Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e67-e73 (doi:10.1542/peds.2008-1292)
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ARTICLE

Contribution of Early Weight Gain to Childhood Overweight and Metabolic Health: A Longitudinal Study (EarlyBird 36)

Daphne S. L. Gardner, MD, Joanne Hosking, PhD, Brad S. Metcalf, BSc, Alison N. Jeffery, MSc, Linda D. Voss, PhD and Terence J. Wilkin, MD

Department of Endocrinology and Metabolism, Peninsula College of Medicine and Dentistry, Plymouth Campus, Plymouth, United Kingdom

BACKGROUND. Early weight gain (0–5 years) is thought to be an important contributor to childhood obesity and consequently metabolic risk. There is a scarcity of longitudinal studies in contemporary children reporting the impact of early weight gain on metabolic health.

OBJECTIVE. We aimed to assess the impact of early weight gain on metabolic health at 9 years of age.

METHOD. Two hundred thirty-three children (134 boys, 99 girls) with a gestational age of >37 weeks were assessed at birth, 5 years of age, and 9 years of age. Measures included weight SD scores at each time point and excess weight gained ({Delta} weight SD score) between them. The outcome measure included composite metabolic score (sum of internally derived z scores of insulin resistance, mean blood pressure, triglyceride level, and total cholesterol/high-density lipoprotein cholesterol ratio).

RESULTS. Weight SD score increased by 0.29 SD score in girls and 0.26 SD score in boys from 0 to 5 years of age and by 0.03 SD score in girls and 0.11 SD score in boys from 5 to 9 years of age. Weight SD score correlated poorly to moderately before 5 years of age but strongly after 5 years of age. Birth weight SD score predicted (girls/boys) 2.4%/0% of the variability in composite metabolic score at 9 years of age. Adding {Delta} weight SD score (0–5 years old) contributed (girls/boys) 11.2%/7.0% to the score, and adding {Delta} weight SD score (5–9 years old) additionally contributed (girls/boys) 26.4%/16.5%. Importantly, once weight SD score at 9 years of age was known, predictive strength was changed little by adding {Delta} weight SD score.

CONCLUSIONS. Most excess weight before puberty is gained before 5 years of age. Weight at 5 years of age bears little relation to birth weight but closely predicts weight at 9 years of age. Single measures of current weight are predictive of metabolic health, whereas weight gain within a specific period adds little. A single measure of weight at 5 years of age provides a pointer to future health for the individual. If metabolic status at 9 years of age means future risk, diabetes/cardiovascular prevention strategies might better focus on preschool-aged children, because the die seems to be largely cast by 5 years of age, and a healthy weight early in childhood may be maintained at least into puberty.

Key Words: insulin resistance • children • metabolic health

Abbreviations: IR—insulin resistance • SDS—SD score • BP—blood pressure • TC—total cholesterol • HDL-C—high-density lipoprotein cholesterol • HOMA—homeostasis model assessment • CI—confidence interval

Accepted Oct 1, 2008.


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