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Updated: Mar 22, 2026

Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
BMI at birth and overweight at age four
Jonathan D Winter1, Yhenneko Taylor2, Lauren Mowrer3
1VCU-Shenandoah Family Practice Residency, Front Royal, VA, United States.
Insights
Newborns with a high body-mass-index (BMI) at birth are more likely to be overweight by age 4. This finding suggests newborn BMI is a better predictor of childhood overweight than newborn macrosomia.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Elevated birth weight is linked to later obesity and health issues.
- Assessing infant adiposity has historically been challenging.
- WHO BMI growth charts for infants under two were introduced in 2006.
Purpose of the Study:
- To evaluate the association between newborn overweight and childhood overweight at age 4.
- To compare the predictive value of newborn body-mass-index (BMI) versus weight-for-age (WFA) for future overweight.
- To examine the correlation between maternal obesity and newborn anthropometrics.
Main Methods:
- Retrospective cohort analysis of anthropometric data from an integrated healthcare system.
- Defined newborn overweight and macrosomia using WHO growth charts (BMI and WFA >85%).
- Logistic regression models analyzed associations with 4-year-old overweight, controlling for covariates.
Main Results:
- Both newborn BMI and WFA above the 85th percentile were significantly associated with overweight at age 4.
- Newborn BMI >85% showed a stronger association (AOR 2.08) than WFA >85% (AOR 1.57).
- Maternal obesity was more strongly correlated with newborn BMI >85% (AOR 4.14) than WFA >85% (AOR 3.09).
Conclusions:
- Newborn body-mass-index (BMI) >85% is an independent predictor of overweight at age 4.
- Newborn overweight, particularly assessed by BMI, may be a superior predictor of 4-year-old overweight compared to macrosomia.
Background:
Extensive investigation has established that an elevated weight at birth is associated with subsequent obesity and obesity related negative health outcomes. The significance of overweight at birth, however, remains ill-defined. Historically, it has been difficult to approximate adiposity in infancy in a way that is both simple and meaningful. Body-mass-index (BMI) growth charts for children younger than two years of age only became available in 2006 when published by the WHO.
Methods:
This retrospective cohort analysis utilised anthropometric data extracted from the electronic medical record of a large integrated healthcare system in North Carolina. BMI and weight-for-age (WFA) >85% of WHO growth charts measured newborn overweight and macrosomia respectively. Logistic regression models assessed the associations between newborn macrosomia and overweight and overweight at 4 years of age, as well as associations with maternal BMI. Models included demographic data, gestational age, and maternal diabetes status as covariates.
Results:
Both BMI and WFA >85% at birth were significantly associated with overweight at age 4 years. However, the greater odds of overweight was associated with newborn BMI >85%, with an adjusted odds ratio (AOR) of 2.08 (95% confidence interval [CI]: 1.4-3.08) versus 1.57 (95% CI: 1.08-2.27). Maternal obesity was also more robustly correlated with newborn BMI >85%, AOR of 4.14 (95% CI: 1.6-10.7), than with newborn WFA >85%, AOR of 3.09 (95% CI: 1.41-6.77).
Conclusions:
BMI >85% at birth is independently associated with overweight at 4 years. Newborn overweight is perhaps superior to newborn macrosomia in predicting overweight at age 4.
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