Neighbourhood socioeconomic circumstances, adiposity and cardiometabolic risk measures in children with severe obesity

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Abstract

Background

It has recently been shown that neighbourhood socioeconomic disadvantage in childhood is associated with obesity, hypertension, fatty liver, and type 2 diabetes in adulthood. 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. Therefore, we evaluated the associations between neighbourhood socioeconomic factors with the severity of obesity, and related cardiometabolic risk factors in a cohort of obese children.

Methods

The Childhood Overweight BioRepository of Australia (COBRA) cohort study comprises 444 children (mean age 11.1 years, mean BMI z-score 2.5). Neighbourhood socioeconomic advantage/disadvantage was evaluated based on postcode information by the national Australian Socio-Economic Indexes for Areas (SEIFA) scores. Participants/parents also completed self-administered questionnaires on neighbourhood related facilities, family education and family income.

Results

In analyses adjusted for age, sex and pubertal status, SEIFA indicating neighbourhood education/occupation was negatively associated with BMI, waist circumference and body fat%. Higher family education was associated with lower BMI. Neighbourhood walkability was related to lower waist circumference. Good shopping facilities in the neighbourhood were associated with increased risk of dyslipidemia and fatty liver, and the existence of parks and playgrounds nearby was related to dyslipidemia.

Conclusions

The present data suggest that neighbourhood-related issues are associated with less severe adiposity among children with established obesity. Concerning cardiometabolic risk factors, shopping facilities were related to dyslipidemia and fatty liver. These findings suggest that increased awareness and efforts are needed to diminish socioeconomic inequalities between neighbourhoods.

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.

Section snippets

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.

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