The relationship of caregiver and household factors to weight status of American Indian preschool children

Obesity affects American Indian (AI) adults and children in higher proportions than any other group in the United States. Environmental factors appear to be the main determinant, however no study to date has explored how these factors are associated with obesity in Apache preschool children. The objective of this cross-sectional study was to examine the relationship of caregiver and household factors to weight status of Apache preschool children and their female caregivers living on the White Mountain Apache reservation in Eastern Arizona.; A total of 154 women and 154 children were included in this study. Anthropometric measurements of height (cm), weight (kg), subscapular (mm) and triceps (mm) were conducted with children and caregivers. The Child Feeding Questionnaire (CFQ) was used to evaluate the caregivers' child-feeding practices. A qualitative food frequency questionnaire was used to assess dietary patterns of the children. Demographic and socio-economic information were collected from an interviewer-administered questionnaire with caregivers. The Radimer/Cornell measure was used to assess the prevalence and severity of food insecurity.; Over 23% of Apache preschool-aged children were overweight (BMI ≥ 95th), and over 25% were at risk of overweight (BMI 85 th–95th). Apache children were significantly heavier their age- and gender matched reference (BMI z-score +1.0 ± 09; p < 0.001). Sixty-seven percent of Apache women were obese (BMI ≥ 30) and 24% were overweight (BMI 25–30). Children were nearly 4 times more likely to be overweight if their caregiver was obese (OR = 3.95; 95% CI, 1.6–10.1).; Over 79% of the study participants experienced food insecurity; 35% were household food insecure, 16% were adult food insecure and 28% of children in Apache households experienced hunger. Food insecurity was not associated with BMI of preschool children or their female caregivers. Specific variables associated with hunger and food insecurity in multivariate analyses were: less household income, less education of caregiver, younger age of caregiver and food stamp participation.; Multivariate models were used to examine significant predictors of controlling feeding practices. Food insecurity was a significant predictor of pressuring children to eat more food and restricting children from consuming high fat foods in this sample. There was a significant inverse relationship between pressure to eat and the following variables: perception of a child's weight, caregiver's education, and caregiver's age. Concern about a child becoming overweight was positively associated with restricting a child from consuming high fat foods. Multiple regression analysis showed even after controlling for household and caregiver characteristics, BMI of caregiver, child's birth weight, and frequency of consumption of foods, pressure to eat and restriction were significantly associated with BMI of Apache preschool age children.; Future research is needed to examine the relationship of food insecurity and child feeding practices to weight status of AI children. Efforts to prevent overweight in American Indian children need to begin before preschool and should focus on modifiable factors at the household level.