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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Early childhood growth trajectories in a Medicaid population
Amrik Singh Khalsa1,2,3, Rui Li4, Joseph Rausch3,5
1Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States.
Insights
Early rapid BMIz increase in low-income children is linked to maternal factors and later obesity. Monitoring these growth trajectories can help address obesity risks in vulnerable populations.
Area of Science:
- Pediatric Health
- Obesity Research
- Public Health
Background:
- Existing evidence on early growth and obesity risk often excludes low-income populations.
- This study focuses on a cohort of Medicaid-insured and uninsured children.
Purpose of the Study:
- To identify early growth trajectories in a vulnerable pediatric population.
- To determine factors associated with these trajectories.
- To assess the link between early growth patterns and later overweight/obesity risk.
Main Methods:
- Utilized BMI z-scores (BMIz) from infants at a pediatric center (2010-2016).
- Modeled group-based BMIz trajectories.
- Employed logistic and log-binomial regression to analyze associations with maternal/child factors and obesity up to 60 months.
Main Results:
- Identified five BMIz trajectories, with two showing rapid increases.
- Lower maternal education, pre-pregnancy maternal overweight/obesity, and smoking were linked to rapid BMIz rise.
- Children in rapid-rising BMIz trajectories were significantly more likely to be overweight/obese at 36, 48, and 60 months.
Conclusions:
- Maternal and child factors are associated with early rapid BMIz increase in Medicaid-insured and uninsured children.
- Clinical monitoring of rapid BMIz rise is crucial for addressing modifiable obesity risk factors in low-income families.
Background:
Evidence on the role of early growth trajectories and later obesity risk is primarily based on privately insured or universally insured samples.
Objectives:
We aimed to characterize and determine factors associated with early growth trajectories and estimate associations with overweight/obesity risk in a Medicaid-insured and uninsured cohort.
Methods:
Infants seen at a large pediatric academic centre in 2010-2016 were included. Weight and length/height measurements were converted to age and sex-specific BMI z-scores (BMIz) based on the World Health Organization (WHO) Growth Standards. Group-based trajectories were modelled using BMIz created groups. Logistic and log-binomial regression models estimated associations between membership in trajectories and maternal/child factors and overweight or obesity at 36, 48, and 60 months, separately. Analyses were performed between 2019 and 2021.
Results:
The best-fitting model identified five BMIz trajectories among 30 189 children and 310 113 clinical encounters; two trajectories showed rapid rise in BMIz. Lower maternal education, pre-pregnancy maternal overweight/obese status, and maternal smoking were positively associated with both rapid-rising BMIz trajectories. Children in either of the two rapid-rising trajectories were 3.00 (95% CI: 2.85, 3.25), 2.97 (95% CI: 2.77, 3.18) and 2.76 (95% CI: 2.53, 3.01) times more likely to have overweight or obesity at 36, 48, and 60 months, respectively compared to children in the stable trajectory groups.
Conclusions:
Among Medicaid insured and uninsured children, several maternal and child characteristics were associated with early rapid-rise in BMIz. Clinical monitoring of early rapidly rising BMI may be important to address modifiable risk factors for obesity in families from low-income households.
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