The divergent association of diet intake, parental education, and nutrition policy with childhood overweight and obesity from low- to high-income countries: A meta-analysis.

Background: It is unclear whether the effects of dietary intake, parental education, and nutrition policy on childhood overweight and obesity is consistent between high-income (HICs) and low- and middle-income (LMICs) countries. The objective of this meta-analysis was to investigate the association of diet, parental education and nutrition policy with childhood overweight and obesity when the economic levels were controlled. Methods: PubMed, Web of Science, Embase and Scopus were searched for observational studies published from January 1980 to October 2023 that examined the association of diet, parental education and nutrition policy with childhood overweight and obesity. Meta random effects model stratified by gross national income per capita was used to assess whether the associations were varied by economic levels. Results: From 18 191 identified studies, 154 met the inclusion criteria. Meta-analysis revealed that higher sugar-sweetened beverage intake was a risk factor for childhood overweight and obesity in both HICs and LMICs countries/regions, whereas higher intake of fruit and/or vegetable was a protective factor only in LMICs countries/regions (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.69-0.85). Moreover, lower parental education level increased the risk (OR = 1.46; 95% CI = 1.32-1.61) and nutrition policy implementation decreased the risk (OR = 0.96; 95% CI = 0.91-0.99) of childhood overweight and obesity only in HICs. Conclusions: Fruit and/or vegetable intake, parental education and nutritional policy exert different influences on childhood overweight and obesity in countries with varied economic levels. These findings will enhance the understanding of the complex interplay between these factors and their impact on childhood health.