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Rifas-Shiman, Mandy B. Belfort, Ken P. Kleinman, Emily Oken and Matthew W. Gillman Pediatrics 2009;123;1177-1183 DOI: 10.1542/peds.2008-1149
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.pediatrics.org/cgi/content/full/123/4/1177
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2009 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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and later obesity were limited by their reliance on weight D Downloaded from www. It is important to distinguish the relative contributions of fetal growth and length of gestation. MD.2008-1149 doi:10. Ken P. compared with 1% for children in the lowest quartiles of both.67 kg. METHODS. weight for length. higher sums of subscapular and triceps skinfold thicknesses. The predicted obesity prevalence among children in the highest quartiles of both birth and 6-month weight-for-length z scores was 40%. 66. Harvard Pilgrim Health Care and Harvard Medical School. MA 02215. and 3 years. November 7-10. because the 2 have different determinants and sequelae13 and may suggest different causes (ie. eDepartment of Nutrition. Massachusetts. Copyright © 2009 by the American Academy of Pediatrics study of pregnant women and their children. MPHa. and 15.7. MPH.2 Rapid weight gain during the ﬁrst weeks or months of infancy predicts obesity3–10 and higher blood pressure11. separately. 6 months. 8. Massachusetts. Matthew W. MD.b. however. What This Study Adds Previous studies addressing infant size and later obesity were limited by reliance on weight measures alone. Whereas birth weight-for-length z scores were associated with higher BMI z scores. 0031-4005. PEDIATRICS (ISSN Numbers: Print. Mean weights at birth. ScDa. Massachusetts The authors have indicated they have no ﬁnancial relationships relevant to this article to disclose. April 2009 1177 . MD. Harvard Medical School and Harvard Pilgrim Health Care. the magnitude of effect was smaller than that of weight-for-length z scores at 6 months.pediatrics. We used multivariate regression analyses to predict the independent effects of birth weight-for-length z score and. and almost all found that higher birth weight was associated with higher attained BMI in childhood and adulthood. 2008 Address correspondence to Elsie M.pediatrics. We studied 559 children in Project Viva.1542/ peds. After adjustment for confounding variables and birth weight-for-length z score. Boston.d. 6th Floor. MD. Children’s Hospital Boston.2008-1149 This work was presented at the Developmental Origins of Health and Disease annual meeting. Key Words obesity. CONCLUSIONS. Taveras.9. Gillman. each increment in 6-month weight-for-length z score was associated with higher BMI z scores. Rifas-Shiman. We found that more-rapid increases in WFL in the ﬁrst 6 months of life were associated with increased risk of obesity at 3 years. MD.1. More than 2 dozen studies have addressed the association between birth weight and later obesity. We measured length and weight at birth. Boston. MPHa. MPHa.org. 133 Brookline Ave. More-rapid increases in weight for length in the ﬁrst 6 months of life were associated with sharply increased risk of obesity at 3 years of age. prospective. MPHa.org. Mandy B. 2007. infant growth. Perth. Online. Our main exposures were weight-for-length z score at birth adjusted for gestational age and weight-for-length z score at 6 months adjusted for weight-for-length z score at birth.55. 2010 PEDIATRICS Volume 123. Emily Oken.10 Most of those studies.4 cm. and 97. Boston. early infancy. either collected gestational age data retrospectively or did not adjust for gestational age. respectively. an ongoing. The goal was to examine the associations of weight-for-length at birth and at 6 months with obesity at 3 years of age. Preventive interventions beginning in infancy may help avoid lifetime complications of excess weight.e Obesity Prevention Program and bCenter for Child Health Care Studies. Belfort. Provided by Indonesia:AAP Sponsored on October 6. and 3 years were 3. Department of Ambulatory Care and Prevention.12 later in childhood and adulthood.org/cgi/doi/10. and obesity (BMI for age and gender of Ն95th percentile) at age 3.1542/peds. a What’s Known on this Subject Rapid weight gain during the ﬁrst weeks or months of infancy predicts obesity and higher blood pressure later in childhood and adulthood. 1098-4275). 48 children (9%) were obese. Divisions of cGeneral Pediatrics and dNewborn Medicine.b. SMa. ABSTRACT OBJECTIVE. E-mail: elsietaveras@hphc. Kleinman. birth size Abbreviations WFL—weight-for-length OR— odds ratio CI— conﬁdence interval WFA—weight-for-age LFA—length-for-age Accepted for publication Jul 30. Number 4. cohort www. the sum of subscapular and triceps skinfold thicknesses.ARTICLE Weight Status in the First 6 Months of Life and Obesity at 3 Years of Age Elsie M. Australia. 6-month weight-for-length z score on BMI z score. At 3 years. Pediatrics 2009. Previous studies addressing size at birth. Corresponding lengths were 49.9. Changes in weight status in infancy may inﬂuence risk of later obesity more than weight status at birth. Boston. the prevalence of overweight among children in the United States has increased dramatically. 6 months.c. Taveras.123:1177– 1183 URING THE PAST 30 years. Sheryl L. Harvard School of Public Health. the impact of prematurity versus nutritional or hormonal “fetal programming”). RESULTS. Department of Ambulatory Care and Prevention. and increased odds of obesity at age 3.15.
