PEDIATRICS Vol. 102 No. 5 November 1998, p. e60
ELECTRONIC ARTICLE:
Muscularity and Fatness of Infants and Young Children Born Small-
or Large-for-Gestational-Age
Received May 6, 1998; accepted Jul 1, 1998.
,
, and
From the * Division of Epidemiology, Statistics and Prevention
Research, National Institute of Child Health and Human Development,
National Institutes of Health, Bethesda, Maryland; National Center
for Health Statistics, Centers for Disease Control and Prevention,
Hyattsville, Maryland; § Klemm Analysis Group, Hyattsville, Maryland;
and Westat, Rockville, Maryland.
Objective. There is growing interest in
the extent to which body composition, both short- and long-term,
differs in infants and children born at the extremes of birth weight.
This is because a growing number of studies have linked low birth
weight and fetal growth restriction to the chronic diseases in
adulthood that often are obesity-related, and there is also evidence to
suggest that heavy infants may be at increased risk for obesity in
later life, again with the attendant obesity-related chronic diseases.
Our objective was to compare anthropometric indices of body composition
of infants and young children born small-for-gestational-age (SGA,
<10th percentile) or large-for-gestational age (LGA, 
90th
percentile) with those of normal birth weight status
(appropriate-for-gestational-age, AGA) in a US sample.
Design. National sample of US-born non-Hispanic white, non-Hispanic black, and Mexican-American infants and young children, 2 to 47 months of age, examined in the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), for whom birth certificates were obtained. The primary outcomes were normalized anthropometric indices (z scores or standard deviation units [SDU]) of nutritional status and body composition (mid-upper arm circumference, triceps and subscapular skinfolds, mid-upper arm muscle and mid-upper arm fat areas (UFA), and the arm fat index). The outcomes thus were scaled to permit comparison across chronologic ages.
Results. The prevalence of SGA was 8.6%,
appropriate-for-gestational-age 80.9%, and LGA 10.5%. From ages 2 to
47 months, for infants and young children born SGA, there was a
persistent overall deficit in muscularity (mid-upper arm circumference
and mid-upper arm muscle area) of approximately 
0.50 SDU, but less of
a deficit in fatness, particularly at the youngest ages. For infants
and young children born LGA, there was a surfeit in muscularity of ~0.45 SDU, with less of a surfeit in fatness, particularly at the
youngest ages. Across all ages, the mean UFA showed a statistically significant deficit for SGA children (0.27 ± 0.10 SDU) and
surfeit for LGA children (0.24 ± 0.08 SDU). At individual ages
for UFA and at individual and all ages combined for skinfold
thicknesses, there were no significant differences in level of
subcutaneous fatness in the three birth-weight-for-gestational-age
groups. There was a tendency in the first year for the arm fat index
(% arm fat) to be significantly higher for SGA infants, but the effect did not persist after the first year.
Conclusion. SGA infants remain smaller and LGA infants larger in size through early childhood, but the discrepancies in weight are primarily attributable to differences in lean body mass (muscularity). Fatness is less affected. Thus, based on the fatness indicators used, at any given weight for infants and children 2 to 47 months of age, percent body fat appears to be relatively higher for children who were SGA at birth and lower in those who were LGA at birth. These differences in body composition for SGA infants support the evidence documenting a link between disturbances in intrauterine growth and chronic disease associated with subsequent adiposity in adulthood. Key words: small-for-gestational-age, large-for-gestational-age, muscularity, fatness, growth, infants.
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