How pre- and postnatal risk factors modify the effect of rapid weight gain in infancy and early childhood on subsequent fat mass development: results from the Multicenter Allergy Study 90.

摘要

BACKGROUND: It is unclear which exposures may cause or modify the adverse effect of rapid weight gain on fat mass development in term children whose birth weight is appropriate-for-gestational age (AGA). OBJECTIVE: To determine which intrauterine or postnatal exposures increase the risk of or modify the effect of rapid weight gain on body fat percentage (BF) and body mass index (BMI) trajectories between 2 and 6 y of age. DESIGN: Term AGA singletons (n = 370) from the German Multicenter Allergy Study (MAS-90), a longitudinal birth cohort study, with repeated anthropometric measurements until 6 y, and data on breastfeeding status, exposure to smoking during pregnancy, and maternal anthropometric and socioeconomic characteristics were included in this analysis. RESULTS: A shorter gestation multivariate-adjusted odds ratio (OR): 5.12; 95 CI: 2.22, 11.82; P = 0.0001, being firstborn (OR: 2.01; 95 CI: 1.10, 3.69; P = 0.02), and having been bottle-fed (OR: 3.02; 95 CI: 1.68, 5.43; P = 0.0002) all significantly increased a child's risk of gaining weight rapidly, whereas a larger BMI at birth was protective (OR: 0.54; 95 CI: 0.38, 0.77; P = 0.0006). Multilevel model analyses showed that rapid growers exposed to tobacco in utero subsequently gained more BF between 2 and 6 y than did rapid growers who had not been exposed (beta +/- SE: 0.78 +/- 0.28/y; P = 0.005). Similarly, change in BF was greater in rapid growers with an overweight mother than in those with a normal-weight mother (1.01 +/- 0.30/y; P = 0.0007). CONCLUSIONS: The occurrence of rapid weight gain between birth and 2 y and the magnitude of its effect on BF development in AGA children is influenced by both intrauterine and postnatal exposures.