we included only those covariates that were of a priori interest or confounded associations of birth WFL z score Downloaded from www. few studies examined possible confounders of the relationship between rapid infant growth and later obesity. Hamburg. height.21 We assessed maternal diet at both the ﬁrst and second trimesters of pregnancy by using a validated. We calculated total weight gain by subtracting prepregnancy weight from the last prenatal weight. food frequency questionnaire. We calculated age. length-for-age (LFA).22 We calculated intakes of docosahexaenoic acid. the change in WFL z score from birth to 6 months of age on our main outcomes. weight. observational.16 Of the 2128 women who delivered a live infant. a prospective. METHODS Study Design and Participants Study subjects were participants in Project Viva. We deﬁned hypertensive disorders during pregnancy according to published standards. we asked mothers to report their weights just before they became pregnant. ␣-linolenic acid. We deﬁned obesity as BMI for age and gender of Ն95th percentile. eicosapentaenoic acid. total nϪ3 polyunsaturated fatty acids. Other Measures Mothers reported information about maternal age. and total nϪ6 polyunsaturated fatty acids for each food frequency questionnaire. because it is algebraically identical to the change in WFL z score from birth to 6 months of age adjusted for the birth WFL z score. separately. We refer to this expression as the change in WFL z score from birth to 6 months. smoking during pregnancy. For this analysis. including prenatal factors such as maternal prepregnancy BMI and smoking. semiquantitative. We measured subscapular and triceps skinfold thicknesses by using Holtain calipers (Holtain. we also examined the change in WFA z score and the change in LFA z score from birth to 6 months of age. and obesity. we excluded 1 participant who was missing birth weight data and 534 who were missing birth length data.pediatrics.and gender-speciﬁc WFL. and the mean of the ﬁrst and second trimester values was the assigned covariate for each woman during pregnancy. 1579 were eligible for 3-year follow-up assessments on the basis of having completed prenatal nutritional assessments and providing consent for their children to undergo follow-up monitoring. Seca.4.8–10 Measures of size that include length or height in addition to weight reﬂect adiposity better than does weight alone14 and thus may be more informative regarding future obesity risk. Brigham and Women’s Hospital. United Kingdom) and calculated the sum of the 2 thicknesses. arachidonic acid. Few studies examined whether there were differences in the relationship between rapid infant growth and later obesity for boys and girls. J.23 Deﬁnitions of glucose tolerance status were described elsewhere. The human subjects committees of Harvard Pilgrim Health Care.and gender-speciﬁc BMI z score. 2010 . In addition. After testing our assumption of linearity.24 At 6 months after delivery. Statistical Analyses We ﬁrst examined the bivariate relationships of our main exposures with other covariates and the main outcomes.19 Research assistants performing all measurements followed standardized techniques20 and participated in biannual in-service training to ensure measurement validity (I.17 Project staff members weighed infants at 6 months and 3 years of age with a digital scale (model 881. and offspring health. We calculated gestational ages from the last menstrual period. we used multiple linear and logistic regression models to assess the independent effects of birth WFL z score and. We collected follow-up information for 1401 children (89% of 1579 children). Germany) and measured infant length at birth and 6 months of age and infant height at 3 years of age with a Shorr measuring board (Shorr Productions. 