Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain

Abstract

This study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow‐up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Bone Fractures in Children and Young Adults With Type 1 Diabetes: Age Distribution, Fracture Location, and the Role of Glycemic Control

“…Previous results on BMI and fracture risk in healthy children are controversial. There is evidence that overweight and obese children have higher risk for upper and lower limb fractures, (15) whereas another study reported decreased fracture risk in obese children and increased fracture risk in children with underweight. (16) In our cohort of children and young adults with T1D, no significant relation between BMI and fractures could be detected.…”

“…Further, the associations of body mass index (BMI) or concomitant pathology such as celiac disease with fracture risk in children with T1D is still controversial. (15)(16)(17)(18) The aim of this study was to evaluate the age distribution and most common fracture sites in children and young adults with T1D. Additionally, associations of fractures with metabolic control, physical activity, and smoking, as well as diabetes complications and comorbidity among children and young adults with T1D were investigated.…”

Adiponectin signalling in bone homeostasis, with age and in disease

“…Moreover, obesity significantly limited fracture repair, with no callus or connected bone observed in obese mice days after fracture unlike control animals. 81 High levels of limb fractures are also observed in obese children, [82][83][84] where abnormal BMAT and adiponectin levels may be contributing to reduced bone strengthen and delayed repair.…”

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“…Childhood obesity is one of the most worrying public health problems of the century. Its burden stems from its immediate influence on the psychological, dental and skeletal wellbeing, its persistence in adolescence years, and its positive association with noncommunicable diseases and mortality in adulthood [1][2][3][4][5]. Early identification of obesity plays a key role in controlling the disease at a time when lifestyle practices get established.…”