Family-related risk factors of obesity among preschool children: results from a series of national epidemiological surveys in China

Intergenerational care and rural childhood obesity in the digital era: Based on screen exposure perspective

Background

Rural Chinese children are experiencing increasing obesity rates, yet studies often neglect the impact of IT and screen media growth on obesity risks in the context of intergenerational care, leading to incomplete strategies for the digital era.

Methods

By comprehensively utilizing the data on rural children aged 6-17 from the China Family Panel Studies (CFPS) and the China Health and Nutrition Survey (CHNS), this study aims to test the logical chain and specific mechanisms regarding "intergenerational care - screen exposure - rural childhood obesity". We employ the Propensity Score Matching (PSM) and Generalized Propensity Score Matching (GPSM) methods to respectively address the self-selection biases associated with inter-generational care and children's screen exposure behaviors.

Results

1) Intergenerational care significantly increases screen exposure among rural children. 2) Gender bias increases the risk of screen exposure for rural boys under intergenerational care. 3) Children with higher screen exposure levels are more affected by intergenerational care, which further undermines parental supervision. 4) Children's screen exposure leads to increased sedentary time and higher probability of purchasing unhealthy foods, thereby exacerbating obesity. This process is facilitated by enhancing preferences for snacks, fast food, and beverages, and weakening preferences for physical activity. 5) GPSM analysis indicates that children's screen exposure has an inverted "U"-shaped impact on unhealthy dietary preferences and a "U"-shaped impact on activity preferences. It results in a nonlinear positive impact of screen exposure on obesity. This study reveals a positive association between screen exposure and obesity, offering new insights into how intergenerational care in the digital era may elevate obesity prevalence through excessive screen time for rural children.

Nutrition-Related Knowledge, Diet Quality, Lifestyle, and Body Composition of 7-12-Years-Old Polish Students: Study Protocol of National Educational Project Junior-Edu-Żywienie (JEŻ)

Increasing students' nutrition knowledge is an important goal of school education which may improve their lifestyle and consequently reduce the incidence of non-communicable chronic diseases, including obesity. This research aimed at assessing the dietary habits, nutrition-related knowledge and attitudes, and nutritional status of Polish students aged 7-12 years. Additional objectives included recognizing nutrition-related knowledge among their parents and teachers as well as the school food and nutrition environment. The final goal was to develop a nutrition education program. This study protocol presents a general and detailed approach for realizing the above-mentioned issues, including conducting quantitative and qualitative research. The study was designed as cross-sectional, covering primary school students from all over Poland, including rural, town, and metropolitan areas. Data on eating habits, lifestyle, nutrition-related knowledge, and attitudes were collected with questionnaires. Measurements of body weight, height, waist and hip circumferences, and handgrip strength were performed in accordance with the International Standards for Anthropometric Assessment (ISAK) recommendations. Body composition was assessed with bioelectrical impedance analysis. Ultimately, 2218 schools from all 16 voivodeships in Poland registered for the project. In total, quantitative data were collected among 27,295 students, 17,070 parents, and 2616 teachers. Anthropometric measurements were taken among 18,521 students. The results allow us to develop a multifaceted educational program based on knowledge and adapted to the perception of students. Our research may contribute to the identification of subpopulations of children and adolescents at risk of excessive body weight and define the predictors of obesity risk in Poland.

Identifying risk factors affecting exercise behavior among overweight or obese individuals in China

Background

The disease burden caused by obesity has increased significantly in China. Less than 30% of those who are obese meet the weekly physical activity standards recommended by the WHO. Risk factors that influence exercise behavior in people with obesity remain unclear.

Methods

Based on the survey from the Chinese General Social Survey program (CGSS) in 2017, 3,331 subjects were identified and enrolled in the univariate and multiple probit regression models. We aimed to identify the association between SRH and the exercise behavior of obese people and further explore the influencing factors of active physical activity in this group of people.

