The midlife health of only children: chronic disease indicators and biomarkers by sibship size in three nationally representative UK cohorts

BACKGROUND

Despite persistent concerns about only children's disadvantage relative to individuals with siblings, existing health-related evidence is inconsistent. Recent evidence from Nordic countries about only children having poorer health outcomes may not apply elsewhere because selection processes differ across contexts. We investigate the midlife health of only children in the UK where one-child families tend to be socio-economically advantaged relative to large families.

METHODS

Using the 1946, 1958 and 1970 British birth cohort studies, we examine various biomarkers and self-reported measures of chronic disease by sibship size when respondents are aged in their mid-40s, mid-50s and mid-60s. We estimate separate linear probability models for each cohort, age and outcome, adjusting for childhood and early adulthood circumstances.

RESULTS

We found no evidence of only children differing from those with one, two or three or more siblings, at any age, in any of the cohorts, on: heart problems, hypertension, high triglycerides, high glycated haemoglobin or high C-reactive protein. However, compared with only children, the probability for cancer (0.019, 95% confidence interval [CI]: 0.002, 0.035; age 46/1970) and poor general health (0.060, CI: 0.015, 0.127; age 55/1958; and 0.110, CI: 0.052, 0.168; age 63/1946) was higher among those with three or more siblings.

CONCLUSIONS

There is no consistent pattern of only child health disadvantage for midlife chronic disease outcomes across ages or cohorts in the UK. Research should focus on better understanding how sibship size differentials are contingent on context.

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.

Food Parenting Practices and Child Eating Behaviors in Australian Families: A Cross-Sectional Sibling Design

BACKGROUND

Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.

OBJECTIVE

Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviors.

DESIGN

A cross-sectional online survey was conducted between October and December 2022.

PARTICIPANTS/SETTING

Data were collected from parents (97.5% women) in Australia with 2 children aged 2 to 5 years (n = 336 parents and n = 672 children).

MAIN OUTCOME MEASURES

Survey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire and seven subscales of the Feeding Practices and Structure Questionnaire-28.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviors and food parenting practices, adjusting for differences in child body mass index z score, age, gender, and early feeding method.

RESULTS

Within-sibling pair differences in eating behaviors were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behavior, and less of the structure-based practice, family meal settings (P values < 0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (P values < 0.007); however, no significant differences in reward for behavior were observed in relation to sibling differences in these eating behaviors. For the more food responsive sibling, parents reported using more control-based practices, including reward for behavior and overt restriction (P values < 0.002).

CONCLUSIONS

Within families, parents may adapt certain practices in response to differences in their children's eating behaviors. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.

Health-related behaviors and weight-related outcomes within sibling pairs: A systematic review

BACKGROUND

Siblings reciprocally contribute to mutual social and physical development. The aim of this review was to examine the health-related behaviors and weight-related outcomes within child-sibling pairs and to determine how these factors vary by sibling composition.

METHODS

Following the PRISMA guidelines, a systematic review of studies published since 2000 obtained from MEDLINE, CINAHL, PubMed, Cochrane Reviews, Web of Science, PsycINFO, Health and Wellness, and Science Direct was performed. The eligibility criteria for inclusion were: 1) peer-reviewed and published in English; 2) included children ages 2 to 20 and their siblings; and 3) explored health-related behaviors (i.e., diet) and/or weight-related outcomes (i.e., body weight) within child-sibling dyads.

RESULTS

A total of 13 studies were included in the review. The study findings are summarized according to three major themes: 1) sibling concordance in health-related behaviors and weight-related outcomes, 2) differences in health-related behaviors within weight-concordant/weight-discordant sibling dyads, and 3) influence of sibling composition on health-related behaviors and weight-related outcomes.

CONCLUSIONS

Family-based interventions for childhood obesity may benefit from including siblings as key family members in promoting children's health-related behaviors and preventing excessive weight gain. Future studies should explore variable sibling dynamics (e.g., adoptive siblings) in more culturally/racially diverse families to further explore the role of a sibling in a child's health.

IMPLICATIONS TO PRACTICE

The findings of this study may help healthcare providers in developing effective family-based obesity interventions for families with more than one child in their household.

