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Early life risk factors and racial/ethnic disparities in childhood obesity

Racial and ethnic disparities in children who are overweight and obese may be determined by risk factors in infancy and early childhood, according to a study published Online First by JAMA Pediatrics, a JAMA Network publication.

Over three decades, the rates of overweight and obesity among children have substantially increased worldwide. In the United States, the prevalence is estimated to be 32 percent among children and adolescents, according to the study background.

Elsie M. Taveras, M.D., M.P.H., now of the MassGeneral Hospital for Children, Boston, and colleagues examined which racial and ethnic disparities were explained by 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 less than 12 hours per day, a television in the room where the child sleeps and any intake of sugar-sweetened beverages or fast food). Study participants included 1,116 mother-child pairs (63 percent white, 17 percent black and 4 percent Hispanic.

"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," the study notes.

Black and Hispanic children had higher body-mass index (BMI) z scores, along with higher total fat mass index and overweight/obesity prevalence than white children. Differences in the BMI z score were attenuated (reduced) for black and Hispanic children when adjustments were made for socioeconomic confounders and parental BMI. But adjustments for pregnancy risk factors did not appear to substantially change these estimates.

However, there appeared to be only minimal differences in BMI z scores between whites, blacks and Hispanics when further adjustments were made for infancy and childhood risk factors, the results indicate.

"We found that the prevalence of overweight and obesity among black and Hispanic children at age 7 years was almost double that of white children. … Our findings suggest that racial/ethnic disparities in childhood obesity may be explained by factors operating in infancy and early childhood and that eliminating these factors could eliminate the disparities in childhood obesity," the authors conclude.

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