Choy Courtney C, Johnson William, Naseri Take, Filipo Vaimoana, Arorae Maria Siulepa, Tafunaina Faatali, Unasa Folla, Savusa Kima, Reupena Muagututia S, Braun Joseph M, Duckham Rachel L, Soti-Ulberg Christina, McGarvey Stephen T, Hawley Nicola L
Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA.
Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02906, USA.
Int J Obes (Lond). 2025 Feb;49(2):322-331. doi: 10.1038/s41366-024-01665-6. Epub 2024 Oct 29.
BACKGROUND/OBJECTIVE: Pacific children are at high obesity risk, yet the behavioral and environmental factors that contribute to obesity development in this setting remain poorly understood. We assessed associations between childhood risk factors for obesity with body mass index (BMI) trajectories between ages 2-9 years in Samoa.
SUBJECTS/METHODS: In a prospective cohort of 485 children from 'Upolu, we measured weight and height at ages 2-4 (2015), 3.5-8 (2017-18), and 5.5-11 years (2019-20). Modern dietary pattern adherence was assessed using factor analysis of primary caregiver-reported food frequency questionnaire data. Physical activity was estimated with the Netherlands Physical Activity Questionnaire. Socioeconomic resources were assessed using an 18-item household asset score. Urbanicity was based on village residence. Associations of these risk factors with predicted weight, height, and BMI (at 1-year intervals and velocity) were assessed using multilevel cubic spline regressions.
Females had greater adjusted weight velocity with high modern dietary pattern adherence compared to low (p-value for interaction with age spline term 1 = 0.028 and age spline term 2 = 0.007). Starting at age 3 years, children with higher physical activity had higher BMI, but this association was not meaningful up to age 9 (all p-value > 0.05). Males with very high compared to low household assets had higher BMI from age 2 to 4 years (95% CI: 0.26-1.53 kg/m, p = 0.006) and greater BMI velocity (p-value for interaction with age spline term 2 = 0.001). Males in the urban region had the greatest BMI gain after age 5 compared to the rural region (p-value for interaction with age spline term 2 = 0.014).
High, centile-crossing BMI trajectories suggest that obesity prevention and intervention are needed among Samoan children before age 9 years. Positive associations between high modern dietary pattern adherence, greater asset ownership, and urbanization offer initial insights into who, and which behavioral risk factors, should be prioritized in implementing public health solutions.
背景/目的：太平洋地区儿童面临较高的肥胖风险，但导致该地区肥胖发生的行为和环境因素仍未得到充分了解。我们评估了萨摩亚2至9岁儿童肥胖风险因素与体重指数（BMI）轨迹之间的关联。
受试者/方法：在一个来自乌波卢岛的485名儿童的前瞻性队列中，我们在2至4岁（2015年）、3.5至8岁（2017 - 18年）以及5.5至11岁（2019 - 20年）时测量了体重和身高。使用对主要照顾者报告的食物频率问卷数据进行因子分析来评估现代饮食模式的依从性。通过荷兰身体活动问卷估计身体活动情况。使用18项家庭资产得分评估社会经济资源。城市化程度以村庄居住情况为依据。使用多级三次样条回归评估这些风险因素与预测体重、身高和BMI（每隔1年及变化速度）之间的关联。
与低现代饮食模式依从性的女性相比，高现代饮食模式依从性的女性调整后的体重增长速度更快（与年龄样条项1的交互作用p值 = 0.028，与年龄样条项2的交互作用p值 = 0.007）。从3岁开始，身体活动较高的儿童BMI较高，但在9岁之前这种关联并不显著（所有p值 > 0.05）。与低家庭资产相比资产非常高的男性在2至4岁时BMI更高（95%置信区间：0.26 - 1.53kg/m²，p = 0.006）且BMI增长速度更快（与年龄样条项2的交互作用p值 = 0.001）。与农村地区相比，城市地区的男性在5岁之后BMI增长最大（与年龄样条项2的交互作用p值 = 0.014）。
高的、跨越百分位的BMI轨迹表明，在9岁之前的萨摩亚儿童中需要进行肥胖预防和干预。高现代饮食模式依从性、更多资产拥有与城市化之间的正相关关系为在实施公共卫生解决方案时应优先考虑哪些人以及哪些行为风险因素提供了初步见解。
