Risk Factors for Obesity At Age 3 in Alaskan Children, Including the Role of Beverage Consumption: Results from Alaska PRAMS 2005- 2006 and its Three-Year Follow-up Survey, CUBS, 2008-2009

Background: Prenatal and early life risk factors are associated with childhood obesity in the preschool years. American Indian/Alaska Native children have one of the highest prevalences of childhood obesity of all US racial/ethnic groups. Methods: Using the Pregnancy Risk Assessment Monitoring System (PRAMS) and its 3-year follow-up ,the Childhood Understanding Behaviors Survey (CUBS), we evaluated health, behavioral, lifestyle and nutritional variables during the pre-pregnancy, prenatal, and postpartum periods and first few years of life in relation to risk for obesity (95^th percentile for body mass index (BMI)) at 3 years of age among Alaska Native and non-Native children. Multivariate logistic regression modeling was conducted using Stata 12.0 to evaluate independent risk factors for obesity in non-Native and Alaska Native children. Results: Longer duration of breastfeeding was independently protective against obesity at age 3(OR 0.95, 95%CI 0.92-0.99) in non-Native children. Among Alaska Native children, increased paternal education was protective, (OR 0.42, 95%CI 0.19-0.95) as was increasing income/dependent ratio. Alaska Native race interacted with maternal use of chew/spit tobacco during pregnancy, whether the mother was trying to get pregnant and consumption of fried potatoes in relation to child obesity at age 3. Among Alaska Native children, residents of the Northern/Southwest region had an increased daily consumption of beverages including water, milk, 100% fruit juice, soda and sweetened/fruit drinks compared to residents of other regions. Conclusions: Risk factors for obesity at age 3 differed for Alaska Native and non-Native children. Among both populations, pre-pregnancy and prenatal factors appeared to have less of an association with obesity at age 3 than current lifestyle. The higher prevalence of obesity in Alaska Native children may be explained by lifestyle patterns and food consumption in certain parts of the state, specifically the Northern/Southwest region.