Department of Health, Medicine and Care, General Practice, Linköping University, SE-58183, Linköping, Sweden.
Crown Princess Victoria Children´s Hospital, Region Östergötland, SE-58185, Linköping, Sweden.
Int J Obes (Lond). 2022 Sep;46(9):1703-1711. doi: 10.1038/s41366-022-01171-7. Epub 2022 Jul 11.
BACKGROUND/OBJECTIVES: This study analysed the relationship between early childhood socioeconomic status (SES) measured by maternal education and household income and the subsequent development of childhood overweight and obesity.
SUBJECTS/METHODS: Data from seven population-representative prospective child cohorts in six high-income countries: United Kingdom, Australia, the Netherlands, Canada (one national cohort and one from the province of Quebec), USA, Sweden. Children were included at birth or within the first 2 years of life. Pooled estimates relate to a total of N = 26,565 included children. Overweight and obesity were defined using International Obesity Task Force (IOTF) cut-offs and measured in late childhood (8-11 years). Risk ratios (RRs) and pooled risk estimates were adjusted for potential confounders (maternal age, ethnicity, child sex). Slope Indexes of Inequality (SII) were estimated to quantify absolute inequality for maternal education and household income.
Prevalence ranged from 15.0% overweight and 2.4% obese in the Swedish cohort to 37.6% overweight and 15.8% obese in the US cohort. Overall, across cohorts, social gradients were observed for risk of obesity for both low maternal education (pooled RR: 2.99, 95% CI: 2.07, 4.31) and low household income (pooled RR: 2.69, 95% CI: 1.68, 4.30); between-cohort heterogeneity ranged from negligible to moderate (p: 0.300 to < 0.001). The association between RRs of obesity by income was lowest in Sweden than in other cohorts.
There was a social gradient by maternal education on the risk of childhood obesity in all included cohorts. The SES associations measured by income were more heterogeneous and differed between Sweden versus the other national cohorts; these findings may be attributable to policy differences, including preschool policies, maternity leave, a ban on advertising to children, and universal free school meals.
背景/目的：本研究分析了儿童早期社会经济地位（SES），通过母亲的教育和家庭收入来衡量，与儿童超重和肥胖的后续发展之间的关系。
对象/方法：本研究的数据来自六个高收入国家的七个具有代表性的前瞻性儿童队列：英国、澳大利亚、荷兰、加拿大（一个全国性队列和一个来自魁北克省的队列）、美国、瑞典。研究对象包括出生时或生命的前 2 年内的儿童。汇总估计涉及总共 26565 名纳入的儿童。超重和肥胖使用国际肥胖工作组（IOTF）的切点来定义，并在儿童晚期（8-11 岁）进行测量。风险比（RR）和汇总风险估计值根据潜在混杂因素（母亲年龄、种族、儿童性别）进行了调整。斜率指数（SII）用于量化母亲教育和家庭收入的绝对不平等。
在瑞典队列中，超重的患病率为 15.0%，肥胖的患病率为 2.4%，而在美国队列中，超重的患病率为 37.6%，肥胖的患病率为 15.8%。总体而言，在所有队列中，母亲教育程度较低（汇总 RR：2.99，95%CI：2.07，4.31）和家庭收入较低（汇总 RR：2.69，95%CI：1.68，4.30）的情况下，肥胖的风险存在社会梯度；队列间异质性从微不足道到中度（p：0.300 到 < 0.001）。与收入相关的肥胖 RR 之间的关联在瑞典最低，而在其他队列中则较高。
在所有纳入的队列中，母亲教育程度与儿童肥胖风险之间存在社会梯度。通过收入衡量的 SES 关联更具异质性，并且在瑞典与其他国家队列之间存在差异；这些发现可能归因于政策差异，包括学前政策、产假、禁止向儿童做广告以及普及免费学校餐。
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