Acceleration of BMI in Early Childhood and Risk of Sustained Obesity
Acceleration of BMI in Early Childhood and Risk of Sustained Obesity
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DOI：
10.1056/nejmoa1803527
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发表时间：
2018-10-04
影响因子：
158.5
通讯作者：
Koerner, Antje
中科院分区：
文献类型：
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作者：
Geserick, Mandy;Vogel, Mandy;Koerner, Antje
背景儿童从出生到青春期的体重指数 (BMI) 动态尚不清楚，确定儿童在特定年龄是否容易发生持续性肥胖很重要。 方法为了评估肥胖发病年龄，我们对 51,505 名儿童的 BMI 随时间变化进行了前瞻性和回顾性分析，这些儿童在 2017 年获得了连续的人体测量数据。 童年（0至14岁）和青春期（15至18岁）。此外，我们还评估了 34,196 名儿童童年时期 BMI 年度增量的动态，定义为每年 BMI 标准差得分的变化。 结果在回顾性分析中，我们发现大多数体重正常的青少年在整个童年时期体重始终正常。大约一半（53%）的肥胖青少年从5岁起就超重或肥胖，并且BMI标准差得分随着年龄的增长进一步增加。在前瞻性分析中，我们发现几乎 90% 3 岁时肥胖的儿童在青春期都出现超重或肥胖。在肥胖青少年中，每年 BMI 增量的最大加速发生在 2 岁至 6 岁之间，此后 BMI 百分位数进一步上升。学龄前儿童（但学龄期除外）BMI 年度增量的高速增长与青春期超重或肥胖的风险相关，该风险是 BMI 稳定儿童的风险的 1.4 倍。出生时大于胎龄儿(43.7%)的青春期超重或肥胖率高于胎龄适当体重者(28.4%)或小于胎龄者(27.2%)，相当于大于胎龄儿发生青少年肥胖的风险是其他组别的1.55倍。 结论肥胖的 青少年中，体重增长最快的时期发生在2岁至6岁之间；大多数在那个年龄肥胖的儿童在青春期也肥胖。
BACKGROUNDThe dynamics of body-mass index (BMI) in children from birth to adolescence are unclear, and whether susceptibility for the development of sustained obesity occurs at a specific age in children is important to determine.METHODSTo assess the age at onset of obesity, we performed prospective and retrospective analyses of the course of BMI over time in a population-based sample of 51,505 children for whom sequential anthropometric data were available during childhood (0 to 14 years of age) and adolescence (15 to 18 years of age). In addition, we assessed the dynamics of annual BMI increments, defined as the change in BMI standard-deviation score per year, during childhood in 34,196 children.RESULTSIn retrospective analyses, we found that most of the adolescents with normal weight had always had a normal weight throughout childhood. Approximately half (53%) of the obese adolescents had been overweight or obese from 5 years of age onward, and the BMI standard-deviation score further increased with age. In prospective analyses, we found that almost 90% of the children who were obese at 3 years of age were overweight or obese in adolescence. Among the adolescents who were obese, the greatest acceleration in annual BMI increments had occurred between 2 and 6 years of age, with a further rise in BMI percentile thereafter. High acceleration in annual BMI increments during the preschool years (but not during the school years) was associated with a risk of overweight or obesity in adolescence that was 1.4 times as high as the risk among children who had had stable BMI. The rate of overweight or obesity in adolescence was higher among children who had been large for gestational age at birth (43.7%) than among those who had been at an appropriate weight for gestational age (28.4%) or small for gestational age (27.2%), which corresponded to a risk of adolescent obesity that was 1.55 times as high among those who had been large for gestational age as among the other groups.CONCLUSIONSAmong obese adolescents, the most rapid weight gain had occurred between 2 and 6 years of age; most children who were obese at that age were obese in adolescence.