title: Impact of Low Maternal Education on Early Childhood Overweight and Obesity in Europe.
abstract: BACKGROUND
  Comparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood.
  
  
  METHODS
  Prospective data of 45 413 children from 11 European cohorts were used. Children's height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts.
  
  
  RESULTS
  Low maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts.
  
  
  CONCLUSIONS
  Considerable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote children's immediate health and well-being and throughout the life course.
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Milagros
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Goldblatt
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Joana
authors.initials: J
authors.lastname: Morrison
authors.affiliation: Department of Epidemiology, Lazio Regional Health System, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Porta
authors.affiliation: Department of Epidemiology, Lazio Regional Health System, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.affiliation: Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hryhorczuk
authors.affiliation: Institute of Pediatrics, Obstetrics, and Gynecology, Kyiv, Ukraine.
authors.forename: Youriy
authors.initials: Y
authors.lastname: Antipkin
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: Marie-Josèphe
authors.initials: MJ
authors.lastname: Saurel-Cubizolles
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Early Origin of the Child's Health and Development Team (ORCHAD), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Lioret
authors.affiliation: Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Martine
authors.initials: M
authors.lastname: Vrijheid
authors.affiliation: Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.|IB-Salut Menorca Health Area, Balearic Islands, Spain.
authors.forename: Maties
authors.initials: M
authors.lastname: Torrent
authors.affiliation: FISABIO - Universitat Jaume I - Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Castellón de la Plana, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Iñiguez
authors.affiliation: Public Health Department of Gipuzkoa, Gipuzkoa, Spain.|BIODONOSTIA Health Research Institute, San Sebastian, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Larrañaga
authors.affiliation: First Department of Paediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece.
authors.forename: Chryssa
authors.initials: C
authors.lastname: Bakoula
authors.affiliation: First Department of Paediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Veltsista
authors.affiliation: Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Manon
authors.initials: M
authors.lastname: van Eijsden
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Tanja G M
authors.initials: TG
authors.lastname: Vrijkotte
authors.affiliation: Faculty of Science, Research Centre of Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Andrýsková
authors.affiliation: Faculty of Science, Research Centre of Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.|Institute of Biostatistics & Analyses (IBA), Masaryk University, Brno, Czech Republic.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dušek
authors.affiliation: EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.|Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
authors.affiliation: EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.|Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: Sofia
authors.identifier: http://orcid.org/0000-0002-9361-1999
authors.initials: S
authors.lastname: Correia
authors.affiliation: Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.|Biocenter Oulu, University of Oulu, Oulu, Finland.|Unit of Primary Care, Oulu University Hospital, Oulu, Finland.|Faculty of Medicine, Center for Life Course Epidemiology, University of Oulu, Oulu, Finland.
authors.forename: Marjo-Riitta
authors.initials: MR
authors.lastname: Järvelin
authors.affiliation: Institute of Health Sciences, University of Oulu, Oulu, Finland.
authors.forename: Anja
authors.initials: A
authors.lastname: Taanila
authors.affiliation: Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Johnny
authors.initials: J
authors.lastname: Ludvigsson
authors.affiliation: Department of Medicine and Health, Community Medicine/General Practice Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Faresjö
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, London, UK.|Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Marmot
authors.affiliation: Research Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003431:Cross-Cultural Comparison; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D063766:Pediatric Obesity / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Czech Republic; Europe; Finland; France; Greece; Italy; Netherlands; Portugal; Spain; Sweden; Ukraine; United Kingdom; child; child development; cohort studies; comparative study; epidemiology; health inequalities; maternal educational status; meta-analysis; obesity; overweight; preschool