{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:32:04Z","timestamp":1777487524706,"version":"3.51.4"},"reference-count":59,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>This study aimed to identify the risk factors for obesity in five-year-old children using data from the database of the Korean National Health Insurance Service. We identified 26,047 children who underwent the sixth screening (at age 5) from the 2017 National Health Screening Program for Infant and Children and for whom data from the fourth screening (at age 3) database and the mothers\u2019 health screening and eligibility database were available. To identify the risk factors of obesity, odds ratios and 95% confidence intervals were calculated by a hierarchical multiple logistic regression. Female sex, a birth weight of over 4 kg, the \u201ccaution\/refer\u201d remark during developmental screening at ages three and five, maternal obesity, and a middle-level income were risk factors for obesity in the subjects. Good appetite, high consumption of milk, heavy intake of sweet food at age three, speedy eating, irregular meals and snack times, large single-meal quantities, heavy intake of oily and salty food, and not performing physical exercise at age five were also considered significant risk factors. For early intervention efforts to prevent childhood obesity, modifiable behavioral factors and other obesity risk factors identified in this study could be used to target high-risk children and dietary behaviors.<\/jats:p>","DOI":"10.3390\/children9030314","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T10:00:40Z","timestamp":1645783240000},"page":"314","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk Factors for Obesity in Five-Year-Old Children: Based on Korean National Health Insurance Service (NHIS) Data"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-2733","authenticated-orcid":false,"given":"Mi Jin","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Nursing, Chodang University, Muan-gun 58530, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2129-1658","authenticated-orcid":false,"given":"Hyunju","family":"Kang","sequence":"additional","affiliation":[{"name":"College of Nursing, Kangwon National University, Chuncheon-si 24341, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2834-2718","authenticated-orcid":false,"given":"Jimi","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022, January 04). World Health Statistics 2021: Monitoring Health for the SDGs, Sustainable Development Goals. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/342703."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Freemark, M. (2018). Pediatric Obesity: Etiology, Pathogenesis, and Treatment, Springer Science & Business Media. [2nd ed.].","DOI":"10.1007\/978-3-319-68192-4"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/obr.12334","article-title":"Predicting adult obesity from childhood obesity: A systematic review and meta-analysis","volume":"17","author":"Simmonds","year":"2016","journal-title":"Obes. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3869","DOI":"10.1111\/jocn.13802","article-title":"Overweight or obesity in children aged 0 to 6 and the risk of adult metabolic syndrome: A systematic review and meta-analysis","volume":"26","author":"Jieun","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1056\/NEJMoa072515","article-title":"Childhood body-mass index and the risk of coronary heart disease in adulthood","volume":"357","author":"Baker","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"12","DOI":"10.7570\/jomes20002","article-title":"Secular trends in pediatric overweight and obesity in Korea","volume":"29","author":"Kim","year":"2020","journal-title":"J. Obes. Metab. Syndr."},{"key":"ref_7","unstructured":"National Health Insurance Service (2022, February 07). Report of the Big Data Analysis on Nutrition Behavior of National Health Screening Program for Infants and Children. Available online: https:\/\/www.nhis.or.kr\/nhis\/healthin\/wbhacc05200m01.do?mode=view&articleNo=206900."},{"key":"ref_8","unstructured":"World Health Organization (2022, February 07). Report of the Commission on Ending Childhood Obesity. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/204176\/?sequence=1."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1056\/NEJMoa1803527","article-title":"Acceleration of BMI in early childhood and risk of sustained obesity","volume":"379","author":"Geserick","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_10","first-page":"761","article-title":"Risk factors for childhood obesity in the first 1000 days: A systematic review","volume":"50","author":"Baidal","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1001\/archpediatrics.2011.153","article-title":"Developmental trajectories of body mass index in early childhood and their risk factors: An 8-year longitudinal study","volume":"165","author":"Pryor","year":"2011","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/sj.ejcn.1600896","article-title":"Multivariate analysis of diet among three-year-old children and associations with socio-demographic characteristics","volume":"54","author":"North","year":"2000","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.appet.2011.05.316","article-title":"Development of healthy eating habits early in life. Review of recent evidence and selected guidelines","volume":"57","author":"Schwartz","year":"2011","journal-title":"Appetite"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"229","DOI":"10.2223\/JPED.160","article-title":"Development children\u2019s eating behavior","volume":"76","author":"Ramos","year":"2000","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1038\/ijo.2010.43","article-title":"Parental influence on children\u2019s early eating environments and obesity risk: Implications for prevention","volume":"34","author":"Anzman","year":"2010","journal-title":"Int. J. Obes."