Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies.
Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies.
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DOI：
10.1016/s2468-2667(18)30045-8
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Hardy R
中科院分区：
文献类型：
--
作者：
Bann D;Johnson W;Li L;Kuh D;Hardy R
在高收入国家，儿童体重指数（BMI）的社会经济不平等已被记录在案;然而，关于它们如何随时间变化，BMI的复合部分（即体重和身高）的不平等如何变化，以及不平等是否在结果分布中存在程度差异，存在不确定性。因此，我们旨在调查英国儿童和青少年体重、身高和BMI的社会经济不平等是如何随着时间的推移而变化的。我们使用了来自四项英国纵向观察性出生队列研究的数据：1946年医学研究理事会全国健康与发展调查（1946 NSHD）、1958年全国儿童发展研究（1958 NCDS）、1970年英国队列研究（1970 BCS）和2001年千年队列研究（2001 MCS）。在每项研究中，BMI（kg/m2）是根据测量的体重和身高得出的。儿童的社会经济地位是由父亲的职业社会阶层来表示的，在10-11岁时测量。我们研究了儿童社会经济地位与7岁、11岁和15岁时人体测量结果之间的关联，以使用性别调整线性回归模型评估每个队列的社会经济不平等。我们还使用多水平模型来检查这些不平等是否从童年到青春期扩大或缩小，分位数回归用于检查不平等的程度是否在结果分布中存在差异。在英格兰、苏格兰和威尔士，1946年登记了5362例单胎出生，1958年登记了17202例，1970年登记了17290例，2001年登记了16404例。 在较早出生的队列（1946-70）中，低社会经济地位与儿童和青少年体重较低相关，但在2001年MCS队列中体重较高。在2001年的MCS中，从儿童期到青春期，体重差异变得更大，但不是较早出生的队列（pinteraction=0·001）。在所有队列中，低社会经济地位也与较矮的身高相关，但这种差异的绝对幅度在几代人之间缩小。在2001年的MCS中，这些差异随着年龄的增长而扩大（pinteraction= 0.002），但在较早出生的队列中则没有。在1946-70年的队列中，儿童期BMI几乎没有不平等，而在2001年的队列中存在不平等，在1958-2001年的队列中，从儿童期到青春期，这种不平等有所扩大（在后面三个队列中，pinteraction<0.05，但在1946年的NSHD中则没有）。2001年队列的BMI和体重差异大于早出生队列，并且在较高分位数时系统性较大-例如，在2001年MCS中，11岁时，观察到BMI第50百分位数的差异为0.98 kg/m2（95% CI 0.63 - 1.33），BMI第90百分位数的差异为2.54 kg/m2（1.85 - 3.22）。在研究期间（1953-2015），社会经济相关的体重不平等逆转，身高不平等缩小，而BMI和肥胖的差异出现并扩大。这些重大变化突出了社会变革对儿童和青少年成长的影响，以及以前预防肥胖及其社会经济不平等的政策的不足。因此，需要新的有效政策来减少儿童和青少年的BMI不平等。英国经济和社会研究理事会、医学研究理事会和医学科学院/惠康信托基金。
Socioeconomic inequalities in childhood body-mass index (BMI) have been documented in high-income countries; however, uncertainty exists with regard to how they have changed over time, how inequalities in the composite parts (ie, weight and height) of BMI have changed, and whether inequalities differ in magnitude across the outcome distribution. Therefore, we aimed to investigate how socioeconomic inequalities in childhood and adolescent weight, height, and BMI have changed over time in Britain. We used data from four British longitudinal, observational, birth cohort studies: the 1946 Medical Research Council National Survey of Health and Development (1946 NSHD), 1958 National Child Development Study (1958 NCDS), 1970 British Cohort Study (1970 BCS), and 2001 Millennium Cohort Study (2001 MCS). BMI (kg/m2) was derived in each study from measured weight and height. Childhood socioeconomic position was indicated by the father's occupational social class, measured at the ages of 10–11 years. We examined associations between childhood socioeconomic position and anthropometric outcomes at age 7 years, 11 years, and 15 years to assess socioeconomic inequalities in each cohort using gender-adjusted linear regression models. We also used multilevel models to examine whether these inequalities widened or narrowed from childhood to adolescence, and quantile regression was used to examine whether the magnitude of inequalities differed across the outcome distribution. In England, Scotland, and Wales, 5362 singleton births were enrolled in 1946, 17 202 in 1958, 17 290 in 1970, and 16 404 in 2001. Low socioeconomic position was associated with lower weight at childhood and adolescent in the earlier-born cohorts (1946–70), but with higher weight in the 2001 MCS cohort. Weight disparities became larger from childhood to adolescence in the 2001 MCS but not the earlier-born cohorts (pinteraction=0·001). Low socioeconomic position was also associated with shorter height in all cohorts, yet the absolute magnitude of this difference narrowed across generations. These disparities widened with age in the 2001 MCS (pinteraction=0·002) but not in the earlier-born cohorts. There was little inequality in childhood BMI in the 1946–70 cohorts, whereas inequalities were present in the 2001 cohort and widened from childhood to adolescence in the 1958–2001 cohorts (pinteraction<0·05 in the later three cohorts but not the 1946 NSHD). BMI and weight disparities were larger in the 2001 cohort than in the earlier-born cohorts, and systematically larger at higher quantiles—eg, in the 2001 MCS at age 11 years, a difference of 0·98 kg/m2 (95% CI 0·63–1·33) in the 50th BMI percentile and 2·54 kg/m2 (1·85–3·22) difference at the 90th BMI percentile were observed. Over the studied period (1953–2015), socioeconomic-associated inequalities in weight reversed and those in height narrowed, whereas differences in BMI and obesity emerged and widened. These substantial changes highlight the impact of societal changes on child and adolescent growth and the insufficiency of previous policies in preventing obesity and its socioeconomic inequality. As such, new and effective policies are required to reduce BMI inequalities in childhood and adolescence. UK Economic and Social Research Council, Medical Research Council, and Academy of Medical Sciences/the Wellcome Trust.