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ARTICLES: Elsie M. Taveras, Sheryl L. Rifas-Shiman, Mandy B. Belfort, Ken P. Kleinman, Emily Oken, and Matthew W. Gillman Weight Status in the First 6 Months of Life and Obesity at 3 Years of Age Pediatrics 2009; 123: 1177-1183 [Abstract] [Full text] [PDF]

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Rapid Weight Gain Predicts Cardiometabolic Risk Regardless of Birth Weight

Young S. Choi, Carl E. Hunt, MD, Uniformed Services University of the Health Sciences, Bethesda, MD   (3 April 2009)

Rapid Weight Gain Predicts Cardiometabolic Risk Regardless of Birth Weight 3 April 2009
Young S. Choi, MD Womack Army Medical Center, Fort Bragg, NC, Carl E. Hunt, MD, Uniformed Services University of the Health Sciences, Bethesda, MD Send letter to journal: Re: Rapid Weight Gain Predicts Cardiometabolic Risk Regardless of Birth Weight young.choi2{at}amedd.army.mil Young S. Choi, et al.	To the Editor.— Taveras et al(1) report on a prospective cohort of 559 children with a mean birth weight of 3.55 kg and mean gestational age of 39.8 weeks. They found that increased weight-for-length z scores at birth were associated with increased odds of obesity at 3 years of age. This is consistent with a systematic review of 24 studies concluding infants with the highest body mass index are at increased risk for subsequent obesity(2). The implications are clear: increased risk for metabolic syndrome and cardiovascular disease. While these findings might be somewhat intuitive and expected, it doesn’t easily explain why full-term small for gestational age (SGA) or pre-term infants are also at risk for cardiovascular disease. Since Barker proposed the “fetal origins hypothesis” of cardiovascular disease(3,4), much literature has been focused on the developmental origins of subsequent health. For instance, low birth weight and/or prematurity is associated in adults with hypertension(5), insulin resistance(6,7), dyslipidema(8), and higher body mass index(9-11). Is there then a common factor that presages obesity and/or the components of the metabolic syndrome in SGA, pre-term, or large full-term infants? The Taveras study would seem to indicate that in full-term infants, obesity is heralded by rapid weight gain in infancy, particularly that which occurs in the first 6 months(1). In addition, the adverse consequence of accelerated growth on cardiometabolic status in SGA and pre -term infants may be comparable or perhaps even greater. For instance, greater weight or linear gain in the first 2 weeks of life was associated with lower flow-mediated endothelium-dependent dilation, irrespective of normal or low birth weight(12). Similarly, accelerated post-natal growth in pre-term infants is associated with increased subcutaneous and total adiposity relative to control term infants(13). Singhal and Lucas propose the “growth acceleration” hypothesis to explain the increased risk of cardiovascular disease associated with rapid weight gain regardless of birth weight(14). In fact epidemiological data supports this hypothesis in the form of a “catch-up fat” phenotype that can be relevant at any age(15). It thus appears that the characteristic phenotype common to cardiometabolic risk, regardless of birth size, is rapid weight gain. We agree that infancy is a crucial period in obesity prevention and may even be more crucial in low birth weight infants born premature or SGA. Rapid weight gain should be prevented, and a careful re-evaluation of the risks and benefits of nutritional therapy should be undertaken in pre-term and SGA infants. Y. Sammy Choi, MD, FAAP, FACP; Departments of Medicine, Pediatrics, and Research; Womack Army Medical Center, Fort Bragg, NC 28310 Carl E. Hunt, MD; Professor of Pediatrics; Uniformed Services University of the Health Sciences, Bethesda, MD 20814 The views expressed herein are those of the authors and not to be construed as representing the official views of the Department of Defense. REFERENCES: 1. Taveras EM, Rifas-Shiman SL, Belfort MB, Kleinman KP, Oken E, Gillman MW. Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics 2009;123:1177-1183 2. Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 2005;331:929-935 3. Barker DJP, Osmond C, Law CM. The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis. J Epidemiol Community Health 1989;43:237-240 4. Barker DJP. Fetal origins of coronary heart disease. BMJ 1995;311:171-174 5. Davis AA, Smith GD, May MT, Ben-Schlomo Y. Association between birth weight and blood pressure is robust, amplifies with age, and may be underestimated. Hypertension. 2006;48:431-436 6. Singhal A, Fewtrell M, Cole TJ, Lucas A. Low nutrient intake and early growth for later insulin resistance in adolescents born preterm. Lancet 2003;361:1089-1097 7. Hofman PL, Regan F, Jackson WE, et al. Premature birth and later insulin resistance. N Engl J Med 2004;351:2179-2186 8. Jaquet D, Czernichow P. Born small for gestational age: increased risk of type 2 diabetes, hypertension and hyperlipidaemia in adulthood. Horm Res 2003;59:131-137 9. Meas T, Deghmoun S, Armoogum P, Alberti C, Levy-Marchal C. Consequences of being born small for gestational age on body composition: an 8-year follow-up study. J Clin Endocrinol Metab 2008;93:3804-3809 10. Euser AM, Finken MJ, Keijzer-Veen MG, Hille ET, Wit JM, Dekker FW. The Dutch POPS-19 Collaborative Study Group. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Am J Clin Nutr 2005;81:480-487 11. Doyle LW, Faber B, Callanan C, Ford GW, David NM. Extremely low birth weight and body size in early adulthood. Arch Dis Child 2004;89:347- 350 12. Singhal A, Cole TJ, Fewtrell M, Deanfield J, Lucas A. Is slower early growth beneficial for long-term cardiovascular health? Circulation 2004;109:1108-1113 13. Uthaya S, Thomas EL, Hamilton G, Dore CJ, Bell J, Modi N. Altered adiposity after extremely preterm birth. Pediatr Res 2005;56:211-215 14. Singhal A, Lucas A. Early origins of cardiovascular disease: is there a unifying hypothesis? Lancet 2004;363:1642-1645 15. Dulloo AG, Jacquet J, Seydoux J, Montani JP. The thrify ‘catch-up fat’ phenotype: its impact on insulin sensitivity during growth trajectories to obesity and metabolic syndrome. Int J Obes 2006;30:S23-S35 Conflict of Interest: None declared