Lifestyle Behaviors in Early Childhood Vital to Managing Risk of Obesity, Cardiometabolic Conditions

Modifiable lifestyle behaviors, such as physical activity, sleep time, television time, and diet, were shown to contribute to risk of obesity and cardiometabolic conditions in early childhood, according to study findings published this week in Pediatric Obesity.

The prevalence of children under the age of 5 identified as obese or overweight has grown globally from 32 million in 1990 to more than 41 million in 2016. In Spain, 42% of boys and 17% of girls aged 7 years old are identified as overweight, with 19% of boys and 17% of girls classified as obese. Prior studies have focused on the association of unhealthy lifestyle behaviors and obesity/overweight among adults, but researchers noted that little is known about the relationship between these behaviors and cardiometabolic risk factors in children, even though childhood obesity has shown to increase risk of cardiovascular and metabolic diseases later in life.

Researchers assessed data derived from the INMA project, a birth cohort from 3 Spanish regions (Gipuzkoa, Sabadell, and Valencia), on the association of 5 lifestyle behaviors (physical activity, sleep duration, television watching, ultra‐processed food, and plant based food consumption) in children aged 4 years and 7 years on obesity and excess weight. Each behavior was assessed separately and also combined using a predefined score, the child healthy lifestyle score (CHLS), with excess weight, obesity, blood pressure, and lipid profile at 4 years old (cross‐sectional assessment) and with excess weight, obesity, and blood pressure at 7 years old (longitudinal assessment).

Each target behavior was categorized into cohort specific tertiles to represent low (1st tertile), medium (2nd tertile), and high (3rd tertile) adherence to healthy lifestyles and each tertile was given a CHLS total score, which was the sum of the 5 lifestyle items (for favorable behaviors: 1st tertile = 0, 2nd tertile = 1, 3rd tertile = 2 points; for unfavorable behaviors: 1st tertile = 2, 2nd tertile = 1, 3rd tertile = 0 points):

• Cross‐sectional analysis included 1480 children aged 4 years
• Follow-up occurred in the longitudinal analysis, which included available data for 1256 children aged 7 years with body mass index (BMI) z‐score, and 1248 children with waist circumference (WC) z‐score
• Systolic and diastolic blood pressure measured through a digital automatic monitor, and lipids measured using non-fasting blood samples collected by venipuncture at 4 years

Study results showed that higher CHLS represented a healthier lifestyle at age 4 years, and was associated with lower BMI and WC, as well as a decreased risk of developing overweight or obesity and abdominal obesity at age 7 years. Children in the third tertile of the CHLS score were shown to have significantly lower odds of developing overweight or obesity (odds ratio [OR] = 0.61; 95% CI, 0.39-0.96; P = .031), and developing abdominal adiposity (OR = 0.48; 95% CI, 0.24-0.96; P = .034), compared with those in the lowest tertile.

Television viewing time was shown to be the lifestyle factor most strongly associated with obesity development as only low TV time was significantly associated with lower odds of developing overweight (OR = 0.54; 95% CI, 0.36-0.82; P = .004) or abdominal obesity at age 7 years (OR = 0.27; 95% CI 0.13-0.53, P ≤ .001) when compared to the other factors.

“A healthy lifestyle behavior in early childhood characterized by low TV time and low consumption of ultra‐processed foods, and high sleep time, physical activity and consumption of plant food, was associated with lower BMI and WC and lower odds of developing overweight or obesity and abdominal obesity at 7 years,” said the study authors.

Initiating multilevel behavior modifications was noted by the authors in tackling childhood obesity. Some potential interventions, such as a school-based sleep education course and higher parental support in promoting sleep have been hypothesized to battle sleep deprivation among adolescents, which can be further extended to other lifestyle behaviors. “Future studies should include information about lifestyle behaviors after follow up, and longer follow up time between exposure and outcome,” wrote the study authors.

Reference

Bawaked RA, Fernandez-Barres S, Navarrete-Munoz EM, et al. Impact of lifestyle behaviors in early childhood on obesity and cardiometabolic risk in children: Results from the Spanish INMA birth cohort study. Pediatric Obesity. 2019;e12590.