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Predicting childhood overweight status by accelerated weight gain from neonatal period to infancy
Shahin Koohmanaee1, Hamidreza Badeli1, Afagh Hassanzadeh Rad1, Mohammad Hassan Novin1, Neda Mostofizadeh2, Setila Dalili1, Ehsan Kazemnejad-Leili1
1 Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
2 Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| Date of Submission | 01-Dec-2021 |
| Date of Decision | 21-Jun-2022 |
| Date of Acceptance | 12-Oct-2022 |
| Date of Web Publication | 31-Jan-2023 |
Correspondence Address:
Dr. Setila Dalili
Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jrms.jrms_1041_21
Background: The increased prevalence of obesity in early childhood is a public health problem. Childhood obesity may affect cardiorespiratory fitness and can induce obesity and its comorbidities in adulthood. We aimed to assess childhood overweight status by accelerated weight gain during infancy. Materials and Methods: This is a historical cohort that was conducted on 637 7-year-old students of Guilan province, north of Iran. Data were collected, including demographic characteristics, weight at 4, 6, 12, and 18 months, and clinical examination. The ROC curve was designated based on the standardized z-scores, and the most appropriate cutoff point by sensitivity and specificity was noted for predicting obesity at 7 years. Rapid weight gain (RWG) was also assessed. Results: Among participants, 334 (53.3%) were female. In this study, the mean and standard deviation of RWG in 0–4 months, 0–6 months, 0–12 months, and 0–18 months were 3.50 ± 0.89, 4.64 ± 1.02, 6.54 ± 1.21, and 8.00 ± 1.46 kg, respectively. The highest AUC was dedicated to 0–18 months (0.7 ± 0.05) and the suitable cut-off for RWG in this interval was 8.55 kg with 65.5% and 72.0% sensitivity and specificity, respectively. Conclusion: Although in the previous investigations, the changes in the first 3 years of life had a significant role in further complications, regarding our results, it seems that even earlier consideration of excess weight gain may be necessary.
Keywords: Child, obesity, overweight, weight
How to cite this article:
Koohmanaee S, Badeli H, Rad AH, Novin MH, Mostofizadeh N, Dalili S, Kazemnejad-Leili E. Predicting childhood overweight status by accelerated weight gain from neonatal period to infancy. J Res Med Sci 2023;28:2 |
How to cite this URL:
Koohmanaee S, Badeli H, Rad AH, Novin MH, Mostofizadeh N, Dalili S, Kazemnejad-Leili E. Predicting childhood overweight status by accelerated weight gain from neonatal period to infancy. J Res Med Sci [serial online] 2023 [cited 2023 Jun 1];28:2. Available from: https://www.jmsjournal.net/text.asp?2023/28/1/2/368850 |
| Introduction | |  |
Childhood obesity is a noncommunicable disease which have taken a worldwide attention due to its prevalence and considered to be a public health problem. Childhood obesity tends to be continued across adulthood and induce comorbidities of adulthood obesity such as type 2 diabetes mellitus and cardiovascular diseases.[1]
It has been shown that obesity is multifactorial and has a close relationship with genetic, psychological, and environmental factors. Various factors may be associated with childhood obesity including nutrition in early life, excessive gestational weight gain,[2] maternal smoking during pregnancy, parent feeding practices, duration of breastfeeding, body mass index (BMI), father's weight, birth order, age, birth weight, and rapid weight gain (RWG).[3],[4]
RWG by definition is the upward centile trend in weight growth charts. In recent years, researchers have been focused on future obesity that will be caused by RWG during infancy.[5] Investigations have proven that RWG is directly associated with BMI in which a change in weight z-score >0.67 in RWG during infancy would result in two- to three-fold increase in subsequent adulthood obesity.[6] Another systematic review and meta-analysis showed that infants with RWG had 3.66 times greater chance of being obese in adulthood.[7] However, regarding the value of RWG and later obesity, it has been understood that infants fed formula had a higher impact on RWG and the following adulthood obesity than breastfed infants.[8] As obesity and dyslipidemia are common in childhood, cardiometabolic risk factors should be screened in addition to obesity, especially in children with RWG.[9] Even thought, the exact time of RWG which led to subsequent adulthood obesity is not clear, by understanding the causes of childhood adiposity, epidemiology of RWG in infant, and investigating the association of RWG during infancy in different populations, one can determine the risk factors of later obesity and propose the later actions to prevent its health complications.[10]
Based on a key role of RWG in the first 1000 days of life as an important predictor for childhood obesity and overweight,[11] the need for investigating the impact of RWG in different regions of world and introducing effective approaches to prevent childhood obesity, we aimed to assess the association of RWG during 0–18 months of infancy with later obesity at 7 years.
