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Epidemiology and Population Health

Socioeconomic inequalities in weight, height and body mass index from birth to 5 years

International Journal of Obesityvolume 42pages16711679 (2018) | Download Citation



Studies in high-income countries show that despite the positive association of weight with socioeconomic position at birth, an inverse socioeconomic gradient in overweight (OW) appears later in childhood. The objectives were to understand the natural history of socioeconomic inequalities in weight, height and body mass index (BMI), by investigating their associations with maternal educational level between birth and 5 years, separately in boys and girls.


A published work of growth modelling between birth and 5 years allowed us to calculate predicted weight, height and BMI at 1 month, 6 months, 1, 3 and 5 years for 1735 children from the French EDEN mother–child cohort. Associations between maternal education and predicted measures of body size were analysed with marginal linear and logistic models, stratified by sex.


In girls, despite a positive association between maternal education and birthweight, an inverse socioeconomic gradient was observed as early as 1 month for BMI. Girls whose mothers had low education levels were shorter on the whole than their counterparts with better-educated mothers, despite their similar weights. In boys, no socioeconomic gradient in BMI was observed at any age, including birth, but positive associations were found as early as 1 month for both weight and height.


The emergence of an inverse socioeconomic gradient in BMI and OW apparently results from a complex pattern of socioeconomic inequalities in weight and height from 1 month onwards. The very start of life thus appears to be an important window of opportunity for addressing socioeconomic inequalities in growth.

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Members of the EDEN Mother–Child Cohort Study Group are listed below Acknowledgements.


  1. 1.

    Pulgaron ER. Childhood obesity: a review of increased risk for physical and psychological comorbidities. Clin Ther. 2013;35:A18–32.

  2. 2.

    Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891–8.

  3. 3.

    Williams EP, Mesidor M, Winters K, Dubbert PM, Wyatt SB. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Curr Obes Rep. 2015;4:363–70.

  4. 4.

    Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17:95–107.

  5. 5.

    Ahluwalia N, Dalmasso P, Rasmussen M, Lipsky L, Currie C, Haug E, et al. Trends in overweight prevalence among 11-, 13- and 15-year-olds in 25 countries in Europe, Canada and USA from 2002 to 2010. Eur J Public Health. 2015;25(Suppl 2):28–32.

  6. 6.

    Olds T, Maher C, Zumin S, Peneau S, Lioret S, Castetbon K, et al. Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Int J Pediatr Obes. 2011;6:342–60.

  7. 7.

    Wabitsch M, Moss A, Kromeyer-Hauschild K. Unexpected plateauing of childhood obesity rates in developed countries. BMC Med. 2014;12:17.

  8. 8.

    Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1:11–25.

  9. 9.

    Verdot CTM, Salanave B, Deschamps V. Corpulence des enfants et des adultes en France métropolitaine en 2015. Résultats de l’étude Esteban et évolution depuis 2006. Bull Epidémiol Hebd. 2017;13:234–41.

  10. 10.

    Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005. Obesity. 2008;16:275–84.

  11. 11.

    Ruiz M, Goldblatt P, Morrison J, Porta D, Forastiere F, Hryhorczuk D, et al. Impact of low maternal education on early childhood overweight and obesity in Europe. Paediatr Perinat Epidemiol. 2016;30:274–84.

  12. 12.

    Bouthoorn SH, Wijtzes AI, Jaddoe VW, Hofman A, Raat H, van Lenthe FJ. Development of socioeconomic inequalities in obesity among Dutch pre-school and school-aged children. Obesity. 2014;22:2230–7.

  13. 13.

    Howe LD, Tilling K, Galobardes B, Smith GD, Ness AR, Lawlor DA. Socioeconomic disparities in trajectories of adiposity across childhood. Int J Pediatr Obes. 2011;6:e144–53.

  14. 14.

    Jansen PW, Mensah FK, Nicholson JM, Wake M. Family and neighbourhood socioeconomic inequalities in childhood trajectories of BMI and overweight: longitudinal study of Australian children. PLoS One. 2013;8:e69676.

  15. 15.

    Guignon N, Herbet J, Fonteneau L, Guthmann J. La santé des enfants scolarisés en CM2 en 2004-2005. Premiers résultats. Etudes Et résultats (DRESS). 2008;632:1–8.

  16. 16.

