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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Identifying children at high risk for overweight at school entry by weight gain during the first 2 years
Andre Michael Toschke1, Veit Grote, Berthold Koletzko
1Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Ludwig-Maximilians University, Munich, Germany. michael.toschke@LRZ.uni-muenchen.de
Insights
Infant weight gain from birth to 24 months best predicts later childhood overweight. However, this predictor has poor positive predictive value, indicating limited usefulness in the general population.
Area of Science:
- Pediatric Health
- Obesity Research
- Growth Monitoring
Background:
- Childhood overweight is a growing public health concern.
- Early anthropometric measurements are used to predict future health outcomes.
- Infant growth patterns may indicate risk for later overweight development.
Purpose of the Study:
- To identify the optimal anthropometric predictor of childhood overweight from birth to two years of age.
- To evaluate the predictive accuracy of various growth parameters and time intervals.
Main Methods:
- Retrospective cohort study of 4235 German children aged 5-7 years.
- Compared weight, length, body mass index (BMI), and ponderal index at birth, 6, 12, and 24 months.
- Utilized receiver operating characteristic (ROC) curves and predictive values to assess predictor accuracy.
Main Results:
- Weight gain from birth to 24 months showed the highest area under the ROC curve (0.76).
- A weight gain cutpoint of 9764g from birth to 24 months yielded the highest Youden index (41%).
- Despite a significant odds ratio (5.7), the positive predictive value was only 19%.
Conclusions:
- Weight gain between birth and 24 months is the most effective anthropometric predictor of later overweight.
- The predictive value is insufficient for widespread application in the general population due to a low positive predictive value.
Objective:
To assess the best anthropometric predictor from birth to 2 years for later overweight, based on recent studies reporting that large infant weight or length gain predicts subsequent overweight.
Design:
Retrospective cohort study.
Setting:
Southern Germany.
Participants:
German children (n = 4235) aged 5.0 to 6.9 years.
Main Outcome Measures:
Overweight at school entry was defined according to sex- and age-specific body mass index cutpoints proposed by the International Obesity Task Force. Weight, length, body mass index, and ponderal index differences between birth, 6 months, 12 months, and 24 months of age were compared by receiver operating characteristic curves and predictive values.
Results:
For all variables, the largest area under the receiver operating characteristic curve was observed with a 24-month follow-up: 0.76 (95% confidence interval [CI], 0.74-0.79) for weight, 0.70 (95% CI, 0.67-0.72) for body mass index, and 0.58 (95% CI, 0.55-0.61) for length gain. The highest Youden index ([sensitivity plus specificity] minus 1) for weight gain from birth to 24 months (41%) was attained for a cutpoint of 9764 g, with a corresponding positive likelihood ratio of 2.39 (95% CI, 2.20-2.59) and positive predictive value of 19% (95% CI, 17%-21%), despite an odds ratio of 5.7 (95% CI, 4.5-7.1).
Conclusions:
Weight gain from birth to 24 months was the best overall predictor of later overweight compared with other anthropometric markers and intervals. However, the corresponding poor positive predictive value suggests that only 1 of 5 children with a large weight gain in the first 2 years is overweight at school entry and reflects an insufficient predictability in the general population.
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