Crossing Growth Percentiles in Infancy and Risk of Obesity in Childhood

Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
JAMA Pediatrics (Impact Factor: 5.73). 11/2011; 165(11):993-8. DOI: 10.1001/archpediatrics.2011.167
Source: PubMed


To examine the associations of upward crossing of major percentiles in weight-for-length in the first 24 months of life with the prevalence of obesity at ages 5 and 10 years.
Longitudinal study.
Multisite clinical practice.
We included 44 622 children aged from 1 month to less than 11 years with 122 214 length/height and weight measurements from January 1, 1980, through December 31, 2008.
The number of major weight-for-length percentiles crossed during each of four 6-month intervals, that is, 1 to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months.
Odds and observed prevalence of obesity (body mass index [calculated as weight in kilograms divided by height in meters squared] ≥95th percentile) at ages 5 and 10 years.
Crossing upwards 2 or more weight-for-length percentiles was common in the first 6 months of life (43%) and less common during later age intervals. Crossing upwards 2 or more weight-for-length percentiles in the first 24 months was associated with elevated odds of obesity at ages 5 years (odds ratio, 2.08; 95% CI, 1.84-2.34) and 10 years (1.75; 1.53-2.00) compared with crossing less than 2 major percentiles. Obesity prevalence at ages 5 and 10 was highest among children who crossed upwards 2 or more weight-for-length percentiles in the first 6 months of life.
Crossing upwards 2 or more major weight-for-length percentiles in the first 24 months of life is associated with later obesity. Upward crossing of 2 weight-for-length percentiles in the first 6 months is associated with the highest prevalence of obesity 5 and 10 years later. Efforts to curb excess weight gain in infancy may be useful in preventing later obesity.

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    • "The current data show that a rapid increase in the BMI during the first year of life, and especially between the ages of 6 and 9 months, significantly increases the risk of being overweight at 8 years of age (Table 3). Other authors have found similar results when studying weight gain in early childhood [13,14] and weight gain during adolescence [7,8,10]. "
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    ABSTRACT: Identifying important ages for the development of overweight is essential for optimizing preventive efforts. The purpose of the study was to explore early growth characteristics in children who become overweight or obese at the age of 8 years to identify important ages for the onset of overweight and obesity. Data from the Norwegian Child Growth Study in 2010 (N = 3172) were linked with repeated measurements from health records beginning at birth. Weight and height were used to derive the body mass index (BMI) in kg/m2. The BMI standard deviation score (SDS) for each participant was estimated at specific target ages, using a piecewise linear mixed effect model. At 8 years of age, 20.4% of the children were overweight or obese. Already at birth, overweight children had a significantly higher mean BMI SDS than normal weight 8-year-olds (p < .001) and this difference increased in consecutive age groups in infancy and childhood. A relatively large increase in BMI during the first 9 months was identified as important for being overweight at 8 years. BMI SDS at birth was associated with overweight at 8 years of age (OR, 1.8; 1.6-2.0), and with obesity (OR, 1.8; 1.4-2.3). The Odds Ratios for the BMI SDS and change in BMI SDS further increased up to 1 year of age became very high from 2 years of age onwards. A high birth weight and an increasing BMI SDS during the first 9 months and high BMI from 2 years of age proved important landmarks for the onset of being overweight at 8 years of age. The risks of being overweight at 8 years appear to start very early. Interventions to prevent children becoming overweight should not only start at a very early age but also include the prenatal stage.
    BMC Public Health 02/2014; 14(1):160. DOI:10.1186/1471-2458-14-160 · 2.26 Impact Factor
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    • "WLH provides the weight spectrum for a specific length segment (4,5).Therefore, the use of BMI as the key index for nutritional evaluation may not be as satisfactory in children under two years of age as it is in older children and adults (6). The age-adjusted references of several anthropometric measurements are currently used as either follow-up or screening criteria to monitor growth in children (7). "
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    ABSTRACT: Objective: To produce weight for length/height (WLH) percentiles to be used for the screening of growth and assessment of failure to thrive in infancy and early childhood. Methods: The data (2009-2010) of the Anthropometry of Turkish Children aged 0-6 years (ATCA-06) study were used. A cross-sectional study was designed to calculate the WLH references. Reference weight values for each 5-cm LH intervals were determined using the LMS Chart Maker Pro version 2.3 software program (The Institute of Child Health, London). Results: A total of 3123 children (1573 female, 1550 male) aged 0-6 years were included in the calculation of the 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th WLH percentiles. The difference between the 3rd and the 97th percentiles for males was 2.02 cm to 12.64 cm in the 50-54.99 cm and 125-130 cm LH ranges. In the girls, the differences between the 3rd-97th percentiles ranged from 2.02 cm to 12.64 cm in the 50-54.99 cm and 125-130 cm LH groups. The maximum difference between the 3rd and 97th percentiles was about half the variation of mean WLH throughout the first six years of life. The most rapid change in WLH was observed in the 0-2-year period. Turkish references for WLH were not different from the World Health Organization standards. Conclusions: This is the first study in Turkey presenting WLH references in 0-6 year old children. We suggest that the use of WLH in the first two years of life may be more useful than age-adjusted references in assessment of nutritional status and diagnosis of failure to thrive. Conflict of interest:None declared.
    Journal of Clinical Research in Pediatric Endocrinology 12/2013; 5(4):224-228. DOI:10.4274/Jcrpe.1139
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    ABSTRACT: Introduction The obesity epidemic has spared no segment of the population, even infants and young children. 1 In 2007-08, almost 10% of U.S. infants and toddlers were overweight. 2 Recently, researchers have looked to events that occur in very early life, even before birth, to understand the causes of childhood obesity and identify factors that may be targeted for prevention. 3 In this section, we outline parameters for normal growth in infancy, review prenatal factors that have been found to be associated with later obesity, and identify areas for intervention. Subject During well-child visits, pediatric clinicians use growth charts to document serial measures of weight and length, and screen for abnormalities in weight status. 4 In the U.S., among children over the age of two, obesity is defined as a body mass index (BMI, weight in kg divided by height in m) 2 above the 95 th percentile for age and sex, compared with a reference population – typically the Centers for Disease Control and Prevention (CDC) 2000 growth charts. 5 Overweight is a BMI between the 85 th and 94 th percentile. In infants below 24 months, excess weight has traditionally been defined using weight for length percentiles compared with the CDC reference data. In the past few years, however, evidence is emerging that the World Health Organization (WHO) 2006 Growth Standard might be a better reference for healthy growth in infancy. 6 WHO included only term infants who were breast-fed for at least 12 months, followed them longitudinally, and excluded data for children with excess adiposity and growth failure. Using the WHO Growth Standard fewer children are diagnosed with poor weight gain, and more with excess adiposity, than when using the CDC Growth Reference. 7,8 Recent recommendations suggest the use of the WHO standard for infants below 24 months, with a BMI above the 97 th percentile indicating excess adiposity. 9 Since BMI reflects both lean and fat mass, however, BMI screening may result in misdiagnosis of individuals with higher or lower lean body mass than expected.
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