Behavioral factors influencing childhood obesity: a systematic review and meta-analysis

Background: This report provides information on 14 behavioral and nutritional factors that can be addressed in childhood overweight/obesity prevention programs. Methods: Web of Science, PubMed, and Scopus were searched through November 2018. Reference lists were also screened for additional references. Observational studies addressing the associations between overweight/obesity in children/adolescents aged between 5 to 19 years and associated risk factors were analyzed. Between-studies heterogeneity was assessed by chi(2), tau(2), and I( )(2)statistics. The likelihood of publication bias was evaluated using the Begg and Egger tests and trim & fill analysis. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Results: Of 34,537 retrieved studies, 199 including 1,636,049 participants were eligible. The ORs (95% CI) of factors associated with childhood overweight/obesity were as follows: sufficient physical activity 0.70 (0.66, 0.75); eating breakfast every day 0.66 (0.59, 0.74); sufficient consumption of fruits/vegetables 0.92 (0.84,1.01); breastfeeding <4 months 1.24 (1.16,1.33); inadequate sleep 1.26 (1.13,1.40); watching TV >1-2h/day 1.42 (1.35, 1.49); playing computer games >2 h/day 1.08 (0.95, 1.23); eating sweets >= 3 times/week 0.78 (0.71, 0.85); eating snack >= 4 times/week 0.84 (0.71, 1.00); drinking sugar-sweetened beverages >= 4 times/week 1.24 (1.07, 1.43); eating fast-food >= 3 times/week 1.03 (0.89, 1.18); eating fried-food >= 3 times/week 1.09 (0.90, 1.33); smoking 1.17 (1.07, 1.29); and drinking alcohol 1.05 (0.95, 1.16). Conclusions: This meta-analysis provided a clear picture of the behavioral and nutritional factors associated with weight gain in children. (C) 2020 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.