    Chung A, Backholer K, Wong E, Palermo C, Keating C, Peeters A. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes Rev. 2016;17:276–95.

  17. 17.

    Stamatakis E, Wardle J, Cole TJ. Childhood obesity and overweight prevalence trends in England: evidence for growing socioeconomic disparities. Int J Obes. 2010;34:41–7.

  18. 18.

    Cameron AJ, Spence AC, Laws R, Hesketh KD, Lioret S, Campbell KJ. A review of the relationship between socioeconomic position and the early-life predictors of obesity. Curr Obes Rep. 2015;4:350–62.

  19. 19.

    Ruiz M, Goldblatt P, Morrison J, Kukla L, Svancara J, Riitta-Jarvelin M, et al. Mother’s education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts. J Epidemiol Community Health. 2015;69:826–33.

  20. 20.

    Langnase K, Mast M, Danielzik S, Spethmann C, Muller MJ. Socioeconomic gradients in body weight of German children reverse direction between the ages of 2 and 6 years. J Nutr. 2003;133:789–96.

  21. 21.

    Morgen CS, Andersen PK, Mortensen LH, Howe LD, Rasmussen M, Due P, et al. Socioeconomic disparities in birth weight and body mass index during infancy through age 7 years: a study within the Danish National Birth Cohort. BMJ Open. 2017;7:e011781.

  22. 22.

    Ruijsbroek A, Wijga AH, Kerkhof M, Koppelman GH, Smit HA, Droomers M. The development of socio-economic health differences in childhood: results of the Dutch longitudinal PIAMA birth cohort. BMC Public Health. 2011;11:225.

  23. 23.

    Balistreri KS, Van Hook J. Trajectories of overweight among US school children: a focus on social and economic characteristics. Matern Child Health J. 2011;15:610–9.

  24. 24.

    Apouey BH. Child physical development in the UK: the imprint of time and socioeconomic status. Public Health. 2016;141:255–63.

  25. 25.

    Howe LD, Lawlor DA, Propper C. Trajectories of socioeconomic inequalities in health, behaviours and academic achievement across childhood and adolescence. J Epidemiol Community Health. 2013;67:358–64.

  26. 26.

    Howe LD, Tilling K, Galobardes B, Smith GD, Gunnell D, Lawlor DA. Socioeconomic differences in childhood growth trajectories: at what age do height inequalities emerge? J Epidemiol Community Health. 2012;66:143–8.

  27. 27.

    Chardon O, Guignon N, De Saint Pol T. La santé des élèves de grande section de maternelle en 2013: des inégalités sociales dès le plus jeune âge. Etudes Et résultats (DRESS). 2015;920:1–6.

  28. 28.

    Lioret S, Maire B, Volatier JL, Charles MA. Child overweight in France and its relationship with physical activity, sedentary behaviour and socioeconomic status. Eur J Clin Nutr. 2007;61:509–16.

  29. 29.

    Thibault H, Carriere C, Langevin C, Barberger-Gateau P, Maurice S. Evolution of overweight prevalence among 5-6-year-old children according to socio-economic status. Acta Paediatr. 2013;102:273–7.

  30. 30.

    Apouey BH, Geoffard PY. Parents’ education and child body weight in France: the trajectory of the gradient in the early years. Econ Hum Biol. 2016;20:70–89.

  31. 31.

    Heude B, Forhan A, Slama R, Douhaud L, Bedel S, Saurel-Cubizolles MJ, et al. Cohort profile: the EDEN mother-child cohort on the prenatal and early postnatal determinants of child health and development. Int J Epidemiol. 2016;45:353–63.

  32. 32.

    Botton J, Scherdel P, Regnault N, Heude B, Charles MA, Group EM-CCS. Postnatal weight and height growth modeling and prediction of body mass index as a function of time for the study of growth determinants. Ann Nutr Metab. 2014;65:156–66.

  33. 33.

    Carles S, Charles MA, Forhan A, Slama R, Heude B, Botton J, et al. A novel method to describe early offspring body mass index (BMI) trajectories and to study its determinants. PLoS ONE. 2016;11:e0157766.

  34. 34.

    De Cunto A, Paviotti G, Ronfani L, Travan L, Bua J, Cont G, et al. Can body mass index accurately predict adiposity in newborns? Arch Dis Child Fetal Neonatal Ed. 2014;99:F238–9.

  35. 35.

