Home Environment Characteristics and BMI Z-Score Among Saudi Preschool Children: A Feasibility Study

Objective: To assess feasibility of using preschools in Saudi Arabia as a source for collecting nutrition-related data; To examine associations among home environment characteristics and child BMI z-score (BMIz).Methods: Fifty-three (3-5 years old) children and their mothers were recruited from two preschools in Jeddah, Saudi Arabia. Mothers completed a self-administered questionnaire. Child anthropometry was completed using standardized procedures. BMIz was calculated using the WHO growth standards and reference data. Associations between child and home environment variables were tested using Pearson correlation, t-tests and ANOVA.Results: Participation rate in the middle-to high-income preschool was higher compared to the low- to middle-income preschool (27.3% vs. 17.4%, respectively). Increase in child age and maternal BMI were associated with lower maternal playtime with the child (r= -0.31, p= 0.02, and r= -0.38, p= 0.006, respectively). Increase in child age was also associated with lower paternal playtime with the child (r= -0.26, p= 0.05). Paternal playtime with the child was positively associated with both paternal involvement in feeding (r= 0.30, p= 0.03) and regular family mealtimes (r= 0.26, p=0.05). There was a trend of positive association between paternal involvement in feeding and higher child BMIz (r= 0.26, p=0.08). Mean child BMIz was lower when mothers had ³ a college education vs. not (p= 0.04). Greater child screen time was associated with fewer family mealtimes (p= 0.01).Conclusion: Increasing awareness is needed in order to improve feasibility of studies conducted in Saudi preschools; Future work is needed to further establish the associations of home environment characteristics and child obesity

Maternal Gestational Diabetes Associated with Higher Child BMI Z-Score at Preschool and Lower Likelihood of Breastfeeding Initiation

Objectives: To examine the association of maternal GDM with 1) child BMI z-score at preschool; 2) breastfeeding initiation and duration, while adjusting for child birthweight in addition to potential confounders. Method: Sample included 53 children (3 - 5 years old) recruited from two preschools in Jeddah, Saudi Arabia. Mothers completed a self-administered questionnaire. Child anthropometry was completed using standardized procedures. BMI z-scores were calculated using the WHO standards/reference data. Linear regression models were tested to examine the association between maternal GDM and child BMI z-score, as well as breastfeeding duration. Logistic regression models were tested to examine the association between maternal GDM and breastfeeding initiation. Models were adjusted for child birthweight, maternal BMI, and maternal age at pregnancy. Results: Mean child BMI z-score was 1.10 (SD= 1.22). About one quarter (24.5%) of mothers reported being diagnosed with GDM. Mean birthweight of children whose mothers were diagnosed with GDM was 3.10 kg (SD= 0.74). Adjusting for covariates, we found that maternal GDM was associated with increased child BMI z-score (B= 1.04, 95% CI= 0.14 - 1.94, P-value= 0.02), and lower odds of breastfeeding initiation (OR= 0.10, 95% CI= 0.02 – 0.49, P-value= 0.005). Maternal GDM was not associated with breastfeeding duration (B= -4.75, 95% CI: -11.79 – 2.29, P-value= 0.18). Conclusion: Findings suggest that maternal GDM is associated with higher child BMI z-score at preschool and lower likelihood of breastfeeding initiation. Studies are needed in order to identify the underlying mechanisms of associations. Obesity prevention programs may target children whose mothers were diagnosed with GDM; prenatal breastfeeding counseling may be offered

Mealtime behavior among siblings and body mass index of 4–8 year olds: a videotaped observational study

Background: Being a last-born child and having a sister have been associated with higher body mass index (BMI). Encouragement to eat that overrides children’s self-regulation has been reported to increase the risk of obesogenic eating behaviors. This study sought to test the hypothesis that encouragement to eat during mealtime from older siblings and sisters mediates associations of being last-born or having a sister with higher BMI. Methods: Children aged 4–8 years (n = 75) were videotaped while eating a routine evening meal at home with one sibling present. Encouragement to eat (defined as direct prompts to eat or general positive statements about food) delivered to the index child (IC) from the sibling was coded from the videotape. Path analysis was used to examine associations between IC’s birth order, sibling’s sex, encouragement counts, and IC’s measured BMI z-score (BMIz). Results: Being the younger sibling in the sibling dyad was associated with the IC receiving more encouragements to eat from the sibling (β: 0.93, 95 % confidence interval (CI): 0.59, 1.26, p < 0.0001). The IC having a sister compared with a brother was not associated with the IC receiving more encouragements to eat from the sibling (β: 0.18, 95 % CI: −0.09, 0.47, p = 0.20). The IC receiving more encouragements to eat from the sibling was associated with lower IC BMIz (β: −0.06, 95 % CI: −0.12, 0.00, p = 0.05). Conclusions: Children were more likely to receive encouragements to eat from older siblings than younger siblings. Being the recipient of encouragements to eat from a sibling was associated with lower, not higher, child BMIz, which may reflect sibling modeling of maternal behavior. Future longitudinal studies are needed to examine whether encouragements to eat from siblings lead to increase in BMI over time. Encouragements from siblings may be a novel intervention target for obesity prevention