Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5–7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS)
Abstract
Objectives To identify the major risk factors of overweight and obesity in prepubertal children.Design Cross-sectional study.Setting In all, 32 primary schools in Kiel (248 000 inhabitants), northwest Germany.Subjects A total of 2631 5-7-y-old German children and their parents.Main outcome measures Weight status, socio-economic status (SES), parental overweight, dietary intake, activity, inactivity and further determinants (birth weight, breast feeding, nutritional status of siblings) of the children.Results The prevalence of overweight (>/=90th BMI percentile of reference) was 9.2% in boys and 11.2% in girls, respectively. Considered univariately, family-, environment- and development-related determinants showed some relations to overweight and obesity. In multivariate analyses parental overweight, a low SES as well as a high birth weight were the strongest independent risk factors of overweight and obesity in children. Additionally, there were sex-specific risk factors: parental smoking and single households were risk factors in boys, whereas a low activity was associated with obesity in girls. Birth weight was associated with obesity, but not with overweight. The prevalence of obesity reached 29.2% in boys and 33.4% in girls with all the three main risk factors.Conclusions Overweight families of low SES have the highest risk of overweight and obese children. Future prevention programmes must also take into account sex-specific risk factors.
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The studies by Duncan et al. and Danielzik et al. were the first to examine the cumulative effects of multiple risk factors on adiposity in children.
“The studies by Duncan et al. [34] and Danielzik et al. [35] were the first ones that examined the cumulative effects of multiple risk factors on adiposity in children.”
From Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study (2016) · cites this paper as [35]
Except for Duncan et al. (New Zealand), all studies examining cumulative effects were conducted in European countries, analyzing selected, national, or multi-country data.
“Except for the study by Duncan et al. that was conducted in New Zealand [34], all of them were conducted in European countries, either analyzing selected samples [35], national samples [15] or multi-country data [16, 17].”
From Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study (2016) · cites this paper as [35]
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BackgroundMethodInfluentialSelf-citationvan Stralen, M. M., Velde, S. J. T., van Nassau, F., Brug, J., Grammatikaki, E., Maes, L., Bourdeaudhuij, I. D., Verbestel, V., Galcheva, S., Iotova, V., et al. (2012) · Obesity Reviews · doi:10.1111/j.1467-789x.2011.00959.x · Cited by 110 · see citing works
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“However, studies in the developed countries had shown inverse association of SES, neighborhood income level and parental education with obesity [61,69-73].”
BackgroundMurrin, C. M., Kelly, G., Tremblay, R. E., & Kelleher, C. C. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-81 · Cited by 108 · see citing works
“Several studies examine the relationship of mother-offspring BMI, birth weight and other anthropometric measures [2,32].”
BackgroundEloranta, A., Lindi, V., Schwab, U., Tompuri, T., Kiiskinen, S., Lakka, H. M., Laitinen, T. P., & Lakka, T. A. (2012) · International Journal of Obesity · doi:10.1038/ijo.2012.89 · Cited by 104 · see citing works
School- and family-based interventions to prevent overweight in children
Müller, M. J., Danielzik, S., & Pust, S. (2005) · Proceedings of The Nutrition Society · doi:10.1079/pns2005424 · Cited by 104 · see citing works
“There is also evidence from studies in prepubertal children that high normal weight and/or normal-weight–overfat children have a high risk of weight gain (Danielzik et al. 2004).”
BackgroundSelf-citationRisk factors for childhood overweight
Agras, W. S., & Mascola, A. J. (2005) · Current Opinion in Pediatrics · doi:10.1097/01.mop.0000172818.87261.ab · Cited by 103 · see citing works
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Social and early-life determinants of overweight and obesity in 18-year-old Swedish men
Koupil, I., & Toĭvanen, P. (2007) · International Journal of Obesity · doi:10.1038/sj.ijo.0803681 · Cited by 101 · see citing works
Weyermann, M., Rothenbacher, D., & Brenner, H. (2006) · International Journal of Obesity · doi:10.1038/sj.ijo.0803260 · Cited by 101 · see citing works
The aetiology of childhood obesity: a review
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Childhood Obesity: An Updated Review
Leung, A. K. C., Wong, A. H. C., & Hon, K. E. (2022) · Current Pediatric Reviews · doi:10.2174/1573396318666220801093225 · Cited by 97 · see citing works
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“However, data on this relationship are conflicting [5, 42].”
BackgroundSvensson, V., Jacobsson, J. A., Fredriksson, R., Danielsson, P., Sobko, T., Schiöth, H. B., & Marcus, C. (2010) · International Journal of Obesity · doi:10.1038/ijo.2010.189 · Cited by 92 · see citing works
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“A second questionnaire (parents’ questionnaire) was given to the adolescents for their parents which included parental body mass and height (Danielzik et al., 2004).”