Results

The proportion of active physical activity in obese people was 25%. Groups with better SRH, higher education and income were more likely to participate in sports. Obese people who lived in rural areas, were unmarried or divorced, or fell within the age range of 35-40 had a significantly lower percentage of engagement in active physical activity.

Conclusions

The proportion of people with obesity who meet the WHO recommendation for physical activity in China is not ideal. Health promotion programs for those who are obese need to be further strengthened and targeted, especially for rural areas, low-income families, and middle-aged obese people.

Obesity risk factors in Turkish preschool children: a cross-sectional study

Amaç: Bu çalışma, Türk okul öncesi çocuklarında obezite ile ilgili potansiyel risk faktörlerini -gebelik öncesi ve sonrası, çocuk, ebeveyn ve çevresel faktörler- belirlemeyi amaçlamaktadır. Gereç ve Yöntem: Özel ve devlete bağlı 25 anaokulunda 3-5 yaş grubu 538 çocuk ve anneleri ile yüz yüze görüşme yöntemi kullanılarak kesitsel bir çalışma gerçekleştirilmiştir. Gebelik, bebeklik ve okul öncesi döneme ait demografik, antropometrik, beslenme, uyku ve fiziksel aktivite bilgileri sorgulanmıştır. İki günlük besin tüketim kayıtları ve antropometrik ölçümleri alınmıştır. Bulgular: Okul öncesi çocuklarda hafif şişmanlık ve obezite sıklığı %27 olarak saptanmıştır. Yirmi sekiz potansiyel risk faktöründen gebelik öncesi obezitesi [1,108 (1,042-1,179)], gebelik sonu obezitesi (OR:4,350, CI:2,053-9,217), gebelikte >200mg/gün kafein alımı (OR:1,588, CI:1,031- 2,446), obezitesi olan babaya sahip olma (OR:1,089 CI:1,027-1,155), devlet okulu yerine özel okula gitme (OR:2,093, CI:1,298-3,376), hızlı yeme (OR:3,355, CI:1,175-9,583), kısa öğle yemeği süresi (OR:0,966, CI:0,934-0,998), günlük uyku süresinin 2 saat ekran süresi (OR:1,560, CI:1,012-2,405) okul öncesi çocukluk obezitesi ile ilişkili bulunmuştur. Sonuç: Ebeveyn obezitesi, gebelikte kafein alımı, yeme hızı, günlük uyku ve ekran süresi Türk okul öncesi çocuklarında obezite risk faktörleri olarak belirlendi. Erken çocukluk döneminde anne ve çocuğa ait risk faktörlerinin belirlenmesi, yaşam tarzının ve obezojenik çevrenin düzenlenmesi, obeziteden koruyucu olabilir.

Overweight Prevalence among Rural Adolescents by Household Head Obesity and Socio-Economic Status in Limpopo, South Africa

Background: Childhood obesity has become the most important and growing public health problem in the world. They add to public health challenges by increasing the burden of chronic non-communicable diseases. However, in spite of its importance, there is limited literature that evaluates the prevalence of obesity among rural adolescents in sub-Saharan Africa. We report the first study to present an insight into rural black overweight South African children and the physical characteristics and socio-economic status of the household head. A quantitative cross-sectional population study was conducted involving 51 selected primary villages within the DIMAMO surveillance area in the Capricorn District of Limpopo Province, South Africa. The study involved 294 adolescents, 154 girls and 140 boys, who were under the age of 18. Of these participants, 127 (43%) were within the normal weight range, and 167 (57%) were overweight. Gender made a significant difference, with more girls being overweight than boys. Adolescents who did not receive child grants and whose heads of household were 45−54 years old, poor, and overweight had a higher prevalence of obesity (p-value < 0.05). This study suggests that public health interventionists need to target both the heads of household and their children in hopes of reducing the prevalence of overweight and obese South African children. We further propose a better understanding of the causes of childhood overweight and obesity to guide policy development and implementation in rural settings.

Risk factors for obesity and overweight in Chinese children: a nationwide survey

OBJECTIVE

This study aimed to analyze a comprehensive set of potential risk factors for obesity and overweight among Chinese children with a full range of ages and with wide geographical coverage.

