Skip to main content

Racial/Ethnic Disparities: a Longitudinal Study of Growth Trajectories Among US Kindergarten Children

Abstract

Background/Objectives

While previous studies have documented racial/ethnic disparities in childhood obesity, less is known about when disparities emerge, how they evolve, and the most appropriate early childhood period for targeted interventions. We examined racial/ethnic differences in growth trajectories among US kindergarten-aged children followed from birth and identified sensitive periods at which disparities emerge.

Subjects and Methods

This is a longitudinal study design using Early Childhood Longitudinal Study Birth Cohort data. We employed random effects growth curves to model trajectories of mean BMI z-scores by race/ethnicity and sex. To visualize sensitive periods for emergence of disparities, we used locally estimated smoothing spline curves to graph the relationship between age and BMI z-score within each racial group.

Results

Unweighted baseline sample size included ~ 7200 children. Overall, 54.6% of children were white, 23.1% Hispanic, 15.7% African-American, 3.4% Asian, 2.8% American-Indian, and 0.4% Pacific-Islander. Mean BMI z-scores for Hispanic boys and American-Indian boys and girls were already significantly higher by 24 months than their white peers and remained higher through kindergarten entry. African-American and Asian children started with significantly lower birth-weights compared to whites, but Asian girls’ growth trajectory remained slow, while African-American girls experienced steeper increases in BMI z-scores and ultimately overtook their white and Asian peers over time. By kindergarten entry, disparities were present across all racial/ethnic groups.

Conclusion

Racial/ethnic disparities in US children’s weight status and growth trajectories emerge at different ages for different racial groups, but they are generally well established by kindergarten age. Our findings indicate that interventions designed to prevent early childhood overweight/obesity should be implemented early in the life course.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Abbreviations

BMI:

Body mass index

ECLS-B:

Early Childhood Longitudinal Study Birth Cohort

NCES:

National Center for Education and Statistics

OLS:

Ordinary least squares

SES:

Socioeconomic status

LOESS:

Locally estimated smoothing splines

US:

United States

References

  1. 1.

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 2012;307(5):483–90.

    Article  PubMed  Google Scholar 

  2. 2.

    National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Hyattsville, MD. 2013. Available at: https://www.cdc.gov/nchs/data/hus/hus12.pdf. Accessed 10/31/2017.

  3. 3.

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14. https://doi.org/10.1001/jama.2014.732.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. 4.

    Wen X, Gillman MW, Rifas-Shiman SL, Sherry B, Kleinman K, Taveras EM. Decreasing prevalence of obesity among young children in Massachusetts from 2004 to 2008. Pediatrics. 2012;129(5):823–31.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Claire Wang Y, Gortmaker SL, Taveras EM. Trends and racial/ethnic disparities in severe obesity among US children and adolescents, 1976-2006. Int J Pediatr Obes. 2011;6(1):12–20.

    Article  PubMed  CAS  Google Scholar 

  6. 6.

    Freedman DS, Khan LK, Serdula MK, Ogden CL, Dietz WH. Racial and ethnic differences in secular trends for childhood BMI, weight, and height. Obesity (Silver Spring). 2006;14(2):301–8.

    Article  Google Scholar 

  7. 7.

    Singh GK, Siahpush M, Kogan MD. Rising social inequalities in US childhood obesity, 2003-2007. Ann Epidemiol. 2010;20(1):40–52.

    Article  PubMed  Google Scholar 

  8. 8.

    Cunningham SA, Kramer MR, Narayan KM. Incidence of childhood obesity in the United States. N Engl J Med. 2014;370(5):403–11.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. 9.

    Institute of Medicine (IOM). Early childhood obesity prevention policies. Washington, DC: The National Academies Press; 2011.

    Google Scholar 

  10. 10.

    Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA. 2008;299(20):2401–5.

    Article  PubMed  CAS  Google Scholar 

  11. 11.

    Belfort MB, Rifas-Shiman SL, Rich-Edwards J, Kleinman KP, Gillman MW. Size at birth, infant growth, and blood pressure at three years of age. J Pediatr. 2007;151(6):670–4.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Dennison BA, Edmunds LS, Stratton HH, Pruzek RM. Rapid infant weight gain predicts childhood overweight. Obesity (Silver Spring). 2006;14(3):491–9.

    Article  Google Scholar 

  13. 13.

