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Is restricted fetal growth associated with later adiposity? Observational analysis of a randomized trial
Michael S Kramer1, Richard M Martin1, Natalia Bogdanovich1
1From the Departments of Pediatrics (MSK and MD) and Epidemiology, Biostatistics and Occupational Health (MSK), McGill University Faculty of Medicine, Montreal, Canada; the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (RMM); the National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, United Kingdom (RMM); State Institution "the Republican Scientific and Practical Centre Mother and Child," Ministry of Health, Republic of Belarus (NB and KV); and the Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (EO).
Insights
Children born small for gestational age (SGA) were shorter, thinner, and had less body fat at age 11.5 years than peers. Postnatal weight gain did not alter these long-term adiposity differences in SGA children.
Area of Science:
- Pediatric endocrinology
- Growth and development
- Public health nutrition
Background:
- Developmental origins research suggests small for gestational age (SGA) birth increases long-term adiposity risks.
- Truncal adiposity is a particular concern in children born SGA.
Purpose of the Study:
- To evaluate the impact of SGA birth and early infancy weight gain on adiposity at 11.5 years of age.
- To compare adiposity markers in children born SGA, LGA, and AGA.
Main Methods:
- Utilized data from 17,046 Belarusian children in a cluster-randomized breastfeeding promotion trial.
- Measured height, weight, circumferences, skinfolds, and body fat percentage at 11.5 years.
- Employed multilevel statistical models controlling for various covariates.
Main Results:
- Children born SGA exhibited significantly lower BMI, body fat percentage, and fat mass index compared to AGA peers.
- A dose-response effect was observed across SGA subcategories.
- SGA infants with early catch-up growth had intermediate growth and adiposity measures.
- Children born LGA showed opposite effects of similar magnitude.
Conclusions:
- At 11.5 years, Belarusian children born SGA were shorter, thinner, and had less body fat than non-SGA peers.
- These differences persisted irrespective of postnatal weight gain.
- Findings contribute to understanding long-term health outcomes related to fetal growth.
Background:
Several recent "developmental origins" studies have reported increased long-term risks of adiposity, especially truncal adiposity, among children born small for gestational age (SGA).
Objective:
We assessed the effects of SGA birth and weight gain in early infancy on adiposity at age 11.5 y.
Design:
From a cluster-randomized breastfeeding promotion trial in 17,046 Belarusian children, we measured height, weight, waist and hip circumferences, triceps and subscapular skinfold thicknesses, and bioimpedance measures of percentage body fat at age 11.5 y. Children born SGA (birth weight <10th percentile) and those born large for gestational age (LGA; >90th percentile for gestational age) were compared with those born appropriate for gestational age (AGA). Weight gain from birth to 6 mo was categorized as high (>0.67-SD increase in weight-for-age), low (>0.67-SD decrease in weight-for-age), or normal. Multilevel statistical models accounted for clustered measurement and controlled for maternal and paternal height and body mass index (BMI), maternal education, geographic region, urban compared with rural residence, and the child's exact age at follow-up.
Results:
Children born SGA had a significantly lower BMI, percentage body fat, and fat mass index than did those born AGA, with a dose-response effect across 2 subcategories of SGA (P < 0.001 for all comparisons). No difference was observed in waist-to-hip ratio, although the subscapular-to-triceps skinfold ratio was slightly but significantly (P < 0.001) higher in children born SGA. Differences among the study groups continued to increase since the previous follow-up at 6.5 y. SGA infants with catch-up growth in the first 3-6 mo had growth and adiposity measures intermediate between those born SGA without catch-up and those born AGA. Opposite effects of similar magnitude were observed in children born LGA.
Conclusion:
The 11.5-y-old Belarusian children born SGA were shorter, were thinner, and had less body fat than their non-SGA peers, irrespective of postnatal weight gain. The Promotion of Breastfeeding Intervention Trial was registered at www.isrctn.org as ISRCTN-37687716.
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