Institute for Global Health, University College London, UK.
Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Chile.
J Glob Health. 2020 Jun;10(1):010419. doi: 10.7189/jogh.10.010419.
The prevalence of childhood overweight has increased by approximately 50% in the past three decades, becoming a major public health concern worldwide. In Chile, an upper middle-income country, about 38% of children between two and four years of age are overweight, almost double the average in Latin America and the Caribbean. Various environmental and individual factors, and their interactions, affect childhood weight. Emerging evidence suggests childcare may also matter. Because the public provision of centre-based care is growing, childcare may be a useful policy tool to help prevent childhood overweight.
Using a nationally representative longitudinal survey of ~ 15 000 children in Chile (2010 and 2012), we estimated whether the type of child care (centre-based or maternal) a child attended at age 24 to 36 months was a significant predictor of the child's sex-and-age-specific body-mass-index (BMI) at age 36-48 months. We restricted our sample to children in full-time maternal care at baseline (12-24 months of age; n = 1273), but tested the robustness of results with the full sample. We compared children in centre-based care and in maternal care using difference-in-difference estimators and propensity score matching, and adjusted our estimates using child, family, and neighborhood characteristics.
Children attending centre-based care had 0.27 SD lower BMI than children in maternal care at follow-up ( < 0.05). We found suggestive evidence this association may be modulated by the child's socioeconomic status and by how frequently the child watched television: we found smaller BMI changes for children at the bottom 80% of socioeconomic status ( < 0.05) and also for children who frequently watched television ( < 0.10). Our results were robust to various model specifications.
Our findings suggest centre-based care programs, with adequate regulation and enforcement, may be a useful support to help curb the early childhood overweight epidemic, in addition to known effects in labor supply and child development.
在过去的三十年中，儿童超重的患病率增加了约 50%，成为全球主要的公共卫生关注点。在智利这个中上收入国家，大约有 38%的 2 至 4 岁儿童超重，几乎是拉丁美洲和加勒比地区平均水平的两倍。各种环境和个体因素及其相互作用影响儿童的体重。新出现的证据表明，儿童保育也很重要。由于公共提供的中心式照顾不断增加，儿童保育可能是预防儿童超重的有用政策工具。
我们使用智利一项具有全国代表性的纵向调查（2010 年和 2012 年），对 15000 名左右的儿童进行了研究，估计 24 至 36 个月大的儿童所接受的儿童保育类型（中心式或母亲式）是否是 36 至 48 个月大的儿童特定性别和年龄的身体质量指数（BMI）的重要预测因素。我们将样本限制在基线时接受全职母亲照顾的儿童（12 至 24 个月龄；n=1273），但使用全样本检验了结果的稳健性。我们使用差异-差异估计值和倾向评分匹配比较了在中心式照顾和母亲照顾下的儿童，并使用儿童、家庭和社区特征调整了我们的估计值。
与在母亲照顾下的儿童相比，在中心式照顾下的儿童在随访时的 BMI 低 0.27 个标准差（ < 0.05）。我们有证据表明，这种关联可能受到儿童社会经济地位和儿童看电视频率的调节：我们发现社会经济地位处于后 80%的儿童（ < 0.05）和经常看电视的儿童（ < 0.10）的 BMI 变化较小。我们的结果在各种模型规格下都是稳健的。
我们的研究结果表明，中心式照顾计划，在充分监管和执行的情况下，可能是遏制儿童早期超重流行的一种有用支持，除了对劳动力供应和儿童发展的已知影响外。
