Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH, UK.
Int J Obes (Lond). 2010 Jul;34(7):1160-8. doi: 10.1038/ijo.2010.15. Epub 2010 Feb 9.
A recent assessment of childcare in OECD (Organisation for Economic Co-operation and Development) countries highlighted the potential for childcare to widen inequalities. Although childcare offers a potential setting for obesity prevention, little research has analysed the association between childcare and overweight, particularly in different socio-economic groups.
Our primary objective was to explore the association between childcare and overweight (including obesity), both overall and by socio-economic background, in a contemporary UK cohort of children at age 3 years (N=12 354). Our secondary objective was to explore infant feeding as a potential mediator between childcare in infancy and overweight at age 3 years.
After controlling for confounders, children who were cared for in informal childcare (75% grandparents) between the age of 9 months and 3 years were more likely to be overweight than those cared for only by a parent (adjusted risk ratio (aRR)=1.15, 95% confidence interval (CI) 1.04-1.27), particularly if they were in full-time childcare (aRR=1.34, 95% CI 1.15-1.57). When stratifying by socio-economic background, the increased risk of overweight in informal childcare (compared with parental care) was limited to children from more advantaged groups: those whose mother was from a managerial or professional background (aRR=1.23, 95% CI 1.02-1.47), had a degree (RR=1.43, 95% CI 1.13-1.83) or lived in a couple household (RR=1.18, 95% CI 1.06-1.32). There was no association between formal childcare and overweight. Infant feeding did not mediate the association between childcare use in infancy and overweight at age 3 years.
Children from more advantaged families who use informal childcare are at increased risk of overweight. The UK government's drive to support parents into paid employment should be accompanied by health-related information and support for both informal and formal carers. As the majority of informal carers were grandparents, the recent government announcement to provide grandparents with National Insurance credits for caring for grandchildren provides a potential opportunity for health promotion.
经合组织（OECD）国家最近对儿童保育的评估强调了儿童保育可能扩大不平等现象。尽管儿童保育提供了预防肥胖的潜在环境，但很少有研究分析儿童保育与超重之间的关系，特别是在不同社会经济群体中。
我们的主要目的是在英国当代 3 岁儿童队列中（N=12354），探讨儿童保育与超重（包括肥胖）之间的关系，包括总体情况和社会经济背景。我们的次要目的是探讨婴儿喂养作为婴儿期儿童保育与 3 岁时超重之间的潜在中介因素。
在控制了混杂因素后，9 个月至 3 岁期间在非正规儿童保育（75%为祖父母）中接受照顾的儿童比仅由父母照顾的儿童更容易超重（调整后的风险比（aRR）=1.15，95%置信区间（CI）1.04-1.27），特别是如果他们接受全日制儿童保育（aRR=1.34，95%CI 1.15-1.57）。按社会经济背景分层时，非正规儿童保育（与父母照顾相比）下超重的风险增加仅限于来自较有利群体的儿童：母亲来自管理或专业背景的儿童（aRR=1.23，95%CI 1.02-1.47）、拥有学位的儿童（RR=1.43，95%CI 1.13-1.83）或居住在夫妻家庭中的儿童（RR=1.18，95%CI 1.06-1.32）。正规儿童保育与超重之间没有关联。婴儿喂养并不能调节婴儿期儿童保育使用与 3 岁时超重之间的关联。
使用非正规儿童保育的来自较富裕家庭的儿童超重风险增加。英国政府支持父母就业的举措应辅以与健康相关的信息，并为非正式和正式照顾者提供支持。由于大多数非正规照顾者是祖父母，政府最近宣布为照顾孙辈的祖父母提供国民保险积分，这为促进健康提供了一个潜在机会。