166-item. and paternal (biological father) height and weight. At the ﬁrsttrimester study visit. As secondary exposures. MD). Outcome Measures Our main outcomes at 3 years of age were the age. Shorr. education. pregnancy outcomes.18 1178 TAVERAS et al Our main exposures were birth WFL z score adjusted for gestational age z score and WFL z score at 6 months of age adjusted for WFL z score at birth.3. MPS personal oral communication. Olney. Patterns of growth in infancy vary between boys and girls.16 Details of recruitment and retention procedures are available elsewhere. we expressed gestational weight gain in categories based on the 1990 recommendations of the Institute of Medicine. 2004 –2007). In analyses. household income. we excluded 164 participants who were missing 6-month WFL z scores and 34 who were missing 3-year BMI data. The primary reason for missing length data was that we did not attempt to obtain newborn measurements for infants who were born on weekends. and BMI z scores by using US national reference data. and Beth Israel Deaconess Medical Center approved the study protocols. In multivariate models.measures alone. then we used the ultrasound determination. if the estimate of gestational age from the second-trimester ultrasound assessment differed by Ͼ10 days. We determined birth WFL z scores by using US national reference data. cohort study of gestational diet. which yielded a cohort of 559 mother-child pairs for analysis. Provided by Indonesia:AAP Sponsored on October 6. mothers also reported the number of hours their children slept in a 24-hour period. Measurements Main Exposures We abstracted birth weight data from the medical records. weight-for-age (WFA).15 The purpose of this study was to examine the extent to which weight-forlength (WFL) at birth and WFL from birth to 6 months of age are associated with obesity at 3 years of age. the sum of subscapular and triceps skinfold thicknesses. with in-person examinations for 1292 (82%).org. Crosswell. with boys tending to gain weight and height in infancy more rapidly than girls. In addition. duration of breastfeeding.
In gender-speciﬁc analyses. All models were ﬁt separately for boys and girls. changes in LFA from birth to 6 months were not associated with our anthropometric outcomes at age 3. and 3 years were 3. separately. In multivariate models adjusted for confounding variables. gender modiﬁed the relationship between the change in WFL z score from birth to 6 months of age and obesity at 3 years of age.67 kg.72 for girls. NC). Adjustment for maternal intake of nϪ3 and nϪ6 polyunsaturated fatty acids during pregnancy. Predicted obesity prevalence among children in the highest quartiles of both birth and 6-month WFL z scores was 40%.35]).54 [95% CI: 3.04 [95% CI: Ϫ0. we observed a linear association between birth WFL z scores (in quartiles) and BMI z scores at 3 years of age.90 for girls. children with higher 6-month WFL z scores were more likely to have mothers with higher prepregnancy BMI values and to have higher birth WFL and were less likely to be breastfed (Table 1). In models adjusted for confounding variables and birth WFL z scores. we observed slightly smaller magnitudes of effect for WFA. By 3 years of age. those in the highest quartile had higher BMI z scores at 3 years of age (␤ ϭ 0.75]). WFL z scores were 0. Maternal intake of nϪ3 and nϪ6 polyunsaturated fatty acids during pregnancy. WFL z scores (mean Ϯ SD) were 0.1 (SAS Institute.84 [95% CI: 3. and gestational age-adjusted multivariate models. expressed as a 1-unit increase rather than in quartiles. and we used parameter estimates from our multivariate model to estimate the predicted probability of obesity at 3 years of age for each of the resulting 16 categories. Multivariate model 2 also included maternal and child sociodemographic variables. we observed a direct association of 6-month WFL z scores.84 – 12. Number 4. 66.92).67]). 2010 . We performed data analyses with SAS 9.40 – 0. 8. and 15.pediatrics. Compared with the WFL results. and gestational diabetes status did not change the estimates. gender-stratiﬁed multivariate analyses of effects of infant gains in adiposity on 3-year outcomes showed no differences PEDIATRICS Volume 123. WFL at 6 months was more strongly related to risk of obesity than was WFL at birth (Fig 1). 