Eight factors in early life are associated with an increased risk of obesity in childhood.

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Aims: To test for the coexistence of social inequalities in undernutrition and obesity in preschool children. Methods: Retrospective, cross sectional, study of routinely collected data from 74 500 children aged 39-42 months in 1998/99. Main outcome measures were weight, height, sex, and age routinely recorded by health visitors. Body mass index (BMI) standardised for age and sex, relative to UK 1990 reference data, was used to define undernutrition (BMI <2nd centile) and obesity (BMI >95th centile; BMI >98th centile). Social deprivation was assessed as Carstairs deprivation category (1 = most affluent to 7 = most deprived). Results: Both undernutrition (3.3%) and obesity (8.5% above 95th centile; 4.3% above 98th centile) significantly exceeded expected frequencies from UK 1990 reference data. Undernutrition and obesity were significantly more common in the more deprived families. Odds ratios in deprivation category 7 relative to category 1 were 1.51 (95% CI 1.22 to 1.87) for undernutrition (BMI <2nd centile) and 1.30 (95% CI 1.05 to 1.60) for obesity (BMI >98th centile). The cumulative prevalence of under and overnutrition (malnutrition) in the most deprived group was 9.5% compared to 6.9% in the least deprived group. Conclusions: Undernutrition and obesity are significantly more common than expected in young children and strongly associated with social deprivation. Both undernutrition and obesity have adverse short and long term health effects. Public health strategies need to tackle malnutrition (both undernutrition and obesity) in children and take into consideration the association with social deprivation.

The accuracy of the multiple pass 24 h recall for assessment of habitual energy intake in preschool children is unclear. The primary aim of this study was to assess its accuracy by comparison with measurement of total energy expenditure by doubly-labelled water in a representative sample of forty-one 3 -4-year-olds. The recall method was well tolerated by subjects and was administered quickly and easily. However, it produced estimates of energy intake which significantly exceeded measures of total energy expenditure from doubly-labelled water, mean paired difference 660 kJ/d (P,0 : 01). Agreement between the two methods was poor at the individual level: limits of agreement 6601/23018 kJ/d. Error and imprecision in both methods contribute to individual differences, but the present study suggests that the multiple pass 24 h recall does not provide accurate estimates of dietary energy intake in individual children. Doubly-labelled water: Energy expenditure: Children: Energy intake misreportingAssessments of dietary energy intake (EI) in pre-school children are commonly made, in applications which range from clinical settings to experimental investigations of the causes of energy imbalance to population surveys. In older children and adolescents (Bandini et al. 1990;Livingstone et al. 1992;Maffeis et al. 1994;Champagne et al. 1996), and adults (Livingstone et al. 1990;Sawaya et al. 1996;Kroke et al. 1999) such assessments tend to be time consuming yet produce results which are prone to imprecision and inaccuracy (largely due to dietary under-reporting).In 3 -4-year-old children, the accuracy and practical utility of EI assessments are less clear because the evidence is somewhat limited: a recent review of dietary assessment methodology for use in children concluded that more validation studies were necessary (Livingstone & Robson, 2000). In subjects in energy balance EI should approximate total energy expenditure (TEE) and so measurement of TEE, with doubly-labelled water, is widely used as a criterion method against which dietary assessment techniques can be validated. This assumption is fair even in young, growing, children because the energy cost of growth is very small after infancy (typically ,2 % of daily EI; Kuzawa, 1998). Our literature search revealed only one comparison of TEE and EI in 3 -4-year-olds. Davies et al. (1994) found in twenty-seven 3 : 5-4 : 5-year-olds in England