METHODS

In the Prevalence and Risk Factors for Obesity and Diabetes in Youth (PRODY) study (2017-2019), the authors analyzed 193,997 children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of China. All participants underwent physical examinations, and their caregivers completed questionnaires including dietary, lifestyle, familial, and perinatal information of participants. A multilevel multinomial logistic regression model was used to evaluate the potential risk factors.

RESULTS

Among the actionable risk factors that were measured, higher consumption frequencies of animal offal (odds ratios [OR] for an additional time/day = 0.91, 95% CI: 0.88-0.95, same unit for OR below unless specified otherwise), dairy products (0.91, 95% CI: 0.88-0.94), freshwater products (0.94, 95% CI: 0.91-0.96), staple foods (0.94, 95% CI: 0.92-0.96), and coarse food grain (OR for every day vs. rarely = 0.92, 95% CI: 0.86-0.98) were associated with lower relative risk of obesity. However, higher restaurant-eating frequency (OR for >4 times/month vs. rarely = 1.21, 95% CI: 1.15-1.29) and longer screen-viewing duration (OR for >2 hours vs. <30 minutes = 1.16, 95% CI: 1.10-1.22) were associated with higher relative risk of obesity. Increased exercise frequency was associated with the lowest relative risk of obesity (OR for every day vs. rarely = 0.72, 95% CI: 0.68-0.77).

CONCLUSIONS

Changes in lifestyle and diet of Chinese children may help relieve their obesity burden.

Prevalence and factors associated with overweight or obesity among 2- to 6-year-old children in Hunan, China: a cross-sectional study

OBJECTIVE

To compare the prevalence of overweight or obesity (ow/ob) with WHO BMI cut-off points, International Obesity Task Force (IOTF) cut-off points and Chinese BMI criteria and examine its potential factors among preschool children in Hunan Province.

DESIGN

A cross-sectional survey including anthropometric measurements and questionnaires about children's information, caregivers' socio-demographic characteristics and maternal characteristics. χ2 tests and univariate and multivariate binary logistic regression were performed to evaluate the possible factors of ow/ob.

SETTING

Hunan, China, from September to October 2019.

PARTICIPANTS

In total, 7664 children 2 to 6 years of age.

RESULTS

According to Chinese BMI criteria, about 1 in 7-8 children aged 2-6 years had ow/ob in Hunan, China. The overall estimated prevalence of ow/ob among 2- to 6-year-old children was significantly higher when based on the Chinese BMI criteria compared with the WHO BMI cut-off points and IOTF cut-off points. According to Chinese BMI criteria, ow/ob was associated with residing in urban areas, older age, male sex, eating snacking food more frequently, macrosomia delivery, caesarean birth, heavier maternal prepregnancy weight and pre-delivery weight.

CONCLUSION

The prevalence of ow/ob in preschool children in Hunan Province remains high. More ow/ob children could be screened out according to Chinese BMI cut-offs compared with WHO and IOTF BMI criteria. In the future, targeted intervention studies with matched controls will be needed to assess the long-term effects of intervention measures to provide more information for childhood obesity prevention and treatment.

Global relationship between parent and child obesity: a systematic review and meta-analysis

BACKGROUND

The growing prevalence of overweight and/or obese children is an important public health problem in both developed and developing countries. Although the association of obesity between parents and their children is well known, its underlying mechanisms are not well established.

PURPOSE

This meta-analysis examined parent-child (PC) relationships in obesity and identified factors such as world region and country income level that may influence this relationship.

METHODS

We identified all related studies published between January 1, 2015 and May 31, 2020 by conducting a literature search using the MeSH terms "obesity," "overweight," "body mass index," "parent," "child," "associate," and "relate" in the PubMed database in English.