6 months. each increment in 6-month WFA z scores (adjusted for birth WFA z score) was associated with higher BMI z scores (␤ ϭ 0. and hypertensive disorders of pregnancy were not associated with 6-month WFL z scores.55.56]). did not change the unadjusted estimates substantially (Table 3).78 Ϯ 1. 11% of boys and 7% of girls were obese.38 Ϯ 0. Change in WFL From Birth to 6 Months In multivariate models adjusted for confounding variables and birth WFL z scores. To assess effect modiﬁcation according to birth size. At 6 months. RESULTS Sample Characteristics The mean weights at birth. Finally. respectively. each increment in LFA z scores at 6 months was associated with a 0. Table 3 shows the association of our 3-year anthropometric outcomes with infants’ WFL z scores at 6 months. Provided by Indonesia:AAP Sponsored on October 6. In Fig 1. and obesity at 3 years of age (Table 2). In both gender-speciﬁc and combined analyses.59]). we also adjusted for breastfeeding status and child’s sleep duration at 6 months of age.11 to 0.47 Ϯ 0. we grouped WFL z scores at birth and at 6 months of age into quartiles. The association between WFL at 6 months and obesity at 3 years did not vary substantially according to birth size (P for interaction ϭ .81 for boys and 0.14) higher BMI z score at 3 years of age. mean Ϯ SD WFL z scores at birth were 0.53]).9.99 –2. In bivariate analyses. smoking during pregnancy.53]) at 3 years of age.17 [95% CI: 0. as well as breastfeeding status and infant sleep duration at 6 months of age.28 – 0.63 Ϯ 0.01 for boys and 0.9. we combined results and adjusted for gender if gender-speciﬁc estimates were similar.30 [95% CI: 0.47 [95% CI: 0. expressed in quartiles.93–1. maternal prepregnancy BMI. Corresponding lengths were 49.43– 0. because breastfeeding and sleep duration might be confounders or intermediates. greater sums of subscapular and triceps skinfold thicknesses (␤ ϭ 1.51 [95% conﬁdence interval [CI]: 0.77–1.96 at 6 months of age. We also tested multiplicative interaction terms in the models to determine whether birth size and. Despite these differences in exposure and outcome frequency.4 cm.06 – 0. and 97.58 [95% CI: 0.19]) at 3 years of age (Table 3).06 [95% CI: 0. April 2009 1179 Downloaded from www. WFL at Birth In age-. higher sums of subscapular and triceps skinfold thicknesses (␤ ϭ 1.16]) at 3 years of age.or change in WFL z score from birth to 6 months of age with child adiposity at 3 years of age.org. 9% of children had BMI values of Ն95th percentile for their age and gender. gender-. Model 1 included only child age and gender. and increased odds of obesity (OR: 6. We also examined the change in WFA z scores and the change in LFA z scores from birth to 6 months of age. we show the covariate-adjusted predicted probability of 3-year obesity according to WFL z score quartiles at birth and at 6 months of age. each increment in 6-month WFL z scores was associated with higher BMI z scores (␤ ϭ 0. At 3 years of age.77 at birth and 0. hypertensive disorders of pregnancy. and paternal BMI. compared with 1% among children in the lowest quartiles of both.57 Ϯ 0.42 to 0. In the ﬁnal multivariate models (model 3).51 [95% CI: 0. these factors were not included in the ﬁnal model. therefore.70 Ϯ 0. each 1-unit increase in birth WFL z scores (continuous) was associated with slightly higher BMI z scores (␤ ϭ 0. we also adjusted for gestational weight gain. sums of subscapular and triceps skinfold thicknesses. Each 1-unit increase in birth WFL z scores was not associated with the sums of subscapular and triceps skinfold thicknesses at 3 years of age (␤ ϭ 0. In multivariate model 3. and increased odds of obesity (OR: 5. with BMI z scores.01 (95% CI: Ϫ0. glucose tolerance status. Adjustment for maternal and child socioeconomic characteristics. Other participant characteristics are shown in Table 1.77– 8. Cary.15.28]) and with increased odds of obesity (odds ratio [OR]: 1. Compared with children in the lowest quartile of birth WFL z scores.
