Study On Relationship Between Nutrition,Family Economic Factors And Childhood,Adult Obesity

Backgroud:With the development of social economy,the prevalence of overweight and obesity among children is rising worldwide,which has become a global public health problem In addition to genetic factors,overweight and obesity in children are also related to nutrition,family lifestyle,social and economic status and other factors.Studies have shown that early life,childhood nutrition and physical development have long-term effects on adult health,such as the onset of obesity in adulthood.However,in China,there is still a lack of nationally representative data to study the development of childhood and adult obesity and explore the influencing factorsObjective:The aim of this study is as follows:(1)verifing the reliability and validity of Food Frequency Questionnaire(FFQ)for children aged 6-17 years to confirm the applicability of children’^dietary patterns;(2)the FFQ information of children in large national surveys was used to extract dietary patterns,and family economic factors were analyzed to explore the relationship between dietary patterns,family economic factors and childhood obesity;(3)to explore the relationship between malnutrition during early life,childhood obesity and adult obesity.Methods:1.In System Survey and Application on Nutrition and Health of Chinese Children Aged 0-18 years(2017-2021),the FFQ applicable to children aged 6-17 years in China was established and determined the list of 11 categories and 72 kinds of food.Of 240 children’s reliability analysis between first FFQ(FFQ1)and the second FFQ(FFQ2)results was conducted,and the validity analysis between FFQ2 and 3 day 24 hours dietary recalls was conducted.The reliability and validity were verified from the perspectives of food intake,nutrient intake and dietary pattern by statistical methods such as correlation coefficient,quartile consistency and dietary pattern consistency.2.Of 7 988 children aged 6-17 years who had FFQ information in small and medium-sized urban areas from China Nutrition and Health Survey(CNHS 2010-2012)were screened out.The FFQ information of these children was used to extract the dietary pattern of children through exploratory factor analysis,and confirmatory factor analysis was used to evaluate the fitting effect of dietary pattern model.Multiple linear quantile regression logistic regression and other statistical methods were used to analyze the relationship between dietary patterns and childhood obesity.Based on the obove database,of 6 343 children aged 6-17 years and parents were matched.The relationship between Body Mass Index(BMI)of parents and family economic factors and childhood obesity was evaluated by logistic regression analysis,stratified analysis and other statistical methods.The prediction of childhood obesity was made by Bayes discriminant analysis3.The population born from October 1959 to September 1961 in the database of two surveys on CNHS(2002,2010-2012)was selected as the group of malnutrition exposure during pregnancy,and the population born from October 1956 to September 1958 as the group of malnutrition exposure in infancy and the population born from October 1962 to September 1964 as the non-exposure group.35 587 samples were obtained.Excess mortality rate was used to define whether an area is severely exposed or not.Logistic regression analysis,stratification analysis and sensitivity analysis were used to explore the relationship between malnutrition in early life and central obesity in different stages of adulthood.Of 204 children’data aged 6-17 years in Nutrition and Chronic Disease Family Cohort(NCDFaC,2002-2015)were used to explore the relationship between childhood obesity and adult obesity.Results:1.Verification results of FFQ reliability and validity1.1 Verification results of FFQ reliability(FFQ1 vs.FFQ2)The intergroup correlation coefficient(ICC)of food and nutrients for children and adolescents aged 6-17 years was between 0.24 and 0.70,among which the ICC coefficient range for children aged 6-11 years is 0.04-0.72,and for children aged 12-17 years is 0.21-0.76.The proportion of same/adjacent quartile is 67.9%to 100.0%.The proportion of opposite quartile is lower.The frequency of intake is higher and the food with a fixed portion,the ICC coefficient is higherThe dietary pattern factor loads extracted from FFQ1 and FFQ2 were consistent in most food groups.The proportion range of the same/adjacent quartile is 76.0%-80.2%;Pearson correlation coefficient and ICC ranged from 0.35 to 0.521.2 Verification results of FFQ validity(FFQ1 vs.3 days 24 hours dietary recalls)The Spearman correlation coefficient range of food and nutrients for children and adolescents aged 6-17 years was 0.03-0.50,among which the Spearman correlation coefficient range for children aged 6-11 years was-0.04-0.33,and for children aged 12-17 years was-0.04-0.59.The proportion of the same/adjacent quartiles ranged from 50.6%to 100.0%,while the proportion of the opposite quartile was lower.The Bland Altman scatter plot of nutrient intake falls within the 95%CI interval with good consistency.2.Relationship between dietary patterns,family economic factor and childhood obesity2.1 Relationship between dietary patterns