Modifiable Early Childhood Risk Factors for Obesity at Age Four Years

Abstract

Background: Childhood obesity is associated with an increased risk of adult obesity and related chronic disease. Our aim was to identify modifiable exposures that are independently associated with obesity in the preschool age group.Methods: A prospective cohort study of 5734 children in New Zealand with anthropometric measurements was completed at age 4.5 years. The modifiable exposures of interest, measured at age 9 months and 2 years, were: food security during infancy; and, at age 2 years, screen time; sleep duration; and takeaway food and soft drink intake. The risk of obesity independently associated with each exposure was determined using Binomial and Poisson regression and described using adjusted risk ratios (RRs) and 95% confidence intervals (CIs), after controlling for confounding variables including gender, ethnicity, birth weight, and mother's age. The probability of obesity given cumulative exposures to the four risk factors and the population attributable fraction (PAF) were estimated.Results: Lower food security during infancy (<mean study sample score; RR = 1.32; 95% CI : 1.06-1.64) and, at age 2 years, more screen time (>1 hour/day; RR = 1.22; 95% CI : 1.01-1.48), shorter sleep duration (£11.5 hours/day; RR = 1.30; 95% CI : 1.05-1.61), and weekly to daily consumption of takeaway/soft drink (RR = 1.25, 95% CI : 1.00-1.57) were independently associated with an increased risk of obesity at age 4.5 years. The cumulative PAF for childhood obesity was 42.9%, under an ideal scenario where all risk factors were eliminated.Conclusion: Exposure to modifiable factors by age 2 years is associated with obesity at age 4.5 years. Interventions to prevent childhood obesity need to be effective during infancy.

Influence of Lifestyle Habits in the Development of Obesity during Adolescence

“…Regarding the first hypothesis (H1), no significant relationship was found between dietary factors and obesity, like other studies [ 2 , 49 , 56 , 85 ]. The results were found in the present study probably because the study sample belonged to a rural area, in which young people maintain good adherence to the Mediterranean diet, which is rich in fruits, vegetables, and fish [ 86 ].…”

“…The relationship between lifestyle habits and the development of excess weight in adolescence is a widely studied topic [ 3 , 49 , 51 , 55 ]. However, the current study used the novel partial least squares structural equation modeling (PLS-SEM) method, which is widely used in other fields and whose results allow the hypotheses to be contrasted and actions in certain areas susceptible to improvement to be proposed [ 20 , 36 , 37 ].…”

“…Given the demonstrated importance of this construct, it was divided into two subgroups to conduct a more exhaustive analysis: ICT-1, made up of items associated with sitting, and ICT-2, made up of others not associated necessarily with physical inactivity. Leisure, education, or communication through a screen has had a sharp rise among adolescents, and a direct relationship was found between the intensive use of such media and the increase in BMI in childhood [ 49 , 61 , 62 , 63 ]. The negative relationship between ICT-2 and the development of excess weight in childhood may be explained by parents’ incorrect perception of the usage of new technologies, which makes it difficult for them to identify when the use of such technologies is already abusive [ 75 , 90 ].…”

“…The control of the potentially modifiable risk factors for excess weight is currently the cornerstone of prevention and treatment [ 48 , 49 ]. Genetics, responsible for less than 5% of childhood obesity, must often be combined with contributing environmental and behavioral factors to affect weight [ 50 ].…”

Lifestyle Risk Factors and the Population Attributable Fractions for Overweight and Obesity in Chinese Students of Zhejiang Province

“…Inadequate sleeping has a greater impact on obesity in 9–13 years old boys than in 4–8 years old boys ( 14 ). The cumulative population attributable fraction (PAF) for childhood obesity was 42.9% in a cohort study in New Zealand, as if the excessive screen time and several other related factors were eliminated ( 15 ). Furthermore, a study found that not participating in sports' teams (PAF, 16.57%; 95% CI, 15.30–17.84%) had the biggest influence on the rate of obesity in American high school students, followed by watching TV and playing computer games ( 16 ).…”