IMPORTANCE Despite the potential for COVID-19 infection control-related events to have an effect on child well-being, comprehensive assessments of postlockdown changes and persistent outcomes are lacking. OBJECTIVE To survey the extent of COVID-19 lockdown-related lifestyle changes, their differences by child age and family socioeconomic status, and the potential association with child adiposity 1 year after lockdown. DESIGN, SETTING, AND PARTICIPANTS A self-administered, electronic survey was introduced to 2 ongoing child cohorts (the Singapore Preconception Study of Long-term Maternal and Child Outcomes [S-PRESTO] cohort of preschool children aged 1-4.5 years and the Growing Up in Singapore Towards Healthy Outcomes [GUSTO] cohort of primary school children aged 9-10.7 years) from July 8, 2020, to September 5, 2020, which was 1 to 3 months after the end of strict universal movement restrictions (duration of 73 days ending on June 19, 2020). All active participants from S-PRESTO and GUSTO, 2 population-based, longitudinal, parent-offspring cohorts in Singapore, were invited to participate and monitored through June 15, 2021. EXPOSURES Exposures included family income before and after the COVID-19 lockdown, changes in child outdoor play or exercise, and COVID-19-related life events; all data were self-reported by parents and school-aged children 1 to 3 months after the lockdown. MAIN OUTCOMES AND MEASURES Primary outcomes were self-reported COVID-19-related life events and changes in child online socialization, outdoor play or exercise, and intrafamily relationships. Study staff measured children's weight, height, and skinfold thickness before and up to 1 year after lockdown. Body mass indices (calculated as weight in kilograms divided by height in meters squared) and World Health Organization-standardized scores were computed. Differences before and after lockdown were compared using baseline-adjusted linear regression. RESULTS A total of 604 parents (53% of active cohort participants) and 356 school-aged children completed the survey and were similar to source cohorts. This represents 373 of 761 eligible children in the GUSTO cohort (mean [SD] age, 9.9 [0.4] years; 197 girls [52.8%]) and 231 of 370 eligible children in the S-PRESTO cohort (mean [SD] age, 2.6 [0.8] years; 121 boys [52.6%]). The COVID-19-related life changes were prevalent and varied (eg, 414 of 600 children [69.0%] reported changes in social activities). More than one-third of primary school-aged children (122 of 356 [34.3%]) and one-quarter of preschool-aged children (56 of 229 [24.5%]) eliminated any outdoor play after the lockdown. Lower family income before the lockdown was associated with increased odds of elimination of outdoor play (adjusted odds ratio per 1000 Singapore dollars [$730 US dollars] decrease, 1.09; 95% CI, 1.01-1.19). Complete elimination of outdoor activity (vs continued outdoor activity) was associated with an increase in body mass index of 0.48 (95% CI, 0.03-0.94) and a body mass index z score of 0.18 units (95% CI, 0-0.37) in school-aged children approximately 1 year after lockdown. CONCLUSIONS AND RELEVANCE Results of this cohort study suggest that 1 to 3 months after a brief, strict lockdown, a large proportion of parents and school-aged children reported elimination of outdoor play, which was more prevalent in lower-income families. Future research to better understand clinical implications and ways to mitigate lockdown outcomes is essential.

中文翻译：

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封锁一年后新加坡学龄前和学龄儿童与 COVID-19 相关的生活经历、户外活动和长期肥胖变化。


重要性 尽管与 COVID-19 感染控制相关的事件可能对儿童福祉产生影响，但仍缺乏对封锁后变化和持续结果的全面评估。目的 调查与 COVID-19 封锁相关的生活方式改变的程度、不同儿童年龄和家庭社会经济状况的差异，以及封锁后 1 年后与儿童肥胖的潜在关联。设新加坡迈向健康成果[GUSTO]队列的9-10.7岁小学生）从2020年7月8日到2020年9月5日，即严格的普遍行动限制结束后的1至3个月（持续时间为73截止日期为 2020 年 6 月 19 日）。来自新加坡 2 个基于人口的纵向亲子队列 S-PRESTO 和 GUSTO 的所有活跃参与者均受邀参与并监测直至 2021 年 6 月 15 日。暴露情况 暴露情况包括 COVID-19 封锁之前和之后的家庭收入，儿童户外玩耍或锻炼的变化，以及与 COVID-19 相关的生活事件；所有数据均由家长和学龄儿童在封锁后 1 至 3 个月内自行报告。主要结果和措施 主要结果是自我报告的与 COVID-19 相关的生活事件以及儿童在线社交、户外游戏或锻炼以及家庭内部关系的变化。研究人员测量了封锁前和封锁后一年内儿童的体重、身高和皮褶厚度。 计算体重指数（以公斤为单位的体重除以以米为单位的身高的平方）和世界卫生组织标准化分数。使用基线调整线性回归比较锁定前后的差异。结果 共有 604 名家长（活跃队列参与者的 53%）和 356 名学龄儿童完成了调查，与源队列相似。这代表了 GUSTO 队列中 761 名符合条件的儿童中的 373 名（平均 [SD] 年龄，9.9 [0.4] 岁；197 名女孩 [52.8%]）和 S-PRESTO 队列中 370 名符合条件的儿童中的 231 名（平均 [SD] 年龄， 2.6 [0.8] 岁；121 名男孩 [52.6%]）。与 COVID-19 相关的生活变化普遍存在且多种多样（例如，600 名儿童中有 414 名 [69.0%] 报告了社交活动的变化）。超过三分之一的小学学龄儿童（356 名中的 122 名 [34.3%]）和四分之一的学龄前儿童（229 名中的 56 名 [24.5%]）在封锁后取消了任何户外活动。封锁前家庭收入较低与取消户外活动的几率增加有关（调整后的几率比每 1000 新加坡元 [730 美元] 下降，1.09；95% CI，1.01-1.19）。完全消除户外活动（与继续户外活动相比）与体重指数增加 0.48（95% CI，0.03-0.94）和体重指数 z 得分增加 0.18 个单位（95% CI，0-0.37）相关封锁后大约一年的学龄儿童。结论和相关性 这项队列研究的结果表明，在短暂、严格的封锁后 1 至 3 个月，很大一部分家长和学龄儿童表示不再参加户外活动，这种情况在低收入家庭中更为普遍。未来的研究必须更好地了解临床意义和减轻封锁结果的方法。