BackgroundSelf-citationOchiai, H., Shirasawa, T., Ohtsu, T., Nishimura, R., Morimoto, A., Obuchi, R., Hoshino, H., Tajima, N., & Kokaze, A. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-766 · Cited by 91 · see citing works
“In the present study, we did not obtain information regarding grandparent(s), exposure to environmental tobacco smoking, and socio-economic status such as family income, which have been reported to be associated with childhood overweight [34-37].”
BackgroundWu, S., Ding, Y., Wu, F., Li, R., Hu, Y., Hou, J., & Mao, P. (2015) · Scientific Reports · doi:10.1038/srep11354 · Cited by 90 · see citing works
Apfelbacher, C., Loerbroks, A., Cairns, J., Behrendt, H., Ring, J., & Krämer, U. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-171 · Cited by 89 · see citing works
“We were also unable to adjust for parental overweight and obesity which is a strong predictor for overweight and obesity in children [16,18,32-35].”
BackgroundChi, D. L., Luu, M., & Chu, F. (2017) · Journal of Public Health Dentistry · doi:10.1111/jphd.12221 · Cited by 92 · see citing works
“…irregular vigorous physical activity (69), low activity during break times at school (115) or on weekdays (48) and weekends (48), limited outdoors playtime (35,202), and irregular or non-participation in organized sports (47,58,69,95,178) was consistently associated with childhood obesity.”
InfluentialHuSKY: a healthy nutrition score based on food intake of children and adolescents in Germany
Kleiser, C., Mensink, G., Scheidt‐Nave, C., & Kurth, B. (2009) · British Journal Of Nutrition · doi:10.1017/s0007114509222689 · Cited by 87 · see citing works
“In contrast, there was no significant association between a dietary index and BMI in the Kiel Obesity Prevention Study(33) or between the HuSKY and BMI in the present analysis.”
BackgroundRelationship of single measures of cardiorespiratory fitness and obesity in young schoolchildren
Mota, J. A. P. S., Flores, L., Flores, L., Ribeiro, J. C., & Santos, M. P. (2006) · American Journal of Human Biology · doi:10.1002/ajhb.20513 · Cited by 86 · see citing works
“Further, different determinants were identified as significant risk factors of childhood obesity between genders, and low activity was associated with obesity in girls (Danielzik et al., 2004).”
BackgroundPredicting childhood obesity using electronic health records and publicly available data
Hammond, R., Athanasiadou, R., Curado, S., Aphinyanaphongs, Y., Abrams, C. B., Messito, M. J., Gross, R. S., Katzow, M. W., Jay, M. R., Razavian, N., et al. (2019) · PLoS ONE · doi:10.1371/journal.pone.0215571 · Cited by 83 · see citing works
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Brekke, H. K., van Odijk, J., & Ludvigsson, J. (2007) · British Journal Of Nutrition · doi:10.1017/s0007114507244460 · Cited by 76 · see citing works
“Parental overweight has been shown to be an independent risk factor for overweight in children (Danielzik et al. 2004), but has to our knowledge not previously been related to early feeding of sugar-rich foods.”
BackgroundDietary Quality Index and Associated Factors among Adolescents of the State of Sao Paulo, Brazil
de Andrade, S. C., Barros, M. B. D. A., Carandina, L., Goldbaum, M., César, C. L. G., & Fisberg, R. M. (2009) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2009.09.066 · Cited by 74 · see citing works
Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate
Danielsson, P., Svensson, V., Kowalski, J. H., Nyberg, G., Ekblom, Ö. B., & Marcus, C. (2012) · Obesity Facts · doi:10.1159/000336060 · Cited by 73 · see citing works
The financial costs, behaviour and psychology of obesity: A one health analysis
Bomberg, E., Birch, L., Endenburg, N., German, A. J., Neilson, J., Seligman, H., Takashima, G., & Day, M. J. (2017) · Journal of Comparative Pathology · doi:10.1016/j.jcpa.2017.03.007 · Cited by 71 · see citing works
“Children whose parents have obesity are more likely to develop obesity themselves (Danielzik et al. , 2004), reflecting the conjoint influences of genetic and environmental factors (Frayling et al. , 2007).”
First lessons from the Kiel Obesity Prevention Study (KOPS)
Danielzik, S., Pust, S., Landsberg, B., & Müller, M. J. (2005) · International Journal of Obesity · doi:10.1038/sj.ijo.0803099 · Cited by 70 · see citing works
Self-citationDrake, A. J., O’Shaughnessy, P. J., Bhattacharya, S., Monteiro, A., Kerrigan, D., Goetz, S., Raab, A., Rhind, S. M., Sinclair, K. D., Meharg, A. A., et al. (2015) · BMC Medicine · doi:10.1186/s12916-014-0251-x · Cited by 70 · see citing works
“Furthermore, since exposure to maternal smoking during pregnancy has sex-specific effects on fetal growth [19,20], the expression of steroidogenic and metabolic genes in fetal liver [21,22] and on the later risk of being overweight/obese [23], we postulated that any effects would be sex-specific.”
