Early growth and childhood obesity: a historical cohort study

Objective: To investigate to what extent prenatal, early postnatal, and late postnatal growth predicts risk of childhood obesity. Methods: This was a historical cohort study of 1335 full term singletons born in southwest England in 1989. The main outcome measure was body mass index (BMI) at age 7. Absolute weights at birth, 6 weeks, and 18 months, and change in weights during the intervening periods were measured. Measures were examined as z scores standardised to the 1990 UK reference population. Results: BMI at age 7 was positively associated with z scores for weight at all ages. Regression coefficients (95% confidence intervals) were: 0.16 ( 0.11 to 0.22), 0.19 ( 0.15 to 0.24), and 0.29 (0.26 to 0.33) for weights at birth, 6 weeks, and 18 months, respectively. Regression coefficients for birth weight, early weight gain ( change in weight z score between birth and 6 weeks), and late weight gain ( change in weight z score between 6 weeks and 18 months), adjusted for each other were: 0.32 (0.27 to 0.38), 0.31 ( 0.26 to 0.37), and 0.28 (0.23 to 0.32), respectively. There was no statistical evidence for interaction among weights, weight gains, or social deprivation. Social deprivation independently predicted BMI at age 7, the major influence being weight gain after 6 weeks of life. Conclusions: These data suggest that obesity risk is acquired gradually over the perinatal and postnatal periods, instead of during a prenatal or early postnatal critical window. The association of obesity risk with social circumstances and the timing of its origin offer pointers to some underlying determinants of obesity.