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1079\/BJN20051418","article-title":"Consistent dietary patterns identified from childhood to adulthood: The cardiovascular risk in Young Finns Study","volume":"93","author":"Raitakari","year":"2005","journal-title":"Br. J. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/pr.2015.208","article-title":"Biological, environmental, and social influences on childhood obesity","volume":"79","author":"Campbell","year":"2016","journal-title":"Pediatr. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E875","DOI":"10.1503\/cmaj.191707","article-title":"Obesity in adults: A clinical practice guideline","volume":"192","author":"Wharton","year":"2020","journal-title":"Can. Med. Assoc. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/S0140-6736(10)60171-7","article-title":"Childhood obesity","volume":"375","author":"Han","year":"2010","journal-title":"Lancet"},{"key":"ref_20","first-page":"e1435","article-title":"The interplay of genetics and environmental factors in the development of obesity","volume":"9","author":"Sheikh","year":"2017","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s13668-019-0256-3","article-title":"Multi-etiological perspective on child obesity prevention","volume":"8","author":"Baranowski","year":"2019","journal-title":"Curr. Nutr. Rep."},{"key":"ref_22","first-page":"386","article-title":"Pre and post-natal risk and determination of factors for child obesity","volume":"9","author":"Trandafir","year":"2016","journal-title":"J. Med. Life"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1111\/jpc.14195","article-title":"What exposures in early life are risk factors for childhood obesity?","volume":"54","author":"Mihrshahi","year":"2018","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1089\/chi.2012.0150","article-title":"Risk factors for overweight\/obesity in preschool children: An ecological approach","volume":"9","author":"Dev","year":"2013","journal-title":"Child. Obes."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1046\/j.1467-789x.2001.00036.x","article-title":"Childhood overweight: A contextual model and recommendations for future research","volume":"2","author":"Davison","year":"2001","journal-title":"Obes. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1750-8606.2010.00150.x","article-title":"Toward a developmental conceptualization of contributors to overweight and obesity in childhood: The Six-Cs model","volume":"5","author":"Harrison","year":"2011","journal-title":"Child. Dev. Perspect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1017\/S0029665118000411","article-title":"Prevention of overweight and obesity in early life","volume":"77","author":"Lanigan","year":"2018","journal-title":"Proc. Nutr. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1542\/peds.101.S2.539","article-title":"Development of eating behaviors among children and adolescents","volume":"101","author":"Birch","year":"1998","journal-title":"Pediatrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1542\/peds.101.S2.549","article-title":"Development of physical activity behaviors among children and adolescents","volume":"101","author":"Kohl","year":"1998","journal-title":"Pediatrics"},{"key":"ref_30","unstructured":"National Health Insurance Service (2022, February 07). Health Insurance Coverage and Population [Internet], Available online: https:\/\/www.nhis.or.kr\/nhis\/policy\/wbhada01700m01.do."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"146","DOI":"10.4082\/kjfm.20.0062","article-title":"Conducting and reporting a clinical research using Korean healthcare claims database","volume":"41","author":"Kim","year":"2020","journal-title":"Korean J. Fam. Med."},{"key":"ref_32","first-page":"799","article-title":"Data resource profile: The national health information database of the National Health Insurance Service in South Korea","volume":"46","author":"Seong","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"377","DOI":"10.5124\/jkma.2010.53.5.377","article-title":"Review of National Health Screening Program for Infant and Children in Korea","volume":"53","author":"Moon","year":"2010","journal-title":"J. Korean Med. Assoc."},{"key":"ref_34","unstructured":"The Ministry of Health and Welfare (2022, February 07). Notice of Standards for Health Examination (2017-228) [Internet], Available online: http:\/\/www.mohw.go.kr\/upload\/viewer\/skin\/doc.html?fn=1513847622334_20171221181343.hwp&rs=\/upload\/viewer\/result\/202202\/."},{"key":"ref_35","unstructured":"National Health Insurance Service (2022, February 07). Health in Magazine [Internet], Available online: https:\/\/www.nhis.or.kr\/magazin\/mobile\/201408\/sub02_02.html."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"480","DOI":"10.3345\/cep.2020.01284","article-title":"Cohort profile: National investigation of birth cohort in Korea study 2008 (NICKs-2008)","volume":"64","author":"Kim","year":"2021","journal-title":"Clinic. Exp. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3345\/kjp.2008.51.1.1","article-title":"2007 Korean National Growth Charts: Review of developmental process and an outlook","volume":"51","author":"Moon","year":"2008","journal-title":"Korean J. Pediatr."},{"key":"ref_38","unstructured":"Eun, B.L., Chung, H.J., Shin, S.M., Oh, K.J., Kim, Y.A., Kim, C.T., Sung, I.K., Kim, S.S., Kim, J.S., and Yoo, H.J. (2022, February 07). A Study on the Development and Validation of Korean Developmental Screening Test for Infants and Children [Internet], Available online: http:\/\/www.nih.go.kr\/board.es?mid=a40801000000&bid=0050&act=view&list_no=61795."