Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort

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Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort
Title:
Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort
Journal Title:
International Journal of Epidemiology
Keywords:
Publication Date:
19 September 2016
Citation:
Izzuddin M Aris, Jonathan Y Bernard, Ling-Wei Chen, Mya Thway Tint, Wei Wei Pang, Wai Yee Lim, Shu E Soh, Seang-Mei Saw, Keith M Godfrey, Peter D Gluckman, Yap-Seng Chong, Fabian Yap, Michael S Kramer, Yung Seng Lee, Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort, International Journal of Epidemiology, Volume 46, Issue 2, April 2017, Pages 513–525, https://doi.org/10.1093/ije/dyw232
Abstract:
Background: Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. Methods: We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child’s BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. Results: Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m2, 16.5 (5.3) mm and 3.8 (1.3) kg/m2, respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m2 and pre-peak velocity of 0.7 (0.3) kg/m2/month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [–0.45 kg/m2 (–0.69, –0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12–1.62) for age; 1.89 (1.60–2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. Conclusions: Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations.
License type:
PublisherCopyrights
Funding Info:
This study is under Translational Clinical Research (TCR) Flagship Programme on Developmental Pathways to Metabolic Disease, NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014 funded by the National Research Foundation (NRF) and administered by the National Medical Research Council (NMRC), Singapore. KMG is supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre and by the European Union’s Seventh Framework Programme (FP7/2007–2013), project EarlyNutrition under grant agreement n°289346. This study is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.
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ISSN:
0300-5771
1464-3685
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