Advertisement

Canadian Journal of Public Health

, Volume 104, Issue 1, pp e69–e74 | Cite as

Perinatal and Early Childhood Factors for Overweight and Obesity in Young Canadian Children

  • Yipu Shi
  • Margaret de Groh
  • Howard Morrison
Quantitative Research

Abstract

BACKGROUND: This study assessed potential early-life factors and their interrelationships with obesity among young Canadian children.

METHODS: Data from a nationally representative sample of children aged 6 to 11 years in the Canadian Health Measures Survey were analyzed. The associations of perinatal and early childhood behaviours and socio-economic factors with overweight or obesity were evaluated using multivariate logistic regression models. Adjusted population attributable risk fractions (PARFs) were calculated using multivariate logistic regression models.

RESULTS: Of 968 term-born children, 21% were overweight and another 13% were obese. Maternal smoking during pregnancy (adjusted odds ratio, 2.26; 95% confidence interval, 1.23–4.15) was positively associated with obesity. This association was mediated by birth weight (suppression effect); once controlled, the strength of the association between smoking and child obesity increased by 12%. Birth weight per 100 g (1.05; 1.005–1.09) was significantly associated with obesity. Exclusive breastfeeding for 6 months (0.44; 0.31–0.61), adequate sleep hours (0.39; 0.16–0.94) and being physically active (0.50; 0.26–0.93) were found to be protective. Breastfeeding, whether exclusive or not, significantly reduced obesity risk among children whose mothers never smoked in pregnancy. PARFs indicated that 24.4%, 11.5%, 11.3% and 6.0% prevalent cases of child obesity might be prevented by exclusive breastfeeding, smoking cessation during pregnancy, adequate sleep during childhood, and avoiding high birth weight, respectively.

CONCLUSIONS: This study identified multiple perinatal and childhood factors associated with obesity in young Canadian children. Effective prevention strategies targeting four modifiable maternal and child risk factors may reduce childhood obesity by up to 54% in Canada.

Key words

Childhood obesity birth weight maternal smoking breastfeeding Canadian Health Measures Survey 

Résumé

CONTEXTE: Nous avons évalué des facteurs potentiels au début de la vie et leurs rapports mutuels avec l’obésité chez de jeunes enfants canadiens.

MÉTHODE: Nous avons analysé les données d’un échantillon national représentatif d’enfants de 6 à 11 ans dans l’Enquête canadienne sur les mesures de la santé. À l’aide de modèles de régression logistique multivariée, nous avons évalué les associations entre les comportements durant la période périnatale et la petite enfance, certains facteurs socioéconomiques, le surpoids et l’obésité, puis calculé les fractions étiologiques du risque ajustées dans la population (FERp).

RÉSULTATS: Sur 968 enfants nés à terme, 21 % étaient en surpoids et 13 % étaient obèses. Le tabagisme maternel durant la grossesse (rapport de cotes ajusté de 2,26; intervalle de confiance de 95 %, 1,23–4,15) était associé positivement à l’obésité. Cette association était assistée par le poids de naissance (effet de suppression); une fois les ajustements apportés, la force de l’association entre le tabagisme et l’obésité de l’enfant augmentait de 12 %. Le poids de naissance p. 100 g (1,05; 1,005–1,09) présentait une corrélation significative avec l’obésité. L’allaitement maternel exclusif pendant 6 mois (0,44; 0,31–0,61), les heures de sommeil suffisantes (0,39; 0,16–0,94) et l’activité physique (0,50; 0,26–0,93) étaient des facteurs de protection. L’allaitement maternel, exclusif ou non, réduisait significativement le risque d’obésité chez les enfants dont les mères n’avaient jamais fumé durant la grossesse. Les FERp ont indiqué que 24,4 %, 11,5 %, 11,3 % et 6,0 % des cas prévalents d’obésité infantile pourraient être prévenus par l’allaitement maternel exclusif, l’arrêt du tabac durant la grossesse, le sommeil suffisant durant l’enfance et l’évitement d’un poids de naissance élevé, respectivement.

