Lifestyle and Life Course Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
Int J Epidemiol. 2011 Oct;40(5):1238-46. doi: 10.1093/ije/dyr086. Epub 2011 May 30.
In Western populations, informal child care is associated with childhood obesity. However, informal child care and obesity share social patterning making evidence from other settings valuable.
We used multivariable linear and logistic regression models to estimate the association of child care at 6 months and at 3, 5 and 11 years with body mass index (BMI) z-score and overweight (including obesity) at 11 years in a Hong Kong Chinese birth cohort. We assessed whether associations varied with sex or socio-economic position (SEP). We used multiple imputation for missing exposures and confounders.
Of the original 8327 cohort members, 7933 are alive, participating and living in Hong Kong. At ~11 years, 6796 had their BMI clinically assessed. Higher SEP was associated with informal care. After imputation, informal care at each of 3, 5 or 11 years was separately associated with higher BMI z-score [3 years 0.10, 95% confidence interval (CI) 0.03-0.18, 5 years 0.12, 95% CI 0.04-0.21, 11 years 0.17, 95% CI 0.04-0.31] and with the presence of overweight [odds ratio (OR) 3 years 1.19, 95% CI 1.03-1.37, 5 years OR 1.20, 95% CI 1.03-1.40, 11 years OR 1.21, 95% CI 1.02-1.45], adjusted for sex, SEP and birth weight z-score. Current informal care had the strongest association. However, informal child care at 5 years also contributed. There was no evidence of differences by sex or SEP.
In a developed, non-Western setting, informal child care was associated with childhood obesity. Modifiable attributes of informal child care warrant investigation for obesity prevention.
在西方人群中，非正规儿童保育与儿童肥胖有关。然而，非正规儿童保育和肥胖具有共同的社会模式，因此其他环境中的证据具有重要价值。
我们使用多变量线性和逻辑回归模型来估计 6 个月时、3 岁、5 岁和 11 岁时的儿童保育与 11 岁时的体重指数（BMI）z 分数和超重（包括肥胖）之间的关联。我们评估了这些关联是否因性别或社会经济地位（SEP）而异。我们使用多重插补来填补暴露和混杂因素的缺失值。
在最初的 8327 名队列成员中，有 7933 人仍然在世、参与并居住在香港。在大约 11 岁时，有 6796 人接受了 BMI 的临床评估。较高的 SEP 与非正规护理有关。在插补后，3 岁、5 岁或 11 岁时的非正规护理分别与较高的 BMI z 分数相关[3 岁时 0.10，95%置信区间（CI）0.03-0.18，5 岁时 0.12，95%CI 0.04-0.21，11 岁时 0.17，95%CI 0.04-0.31]和超重的存在相关[3 岁时的比值比（OR）为 1.19，95%CI 为 1.03-1.37，5 岁时的 OR 为 1.20，95%CI 为 1.03-1.40，11 岁时的 OR 为 1.21，95%CI 为 1.02-1.45]，这些调整了性别、SEP 和出生体重 z 分数。当前的非正规儿童保育与肥胖的关联最强。然而，5 岁时的非正规儿童保育也有一定影响。性别和 SEP 没有差异的证据。
在一个发达的、非西方的环境中，非正规儿童保育与儿童肥胖有关。非正规儿童保育的可改变属性值得进一步研究，以预防肥胖。