    Stettler N, Zemel BS, Kumanyika S, Stallings VA. Infant weight gain and childhood overweight status in a multicenter, cohort study. Pediatrics. 2002;109(2):194–9.

    Article  PubMed  Google Scholar 

  14. 14.

    Taveras EM, Rifas-Shiman SL, Belfort MB, Kleinman KP, Oken E, Gillman MW. Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics. 2009;123(4):1177–83.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Symonds ME, Mendez MA, Meltzer HM, et al. Early life nutritional programming of obesity: mother-child cohort studies. Ann Nutr Metab. 2013;62(2):137–45.

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Koletzko B, Brands B, Chourdakis M, et al. The Power of Programming and the Early Nutrition project: opportunities for health promotion by nutrition during the first thousand days of life and beyond. Ann Nutr Metab. 2014;64(3–4):187–96.

    Article  PubMed  CAS  Google Scholar 

  17. 17.

    Adair LS. Size at birth and growth trajectories to young adulthood. Am J Hum Biol. 2007;19(3):327–37.

    Article  PubMed  Google Scholar 

  18. 18.

    Barker DJ, Eriksson JG, Forsen T, Osmond C. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002;31(6):1235–9.

    Article  PubMed  CAS  Google Scholar 

  19. 19.

    Guerrero AD, Mao C, Fuller B, Bridges M, Franke T, Kuo AA. Racial and ethnic disparities in early childhood obesity: growth trajectories in body mass index. J Racial Ethn Health Disparities. 2016;3(1):129–37.

    Article  PubMed  Google Scholar 

  20. 20.

    Early Childhood Longitudinal Program (ECLS)—Birth Cohort (ECLS-B). Accessed 05/02/2017. Available at: http://nces.ed.gov/ecls/birth.asp.

  21. 21.

    Centers for Disease Control and Prevention (CDC), Growth charts—Available at: http://www.cdc.gov/growthcharts/. Accessed on 05/02/2017.

  22. 22.

    Ogden CL, Flegal KM. Changes in terminology for childhood overweight and obesity. Natl Health Stat Rep 2010;(25)(25):1–5.

  23. 23.

    Anderson SE, Whitaker RC. Prevalence of obesity among US preschool children in different racial and ethnic groups. Arch Pediatr Adolesc Med. 2009;163(4):344–8.

    Article  PubMed  Google Scholar 

  24. 24.

    Cleveland W. Robust locally weighted regression and smoothing scatterplots. J Am Stat Assoc. 1979;74(368):829–36.

  25. 25.

    Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. New York: John Wiley & Sons; 2011. chapters 6 and 8. ISBN: 0470380277

    Google Scholar 

  26. 26.

    Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109:45–60.

    Article  PubMed  Google Scholar 

  27. 27.

    Silventoinen K, Rokholm B, Kaprio J, Sorensen TI. The genetic and environmental influences on childhood obesity: a systematic review of twin and adoption studies. Int J Obes. 2010;34(1):29–40.

    Article  CAS  Google Scholar 

  28. 28.

    Lobstein T, Baur L, Uauy R. IASO International Obesity Task Force. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5(Suppl 1):4–104.

    Article  PubMed  Google Scholar 

  29. 29.

    Whitaker RC, Orzol SM. Obesity among US urban preschool children: relationships to race, ethnicity, and socioeconomic status. Arch Pediatr Adolesc Med. 2006;160(6):578–84.

    Article  PubMed  Google Scholar 

  30. 30.

    Jain A, Mitchell S, Chirumamilla R, et al. Prevalence of obesity among young Asian-American children. Child Obes. 2012;8(6):518–25.

    Article  PubMed  Google Scholar 

  31. 31.

    Hamilton ER, Teitler JO, Reichman NE. Mexican American birthweight and child overweight: unraveling a possible early life course health transition. J Health Soc Behav. 2011;52(3):333–48.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Fuentes-Afflick E. Obesity among Latino preschoolers: do children outgrow the “epidemiologic paradox”? Arch Pediatr Adolesc Med. 2006;160(6):656–7.

    Article  PubMed  Google Scholar 

  33. 33.

    Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101(3):253–65.

    PubMed  PubMed Central  CAS  Google Scholar 

  34. 34.

    Fuentes-Afflick E, Lurie P. Low birth weight and Latino ethnicity. Examining the epidemiologic paradox. Arch Pediatr Adolesc Med. 1997;151(7):665–74.