RESULTS

The meta-analysis of 23 studies that reported an odds ratio (OR) for parent and child obesity associations found a significant association between parents and children who were overweight or obese (pooled OR, 1.97; 95% confidence interval, 1.85-2.10). A meta-regression analysis was used to examine the sources of interstudy heterogeneity. The association between parent and child obesity was higher in Asia than in Europe and the Middle East and higher in high-income countries than in middle-or low-income countries. In addition, a higher association between parent and child obesity was found when both parents were obese than when only the father or mother was obese. This study from multiple countries indicates a significant PC relationship in weight status that varies according to PC pair type, parent and child weight statuses, world region, and country income level.

CONCLUSION

These results demonstrate that the risk of childhood obesity is greatly influenced by parental weight status and indicate that parents could play an important role in preventing child obesity.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Synergistic interaction between bedtime and eating speed in predicting overweight and obesity in Chinese preschool-aged children

This study aimed to examine the association of late bedtime and fast eating speed, both individually and interactively, in predicting overweight and obesity in Chinese preschool-aged children. This was a cross-sectional survey among children aged 3-6 years. Overweight and obesity is defined according to the WHO, IOTF, and China criteria, respectively. Total 1123 preschool-aged children were analyzed. After multivariable adjustment, late bedtime after 11:00 pm and fast eating speed increased the risk of overweight and obesity significantly under the WHO (odds ratio [OR]=1.92 and 1.37, 95% confidence interval [CI]: 1.31-2.80 and 1.00-1.88), IOTF (OR=1.47 and 1.46; 95% CI: 1.00-2.15 and 1.07-2.00), and China (OR=1.66 and 1.39; 95% CI: 1.20-2.29 and 1.07-1.80) criteria. Relative to bedtime before 11:00 pm and eating speed ≥30 min, there was a graded increase with presence of either bedtime after 11:00 pm or eating speed 15-30 min and <15 min. Particularly, the presence of both bedtime after 11:00 and eating speed <15 min yielded the largest OR under the WHO (adjusted OR, 95% CI: 3.98, 1.27-12.51), IOTF (3.59, 1.12-11.50), and China (4.84, 1.71-13.69) criteria. Taken together, our findings indicate a synergistic interaction between bedtime and eating speed in predicting overweight and obesity in Chinese preschool-aged children.

Influence of Grandparental Child Care on Childhood Obesity: A Systematic Review and Meta-Analysis

Objective: This study systematically reviewed the scientific literature on the relationship between grandparental child care and childhood obesity. Methods: Keyword/reference search was performed in CINAHL, PsycINFO, PubMed, and Web of Science. Meta-analysis was conducted to estimate the pooled effect of grandparental child care on children's weight outcomes. Results: A total of 23 studies were identified, including 9 longitudinal, 9 cross-sectional, 2 case-control, and 3 qualitative studies. Eight studies were conducted in China, five in Japan, three in the United Kingdom, two in the United States, and one in five other countries each. Twelve studies focused on grandparents' roles as a main caregiver in the family, and seven on grandparents' co-residence. Data from 14 studies were used in meta-analysis, 10 focusing on childhood overweight/obesity and the other 4 on children's BMI z-scores. Meta-analysis found that grandparental child care was associated with a 30% (95% confidence interval = 21-40) increase in childhood overweight/obesity risk. Grandparental child care was not associated with children's BMI z-scores after correcting for publication bias. Meta-regressions revealed no difference in the estimated effect of grandparental child care on children's weight outcomes by country or grandparents' specific roles (main caregiver in the family vs. co-residence). Conclusions: Preliminary evidence links grandparental child care to elevated risk of childhood overweight/obesity, but not BMI z-scores. Future research should focus on a specific child age group within a country, adopt systematic and field-validated measures on grandparental child care, and elucidate the pathways linking grandparental child care to children's weight outcomes.

Sex differences in the application of WHO standards to Shanghai infants from birth to 18 months

BACKGROUND

The number of obese children in Shanghai has increased annually. Shanghai growth standards are higher than the World Health Organization's (WHO's) growth standards, which may influence caregiver feeding practices and enhance the risk of overweight in infants.