The Influence of Parent’s Education, Birth order and Number of Siblings on Adolescents’ BMI.. [DOI: 10.21203/rs.3.rs-2879484/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Obesity in adolescents show high prevalence specially in developing countries. Although birth order and sib size have been mathematically coupled and in spite of their respective effect on both overweight and obesity, they have not been estimated before separately. Moreover, the educational achievement of parents might have impact on their children’s nutritional status. Objective This study aims to assess how birth order and number of siblings affect adolescent obesity risk and to examine the impact of parent’s education on adolescent obesity, the results will indicate which family members may be prioritized for inclusion in adolescent obesity prevention programs. Methodology A self-administered questionnaire was used to collect data on individuals aged 10 to 18 years old, including sex, age, birth weight, birth order, number of siblings, lifestyle, and parents' educational level by a self-administered questionnaire completed by an adult member of the family, while measurements of subjects’ height and weight were done in the clinic of nutrition and immunity. The CDC's BMI cut-off points were used to classify the subjects as normal (5–84th percentile) and obese (≥ 95th percentile). Results Distribution of the number of siblings was different in both groups as regards BMI but statistically insignificant, we found no statistically significant difference on correlating birth order and number of siblings. Conclusion Adolescent’s BMI were driven by neither the sibling was (younger or older) nor number of their siblings. There was no significant association between parental education and the development of obesity.

The joint associations of high birth weight and not having siblings with metabolic obesity phenotype among school-aged children and adolescents: A National Survey in China

OBJECTIVE

Birth weight (BW) and sibling's status are two important indicators of early intrauterine environment and subsequent living environment, but no evidence has emerged on their joint associations on metabolic obesity phenotype. To determine the joint associations between BW and single-child status with childhood metabolic obesity phenotype was our purpose.

METHODS

A cross-sectional assessment of children and adolescents aged 7-18 years was performed in Chinese seven provinces in 2013. We obtained anthropometric, blood pressure and biochemical measurements, and distributed questionnaires covering demographic, neonatal and lifestyle characteristics. The metabolic obesity phenotype was defined by 2018 consensus-based criteria. Logistic regression and restricted cubic spline models were applied to evaluate the associations of BW and metabolic obesity phenotype, and estimate the multiplicative interactions and the combined associations of BW and single-child status with metabolic obesity phenotype.

RESULTS

Of enrolled 12 346 children and adolescents, the prevalence of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) was 1.96% and 3.03%. There were 8.95% and 4.03% children with high BW or low BW, and 67.55% did not have siblings. High BW was positively associated with MHO (OR = 1.94, 95%CI = 1.28-2.94). Single-child also had increased odds of MHO and MUO (p < 0.05), and it had joint associations with high BW showing 0.85- to 2.58-fold higher odds of MUO and MHO.

CONCLUSIONS

High BW and single-child status have joint positive associations with the subsequent odds of MHO and MUO, which should be jointly prevented through earlier screening and subsequent preventive strategies.

Health outcomes of only children across the life course: An investigation using Swedish register data

Only children (with no full biological siblings) are a growing subgroup in many high-income settings. Previous studies have largely focused on the short-term developmental outcomes of only children, but there is limited evidence on their health outcomes. Using Swedish population register data for cohorts born 1940-75, we compare the health of only children with that of children from multi-child sibling groups, taking into account birth order, family size, and presence of half-siblings. Only children showed lower height and fitness scores, were more likely to be overweight/obese in late adolescence, and experienced higher later-life mortality than those with one or two siblings. However, only children without half-siblings were consistently healthier than those with half-siblings, suggesting that parental disruption confers additional disadvantages. The health disadvantage was attenuated but not fully explained by adjustment for parental characteristics and after using within-family maternal cousin comparison designs.

Sibling group size and BMI over the life course: Evidence from four British cohort studies

Only children, here defined as individuals growing up without siblings, are a small but growing demographic subgroup. Existing research has consistently shown that, on average, only children have higher body mass index (BMI) than individuals who grow up with siblings. How this difference develops with age is unclear and existing evidence is inconclusive regarding the underlying mechanisms. We investigate BMI trajectories for only children and those with siblings up to late adolescence for four British birth cohorts and across adulthood for three cohorts. We use data on BMI from ages 2-63 years (cohort born 1946); 7-55 years (born 1958); 10-46 (born 1970) and 3-17 years (born 2000-2002). Using mixed effects regression separately for each cohort, we estimate the change in BMI by age comparing only children and those with siblings. The results show higher average BMI among only children in each cohort, yet the difference is substantively small and limited to school age and adolescence. The association between sibling status and BMI at age 10/11 is not explained by differential health behaviours (physical activity, inactivity and diet) or individual or family background characteristics in any of the cohorts. Although persistent across cohorts, and despite the underlying mechanism remaining unexplained, the substantively small magnitude of the observed difference and the convergence of the trajectories by early adulthood in all cohorts raises doubts about whether the difference in BMI between only children and siblings in the UK context should be of research or clinical concern. Future research could usefully be directed more at whether only children experience elevated rates of disease, for which high BMI is a risk factor, at different stages of the life course and across contexts.

