Defining Infant Rapid Weight Gain to Best Predict Childhood Obesity

描述（由申请人提供）：美国儿童超重和肥胖的高负担以及相关的不良健康结果促使研究人员确定肥胖的早期预测因素，以便及时针对高危儿童进行预防工作。婴儿快速体重增加（RWG）被认为是预测随后肥胖的早期生长模式，可用于识别有风险的儿童进行早期干预。RWG最常被定义为年龄体重z分数（WAZ）的增加，这与跨越一个主要增长图表百分位数线有关。然而，目前用于评估婴儿RWG的方法有两个显著的局限性。首先，最近关于从使用2000年美国疾病控制与预防中心的生长参考标准过渡到2006年新的世卫组织生长标准的建议，提出了有关评估和理解婴儿RWG的问题。世卫组织新标准以母乳喂养儿童的纵向数据为基础，这些儿童的生长轨迹与配方奶和混合喂养婴儿不同（这是疾控中心参考资料的主要数据来源）。因此，到目前为止，关于婴儿RWG及其与随后肥胖的关系的结论可能会随着新标准的采用而有所不同。其次，对于婴儿期RWG何时应该进行评估缺乏明确的规定。虽然RWG的定义是一致的，关于增加的幅度（WAZ增加bb0.67），但在婴儿期评估RWG的年龄间隔和时间在不同的研究中差异很大。将最能预测未来肥胖的年龄间隔和时间限制纳入婴儿RWG的定义将确保测量的可靠性。此外，考虑到婴儿时期WAZ生长曲线的形状与CDC的生长参考文献不同，目前对RWG的定义（WAZ的变化值为0.67）可能无法为RWG提供预测后期肥胖的最佳截止值。我们建议通过使用来自Kaiser Permanente西北健康维护组织的纵向人体测量数据（n=65,506）来解决这些差距。我们将使用不同生长参考标准（CDC生长参考标准vs . WHO生长标准）和年龄间隔（0-6个月、6-12个月或0-12个月）的标准来比较研究人群中RWG的患病率。此外，我们将确定哪一套RWG标准最能预测3岁时的肥胖，考虑协变量并评估WAZ变化的不同临界点，以在新的世卫组织生长标准背景下定义RWG。如果这项及时的研究得到资助，研究结果将帮助研究人员和临床医生选择一种可靠的婴儿RWG测量方法，这是预测随后肥胖的有效工具。这将有助于研究人员和临床医生在关键时期有效地针对高危儿童进行早期干预

DESCRIPTION (provided by applicant): The high burden of overweight and obesity in US children and associated poor health outcomes are driving researchers to identify early predictors of obesity so that prevention efforts can be targeted in a timely manner to at-risk children. Infant rapid weight gain (RWG) is thought to be an early growth pattern predictive of subsequent obesity and may be used to identify at-risk children for early intervention. RWG is most commonly defined as an increase in weight-for-age z-score (WAZ) >0.67, which correlates with crossing one major growth chart percentile line. However, the methods currently used to evaluate infant RWG have two significant limitations. First, the recent recommendation to transition from using the 2000 CDC growth references to the new 2006 WHO growth standards raises questions regarding the evaluation and understanding of infant RWG. The new WHO standards are based on longitudinal data from breastfed children, who exhibit different growth trajectories than formula and mixed-fed infants (the primary data source for the CDC references). Consequently, the conclusions that have been drawn up to now regarding infant RWG and its relationship to subsequent obesity may differ with the adoption of the new standards. Second, there is a lack of clarity about when in infancy RWG should be assessed. Although RWG is defined consistently with regard to the magnitude of gain (increase in WAZ of >0.67), the age interval and timing of when RWG is assessed during infancy vary widely from study to study. Including the age interval and timing constraints that best predict future obesity into the definition of infant RWG will ensure the reliability of the measure. Furthermore, given the different shape of the WAZ growth curves during infancy compared to the CDC growth references, it is possible that the current definition of RWG (change in WAZ >0.67) might not provide the best cutoff for RWG in terms of predicting later obesity. We propose to address these gaps by using longitudinal anthropometric data (n=65,506) drawn from the Kaiser Permanente Northwest Health Maintenance Organization. We will compare the prevalence of RWG in the study population using criteria varying both by growth reference (CDC growth references v. WHO growth standards), and by age interval (0-6 months, 6-12 months, or 0-12 months). In addition, we will determine which set of criteria for RWG best predicts obesity at 3 years of age, taking into account covariates and evaluating different cutpoints of change in WAZ to define RWG in the context of the new WHO growth standards. Should this timely research be funded, the findings will aid researchers and clinicians in selecting a reliable measure of infant RWG that is a valid tool for predicting subsequent obesity. This will help researchers and clinicians effectively target early interventions to at-risk children during the critical period of infancy, when the potential for a sustained change in the trajectory of weight gain and a reduction in obesity risk is at its peak. 1