Predicting Early Emergence of Childhood Obesity in Underserved Preschoolers

Abstract

Objective: To determine the magnitude of risk of factors that contribute to the emergence of childhood obesity among low-income minority children.

Study design: We conducted a prospective cohort analysis of parent-child pairs with children aged 3-5 years who were nonobese (n = 605 pairs) who participated in a 3-year randomized controlled trial of a healthy lifestyle behavioral intervention. After baseline, height and weight were measured 5 times over 3 years to calculate body mass index (BMI) percentiles and classify children as normal, overweight, or obese. Multivariable logistic regression was used to estimate the odds of obesity after 36 months. Predictors included age, sex, birth weight, gestational age, months of breastfeeding, ethnicity, baseline child BMI, energy intake, physical activity, food security, parent baseline BMI, and parental depression.

Results: Among this predominantly low-income minority population, 66% (398/605) of children were normal weight at baseline and 34% (n = 207/605) were overweight. Among normal weight children at baseline, 24% (85/359) were obese after 36 months; among overweight children at baseline, 55% (n = 103/186) were obese after 36 months. Age at enrollment (OR 2.11, 95% CI 1.64-2.72), child baseline BMI (OR 3.37, 95% CI 2.51-4.54), and parent baseline BMI (OR for a 6-unit change 1.36, 95% CI 1.09-1.70) were significantly associated with the odds of becoming obese for children.

Conclusions: The combination of child age, parent BMI, and child overweight as predictors of child obesity suggest a paradigm of family-centered obesity prevention beginning in early childhood, emphasizing the relevance of child overweight as a phenotype highly predictive of child obesity.

Trial registration: Clinicaltrials.gov: NCT01316653.

Keywords: childhood obesity; latino; predictors; preschoolers.

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Figure 1:

Predictors of Childhood Obesity Emergence. The plot displays results from adjusted multivariable logistic regression, showing odds ratios and 95% confidence intervals of covariates predicting childhood obesity at 36 months among children who were overweight or normal weight at baseline.

Figure 2:

Predicted probability of childhood obesity across 36 months of follow-up. Graphs from two separate models using generalized estimating equations to fit marginal logistic regressions. The first model (Panel A) included the main effects of child baseline BMI category and parent baseline BMI and each of their interactions with time. The second model (Panel B) included child baseline BMI category and child baseline age and each of their interactions with time.