2010 .53 33.03 1.94 . the odds of obesity at 3 years of age were 7. mean Ϯ SD. which suggests that early interventions to prevent rapid increase in weight status in the ﬁrst months of life may help reduce children’s risk of obesity later in childhood.51 Ϯ 0.0 Ϯ 4.54 0. mm BMI of Ն95th percentile.03 .13 Ϯ 0.46 0.6 10 4 1. mean Ϯ SD.8 Ϯ 1.7 0. % (n) White.23 Ϯ 0.0006 . kg Birth WFL z score.55 Ϯ 0.36 0.7 52 11 0. % (n) Annual household income of less than $70 000.9 Ϫ0.20 0.1 25. mean Ϯ SD.87 3 140 1.7 12 (67) 4 (22) 0. % (n) Impaired glucose tolerance Gestational diabetes mellitus Hypertensive disorder of pregnancy. Birth WFL was only minimally associated with our anthropometric outcomes. mean Ϯ SD. % (n) Any breast milk feeding at 6 mo Introduction of solids at Ͻ4 mo Sleep duration at 6 mo.12 Ϯ 0.4 51 11 0. DISCUSSION In this prospective cohort study.3 9 47 17 12.60 Ϯ 0.6 Ϯ 4. kg/m2 Gestational weight gain. Furthermore.1 Ϯ 1.49 12.16 Ϯ 0.8 Ϯ 1. in multivariate models adjusted for confounders and birth WFL z scores.46 0.3 Ϯ 4. % (n) Chronic hypertension Gestational hypertension Preeclampsia Nulliparous.10 Ϯ 0.5 Ϯ 5.13 0.4 50 (276) 10 (53) 0. For example.7 15. mean Ϯ SD Sum of subscapular and triceps skinfold thicknesses.44 Ϯ 1. % (n) Birth characteristics Birth weight. % (n) 559 139 Ϫ0.0001 Ͻ.5 Ϯ 5.4 Ϯ 3.0002 .82 . more-rapid increases in WFL in the ﬁrst 6 months of life were associated with sharply increased risk of obesity and adiposity (measured as the sum of skinfold thicknesses) at 3 years of age.09 Ϯ 0.44 0.6 Ϯ 5.27 .3 Ϯ 3.77 .32 0. mean Ϯ SD.79 39.93 .3 Ϯ 2.99 Ϯ 0.89 33.11 0.39 32.39 12.9 Ϯ 3.7 9 1 46 36 75 26.9 15.48 .3 Ϯ 4.31 0. Provided by Indonesia:AAP Sponsored on October 6. mean Ϯ SD. h/d Age 3 anthropometric characteristics BMI z score.6 23.7 Ϯ 4.2 9 (48) 66 10 12.14 –26.48 Ͻ. most previous studies in this area were limited by their Downloaded from www.21 0.26 Ϯ 0.39 0. and prepregnancy BMI.03 1.09 Ϯ 0.2 50 68 3.03 1.15 Ϯ 0.0 49 85 3.98 Ϯ 0.7 1.7 (4) 8 (41) 3 (15) 48 (266) 33 (184) 74 (415) 26.96 .2 24.1 Ϯ 2.0 24.16 Ϯ 0.TABLE 1 Characteristics of 559 Mother-Infant Pairs in Project Viva.2 Ϯ 2.26 Ϯ 0.1 24. mean Ϯ SD.77 39.0001 between boys and girls.99 .36 