Layte Richard, Cronin Frances M, Nivakoski Sanna, McEvoy Olivia, Brannigan Ross, Stanistreet Debbi
Department of Sociology, Trinity College Dublin, Dublin, Ireland.
School of Population Health, Royal College of Surgeons University of Medicine and Health Sciences in Ireland, Dublin 2, Ireland.
SSM Popul Health. 2023 Aug 30;24:101499. doi: 10.1016/j.ssmph.2023.101499. eCollection 2023 Dec.
Studies in many middle and high-income countries describe an increasing prevalence of adiposity and obesity among children and adolescents. Prevalence is higher among families of low socioeconomic position (SEP) and systematic reviews have identified relevant factors, but have not quantified their relative importance to SEP differentials. This paper examines the relative importance of different factors to Body Mass Index (BMI) and obesity trajectories from age 9 to age 17/18.
Multi-level models of child BMI/obesity risk trajectory by maternal education were conducted using a nationally representative cohort of children born in Ireland in 1998 and aged 9 at baseline (N = 8568), with follow-up at 13 and 17/18 years (88% and 73% response rate respectively). Models were stratified by sex and both time-varying (e.g. child physical activity, diet, sedentary activity) and time-invariant (e.g. early life) factors were tested.
Significant inverse gradients in BMI and obesity risk by level of maternal education were present across both sexes and at each age; unadjusted absolute differentials in obesity risk between highest/lowest education groups increased by 56% for males and 42% for females between age 9 and 17/18. Early life factors accounted for 22% of the differential in obesity risk between the lowest and highest education groups among males at age 9, falling to 13% at 17/18. Among females the proportion fell from 33 to 23%. Unadjusted absolute high/low maternal education group differentials in BMI were 7.5 times higher among males and 11 times higher among females at 17/18 than at age 9.
Given the importance of early life exposures to subsequent differentials in BMI and obesity risk our findings suggest that policy makers should focus resources on primary prevention during the prenatal and early life period if they wish to reduce the prevalence of child and adolescent obesity.
许多中高收入国家的研究表明，儿童和青少年肥胖的患病率呈上升趋势。社会经济地位较低的家庭中肥胖患病率更高，系统评价已确定了相关因素，但尚未量化它们对社会经济地位差异的相对重要性。本文研究了不同因素对9岁至17/18岁儿童体重指数（BMI）和肥胖轨迹的相对重要性。
采用1998年出生于爱尔兰、基线时9岁的全国代表性儿童队列（N = 8568），并在13岁和17/18岁时进行随访（应答率分别为88%和73%），通过母亲教育程度建立儿童BMI/肥胖风险轨迹的多层次模型。模型按性别分层，并对时变因素（如儿童身体活动、饮食、久坐活动）和非时变因素（如早期生活）进行了测试。
在各个年龄和性别中，母亲教育程度与BMI和肥胖风险之间均存在显著的负梯度；9岁至17/18岁期间，最高/最低教育组之间肥胖风险的未调整绝对差异，男性增加了56%，女性增加了42%。早期生活因素在9岁男性中占最低和最高教育组之间肥胖风险差异的22%，在17/18岁时降至13%。在女性中，这一比例从33%降至23%。17/18岁时，未调整的母亲教育程度高/低组之间BMI的绝对差异，男性比9岁时高7.5倍，女性高11倍。
鉴于早期生活暴露对随后BMI和肥胖风险差异的重要性，我们的研究结果表明，如果政策制定者希望降低儿童和青少年肥胖的患病率，应将资源集中于产前和早期生活阶段的一级预防。