Cross-national variation in the association between family structure and overweight and obesity: Findings from the Health Behaviour in School-aged children (HBSC) study

Background

Trends of increased complexity in family structure have developed alongside increasing prevalence of overweight and obesity. This study examines cross-national variations in the likelihood of living with overweight and obesity among adolescents living with one parent versus two parents, as well as the influence of living with stepparents, grandparents and siblings. Furthermore, the study explores how these associations relate to age, gender and individual-level socioeconomic status (SES) and country-level SES. We hypothesised that adolescents living in one-parent versus two-parents families, were more likely to live with overweight and obesity.

Methods

The study is based on nationally representative data from 41 countries participating in the 2013/14 Health Behaviors in School-Aged Children study (n = 211.798). Multilevel logistic regression analysis was used to examine the associations between family structure and overweight and obesity by age, gender, SES, and geographic region, among adolescents aged 11, 13 and 15 years.

Results

Living with one versus two parent(s) was associated with a higher likelihood of overweight and obesity (ORadj.1.13, 95%CI 1.08,1.17). Age, gender, individual-level SES, and living with grandparents were also associated with a higher likelihood of overweight and obesity, whereas living with siblings was associated with a lower likelihood of overweight and obesity. The effect of family structure varied also by age and gender with no significant associations found between living with one parent and overweight and obesity in the 15-year-old age group. Some cross-national variation was observed, and this was partly explained by country-level SES. The effect of family structure increased by a factor 1.08 per one-unit change in country-level SES (OR 1.08, 95%CI1.03, 1.12).

Conclusion

The study indicates that living in a one-parent family, as well as living together with grandparents, are associated with overweight and obesity among adolescents, particularly in the Nordic European region. Existing welfare policies may be insufficient to eliminate inequalities related to family structure differences.

Having siblings promotes a more healthy weight status—Whereas only children are at greater risk for higher BMI in later childhood

Background

Birth order and having at least one sibling are known to be associated with an increased risk for development of overweight. However, there are no studies assessing pre- and postnatal factors for developing overweight within families. Therefore, the present study aimed to analyse the association of the mother’s weight gain during pregnancy, prepregnancy BMI, mother’s age at birth, breastfeeding, age gap between siblings, and physical activity together with sibling-related characteristics on the development of overweight in children and adolescents.

Methods

Data were obtained from the longitudinal LIFE Child cohort. The study sample included n = 1932 children, stratified into first-born (n = 578), second-born (n = 608), third-or-later-born single-born siblings (n = 162), only children (n = 526), and twin children (n = 58). Children with chronic or syndromic diseases, born prematurely or from mothers with gestational diabetes were excluded. Data were adjusted for multiple children per family using mixed models. Pregnancy weight gain, prepregnancy BMI and mother’s age were considered prenatal co-variates. Postnatal factors included the duration of breastfeeding and the children’s physical activity level.

Results

Particularly until the onset of puberty, the BMI-SDS differed between single-born siblings, only children and twins, and increased with birth order. Compared to children with siblings, only children exhibited a strong increase in BMI-SDS starting at age nine. A higher age gap between siblings was associated with a higher BMI-SDS in second- and third-or-later-born children. Single-born siblings had the highest rate and duration of breastfeeding. Physical activity was highest in twins and third-or-later-born children and lowest in only children. In a multivariate model, being an only child showed a highly significant association with BMI-SDS.

Conclusion

The present study demonstrated that siblings had a lower BMI-SDS than only children did. For single-born siblings, the association between birth order and increased BMI-SDS seemed to persist only up to 11 years of age.

Sibling absence and body mass index: From adolescence to adulthood

OBJECTIVES

To examine if sibling absence is associated with higher BMI and to identify potential lifestyle factors underlying this effect; to determine if sibling effects on BMI persist into adulthood.

METHODS

We used data from all five waves of the National Longitudinal Study of Adolescent to Adult Health to study the sibling factors and BMI of 3,563 participants who were in grades 7-12 at first wave (1994-95). These participants were measured again in the second wave (1996), the third wave (2001-2002), the fourth wave (2008-2009), and most recently, the fifth wave (2016-2018). We identified categories of siblings, comparing the BMI of those without siblings either to birth order or sibship size. BMI was calculated based on direct measurements of height and weight; underlying mechanisms were self-reported.

RESULTS

Participants without siblings had significantly higher BMI than those with siblings, across waves, regardless of sibship size. Those without siblings had consistently higher BMI than middle-born, but not last-born participants. Adolescents without siblings reported eating fast food more frequently and spending more screen time.

CONCLUSIONS

Sibling absence is associated with higher BMI in adolescence and this difference persists into adulthood.

