University of Helsinki, Department of Public Health, Helsinki, Finland,
University of Helsinki, Department of Public Health, Helsinki, Finland.
Obes Facts. 2019;12(5):564-574. doi: 10.1159/000502237. Epub 2019 Sep 4.
Childhood disadvantage is associated with a higher risk of adult obesity, but little is known about its associations with body mass index (BMI) trajectories during adulthood. This study aimed first to identify adulthood BMI trajectories, and second to investigate how childhood disadvantage is associated with trajectory group membership.
Data from the Helsinki Health Study, a longitudinal cohort study of initially 40- to 60-year-old employees of the City of Helsinki in Finland, were used. The baseline survey was conducted in 2000-2002, and similar follow-up surveys in 2007, 2012, and 2017. Based on self-reported BMI, participants' (n =5,266; 83% women) BMI trajectories, including their retrospectively reported BMI at the age of 25 years, were examined. Data on childhood disadvantage, including parental education and 7 types of childhood adversity (their own serious illness; parental divorce, death, mental disorder, or alcohol problems; economic difficulties at home; and peer group bullying) before the age of 16 years, were obtained from the baseline survey. Group-based trajectory modeling was used to identify BMI trajectories, and multinomial logistic regression to analyze the odds for trajectory group membership for the disadvantage variables.
Four ascending BMI trajectories in women and men were found: persistent normal weight (trajectory 1; women 35% and men 25%), normal weight to overweight (trajectory 2; women 41% and men 48%), normal weight to class I obesity (trajectory 3; women 19% and men 23%) and overweight to class II obesity (trajectory 4; women 5% and men 4%). Compared to trajectory 1, women with multiple adversities and repetitive peer bullying in childhood had greater odds of belonging to trajectories 3 and 4, whereas men with parental alcohol problems had greater odds of belonging to trajectory 4. For women and men, a low level of parental education was associated with a higher-level BMI trajectory.
Low parental education for both genders, multiple adversities and repetitive peer bullying in childhood among women, and parental alcohol problems among men increased the odds of developing obesity during adulthood. Further studies are needed to clarify how gender differences modify the effects of childhood disadvantage on adult BMI trajectories.
儿童时期的不利因素与成人肥胖风险增加有关，但人们对其与成人期体重指数（BMI）轨迹的关系知之甚少。本研究旨在首先确定成人 BMI 轨迹，其次探讨儿童时期的不利因素与轨迹组归属的关系。
本研究使用了芬兰赫尔辛基市的赫尔辛基健康研究（一项针对最初年龄在 40-60 岁的员工的纵向队列研究）的数据。基线调查于 2000-2002 年进行，随后在 2007 年、2012 年和 2017 年进行了类似的随访调查。基于自我报告的 BMI，对 5266 名参与者（83%为女性）的 BMI 轨迹进行了检查，包括他们在 25 岁时的回顾性 BMI。通过基线调查获得了儿童时期不利因素的数据，包括父母的教育程度和 7 种儿童时期逆境（自身严重疾病；父母离婚、死亡、精神障碍或酗酒问题；家庭经济困难；以及同龄群体欺凌）。采用基于群组的轨迹建模来识别 BMI 轨迹，采用多变量逻辑回归分析不利因素变量对轨迹组归属的几率。
在女性和男性中发现了四种上升的 BMI 轨迹：持续正常体重（轨迹 1；女性 35%，男性 25%）、正常体重到超重（轨迹 2；女性 41%，男性 48%）、正常体重到 I 级肥胖（轨迹 3；女性 19%，男性 23%）和超重到 II 级肥胖（轨迹 4；女性 5%，男性 4%）。与轨迹 1 相比，儿童时期有多种逆境和反复被同龄人欺凌的女性更有可能属于轨迹 3 和 4，而有父母酗酒问题的男性更有可能属于轨迹 4。对于女性和男性，父母教育程度低与较高的 BMI 轨迹相关。
对于两性来说，父母教育程度低、女性儿童时期的多种逆境和反复被同龄人欺凌、男性父母酗酒问题都增加了成年后肥胖的几率。需要进一步的研究来阐明性别差异如何影响儿童时期不利因素对成人 BMI 轨迹的影响。
