The effect of environmental factors in childcare facilities and individual lifestyle on obesity among Japanese preschool children; a multivariate multilevel analysis

Lifestyle in preschool children is associated with the onset of childhood obesity. However, the effect of environmental factors in childcare facilities on lifestyle and obesity in preschool children is unknown. The aim of this study was to determine the effect of environmental factors in childcare facilities on the association between obesity and individual lifestyle in preschool children. Subjects included 2902 infants, aged 4 to 6 years old in Kitakyushu City, Japan. A stratified multilevel analysis was conducted with 2 strata: factors related to individual lifestyle and maternal factors as the individual level and factors related to the childcare facility as the environmental level. Two-level multilevel regression analysis was conducted with the presence or absence of obesity. The proportion of infants with obesity was 4.2%. The childhood obesity was significantly associated with the mastication, nutritional methods during infancy, absence of breakfast, presence of skipping meals due to overeating of snacks, usual play activity, screen time on weekdays, maternal body mass index, and maternal weight increase during pregnancy at the individual level. On the other hand, childhood obesity had a significantly negative association with the receiving snacks in facilities by using multilevel analysis. The present study revealed that establishing and maintaining environmental factors in childcare facilities may play important roles in the prevention of obesity from early childhood.