Lin Dan, Chen Didi, Huang Jun, Li Yun, Wen Xiaosa, Wang Ling, Shi Huijing
Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.
Department of School Health, Minhang District Center of Disease Control and Prevention, Shanghai, China.
Front Pediatr. 2021 Dec 22;9:742551. doi: 10.3389/fped.2021.742551. eCollection 2021.
The late occurrence of adiposity peak (AP) and the early occurrence of adiposity rebound (AR) are considered the earliest indicators for obesity and its related health conditions later in life. However, there is still limited information for their upstream factors. Therefore, in this study, we aimed to identify the parental and child factors associated with the timing of AP and AR in the early stage of life. This is a population-based longitudinal study conducted in Shanghai, China. The BMI data of children born between September 2010 and October 2013 were followed from birth to 80 months. Subject-specific body mass index trajectories were fitted by non-linear mixed-effect models with natural cubic spline functions, and the individual's age at AP and AR was estimated. The generalized linear regression models were applied to identify the upstream factors of late occurrence of AP and early occurrence AR. For 7,292 children with estimated AP, boys were less likely to have a late AP [adjusted risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.77-0.90, < 0.001], but preterm born children had a higher risk of a late AP (adjusted RR = 1.25, 95% CI: 1.07-1.47, < 0.01). For 10,985 children with estimated AR, children with breastfeeding longer than 4 months were less likely to have an early AR (adjusted RR = 0.80, 95% CI: 0.73-0.87, < 0.001), but children who were born to advanced-age mothers and who were born small for gestational age had a higher risk of having an early AR (adjusted RR = 1.21, 95% CI: 1.07-1.36, < 0.01; adjusted RR = 1.20, 95% CI: 1.04-1.39, = 0.01). Modifiable pre-birth or early-life factors associated with the timing of AP or AR were found. Our findings may help develop prevention and intervention strategies at the earliest stage of life to control later obesity and the health conditions and diseases linked to it.
肥胖峰值（AP）出现较晚以及肥胖反弹（AR）出现较早被认为是肥胖及其后期相关健康状况的最早指标。然而，关于其上游因素的信息仍然有限。因此，在本研究中，我们旨在确定与生命早期AP和AR发生时间相关的父母及儿童因素。这是一项在中国上海进行的基于人群的纵向研究。对2010年9月至2013年10月出生儿童的BMI数据从出生追踪至80个月。采用具有自然三次样条函数的非线性混合效应模型拟合个体特异性体重指数轨迹，并估计个体的AP和AR年龄。应用广义线性回归模型确定AP出现较晚和AR出现较早的上游因素。对于7292名估计有AP的儿童，男孩出现AP较晚的可能性较小[调整风险比（RR）=0.83，95%置信区间（CI）：0.77 - 0.90，<0.001]，但早产儿童出现AP较晚的风险较高（调整RR = 1.25，95%CI：1.07 - 1.47，<0.01）。对于10985名估计有AR的儿童，母乳喂养超过4个月的儿童出现AR较早的可能性较小（调整RR = 0.80，95%CI：0.73 - 0.87，<0.001），但高龄母亲所生以及小于胎龄儿出生的儿童出现AR较早的风险较高（调整RR = 1.21，95%CI：1.07 - 1.36，<0.01；调整RR = 1.20，95%CI：1.04 - 1.39，=0.01）。发现了与AP或AR发生时间相关的可改变的出生前或生命早期因素。我们的研究结果可能有助于在生命的最早阶段制定预防和干预策略，以控制后期肥胖及其相关的健康状况和疾病。
