title: Family-based factors associated with overweight and obesity among Pakistani primary school children.
abstract: BACKGROUND
  Childhood obesity epidemic is now penetrating the developing countries including Pakistan, especially in the affluent urban population. There is no data on association of family-based factors with overweight and obesity among school-aged children in Pakistan. The study aimed to explore the family-based factors associated with overweight and obesity among Pakistani primary school children.
  
  
  METHODS
  A population-based cross-sectional study was conducted with a representative multistage cluster sample of 1860 children aged five to twelve years in Lahore, Pakistan. Overweight (> +1SD BMI-for-age z-score) and obesity (> +2SD BMI-for-age z-score) were defined using the World Health Organization reference 2007. Chi-square test was used as the test of trend. Linear regression was used to examine the predictive power of independent variables in relation to BMI. Logistic regression was used to quantify the independent predictors of overweight and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained. All regression analyses were controlled for age and gender and statistical significance was considered at P < 0.05.
  
  
  RESULTS
  Significant family-based correlates of overweight and obesity included higher parental education (P < 0.001), both parents working (P = 0.002), fewer siblings (P < 0.001), fewer persons in child's living room (P < 0.001) and residence in high-income neighborhoods (P < 0.001). Smoking in living place was not associated with overweight and obesity. Higher parental education (P < 0.001) and living in high-income neighborhoods (P < 0.001) showed a significant independent positive association with BMI while greater number of siblings (P = 0.001) and persons in child's living room (P = 0.022) showed a significant independent inverse association. College-level or higher parental education as compared to high school-level or lower parental education (aOR 2.54, 95% CI 1.76-3.67), living in high-income neighborhoods as compared to low-income neighborhoods (aOR 2.13, 95% CI 1.31-3.46) and three or less siblings as compared to more than three siblings (aOR 1.75, 95% CI 1.26-2.42) were significant independent predictors of overweight.
  
  
  CONCLUSIONS
  Family-based factors were significantly associated with overweight and obesity among school-aged children in Pakistan. Higher parental education, living in high-income neighborhoods and fewer siblings were independent predictors of overweight. These findings support the need to design evidence-based child health policy and implement targeted interventions, considering the impact of family-based factors and involving communities.
authors.affiliation: Ubeera Memorial Research Society, Allama Iqbal Medical College, Lahore, 54000 Punjab, Pakistan. mushtaqmu@gmail.com
authors.forename: Muhammad Umair
authors.initials: MU
authors.lastname: Mushtaq
authors.forename: Sibgha
authors.initials: S
authors.lastname: Gull
authors.forename: Ubeera
authors.initials: U
authors.lastname: Shahid
authors.forename: Mahar Muhammad
authors.initials: MM
authors.lastname: Shafique
authors.forename: Hussain Muhammad
authors.initials: HM
authors.lastname: Abdullah
authors.forename: Mushtaq Ahmad
authors.initials: MA
authors.lastname: Shad
authors.forename: Arif Mahmood
authors.initials: AM
authors.lastname: Siddiqui
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000523:psychology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology* / Q000523:psychology; D010154:Pakistan / Q000453:epidemiology; D010287:Parent-Child Relations; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012574:Schools