The impact of dietary and lifestyle factors on obesity among chinese children during the first 6 years of life: a 2014-2015 multi-centre study.

OBJECTIVE

To identify lifestyle and dietary factors associated with obesity in children during the first 6 years of life.

METHODS

Children aged 0-6 years were recruited from 12 Children's Health Care Centers in Jiangsu, China, by a multistage stratified cluster random-sampling method. Diet, sleep, supplementation and outdoor activity were collected by questionnaire/interview. Obesity was defined as Body mass index Z-score >2 (World Health Organization standards). Logistic regression was used to examine the associations between lifestyle/dietary factors and obesity, adjusting for sex, age, delivery mode, birth weight, region, and season, with additional stratified and restricted cubic spline dose-response analyses.

RESULTS

A survey of 5,243 children were enrolled in the present study. Prevalence varied by characteristics: sleep <10 h (8.5%), >14 h (9.9%), outdoor activity <1 h (10.7%), complementary feeding before 4 months (9.8%), daily calcium ≥300 mg (10.4%), preference for meat (10.0%), fish/shrimp ≥ 2 times/week (7.1%), daily milk ≥600 mL (6.3%), daily meat >150 g (11.2%), and daily egg >60 g (11.1%). Adjusted analyses identified higher obesity odds for sleep <10 h [odds ratio (OR) 1.327, 95% Confidence Interval (95% CI) 1.024-1.719] or >14 h (2.503, 1.640-3.820), outdoor activity <1 h (2.018, 1.465-2.779), vitamin D supplementation <15 days (1.686, 1.063-2.673), complementary feeding <4 months (1.665, 1.114-2.487), preference for meat (1.369, 1.049-1.859), fish/shrimp ≥ 2 times/week (1.354, 1.026-1.788), daily meat >150 g (2.060, 1.207-3.514), daily egg >60 g (2.937, 1.075-8.024), and daily milk ≥600 mL (1.830, 1.083-3.094 vs. ≤100 mL). A vegetarian preference was inversely associated with obesity.

CONCLUSION

There was a non-linear association between obesity and sleep duration. Lack of outdoor activity was an independent associated factor for obesity. In nominal analyses, excessive intake of milk, fish/shrimp, meat, and eggs was associated with higher odds of obesity in children during the first 6 years of life, whereas an inverse association was observed, with obesity risk decreasing among individuals who preferred vegetarian foods. After false discovery rate correction, sleep duration >14 h, outdoor activity <1 h/day, preference for vegetarian foods, and meat intake >150 g/day remained statistically significant.