0.3 21 .2 Ϯ 3. % (n) Paternal BMI. We found the predicted probability of obesity at age 3 to be 40% among infants in the highest quartiles of both birth 1180 TAVERAS et al and 6-month WFL. mean Ϯ SD.7 Ϯ 1.7 7 1 42 33 69 25.9 15.48) for girls for each increment in 6-month WFL z scores (P for interaction term ϭ .08 .35 0.5 Ϯ 5.44 .4 0.09 Ϯ 0.6 15.org.53 (95% CI: 2. mean Ϯ SD. % (n) College graduate or more.8 17.97 .8 Ϯ 5.8 14 3 0.32 Ϯ 0. Our study was unique in 3 ways.49 0.18 .7 47 11 0.26 . we had research-level measures of length at birth and 6 months. mean Ϯ SD Gestational age at birth.95 6-mo WFL z Score Quartile 2 140 0.7 Ϯ 3.71 39.88 4 140 1.0 49 65 3.7 11 3 0.92) for boys and 7.9 3 47 10 12.5 9 4 50 35 73 27.55 Ϯ 0.5 1 55 19 12.17 Ϯ 0.2 Ϯ 1.8 Ϯ 1.2 49 69 3. including socioeconomic status and maternal smoking.0 15.7 Ϯ 1. y Prepregnancy BMI.70 39.2 Ϯ 2.37 0.0001 .9 18.31 0.0 16.04 54 (301) 14 (74) 12.1 Ϯ 1.01 .63 .41 P for Trend 32. the observed associations between rapid increases in weight status in the ﬁrst 6 months of life and later obesity did not vary according to gender.4 Ϯ 5.5 Ϯ 1. First.2 Ϯ 2.55 Ϯ 0.05 32.15 Ϯ 1.1 Ϯ 2.66).44 –16.97 Ϯ 0.12 Ϯ 0.6 Ϯ 4.4 Ϯ 4.15 Ϯ 0.8 0.19 Ϯ 0.36 12.62 (95% CI: 3.9 0. g/d Docosahexaenoic acid plus eicosapentaenoic acid ␣-Linolenic acid Arachidonic acid Total nϪ3 polyunsaturated fatty acids Total nϪ6 polyunsaturated fatty acids Glucose tolerance status. wk Birth weight-for-gestational age z score (fetal growth).19 Ϯ 0.1 Ϯ 5.34 Ϯ 0.0 Ϯ 4.4 Ϯ 4.48 Ϯ 0.pediatrics.1 15.14 Ϯ 0.50 0.03 1. kg Excessive gestational weight gain (Institute of Medicine category).09 Ϯ 0.47 Ϯ 0.40 12.95 Ϯ 0. % (n) Maternal diet during pregnancy. These effects were independent of a number of potential confounders.36 12.73 Ϯ 0.43 Ϯ 1.0 Ϯ 4.94 .3 Ϯ 4.0001 Ͻ.5 Ϯ 5.06 Ͻ.96 .9 49 6 0.03 1.7 49 (276) 72 (400) 3.33 0. % (n) Mother smoked during index pregnancy.64 Ϯ 0.80 39.9 13 6 0 5 4 52 28 81 26.11 . gestational weight gain. kg/m2 Child and home environment Male.3 Ϯ 5.95 Ϯ 0.13 Ϯ 0.16 Ϯ 0. According to Infants’ 6-Month WFL z Score Quartiles Overall 1 N Mean z score Maternal characteristics Maternal age at enrollment. mean Ϯ SD Infant feeding at 6 mo.8 15.05 .
