Systematic Examination of Infant Size and Growth Metrics as Risk Factors for Overweight in Young Adulthood

<div><p>Objective</p><p>To systematically examine infant size and growth, according to the 2006 WHO infant growth standards, as risk factors for overweight status in young adulthood in a historical cohort. Specifically, to assess: Whether accounting for length (weight-for-length) provides a different picture of risk than weight-for-age, intervals of rapid growth in both weight-for-age and weight-for-length metrics, and what particular target ages for infant size and intervals of rapid growth associate most strongly with overweight as a young adult.</p><p>Patients/Methods</p><p>Data analysis of 422 appropriate for gestational age white singleton infants enrolled in the Fels Longitudinal Study. Odds ratios (OR) for overweight and obesity in young adulthood (age 20–29) were calculated using logistic regression models for the metrics at each target age (0, 1, 3, 6, 9, 12, 18, 24 months) comparing ≥85^th v. <85^th percentile, as well as rapid growth (Δ≥0.67 Z-score) through target age intervals. Models accounted for both maternal and paternal BMI.</p><p>Results</p><p>Infants ≥85^th percentile of weight-for-age at each target age (except 3 months) had a greater odds of being overweight as a young adult. After accounting for length (weight-for-length) this association was limited to 12, and 18 months. Rapid weight-for-age growth was infrequently associated with overweight as a young adult. Rapid weight-for-length growth from 0 to 24 months, 1 to 6, 9, 12, 18, and 24 months and from 3 to 9, 12, 18, and 24 months was strongly associated with overweight status as a young adult.</p><p>Conclusions</p><p>The WHO weight-for-length metric associates differently with risk of being overweight as a young adult compared to weight-for-age. Intervals of rapid weight-for-length growth ranging from months (0–24), (1–12, 18, and 24) and (3–9, and 12) displayed the largest OR for being overweight as a young adult.</p></div

Odds ratio and 95% confidence interval of being overweight (BMI≥25 kg/m²) as a young-adult (age 20–29 years) according to infant growth status between target ages: Rapid Weight-for-Age growth (Δ≥0.67 Z score) vs. Non-rapid Weight-for-Age growth (Δ<0.67 Z score).

<p>-Overall N = 422, 101 overweight young adults (BMI≥25 kg/m²).</p><p>-Target age represents the beginning and end point of the growth period, e.g. 0–1 is birth to1 month.</p><p>-Rapid infant growth: (Δ≥0.67 Z score of WHO weight-for-age standard) ∼ change in centile on growth chart.</p><p>- OR (95% CI) represents estimate for rapid growth (Δ≥0.67) between target ages compared to non-rapid growth (Δ<0.67 Z score) (OR = 1.00).</p><p>- ^aN^ovwt/ N^rapid  =  Number who became overweight as young adults in the group who experienced rapid growth between target age points.</p><p>-All models adjusted for sex, gestational age at birth, age at adulthood obesity assessment, birth year, maternal and paternal age and BMI and birth weight-for-age Z-score.</p

Standardized Pancreatic Cancer rate and Hazard Ratios According to Body Mass Index (BMI), The Singapore Chinese Health Study.

<p>SCHS =  Singapore Chinese Health Study.</p><p>Standardized rate = Age and sex standardized cancer rate per 100,000 person years using person year time, age & sex distributions of SCHS.</p><p>HR (95% CI)  =  Hazard Ratio; 95% confidence interval: Model adjusted for age, sex, year of enrollment, dialect, education, diabetes status,</p><p>smoking (in whole population analysis), age of initiation of smoking habits, number of cigarettes per day, years of smoking, alcohol intake, dietary pattern score,</p><p>physical activity, sleep and energy intake.</p><p>BMI categories combined for ever-smokers into ≥ 24.5 kg/m²_.</p

Mean WHO Infant Weight-for-Age, Length-for-Age, and Weight-For-Length Z scores by sex in the Fels Longitudinal study.

<p>Mean WHO Infant Weight-for-Age, Length-for-Age, and Weight-For-Length Z scores by sex in the Fels Longitudinal study.</p

Population characteristics by sex.

<p>All values Mean (SD).</p>a<p>Age BMI adult = Age of adult anthropometric assessment.</p><p>Overweight =  BMI≥25 kg/m².</p><p>Obese  =  BMI≥30 kg/m².</p>b<p>Maternal BMI =  Non-pregnant BMI nearest infant birth.</p>c<p>Paternal BMI =  BMI nearest infant birth.</p><p>Maternal and Paternal age  =  Age at infant birth.</p

Participant Characteristics According to Body Mass Index (kg/m²) at Baseline, The Singapore Chinese Health Study.

<p>Dietary pattern (top 20%)  =  Dietary pattern score of greatest conformity in the population to a diet rich in vegetables, fruit and soy foods.</p><p>Data for age represent mean (SD).</p

Standardized Pancreatic cancer rates and Hazard Ratios According to Body Mass Index (BMI), Excluding the First Three Years of Follow-Up, The Singapore Chinese Health Study.

<p>SCHS =  Singapore Chinese Health Study.</p><p>Standardized rate = Age and sex standardized cancer rate per 100,000 person years using person year time, age & sex distributions of SCHS.</p><p>HR (95% CI)  =  Hazard Ratio; 95% confidence interval: Model adjusted for age, sex, year of enrollment, dialect, education, diabetes status,</p><p>smoking (in whole population analysis), age of initiation of smoking habits, number of cigarettes per day, years of smoking, alcohol intake, dietary pattern score,</p><p>physical activity, sleep and energy intake.</p><p>BMI categories combined for ever-smokers into ≥ 24.5 kg/m²_.</p

Odds ratio and 95% confidence interval of being overweight (BMI≥25 kg/m²) as a young-adult (age 20–29 years) according to percentile of the WHO infant growth standards: Infants ≥85^th percentile vs. <85^th percentile.

<p>-Overall N = 422, 101 overweight young adults (BMI≥25 kg/m²).</p><p>- OR (95% CI) represents estimate for ≥85^th percentile by target age compared to <85^th percentile by target age (OR = 1.00).</p><p>- ^aN^ovwt/ N^85th =  Number who became overweight as young adults in the group who were ≥85^th% at the target age.</p><p>- Model 1: <i>¹OR (95% CI)</i>  =  Adjusted for sex, gestational age at birth, age at adulthood obesity assessment, birth year,</p><p>- Model 2: <i>²OR (95% CI)</i>  =  Model 1 further adjusted for birth WHO weight-for-age or weight-for-length Z-score.</p><p>- Model 3: ³<i>OR (95% CI)</i>  =  Model 2 plus maternal and paternal age and BMI.</p

Cubic spline of the association between glycated hemoglobin (HbA1c %) and self-reported incident diabetes, adjusted for age, gender, and dialect, The Singapore Chinese Health Study.

<p>The hazard ratio (HR) is per each absolute increase of 1 percentage point in the glycated hemoglobin value at baseline. The shaded area is the 95% confidence interval from the restricted-cubic-spline model. The HR scale is logarithmic, the model is centered at the mean/median (5.7%), and the plot was truncated at the 5th and 95th percentiles of glycated hemoglobin (4.9% and 6.5%, respectively). The hazard ratio was adjusted for age, gender, and dialect.</p

Timeline and assembly of sub-sample, The Singapore Chinese Health Study.

<p>Timeline and assembly of sub-sample, The Singapore Chinese Health Study.</p