Developmental Trajectories of Overweight During Childhood: Role of Early Life Factors

Abstract

Objective: Our goal was to identify developmental trajectories of overweight in children and to assess early life influences on these trajectories. Research Methods and Procedures: Participants consisted of 1739 white, black, and Hispanic children who were younger than 2 years at the first survey and were followed up to 12 years of age. Repeated measures of overweight, defined as BMI Ն95th percentile, were used to identify overweight trajectories with a latent growth mixture modeling approach. Results: Three distinct overweight trajectories were identified: 1) early onset overweight (10.9%), 2) late onset overweight (5.2%), and 3) never overweight (83.9%). After adjustment for multiple potential risk factors, male gender [odds ratio (OR), 1.5; 95% confidence interval (CI), 1.0 to 2.2], black ethnicity (OR, 1.7; 95% CI, 1.1 to 2.6), maternal 25 Յ BMI Ͻ30 kg/m 2 (OR, 2.2; 95% CI, 1.3 to 3.7) or Ն30 kg/m 2 (OR, 5.1; 95% CI, 2.9 to 9.1), maternal weight gain during pregnancy Ն20.43 kg (OR, 1.7; 95% CI, 1.0 to 2.9), and birth weight Ն4000 g (OR, 2.0; 95% CI, 1.2 to 3.4) were associated with an increased risk of early onset overweight. These risk factors, except maternal weight gain, exerted similar effects on late onset overweight. In addition, maternal smoking (OR, 1.6; 95% CI, 0.8 to 3.1) and birth order Ն3 (OR, 2.3; 95% CI, 1.0 to 5.2) were associated with an increased risk of late onset overweight only. Breastfeeding Ն4 months was associated with a decreased risk of both early (OR, 0.7; 95% CI, 0.3 to 1.3) and late onset overweight (OR, 0.7; 95% CI, 0.3 to 1.7). Discussion: Two trajectories of overweight and one never overweight group were identified. Early life predictors may have a significant influence on the developmental trajectories of overweight in children.

Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood

“…26 GWG is positively associated with birth weight even when stratifying on factors such as maternal BMI, age, parity and educational level. 27 In accordance with others, [11][12][13][14][15][16] our data suggest that birth weight is not a predominant mediator of the effect of GWG on offspring BMI. Instead, these intrauterine effects could be related to permanent modulation of appetite control, neuro-endocrine pathways influencing adipose tissue development and function or Gestational weight gain and offspring obesity L Schack-Nielsen et al energy metabolism causing development of obesity in later life.…”

“…Our finding of a consistent positive effect of maternal prepregnancy BMI on offspring BMI at all ages is supported by numerous studies 12,25,26 and is likely to primarily reflect the well-known genetic effects on obesity. 30 In addition, in agreement with other studies, 31,32 women who had the highest pre-pregnancy BMI had the lowest GWG.…”

“…16 In three of these studies, [11][12][13] the prevalence of maternal and childhood overweight was higher than in our study. This consistency is particularly important because our cohort had an overrepresentation of mothers with previous or current pregnancy complications as well as single mothers, whereas the study populations of the other studies were characterized as socially advantaged, 11,15 nationally representative 12 or multiethnic. 14 In contrast, studies with other primary focuses have reported no effect of GWG on offspring BMI in childhood 25 or young adulthood.…”

“…In another study, normal-weight children were compared with children with early (o6 years) and late onset of overweight (6-10 years), and GWG was found to predict only early-onset overweight. 12 It is possible that the effect of GWG is to make the offspring more susceptible to an obesogenic environment, which would imply that the expression of the effect is dependent on environmental exposures more than on the age of the individual.…”

“…7,9,10 Such acceleration has been observed in the stepwise development of the obesity epidemic in Denmark, where the second phase was much steeper than the first phase. 1 Furthermore, a high gestational weight gain (GWG) has recently been associated with an increased risk of overweight in children aged 2-14 years [11][12][13][14][15] and in 21-year olds, 16 after adjusting for maternal BMI. Thus, recommenda-tions for GWG may also need to take into account the longterm effects on the offspring.…”