CONCLUSION: De nombreux facteurs de la période périnatale et de l’enfance sont associés à l’obésité chez ces jeunes enfants canadiens. Des stratégies de prévention efficaces ciblant quatre facteurs de risque modifiables chez les mères et les enfants pourraient réduire l’obésité infantile jusqu’à 54 % au Canada.

Mots clés

obésité infantile poids de naissance tabagisme maternel allaitement Enquête canadienne sur les mesures de la santé 

References

  1. 1.
    Shields M, Tremblay MS. Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points. Int J Pediatr Obes 2010;5(3):265–73.CrossRefGoogle Scholar
  2. 2.
    Charney E, Goodman HC, McBride M, Lyon B, Pratt R. Childhood antecedents of adult obesity. Do chubby infants become obese adults? N Engl J Med 1976;295(1):6–9.CrossRefGoogle Scholar
  3. 3.
    Shankaran S, Bann C, Das A, Lester B, Bada H, Bauer CR, et al. Risk for obesity in adolescence starts in early childhood. J Perinatol 2011;31(11):711–16.CrossRefGoogle Scholar
  4. 4.
    Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study. Pediatrics 2001;108(3):712–18.CrossRefGoogle Scholar
  5. 5.
    Monasta L, Batty GD, Cattaneo A, Lutje V, Ronfani L, van Lenthe FJ, et al. Early-life determinants of overweight and obesity: A review of systematic reviews. Obes Rev 2010;11(10):695–708.CrossRefGoogle Scholar
  6. 6.
    Yu ZB, Han SP, Zhu GZ, Zhu C, Wang XJ, Cao XG, et al. Birth weight and subsequent risk of obesity: A systematic review and meta-analysis. Obes Rev 2011;12(7):525–42.CrossRefGoogle Scholar
  7. 7.
    Oken E, Levitan EB, Gillman MW. Maternal smoking during pregnancy and child overweight: Systematic review and meta-analysis. Int J Obes (Lond) 2008;32(2):201–10.CrossRefGoogle Scholar
  8. 8.
    Janz T. Current smoking trends. Health at a Glance June 2012. Available at: http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11676-eng.pdf (Accessed August 22, 2012).Google Scholar
  9. 9.
    Arenz S, Rückerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity—A systematic review. Int J Obesity 2004;28(10):1247–56.CrossRefGoogle Scholar
  10. 10.
    Beyerlein A, Toschke AM, von Kries R. Breastfeeding and childhood obesity: Shift of the entire BMI distribution or only the upper parts? Obesity (Silver Spring) 2008;16(12):2730–33.CrossRefGoogle Scholar
  11. 11.
    Bogen DL, Hanusa BH, Whitaker RC. The effect of breast-feeding with and without formula use on the risk of obesity at 4 years of age. Obes Res 2004;12(9):1527–35.CrossRefGoogle Scholar
  12. 12.
    Wadsworth M, Marshall S, Hardy R, Paul A. Breast feeding and obesity. Relation may be accounted for by social factors. BMJ 1999;319(7224):1576.CrossRefGoogle Scholar
  13. 13.
    Prentice-Dunn H, Prentice-Dunn S. Physical activity, sedentary behavior, and childhood obesity: A review of cross-sectional studies. Psychol Health Med 2012;17(3):255–73.CrossRefGoogle Scholar
  14. 14.
    Wells JC, Hallal PC, Reichert FF, Menezes AM, Araujo CL, Victora CG. Sleep patterns and television viewing in relation to obesity and blood pressure: Evidence from an adolescent Brazilian birth cohort. Int J Obes (Lond) 2008;32(7):1042–49.CrossRefGoogle Scholar
  15. 15.
    Wijlaars LP, Johnson L, van Jaarsveld CH, Wardle J. Socioeconomic status and weight gain in early infancy. Int J Obes (Lond) 2011;35(7):963–70.CrossRefGoogle Scholar
  16. 16.
