BACKGROUND: Comparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood. METHODS: Prospective data of 45 413 children from 11 European cohorts were used. Children's height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts. RESULTS: Low maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts. CONCLUSIONS: Considerable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote children's immediate health and well-being and throughout the life course.

1st Department of Paediatrics Aghia Sophia Children's Hospital University of Athens Athens Greece

Biocenter Oulu University of Oulu Oulu Finland

BIODONOSTIA Health Research Institute San Sebastian Spain

Center for Global Health University of Illinois College of Medicine Chicago IL USA

Center for Research in Environmental Epidemiology Barcelona Spain

Department of Clinical Epidemiology Predictive Medicine and Public Health University of Porto Medical School Porto Portugal

Department of Epidemiology and Biostatistics MRC Health Protection Agency Centre for Environment and Health School of Public Health Imperial College London London UK

Department of Epidemiology and Health Promotion Public Health Service of Amsterdam Amsterdam The Netherlands

Department of Epidemiology Lazio Regional Health System Rome Italy

Department of Medicine and Health Community Medicine General Practice Faculty of Health Sciences Linköping University Linköping Sweden

Department of Public Health Academic Medical Center University of Amsterdam Amsterdam The Netherlands

Division of Pediatrics Department of Clinical and Experimental Medicine Linköping University Linköping Sweden

EPIUnit Institute of Public Health University of Porto Porto Portugal

Faculty of Medicine Center for Life Course Epidemiology University of Oulu Oulu Finland

Faculty of Science Research Centre of Toxic Compounds in the Environment Masaryk University Brno Czech Republic

FISABIO Universitat Jaume 1 Universitat de València Joint Research Unit of Epidemiology and Environmental Health Castellón de la Plana Spain

IB Salut Menorca Health Area Balearic Islands Spain

Institut National de la Santé et de la Recherche Médicale Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris Descartes University Paris France

Institut National de la Santé et de la Recherche Médicale Center for Epidemiology and Statistics Sorbonne Paris Cité Paris Descartes University Paris France

Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic

Institute of Health Sciences University of Oulu Oulu Finland

Institute of Pediatrics Obstetrics and Gynecology Kyiv Ukraine

Public Health Department of Gipuzkoa Gipuzkoa Spain

Research Department of Epidemiology and Public Health UCL Institute of Health Equity University College London London UK

Research Department of Epidemiology and Public Health University College London London UK

Spanish Consortium for Research on Epidemiology and Public Health Barcelona Spain

Unit of Primary Care Oulu University Hospital Oulu Finland

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