Does Rapid Growth in Infancy and Childhood Increase Risk of Later Obesity?

Background It has long been thought that nutritional status during pregnancy, infancy, and early childhood might influence long-term health of the offspring. As such, scientists and public health officials are very interested in identifying critical periods of growth and development during these time periods during which environmental influences, such as poor nutrition or rapid weight gain, can have lasting effects. In a series of articles published in the June 2008 issue of The American Journal of Clinical Nutrition, researchers explore the possibility that rapid weight gain during early life might be related to the risk of later obesity. In an accompanying editorial, Gillman examines the collective evidence that early growth patterns influence later adiposity. Study Design Three independent studies related to early growth patterns and later obesity are included in this issue. In the first, Botton and colleagues compared growth rates at different ages from 3 mo to 5 y with fat mass, fat-free mass, and waist circumferences in a group of 368 French children between the ages of 8 and 17 y. Body composition was determined by using bipodal impedancemetry. In the second, Chomtho et al investigated the associations between weight gain during different periods in infancy and later fat mass and fat-free mass in 105 boys and 129 girls living in England (420 y of age). Body composition was determined by using a combination of state-of-the-art methods. In the third, a group of Finnish and British scientists led by Ylihrsil studied the relation between adiposity during infancy and childhood, estimated by body mass index, and later adult body composition in 1917 Finnish men and women (5670 y of age). Results Botton reported that boys and girls who had grown most rapidly during the first 3 mo of life were at greatest risk of having higher fat mass and waist circumference during adolescence. More specifically, every 143-g/mo increase in weight velocity during this time increased the risk of being overweight or obese by 52%. After 3 mo, relations between growth velocity and later overweight decreased until 2 y, growth being more directed towards height during this period, and then reappeared at 3 y. Data from the Chomtho et al study also suggested that greater weight gain during early infancy is positively associated with later adiposity. Moreover, their results show that early rapid growth might predispose children to central adiposity, which is thought to be especially dangerous in terms of later heart health. Interestingly, the Finnish/British researchers reported that rapid growth during the first 2 y of life was associated with increased adult lean body mass but not excessive fat accumulation. However, a rapid gain in body mass index later in childhood was related to increased fat mass later in life. Conclusions Results from these independently conducted studies generally support the hypothesis that early alterations in growth rates may be related to a person's risk of being obese in adolescence, adulthood, or both. Because obesity is a major modifiable risk factor for cardiovascular disease, understanding the physiologic basis for this relation is critical. As pointed out by Gillman in his editorial, all parents want to know, "How big should my baby be?" Unfortunately, there is not yet a consensus answer to this question based on the available data. Further investigations aimed at answering this question may hold great promise for preventing obesity and its related complications such as heart disease and stroke.