The impact of maternal influences on childhood obesity

There was a lack of detailed information about maternal influences on their children’s body mass index (BMI) in Taiwan. The aim of this study was to find the evidence to describe how mothers’ factors could affect their 2 to 9-year-old children’s BMI, with data collected from May 2021 to June 2021. Anonymous self-administered questionnaires were completed by 1035 participants from Taiwan’s six metropolitan cities and eight counties. After controlling for children’s factors, such as number of children in a family, children’s constitution, children’s age and gender, hierarchical regression models were used to analyze the effects of five maternal factors on their children’s BMI: maternal BMI, age, education level, monthly household income, and marital status (single parent or not). The results were found as follow: maternal BMI [β = .24], maternal educational level [β = −.141], and monthly household income [β = .071], significantly (p < 0.05) influenced their children’s BMI. Higher maternal BMI was associated with a higher children’s BMI. Mothers with lower levels of education background were more likely to have children with a higher BMI. Monthly household income was a positive factor influencing children’s BMI. In conclusion, this study is the first detailed description of maternal influences on their 2–9 years old children’s BMI in Taiwan. Although the study could not cover all of the factors influencing Taiwan’s childhood obesity, we have discovered maternal BMI, education level, and monthly household income were significant factors associated with children’s BMI.

Association Between Length of Only-Child Period During Early Childhood and Overweight at Age 8-A Population-Based Longitudinal Study in Japan

INTRODUCTION

Prior studies have shown that children who are the only child are more likely to be overweight compared to their peers with siblings, regardless of whether they are the oldest, in the middle, or youngest. The study objective was to clarify whether there is an association between the length of the only-child period and the risk of overweight in firstborns who experienced an only-child period during early childhood before their siblings were born.

METHODS

A total of 7,576 first-born boys and 7,229 first-born girls were examined from a nationwide longitudinal survey in Japan. The length of the only-child period was determined by "birth interval"; i.e., the interval between the birth of the index child and the birth of the second child. It was categorized as short (<1.5 years), moderate (between 1.5 and 4 years), long (between 4 and 8 years), and only-child (the second baby was not born for 8 years). Overweight was defined as body mass index (BMI) z-score 1 standard deviation or more at age 8. Logistic regression was used to examine the association between length of only-child period and childhood overweight, adjusting for covariates.

RESULTS

Moderate birth interval was inversely associated with being overweight in comparison with only-child in both boys (odds ratio (OR): 0.83, 95% CI, 0.72-0.96) and girls (OR: 0.75, 95% CI, 0.63-0.88). Long birth interval also showed inverse association in boys (OR: 0.78, 95% CI, 0.62-0.97), and marginal inverse association in girls (OR: 0.80, 95% CI, 0.62-1.04).

CONCLUSION

First-born children who experienced short birth intervals did not show a different overweight risk from only-child. First-born children who experienced 1.5-8 years of the birth interval had a lower risk of childhood overweight compared with only-child.

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.

Linkage Between 2 Information Systems: Combined Live Births and Food and Nutrition Surveillance as a Public Health Tool for Investigation of the Determinants of Obesity Among Children and Adolescents in Southern Brazil

BACKGROUND

Childhood obesity has been growing steadily, at an earlier age, and currently comprises a public health issue. A number of studies have pointed to perinatal factors as possible determinants in the development of childhood obesity.

OBJECTIVE

To evaluate the influence of perinatal factors on the development of obesity in children and adolescents in southern Brazil.

DESIGN

Retrospective cohort study in which a linkage was made between anthropometric data of children and adolescents aged 0 to 15 years who had been registered in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2016 and their perinatal data registered in the Live Birth Information System (SINASC) from 2000 to 2014. The SINASC was used to extract maternal covariables (age, schooling, marital status), prenatal variables (parity and number of prenatal visits), and perinatal variables (type of delivery, sex, and birth weight). Variables such as age, inclusion in the Bolsa Família income transfer program, and the number of anthropometric evaluations were extracted from SISVAN.

RESULTS

The sample comprised 537 children and adolescents. The median age was 8 years (interquartile range: 2-11 years). The prevalence of obesity was 15.1%. Poisson regression revealed a higher risk of obesity in children born via cesarean delivery (relative risk [RR] = 1.48; 95% CI: 1.01-2.17), children of primiparous mothers (RR = 1.72; 95% CI: 1.16-2.53), girls (RR = 1.77; 95% CI:1.21-2.60), and those aged between 5 and 9 years (RR = 26.8; 95% CI: 3.75-191.55) and older than 10 years (RR = 20.74; 95% CI: 2.89-148.61).

CONCLUSIONS

The linkage between SINASC and SISVAN allowed identification of prenatal and perinatal risk factors for the development of childhood obesity. These findings should contribute to the development of health promotion and prevention policies.

Primipaternities and human birthweights

OBJECTIVES

To investigate in singleton multiparous pregnancies the effect of having a new father for an index pregnancy on new-borns' birthweights and intrauterine growth restriction.

DESIGN

20 year-observational cohort study (2001-2020).

SETTINGS

Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity (French overseas department, Indian Ocean).