METHOD

A cluster-randomized controlled trial analysed 15,019 infants (healthy newborns, ≥3 clinical consultations in one year) from 19 community health service centers in two urban areas in Shanghai. Randomization was performed at the community level. A total of 8510 infants in the S-group were assessed with the Shanghai growth standards, and 6509 infants in the W-group were assessed by the WHO growth standards. Follow-up data were collected at 1, 2, 4, 6, 9, 12 and 18 months. Changes in the weight-for-age z score (WAZ), length-for-age z score (LAZ), and weight-for length z score (WLZ) were assessed using mixed regression models. Sex differences were compared between groups at all follow-up periods.

RESULTS

Compared to the S-group, the percent of overweight in boys in the W-group significantly decreased starting at 9 months (4.9% vs 3.3%, P = 0.011 at 9 months, 4.5% vs 2.5%, P < 0.001 at 12 months and 3.1% vs 0.8%, P < 0.001 at 18 months), and the percent of overweight in girls in the W-group significantly decreased starting at 12 months (3.0% vs 1.8%, P = 0.009 at 12 months and 1.7% vs 0.6%, P = 0.039 at 18 months). A decreased weight in boys (from 4 months to 18 months, P < 0.05) and an increased length in girls (from 6 months to 18 months, P < 0.05) were the key reasons for the decreased overweight percentage in the W-group.

CONCLUSION

The adoption of the WHO growth standards could result in markedly decreased weight gain in boys and increased length gain in girls beyond the age of 18 months among urban Shanghai infants.

TRIAL REGISTRATION NUMBER

ChiCTR1800015371.

How do grandparents influence child health and development? A systematic review

Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren's physical health, socio-emotional and behavioral health, and cognitive and educational development.  Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which "grandparent effects" are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement-contact, behavior, and support-and for careful description of structural and interpersonal contexts in caregiving research.

Risk Factors for Obesity Among Children Aged 24 to 80 months in Korea: A Decision Tree Analysis

PURPOSE

The purpose of this study was to examine the multiple intergenerational risk factors of obesity among children aged 24 to 80 months using national cohort data.

DESIGN AND METHODS

This is a retrospective longitudinal cohort study using the Korean National Health Insurance (KNHI) database, and the number of study participants was 1,001,775 families. Social-Economic Status (SES), parental and child-related factors were examined. Descriptive statistics and Chi-squared Automatic Interaction Detection (CHAID) for a decision tree analysis were conducted.

RESULTS

The prevalence of obesity was 6.57%, and that of overweight was 11.31% among the entire study population. The 17 groups with a prevalence of childhood obesity higher than the mean prevalence rate were classified as high-risk groups for childhood obesity; there were 6 groups with a prevalence of childhood obesity twice as high as the mean prevalence rate from this study. The best predictors were as follows: mothers being obese prior to conception, fathers being obese, non- medical aid beneficiaries, and mothers with hypertension during gestation.

CONCLUSIONS

The best predictors of children obesity were parental obesity history and SES. Other parental predictors of outcomes were gestational hypertension and diabetes, older pregnancy, drinking during gestation, and depression after delivery. Child-related outcome predictors were noncompliance with exclusive breastfeeding, a sugar-sweetened beverage intake ≥200 ml per day, and irregular breakfast consumption.

PRACTICE IMPLICATIONS

These findings could help community health nurses assess high-risk groups for early childhood obesity and develop or provide effective interventions in the early stages of life.

A two-year study of parental obesity status and childhood obesity in China

BACKGROUND AND AIMS

We evaluated the association between parental obesity and their children's obesity parameters [e.g., percentage of body fat (PBF)] over time.

