title: Factors predicting severe childhood obesity in kindergarteners.
abstract: BACKGROUND
  Severe obesity has increased >300% in US children since 1976, and is associated with multiple cardiovascular risk factors and high adult obesity rates.
  
  
  OBJECTIVE
  The objective of this study was to identify predictors of severe obesity in kindergarteners.
  
  
  METHODS
  Multivariable logistic regression and recursive partitioning analysis (RPA) were used to identify prenatal/pregnancy, infant, and early childhood predictors of severe kindergarten obesity (body mass index (BMI) 99th percentile) in the Early Childhood Longitudinal Study Birth Cohort, a nationally representative longitudinal study that followed children from birth through kindergarten.
  
  
  RESULTS
  For the 6800 children, the severe kindergarten obesity prevalence was 5.7%, with higher adjusted odds for crossing the 85th percentile of BMI at 2 years old (odds ratio (OR), 8.0; 95% confidence interval (CI), 4.1-15.7), preschool age (OR, 7.9; 95% CI, 4.9-12.8) and 9 months old (OR, 1.8; 95% CI, 1.2-2.6); maternal severe obesity (OR, 3.4; 95% CI, 1.9-5.8) and gestational diabetes (OR, 2.9; 95% CI, 1.5-5.5); drinking tea or coffee between meals/before bedtime at 2 years old (OR, 3.3; 95% CI, 1.3-8.5); Latino (OR, 2.3; 95% CI, 1.4-3.7) and multiracial (OR, 2.3; 95% CI, 1.1-4.8) race/ethnicity; and drinking sugary beverages at kindergarten age at least weekly (OR, 2.3; 95% CI, 1.4-3.7). Ever-attending center-based daycare (OR, 0.3; 95% CI, 0.1-0.9), eating fruit at least weekly at kindergarten age (OR, 0.3; 95% CI, 0.1-0.7), and maternal history of a prior newborn birth weight 4000 g (OR, 0.1; 95% CI, 0.02-0.6) were associated with reduced odds of severe obesity. RPA identified low severe obesity prevalence (1.9%) for non-85th BMI-percentile preschool crossers and high severe obesity (56-80%) for predictor clusters which included crossing the 85th BMI percentile at earlier ages, low parental education, specific maternal age cutoffs, preschooler bedtime rules, and outside walking/play frequency for 9-month-olds.
  
  
  CONCLUSIONS
  Certain parental, prenatal/pregnancy, infant, and early childhood factors, both alone and in combination, are potent predictors of severe obesity in kindergarteners.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390, USA. glenn.flores@utsouthwestern.edu
authors.forename: G
authors.initials: G
authors.lastname: Flores
authors.forename: H
authors.initials: H
authors.lastname: Lin
mesh_terms: D001724:Birth Weight; D015992:Body Mass Index; D002675:Child, Preschool; D004032:Diet; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012890:Sleep; D014481:United States / Q000453:epidemiology