65) 1. we were able to adjust for several prenatal and postnatal confounders. prepregnancy BMI.63–34. In contrast to a previous study that examined changes in length in infancy. age.71) 1. PEDIATRICS Volume 123. BMI of >95th Percentilea Model 1: child’s age and gender Model 2: model 1 plus maternal age. and parity and child’s race/ethnicity Model 3: model 2 plus gestational weight gain. paternal BMI.48–8. education. as opposed to simply birth weight.54 (0.16 (0.17 (6.35 (0. and prepregnancy BMI.89) 1.03) 7.94–1. maternal smoking.73 (0.7 relative risks of later obesity ranged from 1.pediatrics.00 (reference) 0.95 (1.49) 0. age.29–12. household income.7. a All trend P values are Ͻ. and child age. education. Second.93–1.30 (0.47) 0.6 we found that changes in LFA from birth to 6 months were not associated with later obesity.96–3.28 to 1.92) 28.00 (reference) 0.52) 6.46–0.42–125.46–0. gestational weight gain.72) 1. some of which were not available for previous longitudinal birth cohorts (eg.02–1. smoking history. and household income. education.46–0. c The comparison group was children with BMI values in the 5th to Ͻ85th percentiles. Number 4.51 (0.84–12. reliance on weight alone.63 (Ϫ0. income. Our ﬁndings are consistent with previous studies of both contemporary9. and father’s BMI.00 (reference) 1. paternal BMI).67) OR (95% CI). with changes in WFL from birth to 6 months of age.31 (1.0001.92) 8.43) 33.59) 5. gender.68 (0.00 (reference) 0.01 to 0.86 (0. Changes in WFA and changes in WFL from birth to 6 months were associated with later obesity and higher adiposity.96) 0. and paternal BMI 0. 40 30 20 10 0 4 3 2 1 Quartile of WFL-z at 6 mo 2 1 Q u FL W of th tile bir ar at 4 3 z FIGURE 1 Predicted probability of obesity (BMI of Ն95th percentile) at 3 years of age according to quartile of WFL z score at birth and at 6 months of age.37) 3.17 to 5.37 (6.62) 0.55) 0.org.08–1.TABLE 2 Associations of Quartiles of 6-Month WFL z Score Adjusted for WFL z Score at Birth With Risk of Clinical Outcomes at 3 Years of Age Clinical Outcomes at 3 y 1 Quartile of 6-mo WFL z Score Adjusted for WFL z Score at Birtha 2 3 4 ␤ (95% CI) BMI z score Age and gender adjusted Multivariate modelb Sum of subscapular and triceps skinfold thicknesses Age and gender adjusted Multivariate model OR (95% CI) BMI of Ն95th percentilec Age and gender adjusted Multivariate model 0. mother’s age. Our observed magnitudes of effect were larger than previously reported values.28 (0.62) 0.36 (1.84 (3.42) 0.59–9.38–2.70 among infants with more-rapid weight gain in the ﬁrst year of life.99 (0.00 (reference) 1.10 and historical3 cohorts and conﬁrm the ﬁndings of 2 systematic reviews of infant growth and obesity that concluded that infants at the highest end of the weight or BMI distribution and infants who grew most rapidly (usually measured as weight gain) were more likely to be obese later in life. Provided by Indonesia:AAP Sponsored on October 6.43–0. possibly because we were able to use measures of length in addition to weight. 2010 .32) 1.44–47. which suggests that it is rapid weight gain in infancy that puts children at risk.51 (Ϫ0. which together reﬂect adiposity better than weight alone.29 (1. and race/ethnicity. a The comparison group was children with BMI values in the 5th to Ͻ85th percentiles.20–4.54–0. and race/ethnicity.19–177.21 (Ϫ0.8 In the review by Baird et al. we were able to compare the effect of birth WFL adjusted for gestational age (“fetal growth”).38 (1.45 to 1. parity.00 (reference) 0.68) Results are from multivariate analyses of data for infants participating in Project Viva.54 (0. gestational weight gain.94) 1.52 (3.03–1.75 (0.07–0.75) 5.85 (3. April 2009 1181 Predicted probability of obesity at age 3 y Downloaded from www.36–11. TABLE 3 Changes in 3-Year Obesity-Related Outcomes for Each 1-Unit Increment in WFL z Score at 6 Months of Age Adjusted for WFL z Score at Birth Model BMI z Score ␤ (95% CI) Sum of Subscapular and Triceps Skinfold Thicknesses 1. parity. with adjustment for maternal smoking status. It is also possible that the relatively close measurement of exposures and outcomes contributed to our observed magnitudes of effect. maternal prepregnancy BMI.19) Results are from multivariate analyses of data for 559 mother-child pairs participating in Project Viva.14 (2. b The multivariate model adjusted for child’s gender.50) 1.54 (1.81–2.12) 1.08) 2. Third.
