Are environmental area characteristics at birth associated with overweight and obesity in school-aged children? Findings from the SLOPE (Studying Lifecourse Obesity PrEdictors) population-based cohort in the south of England

Sam Wilding; Nida Ziauddeen; Dianna Smith; Paul Roderick; Debbie Chase; Nisreen A Alwan

doi:10.1186/s12916-020-01513-0

Are environmental area characteristics at birth associated with overweight and obesity in school-aged children? Findings from the SLOPE (Studying Lifecourse Obesity PrEdictors) population-based cohort in the south of England

BMC Med. 2020 Mar 19;18(1):43. doi: 10.1186/s12916-020-01513-0.

Authors

Sam Wilding¹, Nida Ziauddeen¹, Dianna Smith², Paul Roderick¹, Debbie Chase³, Nisreen A Alwan^{4

5}

Affiliations

¹ School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
² School of Geography and Environmental Science, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
³ Southampton City Council, Southampton, UK.
⁴ School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK. n.a.alwan@soton.ac.uk.
⁵ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK. n.a.alwan@soton.ac.uk.

Abstract

Background: Geographical inequalities in overweight and obesity prevalence among children are well established in cross-sectional research. We aimed to examine how environmental area characteristics at birth are related to these outcomes in childhood.

Methods: Anonymised antenatal and birth data recorded by University Hospital Southampton linked to school-measured weight and height data for children within Southampton, UK, were utilised (14,084 children at ages 4-5 and 5637 at ages 10-11). Children's home address at birth was analysed at the Lower and Middle layer Super Output Area (LSOA/MSOA) levels (areas with average populations of 1500 and 7000, respectively). Area-level indices (walkability, relative density of unhealthy food outlets, spaces for social interaction), natural greenspace coverage, supermarket density and measures of air pollution (PM_2.5, PM₁₀ and NO_x) were constructed using ArcGIS Network Analyst. Overweight/obesity was defined as a body mass index (BMI; kg/m²) greater than the 85th centile for sex and age. Population-average generalised estimating equations estimated the risk of being overweight/obese for children at both time points. Confounders included maternal BMI and smoking in early pregnancy, education, ethnicity and parity. We also examined associations for a subgroup of children who moved residence between birth and outcome measurement.

Results: There were mixed results between area characteristics at birth and overweight/obesity at later ages. MSOA relative density of unhealthy food outlets and PM₁₀ were positively associated with overweight/obesity, but not among children who moved. LSOA greenspace coverage was negatively associated with the risk of being overweight/obese at ages 10-11 in all children (relative risk ratio 0.997, 95% confidence interval 0.995-0.999, p = 0.02) and among children who moved.

Conclusions: Local access to natural greenspaces at the time of birth was inversely associated with becoming overweight or obese by age 10-11, regardless of migration. Increased access/protection of greenspace may have a role in the early prevention of childhood obesity.

Keywords: Area indices; Childhood overweight; Greenspace; Obesity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Cross-Sectional Studies
England
Environmental Exposure / adverse effects*
Female
Humans
Male
Overweight / epidemiology*
Pediatric Obesity / epidemiology*

Abstract

Publication types

MeSH terms

Grants and funding