Early adiposity rebound: causes and consequences for obesity in children and adults

Abstract

Childhood obesity is an important public health problem, with a rapidly increasing frequency worldwide. Identification of critical periods for the development of childhood and adolescent obesity could be very useful for targeting prevention measures. Weight status in early childhood is a poor predictor of adult adiposity status, and most obese adults were not obese as children. We first proposed to use the body mass index (BMI) charts to monitor individual BMI development. The adiposity rebound (AR) corresponds to the second rise in BMI curve that occurs between ages 5 and 7 years. It is not as direct a measure as BMI at any age, but because it involves the examination of several points during growth, and because it is identified at a time when adiposity level clearly change directions, this method provides information that can help us understand individual changes and the development of health risks. An early AR is associated with an increased risk of overweight. It is inversely associated with bone age, and reflects accelerated growth. The early AR recorded in most obese subjects and the striking difference in the mean age at AR between obese subjects (3 years) and non-obese subjects (6 years) suggest that factors have operated very early in life. The typical pattern associated with an early AR is a low BMI followed by increased BMI level after the rebound. This pattern is recorded in children of recent generations as compared to those of previous generations. This is owing to the trend of a steeper increase of height as compared to weight in the first years of life. This typical BMI pattern (low, followed by high body fatness level) is associated with metabolic diseases such as diabetes and coronary heart diseases. Low body fatness before the AR suggests that an energy deficit had occurred at an early stage of growth. It can be attributable to the high-protein, low-fat diet fed to infants at a time of high energy needs, the former triggering height velocity and the latter decreasing the energy density of the diet and then reducing energy intake. The high-fat, low-protein content of human milk may contribute to its beneficial effects on growth processes. Early (pre-and postnatal) life is a critical period during which environmental factors may programme adaptive mechanisms that will persist in adulthood. Under-nutrition in fetal life or during the first years after birth may programme a thrifty metabolism that will exert adverse effects later in life, especially if the growing child is exposed to overnutrition. These observations stress the importance of an adequate nutritional status in childhood and the necessity to provide nutritional intakes adapted to nutritional needs at various stages of growth. Because the AR reflects particular BMI patterns, it is a useful tool for the paediatrician to monitor the child's adiposity development and for researchers to investigate the different developmental patterns leading to overweight. It contributes to the understanding of chronic disease programming and suggests ne...

The influence of habitual protein intake in early childhood on BMI and age at adiposity rebound: results from the DONALD Study

“…19,22,23 We decided to stratify by sex, as differences between girls and boys concerning the physiology of the AR cannot be ruled out. 41 Although our results suggest that there is an association between early protein intake and BMI values in childhood, we were not able to confirm the hypothesis that such a relation is mediated by an earlier AR. Only a limited number of studies have examined the relation between early protein intake and timing of AR so far.…”

Adiposity Rebound and the Development of Metabolic Syndrome

“…We speculate that this may be due to more rapid growth in height because of improvement of nutritional status. 23,24 Associations of the age of AR with serum lipids, lipoproteins, AI, SBP, and DBP, with an earlier AR related to appearance of more atherogenic variables at 12 years of age, was apparent in boys in the current study; only Apo B showed a significant association with AR age in girls. The underlying mechanism of these sexually dimorphic differences may involve sex hormone levels and the androgen/estrogen balance.…”

“…The peak BMI in infancy has been shown to be ∼1 year old. 23 In our study, BMI at 1 year in all groups was not higher than that at 8 months, and BMI at 8 months in some groups was a little higher than that at 4 months. Thus, the peak BMI in our subjects occurred between 4 and 8 months, which is somewhat earlier than in previous reports.…”

Correlates of changes in BMI of children from the Azores islands

“…Rolland-Cachera et al 27 noted that the age that the rebound occurs (the age at adiposity rebound) predicts later fatness, an earlier rebound predicting greater fatness in adolescents 2 and adults. 28 In addition, the correlation of BMI values at 6 years of age and growth rate was 0.54 and in the US children reported by Danner 12 was 0.45. This association implies steeper BMI changes for those children with higher BMI values at 8 years of age, which references a close monitoring of height changes and possible associations with nutrition habits and PA levels.…”