Master's Project Title:

Predictors of Obesity and Severe Obesity at Four Years: An Analysis of Minnesota Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

MCH Student:

Christine Elizabeth Papai

Date of Defense:

February 19, 2014


Objective: The aim of this study was to identify  risk factors for obesity and severe  obesity at age 4 identifiable during the first  3 years of life and investigate variations by  race and ethnicity.

Methods: Analysis of records for 42,791 low- income children born between 2005 and  2008 who were enrolled in the Minnesota  Special Supplemental Nutrition Program for  Women, Infants, and Children. The outcome measures were obesity  and severe obesity,  defined as BMI-for-age at or above the 95t hand 97.5th percentile, respectively, at age 48- 59 months. Multivariate logistic regression was  used to model the effects of various risk  factors on both outcomes.

Results: Multivariate analyses found high birth weight ( ≥ 4000g) and breastfeeding  duration to be the strongest  significant predictors. High birth weight was strongest for  American Indian Non-Hispanics (NH) (odds  ratio (OR), 2.0; 95% confidence interval  (CI), 1.6-2.5 for obesity and OR, 2.2; CI, 1.7- 2.9 for severe obesity) and Asian NH (OR,  2.2; CI, 1.5-3.2 and OR, 2.2; CI, 1.5-3.3). A dos e-response relationship between longer  breastfeeding duration a nd reduced odds of obesity and severe obesity was seen in some  groups. Breastfeeding duration beyond 26 week s was most protective for White NH (OR,  0.5; CI, 0.5-0.6 and OR, 0.5; CI, 0.4-0.5) and  American Indian NH (OR, 0.6; CI, 0.5-0.7  and OR, 0.6; CI, 0.4-0.8), marginally protective  for Hispanics, and in significant for Black  NH.

Conclusions: Interventions focused on reducing  high birth weight and increasing  breastfeeding duration may decrease obesity in 4-year-olds an d reduce racial disparities.