| Materials and Methods | | |
This is a prospective cohort study which was conducted on 637, 7-year old children with term birth (≥37 weeks of gestation) and normal birth weight (2500–4000 g) from Guilan province. Samples were selected by clustered sampling method. Written consents were obtained and all participants were examined by trained physicians practicing in 15 regional urban health centers from which the data for the study were recorded. We used CDC growth and BMI charts for evaluating children. This study was a grant approved by the Vice-Chancellor of Research at Guilan University of Medical Sciences (Number: 93121131).
Data were collected by a form including demographic characteristics such as weight at 0, 4, 6, 12, and 18 months of age, and current clinical examinations. All examiners used the same tools for measuring the variables. All tools were calibrated daily.
For determining an appropriate cutoff point for predicting RWG on obesity at 7 years, the differences between the weight of the child at birth and 4, 6, 12, and 18 months of age were calculated. Then, the z-scores of weight were mentioned based on the mean and standard deviation (SD) of the population and the differences were standardized.
The ROC curve was designated based on the standardized z-scores. The most appropriate cutoff point by sensitivity and specificity was noted for predicting the obesity at 7 years.
RWG was defined as an increase in weight-for-age z-scores of 0.67 SDs.[12],[13]
Children at 7 years were divided into normal (5th–85th percentile) or overweight and obese (85th–95th, and >95th percentile, respectively) groups based on BMI percentile for sex and age. In these groups, the pattern of weight gain was indicated as the change in weight-for-age z-scores in each age group and was classified as catch-down growth (z score <−0.67), normal (z score − 0.67 ± 0.67), and RWG (≥+0.67).
Statistical analysis
Data analysis was done by SPSS software, version 21. Data were reported by descriptive statistics. Chi-square test was used to compare qualitative data. Cutoff point and sensitivity and specificity using the ROC curve were designated. Logistic regression analysis by backward LR method was applied in multivariate analysis. We imported P< 0.05 indicated statistical significance.
| Results | | |
In this investigation, 50 out of 637 enrolled participants were excluded due to incomplete records. Among the participants, 334 (53.3%) were girls and the remained were boys. In this study, the mean and SD of RWG in 0–4 months, 0–6 months, 0–12 months, and 0–18 months were 3.50 ± 0.89, 4.64 ± 1.02, 6.54 ± 1.21, and 8.00 ± 1.46 kg, respectively.
All AUC intervals for different age groups were significant for predicting obesity at 7 years of age, but based on the AUC index, the highest belonged to 0–18 months and the suitable cutoff for RWG in this interval was 8.55 kg with sensitivity and specificity of 65.5% and 72.0%, respectively.
Results showed that gaining weight >4.078 and 3.428 kg from the ages of 0–4 months, 0–6 months increased the probability of obesity at the age of 7 years, respectively [Table 1].
The relationship between obesity at 7 years and the pattern of weight gain in different age groups showed that only 0–12 months and 0–18 months weight gain significantly related with childhood obesity (P = 0.006 and P< 0.0001, respectively). The response trend over time is shown in [Figure 1].
The percentage of obesity in children with RWG at 0–12 months was 10.4% which was 3 folds higher than normal weight and children with catch-down growth. Furthermore, 12.7% of children with RWG at 0–18 months were obese at 7 years which was, respectively, 4 and 7 folds higher than normal and catch down growth children [Table 2].