infant growth.33 CONCLUSIONS There is growing evidence that rapid changes in weight status during infancy may substantially increase individuals’ risk of obesity later in life. Size at birth.25 we did not ﬁnd maternal glucose tolerance to be associated with 6-month WFL or to be a confounder of the relationship between changes in WFL in infancy and later obesity. Tate AR. JAMA.30 the mode of infant feeding was not a confounder in this study. Ogden CL. several limitations should be considered. Rapid infant weight gain predicts childhood overweight. Stratton HH. Prevalence of overweight among preschool children in the United States. Rapid growth in infancy and childhood and obesity in later life: a systematic review. Although breastfeeding was independently associated with a lower prevalence of obesity at age 3.18(7):815– 831 13. Birth weight. It is possible that the quality of the infant diet after weaning also may mediate the relationship between infant weight gain and later obesity. Int J Obes Relat Metab Disord. Kumanyika SK. Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans. including prepregnancy weight. 99(4). infant growth. ACKNOWLEDGMENTS This study was supported in part by grants from the National Institutes of Health (grants HD34568. Finally. Prevalence of overweight and obesity in the United States. the quality of the infant diet after weaning.pediatrics. Obes Rev.80(4):502–511 14.In this study. Troiano RP.331(7522):929 8. These factors might have introduced bias. Some mathematical properties of weight-for-height indices used as measures of adiposity. McDowell MA. Briefel RR. Pruzek RM.org/cgi/content/full/99/ 4/e1 3. Flegal KM. and childhood body mass index: Hong Kong’s children of 1997 birth cohort. 2008. Br Med J. 1987. 1970. 1999 –2004.org. Victora CG.26–29 we did not ﬁnd this factor to be a confounder.6(2):143–154 9. and infant sleep. Kleinman KP. Flegal KM. Kuczmarski RJ. Our ﬁndings conﬁrmed that rapid gains in WFL in the ﬁrst 6 months of life were associated with sharply increased risk of later obesity. Available at: www. Hui LL. Stettler N. Law CM. Stallings VA. Br J Prev Soc Med. Relationship between growth and feeding in infancy and body mass index at the age of 6 years. 2005. Rich-Edwards J. Gillman MW.pediatrics. Roberts H. we were not able to examine social and behavioral interactions regarding infant feeding. Kleinman KP. 2005. and HL68041). Dennison BA. J Hypertens. BMJ. cohort study. Monteiro PO. 1997. their educational and income levels were relatively high. Belfort MB. Schooling CM. In addition. Follow-up study of physical growth of children who had excessive weight gain in ﬁrst six months of life.14(3):491– 499 10. Huxley RR. 2006. Infant weight gain and childhood overweight status in a multicenter.30(7):1094 –1096 16. Stettler N. Katz SH. Our results may not be generalizable to more socioeconomically disadvantaged populations. 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pediatrics.pediatrics.1177-1183 DOI: 10.org/cgi/eletters/123/4/1177 This article.org/cgi/content/full/123/4/1177 This article cites 29 articles. Belfort.org/cgi/collection/nutrition_and_metabolis m Information about reproducing this article in parts (figures. along with others on similar topics. Gillman Pediatrics 2009.org/misc/reprints. Emily Oken and Matthew W.org/misc/Permissions. 2010 .123.org/cgi/content/full/123/4/1177#BIBL This article has been cited by 2 HighWire-hosted articles: http://www.pediatrics.org.1542/peds. tables) or in its entirety can be found online at: http://www. Provided by Indonesia:AAP Sponsored on October 6. can be found at: http://www.shtml Information about ordering reprints can be found online: http://www.pediatrics. Mandy B.Weight Status in the First 6 Months of Life and Obesity at 3 Years of Age Elsie M. Ken P. appears in the following collection(s): Nutrition & Metabolism http://www.pediatrics.org/cgi/content/full/123/4/1177#otherartic les One P3R has been posted to this article: http://www.shtml Citations Post-Publication Peer Reviews (P3Rs) Subspecialty Collections Permissions & Licensing Reprints Downloaded from www. Sheryl L.2008-1149 Updated Information & Services References including high-resolution figures. 12 of which you can access for free at: http://www.pediatrics.pediatrics. Kleinman. Rifas-Shiman.pediatrics. Taveras.
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