Weight gain in early childhood increases heart and metabolic risk in adolescence

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Earlier onset of weight gain, under two-years of age, is associated with higher cholesterol, higher blood pressure, and more central fat in adolescence, compared with onset of weight gain in children aged three to five, finds a 14-year University of Sydney study.

The study tracked the Body Mass Index (BMI) of children from birth to 14 years and found that earlier onset of high BMI (in children under two years) resulted in higher cholesterol levels, higher blood pressure, and more central (unhealthy) fat in adolescence, compared with onset of high BMI in children aged three to five.

Teenage obesity is a major health problem in Australia, but the pathways to and the consequences of obesity in teenagers has not been well studied. This is the first study to look at the consequences of weight gain at two different stages of early childhood and its impact on developing cardiovascular disease as an adult.

“Our study found that there are two main pathways to obesity as a teenager – rapid weight gain in the first two years of life (early weight gain) or rapid weight gain between ages two and five years of age (later weight gain),” said senior author University of Sydney’s Professor David Celermajer, Scandrett professor of cardiology at Sydney Medical School and the Heart Research Institute. “The data shows that there are consequences of the timing of the onset of excess BMI in early childhood.

“Earlier onset of a rising BMI that persisted through childhood results in greater central fat and higher cholesterol in teenagers, independent of their BMI at 14 years.”

A group of 410 Australian children were assessed from birth throughout childhood to age 14 years, recording their weight, height, and waist circumference. Of the 410 children, 190 had detailed measurements of cholesterol, blood pressure and central weight recorded at age 14 years.

Three groups were identified in the study: normal BMI, “Early Rising” excess BMI from two years, and “Late Rising” excess BMI from five years.

Lead author Dr Jennifer Barraclough, cardiologist and PhD student at University of Sydney and the Heart Research Institute said: “The early weight gain group have more centrally placed or unhealthy fat than the later weight gain group. Fat around the middle is a key risk factor for cardiovascular disease in adulthood.

“The early weight gain group also had significantly higher cholesterol levels compared to a group of healthy weight teenagers.

“Our study shows that the earlier the onset of excess fat before five years of age, the more likely the individual is to have fat around the middle by adolescence.

“The study also found that both early and late weight gain groups were more likely to have mothers with overweight or obesity and a high BMI, than healthy weight teenagers.”

Co-author Professor Louise Baur, head of child adolescent health at the University’s Sydney Medical School and The Children’s Hospital Westmead said: “This study has shown that it is important for families and the community to understand the risks of excess weight gain in early life and to ensure healthy eating and activity are supported from a very young age.

“These findings may provide an opportunity to identify ‘high risk’ young children and trial interventions at an early age, prior to the development of high cholesterol and centrally placed fat which becomes evident in adolescence and increases the risk of heart disease as an adult.”

Baur highlighted the importance of healthy infant feeding. “Breastfeeding should be supported where possible until at least 12 months, with solids introduced from around 6 months. Healthy eating and physical activity for all family members is also an important factor promoting healthy weight gain in the young child. Family doctors and early childhood nurses can also help to monitor weight gain in this critical period of life,” she said.

Abstract
Objective: To assess the influence of the trajectory of weight gain from birth to adolescence on cardiovascular and metabolic risk. We studied childhood body mass index (BMI) trajectories from birth to age 14 years and cardiometabolic risk factors at age 14 years.
Study design: In total, 410 children with weight and height measurements were assessed from birth throughout childhood, from the Childhood Asthma Prevention Study, a prospective community-based cohort. BMI trajectory groups were determined by latent basis growth mixture models. Of these subjects, 190 had detailed cardiometabolic risk factors assessed at age 14 years.
Results: Three BMI trajectory groups were identified; normal BMI, “early rising” excess BMI from 2 years, and “late rising” excess BMI from 5 years. Differences were found between normal and excess BMI in children at 14 years of age. In addition, children with an early rising BMI trajectory had statistically significantly higher central adiposity and a more atherogenic lipoprotein profile at age 14 years than children with a late rising BMI trajectory (P < .05). No differences between BMI trajectory groups in vascular structure or function was identified at age 14 years.
Conclusions: Earlier onset of an elevated BMI trajectory persisting from birth to age 14 years results in an unfavorable cardiometabolic risk profile at age 14 years, including central adiposity and more atherogenic lipoproteins, independent of achieved BMI.

Authors
Jennifer Y Barraclough, Frances L Garden, Brett G Toelle, Guy B Marks, Louise A Baur, Julian G Ayer, David S Celermajer

University of Sydney material
Journal of Pediatrics abstract


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