BackgroundKnight, B., Shields, B. M., Hill, A., Powell, R. J., Wright, D. E., & Hattersley, A. T. (2007) · Diabetes Care · doi:10.2337/dc06-1849 · Cited by 69 · see citing works
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“Other authors corroborate this result, although using other markers; for example, education level as a proxy for socioeconomic status, with children from families with lower education levels having a higher risk of childhood obesity (Danielzik et al. 2004; Lamerz et al. 2005; Romon et al. 2005), although this effect c…”
ResultCoen, V. D., Vansteelandt, S., Maes, L., Huybrechts, I., Bourdeaudhuij, I. D., & Vereecken, C. A. (2012) · Appetite · doi:10.1016/j.appet.2012.03.024 · Cited by 69 · see citing works
Blomquist, H. K. S., & Bergström, E. (2006) · Acta Paediatrica · doi:10.1111/j.1651-2227.2006.00018.x · Cited by 69 · see citing works
“The risk of childhood overweight tracking into adult obesity increases with the degree of obesity, the age of the child, and parental obesity (3,4).”
BackgroundCairney, J., & Veldhuizen, S. (2017) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2017.04.005 · Cited by 69 · see citing works
“Existing work supports important roles for parent overweight status, family socioeconomic status, and birth weight (Danielzik et al., 2004), as well as nutrition”
BackgroundNoce, A., Tarantino, A., Claudette, T. D., Vasili, E., LORENZO, A. D., & Nicola, D. D. (2014) · Mediators of Inflammation · doi:10.1155/2014/901308 · Cited by 68 · see citing works
Obesity and the risk for mental disorders in a representative German adult sample
Hach, I., Ruhl, U. E., Klose, M., Klotsche, J., Kirch, W., & Jacobi, F. (2006) · European Journal of Public Health · doi:10.1093/eurpub/ckl227 · Cited by 68 · see citing works
Leiva, A., Pardo, F., Ramírez, M. A., Farías, M., Casanello, P. C., & Sobrevía, L. (2011) · Experimental Diabetes Research · doi:10.1155/2011/349286 · Cited by 67 · see citing works
“Thus, prevention of childhood and adult obesity may require beginning even before conception [145–147].”
BackgroundTaking the long view: The prenatal environment and early adolescent overweight
Salsberry, P. J., & Reagan, P. B. (2007) · Research in Nursing & Health · doi:10.1002/nur.20215 · Cited by 66 · see citing works
Rosas, L. G., Guendelman, S., Harley, K. G., Fernald, L. C. H., Neufeld, L. M., Mejía‐Rodríguez, F., & Eskenazi, B. (2010) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-010-9332-x · Cited by 66 · see citing works
“Maternal weight status was a strong correlate of child weight status in both the Mexican-American and Mexican children sampled, which has also been shown in other studies [73, 74].”
ResultDanielzik, S., Pust, S., & Müller, M. J. (2007) · Acta Paediatrica · doi:10.1111/j.1651-2227.2007.00165.x · Cited by 66 · see citing works
“ORs were adjusted for age, baseline BMI, TSF or WC of children as well as SES and weight status of mothers because these variables were found to be the major determinants of childhood overweight (11).”
MethodSelf-citationXi, B., Wang, C., Wu, L., Zhang, M., Shen, Y., Zhao, X., Wang, X., & Mi, J. (2011) · American Journal of Epidemiology · doi:10.1093/aje/kwr008 · Cited by 66 · see citing works
Iguacel, I., Gasch‐Gallén, À., Ayala‐Marín, A. M., Miguel‐Etayo, P. D., & Moreno, L. A. (2020) · International Journal of Obesity · doi:10.1038/s41366-020-00697-y · Cited by 67 · see citing works
Determinants of overweight with concurrent stunting among Ghanaian children
Atsu, B. K., Guure, C. B., & Laar, A. K. (2017) · BMC Pediatrics · doi:10.1186/s12887-017-0928-3 · Cited by 65 · see citing works
“Determinants of overweight as reviewed from literature include; parental overweight [32, 33]; a male child with a young overweight mother [23]; age and household composition [34] occupation of the mother and mother’s BMI [35]; socioeconomic class and ethnic variables [36] family size and income [37, 38].”
BackgroundDeterminants of the prevalence and incidence of overweight in children and adolescents
Plachta‐Danielzik, S., Landsberg, B., Johannsen, M., Lange, D., & Müller, M. J. (2010) · Public Health Nutrition · doi:10.1017/s1368980010000583 · Cited by 64 · see citing works
“in 5- to 7-year-old children, different determinants were observed between overweight and obesity((37)).”
