Changes in body mass index-z scores in 3-year-old children during the COVID-19 pandemic: a 2-year retrospective cohort study

Ardic, Cuneyt; Uzun, Kerem; Karakullukcu, Ayse; Karakullukcu, Serdar

doi:10.1590/1806-9282.20230336

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (10) • 2023 • https://doi.org/10.1590/1806-9282.20230336 copy

Changes in body mass index-z scores in 3-year-old children during the COVID-19 pandemic: a 2-year retrospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Given how dramatically the pandemic has affected food systems, the economy, and the daily lives of children over the past 2 years, the potential impact of the pandemic on childhood obesity requires careful investigation. The aim of this study was to investigate the change in body mass index z-score in 3-year-old children and the inducing factors during the pandemic period.

METHODS:

The body mass index z-scores of all children participating in the study were calculated at the beginning of the pandemic (3-year-old body mass index z-score) and in its second year (5-year-old body mass index z-score).

RESULTS:

This study, conducted during the 2-year pandemic period, found a strong association between the body mass index z-scores of children aged 3 and 5 years. The mean body mass index z-score increased between these time points for both boys and girls (p=0.013; p=0.034). In two different linear regression models created for the change in body mass index z score, gestational weight gain was found to be related. The regression coefficients (95% confidence intervals) and corresponding p-values were 0.580 (0.217–0.944) and p=0.002 for model 1, whereas they were 0.585 (0.217–0.961) and p=0.002 for model 2.

CONCLUSION:

This study showed an increase in body mass index z-scores in early childhood period during the COVID-19 pandemic. To prevent this increase, new strategies should be developed by considering the changes brought by the pandemic period.

KEYWORDS:
Childhood obesity; COVID-19; Body mass index; Pandemic

		3-year-old BMI z-score	5-year-old BMI z-score	p^* * Wilcoxon test. Bold indicates statistically significant values.
All group		0.38±1.23	0.68±1.50	<0.001
Gender
	Female	0.26±1.01	0.49±1.30	0.034
	Male	0.50±1.41	0.88±1.66	0.013
Infant nutritional status (First 6 months)
	Exclusive breastfeeding	0.57±1.34	0.80±1.51	0.152
	Not exclusive breastfeeding	0.25±1.14	0.61±1.49	0.002
Type of birth
	Vaginal delivery	0.25±1.22	0.65±1.47	0.003
	Cesarean section	0.51±1.23	0.71±1.53	0.106
History of COVID-19
	Yes	0.45±1.29	0.81±1.66	0.031
	No	0.35±1.21	0.63±1.43	0.011
Kindergarten attendance
	Yes	0.63±1.26	0.78±1.50	0.331
	No	0.29±1.21	0.65±1.50	0.002
Possibility of outdoor activities
	Yes	0.40±1.18	0.73±1.43	0.006
	No	0.34±1.30	0.62±1.58	0.065
Gestational weight gain status
	Excessive	0.47±1.15	1.06±1.43	<0.001
	Adequate-inadequate	0.29±1.30	0.33±1.47	0.823
Smoking during pregnancy
	Yes	0.70±1.39	1.04±1.53	0.283
	No	0.37±1.22	0.67±1.50	0.002
Mother's educational status
	Middle school or below	0.15±1.25	0.54±1.47	0.012
	High school or above	0.49±1.20	0.76±1.51	0.024
Father's educational status
	Middle school or below	0.33±1.25	0.52±1.35	0.234
	High school or above	0.39±1.22	0.73±1.54	0.002
Socioeconomic status
	Low	0.38±1.38	0.49±1.51	0.681
	Normal/high	0.38±1.21	0.71±1.49	0.001

	BMI z-score change
	Model 1			Model 2
	b	95%CI	p	b	95%CI	p
Gender (male)	0.075	-0.284–0.434	0.681	0.124	-0.238–0.486	0.500
Infant nutritional status (first 6 months) (not exclusive breastfeeding)	-0.139	-0.512–0.234	0.465	-0.127	-0.502–0.248	0.505
Type of birth (Cesarean section)	-0.243	-0.607–0.121	0.190	-0.245	-0.613–0.123	0.192
Mother's educational status (high school or above)	-0.167	-0.571–0.236	0.415	-0.155	-0.561–0.251	0.453
Father's educational status (high school or above)	0.151	-0.294–0.596	0.504	0.138	-0.310–0.585	0.545
Socioeconomic status (normal/high)	-0.020	-0.673–0.633	0.951	0.029	-0.628–0.686	0.931
Gestational weight gain status (excessive)	0.580	0.217–0.944	0.002	0.585	0.217–0.961	0.002
History of COVID-19 (yes)	–	–	–	0.103	-0.298–0.503	0.615
Kindergarten attendance (yes)	–	–	–	-0.242	-0.656–0.171	0.250
Screen time (increased)	–	–	–	-0.050	-0.420–0.320	0.789
Sleep duration (decreased)	–	–	–	-0.103	-1.024–0.817	0.825
Fast-food nutrition (increased)	–	–	–	-0.462	-0988–0.063	0.085

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[1] *Corresponding author: drcuneytardic@hotmail.com