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Pediatrics

Centre-based childcare in early childhood and growth in later childhood: a prospective cohort study

International Journal of Obesity volume 47, pages 724–731 (2023)Cite this article

Subjects

Abstract

Background

Attending government-regulated centre-based childcare may influence important health behaviours including dietary quality, physical activity and routines related to child growth. However, the relationship between centre-based childcare and childhood obesity remains unclear.

Objectives

The primary objective was to evaluate the association between centre-based childcare attendance in early childhood and body mass index z-score (zBMI) in later childhood. Secondary objectives included exploring whether family income, child sex, or non-centre-based setting modified these relationships.

Methods

A prospective cohort study of children aged 1 to 10 years who participated in the TARGet Kids! cohort was conducted. Linear mixed-effect modelling was used to evaluate the relationship between centre-based childcare attendance (in hours/week) compared to non-centre-based childcare between 1–4 years of age and zBMI between 4 and 10 years of age. Generalised estimating equation modelling was used to explore weight status categories. Models were adjusted for confounders and effect modification was explored.

Results

A total of 3503 children were included. Children who attended centre-based childcare full-time (40 h/week) had 0.11 (95% CI: −0.19, −0.03; p = 0.01) lower zBMI at 4 and 7 years of age and lower odds of overweight and obesity at 4 years (OR 0.78; 95% CI: 0.62, 0.97; p = 0.03), but no evidence of an association was found at 10 years of age. Children from families with income < $50,000CDN who attended centre-based childcare full-time had 0.32 (95% CI: −0.50, −0.14; p = 0.001) lower zBMI and lower odds of overweight and obesity (OR 0.52; 95% CI: 0.28, 0.99; p = 0.05) at 10 years of age.

Conclusions

Attending centre-based childcare in early childhood was associated with a lower zBMI and odds of overweight and obesity in later childhood. These associations were stronger for children from lower income families. Centre-based childcare may be an early intervention for the prevention of childhood obesity.

Clinical trial

Clinical Trial Registry Number: NCT01869530 (clinicaltrials.gov).

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Fig. 1: Participant flow diagram.
Fig. 2: Linear mixed effects models adjusted for clinically relevant covariates with child age [4, 7 and 10 years] as an effect modifier.
Fig. 3: Linear mixed effects models adjusted for clinically relevant covariates with child age [4, 7 and 10 years] and family income as effect modifiers.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available as we do not have REB approval for data sharing.

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Acknowledgements

We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network.

Funding

Funding was provided by the Canadian Institutes of Health Research (CIHR) Institute of Human Development, Child, and Youth Health (MOP-333560 [to JM]). The funding agency had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Michaela D. Kucab

  2. Department of Paediatrics, St. Michael’s Hospital, Toronto, ON, Canada

    Michaela D. Kucab & Jonathon L. Maguire

  3. Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada

    Charles D. G. Keown-Stoneman

  4. Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Charles D. G. Keown-Stoneman

  5. Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada

    Catherine S. Birken

  6. Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada

    Catherine S. Birken

  7. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Catherine S. Birken & Jonathon L. Maguire

  8. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Catherine S. Birken & Jonathon L. Maguire

  9. Department of Nutritional Sciences, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada

    Catherine S. Birken & Jonathon L. Maguire

  10. Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada

    Michal Perlman

  11. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Jonathon L. Maguire

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Consortia

TARGet Kids! Collaboration

  • Michaela D. Kucab
  • , Charles D. G. Keown-Stoneman
  • , Catherine S. Birken
  •  & Jonathon L. Maguire

Contributions

MK and JM conceptualised and designed the research study, performed the initial statistical analyses, interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. CKS designed the study, supervised the statistical analyses and interpretation of data, and critically reviewed the manuscript for important intellectual content. CB and MP designed the study and critically reviewed the manuscript for important intellectual content. All authors read and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jonathon L. Maguire.

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Competing interests

JLM has received research funding from the Canadian Institutes of Health Research, Physician Services Inc, Ontario SPOR Support Unit, as well as an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided nonfinancial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). C.B. has received research funding from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Physician Services Inc, The Leong Center at the University of Toronto, Centre for Addictions and Mental Health, Ontario Child Health Support Unit (OCHSU) Impact Child Health Award, and a Walmart Community Grant through the SickKids Foundation for a study on food insecurity in the inpatient hospital setting. The other authors had no conflicts of interest relevant to this article to disclose.

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Kucab, M.D., Keown-Stoneman, C.D.G., Birken, C.S. et al. Centre-based childcare in early childhood and growth in later childhood: a prospective cohort study. Int J Obes 47, 724–731 (2023). https://doi.org/10.1038/s41366-023-01316-2

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