Department of Pediatrics, Division of Neonatal Medicine, Women & Infants Hospital and Alpert Medical School of Brown University, Providence, RI.
Department of Pediatrics, Division of Neonatal Medicine, UT Southwestern, Dallas, TX.
J Pediatr. 2018 Sep;200:132-139.e3. doi: 10.1016/j.jpeds.2018.04.073. Epub 2018 May 21.
To identify rates of overweight (body mass index [BMI] ≥85th percentile) and obesity (BMI ≥95th percentile) at 6-7 years of age and associated risk factors among extremely preterm infants born at <28 weeks of gestation.
Anthropometrics, blood pressure, and active and sedentary activity levels were prospectively assessed. Three groups were compared, those with a BMI ≥85th percentile (overweight or obese for age, height, and sex) and ≥95th percentile (obese) vs <85th percentile. Multiple regression analyses estimated the relative risks of BMI ≥85th percentile and ≥95th percentile associated with perinatal and early childhood factors.
Of 388 children, 22% had a BMI of ≥85th percentile and 10% were obese. Children with obesity and overweight compared with normal weight children had higher body fat (subscapular skinfold and triceps skinfold >85th percentile), central fat (waist circumference >90th percentile), spent more time in sedentary activity (20.5 vs 18.2 vs 16.7 hours/week), and had either systolic and/or diastolic hypertension (24% vs 26% vs 14%), respectively. Postdischarge weight gain velocities from 36 weeks postmenstrual age to 18 months, and 18 months to 6-7 years were independently associated with a BMI of ≥85th percentile, whereas weight gain velocity from 18 months to 6-7 years was associated with obesity.
One in 5 former extremely preterm infants is overweight or obese and has central obesity at early school age. Postdischarge weight gain velocities were associated with overweight and obesity. These findings suggest the obesity epidemic is spreading to the most extremely preterm infants.
ClinicalTrials.gov: NCT00063063 and NCT0000.
确定胎龄<28 周出生的极早产儿在 6-7 岁时超重（体重指数[BMI]≥第 85 百分位数）和肥胖（BMI≥第 95 百分位数）的发生率，并确定与这些情况相关的危险因素。
前瞻性评估了体格测量、血压以及活跃和久坐活动水平。比较了三组，即 BMI≥第 85 百分位数（按年龄、身高和性别计算超重或肥胖）和≥第 95 百分位数（肥胖）与<第 85 百分位数的儿童。多元回归分析估计了 BMI≥第 85 百分位数和≥第 95 百分位数与围产期和幼儿期因素相关的相对风险。
在 388 名儿童中，22%的儿童 BMI≥第 85 百分位数，10%的儿童肥胖。与体重正常的儿童相比，肥胖和超重的儿童体脂（肩胛下皮褶和肱三头肌皮褶>第 85 百分位数）、中心性肥胖（腰围>第 90 百分位数）更多，久坐活动时间更长（20.5 比 18.2 比 16.7 小时/周），且分别有 24%、26%和 14%的儿童患有收缩压和/或舒张压高血压。从校正胎龄 36 周至 18 个月，以及从 18 个月至 6-7 岁的出院后体重增长速度与 BMI≥第 85 百分位数独立相关，而从 18 个月至 6-7 岁的体重增长速度与肥胖相关。
每 5 名前极早产儿中就有 1 名超重或肥胖，且在刚入小学时就存在中心性肥胖。出院后的体重增长速度与超重和肥胖有关。这些发现表明，肥胖症正在蔓延到最极早产儿中。
ClinicalTrials.gov：NCT00063063 和 NCT0000。