METHODS AND RESULTS

The study included 2066 Chinese parents-children trios (n = 1001 girls and 1065 boys, aged 6-14 years). Children's height, weight, waist circumference (WC) and PBF (bioelectrical impedance analysis) were annually assessed from 2014 (baseline) to 2016. Information on parental height and body weight, and children's diet and physical activity was collected in 2014. The association between parental obesity and changes in their children's PBF during follow-up was analyzed using a mixed effects model. We also examined changes in children's BMI and WC in secondary analyses. Baseline mean BMI, WC, and PBF for children were 17.6 ± 3.5 kg/m², 60.5 ± 9.6 cm, and 16.6 ± 6.5%, respectively. We observed that maternal, but not paternal, obesity was associated with a greater increase in children's PBF during the follow-up. An adjusted mean difference in annual increase of PBF was 0.41% [95% confidence interval (CI): 0.01%, 0.84%] for children with obese mothers, compared with those with normal-weight mothers. Both maternal and paternal obesity was associated with a greater increase in their children's BMI and WC (p trend<0.01 for both); however, the associations were stronger in mother-children pairs than those in father-children pairs.

CONCLUSIONS

Maternal obesity was associated with a greater increase in PBF in Chinese school-aged children.

Influence of sexual maturation status on the relationship between body adiposity indicators and age: a cross-sectional study

Objectives

To determine the influence of sexual maturation status on adiposity indicators of children and adolescents.

Results

2412 individuals participated, 1285 (47.4%) males and 1408 (52.6%) females. There was moderate to weak correlation between age and adiposity indicators for both sexes. By analyzing the relationship between age and body fat indexes adjusted for Sexual Maturation Status, several changes were observed, mainly in girls. Precocious maturation was associated with increased adiposity indicators in girls, whereas late maturation was associated with decreased adiposity indicators in both sexes. Precocious maturation was associated with increased adiposity indicators in girls, whereas late maturation was associated with decreased adiposity indicators in both sexes.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4095-5) contains supplementary material, which is available to authorized users.

The Association of Grandparent Care with Childhood Overweight and Obesity in Chinese American Families

BACKGROUND

Grandparents are often the caretakers of children in Chinese American families. Studies have shown that Chinese grandparents underestimate the weight of their grandchildren and associate food with increased height and strength. This study examines the association of grandparental care with weight status in Chinese American children and adolescents.

METHODS

This is a cross-sectional study of 12,029 Chinese American pediatric patients ages 2-19 at a community health center in New York City in 2015. Grandparental care was defined as child care provided by at least one grandparent. Multivariable logistic regression was conducted to assess for association between having a grandparent caretaker and weight status in the age groups 2-5, 6-11, and 12-19 while adjusting for sex, place of birth, neighborhood poverty, and two-parent households.

RESULTS

Approximately 12% of Chinese American children in this population had a grandparent caretaker. Children and adolescents with grandparent caretakers are more likely to be overweight than their counterparts with no grandparent caretakers at ages 6-11 (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.23-1.79) and ages 12-19 (OR: 1.54; 95% CI: 1.18-2.02). No association was found between grandparental care and overweight in ages 2-5 nor with obesity in any age group.

CONCLUSIONS

Grandparental care is associated with the weight of school-age children and adolescents. Targeted education on appropriate nutrition for the child's age is needed for grandparents who take care of children.

Parents Matter: Associations of Parental BMI and Feeding Behaviors With Child BMI in Brazilian Preschool and School-Aged Children

Background: Brazil is undergoing nutritional transition and rates of obesity in preschool and school-aged children are increasing. Excess weight in the first years of life could predict excess weight in adulthood, making it essential to study risk factors in this population.

Objective: Our goal was to investigate associations of parent feeding behaviors, as well as more distal familial influences including family SES and maternal and paternal weight, with BMI z-score in preschool and school-aged children in a Brazilian sample.

Methods: Cross-sectional study. Data were collected in 14 Brazilian private schools. Parents of children aged 2–8 years (n = 1,071) completed a questionnaire assessing parent feeding behaviors, as well as sociodemographic and anthropometric information. Hierarchical linear regression models were fitted to investigate relationships between parent and child characteristics and child BMI z-score in preschool (2–5 years, n = 397) and school-aged (6–8 years, n = 618) children.