and childhood obesityOf 7 988 children FFQ’s information used for extracting dietary patterns,and two kinds of dietary patterns were extracted,respectively westernized dietary patterns and traditional Chinese dietary pattern.The westernized dietary pattern characterized by a high intake of pastries/sweets,sugar-sweetened beverages,aquatic products,red meat,nuts,fruits,dairy products,fresh vegetable juices,poultry and eggs,moderate intake of fresh vegetables,coffee/tea and bacteria algae.The traditional Chinese dietary pattern characterized by a high intake of sweet potato,beans,fried pasta and fresh vegetables,moderate intake of red meat and pickles bacteria algae pastry/sweets.According to the two dietary patterns obtained by exploratory factor analysis,the confirmatory factor analysis was carried out,and the fitting effect of the dietary pattern model works wellThe results showed that the children with low age,high energy intake,high family income,who did housework for a short time and in modern travel(such as car travel)tended to follow the westernized dietary pattern.Children with high age,high energy intake,low family income,in traditional travel(such as walking)and do housework for a long time tended to follow the traditional Chinese dietary patternCompared with the westernized dietary pattern Q1 quantile,the Q4 quantile was associated with an increase of BMI,with β regression coefficient(95%CI)was 0.57(0.40,0.85),OR value(95%CI)was 1.49(1.21,1.84),and obesity risk presented a linear trend from Q1 to Q4 quantile(P<0.001).2.2 Relationship between family economic factors and childhood obesityOf 6 343 children’s data aged 6-17 years with paretal information was analyzed and found that parental obesity and high Socioeconomic Status(SES)are risk factors for children’s obesity.The higher parental BMI,the higher annual per capita income,the higher education level of mothers,the higher overweight and obesity rate of children and adolescents was,presenting a positive correlationSES was positively correlated with childhood obesity of different ages and sex Meanwhile,it was found that high paternal education had a protective effect on BMI of adolescents aged 12-17 years.The Bayes retrospective discriminant evaluation results showed that 66.6%of the probability could correctly predict childhood obesity3.The relationship between malnutrition in early life,childhood obesity and adult obesity3.1 The relationship between malnutrition early in life and adult obesityAfter the analysis of 35 578 people in two large surveys,it was found that,compared with the non-exposed group,exposure to malnutrition in early life(especially during pregnancy)was a risk factor for central obesity,and the OR value(95%CI)corresponding to exposure during pregnancy in 2002 and 2012 was 1.31(1.19-1.44)and 1.09(1.00-1.19),respectivelyStratified by severity of exposure to famine,the OR value(95%CI)of severe exposure during pregnancy in 2012 was 1.13(1.01-1.27).Stratified by sex,women exposed during pregnancy and infancy in 2002 and 2012 had a risk of central obesity,with no statistically significant difference among men.Stratified analysis of urban and rural areas showed that urban population has the risk of central obesity.Stratified analysis with exercise,found that non-exercise would increase the risk effect of obesity caused by malnutrition in early life,and there was no statistical difference among the exercise population.Stratified analysis by education level found that there was a risk of central obesity in the highly educated population3.2 The relationship between childhood obesity and adult obesityFollowing 205 children and adolescents aged 6-17 into adulthood,it was found that childhood BMI(Q4 quantile)was positively correlated with adult BMI,the regression coefficients(95%CI)were 3.76(1.36,6.16),childhood obesity was a risk factor for adult obesity,and the OR value(95%CI)was 5.76(1.37-24.34)Conclusion:1.The 11 types and 72 kinds of FFQ developed in this study can correctly and reasonably evaluate the food and nutrient intake of children,and accurately evaluate the dietary patterns of different individuals,indicating that this FFQ is an effective method for the dietary evaluation of children and can be applied to large-scale epidemiological investigation2.In this study,two different dietary patterns of children aged 6-17 years were extracted using FFQ data of children in small and medium-sized cities in a large national survey,respectively the westernized dietary pattern and the traditional Chinese dietary pattern.Westernized dietary pattern was independent risk factor for childhood obesity.3.By matching parents’ information from large national surveys,found that high BMI of parents and SES(mothers with high education level,high family income and living in cities)are risk factors for childhood and adolescent obesity4.This study investigated the relationship between malnutrition in early life and central obesity in different life stages of adulthood in people 40 and 50 years after famine exposure,and found that malnutrition in early life,especially intrauterine malnutrition,was a risk factor for central obesity in adulthood5.Thirteen years of follow-up studies have shown that childhood obesity had a direct effect on adult obesity.