Abstract
BackgroundThe adiposity rebound is the second rise in body mass index that occurs between 3 and 7 years. An early age at adiposity rebound is known to be a risk factor for later obesity. The aim here is to clarify the connection between the age at rebound and the corresponding pattern of body mass index change, in centile terms, so as to better understand its ability to predict later fatness.DiscussionLongitudinal changes in body mass index during adiposity rebound, measured both in original (kg/m2) and standard deviation (SD) score units, are studied in five hypothetical subjects. Two aspects of the body mass index curve, the body mass index centile and the rate of body mass index centile crossing, determine a child's age at rebound. A high centile and upward centile crossing are both associated separately with an early rebound, while a low centile and/or downward centile crossing correspond to a late rebound. Early adiposity rebound is a risk factor for later fatness because it identifies children whose body mass index centile is high and/or crossing upwards. Such children are likely to have a raised body mass index later in childhood and adulthood. This is an example of Peto's "horse racing effect". The association of centile crossing with later obesity is statistical not physiological, and it applies at all ages not just at rebound, so adiposity rebound cannot be considered a critical period for future obesity. Body mass index centile crossing is a more direct indicator of the underlying drive to fatness.SummaryAn early age at adiposity rebound predicts later fatness because it identifies children whose body mass index centile is high and/or crossing upwards. Such children are likely to have a raised body mass index later. Body mass index centile crossing is more direct than the timing of adiposity rebound for predicting later fatness.
Highlights
The adiposity rebound is the second rise in body mass index that occurs between 3 and 7 years
Body mass index centile crossing is more direct than the timing of adiposity rebound for predicting later fatness
There is continuing interest and concern about the worldwide epidemic of child obesity, its role in the development of later obesity and adult chronic disease. [1,2] The adiposity rebound is the second rise in adiposity, as measured by body mass index (BMI = weight/ height2), which occurs between 3 and 7 years of age in individual children
Summary
Effect of BMI centile The age at adiposity rebound is defined as the age (beyond infancy) when an individual's BMI is at a minimum [3]. To see how the adiposity rebound distorts centile crossing on the BMI chart, Figures 2 and 3 show the centile patterns of girls A to E shifted to a start age of 13 years, where they are labelled AA to EE respectively. Their hypothetical data are selected to cover the range of BMI and age at rebound. Using the racing analogy again, the leading horses at any point in the race have run the fastest to that point and are likely to continue running fast This implies that the period leading up to rebound is a critical period [7] when children "choose" a trajectory of static, rising or falling centile which predicts both their age and BMI centile at rebound. This is perhaps why Dietz called it an epiphenomenon [9]
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