Neonatal Adiposity and Childhood Obesity

Abstract

OBJECTIVES: To explore the longitudinal association of neonatal adiposity (fat mass percentage) with BMI trajectories and childhood overweight and obesity from ages 2 to 6 years. METHODS:We studied 979 children from the Healthy Start cohort. Air displacement plethysmography was used to estimate fat mass percentage. Child weight and recumbent length or standing height were abstracted from medical records. Overweight and obesity were defined as BMI levels $85th percentile for age and sex. Mixed-effects models were used to examine the association between neonatal fat mass percentage and BMI trajectories from age 2 to 6 years. We tested for effect modification by sex, race and/or ethnicity, and breastfeeding duration. We estimated the proportion of children classified as overweight or obese at specific levels of neonatal fat mass percentage (mean 6 SD). RESULTS:The mean neonatal adiposity level was 9.1% 6 4.0%. Child BMI levels differed by neonatal adiposity. Each SD increase in neonatal adiposity resulted in a 0.12 higher overall BMI level between ages 2 to 6 years (95% confidence interval: 0.03 to 0.20; P , .01), and this association was not modified by offspring sex, race and/or ethnicity, or breastfeeding duration. Increasing neonatal adiposity was associated with an increasing proportion of childhood overweight and obesity by age 5 years (P = .02). CONCLUSIONS:We provide novel evidence that higher neonatal adiposity is significantly associated with higher overall BMI levels and an increased likelihood of overweight or obesity from ages 2 to 6 years. Because various prenatal exposures may specifically influence offspring fat accretion, neonatal adiposity may be a useful surrogate end point for prenatal interventions aimed at reducing future childhood overweight and obesity.

Reducing intergenerational obesity and diabetes risk

“…Specifically, offspring body composition at birth appears to be more sensitive than total weight to modifiable intrauterine exposures, including maternal obesity [71], gestational diabetes [31], and prenatal diet [72] or physical activity [73]. Neonatal adiposity (% fat mass) also tracks over time [74] and predicts offspring BMI and overweight/ obesity status from ages 2 to 6 years [75], demonstrating the prognostic significance of even small differences at birth. At the same time, to definitively determine the impact of preconception interventions on intergenerational obesity and diabetes risks, future preconception trials must include rigorous evaluation of offspring outcomes, with extended follow-up into childhood, adolescence and the reproductive years, plus continued follow-up into the third generation to assess transgenerational impact.…”

Maternal dietary fat intake during pregnancy and newborn body composition

“…Other longitudinal studies have demonstrated that increased neonatal adiposity is associated with increased risk of being overweight or obese between two and six years old, and each standard deviation increase in neonatal adiposity is associated with a 0.12 kg/m 2 higher BMI. ( 11 ) Our study provides preliminary evidence to support dietary interventions during pregnancy as even modest benefits may play a role in breaking the cycle of generational obesity. Our findings that maternal dietary fat intake is particularly worrisome for males aligns with Chen et al, who concluded that addition of maternal dietary fat (while keeping other macronutrients constant) was associated with higher total abdominal fat in males but not females.…”

“…Our study supports the existing hypothesis that maternal diet determines maternal circulating lipids, which plays a role in fetal adipogenesis and affects subsequent risk for neonatal, childhood, and adult obesity. ( 11 , 19 , 20 ) Crume et al also demonstrated a positive association between maternal saturated fat intake and neonatal fat mass, ( 12 ) and Horan et al concluded a positive relationship between infant abdominal circumference at birth and maternal saturated fat intake during the third trimester of pregnancy. ( 15 ) Blumfield et al did not assess fat intake by trimester, but did not find a relationship between maternal saturated fat intake and infant mid-thigh or abdominal fat.…”

“…( 6 ) Evidence has also shown that increased neonatal adiposity is associated with increased risk of being overweight or obese between two and six years old. ( 11 )However, the role that maternal diet plays in determining human infant adiposity remains poorly understood. If altering maternal diet during pregnancy could impact infant adiposity and lower lifetime risk for chronic disease independently of BW, then improving dietary intake of pregnant mothers could be a tool to prevent chronic disease at the earliest stages of life.…”

Extrauterine Growth Restriction in Very Low Birth Weight Infants: Concordance Between Fenton 2013 and INTERGROWTH-21st Growth Charts

“…Adequate nutritional support during the hospital stay is critical to reduce EUGR rate. However, if it is excessive, this can lead to an increase in fat mass and a higher future risk of non-communicable diseases such as obesity or metabolic syndrome ( 29 ).…”