    Peterson CM, Su H, Thomas DM, Heo M, Golnabi AH, Pietrobelli A, et al. Tri-ponderal mass index vs body mass index in estimating body fat during adolescence. JAMA Pediatr. 2017;171:629–36.

  36. 36.

    Villar J, Puglia FA, Fenton TR, Cheikh Ismail L, Staines-Urias E, Giuliani F, et al. Body composition at birth and its relationship with neonatal anthropometric ratios: the newborn body composition study of the INTERGROWTH-21st project. Pediatr Res. 2017;82:305–16.

  37. 37.

    Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007;335:194.

  38. 38.

    Gibbs BG, Forste R. Socioeconomic status, infant feeding practices and early childhood obesity. Pediatr Obes. 2014;9:135–46.

  39. 39.

    Botton J, Heude B, Maccario J, Ducimetiere P, Charles MA, Group FS. Postnatal weight and height growth velocities at different ages between birth and 5 y and body composition in adolescent boys and girls. Am J Clin Nutr. 2008;87:1760–8.

  40. 40.

    Fields DA, Gilchrist JM, Catalano PM, Gianni ML, Roggero PM, Mosca F. Longitudinal body composition data in exclusively breast-fed infants: a multicenter study. Obesity. 2011;19:1887–91.

  41. 41.

    Finch BK, Beck AN. Socio-economic status and z-score standardized height-for-age of U.S.-born children (ages 2-6). Econ Hum Biol. 2011;9:272–6.

  42. 42.

    Matijasevich A, Howe LD, Tilling K, Santos IS, Barros AJ, Lawlor DA. Maternal education inequalities in height growth rates in early childhood: 2004 Pelotas birth cohort study. Paediatr Perinat Epidemiol. 2012;26:236–49.

  43. 43.

    Herngreen WP, van Buuren S, van Wieringen JC, Reerink JD, Verloove-Vanhorick SP, Ruys JH. Growth in length and weight from birth to 2 years of a representative sample of Netherlands children (born in 1988-89) related to socioeconomic status and other background characteristics. Ann Hum Biol. 1994;21:449–63.

  44. 44.

    van Rossem L, Silva LM, Hokken-Koelega A, Arends LR, Moll HA, Jaddoe VW, et al. Socioeconomic status is not inversely associated with overweight in preschool children. J Pediatr. 2010;157:929–35 e1.

  45. 45.

    OECD. Growing unequal?: Income distribution and poverty in OECD countries. Paris: OECD Publishing; 2008.

  46. 46.

    Aizer A, Currie J. The intergenerational transmission of inequality: maternal disadvantage and health at birth. Science. 2014;344:856–61.

  47. 47.

    Barker D, Barker M, Fleming T, Lampl M. Developmental biology: support mothers to secure future public health. Nature. 2013;504:209–11.

  48. 48.

    Heude B, Kettaneh A, Rakotovao R, Bresson JL, Borys JM, Ducimetiere P, et al. Anthropometric relationships between parents and children throughout childhood: the Fleurbaix-Laventie Ville Sante Study. Int J Obes. 2005;29:1222–9.

  49. 49.

    Regnault N, Botton J, Forhan A, Hankard R, Thiebaugeorges O, Hillier TA, et al. Determinants of early ponderal and statural growth in full-term infants in the EDEN mother-child cohort study. Am J Clin Nutr. 2010;92:594–602.

  50. 50.

    Thompson AL, Adair LS, Bentley ME. Pressuring and restrictive feeding styles influence infant feeding and size among a low-income African-American sample. Obesity. 2013;21:562–71.

  51. 51.

    Dennis CL. Breastfeeding initiation and duration: a 1990-2000 literature review. J Obstet Gynecol Neonatal Nurs. 2002;31:12–32.

  52. 52.

    Betoko A, Lioret S, Heude B, Hankard R, Carles S, Forhan A, et al. Influence of infant feeding patterns over the first year of life on growth from birth to 5 years. Pediatr Obes. 2017;12(Suppl 1):94–101.

  53. 53.

    Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr. 2015;104:30–7.

  54. 54.

    Saldanha-Gomes C, Heude B, Charles MA, de Lauzon-Guillain B, Botton J, Carles S, et al. Prospective associations between energy balance-related behaviors at 2 years of age and subsequent adiposity: the EDEN mother-child cohort. Int J Obes. 2017;41:38–45.

  55. 55.

