Abstract
Early childhood obesity continues to be a clinical and public health challenge in the United States; almost a third of children ages 2-to-5 years old are either overweight or obese. Non-Hispanic Blacks (NHB) have double and Hispanics have triple the rates of obesity by age 5 compared to non-Hispanic Whites (NHW) and Asians (10.4%, 15.6%, 5.2%, and 5.0%, respectively). Current evidence suggests that pregnancy, infancy, and early childhood are critical periods in the development of overweight/obesity throughout the lifespan. However, the majority of studies included non-Hispanic White, high-income study samples, presenting serious doubts as to the generalizability of their conclusions. To better understand how early life factors impact the onset of childhood obesity by age 2, this study utilized data from the UHealth Electronic Medical Records (EMR) database. First, multivariate linear regression models were conducted on a series of prenatal and perinatal risk and protective variables and the outcome of zBMI at age 2 years. Next, race/ethnicity was analyzed as a moderator of the relationship between each of those risk/protective variables and zBMI at age 2 years. Finally, age- and sex-specific BMI percentiles were dichotomized into overweight versus lean and a series of data mining techniques were conducted to investigate predictors including 10-fold cross validation of logistic regression, Classification and Regression Trees (CART) methodology, and naïve Bayes estimation. Obesity complicating pregnancy and Medicaid use were consistent risk factors, and breastfeeding initiation was a consistent protective factor. Results from this dissertation inform clinical decision support recommendations as well as the development of obesity prevention interventions targeting pregnancy, prenatal, and early childhood developmental periods.