MAIN OUTCOMES AND MEASURES

Comparing the 811 multiparas (cases) who had a new partner with the 49,712 who did not (controls), there were no differences concerning maternal age, education, ovulation induction/IVF, previous miscarriages, exams during pregnancies, pre-pregnancy BMI, gestational diabetes, and chronic hypertension. Cases had more previous pregnancies than controls (gravidity 4.2 vs 2.8, p < 0.001), volunteer abortions (OR1.93, p < 0.001), in vitro fecundations (OR 4.34, p < 0.001), were more likely to be unmarried (OR 2.94, p < 0.001) smoker (OR 2.2, p < 0.0001) and consuming alcohol during pregnancy (OR 2.35, p = 0.001). Cases had a much higher risk of preeclampsia than controls (OR 3.94, p < 0.001), especially early-onset preeclampsia (< 34 weeks) with an OR 4.1 (p < 0.001). Controlling for confounding factors (preeclampsia, smoking, alcohol use, early prematurity < 33 weeks, maternal ethnicity), primipaternity was an independent factor for small for gestational age newborns (OR 1.48, p < 0.001).

CONCLUSIONS

It has been known for decades that primiparas have lighter babies than multiparas. Primipaternity represents also a risk for lower birth weights. Human birthweight seems to be linked with a "couple habituation" (to paternal genes) which may be not fully established in the first pregnancy of the couple.

Sibling Inequalities in Overweight and the Role of Mother’s Education: Evidence From the Indonesian Family Life Survey

Background:

Previous studies have shown that sibling inequalities in overweight vary across contexts. Furthermore, research on the extent to which parental factors such as mother’s education can compensate for or reinforce such disparities is considerably rare.

Objective:

This study analyzes to what extent and how the chances of overweight among children (0-19 years of age) vary systematically by gender, birth order, and number of siblings. We also look at whether mother’s education buffers or aggravates sibling inequalities in overweight.

Methods:

Data were from the fifth wave of the Indonesian Family Life Survey-5 2014/2015, which comprised 6723 children born in 4784 families. We applied within-family centered birth order dummies to disentangle the effects of birth order from those of number of siblings. Cluster-robust logistic regressions were conducted.

Results:

Overweight occurred more in eldest and youngest children, and in children of smaller families. Mother’s education amplified sibling inequalities. Odds of overweight in children increased along with more years of education the mothers had. This was greater for boys and eldest children. Further analyses indicated that boys whose mothers spent more years in school consumed high-calorie foods more often.

Conclusion:

The overall results indicate that mother’s education aggravates sibling inequalities in overweight. Nutrition interventions to reduce overweight in children should target the eldest and the youngest children and children of smaller families. Mothers who had more school years, and particularly their sons, should also be in the target group. Boys should be advised to consume high-calorie foods less often.

The impact of lifestyle and socioeconomic parameters on body fat level in early childhood

The aim of this study was to examine the differences between selected lifestyle and socioeconomic parameters among preschool (3-7 years of age) children of differing adiposity status. The study was conducted from February to June 2018 in 20 randomly selected kindergartens in Kraków, Poland. Triceps, biceps, subscapular, suprailiac, abdominal and calf skinfold thicknesses were measured. The sum of all six skinfolds was calculated and the children were subsequently characterized by low (≤-1 SD [standard deviation]), normal (-1 to 1 SD) or high body fat (≥1 SD). Socioeconomic and lifestyle characteristics were obtained using a questionnaire filled out by the children's parents or legal guardians. Preschool children in the high adiposity category had, on average, fewer siblings and longer screen time; additionally, their parents had lower education and more often worked in manual jobs, in comparison to the children in the low and average adiposity categories. In conclusion, it was observed that children in different adiposity categories varied in terms of some socioeconomic as well as lifestyle characteristics. Knowledge regarding the influence that those factors can have on the metabolic health of children is essential for children's present as well as future well-being. Moreover, it can help health care professionals and parents decide what intervention and/ or preventive measures should be undertaken to ensure the best possible outcomes, as the development of successful obesity prevention strategies should rely on evidence-based information. Nonetheless, future research examining the issue of factors influencing the metabolic health of children, as well as these outcomes later in life, is crucial. Well-planned studies including a large number of individuals, as well as longitudinal research, will be particularly beneficial in this regard.

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.

Learned Experience and Resource Dilution: Conceptualizing Sibling Influences on Parents' Feeding Practices

Studies from diverse cultures report mixed results in the relationship between birth order and risk for obesity. Explanations may thus lie in the postnatal period when growth is shaped by the family environment, including parental feeding practices, which may be affected by siblings. Consistent with a family systems perspective, we describe two processes that may explain birth order effects on parental feeding practices and child outcomes: learned experience and resource dilution. Parents learn from experience when earlier-born children influence their parents’ knowledge, expectations, and behavior toward later-born siblings through their behaviors and characteristics—which can have both positive and negative implications. Resource dilution is a process whereby the birth of each child limits the time, attention and other resources parents have to devote to any one of their children. The goal of this review is to provide a theoretical basis for examining potential sibling influences on parental responsive feeding toward developing recommendations for future research and practice aimed at preventing obesity throughout family systems.

