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Canadian Journal of Public Health

, Volume 109, Issue 4, pp 489–497 | Cite as

Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario

  • Meloja Satkunam
  • Laura N. Anderson
  • Sarah Carsley
  • Jonathon L. Maguire
  • Patricia C. Parkin
  • Ann E. Sprague
  • Geoff D. C. Ball
  • Catherine S. Birken
  • on behalf of the TARGet Kids! Collaboration and Team ABC
Quantitative Research

Abstract

Objectives

International data suggest the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario.

Methods

A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n = 3713) and BORN Ontario (n = 768). Body mass index z score (zBMI) definitions were adapted from the World Health Organization (WHO) (z score > 3) and the US Centers for Disease Control (CDC) (> 120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories.

Results

A total of 1.1% (95% CI, 0.8–1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI, 0.2–0.6) using the CDC definition. Median neighbourhood household income (OR = 0.80, 95% CI, 0.69–0.93) and maternal pre-pregnancy BMI (OR = 1.08, 95% CI, 1.01–1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy BMI and severe obesity was 1.04 (95% CI, 0.94–1.15).

Conclusion

More than 1% of Ontario children met the adapted WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence, and risk factors for severe obesity in young children across Canada.

Keywords

Obesity Obesity, morbid Obesity, pediatric Obesity, childhood onset Body mass index 

Résumé

Objectifs

Selon les données internationales, la prévalence de l’obésité sévère chez les jeunes enfants pourrait être en hausse, mais il n’existe pas de données canadiennes à ce sujet. Nous avons voulu examiner les définitions de l’obésité sévère et évaluer les facteurs de risque associés chez les jeunes enfants en Ontario.

Méthode

Nous avons mené une étude transversale auprès d’enfants de 17 à 24 mois à l’aide de deux sources de données ontariennes : TARGet Kids! (n = 3713) et BORN Ontario (n = 768). Nous avons adapté les définitions du score-z de l’indice de masse corporelle (IMC) de l’Organisation mondiale de la santé (OMS) (score-z > 3) et des Centers for Disease Control américains (CDC) (>120% du 95e centile) et nous les avons appliquées pour définir l’obésité sévère chez les jeunes enfants. Par régression logistique multinomiale, nous avons évalué les associations entre les facteurs de risque démographiques et liés à la grossesse et les catégories du score-z de l’IMC.

Résultats

Un total de 1,1% (IC de 95% : 0,8–1,4) des enfants répondaient à la définition de l’obésité sévère adaptée de celle de l’OMS, et 0,3% (IC de 95% : 0,2–0,6) répondaient à la définition adaptée de celle des CDC. Le revenu médian des ménages selon le quartier (rapport de cotes [RC] = 0,80, IC de 95% : 0,69–0,93) et l’IMC maternel avant la grossesse (RC = 1,08, IC de 95% : 1,01–1,15) étaient associés à l’obésité sévère dans nos analyses non ajustées. En tenant compte des facteurs confusionnels possibles, le RC de l’association entre l’IMC maternel avant la grossesse et l’obésité sévère était de 1,04 (IC de 95% : 0,94–1,15).

Conclusion

Plus de 1% des enfants ontariens répondent à la définition de l’obésité sévère de l’OMS pour les très jeunes enfants. Nous avons repéré des facteurs de risque modifiables. Il faudrait pousser la recherche pour comprendre la terminologie, la prévalence et les facteurs de risque de l’obésité sévère chez les jeunes enfants à l’échelle du Canada.

Mots-clés

Obésité Obésité morbide Obésité pédiatrique Indice de masse corporelle 

Notes

Acknowledgements

We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network.

Funding

Funding for this study was received from the Canadian Institutes of Health Research.

Compliance with ethical standards

Conflict of interest

JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). PCP received unrestricted research grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009), Dairy Farmers of Ontario (2008–2010), and Mead Johnson Nutrition provided non-financial support (Fer-In-Sol® liquid iron supplement) (2011–2017) for an ongoing investigator-initiated trial of iron deficiency in young children that was funded by Canadian Institutes of Health Research (FRN # 115059). These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review, or approval of the manuscript. All other authors declare they have no conflicts of interest.

