Adiposity among children in Norway by urbanity and maternal education: a nationally representative study

Abstract

Background: International research has demonstrated that rural residency is a risk factor for childhood adiposity. The main aim of this study was to investigate the urban-rural gradient in overweight and obesity and whether the association differed by maternal education.

Methods: Height, weight and waist circumference (WC) were measured in a nationally representative sample of 3166 Norwegian eight-year-olds in 2010. Anthropometric measures were stratified by area of residence (urbanity) and maternal education. Risk estimates for overweight (including obesity) and waist-to-height ratio ≥0.5 were calculated by log-binomial regression.

Results: Mean BMI and WC and risk estimates of overweight (including obesity) and waist-to-height ratio ≥0.5 were associated with both urbanity and maternal education. These associations were robust after mutual adjustment for each other. Furthermore, there was an indication of interaction between urbanity and maternal education, as trends of mean BMI and WC increased from urban to rural residence among children of low-educated mothers (p = 0.01 for both BMI and WC), whereas corresponding trends for children from higher educational background were non-significant (p > 0.30). However, formal tests of the interaction term urbanity by maternal education were non-significant (p-value for interaction was 0.29 for BMI and 0.31 for WC).

Conclusions: In this nationally representative study, children living rurally and children of low-educated mothers had higher mean BMI and waist circumference than children living in more urban areas and children of higher educated mothers.

Figure 1

Relative risk (RR) and 95% CI of overweight (including obesity) (IOTF) and WHtR ≥ 0.5 (waist-to-height ratio ≥ 0.5) by area of residence, adjusted for gender. P-values for differences between categories; * p < 0.05, ** p < 0.01.

Figure 2

Relative risk (RR) and 95% CI of overweight (including obesity) (IOTF) and WHtR ≥ 0.5 (waist-to-height ratio ≥ 0.5) by maternal education level, adjusted for gender. P-values for differences between categories; * p < 0.05, ** p < 0.01.

Figure 3

Mean BMI (kg/m²) per maternal education level (tertiary, secondary and primary) by area of residence, adjusted for gender. P-values for trend within each educational group.

Figure 4

Mean waist circumference (cm) per maternal education level (tertiary, secondary and primary) by area of residence, adjusted for gender. P-values for trend within each educational group.