    Article  PubMed  CAS  Google Scholar 

  35. 35.

    Johnson W, Choh AC, Lee M, Towne B, Czerwinski SA, Demerath EW. Characterization of the infant BMI peak: sex differences, birth year cohort effects, association with concurrent adiposity, and heritability. Am J Hum Biol. 2013;25(3):378–88.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Roy SM, Chesi A, Mentch F, et al. Body mass index (BMI) trajectories in infancy differ by population ancestry and may presage disparities in early childhood obesity. J Clin Endocrinol Metab. 2015;100(4):1551–60.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. 37.

    Van Hook J, Baker E. Big boys and little girls: gender, acculturation, and weight among young children of immigrants. J Health Soc Behav. 2010;51(2):200–14.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Epstein LH, Paluch RA, Raynor HA. Sex differences in obese children and siblings in family-based obesity treatment. Obes Res. 2001;9(12):746–53.

    Article  PubMed  CAS  Google Scholar 

  39. 39.

    Fulton JE, McGuire MT, Caspersen CJ, Dietz WH. Interventions for weight loss and weight gain prevention among youth: current issues. Sports Med. 2001;31(3):153–65.

    Article  PubMed  CAS  Google Scholar 

  40. 40.

    Waters E, de Silva-Sanigorski A, Burford BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;(12):CD001871. https://doi.org/10.1002/14651858.CD001871.pub3.

  41. 41.

    Sweeting HN. Gendered dimensions of obesity in childhood and adolescence. Nutr J. 2008;7:1,2891–7-1.

    Article  Google Scholar 

  42. 42.

    Atlantis E, Barnes EH, Fiatarone Singh MA. Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Int J Obes. 2006;30:1027–40.

    Article  CAS  Google Scholar 

  43. 43.

    Stark MJ, Niederhauser VP, Camacho JM, Shirai L. The prevalence of overweight and obesity in children at a health maintenance organization in Hawai'i. Hawaii Med J. 2011;70(7 Suppl 1):27–31.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Shaw NJ, Crabtree NJ, Kibirige MS, Fordham JN. Ethnic and gender differences in body fat in British schoolchildren as measured by DXA. Arch Dis Child. 2007;92(10):872–5.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Flegal KM, Ogden CL. Childhood obesity: are we all speaking the same language? Adv Nutr. 2011;2(2):159S–66S.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Office of Management and Budget. Federal Register/Vol. 62, No. 210/Thursday, October 30, 1997/Notices. Available at: https://www.gpo.gov/fdsys/pkg/FR-1997-10-30/pdf/97-28653.pdf Accessed 05/02/2017.

  47. 47.

    Doyle JM, Kao G. Are racial identities of multiracials stable? Changing self-identification among single and multiple race individuals. Soc Psychol Q. 2007;70(4):405–23.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69–101.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Inyang A. Isong.

Ethics declarations

Conflict of Interest

Drs. Richmond and Kawachi declare no conflict of interest.

Dr. Isong received funding support (stipend) during her doctoral program from the Pritzker obesity prevention award.

Dr. Mauricio Avendaño is supported by the European Union’s Horizon2020 research and innovation programme under grant agreements 633666 (Lifepath) and 667661 (MINDMAP) and the National Institute on Aging (award number R01AG040248).

Research Involving Human Participants and/or Animals

This study involved secondary data analysis, with no direct contact with human participants and/or animals. The study was approved by the NCES and Harvard School of Public Health IRB.

Informed Consent

This study involved secondary data analysis, with no direct contact with human participants and/or animals. We used secondary data from the Early Childhood Longitudinal Study Birth Cohort (ECLS-B) study, sponsored and conducted by the National Center for Education and Statistics (NCES).

Electronic Supplementary Material

ESM 1

(DOCX 13.4 kb)

ESM 2

(DOCX 14.4 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Isong, I.A., Richmond, T., Avendaño, M. et al. Racial/Ethnic Disparities: a Longitudinal Study of Growth Trajectories Among US Kindergarten Children. J. Racial and Ethnic Health Disparities 5, 875–884 (2018). https://doi.org/10.1007/s40615-017-0434-1

Download citation

Keywords

  • Racial/ethnic disparities
  • BMI z-score
  • Growth trajectories
  • Obesity
  • ECLS-B