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Original Investigation |

Reducing Racial/Ethnic Disparities in Childhood Obesity:  The Role of Early Life Risk Factors

Elsie M. Taveras, MD, MPH1,2,4; Matthew W. Gillman, MD, SM1; Ken P. Kleinman, ScD1; Janet W. Rich-Edwards, MPH, ScD3; Sheryl L. Rifas-Shiman, MPH1
[+] Author Affiliations
1Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
2Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
3Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, Massachusetts
4currently with the Division of General Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
JAMA Pediatr. 2013;167(8):731-738. doi:10.1001/jamapediatrics.2013.85.
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Importance  Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence of obesity among racial/ethnic minority children.

Objective  To examine the extent to which racial/ethnic disparities in adiposity and overweight are explained by differences in risk factors during pregnancy (gestational diabetes and depression), infancy (rapid infant weight gain, feeding other than exclusive breastfeeding, and early introduction of solid foods), and early childhood (sleeping <12 h/d, presence of a television set in the room where the child sleeps, and any intake of sugar-sweetened beverages or fast food).

Design  Prospective prebirth cohort study.

Setting  Multisite group practice in Massachusetts.

Participants  Participants included 1116 mother-child pairs (63% white, 17% black, and 4% Hispanic)

Exposure  Mother’s report of child’s race/ethnicity.

Main Outcomes and Measures  Age- and sex-specific body mass index (BMI) z score, total fat mass index from dual-energy x-ray absorptiometry, and overweight or obesity, defined as a BMI in the 85th percentile or higher at age 7 years.

Results  Black (0.48 U [95% CI, 0.31 to 0.64]) and Hispanic (0.43 [0.12 to 0.74]) children had higher BMI z scores, as well as higher total fat mass index and overweight/obesity prevalence, than white children. After adjustment for socioeconomic confounders and parental BMI, differences in BMI z score were attenuated for black and Hispanic children (0.22 U [0.05 to 0.40] and 0.22 U [−0.08 to 0.52], respectively). Adjustment for pregnancy risk factors did not substantially change these estimates. However, after further adjustment for infancy and childhood risk factors, we observed only minimal differences in BMI z scores between whites, blacks (0.07 U [−0.11 to 0.26]), and Hispanics (0.04 U [−0.27 to 0.35]). We observed similar attenuation of racial/ethnic differences in adiposity and prevalence of overweight or obesity.

Conclusions and Relevance  Racial/ethnic disparities in childhood adiposity and obesity are determined by factors operating in infancy and early childhood. Efforts to reduce obesity disparities should focus on preventing early life risk factors.

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Figure.
Body Mass Index z Score at Age 7 Years

Body mass index (BMI) z score at age 7 years among black and Hispanic children compared with non-Hispanic white children (reference group) before and after adjustment for confounders and early life risk factors for obesity. Model 1 includes adjustment for child age and sex. Each subsequent model includes the adjustments in the preceding model with the following further adjustments: model 2 includes maternal age, educational level, parity, and household income; model 3, maternal and paternal BMI; model 4, the pregnancy factors of gestational diabetes and second-trimester depression; model 5, the infancy factors of rapid infant weight gain (defined as being in the highest quartile of change in weight-for-age z score between birth and age 6 months), feeding other than exclusive breastfeeding, and introduction of solid foods before age 4 months; and model 6, the early childhood risk factors of insufficient sleep, presence of a television set in the room where the child sleeps, and intake of sugar-sweetened beverages and fast food.

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