Abstract
BACKGROUND: This study assessed potential early-life factors and their interrelationships with obesity among young Canadian children.
METHODS: Data from a nationally representative sample of children aged 6 to 11 years in the Canadian Health Measures Survey were analyzed. The associations of perinatal and early childhood behaviours and socio-economic factors with overweight or obesity were evaluated using multivariate logistic regression models. Adjusted population attributable risk fractions (PARFs) were calculated using multivariate logistic regression models.
RESULTS: Of 968 term-born children, 21% were overweight and another 13% were obese. Maternal smoking during pregnancy (adjusted odds ratio, 2.26; 95% confidence interval, 1.23–4.15) was positively associated with obesity. This association was mediated by birth weight (suppression effect); once controlled, the strength of the association between smoking and child obesity increased by 12%. Birth weight per 100 g (1.05; 1.005–1.09) was significantly associated with obesity. Exclusive breastfeeding for 6 months (0.44; 0.31–0.61), adequate sleep hours (0.39; 0.16–0.94) and being physically active (0.50; 0.26–0.93) were found to be protective. Breastfeeding, whether exclusive or not, significantly reduced obesity risk among children whose mothers never smoked in pregnancy. PARFs indicated that 24.4%, 11.5%, 11.3% and 6.0% prevalent cases of child obesity might be prevented by exclusive breastfeeding, smoking cessation during pregnancy, adequate sleep during childhood, and avoiding high birth weight, respectively.
CONCLUSIONS: This study identified multiple perinatal and childhood factors associated with obesity in young Canadian children. Effective prevention strategies targeting four modifiable maternal and child risk factors may reduce childhood obesity by up to 54% in Canada.
Key words: Childhood obesity, birth weight, maternal smoking, breastfeeding, Canadian Health Measures Survey
Résumé
CONTEXTE: Nous avons évalué des facteurs potentiels au début de la vie et leurs rapports mutuels avec l’obésité chez de jeunes enfants canadiens.
MÉTHODE: Nous avons analysé les données d’un échantillon national représentatif d’enfants de 6 à 11 ans dans l’Enquête canadienne sur les mesures de la santé. À l’aide de modèles de régression logistique multivariée, nous avons évalué les associations entre les comportements durant la période périnatale et la petite enfance, certains facteurs socioéconomiques, le surpoids et l’obésité, puis calculé les fractions étiologiques du risque ajustées dans la population (FERp).
RÉSULTATS: Sur 968 enfants nés à terme, 21 % étaient en surpoids et 13 % étaient obèses. Le tabagisme maternel durant la grossesse (rapport de cotes ajusté de 2,26; intervalle de confiance de 95 %, 1,23–4,15) était associé positivement à l’obésité. Cette association était assistée par le poids de naissance (effet de suppression); une fois les ajustements apportés, la force de l’association entre le tabagisme et l’obésité de l’enfant augmentait de 12 %. Le poids de naissance p. 100 g (1,05; 1,005–1,09) présentait une corrélation significative avec l’obésité. L’allaitement maternel exclusif pendant 6 mois (0,44; 0,31–0,61), les heures de sommeil suffisantes (0,39; 0,16–0,94) et l’activité physique (0,50; 0,26–0,93) étaient des facteurs de protection. L’allaitement maternel, exclusif ou non, réduisait significativement le risque d’obésité chez les enfants dont les mères n’avaient jamais fumé durant la grossesse. Les FERp ont indiqué que 24,4 %, 11,5 %, 11,3 % et 6,0 % des cas prévalents d’obésité infantile pourraient être prévenus par l’allaitement maternel exclusif, l’arrêt du tabac durant la grossesse, le sommeil suffisant durant l’enfance et l’évitement d’un poids de naissance élevé, respectivement.
CONCLUSION: De nombreux facteurs de la période périnatale et de l’enfance sont associés à l’obésité chez ces jeunes enfants canadiens. Des stratégies de prévention efficaces ciblant quatre facteurs de risque modifiables chez les mères et les enfants pourraient réduire l’obésité infantile jusqu’à 54 % au Canada.
Mots clés: obésité infantile, poids de naissance, tabagisme maternel, allaitement, Enquête canadienne sur les mesures de la santé
Footnotes
Conflict of Interest: None to declare.
References
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