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Growth During Infancy and Early Childhood and Its Association With Metabolic Risk Biomarkers at 11.5 Years of Age
Xun Zhang1, Richard M Martin2, Emily Oken3
1Department of Obstetrics and Gynecology, School of Medicine, National University of Singapore, Singapore.
Insights
Childhood growth, not fetal development, strongly impacts cardiometabolic health. Later childhood growth shows the most significant associations with metabolic markers, challenging earlier "sensitive period" theories.
Area of Science:
- Pediatric Endocrinology
- Metabolic Health
- Growth and Development
Background:
- Traditional views suggest fetal and early infancy are critical periods for cardiometabolic disease risk.
- Previous research often focused solely on weight gain, neglecting length/height and body mass index (BMI).
- Methodological limitations in comparing different age periods have previously confounded findings.
Purpose of the Study:
- To re-evaluate the sensitive periods for cardiometabolic disease development.
- To investigate the association of growth in weight, length/height, and BMI during various childhood stages with later metabolic health.
- To challenge the established notion of critical early-life windows for metabolic disease risk.
Main Methods:
- Secondary analysis of the Promotion of Breastfeeding Intervention Trial (1996-2010) birth cohort.
- Utilized mixed-effects linear models to analyze growth trajectories from conception to 11.5 years.
- Examined associations between growth measures (weight, length/height, BMI) and metabolic markers (glucose, insulin, insulin resistance, beta-cell function, adiponectin) at age 11.5.
Main Results:
- Strong associations were found between all three growth measures and metabolic markers at age 11.5 years.
- The most significant associations were observed during the later childhood period (ages 6.5-11.5 years).
- Negligible associations were noted during gestation and the first year of life, contradicting earlier theories.
Conclusions:
- Later childhood, specifically ages 6.5-11.5 years, appears more sensitive to adverse metabolic associations with rapid growth.
- The findings challenge the concept of critical "sensitive" periods in fetal life and early infancy for cardiometabolic disease.
- Growth during later childhood is a more critical determinant of adolescent metabolic health than previously recognized.
Abstract:
The evidence that fetal life and early infancy are "critical" or "sensitive" ages for later development of cardiometabolic disease is based on flawed methods for comparing different age periods. Moreover, most previous studies have limited their focus to weight gain, rather than growth in length/height or body mass index (weight (kg)/height (m)2). We undertook a secondary analysis of data from the Promotion of Breastfeeding Intervention Trial (1996-2010), a birth cohort study nested within a large cluster-randomized trial in the Republic of Belarus, that had repeated measurements of weight and length/height taken from birth to 11.5 years of age. We used mixed-effects linear models to analyze associations of changes in standardized weight, length/height, and body mass index during 5 age periods (conception to birth, birth to age 3 months, ages 3-12 months, ages 12 months-6.5 years, and ages 6.5-11.5 years) with fasting glucose, insulin, insulin resistance, β-cell function, and adiponectin at age 11.5 years. We observed strong associations between the metabolic markers and all 3 growth measures, with the largest magnitudes being observed during the latest age period (ages 6.5-11.5 years) and negligible associations during gestation and the first year of life. Later age periods appear more "sensitive" than earlier periods to the adverse metabolic association with rapid growth in childhood.
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