Objective To analyze the factors influencing obesity among preschool children and the relationships between these factors, so as to provide scientific evidence for the prevention and control of early childhood obesity. Methods A case-control study was conducted in Jinan and Weifang, Shandong Province from March to July 2024, involving 94 obese and 91 normal preschool children. Data on obesity risk factors were collected using a 3-day 24-hour dietary recall, questionnaires, and accelerometer monitoring.Chinese Diet Balance Index for Preschool Children(DBI_C)of each food was calculated.Differences between the two groups in terms of birth and early feeding practices, dietary behaviors and intake, physical activity, and sleep patterns were compared. Then a multivariate Logistic regression model was constructed. Interaction effects and mediation models were further analyzed. Results Multivariate analysis revealed that preschool children′s obesity was positively associated with maternal age (OR=1.12, 95%CI: 1.02 - 1.23), maternal overweight/obesity (OR=3.71, 95%CI: 1.62 - 8.49), food responsiveness score (OR=2.59, 95%CI: 1.56 - 4.31), food preference score (OR=1.79, 95%CI: 1.10 - 2.91), DBI_C scores for cereals (OR=1.18, 95%CI: 1.06 - 1.31) and animal foods (OR=1.07, 95%CI: 1.00 - 1.14),while it was negatively associated with emotional eating reduction score (OR=0.56, 95%CI: 0.32 - 0.98). Children′s birth, early feeding history, father′s age, parental education level, physical activity, or sleep was found not to be associated with obesity. There was an interaction between maternal age and weight status, and children′s dietary behaviors on their susceptibility to obesity. In the mediation model, it was found that the DBI_C scores for cereal and animal foods partially mediated the relationship between food responsiveness and obesityas well as food preference and obesity among preschool children. Conclusions Besides maternal factors, poor dietary behaviors and excessive intake of cereal and animal foods are the main modifiable factors contributing to preschool children′s obesity. Maternal factors interacted with poor dietary behaviors, and the excessive intake of cereal and animal foods partially mediates the association between poor dietary behaviors and obesity, which provides scientific evidence for the development of intervention measures for preschool children′s obesity.
Key words
balanced diet index /
obesity /
dietary behavior /
physical activity /
interaction /
mediation effect /
preschool children
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