BackgroundSelf-citationBosy‐Westphal, A., Onur, S., Geisler, C., Wolf, A., Korth, O., Pfeuffer, M., Schrezenmeir, J., Krawczak, M., & Müller, M. J. (2006) · International Journal of Obesity · doi:10.1038/sj.ijo.0803481 · Cited by 63 · see citing works
Self-citationPrevention of overweight in preschool children: results of kindergarten-based interventions
Jouret, B., Ahluwalia, N., Dupuy, M., Cristini, C., Nègre‐Pagès, L., Grandjean, H., & Tauber, M. (2009) · International Journal of Obesity · doi:10.1038/ijo.2009.166 · Cited by 62 · see citing works
Seasonal Variation in Physical Activity Among Preschool Children in a Northern Canadian City
Carson, V., Spence, J. C., Cutumisu, N., Boulé, N. G., & Edwards, J. (2010) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2010.10599699 · Cited by 62 · see citing works
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Kassotis, C. D., & Stapleton, H. M. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00039 · Cited by 59 · see citing works
“UOG development has also been associated with increased prevalence of low birth weight and small for gestational age births in the Northeast US (38), and decreased prevalence of low birth weights and increased risk of higher birth weight babies in Colorado (39); both low (40, 41) and high (42, 43) birth weights are as…”
BackgroundEffects of paternal overnutrition and interventions on future generations
Billah, M. M., Khatiwada, S., Morris, M. J., & Maloney, C. (2022) · International Journal of Obesity · doi:10.1038/s41366-021-01042-7 · Cited by 58 · see citing works
Risk factors for excess body fatness in New Zealand children.
Duncan, S., Schofield, G., Duncan, E., & Rush, E. (2008) · PubMed · Cited by 55 · see citing works
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Self-citationArmoon, B., & Karimy, M. (2019) · BMC Pediatrics · doi:10.1186/s12887-019-1540-5 · Cited by 52 · see citing works
Yan, J. (2015) · Economics & Human Biology · doi:10.1016/j.ehb.2015.03.002 · Cited by 52 · see citing works
“HBW babies are at a greater risk for overweight, obesity, diabetes, cancer, and other disorders later in life (Hjalgrim et al., 2003; Danielzik et al., 2004; Harder et al., 2007; Wei et al., 2007; Mandl et al., 2009).”
Bosy‐Westphal, A., Danielzik, S., Becker, C., Geisler, C., Onur, S., Korth, O., Bührens, F., & Müller, M. J. (2005) · Journal of Nutrition · doi:10.1093/jn/135.9.2257 · Cited by 51 · see citing works
Self-citationFamily-based factors associated with overweight and obesity among Pakistani primary school children
Mushtaq, M. U., Gull, S., Shahid, U., Shafique, M. M., Abdullah, H. M., Shad, M. A., & Siddiqui, A. M. (2011) · BMC Pediatrics · doi:10.1186/1471-2431-11-114 · Cited by 50 · see citing works
“Childhood obesity has been associated with higher socioeconomic class in the developing countries [24-27,42,44]; however, studies in the developed world have shown inverse association of socioeconomic class with childhood obesity [15,28-31,45-47].”
BackgroundDeterminants of weight gain in children from 7 to 10years
Valerio, G., D’Amico, O., Adinolfi, M., Munciguerra, A., D'Amico, R., & Franzese, A. (2006) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2005.10.008 · Cited by 50 · see citing works
Chen, J., & Wu, Y. (2008) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2007.03.002 · Cited by 49 · see citing works
- Authors
- Danielzik, S., Czerwinski-Mast, M., Langnäse, K., Dilba, B., & Müller, M. J.
- Affiliations
- Christian-Albrechts-Universität zu Kiel (DE)
- Corresponding author
- Müller, M J
- Venue
- International Journal of Obesity
- Published
- 2004-08-24
- Volume
- 28
- Issue
- 11
- Pages
- 1494-1502
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- OpenAlex
- W1974550323
- Cited by
- 396
- References
- 49
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 16 · 2020: 14 · 2019: 19 · 2018: 13 · 2017: 13 · 2016: 27 · 2015: 22 · 2014: 23 · 2013: 28 · 2012: 33
- FWCI
- 22.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Danone
- Deutsche Forschungsgemeinschaft
- World Cancer Research Fund
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- childhood obesity, childhood overweight, parental overweight, socioeconomic status, birth weight, prepubertal children, risk factors, parental smoking, single-person households, physical activity, sex differences
- MeSH terms
- Analysis of Variance, Birth Weight, Child, Child, Preschool, Cross-Sectional Studies, Family Health, Female, Germany, Humans, Male, Nutritional Status, Obesity, Parents, Risk Factors, Social Class, Logistic Models
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