Earliest age to detect lifetime cardiometabolic health stratification in children

Cardiovascular risk factors such as overweight and high cholesterol in childhood are predictive of high disease risk in adulthood. However, the optimal timing and scope of early prevention remains uncertain due to sparse data. Our aim was to identify the earliest age at which adult-like cardiometabolic stratification emerges in population-based time-series of the first five decades of life.

Children born in 1962-1992 were included from three European cohorts (local community samples). Suitable measurement series of weight, height and lipoprotein lipids were analyzed for 5683 participants (ages 0-49 years, follow-ups 10-31 years depending on cohort). Longitudinal tracking was quantified by autocorrelation (R²) over the same individuals between two visits at least a decade apart. The pattern of R² as a function of age at the first visit was examined to identify the earliest age when adult-like plateau was reached.

Autocorrelation of body mass index was low in children under four (R² ≤12%), but reached adult levels at age nine (R² = 51% for 10-year follow-up and R² = 27% for 31-year follow-up). Lipoprotein lipids did not exhibit a reduction in autocorrelation at young ages. For circulating cholesterol, 10-year autocorrelation at 15 months of age was R² = 30%.

Adult-like cardiometabolic stratification is detectable in young children, but accuracy (without extreme indication) may be too low for personalized risk prediction. Consequently, we emphasize broad preventative programs that extend into adulthood to reduce the overall prevalence of cardiometabolic risk factors in the population.