Supplementary material

41997_2018_65_MOESM1_ESM.docx (15 kb)
Supplemental Table 1 (DOCX 15 kb)

References

  1. Andreyeva, T., Sturm, R., & Ringel, J. S. (2004). Moderate and severe obesity have large differences in health care costs. Obesity Research, 12(12), 1936–1943.CrossRefGoogle Scholar
  2. Anderson, L. N., Ball, G. D. C., Birken, C. S., et al. (2017). The team to address bariatric care in Canadian children (Team ABC3): team grant research proposal. BMC Research Notes, 10(1), 1–15.CrossRefGoogle Scholar
  3. Biro, S., Barber, D., Williamson, T., Morkem, R., Khan, S., & Janssen, I. (2016). Prevalence of toddler, child and adolescent overweight and obesity derived from primary care electronic medical records: an observational study. CMAJ Open, 4(3), E538–E544.CrossRefGoogle Scholar
  4. Carsley, S., Borkhoff, C. M., Maguire, J. L., et al. (2015). Cohort profile: the applied research group for Kids (TARGet Kids!). International Journal of Epidemiology, 44(3), 776–788.CrossRefGoogle Scholar
  5. Flegal, K. M., Wei, R., Ogden, C. L., Freedman, D. S., Johnson, C. L., & Curtin, L. R. (2009). Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. The American Journal of Clinical Nutrition, 90(4), 1314–1320.CrossRefGoogle Scholar
  6. Furlong, K. R., Anderson, L. N., Kang, H., et al. (2016). BMI-for-age and weight-for-length in children 0 to 2 years. Pediatrics, 138(1).CrossRefGoogle Scholar
  7. Garnett, S. P., Baur, L. A., Jones, A. M. D., & Hardy, L. L. (2016). Trends in the prevalence of morbid and severe obesity in Australian children aged 7–15 years, 1985–2012. PLoS One, 11(5), 1–7.CrossRefGoogle Scholar
  8. Groothuis-Oudshoorn, K., & Van Buuren, S. (2011). Mice: multivariate imputation by chained equations in R. Journal of Statistical Software, 45(3).Google Scholar
  9. Kelly, A. S., Barlow, S. E., Rao, G., et al. (2013). Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation, 128.CrossRefGoogle Scholar
  10. Koebnick, C., Smith, N., Coleman, K. J., et al. (2010). Prevalence of extreme obesity in a multiethnic cohort of children and adolescents. Journal of Pediatrics, 157(1), 26–31.CrossRefGoogle Scholar
  11. Marchand, V. (2010). Promoting optimal monitoring of child growth in Canada: using the new World Health Organization growth charts. Paediatrics & Child Health, 15(2), 77–79.CrossRefGoogle Scholar
  12. Maternal Diabetes in Canada. Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternal-diabetes-canada.html. Published 2014. Accessed August 28, 2016.Google Scholar
  13. Maternal Hypertension in Canada. Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternal-hypertension-canada.html. Published 2014. Accessed August 28, 2016.Google Scholar
  14. Morinis, J., Maguire, J., Khovratovich, M., McCrindle, B. W., Parkin, P. C., & Birken, C. S. (2012). Paediatric obesity research in early childhood and the primary care setting: The TARGet Kids! research network. International Journal of Environmental Research and Public Health, 9(4), 1343–1354.CrossRefGoogle Scholar
  15. Oken, E., Levitan, E. B., & Gillman, M. W. (2008). Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. International Journal of Obesity, 32, 201–210.CrossRefGoogle Scholar
  16. Ontario’s Enhanced 18-Month Well-Baby Visit Electronic Medical Record (EMR) Integration and Repository Project. BORN Ontario. https://www.bornontario.ca/en/partnership-projects/enhanced-18-month-well-baby-visit-project/. Published 2013. Accessed May 25, 2016.Google Scholar
  17. Pan, L., Blanck, H. M., Sherry, B., Dalenius, K., & Grummer-Strawn, L. (2012). Trends in the prevalence of extreme obesity among US preschool-aged children living in low-income families, 1998-2010. JAMA, 308(24), 2563–2565.CrossRefGoogle Scholar
