Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study.

Objective: To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children. Design: Regional cohort study. Setting: Oppland County, Norway. Methods: At the routine school entry health assessment at 5-6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child's neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate. Participants: We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined. Main outcome measures: SDQ subscale and Total Difficulties Scores. Results: The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis. Conclusions: The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.

A family-oriented intervention programme to curtail obesity from five years of age had no effect over no intervention.

AIM: To examine the effect of a family-oriented multidisciplinary intervention programme to curtail weight increase in young children with obesity. METHODS: Children who weighed more than one kilogram above the 97th percentile for height at the preschool assessment in Oppland County, Norway, were identified. Parents residing in one part of the county were invited to participate in a group-based three-year intervention programme while the rest had no interventions. Body mass index (BMI) and family characteristics at entry and measurements at birth were explanatory variables, and change in BMI standard deviation score (SDS) the outcome measure. For the intervention group, outcome was also related to skinfold thicknesses, waist-to-height ratio and physical ability. RESULTS: The programme was completed by 31 families in the intervention and 33 in the control group. At entry, the respective median (interquartile) age was 5.83 (0.36) and 5.74 (0.66) years, and the BMI SDS 2.35 (1.06) and 1.95 (0.49), P = .012. The median decrease in BMI SDS was 0.19 in both groups. The decline increased with increasing BMI SDS at entry, but irrespective of group. Social or behavioural factor or other anthropometric measures were not associated with outcome. CONCLUSION: The intervention programme had no effect on BMI SDS.

Social and somatic determinants of underweight, overweight and obesity at 5 years of age: a Norwegian regional cohort study.

OBJECTIVE: To identify associations between the weight groups underweight (UW), overweight (OW) and obesity (OB) at 5 years of age and exposures related to pregnancy, anthropometric measures at birth, sociodemographic factors, and family health, anthropometric measures and habits. DESIGN: Regional cohort study. SETTING: Oppland County, Norway. METHODS: Pregnancy data were obtained from a prospective perinatal register for children born in the county, and weight and height were measured by midwives at birth and by public health nurses at 5 years. Other information was obtained from questionnaires completed by parents. PARTICIPANTS: Of 1895 eligible children, current weight and height were obtained for all, weight and length at birth and information from parents for 1119 (59%) and pregnancy register data for 749 (40%) of the children. The significance of potential explanatory variables from descriptive statistics was tested in multinomial logistic regression analysis. RESULTS: The prevalence of UW, OW and OB among participants was 7.8%, 10.6% and 3.5%, respectively. UW was associated with anthropometric measures at birth and those of parents, but not with sociodemographic or behavioural characteristics. OW and OB were associated with anthropometric measures of parents and siblings and with a variety of unfavourable social characteristics, lack of prolonged breast feeding, sedentary behaviour and dental caries, but not with current dietary habits. After adjustments, OW and OB were marginally related to birth parameters and diet and unrelated to physical activity, but significantly related to parental body mass index, low parental education and maternal smoking. CONCLUSION: The strong associations between sociodemographic and behavioural factors and OW and OB, but not with UW, may suggest that environmental factors are major contributing causes of OW and particularly OB at 5 years. These results may be helpful in targeting preventive measures against OW and OB.

Mental health at 5 years among children born extremely preterm: a national population-based study.

The objective of this study was to compare mental health at 5 years in children born extremely preterm with a reference group, and assess associations between functional abilities and mental health within the preterm group. In a national Norwegian cohort with gestational age 22-27 weeks or birthweight 500-999 g, mental health was assessed with the Strengths and Difficulties Questionnaire (SDQ), cognitive function with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), motor function with the Movement Assessment Battery for children (ABC-test) and severity of cerebral palsy (CP) with the Gross Motor Function Classification for CP (GMFCS). Neurodevelopmental disabilities (NDD) were described as mild and moderate/severe. SDQ of the preterm children was compared with that of an unselected reference group. SDQ sub-scores ≥90th percentile of the reference group were defined as a mental health problem and a Total Difficulties Score ≥90th percentile (TDS90) as suggestive of psychiatric disorder. Of 361 eligible preterm children, parents completed SDQ for 255 (71%). 97 (38%) had TDS90 compared to 116 (11%) of the reference group (OR 5.1; 95% CI 3.7-7.1). For the preterms, the rate of TDS90 was higher for those with moderate/severe NDD (27/37 vs. 27/116, adjusted OR 8.0; 95% CI 3.2-19, and mild NDD 43/102 [adjusted OR 2.2 (1.2-4.1)]. For preterms with no NDD, TDS90 was more common than for the reference group (27/116 vs. 116/1,089, OR 2.5; 95% CI 1.6-4.1). Extreme prematurity was associated with increased risk of later mental health problems, particularly if they had other functional impairments.