Courtney Choy, MPH (PhD Student)


GHES U.S. Fellow 2019-2020

FELLOWSHIP SITE: Samoa Ministry of Health

Project Title: A multilevel and structural equation modeling approach to understand longitudinal growth, obesity, and cardiometabolic risk among Samoan children

Despite considerable investments in prevention and treatment of obesity in children, prevalence continues to increase with catastrophic individual and societal costs. Pacific Islanders are among the most at risk. Obesity prevention strategies are clearly needed, but the early determinants among Pacific Islanders are poorly understood. As such, we established the Ola Tuputupua’e “Growing Up” cohort in Samoa; the first longitudinal study of children among the Pacific Island nations. To date, the cohort includes 450 children and their biological mothers with measurements from 2015 (2-4 years old) and 2017-2018 (3.5-7 years old). Cross-sectional findings demonstrate that this cohort is ideal for research given the high obesity prevalence and early emergence of cardiometabolic risk. The research objective is to develop a comprehensive model of childhood obesity development in Samoa that 1) describes growth and body composition during a critical age period for obesity development, 2) captures influences of individual and household factors and the age periods during which growth is most sensitive to them, and 3) quantifies the influence of longitudinal growth on cardiometabolic disease markers. We will focus on body mass index trajectories to assess growth over time, diet and physical activity as modifiable individual-level factors, and household urbanicity and socioeconomic status as structural household-level factors. We will collect data between 2019-2020 from the same children (5.5-9 years old) to provide a third time point for analysis and utilize newly collected dual energy-x-ray absorptiometry body composition data. This research will be among the first to use a longitudinal, multilevel design to examine the effects of individual and household-level factors on growth, body composition, and cardiometabolic disease markers among children in the Pacific Island nations. The findings will likely apply to other settings and enhance our understanding of causal pathways of obesity and cardiometabolic risk during childhood to concretely inform strategies.