Socioeconomic differences in childhood BMI trajectories in Belarus

Objective: To examine associations of parental socioeconomic position with early-life offspring body mass index (BMI) trajectories in a middle-income country.
Subjects: 12,385 Belarusian children born 1996-97 and enrolled in a randomized breastfeeding promotion trial at birth, with 3-14 measurements of BMI from birth to 7 years.
Methods: Cohort analysis in which exposures were parental education (common secondary or less; advanced secondary or partial university; completed university) and occupation (manual; non-manual) at birth, and the outcome was BMI z-score trajectories estimated using multilevel linear spline models, controlling for trial arm, location, parental BMI, maternal smoking status and number of older siblings.
Results: Infants born to university-educated mothers were heavier at birth than those born to secondary school-educated mothers [by 0.13 BMI z-score units (95% confidence interval, CI: 0.07, 0.19) for girls and 0.11 (95% CI: 0.05, 0.17) for boys; equivalent for an infant of average birth length to 43g and 38g, respectively]. Between the ages of 3-7 years children of the most educated mothers had larger BMI increases than children of the least educated mothers. At age 7 years, children of university-educated mothers had higher BMIs than those born to secondary school-educated mothers by 0.11 z-score (95% CI: 0.03, 0.19) among girls and 0.18 (95% CI: 0.1, 0.27) among boys, equivalent to differences in BMI for a child of average height of 0.19 and 0.26 kg/m2, respectively. After further controlling for parental BMI, these differences attenuated to 0.08 z-score (95% CI: 0, 0.16) and 0.16 z-score (95% CI: 0.07, 0.24) respectively, but changed very little after additional adjustment for number of older siblings and mother’s smoking status. Associations were similar when based on paternal educational attainment and highest household occupation.
Conclusions: In Belarus, consistent with some middle-income countries, higher socioeconomic position was associated with greater BMI trajectories from age 3 onwards.