Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Int J Epidemiol. 2019 Feb 1;48(1):157-167. doi: 10.1093/ije/dyy286.
Few studies have examined the independent and combined relationships of body mass index (BMI) peak and rebound with adiposity, insulin resistance and metabolic risk later in life. We used data from Project Viva, a well-characterized birth cohort from Boston with repeated measures of BMI, to help fill this gap.
Among 1681 children with BMI data from birth to mid childhood, we fitted individual BMI trajectories using mixed-effects models with natural cubic splines and estimated age, and magnitude of BMI, at peak (in infancy) and rebound (in early childhood). We obtained cardiometabolic measures of the children in early adolescence (median 12.9 years) and analysed their associations with the BMI parameters.
After adjusting for potential confounders, age and magnitude at infancy BMI peak were associated with greater adolescent adiposity, and earlier adiposity rebound was strongly associated with greater adiposity, insulin resistance and metabolic risk score independently of BMI peak. Children with a normal timing of BMI peak plus early rebound had an adverse cardiometabolic profile, characterized by higher fat mass index {β 2.2 kg/m2 [95% confidence interval (CI) 1.6, 2.9]}, trunk fat mass index [1.1 kg/m2 (0.8, 1.5)], insulin resistance [0.2 units (0.04, 0.4)] and metabolic risk score [0.4 units (0.2, 0.5)] compared with children with a normal BMI peak and a normal rebound pattern. Children without a BMI peak (no decline in BMI after the rise in infancy) also had adverse adolescent metabolic profiles.
Early age at BMI rebound is a strong risk factor for cardiometabolic risk, independent of BMI peak. Children with a normal peak-early rebound pattern, or without any BMI decline following infancy, are at greatest risk of adverse cardiometabolic profile in adolescence. Routine monitoring of BMI may help to identify children who are at greatest risk of developing an adverse cardiometabolic profile in later life and who may be targeted for preventive interventions.
很少有研究检查体重指数（BMI）峰值和反弹与成年后肥胖、胰岛素抵抗和代谢风险的独立和联合关系。我们利用来自波士顿的特征良好的出生队列项目 Viva 的数据，该队列对 BMI 进行了多次测量，以帮助填补这一空白。
在 1681 名具有从出生到儿童中期 BMI 数据的儿童中，我们使用具有自然三次样条的混合效应模型拟合个体 BMI 轨迹，并估计了婴儿期（婴儿期）和反弹期（儿童早期）的 BMI 峰值（婴儿期）和反弹（儿童早期）的年龄和幅度。我们在青少年早期（中位数 12.9 岁）获得了儿童的心脏代谢测量值，并分析了它们与 BMI 参数的关联。
在校正潜在混杂因素后，婴儿期 BMI 峰值的年龄和幅度与青少年肥胖有关，而早期 BMI 反弹与肥胖、胰岛素抵抗和代谢风险评分独立相关，与 BMI 峰值无关。具有正常 BMI 峰值和早期反弹的儿童具有不良的心脏代谢特征，其特征是体脂指数更高{β 2.2kg/m2 [95%置信区间（CI）1.6, 2.9]}，躯干脂肪量指数更高[1.1kg/m2（0.8, 1.5）]，胰岛素抵抗更高[0.2 单位（0.04, 0.4）]和代谢风险评分更高[0.4 单位（0.2, 0.5）]与具有正常 BMI 峰值和正常反弹模式的儿童相比。没有 BMI 峰值（婴儿期后 BMI 没有下降）的儿童在青少年时期也有不良的代谢特征。
BMI 反弹的早期年龄是心脏代谢风险的一个强危险因素，与 BMI 峰值无关。具有正常峰值-早期反弹模式或婴儿期后没有任何 BMI 下降的儿童，在青少年时期发生不良心脏代谢特征的风险最大。常规监测 BMI 可能有助于识别在以后的生活中发生不良心脏代谢特征风险最大的儿童，并且可以针对这些儿童进行预防干预。