Birth weight increases with birth order despite decreasing maternal pregnancy weight gain

AIM

We investigated whether birth order is an influencing factor for birth weight independent from maternal factors.

METHODS

Data were obtained from the longitudinal cohort study LIFE Child and included 1864 children, of which 526 were only children. The 1338 siblings were ranked into first-borns (n = 570), second-borns (n = 606) and third-or-later-borns (n = 162). Children born prematurely, suffering from chronic or syndromic diseases, were excluded. We performed intra-family comparisons to reduce bias and assessed the impact of perinatal parameters, such as birth order on birth weight, using mixed models.

RESULTS

Birth weight increased with birth order. In univariate analyses, birth order had a significant effect on birth weight-SDS with second-borns having 0.29 SDS (app. 130 g) and third-borns 0.40 SDS (app. 180 g) higher values than first-borns (P < .001). Maternal pregnancy weight gain was associated with higher birth weight-SDS (P < .01) in univariate analysis, though maternal pregnancy weight gain was lower for higher birth orders. Multivariate analyses revealed that being a second or third-or-later-born child had a stronger impact on birth weight than all maternal factors.

CONCLUSION

Birth order must be considered a potential risk factor for higher birth weight. Maternal pregnancy weight gain is not the driving factor for higher birth weight in siblings.

Siblings' Influence on the Motor Competence of Preschoolers

The number of single-child families has been rising steadily in recent years, resulting in a childhood absent of sibling relationships. Being an only child has been shown to have a negative impact on physical fitness, somatic fitness, and motor development. In this study, we aimed to understand how living with and without siblings can impact the motor competence of children. One hundred and sixty-one children (87 boys, 74 girls) from 3.0 to 6.0 years of age (34 only children, 125 siblings) and with no known motor or cognitive disability were assessed using the Motor Competence Assessment (MCA). Their standardized results on the three MCA subscales (stability, locomotor, and manipulative) and total MCA were used to group them into high, average, and low motor competence groups. Motor competence percentile distribution of the sibling and only child group condition was compared using chi-square tests. Results showed a significative and positive association between the sibling condition and the distribution between the three MC groups (chi-square = 6.29; p = 0.043), showing that children in a household with siblings, independent of their age and sex, show a clear tendency for developing better motor competence.

High Prevalence of Obesity but Low Physical Activity in Children Aged 9-11 Years in Beijing

OBJECTIVE

To investigate the prevalence and associated factors of childhood overweight/obesity in the Shunyi district of Beijing, China.

METHODS

This study adopted a cross-sectional survey and included 10,855 children aged 6-18 years in the Shunyi district of Beijing, China. Analyses were stratified by age group (6-8, 9-11, 12-14, and 15-18 years).

RESULTS

The prevalence of overweight and obesity among children aged 6-18 years was high with 17.62% and 29.05% in boys, 17.57% and 18.04% in girls, respectively. Both boys and girls aged 9-11 years had the highest rate of obesity in comparison with the other age groups, though the differences in children aged 9-11 years and 12-14 years were not statistically significant. Compared with age 6-8 years, age 9-11 years (OR=1.59, 95% CI 1.41-1.79, P<0.01) and 12-14 years (OR=1.26, 95% CI 1.48-1.73, P<0.01) were independently positively associated with obesity. Importantly, in all subjects, the percentages of being physically active (exercise time ≥120 minutes/week) were lower in children aged 9-11 years in comparison to children in other age groups. This phenomenon remained when this comparison was performed respectively in the normal-weight, overweight, and obesity groups. Even after adjustment for other potential confounders, the probability of being physically active (exercise time ≥120 minutes/week) was lower in children aged 9-11 years (OR=0.86, 95% CI 0.78-0.94, P<0.01), but higher in children aged 12-14 years (OR=1.91, 95% CI 1.69-2.17, P<0.01) and aged 15-18 years (OR=2.22, 95% CI 1.85-2.66, P<0.01), when compared with children aged 6-8 years.

CONCLUSION

Children aged 9-11 years had a higher prevalence of obesity, but a lower percentage of being physically active. Targeted intervention programs in this key group are needed to address this problem in China.

Correlates of children's physical activity during the COVID-19 confinement in Portugal

OBJECTIVES

The aim of the study was to understand the role of household variables on the percentage of physical activity (%PA) during the coronavirus disease 2019 (COVID-19) confinement in Portugal.