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"490","DOI":"10.5535\/arm.2019.43.4.490","article-title":"Clinical Usefulness of the Korean Developmental Screening Test (K-DST) for Developmental Delays","volume":"43","author":"Jang","year":"2019","journal-title":"Ann. Rehabil. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1111\/j.1467-789X.2011.00867.x","article-title":"Birth weight and subsequent risk of obesity: A systematic review and meta-analysis","volume":"12","author":"Yu","year":"2011","journal-title":"Obes. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1038\/ijosup.2015.23","article-title":"Birth weight and childhood obesity: A 12-country study","volume":"5","author":"Qiao","year":"2015","journal-title":"Int. J. Obes. Suppl."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1111\/j.1471-0528.2006.00989.x","article-title":"The short-and long-term implications of maternal obesity on the mother and her offspring","volume":"113","author":"Catalano","year":"2006","journal-title":"BJOG"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/AOG.0000000000000177","article-title":"Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births","volume":"123","author":"Kim","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.amepre.2015.11.010","article-title":"Interventions for childhood obesity in the first 1000 days a systematic review","volume":"50","author":"Locks","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1136\/bmj.38470.670903.E0","article-title":"Early life risk factors for obesity in childhood: Cohort study","volume":"330","author":"Reilly","year":"2005","journal-title":"BMJ"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1056\/NEJM199709253371301","article-title":"Predicting obesity in young adulthood from childhood and parental obesity","volume":"337","author":"Whitaker","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.2047-6310.2012.00100.x","article-title":"Stronger influence of maternal than paternal obesity on infant and early childhood body mass index: The Fels Longitudinal Study","volume":"8","author":"Linabery","year":"2013","journal-title":"Pediatr. Obes."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.physbeh.2007.11.016","article-title":"Child and adolescent obesity: Epidemiology and developmental perspectives","volume":"94","author":"Adair","year":"2008","journal-title":"Physiol. Behav."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s10995-006-0141-8","article-title":"Prenatal programming of childhood overweight and obesity","volume":"11","author":"Huang","year":"2007","journal-title":"Matern. Child. Health J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.2337\/db11-0400","article-title":"Maternal environment and the transgenerational cycle of obesity and diabetes","volume":"60","author":"Dabelea","year":"2011","journal-title":"Diabetes"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1017\/S1368980011002059","article-title":"Measures of the home environment related to childhood obesity: A systematic review","volume":"15","author":"Pinard","year":"2012","journal-title":"Public Health Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1001\/archpediatrics.2010.19","article-title":"Examination of shared risk and protective factors for overweight and disordered eating among adolescents","volume":"164","author":"Haines","year":"2010","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1748-720X.2007.00112.x","article-title":"Are dietary intakes and eating behaviors related to childhood obesity? A comprehensive review of the evidence","volume":"35","author":"Newby","year":"2007","journal-title":"J. Law Med. Ethics"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"28368","DOI":"10.1038\/srep28368","article-title":"Meal size is a critical driver of weight gain in early childhood","volume":"20","author":"Syrad","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1093\/ajcn\/68.6.1157","article-title":"Dietary fat does affect obesity!","volume":"68","author":"Bray","year":"1998","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_56","first-page":"489","article-title":"Effects of peer models\u2019 food choices and eating behaviors on preschoolers\u2019 food preferences","volume":"51","author":"Birch","year":"1980","journal-title":"Child. Dev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3109\/17477160903067601","article-title":"Associations between objectively measured habitual physical activity and adiposity in children and adolescents: Systematic review","volume":"5","author":"Kelly","year":"2010","journal-title":"Int. J. Pediatr. Obes."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1467-789X.2011.00960.x","article-title":"Energy balance-related behaviours associated with over-weight and obesity in preschool children: A systematic review of prospective studies","volume":"13","author":"Uijtdewilligen","year":"2012","journal-title":"Obes. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ypmed.2015.07.019","article-title":"Prevalence of sedentary behavior in children under 2 years: A systematic review","volume":"78","author":"Downing","year":"2015","journal-title":"Prev. Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/3\/314\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:27:17Z","timestamp":1760135237000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/9\/3\/314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,25]]},"references-count":59,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["children9030314"],"URL":"https:\/\/doi.org\/10.3390\/children9030314","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,25]]}}}