of family and peers on youth sports participation. The review identified 111 articles of which the majority were cross-sectional, included boys and girls, and were conducted primarily in the United States, Canada, Australia, and the United Kingdom. The articles were grouped into 8 research themes: (1) reasons for participation, (2) social norms, (3) achievement goal theory, 4) family structure, (5) sports participation by family members, (6) parental support and barriers, (7) value of friendship, and (8) influence of teammates. Friendships were key to both initiation and maintenance of participation, parents facilitated participation, and children with more active parents were more likely to participate in sport. Less is known on how family structure, sibling participation, extended family, and other theoretical frameworks may influence youth sport. The review suggests that social influences are important factors for ensuring participation, maximizing the quality of the experience, and capitalizing on the benefits of youth sport. Future research studies, programs, and policies promoting and developing evidence-based youth sporting experiences should consider social influences on youth sport participation.

Increased obesity risks for being an only child in China: findings from a nationally representative study of 19,487 children

OBJECTIVES

Given the rapid demographic transition and obesity growth in China, it is important to study how the large only-child population (≈100 million) might contribute to the obesity epidemic. This study evaluated associations of only-child status with weight and energy expenditure-related behaviors in China and examined how the associations may vary by sex and urbanicity.

STUDY DESIGN

Secondary analyses of nationally representative cross-sectional data from China Education Panel Survey: Junior Cohorts 2013-14, which included 19,487 students from 112 middle schools in 28 regions across China.

METHODS

We used propensity-score-weighted multilevel models to test associations between only-child status and weight outcomes.

RESULTS

Compared with sibling-sons, only-sons had higher body mass index (BMI) (Beta = 0.32, P < 0.05) and higher risks of overweight (OR = 1.24, 95% CI = [1.07-1.45]) and obesity (OR = 1.29, 95% CI = [1.02-1.64]); and spent less time on TV watching (Incidence rate ratio (IRR) = 0.89, 95% CI = [0.81-0.98]), internet use (IRR = 0.87, 95% CI = [0.79-0.96]), after-school sports (IRR = 0.91, 95% CI = [0.83-0.99]), and household chores (IRR = 0.85, 95% CI = [0.80-0.92]). Overweight/obesity risks for only-sons were particularly pronounced in urban China, where only-sons were 36% more likely to be overweight and 43% more likely to be obese than sibling-sons. Only-daughters had a higher risk of obesity (OR = 1.43, 95% CI = [1.01-2.04]) than sibling-daughters. However, the association was not significant for either urban girls or rural girls examined separately. Only-daughters in rural areas spent less time helping with household chores (IRR = 0.88, 95% CI = [0.80-0.97]) than sibling-daughters.

CONCLUSIONS

Future childhood obesity interventions should pay special attention targeting the large young only-child population in China.

Body mass index associations between mother and offspring from birth to age 18: the Fels Longitudinal Study

BACKGROUND

Parental obesity is a known determinant of childhood obesity. Previous research has shown a strong maternal influence on body mass index (BMI) during infancy and early childhood.

OBJECTIVES

The purpose of this research was to investigate the BMI associations between mother and offspring from birth to age 18 years.

METHODS

Participants were selected from the Fels Longitudinal Study. The current study sample includes 427 (215 mother/son and 212 mother/daughter) mother/child pairs. These pairs are repeatedly measured at multiple age groups in children, resulting in a total of 6,263 (3,215 mother/son, 3,048 mother/daughter) observations for data analysis. Inclusion criteria were children with measured height and weight for BMI collected at ages 0 to 18 years and their mother with BMI data. Maternal influences of BMI on offspring BMI from birth to early adulthood were analyzed by Spearman correlations and linear regression analyses.

RESULTS

Mother/son BMI correlations became statistically significant (p ≤ 0.05) at age 5-6 years and were significant through puberty and into early adulthood at age 18 years. Mother/daughter correlations became significant at age 1.5 years and also continued through adolescence, puberty and early adulthood at age 18 years. Associations persisted after the study sample was grouped into life stages and adjusted for decade of birth and parity.

CONCLUSIONS

The mother/daughter relationship was more strongly correlated than the mother/son relationship and also became statistically significant at an earlier age than boys.

Malnutrition and birth related determinants among children in Qazvin, Iran

Background

Little is known about the effect of birth weight, birth order and number of siblings on the nutritional status in children in Iran, especially in Qazvin province. The aim of this study was to provide the current data on malnutrition and birth related determinants among children in Qazvin, Iran. This study was conducted in six cities of Qazvin province (Iran), during December 2009-December 2010. Data on age, weight and height were taken and birth weight, number of children in family, birth order, parental career and educational state and family caretaker were collected by a questionnaire that a trained team filled in. Sample size was1351, almost 225 children under 6-years-old from each city participated in the study (692 boys and 659 girls). In each city, subjects were randomly selected among children who had profiles at health centers. The overall prevalence of wasting, stunting and underweight was 10.3%, 5.8% and 4.8% respectively. There was association between 'birth weight' and wasting ( P = 0.022), stunting ( P = 0.032) and underweight ( P < 0.001). A non-significant association was obtained between factors 'number of children at home' and 'birth order' with wasting, stunting and underweight. These data suggest that birth weight can influence malnutrition indicators; therefore, knowing risk factors of malnutrition in population subgroups is important for planners in country because it helps the future studies concentrate on the most determining ones.

Is the number of siblings associated with dietary patterns in adolescents? The 1993 birth cohort of Pelotas (Brazil)

Our study aimed to estimate the association between number of siblings and dietary patterns in adolescents. Prospective longitudinal study was developed using data from the birth cohort of the city of Pelotas, Brazil, which included 5249 participants. At the 18-year-old follow-up, from 4563 individuals located, 4106 were interviewed (follow-up rate 81.3%). Of these, 3751 were included in our principal component analysis of dietary patterns. Regular dietary intake of 45 food groups over the previous year was measured with a food frequency questionnaire. We identified four patterns, which accounted for 40% of the total variance in food group consumption. These were labeled "Protein and fast food", "Fruit and vegetables", "Common Brazilian", and "Sweets, soft drinks, and dairy products". Crude and adjusted analyses of the association between number of siblings and dietary patterns were performed using linear regression. The number of siblings was positively associated with a higher adherence to each dietary pattern, with the exception of the "Common Brazilian" patterns, for which there was no apparent relationship with number of siblings. The findings showed that a greater number of siblings is related to a more diverse diet in the later adolescence, which may predict better nutrient adequacy and health outcomes.