STUDY DESIGN

A cross-sectional study design using an anonymous online survey was launched to assess how Portuguese families with children aged younger than 13 years adjusted their daily routines to the confinement.

METHODS

Separate analyses of variance were performed to investigate how factors such as the number of children, age, sex, the housing characteristics, and the adults' job situation can affect the percentage of time for PA (%PA).

RESULTS

Findings, based on data from 2159 children, indicate that (1) boys and girls did not differ in the %PA on any of the age-groups; (2) children with an outdoor space and who had other children in the household were significantly more active (P < .001); (3) children from families with all adults working from home showed lower levels of %PA; and (4) being younger, having a big outdoor space, having other children in the household, and having at least one adult free from working from home were significant positive predictors of children's %PA, explaining 21% of the overall variance.

CONCLUSION

Time allocated for PA during this period is reduced compared with what is usually reported on normal days. It is necessary to find strategies to increase children's PA, especially in families in which both parents are working and have no outdoor space.

[Family functioning, parental rearing and its relationship to nutritional status in preschoolers]

Objetivo

Analizar la asociación entre funcionalidad familiar, crianza parental y estado nutricional en preescolares.

Diseño

Estudio cuantitativo, descriptivo correlacional y transversal.

Emplazamiento

Instituciones públicas de educación preescolar en el estado de Nuevo León, México. Atención Primaria.

Participantes

Muestra compuesta por 228 diadas (madre o padre y preescolar); se tomó como único criterio de inclusión ser el responsable principal de la crianza del preescolar.

Mediciones principales

Se empleó un cuaderno de recogida datos sociodemográficos, el estado nutricional se determinó basándose en recomendaciones de la Organización Mundial de la Salud, se utilizaron la Escala de Evaluación de la Cohesión y la Adaptabilidad Familiar y el cuestionario de Estilos de Crianza Parental. Se obtuvo estadística descriptiva y el coeficiente de correlación de Spearman.

Resultados

El promedio de edad de los padres fue de 32,09 años, el 60,5% de las madres se dedican al hogar y el 100% de los padres trabaja; la media de escolaridad en años fue de 12,16; el 68,9% de los participantes son casados; referente a los preescolares, el 29,4% presentó sobrepeso u obesidad. En cuanto a la funcionalidad familiar, se identificó que en la dimensión de cohesión es semirrelacionada el 44,3%. El estilo de crianza parental que predominó en los padres fue el permisivo con el 62,3%.

Conclusiones

La mayoría de los padres de familia presentaron desequilibrio en la funcionalidad familiar. No se encontró significación estadística entre funcionalidad familiar y crianza parental con estado nutricional en preescolares (p < 0,05).

Correlation between body mass index, neck circumference, and waist-hip ratio as indicators of obesity among a cohort of adolescent in Bahrain: A preliminary cross-sectional study

Neck circumference (NC) is an attractive method for determining overweight and obesity in school age children because it is inexpensive and culturally acceptable. However, this technique has not been assessed for its accuracy in school children from countries of the Gulf Cooperation Council, which have high prevalence of overweight and obesity.The aim of this preliminary study was to investigate the correlation between the body mass index (BMI), NC, and waist-hip ratio and demographic characteristics among 10- to 18-year-old adolescent school children in Bahrain.BMI was calculated using Center of Disease Control and Prevention Children's BMI Tool for Schools. Data was collected for a total of n = 397 adolescents from 4 different private schools with an average age of 12.91 years; 57.7% were male and 42.3% female.In this sample of adolescents, 50.1% were either overweight (21.4%) or obese (28.7%). BMI was significantly associated with waist-hip ratio (P < .01), gender (P < .05), and age (P < .01). Multiple linear regressions revealed that NC was significantly associated with age (P < .001) and less so with gender (P = .071) and BMI was significantly associated with NC (P < .01), gender (P < .01), and age (P < .05). Analysis of the receiver operating characteristic for males and females combined showed fair sensitivity and specificity (Area under the curve (AUC) = 0.707; 95% CI: 0.656, 0.758).NC is weakly correlated with BMI, and only a fair instrument for identifying overweight/obesity based on receiver operating characteristic curve analysis. Therefore, NC could only be used as an adjunct screening tool for weight status in this sample.