    Lioret S, Touvier M, Dubuisson C, Dufour A, Calamassi-Tran G, Lafay L. et al. Trends in child overweight rates and energy intake in France from 1999 to 2007: relationships with socioeconomic status. Obesity. 2009;17:1092–100.

  56. 56.

    Samani-Radia D, McCarthy HD. Comparison of children’s body fatness between two contrasting income groups: contribution of height difference. Int J Obes. 2011;35:128–33.

  57. 57.

    van den Berg G, van Eijsden M, Vrijkotte TG, Gemke RJ. BMI may underestimate the socioeconomic gradient in true obesity. Pediatr Obes. 2013;8:e37–40.

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We are extremely grateful to all the families who took part in this study, the midwives and psychologists who recruited and followed them, and the whole EDEN team, including research scientists, engineers, technicians and managers and especially Josiane Sahuquillo and Edith Lesieux for their commitment and their role in the success of the study. We also acknowledge the commitment of the members of the EDEN Mother–Child Cohort Study Group listed below. We thank Jo Ann Cahn for her help in preparing the manuscript.

Members of the EDEN Mother–Child Cohort Study Group

I. Annesi-Maesano, J.Y. Bernard, J. Botton, M.A. Charles, P. Dargent-Molina, B. de Lauzon-Guillain, P. Ducimetière, M. de Agostini, B. Foliguet, A. Forhan, X. Fritel, A. Germa, V. Goua, R. Hankard, B. Heude, M. Kaminski, B. Larroque†, N. Lelong, J. Lepeule, G. Magnin, L. Marchand, C. Nabet, F Pierre, R. Slama, M.J. Saurel-Cubizolles, M. Schweitzer and O. Thiebaugeorges.

Author contributions

MB, SL, BH and JB conceived and designed the work, with advice from MAC. MB analysed the data with advice from BH, JB and SL. MB, BH and SL drafted and revised the manuscript. All authors interpreted the data and criticised the manuscript for important intellectual content. MAC and BH designed and led the EDEN mother–child cohort. AF is responsible for the EDEN data management. JB and SC have fitted weight and height growth trajectories using the Jenss–Bayley nonlinear model and provided the relevant data. All authors have read and approved the final version of the manuscript. This article is the work of the authors. MB serves as guarantor for the contents of this article. All authors had full access to all of the data (including statistical reports and tables) in the study and take the responsibility for the integrity of the data and the accuracy of the data analysis. All researchers are independent of the funding bodies. All members in the EDEN –child cohort study group designed the study and revised the draft manuscript.


Support for the EDEN study (Étude des Déterminants pré- et postnatals précoces du développement et de la santé de l’ENfant) was provided by the following organisations: Fondation pour la Recherche Médicale, French Ministry of Research, Institut Fédératif de Recherche and Cohort Program, INSERM Nutrition Research Program, French Ministry of Health Perinatal Program, French Agency for Environment Security (AFFSET), French National Institute for Population Health Surveillance (INVS), Paris-Sud University, French National Institute for Health Education (INPES), Nestlé, Mutuelle Générale de l'Éducation Nationale, French Speaking Association for the Study of Diabetes and Metabolism (Alfediam), National Agency for Research (ANR nonthematic program), and National Institute for Research in Public Health (IRESP TGIR Cohorte Santé 2008 Program). The study sponsors were not involved in the study design, data collection or data analyses.

Author information


  1. Paris Descartes University, Paris, France

    • M. Ballon
    • , J. Botton
    • , M. A. Charles
    • , S. Carles
    • , B. de Lauzon-Guillain
    • , A. Forhan
    • , B. Heude
    •  & S. Lioret
  2. U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), Early Origin of the Child’s Health and Development Team (ORCHAD), Inserm, Villejuif, France

    • M. Ballon
    • , J. Botton
    • , M. A. Charles
    • , S. Carles
    • , B. de Lauzon-Guillain
    • , A. Forhan
    • , B. Heude
    •  & S. Lioret
  3. Faculty of Pharmacy, Université Paris-Sud, Université Paris-Saclay, 92296, Châtenay-Malabry, France

    • J. Botton
  4. Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, VIC, Australia

    • A. J. Cameron


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  1. on behalf of the EDEN Mother–Child Cohort Study Group

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    The authors declare that they have no conflict of interest.

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    Correspondence to M. Ballon.

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