Results: Final models indicated that higher maternal BMI and “restriction for weight control” were associated with higher child BMI z-score in both age groups (excessive weight, i.e., BMI ≥ +1 z-score, in preschoolers and school-aged children: 24.4 and 35.9%, respectively). In preschoolers only, “healthy eating guidance” and “pressure” were associated with lower child BMI z-score. For school-aged children, male sex, higher father BMI, and “restriction for health” were associated with higher child BMI z-score.

Conclusions: Parent feeding behaviors and parent weight, as well as child sex, are associated with child BMI z-score, with evidence for differential relationships in preschool and school-aged children. Optimal obesity prevention and treatment strategies may differ by child age.

Like Mother, Like Child: The Influences of Maternal Attitudes and Behaviors on Weight-Related Health Behaviors in Their Children

BACKGROUND

Childhood obesity has become a global health issue, yet little is known about the influence of maternal factors on children's weight-related health behaviors (dietary habits and physical activity), especially in China. The purpose of this study was to examine the influence of maternal factors on children's eating behaviors and physical activity in Chinese preschool-age children.

METHOD

A cross-sectional study was utilized to describe weight-related health behaviors among preschool-aged children and identify maternal factors that are associated with children's weight-related health behaviors in China. Mothers completed questionnaires regarding family eating and activity habits, child feeding practices, and maternal self-efficacy regarding their child's health-related health behaviors.

RESULTS

A total of 222 mother-child dyads participated in this study. Maternal health-related behavior and attitudes regarding feeding practices and self-efficacy were associated with children's health-related behaviors, including eating behaviors and physical and sedentary activities. The influence of maternal behaviors and attitudes were domain specific.

DISCUSSION

Improvement of children's health behaviors, promoting a healthy lifestyle of the mother and self-efficacy, and providing health home environment for the child are critical in obesity prevention.

IMPLICATIONS FOR PRACTICE

Because children's health is critical to the health of the nation and to global development, understanding the factors related to children's health-related behaviors is an important first step toward development of tailored, culturally sensitive interventions for promoting a healthy lifestyle and preventing obesity.

Effect of Sleep Duration, Diet, and Physical Activity on Obesity and Overweight Elementary School Students in Shanghai

BACKGROUND

This was a cross-sectional survey to investigate the relationship of age, parent education, sleep duration, physical activity, and dietary habits with overweight or obesity in school-age children in Shanghai.

METHODS

The survey gathered information from 13,001 children in grades 1 through 5 (age 6 to 10 years) among 26 elementary schools in 7 districts. Activity level was evaluated using the International Children's Leisure Activities Study Survey Questionnaire (CLASS-C). The definitions of normal, overweight, and obese were adjusted for each age.

RESULTS

Logistic regression analysis indicated that age, being male, having ≤10 hours of sleep on non-school days, eating ≥1 vegetable/day, or drinking ≥1 sugar-sweetened drink/day increased the risk for a child being overweight or obese compared with having >10 hours of sleep or ≤3 vegetables or ≤3 sugar-sweetened drinks/month (p ≤ .008). Having >2 hours of outdoor activities on non-school days reduced the risk of being overweight or obese compared with ≤2 hours of outdoor activities on non-school days (p < .001).

CONCLUSIONS

We found that age, sex, sleep, and some dietary habits impacted weight, and suggests that specific cultural and economic factors may impact risk of a child being overweight or obese.

Predicting weight status in Chinese pre-school children: independent and interactive effects of caregiver types and feeding styles

Objective

To investigate caregiver type as a potential moderating effect in the relationship between feeding style and weight status among Chinese pre-school children.

Design

Cross-sectional data collected with the Caregiver’s Feeding Style Questionnaire (CFSQ), anthropometric data, childcare and sociodemographic information.

Setting

Shenyang, China.

Subjects

Caregiver–child dyads (n 857).

