Crossing Growth Percentiles in Infancy and Risk of Obesity in Childhood
ABSTRACT 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.
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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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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