Physical Fitness and Somatic Characteristics of the Only Child

The purpose of this study was to examine if only child show differences on somatic growth and physical fitness compared to be a child with siblings. The participants included 542 children (boys: N = 270; girls: N = 270) between 7 and 15 years of age. Somatic growth (height, weight, body mass index) and physical fitness (handgrip strength; flexed harm hang; 60-s sit-ups; standing long jump; 10-m shuttle run and PACER test) were assessed. Variance analysis revealed significant advantages for children with siblings in the flexed arm hang (p = 0.046), 60-s sit-ups (p = 0.002), 10-m shuttle run (p = 0.013) and PACER (p = 0.032). An examination of the possible differential effect of sex on the results revealed no significance for physical fitness variables, but significant interaction were found for weight (p = 0.004) and body mass index (p = 0.005). Despite a lack of interactions between offspring and sex in physical fitness, significant differences between sexes were found in all fitness variables. In conclusion, having siblings showed to be advantageous for general physical fitness in children. This evidence may be used for future analysis and interventions in motor competence, namely considering the growing number of only children in some regions of the world.

Family Eating Behavior and Child Eating Patterns Differences Between Children With and Without Siblings

OBJECTIVE

To examine the differences in family eating behaviors and child eating patterns in children with siblings (nonsingletons) and without siblings (singletons).

METHODS

Cross-sectional analysis of mother-child dyads of 5-7-year-old children, (nonsingletons with a 2-to-4-year-old sibling) was conducted. Anthropometrics were measured. Mothers completed questionnaires and a child dietary log. Healthy Eating Index 2010 (HEI) score was calculated. Linear regression models adjusting for child age, child sex, maternal body mass index, and hours-away-from-home were conducted, with a revised P < .021.

RESULTS

Sixty-eight mother-child dyads (27 singletons, 41 nonsingletons) participated. Singletons exhibited less healthy family eating behaviors (β = -4.98, SE = 1.88, P = .003), and lower total HEI scores than did nonsingletons (average: β = -8.91, SE =2.40, P = .001). On average, singletons had lower scores in 3 HEI components compared with nonsingletons (P < .021 for all).

CONCLUSION

In this sample, singleton children exhibited less healthy eating behaviors. Additional investigation into parent-level differences is warranted.

Difference in Objectively Measured Physical Activity and Obesity in Children With and Without Siblings

Background/Context: Children without siblings (singletons) have higher rates of obesity than do children with siblings (nonsingletons). Higher moderate to vigorous physical activity (PA) and less sedentary behavior (SB) are associated with lower childhood obesity.

PURPOSE

To examine the difference in PA and SB between singleton and nonsingleton children.

METHODS

Mothers of children ages 5.0-7.9 years old who were singletons or nonsingletons with a sibling between the ages of 2.0 and 4.9 years old were recruited. Height, weight, and waist circumference of the 5.0- to 7.9-year-old children were measured, and age and sex percentiles were calculated. Accelerometry measured SB and PA, including light PA, moderate to vigorous PA, and counts per minute.

RESULTS

Fifty-six mother-child dyads (23 singletons and 33 nonsingletons) with an average child age of 5.7 (0.7) years participated. More singletons were classified as overweight or obese than were nonsingletons (49% vs 17%, P = .04). In adjusted linear models, singletons had less light PA per day (β = -38.1, SE = 19.2, P = .001) and more SB (β = 38.0, SE = 16.5, P = .02) than did nonsingletons, with no difference in moderate to vigorous PA or counts per minute.

CONCLUSION

In this sample, singletons had higher obesity and lower light PA than did nonsingleton children. Investigation into differences in singleton/nonsingleton families, including family health behaviors, may help assess sibling influence in early behavior development.

Sibling influence on children's objectively measured physical activity: a meta-analysis and systematic review

Abstract

Children without siblings (only children) have higher rates of obesity than children with siblings. Childhood obesity may be prevented by minimising sedentary behaviour and accumulating sufficient physical activity in young children. A growing number of articles have examined the influence of siblings on physical activity and sedentary behaviour, yet these articles have not been synthesised.

Objective

To synthesise literature and describe the influence of siblings on objectively measured physical activity and sedentary behaviour of children (ages 2–18 years).

Design

Outcomes were analysed in a systematic review and meta-analysis.

Data sources

PubMed, EMBASE, Web of Science and Medline OVID were searched for articles related to siblings, physical activity, sedentary behaviour and obesity outcomes from 1947 to March 2018.

Eligibility criteria

Articles that evaluated sibling status on physical activity objectively measured by accelerometer or pedometer were included.

Results

Nineteen articles, representing 17 independent datasets, were included in the review. Nine were included in the quantitative analysis. Pooled data from nine articles indicated children with siblings had higher moderate-to-vigorous physical activity (MVPA) relative to only children, with a potential dose response for higher number of children in household and higher MVPA (Mean Difference=3.13, 95% CI 1.90 to 4.35, p=0.001). Findings were mixed for the influence of siblings on sedentary behaviour and light physical activity.

Summary/Conclusion

Children with siblings had healthier physical activity patterns, as measured by accelerometer or pedometer, than did only children. Suggested mechanisms include peer modelling, encouraging active transport and sports participation, opportunity for playmate and serving as additional caregivers.

Trial registration number

CRD42017055463.