Impact of lifestyle behaviors in early childhood on obesity and cardiometabolic risk in children: Results from the Spanish INMA birth cohort study

Background Identifying modifiable lifestyle behaviors linked to childhood obesity is necessary to develop preventive strategies. Objective To estimate the association of five lifestyle behaviors in children aged 4 years on obesity and cardiometabolic risk factors at age 4 years and on obesity and blood pressure at age 7 years. Methods We used child lifestyle data from the INMA project at age 4 years (n = 1480). We constructed a child lifestyle score by summing five behaviors (physical activity, sleep time, television time, plant based foods and intake of ultra-processed foods) and we categorized it into tertiles. At ages 4 and 7 years, we calculated age- and sex-specific z-scores for BMI, waist circumference (WC), and blood pressure. At age 4, we also calculated age-, and sex-, specific z-scores for triglycerides and HDL. We used linear and logistic regression analyses. Results The lifestyle score was not associated with the outcomes at 4 years, but it was negatively associated with BMI and WC z-scores at age 7 years. Children at age 4 years in the highest tertile of the score had lower risk of overweight or obesity at age 7 years (OR = 0.61; 95% CI 0.39; 0.96) and abdominal obesity (OR = 0.48; 95% CI 0.24; 0.96). Conclusions Higher adherence to a healthy lifestyle at age 4 years decreased risk of overweight, obesity and abdominal obesity at 7 years.