Postnatal Growth and Prevalence of Obesity in Infants Born Large-for-Gestational Age during the First 3 years of Life: Personal Experience and Exploration of Current Literature.

Acta Biomed 2022; Vol. 93, N. 6: e2022327 DOI: 10.23750/abm.v93i6.13823 © Mattioli 1885 Original article Postnatal growth and prevalence of obesity in infants born large-for-gestational age during the first 3 years of life: Personal experience and exploration of current literature Fawzia Alyafei1, Ashraf Soliman1, Vincenzo De Sanctis2, Noor Hamed1, Nada Alaaraj1, Shayma Ahmad1, Fatima AlKhori1, Saleha Abbasi1 1 Department of Pediatrics, Hamad General Hospital, Doha, Qatar; 2Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy Abstract. Aims of study: We evaluated the growth patterns in a cohort of infants (n = 120) born largefor-gestational-age (LGA) [birth weight (Bwt) > 4 kg] from birth to age 3 years of age in comparison with normal age and sex-matched children (WHO). Results: LGA infants had high weight for age Z score (WAZ) at birth that decreased significantly during the first 6 months of life (by a mean of – 0.67 SD) that was followed by significant gain during the following 6 months of life (around + 0.4 SD). These children grew on a higher centile of WAZ with no significant change during the second and third years of life. The prevalence of obesity (WAZ > 2) increased markedly from 24% at the end of their first year to 34% and 36% at the end of the second and third years of life, respectively. The mean length for age Z score (LAZ) decreased significantly during the first 6 months (by a mean of -0.9 SD) but was maintained at high centile (> 1 SD) during the second and 3rd years. The weight for length SDS (WLZ) increased significantly during the first 18 months of life and decreases gradually during the second half of the 2nd year and the 3rd year. Their head circumference SDS decreased significantly in the first 6 months and then sustained around the 70th centiles (+1 SD) in the following 18 months. Conclusion: Our study showed that in LGA babies obesity increased progressively after the first year of life to reach 36% at the end of the third year. Therefore, it is important to apply early nutritional intervention to decrease the occurrence of obesity and reduce later cardiometabolic risks. (www.actabiomedica.it) Key words: Large for age (LGA), postnatal growth, obesity. Introduction The prevalence of childhood obesity has been trending upwards over the last few decades and has led to the classification of childhood obesity as an epidemic. In 2020, about 40 million children below 5 years were overweight or obese (1). Overweight or obesity during childhood has important short-term and long-term consequences. In the short term, children who are overweight or obese are more likely to suffer from: low self-esteem, emotional and behavioural disorders, liver complications, musculoskeletal problems, especially in the lower extremities, metabolic and cardiovascular risk factors. In the long term, because childhood onset obesity frequently persists into adulthood, it is also associated with increased long-term morbidity and mortality (2). Therefore, prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult (3,4). The predictable normal infant growth starts with a fast deceleration of growth velocity starting from birth 2 that reaches a near plateau at the end of the first year of life and then continues to slow slowly through the second year. Postnatal growth of full-term infants can be classified as delayed, normal, or rapid depending on their infantile growth velocity that displays a sharp descending, a steady, or a sharp ascending change on the growth reference charts (5). One definition of fast infantile growth is the change in weight or length-for-age standard deviation score of more than + 0.67 from birth to the age of 24 months. On the other hand, delayed growth can be defined as the change in weight or length-for-age standard deviation score of more than − 0.67 from birth to 2 years of age (6). Neonatal macrosomia has been reported to increase over the past 50 years (7). Macrosomia is a term used to describe a baby who is significantly larger than average. Whereas large-for gestational-age (LGA) relates to a baby’s size before and at birth, macrosomia is usually used to describe babies following birth who are larger than the 90th or 95th percentile for sex and gestational age on an infant growth chart or who weigh 4 kg or more at birth (8) These LGA babies are more susceptible to neonatal complications. Later in life, they are reported to suffer from hypertension, obesity/ overweight, insulin resistance, metabolic syndrome, and type 2 diabetes later in life. It was suggested that fast weight gain and rapid linear growth during the infancy period can predispose to obesity and adverse cardiometabolic outcomes during adulthood (9-13). Substantial variation in prevalence of macrosomia occurs in different countries, ranging from 0.5% (India) to 13.9% (China) while the prevalence of LGA ranges from 4.3% (Korea) to 22.1% (China) (14,15). The most frequently seen causes of LGA are gestational diabetes, maternal obesity and excessive gestation weight gain (GWG) during pregnancy, which can in part be caused by overconsumption of high-fat, calorie-dense foods (16). Gestational diabetes mellitus and maternal obesity are associated with increased rates of LGA in humans as well as in animal models. The currently available evidence highlights the association between infant growth rate and subsequent obesity risk, however, there is a limited comprehensive understanding of this relationship between the pattern Acta Biomed 2022; Vol. 93, N. 6: e2022327 of growth rate and the development of childhood obesity in infants born LGA. The aim of our study was to evaluate the growth patterns of a cohort of infants born LGA from birth to age 3 years in comparison with normal age and sex-matched children. Subjects and methods This was a retrospective observational study of 120 LGA infants who were born between January 2016 and December 2017 in Qatar. Out of the 120 LGA (78 males and 42 females), 69% were infants of mothers with gestational diabetes (IDM), 93/120 were delivered vaginally and 27 infants were delivered by C-Section. 48/120 were born between 40 and 41 weeks, 47/120 were born <40 weeks and 25/120 were born after 41 weeks of gestation. 45/120 were Qataris, 43 were Arabs and 32 were Asians (Indians, Pakistanis, and Filipinos). Infants were evaluated at birth, 2, 4, 6, 12, 18, 24 and 36 months of age. Infant anthropometric measurements were taken at each visit and included weight, length, head circumference. Weight for age Z score (WAZ), length for age Z score (LAZ), and weight for length Z score (WLZ) were calculated using WHO standards for age and sex. Statistical analysis Data are reported as mean ± SD, or as frequencies and percentages. Student paired t-test was used to compare (...truncated)