Journal
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 35, Issue 6, Pages 1022-1030Publisher
WILEY
DOI: 10.1002/jbmr.3984
Keywords
PEDIATRICS; EPIDEMIOLOGY; FRACTURE PREVENTION; FRACTURE RISK ASSESSMENT; NUTRITION; OBESITY
Categories
Funding
- NIHR Biomedical Research Centre, Oxford
- La Marato de TV3 Foundation [201621-30]
- Versus Arthritis Clinical Research Fellowship [21605]
- MRC Doctoral Training Fellowship [MR/K501256/1]
- Department of Health of the Generalitat de Catalunya [SLT002/16/00308]
- National Institute for Health Research Clinician Scientist award [CS-2013-13-012]
- National Institute for Health Research (NIHR)
- MRC [1959917] Funding Source: UKRI
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This study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (+/- 6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow-up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. (c) 2020 American Society for Bone and Mineral Research.
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