Hongai Li,1,* Wei Xiang,1,2,* Yajun Yi,3 Xiaoyan Huang,1 Hailing Luo,1 Yuhua Cai,1 Li Liu,1 Haidan Li,1 Yan Huang,1 Qing Luo,1 Lichun Fan,1 Qiuyu Lin1 

1Department of Pediatrics, Hainan Women and Children’s Medical Center (Children’s Hospital Affiliated to Hainan Medical University), Haikou, 570206, People’s Republic of China; 2National Health Commission (NHC) Key Laboratory of Control of Tropical Diseases, Hainan Medical University, Haikou, 571199, People’s Republic of China; 3Department of Medicine, Vanderbilt University Medical School, Nashville, TN, 37212, USA

*These authors contributed equally to this work

Correspondence: Qiuyu Lin, Department of Pediatrics, Hainan Women and Children’s Medical Center (Children’s Hospital Affiliated to Hainan Medical University), Haikou, People’s Republic of China, Tel +8615595779936, Fax +86089836689190, Email 45024711@qq.com Lichun Fan, Department of Pediatrics, Hainan Women and Children’s Medical Center (Children’s Hospital Affiliated to Hainan Medical University), Haikou, People’s Republic of China, Tel +8618689852199, Email 285562830@qq.com

Objective: To evaluate the epidemiological landscape and identify the risk factors associated with overweight and obesity in early childhood in China.
Methods: We collected measurements of weight and height and calculated the body mass index (BMI) for preschool children. The overweight and obesity status of children aged 2 to 6 years was examined using the 2005 China BMI growth chart. WHO weight-for-length (WFL) charts were used to identify those at risk for early childhood overweight. Data on potential risk factors for childhood overweight/obesity were obtained through questionnaires. Multiple logistic regression analyses were conducted to determine the association between risk factors and overweight/obesity.
Results: Among the 13,896 participants, 7.5% of infants and toddlers were overweight, 18.4% of preschoolers were overweight, and 10.3% of preschoolers were obese. The prevalence of obesity among preschool boys (12.6%) was significantly greater than that among preschool girls (7.7%, p< 0.001). Our analysis identified nine risk factors significantly associated with an increased risk of early childhood overweight or obesity. These include guardian status, paternal height, frequency of weekly candy consumption, maternal weight, leg circumference, waist circumference, age at the onset of overweight, age group, and maternal education level. In addition, children born to overweight mothers had a 1.02-fold higher likelihood of being overweight/obese compared to children with mothers of normal weight (95% confidence interval: 1.00– 1.03; p=0.0106). Upon adjustment for all potentially confounding variables, the odds ratios for the frequency of weekly candy consumption in children were negatively linked to overweight/obesity (0.98; 95% confidence interval: 0.96– 1.00). In addition, gender-dietary habit interactions significantly influenced the risk of overweight/obesity in both positive and negative directions.
Conclusion: Our research on the prevalence and predictors of overweight/obesity in preschool children underscores the importance of recognizing and understanding early childhood obesity within its context. Obesity prevention efforts should target key risk factors, such as parental obesity and unhealthy early childhood lifestyles.

Keywords: epidemiology, obesity, preschool children, infant, toddler