Results

After controlling for confounders, authoritarian feeding style was associated with a 0·30 lower BMI Z-score. Fathers as primary caregivers were related to lower BMI Z-score (β=−0·66), while grandparents as main caregivers were associated with higher BMI Z-score (β=0·66) after adjusting for covariates. Mothers buffered the relationship between authoritarian (β=0·50, 95 % CI 0·04, 0·95) or indulgent (β=−0·60, 95 % CI −1·06, −0·14) feeding styles and BMI Z-score. Grandparents strengthened the trend that indulgent feeding style was related to higher BMI Z-score (β=0·54, 95 % CI 0·01, 1·08).

Conclusions

The results of independent and interactive effects of specific feeding styles and caregiver types had different influences on child BMI Z-scores. Longitudinal investigations are needed to evaluate the effect of fathers’ and grandparents’ feeding on their children’s nutrition and weight status.

A systematic review of grandparents' influence on grandchildren's cancer risk factors

Many lifestyle patterns are established when children are young. Research has focused on the potential role of parents as a risk factor for non communicable disease in children, but there is limited investigation of the role of other caregivers, such as grandparents. The aim of this review was to identify and synthesise evidence for any influence grandparents' care practices may have on their grandchildren's long term cancer risk factors. A systematic review was carried out with searches across four databases (MEDLINE, Embase, Web of Science, PsycINFO) as well as searches of reference lists and citing articles, and Google Scholar. Search terms were based on six areas of risk that family care could potentially influence-weight, diet, physical activity, tobacco, alcohol and sun exposure. All study designs were included, as were studies that provided an indication of the interaction of grandparents with their grandchildren. Studies were excluded if grandparents were primary caregivers and if children had serious health conditions. Study quality was assessed using National Institute for Health and Care Excellence checklists. Grandparent impact was categorised as beneficial, adverse, mixed or as having no impact. Due to study heterogeneity a meta-analysis was not possible. Qualitative studies underwent a thematic synthesis of their results. Results from all included studies indicated that there was a sufficient evidence base for weight, diet, physical activity and tobacco studies to draw conclusions about grandparents' influence. One study examined alcohol and no studies examined sun exposure. Evidence indicated that, overall, grandparents had an adverse impact on their grandchildren's cancer risk factors. The theoretical work in the included studies was limited. Theoretically underpinned interventions designed to reduce these risk factors must consider grandparents' role, as well as parents', and be evaluated robustly to inform the evidence base further.

A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research

RESEARCH QUESTIONS

What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children?

OBJECTIVES

Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children.

METHODS

The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed.

RESULTS

Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health).

CONCLUSIONS

Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.

Changes in the effects of living with no siblings or living with grandparents on overweight and obesity in children: Results from a national cohort study in Japan

Effects of living without siblings and living with grandparents on overweight and obesity may change with child's age. We aimed to examine these effects from early childhood to school age at the national level in Japan. Subjects were 43,046 children born in Japan during two weeks in 2001 who were followed annually from 2.5 to 13 years of age in the Longitudinal Survey of Newborns in the 21st Century. We used measured body height and weight reported by participants at each survey and followed the criteria of the International Obesity Task Force to define overweight and obesity. Random-effects logit models by sex, adjusted for time-varying and time-invariant covariates, assessed odds ratios of overweight and obesity for living without siblings and for living with grandparents at each age. The likelihood of overweight and obesity was significantly higher at 8 years and older among children living without siblings, compared with those living with siblings, and odds ratios were highest at 11 years of age in boys (1.87, 95% confidence interval [CI]: 1.49, 2.33) and at 10 and 13 years of age in girls (1.75 [95% CI: 1.36, 2.23] and 1.73 [95% CI: 1.30, 2.31], respectively). It was also significantly higher at 5.5 years and older among children living with grandparents, compared with those living without grandparents, and odds ratios were highest at 10 and 13 years of age in boys (1.53 [95% CI: 1.30, 1.80] and 1.54 [95% CI: 1.27, 1.86], respectively) and at 11 years of age in girls (1.51, 95% CI: 1.24, 1.84). In Japan, living without siblings and living with grandparents may increase the likelihood of overweight and obesity at 8 and 5.5 years and older, respectively. Child's age should be considered during formulation of strategies for prevention of overweight and obesity in these groups.