Low income associated with increased BMI and chronic stress

1. In a prospective cohort study, low income was associated with increased body mass index (BMI) and cortisol levels over time.

2. There was no correlation between increased cortisol and BMI, suggesting an independent relationship between low income and BMI that is not influenced by cortisol levels.

Level of evidence assessment: 2 (Good)

Summary of the study: Childhood obesity is a significant public health challenge with broad long-term health implications. It is well documented that socioeconomic factors such as poverty and household income contribute to the risk of childhood obesity. This study explored the relationship between income and chronic stress as measured by hypothalamic-pituitary-adrenal (HPA) axis activation and cortisol production. Children 2 to 4 years old were prospectively enrolled and followed for 36 months with measurements of body mass index (BMI), household income, and cortisol levels in hair samples. Among children from very low-income households (e BMI percentile; BMIp95) during the follow-up period and higher capillary cortisol accumulations. However, cortisol levels were not correlated with BMI. This study suggests that low-income children have higher BMI and more chronic stress (measured by capillary cortisol), but these processes may be independent of each other. Shortcomings of this study include a short follow-up period of 36 months and narrow inclusion criteria (age 2-4 years), limiting both its generalizability across age groups and its ability to track changes at adolescence. Future studies are needed to assess the relationship between obesity, chronic stress, and income to address modifiable risk factors (such as income and poverty) on long-term health.

Click here to read the article in the Journal of Pediatrics

Relevant reading: Association between household poverty dynamics and childhood overweight risk and health behaviors in the United States: an 8-year nationally representative longitudinal study of 16,800 children.

In depth [prospective cohort]: This prospective study collected data from 2012 to 2017 as part of the Childhood Obesity Prevention and Treatment (COPTR) consortium and the NET-Works group. Children 2-4 years old (N=534) were recruited from pediatric primary care clinics in Minneapolis, Minnesota. At the 36-month follow-up visit, 92% of participants were retained. Participants whose household income was less than $25,000 were defined as the very low income group, with a reference group whose income was between $25,000 and $65,000. BMI measurements were based on the 95e BMI percentile and cortisol measurements were taken from hair samples to quantify a cumulative effect of the HPA axis. The rate of change in BMIp95 was significantly higher (p

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