    Tremblay MS, Gorber SC. Canadian Health Measures Survey: Brief overview. Can J Public Health 2007;98(6):453–56.PubMedGoogle Scholar
  17. 17.
    Casey PH, Kraemer HC, Bernbaum J, Yogman MW, Sells JC. Growth status and growth rates of a varied sample of low birth weight, preterm infants: A longitudinal cohort from birth to three years of age. J Pediatr 1991;119(4):599–605.CrossRefGoogle Scholar
  18. 18.
    de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull WHO 2007;85(9):660–67.PubMedGoogle Scholar
  19. 19.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51(6):1173–82.CrossRefGoogle Scholar
  20. 20.
    Benichou J. A review of adjusted estimators of attributable risk. Stat Methods Med Res 2001;10(3):195–216.CrossRefGoogle Scholar
  21. 21.
    Toschke AM, Ruckinger S, Bohler E, von Kries R. Adjusted population attributable fractions and preventable potential of risk factors for childhood obesity. Public Health Nutr 2007;10(9):902–6.CrossRefGoogle Scholar
  22. 22.
    Canadian Health Measures Survey. Data User Guide: Cycle 1. 2012. Available at: http://www23.statcan.gc.ca/imdb-bmdi/pub/document/5071_D2_T1_V1-eng.htm (Accessed November 9, 2012).Google Scholar
  23. 23.
    von Kries R, Toschke AM, Koletzko B, Slikker W, Jr. Maternal smoking during pregnancy and childhood obesity. Am J Epidemiol 2002;156(10):954–61.CrossRefGoogle Scholar
  24. 24.
    Beyerlein A, Ruckinger S, Toschke AM, Schaffrath RA, von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? Eur J Epidemiol 2011;26(5):413–20.CrossRefGoogle Scholar
  25. 25.
    Sharma AJ, Cogswell ME, Li R. Dose-response associations between maternal smoking during pregnancy and subsequent childhood obesity: Effect modification by maternal race/ethnicity in a low-income US cohort. Am J Epidemiol 2008;168(9):995–1007.CrossRefGoogle Scholar
  26. 26.
    Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, et al. Early life risk factors for obesity in childhood: Cohort study. BMJ 2005;330(7504):1357.CrossRefGoogle Scholar
  27. 27.
    Kramer MS, Morin I, Yang H, Platt RW, Usher R, McNamara H, et al. Why are babies getting bigger? Temporal trends in fetal growth and its determinants. J Pediatr 2002;141(4):538–42.CrossRefGoogle Scholar
  28. 28.
    Kahn RS, Certain L, Whitaker RC. A reexamination of smoking before, during, and after pregnancy. Am J Public Health 2002;92(11):1801–8.CrossRefGoogle Scholar
  29. 29.
    Wen X, Shenassa ED, Paradis AD. Maternal smoking, breastfeeding, and risk of childhood overweight: Findings from a national cohort. Matern Child Health J 2012 Jun 20 (Epub ahead of print).Google Scholar
  30. 30.
    Tomeo CA, Rich-Edwards JW, Michels KB, Berkey CS, Hunter DJ, Frazier AL, et al. Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology 1999;10(6):774–77.CrossRefGoogle Scholar
  31. 31.
    Chalmers B, Levitt C, Heaman M, O’Brien B, Sauve R, Kaczorowski J. Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth 2009;36(2):122–32.CrossRefGoogle Scholar
  32. 32.
    McDowell MM, Wang CY, Kennedy-Stephenson J. Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Surveys, 1999–2006. NCHS Data Brief 2008;5:1–8.Google Scholar

Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  1. 1.Social Determinants and Science Integration Directorate, Public Health Agency of CanadaOttawaCanada

Personalised recommendations