Early-life weight gain patterns of term small-for-gestational-age infants and the predictive ability for later childhood overweight/obesity: A prospective cohort study

Abstract

ObjectivesWe aimed to identify the weight gain patterns of small-for-gestational age (SGA) infants in early life and to explore the predictive value for later overweight/obesity in childhood.MethodsWe obtained data from a prospective cohort including term SGA infants born between January 2006 and November 2015 who received regular health care from birth to 5 years in West China Second University Hospital, Chengdu, China. A latent class growth analysis (LCGA) was applied to group children with similar growth trajectory patterns. Multiple logistic regression was performed to examine the association between weight gain patterns and later overweight/obesity.ResultsA total of 296 term SGA infants were finally included. Five weight gain trajectories were identified, including excessive rapid catch-up growth (ERCG) (class 1, 10.9%), rapid catch-up growth (RCG) (class 2, 17.9%), appropriate catch-up growth (ACG) (class 3, 53.0%), slow catch-up growth (SCG) (class 4, 13.4%) and almost no catch growth (NCG) (class 5, 4.8%). SGA infants in class 1 and class 2 had a higher BMI according to age- and sex-specific Z scores from 2–5 years of age. In addition, 25% of SGA infants in class 1 and 13.2% of SGA infants in class 2 were found to be overweight/obese at 2-5 years of age. After adjusting for confounders, we found that extremely rapid weight gain (class 1) in the first 2 years of life increased the risk of overweight/obesity by 2.1 times at 2 to 5 years of age (aOR=2.1, 95% CI: 1.3~4.8; P<0.05). Furthermore, the increment of ΔWAZ between 0 and 4 mo was prominently related to the risk of overweight/obesity at 2 to 5 years for term SGA infants (aOR=3.2, 95% CI: 1.7~8.1; P<0.001). A receiver operating characteristic (ROC) curve showed the area under curve (AUC) was 0.7, with a 95% confidence interval (CI) from 0.6 to 0.8 (P<0.001).ConclusionsThe extremely rapid weight gain pattern of term SGA infants in the first 2 years of life increased the risk of overweight/obesity at 2 to 5 years of age. It suggests monitoring weight gain across the infant period represents a first step towards primary prevention of childhood obesity.

Small for gestational age and anthropometric body composition from early childhood to adulthood: the Aboriginal Birth Cohort study

“…This interesting finding highlights the potential complex interplay between possible early catch-up growth among those born SGA, lifestyle factors later in life, and the nutritional challenges prevalent in remote communities ( 29 , 43 ). Rapid catch-up growth among SGA infants is a risk factor for being overweight/obese at 2–5 years of age ( 9 ) and is associated with increased fat mass at 9 years of age ( 37 ), and fat mass with central adiposity at 32 years of age ( 44 ). Lower birth weight combined with faster growth in the first 5 years has also been associated with increased hepatic fat in early childhood ( 45 ).…”

Latent Classes of Anthropometric Growth in Early Childhood Using Uni- and Multivariate approaches in a South African Birth Cohort

“…Wang et al, found dynamic BMI growth patterns (such as BMI catch-up and stable overweight) were more predictive, and thus more informative, than static BMI measurements of cardiovascular structure and function in early childhood (32). Rapid weight gain in early childhood (or catch-up growth) has been associated with an increased risk of overweight, obesity and other chronic diseases during later childhood and adulthood (33)(34)(35)(36). Additionally, catch-up growth has been associated with various factors such as altered insulin metabolism (37,38) and hence an increased risk of Type II diabetes (39), increased systolic blood pressure (40), increased risk of coronary heart disease (7) and an increased risk of childhood asthma (41) Various factors may modify the risk of rapid weight gain or obesity, including bottle feeding, shorter gestation age and being firstborn (42,43).…”

Growth trajectory of full-term small-for-gestational-age infants: a 3-year longitudinal study in China

“…32 There is growing evidence that children who grow up quickly during childhood are more likely to be obese and have metabolic disorders such as insulin resistance and non-insulin-dependent diabetes, hypertension and cardiovascular disease during adulthood. 33 Li et al 34 found that the extremely rapid weight gain pattern of term SGA infants from birth to 2 years was significantly related to the increased risk of overweight/obesity at 2-5 years in later life. The risk was approximately two times higher than that of full-term non-SGA infants.…”