Associations of individual factors and early childhood education and care (ECEC) centres characteristics with preschoolers’ BMI in Germany

Abstract

Background The number of obese children is rising worldwide. Many studies have investigated single determinants of children’s body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. Methods Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children’s standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. Results Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 – 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI. Conclusions The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.

Do maternal socioeconomic status influence child overweight?

“…Currently, many developed nations have been actively conducting research which are grounded in the ecosystem theory of childhood overweight or obesity. These investigations primarily seek to elucidate the interplay between socio-economic stratification in the environments where children reside and the prevalence of obesity [ 3 , 9 , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ]. The theoretical framework of this study emphasizes that childhood overweight is the outcome of intricate interactions among multiple factors.…”

“…The family constitutes the most immediate being in supplying resources to children, especially for those under the age of five. Families with higher incomes tend to adopt healthier behaviors such as; making healthier food choices, allocating more time for physical activity and having greater access to better healthcare, all of which contribute to lower BMI in children [ 36 , 37 ]. Within this familial context, mothers as the primary caregivers in a family setting tend to exert a direct influence on their children's dietary choices, physical activity, screen time, sleep patterns, and other health-related habits that contribute to the risk of childhood obesity [ [40] , [41] , [42] , [43] , [44] ].…”

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

“…All analyses were repeated with an alternative calculation for the BMI in children ( 60 ). The standard deviation score of the BMI (SDS BMI) was calculated based on representative data for Germany ( 61 ).…”

Physical activity promotion in daycare centres in Germany: study protocol for a cross-sectional survey within the BeweKi study

“…In general, prevention measures in daycare can depend on the type of organisation that operates the daycare centre (carrier), that is, private, public (municipal or regional) or faith-based organisations 25. Other factors may include (a) structural and conceptual characteristics, (b) culture, policies, practices and (c) characteristics of directors and pedagogical staff 26–29. Some of these factors have been implied to be associated with higher levels of physical activity in daycare.…”

“…25 Other factors may include (a) structural and conceptual characteristics, (b) culture, policies, practices and (c) characteristics of directors and pedagogical staff. 26–29 Some of these factors have been implied to be associated with higher levels of physical activity in daycare. For example, the size of the playground, the available space per child and certain outdoor equipment characteristics such as specific playground features (as structural characteristics) are positively correlated with physical activity levels of children.…”