Associations of Infant Feeding and Timing of Weight Gain and Linear Growth during Early Life with Childhood Blood Pressure: Findings from a Prospective Population Based Cohort Study.

Marieke De Beer,Tanja G M Vrijkotte,Clive Osmond,Caroline H D Fall,Reinoud J B J Gemke,Manon Van Eijsden,Gualtiero I Colombo

doi:10.1371/journal.pone.0166281

Abstract

ObjectiveSmall birth size and rapid postnatal growth have been associated with higher future blood pressure. The timing of these effects, the relative importance of weight gain and linear growth and the role of infant feeding need to be clarified.MethodsWe assessed how blood pressure relates to birth weight, infant and childhood growth and infant feeding (duration of exclusive breastfeeding and timing of introduction of complementary feeding) in 2227 children aged 5 years from a prospective cohort study (Amsterdam Born Children and their Development). Postnatal growth was represented by statistically independent measures of relative weight gain (weight gain independent of height) and linear growth in four age periods during infancy (0–1 month; 1–3 months; 3–6 months; 6–12 months) and from 12 months to 5 years.ResultsLower birth weight was associated with higher childhood diastolic blood pressure (-0.38 mm Hg.SD-1; P = 0.007). Faster relative weight gain and linear growth after 1 month were positively associated with systolic and diastolic blood pressure. Associations of linear growth with systolic blood pressure ranged from 0.47 to 1.49 mm Hg.SD-1; P<0.01 for all. Coefficients were similar for different periods of infancy and also for relative weight gain and linear growth. Compared to breastfeeding <1 month, breastfeeding >1 month was associated with lower blood pressure (e.g. >6 months -1.56 mm Hg systolic blood pressure; P<0.001). Compared to >6 months, introduction of complementary feeding <6 months was associated with higher blood pressure (e.g. 4–6 months 0.91 mm Hg systolic blood pressure; P = 0.004).ConclusionsAfter the age of one month faster growth in either weight or height is associated with higher childhood blood pressure. It is unknown whether faster weight gain and linear growth carry the same risk for adult hypertension and cardiovascular morbidity. Longer breastfeeding and delayed introduction of complementary feeding may be associated with lower adult blood pressure.

Highlights

The World Health Organization has attributed 13% of deaths worldwide to raised blood pressure (BP), making it one of the most important modifiable cardiovascular risk factors globally. [1] Data from diverse populations have shown that blood pressure tracks from childhood to adulthood, with average correlation coefficients around 0.3–0.4.[2]
Faster relative weight gain and linear growth after 1 month were positively associated with systolic and diastolic blood pressure
Longer breastfeeding and delayed introduction of complementary feeding may be associated with lower adult blood pressure

Summary

Introduction

The World Health Organization has attributed 13% of deaths worldwide to raised blood pressure (BP), making it one of the most important modifiable cardiovascular risk factors globally. [1] Data from diverse populations have shown that blood pressure tracks from childhood to adulthood, with average correlation coefficients around 0.3–0.4.[2]. The World Health Organization has attributed 13% of deaths worldwide to raised blood pressure (BP), making it one of the most important modifiable cardiovascular risk factors globally. [1] Data from diverse populations have shown that blood pressure tracks from childhood to adulthood, with average correlation coefficients around 0.3–0.4.[2] Fetal growth restriction has been identified as a risk factor for raised BP in later life.[3,4] Studies addressing the relationship of weight gain in infancy to later life BP have shown mixed results. Some studies, including the Hertfordshire, Brompton, Hong Kong and Northern Finland Birth cohorts, showed no association.[6,7,8,9] The Barry Caerphilly Growth, COMPASS, Pelotas birth cohort and ALSPAC studies showed a positive association between infant weight gain and later life BP.[10,11,12,13] Two of these studies suggested that it is weight gain in early infancy (the first 5–6 months of life) that is most important.[10,12] There is confusion about what constitutes optimal infant weight gain for future cardiovascular health

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Results

Conclusion