Schmidt Swantje C, Sleddens Ester F C, de Vries Sanne I, Gubbels Jessica, Thijs Carel
Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
Department of Health Promotion, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
Soc Sci Med. 2015 Jun;135:99-108. doi: 10.1016/j.socscimed.2015.04.018. Epub 2015 Apr 30.
Changes in the neighborhood environment may explain part of the rapid increase in childhood overweight and obesity during the last decades. To date few theory-driven rather than data-driven studies have explored longitudinal associations between multiple neighborhood characteristics and child body weight development. We aimed to assess the relationship between physical, social and perceived safety related characteristics of the neighborhood and Body Mass Index (BMI) development in children during early school age, using a longitudinal design. We included an examination of moderating and confounding factors based on a conceptual model adapted from the EnRG framework (Environmental Research framework for weight Gain prevention) and empirical research. Analyses included 1887 children from the KOALA Birth Cohort Study followed from baseline age 4-5 years until 8-9 years. For children age 4-5 years, parents completed a questionnaire measuring characteristics of the neighborhood. Reliability and factor analyses were used to identify constructs for neighborhood characteristics. Linear regression analysis was performed to assess the relationship between neighborhood constructs and BMI z-scores cross-sectionally at age 4-5 years and longitudinally using Generalized Estimating Equations with BMI z-scores over 5 repeated measurements until age 8-9 years. Fourteen constructs were identified and grouped in three domains including perceived physical, social, or safety related characteristics of the neighborhood. Cross-sectionally, a lower BMI z-score was associated with higher perceived physical attractiveness of the neighborhood environment (standardized regression coefficient (β) -0.078, 95% CI -0.123 to -0.034) and a higher level of social capital (β -0.142, -0.264 to -0.019). Longitudinally, similar associations were observed with potentially even stronger regression coefficients. This study suggests that BMI in children is mainly related to the modifiable physical and social environment of the conceptual model and not related to safety as perceived by parents.
社区环境的变化或许能解释过去几十年里儿童超重和肥胖率迅速上升的部分原因。迄今为止，很少有理论驱动而非数据驱动的研究探讨过多种社区特征与儿童体重发展之间的纵向关联。我们旨在采用纵向设计，评估社区在身体、社会和感知安全方面的相关特征与儿童在学龄早期的体重指数（BMI）发展之间的关系。我们基于从EnRG框架（预防体重增加的环境研究框架）改编而来的概念模型和实证研究，对调节因素和混杂因素进行了考察。分析纳入了考拉出生队列研究中的1887名儿童，从4至5岁的基线年龄一直追踪到8至9岁。对于4至5岁的儿童，家长填写了一份问卷，用以测量社区的特征。通过可靠性和因子分析来确定社区特征的结构。进行线性回归分析，以评估社区结构与4至5岁时的BMI z分数之间的横断面关系，以及纵向关系，纵向分析使用广义估计方程，对直到8至9岁的5次重复测量的BMI z分数进行分析。确定了14个结构，并将其分为三个领域，包括社区在身体、社会或安全方面的感知相关特征。横断面分析显示，较低的BMI z分数与社区环境更高的感知身体吸引力相关（标准化回归系数（β）为-0.078，95%置信区间为-0.123至-0.034），以及与更高水平的社会资本相关（β为-0.142，-0.264至-0.019）。纵向分析观察到了类似的关联，回归系数可能更强。这项研究表明，儿童的BMI主要与概念模型中可改变的身体和社会环境有关，而与家长所感知的安全无关。
