Soskolne Varda, Cohen-Dar Michal, Obeid Samira, Cohen Nitsa, Rudolf Mary C J
Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel.
Northern Region Health Office, Ministry of Health, Nazareth Illit, Israel.
Front Endocrinol (Lausanne). 2018 Aug 21;9:456. doi: 10.3389/fendo.2018.00456. eCollection 2018.
Scientific evidence regarding protective factors that contribute to healthy weight in childhood is limited and is particularly scarce in lower socio-economic populations in different ethnic groups. This study aimed to assess the prevalence of biological, behavioral and psychosocial factors for child overweight/obesity in Jewish and Arab population groups in Israel, and to compare their associations with child overweight/obesity in the two groups. Children aged 5-6 years were randomly selected from 20 Mother and Child Health clinics in towns and villages of lowest socio-economic ranking in Northern Israel. Children and mothers were invited for a special "One Stop Shop-Preparation for School" visit which included growth measurements. Questionnaires were distributed to mothers for self-report on biological, SES, psychological and lifestyle factors. Perinatal and early nutritional data were retrieved from clinic records. Multivariate analyses using logistic regression models predicting child overweight/obesity were conducted separately for Jewish ( = 371) and Arab ( = 575) children. Overweight/obesity (BMI ≥85th centile) rates were higher in Jewish (25%) than Arab (19%) children. In both Jewish and Arab groups, respectively, maternal BMI (OR = 1.10 [95%CI = 1.04, 1.17]; OR = 1.08 [95%CI = 1.04, 1.13]), and child birthweight (OR = 1.33 [95%CI = 1.04, 1.71]; OR = 1.39 [95%CI = 1.11, 1.73]) were significant risk factors for overweight/obesity, and maternal self-efficacy regarding child's lifestyle was significantly protective (OR = 0.49 [95%CI = 0.28, 0.85]; OR = 0.54 [95%CI = 0.34, 0.85]). Additionally, four other maternal psychological and child behaviors were significantly associated with overweight/obesity in the Jewish group and two child lifestyle behavior factors in the Arab group. Moreover, significant interactions indicating moderation effects were found only in the Jewish group: maternal education and maternal age moderated the effect of maternal BMI on child overweight/obesity. No other moderation of risk factors was found. In this study of children from low SES families, protective factors contributed to healthy child weight alongside risk factors for overweight/obesity. They differed between the population groups, and fewer variables explained overweight/obesity in Arab children. Although further expansion of these findings is required they point at the relevance of protective factors, maternal self-efficacy in particular, for understanding childhood obesity in specific ethnic contexts and for planning culturally adapted prevention programs in disadvantaged populations.
关于有助于儿童保持健康体重的保护因素的科学证据有限，在不同种族的低社会经济人群中尤其匮乏。本研究旨在评估以色列犹太和阿拉伯人群中儿童超重/肥胖的生物、行为和心理社会因素的流行情况，并比较两组中这些因素与儿童超重/肥胖的关联。从以色列北部社会经济排名最低的城镇和村庄的20家母婴健康诊所中随机选取5-6岁的儿童。邀请儿童和母亲参加一次特别的“一站式入学准备”访问，其中包括生长测量。向母亲发放问卷，以自我报告生物、社会经济地位、心理和生活方式因素。从诊所记录中获取围产期和早期营养数据。分别对犹太儿童（n = 371）和阿拉伯儿童（n = 575）进行了使用逻辑回归模型预测儿童超重/肥胖的多变量分析。犹太儿童超重/肥胖（BMI≥第85百分位）率（25%）高于阿拉伯儿童（19%）。在犹太和阿拉伯组中，母亲BMI（OR = 1.10 [95%CI = 1.04, 1.17]；OR = 1.08 [95%CI = 1.04, 1.13]）和儿童出生体重（OR = 1.33 [95%CI = 1.04, 1.71]；OR = 1.39 [95%CI = 1.11, 1.73]）是超重/肥胖的显著危险因素，而母亲对孩子生活方式的自我效能感具有显著的保护作用（OR = 0.49 [95%CI = 0.28, 0.85]；OR = 0.54 [95%CI = 0.34, 0.85]）。此外，犹太组中还有其他四个母亲心理因素和儿童行为与超重/肥胖显著相关，阿拉伯组中有两个儿童生活方式行为因素与超重/肥胖显著相关。此外，仅在犹太组中发现了表明调节作用的显著交互作用：母亲教育程度和母亲年龄调节了母亲BMI对儿童超重/肥胖的影响。未发现其他危险因素的调节作用。在这项针对低社会经济地位家庭儿童的研究中，保护因素与超重/肥胖的危险因素共同影响着儿童的健康体重。两组人群中的保护因素有所不同，解释阿拉伯儿童超重/肥胖的变量较少。尽管需要进一步扩展这些研究结果，但它们指出了保护因素，特别是母亲自我效能感，对于理解特定种族背景下的儿童肥胖以及为弱势群体制定适合文化背景的预防计划的相关性。
