Abstract
BackgroundLittle is known about whether associations between childhood adiposity and later adverse cardiovascular health outcomes are driven by tracking of overweight from childhood to adulthood and/or by vascular and metabolic changes from childhood overweight that persist into adulthood. Our objective is to characterise associations between trajectories of adiposity across childhood and a wide range of cardiovascular risk factors measured in adolescence, and explore the extent to which these are mediated by fat mass at age 15.Methods and FindingsUsing data from the Avon Longitudinal Study of Parents and Children, we estimated individual trajectories of ponderal index (PI) from 0–2 years and BMI from 2–10 years using random-effects linear spline models (N = 4601). We explored associations between PI/BMI trajectories and DXA-determined total-body fat-mass and cardiovascular risk factors at 15 years (systolic and diastolic blood pressure, fasting LDL- and HDL-cholesterol, triglycerides, C-reactive protein, glucose, insulin) with and without adjustment for confounders. Changes in PI/BMI during all periods of infancy and childhood were associated with greater DXA-determined fat-mass at age 15. BMI changes in childhood, but not PI changes from 0–2 years, were associated with most cardiovascular risk factors in adolescence; associations tended to be strongest for BMI changes in later childhood (ages 8.5–10), and were largely mediated by fat mass at age 15.ConclusionChanges in PI/BMI from 0–10 years were associated with greater fat-mass at age 15. Greater increases in BMI from age 8.5–10 years are most strongly associated with cardiovascular risk factors at age 15, with much of these associations mediated by fat-mass at this age. We found little evidence supporting previous reports that rapid PI changes in infancy are associated with future cardiovascular risk. This study suggests that associations between early overweight and subsequent adverse cardiovascular health are largely due to overweight children tending to remain overweight.
Highlights
The prevalence of obesity in children and adolescents has risen dramatically in recent decades across most western countries and several low-income countries[1], some recent data suggest prevalence may have stabilised in the USA, UK and Sweden.[2,3,4] A systematic review demonstrated that high body mass index (BMI) from age seven onwards is associated with an increased risk of coronary heart disease in adulthood.[5]
Greater increases in BMI from age 8.5–10 years are most strongly associated with cardiovascular risk factors at age 15, with much of these associations mediated by fat-mass at this age
This study suggests that associations between early overweight and subsequent adverse cardiovascular health are largely due to overweight children tending to remain overweight
Summary
The prevalence of obesity in children and adolescents has risen dramatically in recent decades across most western countries and several low-income countries[1], some recent data suggest prevalence may have stabilised in the USA, UK and Sweden.[2,3,4] A systematic review demonstrated that high body mass index (BMI) from age seven onwards is associated with an increased risk of coronary heart disease in adulthood.[5]. Other studies, including previous reports using data from the same cohort as we analyse in this study, have suggested that rapid weight gain or gain in BMI or ponderal index (PI) in infancy (i.e. prior to 2 years) is importantly associated with increased obesity and adverse cardiovascular risk factors in later life.[12,13,14] few of these studies have been able to compare the associations of changes in weight (or weight adjusted for height) during infancy with later outcomes with the associations of growth in later periods of childhood with these outcomes. Our objective is to characterise associations between trajectories of adiposity across childhood and a wide range of cardiovascular risk factors measured in adolescence, and explore the extent to which these are mediated by fat mass at age 15
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