Neighbourhood socioeconomic circumstances, adiposity and cardiometabolic risk measures in children with severe obesity
Introduction
The childhood obesity pandemic is one the most alarming trends for public health worldwide. Current forecasts suggest that the life expectancy of today’s children will be shorter than their parents [1]. To counteract the existing weight-trajectory trends and provide useful information for early prevention and intervention of obesity, it is essential to identify modifiable factors that are associated with obesity in childhood and its cardiometabolic complications, such as dyslipidemia, elevated blood pressure and non-alcoholic fatty liver disease (NAFLD).
Familial factors, such as having parents with obesity, have been consistently associated with obesity risk in offspring [2], [3], [4]. In addition, household socioeconomic status (i.e. family education, occupation or income) has been related with child adiposity, independent of parental BMI levels [3], [5]. Furthermore, it has recently been shown, in population-based longitudinal studies commencing in childhood, that neighbourhood socioeconomic disadvantage is associated with obesity, hypertension, fatty liver, and type 2 diabetes in adulthood [6]. However, it is largely unknown whether neighbourhood socioeconomic circumstances are important predictors of adiposity and associated measures in children, especially in those with severe obesity.
In the present study, we utilized data from the Childhood Overweight BioRepository of Australia (COBRA) cohort. Our primary aim was to examine whether neighbourhood socioeconomic advantage/disadvantage is associated with the severity of obesity, and pre-clinical cardiometabolic measures.
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Material and methods
The Childhood Overweight BioRepository of Australia (COBRA) study was established through the weight management service at a tertiary children’s hospital and data have been collected since 2009 [7]. Children and adolescents were referred to the service by general practitioners or pediatricians with pre-referral criteria needing to be met. These are (i) aged <10 years and BMI > 95th percentile or aged >10 years with BMI > 95th percentile and established comorbidity (dyslipidemia, hypertension, type 2
Questionnaire data
Data on socioeconomic variables were collected during the patients’ visits at the clinic. To evaluate neighbourhood socioeconomic position, four different Socio-Economic Indexes for Areas (SEIFA) scores were used based on the postcode where the participant lived: education and occupation, economic resources, relative socio-economic advantage and disadvantage, and relative socio-economic disadvantage [8]. These national SEIFA indices are standardized scores derived by geographic area compiled
Results
Characteristics of the cohort are shown in Table 1. Of 444 children, 48.1% were boys and the mean age of the cohort was 11.1 years (range 1–18 years). Mean BMI was 32.6 kg/m2, CDC z-score 2.5, (range 1.1–6.5), waist circumference 101 cm (N = 332) and body fat% 42.6% (N = 333). Blood pressure, lipid, glucose and liver data were available for between 269 and 368 participants. SEIFA data were available for all 444 children, and mean Relative Socio-Economic Advantage and Disadvantage score was 1001.
Discussion
In this cohort of children with severe obesity, we observed that neighbourhood education/occupation and relative socioeconomic advantage/disadvantage associated SEIFA scores were associated with adiposity measures, but not with cardiometabolic risk factors. Among individuals with questionnaire data available on neighbourhood related factors and family SES, good walking opportunities and higher parental education levels were associated with better adiposity status, whereas better access to basic
Funding sources
MJ is supported by Juho Vainio Foundation and federal research grants to Turku University Hospital. CS is supported by Ettore e Valeria Rossi foundation Bern, Switzerland; Batzebär foundation Inselspital Bern, Switzerland; Freie akademische Gesellschaft Basel, Switzerland; Novo Nordisk. BEH is supported by an NHMRC Early Career Fellowship (1072086). CGM is supported by a National Heart Foundation of Australia Future Leader Fellowship (100849). DPB is supported by NHMRC Senior Research Fellowship
Financial disclosure
There are no financial relationships relevant to this article to disclose.
Conflicts of interest
The authors declare no potential conflicts of interest, including no specific financial interests relevant to the subject of this manuscript.
Ethics
The authors declare that all experiments on human subjects were conducted in accordance with the Declaration of Helsinki, and that all procedures were carried out with the adequate understanding and written consent of the subjects.
The authors also certify that formal approval to conduct the experiments described has been obtained from the human subjects review board of their institution and could be provided upon request.
References (16)
- et al.
Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention
Am J Clin Nutr
(2015) - et al.
Associations between fast food and physical activity environments and adiposity in mid-life: cross-sectional, observational evidence from UK Biobank
Lancet Public Health
(2018) - et al.
Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort
Prev Med Rep
(2017) - et al.
A potential decline in life expectancy in the United States in the 21st century
N Engl J Med
(2005) - et al.
Predicting obesity in young adulthood from childhood and parental obesity
N Engl J Med
(1997) - et al.
Childhood environmental and genetic predictors of adulthood obesity: the cardiovascular risk in young Finns study
J Clin Endocrinol Metab
(2011) - et al.
Predictors of favorable growth patterns during the obesity epidemic among US school children
Clin Pediatr (Phila)
(2015) - et al.
Neighbourhood socioeconomic disadvantage, risk factors, and diabetes from childhood to middle age in the Young Finns Study: a cohort study
Lancet Public Health
(2018)