Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
J Pediatr. 2018 Oct;201:69-77.e8. doi: 10.1016/j.jpeds.2018.05.041. Epub 2018 Jun 28.
To assess associations of pre-, perinatal, and parental factors with age and magnitude at body mass index (BMI) peak and rebound.
Among 1681 children with BMI data from birth to mid-childhood in Project Viva, we fitted individual BMI trajectories using mixed-effect models with natural cubic spline functions and estimated age and magnitude at peak in infancy and rebound in early childhood. We used stepwise multivariable regression to identify predictors of peak and rebound in the 1354 (63.6%) children with estimable trajectory milestones.
The mean (SD) of age at BMI peak was 8.4 (2.7) months and at rebound was 59.8 (19.6) months, and the mean (SD) of magnitude at peak was 18.0 (1.4) kg/m and at rebound was 15.9 (1.2) kg/m. Girls had a later age at peak, earlier age at rebound, and lower magnitudes at peak and rebound than boys. Maternal isolated hyperglycemia (vs normoglycemia: β 0.7 months [95% CI 0.2-1.2]) and pre-eclampsia (vs normal blood pressure: 1.6 months [0.8-2.4]) were associated with a later peak, and impaired glucose tolerance (vs normoglycemia: -0.5 kg/m [-0.9, -0.1]) was associated with a lower magnitude at peak. Greater maternal first-trimester weight gain, smoking during pregnancy, no breastfeeding, parental obesity, and no university education were associated with greater BMI at rebound.
We have identified modifiable prenatal and parental predictors of BMI peak in infancy and rebound in childhood. Early-life interventions that address these factors may be effective in changing BMI peak and rebound and potentially preventing later obesity.
评估产前、围产期和父母因素与体重指数（BMI）峰值和反弹时的年龄和幅度的关系。
在 Viva 项目中，有 1681 名儿童的 BMI 数据从出生到儿童中期，我们使用混合效应模型和自然三次样条函数拟合个体 BMI 轨迹，并估计婴儿期和儿童早期 BMI 峰值和反弹时的年龄和幅度。我们使用逐步多变量回归来确定可评估轨迹里程碑的 1354 名（63.6%）儿童中峰值和反弹的预测因素。
BMI 峰值的平均（SD）年龄为 8.4（2.7）个月，反弹的平均（SD）年龄为 59.8（19.6）个月，峰值的平均（SD）幅度为 18.0（1.4）kg/m，反弹的平均（SD）幅度为 15.9（1.2）kg/m。与男孩相比，女孩的峰值年龄较晚，反弹年龄较早，峰值和反弹幅度较低。母亲孤立性高血糖（与正常血糖相比：0.7 个月[95%CI 0.2-1.2]）和子痫前期（与正常血压相比：1.6 个月[0.8-2.4]）与峰值较晚有关，而糖耐量受损（与正常血糖相比：-0.5kg/m[-0.9, -0.1]）与峰值幅度较低有关。母亲孕早期体重增加较多、孕期吸烟、未母乳喂养、父母肥胖和未接受大学教育与 BMI 反弹幅度较大有关。
我们已经确定了可改变的产前和父母因素，这些因素与婴儿期 BMI 峰值和儿童期反弹有关。针对这些因素的早期生活干预可能有助于改变 BMI 峰值和反弹，并可能预防以后肥胖。
