Birth by caesarean section has been recently implicated in the aetiology of childhood obesity, but studies examining the association have varied with regard to their settings, designs, and adjustment for potential confounders. We conducted a systematic review and meta-analysis to summarize the available evidence and to explore study characteristics as sources of heterogeneity. A search of Medline, EMBASE, and Web of Science identified 28 studies. Random effects meta-analysis was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Caesarean section had a RR of 1.34 (CI 1.18-1.51) for obesity in the child compared with vaginal birth. The RR was lower for studies that adjusted for maternal pre-pregnancy weight than for studies that did not (1.29, CI 1.16-1.44 vs. 1.55, CI 1.11-2.17). Studies that examined multiple early life factors reported lower RRs than studies that specifically examined caesarean section (1.39, CI 1.23-1.57 vs. 1.23, CI 0.97-1.56). Effect estimates did not vary by child's age at obesity assessment, study design or country income. Children born by caesarean section are at higher risk of developing obesity in childhood. Findings are limited by a moderate heterogeneity among studies and the potential for residual confounding and publication bias.

Limiting the availability of EECDs in children's bedrooms and discouraging their night-time use may be considered as a strategy to promote sleep and reduce childhood obesity.

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Objective: Canada's Aboriginal population is vulnerable to food insecurity and increasingly lives off-reserve. The Canadian Community Health Survey, Cycle 2.2 Nutrition, was used to compare the prevalence and sociodemographic correlates of food insecurity between non-Aboriginal and off-reserve Aboriginal households. Design: Food insecurity status was based on Health Canada's revised interpretation of responses to the US Household Food Security Survey Module. Logistic regression was used to assess if Aboriginal households were at higher risk for food insecurity than non-Aboriginal households, adjusting for household sociodemographic factors. Setting: Canada. Subjects: Households (n 35,107), 1528 Aboriginal and 33 579 non-Aboriginal. Results: Thirty-three per cent of Aboriginal households were food insecure as compared with 9 % of non-Aboriginal households (univariate OR 5?2, 95 % CI 4?2, 6?3). Whereas 14 % of Aboriginal households had severe food insecurity, 3 % of non-Aboriginal households did. The prevalence of sociodemographic risk factors for household food insecurity was higher for Aboriginal households. Aboriginal households were more likely to have three or more children (14 % v. 5 %), be lone-parent households (2 1 % v. 5 %), not have home ownership (52 % v. 31 %), have educational attainment of secondary school or less (43 % v. 26 %), have income from sources other than wages or salaries (38 % v. 29 %), and be in the lowest income adequacy category (33 % v. 12 %). Adjusted for these sociodemographic factors, Aboriginal households retained a higher risk for food insecurity than non-Aboriginal households (OR 2?6, 95 % CI 2?1, 3?2). Conclusions: Off-reserve Aboriginal households in Canada merit special attention for income security and poverty alleviation initiatives.

BackgroundIn 2005, we reported on the success of Comprehensive School Health (CSH) in improving diets, activity levels, and body weights. The successful program was recognized as a "best practice" and has inspired the development of the Alberta Project Promoting active Living and healthy Eating (APPLE) Schools. The project includes 10 schools, most of which are located in socioeconomically disadvantaged areas. The present study examines the effectiveness of a CSH program adopted from a "best practice" example in another setting by evaluating temporal changes in diets, activity levels and body weight.MethodsIn 2008 and 2010, we surveyed grade 5 students from approximately 150 randomly selected schools from the Canadian province of Alberta and students from 10 APPLE Schools. Students completed the Harvard Youth/Adolescent Food Frequency Questionnaire, questions on physical activity, and had their height and weight measured. Multilevel regression methods were used to analyze changes in diets, activity levels, and body weight between 2008 and 2010.ResultsIn 2010 relative to 2008, students attending APPLE Schools were eating more fruits and vegetables, consuming fewer calories, were more physically active and were less likely obese. These changes contrasted changes observed among students elsewhere in the province.ConclusionsThese findings provide evidence on the effectiveness of CSH in improving health behaviors. They show that an example of "best practice" may lead to success in another setting. Herewith the study provides the evidence that investments for broader program implementation based on "best practice" are justified.