Logistic regression analysis showed that RWG in 0–18 months had the highest effect on obesity at 7 years in both boys and girls (P < 0.001) with odds-ratio 1.93 and 1.4, respectively [Table 3]. | Table 3: Stepwise backward logistic regression method of logistic regression analysis regarding sex
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| Discussion | | |
Weight gain during infancy is the underlying reason for later obesity.[14] The present study demonstrated that the prevalence of RWG was approximately 20% in all age groups. This result was lower than previous studies. Bertotto et al. and Ekelund et al. indicated that the prevalence of excess weight gain at 1st year of age was 30% and 25.4%, respectively.[15],[16] Although Bertotto et al. documented 20% of children as overweight and 5.5% as obese.[17] Another study by Retamal and Mascie-Taylor showed RWG prevalence of 30% and obesity prevalence of 10% and concluded that when the children were categorized at overweight or obese group, they tended to remain with it.[18] This difference may rise from the fact that we assessed RWG based on mean percentile of weight in our participants and not regarding CDC growth charts. Furthermore, Eckhardt et al. indicated some inconsistencies regarding the growth references and age intervals in which they stated that RWG prevalence of CDC reference tends to produced higher percentiles in early infancy (0–3 months of age) and WHO standards tends to produced higher percentiles in later infancy (6–12 months of age). They reported RWG prevalence for 0–3 month age interval of 9.9% for both references which were in concordant with and validated our results.[19]
In the 1st month after birth, babies experience growth velocity, which decrease in later months. This is why the cutoff point for weight gain in the first 6 months was lower than the first 4 months. Previous investigators believed that this difference might be noted because of rapid physiologic weight gain (gestational weight gain) in the first 4 months after birth than the 4th to 8th months.[20] In addition, underlying reasons may arise from the pre- and postnatal exposures including smoking during pregnancy,[21] pre-pregnancy weight status,[22] and breastfeeding[23] on infant weight gain. In concordance with this result, a randomized feeding trial reported that consuming more dietary energy during early infancy leads to weight gain.[24] It seems that the weight gain more than 3.428 kg in the first 6 months of life might be occurred as a result of poor weight gaining and consequently motivate parents to boost feeding.[25]
Our results showed a lack of significant association of RWG in 0–4 months with childhood obesity, and overweight. Similar to our findings, a study investigating 128 individuals from infancy to 17 years concluded that those with accelerated weight gain in early infancy did not result in later obesity.[26] In contrast, Stettler et al. reported a prevalence of RWG at 7 years of 5.4% and mentioned that RWG pattern during the first 4 months of life was significantly associated with an increased risk of overweight at 7 years.[27] This result was inconsistent with ours. Kain et al. also declared that obesity and overweight may promote general or central obesity at 7 years of age[28] so, early prevention was recommended.
Current study based on the pattern of weight gain on different age groups showed that RWG at 0–12 months and 0–18 months were significantly related with childhood obesity. Furthermore, our results indicated that RWG at 0–18 months promotes the risk of obesity at 7 years. This result was consistent with the study of Goodell et al.[29] They noted that the existence of RWG during the 1st year of life induced 9.24 (confidence interval [CI]: 3.73–22.91) folds increased the risk of obesity compared to the lack of RWG.
Furthermore, results showed that RWG at 0–18 months with the cutoff point of 8.555 had the both highest sensitivity and specificity and is the predictor of obesity at 7 years. Nearly close to this number, Gungor et al. assessed children aged 0–24 months and noted that weight gain of 9.01 kg or more had the best combined sensitivity and specificity for childhood weight gain.[30] Determining the best cutoff point has the advantages of less false-negative and false-positive results and assured us that less bias engaged in our study.
Although in the previous investigations, the changes in the first 3 years of life had a significant role in further complications, regarding our results, it seems that even earlier consideration of excess weight gain may be necessary. In addition, investigators did not assess breast feeding or the solids/foods consumption during infancy and 7 years of age and it may be the limitation of this study. Besides, the association between obesity and socio-economic status was not assessed, therefore, performing multicenter investigations on nutritional status are highly recommended to produce comprehensive results and introduce obesity prevention strategies.
Altogether, our results demonstrated the significant association of accelerated weight gain at two age intervals (0–12 months and 0–18 months) with later obesity at 7 years. In addition, weight gain of 8.55 kg or more at 0–18 months was set as cutoff point for predicting obesity with the highest sensitivity and specificity in the assessed population. Interestingly, cutoff point at 0–4 months was higher than 0–6 months (4.078 compared to 3.428) which enabled us to propose controlled feeding strategy in infants even with no significant RWG to prevent later obesity. Furthermore, logistic regression analysis indicated that RWG at 0–18 months had the highest effect on obesity.
| Conclusions | | |
Our finding provides a road to be paved for understanding the importance of RWG in specific time intervals during infancy and its subsequent obesity. In the investigated population, 0–18 months of age proposed as a predictor for later obesity. This exact time period informs us to prevent future obesity complications if noticing weight gain over 8.55 kg at 0–18 months of age.
Acknowledgments
This study was financially supported by the Vice Chancellor of Research of Guilan University of Medical Sciences. It was a grant approved by the Vice-Chancellor of Research at Guilan University of Medical Sciences (Number: 93121131).
Ethical considerations
informed consent letters were obtained from parents.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3]
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