Higher maternal education is associated with favourable growth of young children in different countries
- Rajalakshmi Lakshman1,2,
- Jing Zhang3,
- Jianduan Zhang3,
- Felix S Koch4,5,6,
- Claude Marcus7,
- Johnny Ludvigsson8,
- Ken K Ong1,9,
- Tanja Sobko7,10
- 1MRC Epidemiology Unit, Addenbrookes Hospital, Cambridge, UK
- 2UKCRC Centre for Diet and Activity Research, Institute of Public Health, University of Cambridge, Cambridge, UK
- 3Department of Woman and Child's Care and Adolescence Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- 4Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- 5Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- 6Department of Psychology, Linköping University, Linköping, Sweden
- 7Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- 8Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- 9Department of Paediatrics, University of Cambridge, Cambridge, UK
- 10Division of Health Improvement, JC School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Correspondence to Dr Tanja Sobko, Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Division of Health Improvement, JC School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong;
- Received 1 October 2012
- Revised 11 January 2013
- Accepted 26 January 2013
- Published Online First 28 February 2013
Background Childhood growth affects long-term health and could contribute to health inequalities that persist throughout life.
Methods We compared growth data of 4-year-old to 6-year-old children born 1997–2002 in UK (n=15 168), Sweden (n=6749) and rural China (n=10 327). SD scores (SDS) were calculated against the WHO Growth Standard. Obesity and overweight were defined by the International Obesity Taskforce cut-offs, and stunting, underweight and thinness by height, weight or body mass index (BMI)<−2 SDS. Associations with maternal education were standardised by calculating the Slope Index of Inequality (SII).
Results Mean SDS height, weight and BMI in the UK (−0.01, 0.42, 0.62, respectively) and Sweden (0.45, 0.59, 0.45) were higher than in China (−0.98, −0.82, −0.29). Higher maternal education was consistently associated with taller offspring height SDS (SII: UK 0.25; Sweden 0.17; China 1.06). Underweight and stunting were less common in the UK (prevalence: 0.6% and 2.2%, respectively) and Sweden (0.3% and 0.6%) than in China (9.5% and 16.4%), where these outcomes were inversely associated with maternal education (SII: −25.8% and −12.7%). Obesity prevalence in the UK, Sweden and China was 4.8%, 3.7% and 0.4%, respectively. Maternal education was inversely associated with offspring obesity in the UK (SII: −3.3%) and Sweden (−2.8%), but not in China (+0.3%).
Conclusions Higher maternal education was associated with more favourable growth in young children: lower obesity and overweight in the UK and Sweden, and lower stunting and underweight in rural China. Public health strategies to optimise growth in early childhood need to acknowledge socioeconomic factors, but possibly with a different emphasis in different settings.