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

Michaela D Kucab; Charles D G Keown-Stoneman; Catherine S Birken; Michal Perlman; Jonathon L Maguire; TARGet Kids! Collaboration

doi:10.1038/s41366-023-01316-2

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

Int J Obes (Lond). 2023 Aug;47(8):724-731. doi: 10.1038/s41366-023-01316-2. Epub 2023 Apr 27.

Authors

Michaela D Kucab^{1

2}, Charles D G Keown-Stoneman^{3

4}, Catherine S Birken^{5

6

7

8

9}, Michal Perlman¹⁰, Jonathon L Maguire^{11

12

13

14

15}; TARGet Kids! Collaboration

Affiliations

¹ Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada.
³ Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada.
⁴ Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁵ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁶ Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada.
⁷ Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁹ Department of Nutritional Sciences, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada.
¹⁰ Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada. jonathon.maguire@utoronto.ca.
¹² Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. jonathon.maguire@utoronto.ca.
¹³ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada. jonathon.maguire@utoronto.ca.
¹⁴ Department of Nutritional Sciences, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada. jonathon.maguire@utoronto.ca.
¹⁵ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. jonathon.maguire@utoronto.ca.

PMID: 37106078
DOI: 10.1038/s41366-023-01316-2

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).

Publication types

Clinical Study
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Child
Child Care*
Child, Preschool
Female
Humans
Infant
Male
Overweight
Pediatric Obesity* / epidemiology
Pediatric Obesity* / etiology
Pediatric Obesity* / prevention & control
Prospective Studies

Associated data

ClinicalTrials.gov/NCT01869530

Grants and funding

MOP-333560/CIHR/Canada