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Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario

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Abstract

Objectives

International data suggest the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario.

Methods

A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n = 3713) and BORN Ontario (n = 768). Body mass index z score (zBMI) definitions were adapted from the World Health Organization (WHO) (z score > 3) and the US Centers for Disease Control (CDC) (> 120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories.

Results

A total of 1.1% (95% CI, 0.8–1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI, 0.2–0.6) using the CDC definition. Median neighbourhood household income (OR = 0.80, 95% CI, 0.69–0.93) and maternal pre-pregnancy BMI (OR = 1.08, 95% CI, 1.01–1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy BMI and severe obesity was 1.04 (95% CI, 0.94–1.15).

Conclusion

More than 1% of Ontario children met the adapted WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence, and risk factors for severe obesity in young children across Canada.

Résumé

Objectifs

Selon les données internationales, la prévalence de l’obésité sévère chez les jeunes enfants pourrait être en hausse, mais il n’existe pas de données canadiennes à ce sujet. Nous avons voulu examiner les définitions de l’obésité sévère et évaluer les facteurs de risque associés chez les jeunes enfants en Ontario.

Méthode

Nous avons mené une étude transversale auprès d’enfants de 17 à 24 mois à l’aide de deux sources de données ontariennes : TARGet Kids! (n = 3713) et BORN Ontario (n = 768). Nous avons adapté les définitions du score-z de l’indice de masse corporelle (IMC) de l’Organisation mondiale de la santé (OMS) (score-z > 3) et des Centers for Disease Control américains (CDC) (>120% du 95e centile) et nous les avons appliquées pour définir l’obésité sévère chez les jeunes enfants. Par régression logistique multinomiale, nous avons évalué les associations entre les facteurs de risque démographiques et liés à la grossesse et les catégories du score-z de l’IMC.

Résultats

Un total de 1,1% (IC de 95% : 0,8–1,4) des enfants répondaient à la définition de l’obésité sévère adaptée de celle de l’OMS, et 0,3% (IC de 95% : 0,2–0,6) répondaient à la définition adaptée de celle des CDC. Le revenu médian des ménages selon le quartier (rapport de cotes [RC] = 0,80, IC de 95% : 0,69–0,93) et l’IMC maternel avant la grossesse (RC = 1,08, IC de 95% : 1,01–1,15) étaient associés à l’obésité sévère dans nos analyses non ajustées. En tenant compte des facteurs confusionnels possibles, le RC de l’association entre l’IMC maternel avant la grossesse et l’obésité sévère était de 1,04 (IC de 95% : 0,94–1,15).

Conclusion

Plus de 1% des enfants ontariens répondent à la définition de l’obésité sévère de l’OMS pour les très jeunes enfants. Nous avons repéré des facteurs de risque modifiables. Il faudrait pousser la recherche pour comprendre la terminologie, la prévalence et les facteurs de risque de l’obésité sévère chez les jeunes enfants à l’échelle du Canada.

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Acknowledgements

We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network.

Funding

Funding for this study was received from the Canadian Institutes of Health Research.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

    Meloja Satkunam & Laura N. Anderson

  2. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

    Meloja Satkunam, Laura N. Anderson & Sarah Carsley

  3. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Sarah Carsley, Jonathon L. Maguire, Patricia C. Parkin & Catherine S. Birken

  4. The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada

    Jonathon L. Maguire

  5. Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada

    Jonathon L. Maguire, Patricia C. Parkin & Catherine S. Birken

  6. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Jonathon L. Maguire, Patricia C. Parkin & Catherine S. Birken

  7. Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Room 109801, 10th Floor - Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada

    Patricia C. Parkin & Catherine S. Birken

  8. Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada

    Ann E. Sprague

  9. Faculty of Medicine and Dentistry, Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada

    Geoff D. C. Ball

Authors
  1. Meloja Satkunam
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  2. Laura N. Anderson
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  3. Sarah Carsley
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  8. Catherine S. Birken
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Consortia

on behalf of the TARGet Kids! Collaboration and Team ABC

Corresponding author

Correspondence to Catherine S. Birken.

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Conflict of interest

JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). PCP received unrestricted research grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009), Dairy Farmers of Ontario (2008–2010), and Mead Johnson Nutrition provided non-financial support (Fer-In-Sol® liquid iron supplement) (2011–2017) for an ongoing investigator-initiated trial of iron deficiency in young children that was funded by Canadian Institutes of Health Research (FRN # 115059). These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review, or approval of the manuscript. All other authors declare they have no conflicts of interest.

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Satkunam, M., Anderson, L.N., Carsley, S. et al. Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario. Can J Public Health 109, 489–497 (2018). https://doi.org/10.17269/s41997-018-0065-2

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