Birth Weight and Long-Term Overweight Risk: Systematic Review and a Meta-Analysis Including 643,902 Persons from 66 Studies and 26 Countries Globally

Abstract

BackgroundOverweight is among the major challenging health risk factors. It has been claimed that birth weight, being a critical indicator of prenatal developmental conditions, is related to long-term overweight risk. In order to check this important assumption of developmental and preventive medicine, we performed a systematic review and comprehensive meta-analysis.Methods and FindingsRelevant studies published up to January 2011 that investigated the relation between birth weight and later risk of overweight were identified through literature searches using MEDLINE and EMBASE. For meta-analysis, 66 studies from 26 countries and five continents were identified to be eligible, including 643,902 persons aged 1 to 75 years. We constructed random-effects and fixed-effects models, performed subgroup-analyses, influence-analyses, assessed heterogeneity and publication bias, performed meta-regression analysis as well as analysis of confounder adjusted data. Meta-regression revealed a linear positive relationship between birth weight and later overweight risk (p<0.001). Low birth weight (<2,500 g) was found to be followed by a decreased risk of overweight (odds ratio (OR) = 0.67; 95% confidence interval (CI) 0.59–0.76). High birth weight (>4,000 g) was associated with increased risk of overweight (OR = 1.66; 95% CI 1.55–1.77). Results did not change significantly by using normal birth weight (2,500–4,000 g) as reference category (OR = 0.73, 95% CI 0.63–0.84, and OR = 1.60, 95% CI 1.45–1.77, respectively). Subgroup- and influence-analyses revealed no indication for bias/confounding. Adjusted estimates indicate a doubling of long-term overweight risk in high as compared to normal birth weight subjects (OR = 1.96, 95% CI 1.43–2.67).ConclusionsFindings demonstrate that low birth weight is followed by a decreased long-term risk of overweight, while high birth weight predisposes for later overweight. Preventing in-utero overnutrition, e.g., by avoiding maternal overnutrition, overweight and/or diabetes during pregnancy, might therefore be a promising strategy of genuine overweight prevention, globally.

Birth weight and childhood obesity: a 12-country study

“…[4][5][6] Several studies have indicated that high birth weight is associated with an increased risk of childhood obesity. [7][8][9][10][11][12][13][14][15][16][17][18][19] However, few studies have examined the extent to which birth weight is associated with obesity in young school children in high-, middle-and low-income countries. Moreover, the association between low birth weight and the risk of childhood obesity is controversial.…”

“…Moreover, the association between low birth weight and the risk of childhood obesity is controversial. 7,8,10,[12][13][14][15][16][17][18] Several studies have suggested that maternal and child factors, such as maternal history of gestational diabetes, infant feeding mode, moderate-to-vigorous physical activity (MVPA), diet, sedentary and sleeping times may confound the association between birth weight and later risk of childhood obesity, 20-22 yet few studies were able to adjust for these factors simultaneously. Therefore, the aim of the present study was to examine the association between birth weight and the risk of obesity in 9-11-year-old children from 12 countries, adjusting for several confounding variables.…”

A Life Course Perspective on Health Trajectories and Transitions

“…Nonetheless, the confounding structure has been widely debated in publications focusing largely on blood pressure (Hardy et al 2006b;Huxley et al 2002), as was the proposal that the negative associations may be a statistical artefact due to over-adjustment for adulthood body size (Tu et al 2005). A potential reversal of the birth weight-blood pressure association from positive to negative on adjustment for adult size may occur because any relationship of birth weight with adulthood body mass index (BMI), a measure of weight standardised for height that is often used as an indicator of adiposity, is generally agreed to be positive not negative (Schellong et al 2012). This is thought to be because birth weight is strongly predictive of later fat-free mass, arguably the largest component of BMI, and to a much lesser extent adiposity (Wells et al 2007).…”

Relationship between prenatal growth, postnatal growth and childhood obesity: a review

“…4,[6][7][8] It has been hypothesized that the relation between birthweight and obesity may follow a U or J-shaped curve, with higher risk at both extremes of the birthweight distribution. 7,9 Empirical evidence has shown that obesity risks typically increase linearly with weight at birth: high birthweight infants are at higher risk of long-term overweight; 8 evidence of higher risk of obesity at the low end of the birthweight distribution has been less frequently observed. 8,[10][11][12] High birthweight may be associated with later obesity due to larger size stemming from high levels of lean mass, 13,14 while low birthweight may be associated with higher central adiposity.…”

“…7,9 Empirical evidence has shown that obesity risks typically increase linearly with weight at birth: high birthweight infants are at higher risk of long-term overweight; 8 evidence of higher risk of obesity at the low end of the birthweight distribution has been less frequently observed. 8,[10][11][12] High birthweight may be associated with later obesity due to larger size stemming from high levels of lean mass, 13,14 while low birthweight may be associated with higher central adiposity. [15][16][17][18] Studies have also indicated that postnatal growth during the first 1-2 years of life may be positively associated with subsequent obesity in childhood, adolescence and adulthood, as obesity risks, both in terms of body mass index (BMI) and adverse body composition, are higher for those who experienced rapid postnatal weight gain.…”