Likelihood of obesity in early and late childhood based on growth trajectory during infancy

International Journal of Obesity ARTICLE www.nature.com/ijo OPEN Pediatrics Likelihood of obesity in early and late childhood based on growth trajectory during infancy George Moschonis ✉ Yannis Manios2,5 1✉ , Anela Halilagic1, Eva Karaglani2, Christina Mavrogianni2, Niki Mourouti2,3, Clare E. Collins 4 and 1234567890();,: © The Author(s) 2023 BACKGROUND: Childhood obesity rates have reached epidemic levels with Mediterranean countries reporting among the highest numbers globally. Evidence suggests early life factors, including infant growth rate, increase the likelihood of obesity later in childhood. However, optimal rates of infant growth associated with lower odds of future obesity still remain undetermined. The study aim was to determine the optimal infant growth rate associated with a lower likelihood of childhood overweight and obesity. METHODS: Perinatal and anthropometric data collected from 1778 Greek preschool (2–5 years old) and 2294 Greek preadolescent (10–12 years old) children participating in the ToyBox and the Healthy Growth Study (HGS) respectively, was combined for examination. Logistic regression models and receiver operating curves were used to determine the association between infant growth rate and development of childhood overweight and obesity, as well as optimal infant growth rate, respectively. RESULTS: Rapid weight gain during the first 6 months of life was positively associated with overweight and obesity in preadolescent children (OR:1.36, 95% CI: 1.13–1.63). Optimal cut-off points for several infancy growth rate indices (i.e., WAZ, WLZ, HAZ, BAZ) associated with a lower likelihood of overweight and obesity in preschool years and preadolescence were also identified. CONCLUSIONS: The current findings could possibly set the basis for healthcare professionals and families to better monitor, assess, and control infant growth rates, thus providing another obesity prevention strategy from early life. These findings, however, and the recommended optimal cut-offs need to be confirmed through further prospective research. International Journal of Obesity; https://doi.org/10.1038/s41366-023-01310-8 INTRODUCTION The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that may impair health [1]. Obesity prevalence has tripled since 1975 [1] with the rise of obesity amongst children also reaching epidemic proportions [2]. Childhood obesity is associated with adverse health consequences and an increased risk of comorbidities later into adulthood [3, 4]. Obese children are psychosocially vulnerable, a consequence of being “socially stigmatised”, bullied, teased, and socially isolated [3]. In some European countries, one third of children between the ages of 6 and 9 years are classified as being overweight or obese [5]. The highest prevalence observed is in Mediterranean countries, including Greece, Cyprus, Italy and Spain [5], where approximately 25% of preschool and 45% of preadolescent children were classified as being overweight or obese [6, 7]. Although the pathogenesis of overweight and obesity is complex and multi-factorial [8], the primary aetiology of weight gain is a sustained positive energy balance, whereby energy intake is greater than expenditure [9]. The first 1000 days, in which the foetus and infant are exposed to risk factors that impact on growth, development, and future health status, has been highlighted as a critical period for the development of obesity [10]. Growth rate during infancy is determined by measuring changes in body weight and/or recumbent length between birth and 24 months of age. Common time periods used to assess growth rate are from birth to 6, 12, and 24 months. These measurements allow health professionals and researchers to assess growth from birth until the end of adolescence through the use of appropriate sex-specific growth reference values, including percentiles and standard deviation scores (i.e., z-scores). The change in these percentiles and z-scores over time are used to assess the trajectory of growth and its potential deviation from normal. This may present as either poor or rapid growth and requires appropriate intervention to mitigate the likelihood of negative health impacts. In this context, recent evidence on the relationship between infant growth rate and overweight and obesity in childhood has identified a positive association between rapid growth during 1 Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia. 2Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece. 3Department of Nutrition and Dietetics, Hellenic Mediterranean University, Sitia, Greece. 4School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia. 5Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece. ✉email: ; Received: 16 June 2022 Revised: 4 April 2023 Accepted: 6 April 2023 G. Moschonis et al. 2 infancy and obesity later in childhood [11]. Rapid infant growth is also positively associated with measures of adiposity, such as body mass index (BMI), waist circumference, and fat mass [11]. However, the optimal rate of infant growth during infancy that is linked to a lower likelihood of developing overweight or obesity later in childhood is still unknown. For this reason, this study investigated the association between infant growth during the first six months of life and the likelihood for subsequent obesity development. The primary aim, however, was to identify the optimal growth rate from birth to six months of age associated with a lower likelihood of obesity development in preschool years and preadolescence. METHODS Study design and populations The current paper represents a secondary analysis of data from two studies conducted with preschool and preadolescent children in Greece, namely the ToyBox (www.toybox-study.eu) and the Healthy Growth Study (HGS), respectively. ToyBox was a randomised controlled intervention conducted with preschool children (2–5 years) from six European countries. For the current secondary analysis, the ToyBox study data from children living in Greece was utilised. HGS was a cross-sectional epidemiological study conducted with preadolescent children (10–12 years) attending fifth or sixth grade in municipalities within the Greek counties of Attica, Aitoloakarnania, Thessaloniki, and Iraklion. For this secondary data analysis, cross-sectional data collected at baseline from all children was utilised, as well as perinatal data collected retrospectively from birth certificates, health records, and parental recalls. Ethics approval ToyBox study and HGS ethics approval was obtained from the Bioethics Committee of Harokopio University in Athens, Greece, and the Greek Ministry of Ed (...truncated)