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Association between size at birth, rapid weight gain in infancy, and overweight status among Palestinian refugees

Zeina Jamaluddine1, Oona M R Campbell2, Miho Sato3

  • 1Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.

The American Journal of Clinical Nutrition
|December 6, 2025
PubMed

Insights

Rapid infant weight gain predicts childhood overweight/obesity, irrespective of birth size. Exclusive human milk feeding reduces this risk, promoting healthier growth patterns in refugee children.

Area of Science:

  • Pediatric Nutrition
  • Public Health
  • Epidemiology

Background:

  • Inconsistent evidence exists regarding birth size and rapid weight gain's link to overweight/obesity.
  • Refugee populations face unique nutritional challenges impacting weight patterns, with limited available data.

Purpose of the Study:

  • To investigate the associations between birth size, infant feeding practices, rapid weight gain in the first year, and subsequent childhood overweight/obesity among Palestinian refugees.

Main Methods:

  • Retrospective cohort study of 388,347 Palestinian refugee births (2010-2020) using UNRWA electronic health records.
  • Analysis of birth size phenotypes, rapid weight gain (defined by z-score change), and overweight/obesity (defined by weight-for-height z-score).
  • Multilevel mixed-effects and structural equation modeling were employed to analyze the data.

Main Results:

  • Small for gestational age infants had higher odds of rapid weight gain but lower odds of overweight/obesity.
  • Large for gestational age infants had lower odds of rapid weight gain but significantly higher odds of overweight/obesity.
  • Rapid weight gain strongly predicted overweight/obesity (aOR: 6.53), while exclusive human milk feeding was associated with lower odds of rapid weight gain (aOR: 0.66).

Conclusions:

  • Rapid infant weight gain is a key predictor of childhood overweight/obesity, independent of birth size.
  • Exclusive human milk feeding plays a crucial role in mitigating the risk of rapid weight gain and subsequent overweight/obesity in this population.
Abstract

Keywords:
childhood overweightrapid weight gainsize at birthsmall for gestational age

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