  18. Postal Code OM Conversion File (PCCF), Reference Guide. Statistics Canada Catalogue no. 92–154-G. http://www.statcan.gc.ca/pub/92-154-g/92-154-g2016001-eng.htm. Published 2016. Accessed September 6, 2016.
  19. Roberts KC, Shields M, de Groh M, Aziz A, Gilbert JA. Overweight and obesity in children and adolescents: results from the 2009 to 2011 Canadian Health Measures Survey. Ottawa: Statistics Canada. https://www.statcan.gc.ca/pub/82-003-x/2012003/article/11706-eng.pdf. Published 2012. Accessed June 20, 2016.Google Scholar
  20. Rodd, C., & Sharma, A. K. (2016). Recent trends in the prevalence of overweight and obesity among Canadian children. CMAJ, 188(13), E313–E320.CrossRefGoogle Scholar
  21. Rokholm, B., Baker, J. L., & Sorensen, T. I. A. (2010). The levelling off of the obesity epidemic since the year 1999—a review of evidence and perspectives. Obesity Reviews, 11(12), 835–846.CrossRefGoogle Scholar
  22. Shields, M., & Tremblay, M. S. (2010). Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points. International Journal of Pediatric Obesity, 5(3), 265–273.CrossRefGoogle Scholar
  23. Skinner, A. C., Perrin, E. M., & Skelton, J. A. (2016). Prevalence of obesity and severe obesity in US children, 1999–2014. Obesity, 24(5), 1116–1123.CrossRefGoogle Scholar
  24. Skelton, J. A., Cook, S. R., Auinger, P., Klein, J. D., & Barlow, S. E. (2009). Prevalence and trends of severe obesity among US children and adolescents. Academic Pediatrics, 9(5), 322–329.CrossRefGoogle Scholar
  25. Tjepkema, M. Adult obesity in Canada: measured height and weight. Ottawa: Statistics Canada http://www.statcan.gc.ca/pub/82-620-m/2005001/pdf/4224906-eng.pdf. Published 2004. Accessed July 31, 2016.Google Scholar
  26. Valerio, G., Maffeis, C., Balsamo, A., et al. (2013). Severe obesity and cardiometabolic risk in children: comparison from two international classification systems. PLoS One, 8(12), 6–13.CrossRefGoogle Scholar
  27. Wang, Y., & Lobstein, T. (2006). Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity, 1(1), 11–25.CrossRefGoogle Scholar
  28. WHO. (2006). Child Growth Standards based on length/height, weight and age. Acta Paediatr (Oslo, Norw 1992) Suppl, 450, 76–85.Google Scholar
  29. Woo Baidal, J. A., Locks, L. M., Cheng, E. R., Blake-Lamb, T. L., Perkins, M. E., & Taveras, E. M. (2016). Risk factors for childhood obesity in the first 1,000 days. American Journal of Preventive Medicine, 50(6), 761–779.CrossRefGoogle Scholar
  30. Yu, Z. B., Han, S. P., Zhu, G. Z., et al. (2011). Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obesity Reviews, 12(7), 525–542.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Meloja Satkunam
    • 1
    • 2
  • Laura N. Anderson
    • 1
    • 2
  • Sarah Carsley
    • 2
    • 3
  • Jonathon L. Maguire
    • 3
    • 4
    • 5
    • 6
  • Patricia C. Parkin
    • 3
    • 5
    • 6
    • 7
  • Ann E. Sprague
    • 8
  • Geoff D. C. Ball
    • 9
  • Catherine S. Birken
    • 3
    • 5
    • 6
    • 7
  • on behalf of the TARGet Kids! Collaboration and Team ABC
    • 3
  1. 1.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  2. 2.Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Institute for Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  4. 4.The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  5. 5.Department of Nutritional SciencesUniversity of TorontoTorontoCanada
  6. 6.Department of Pediatrics, Faculty of MedicineUniversity of TorontoTorontoCanada
  7. 7.Division of Paediatric Medicine, Department of PaediatricsThe Hospital for Sick ChildrenTorontoCanada
  8. 8.Better Outcomes Registry & Network (BORN) OntarioOttawaCanada
  9. 9.Faculty of Medicine and Dentistry, Department of Pediatrics, Edmonton Clinic Health AcademyUniversity of AlbertaEdmontonCanada

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