Change In Weight Standard Deviation Score Research Articles

Birth outcomes and early growth patterns associated with age at adiposity rebound: the Ma’anshan birth cohort (MABC) study

ObjectiveEarly onset of adiposity rebound (AR) is considered an early indicator of obesity risk. Our objective was to investigate the association of birth outcomes and early physical growth patterns with early AR in children.MethodsStudy subjects (n = 2705) were enrolled from the Ma’anshan birth cohort (MABC). The body mass index (BMI), head circumference, waist circumference, and body fat were collected. Rapid weight gain (RWG) was defined by the change in weight standard-deviation score in the first two years of life. Group-based trajectory modeling (GBTM) was used to determine children’s physical growth trajectories. The age of AR was fitted using fractional polynomial function models.ResultsChildren with very high BMI trajectories (RR = 2.83; 95% CI 2.33 to 1.40), rising BMI trajectories (RR = 3.15; 95% CI 2.66 to 3.72), high waist circumference trajectories (RR = 4.17; 95% CI 3.43 to 5.06), and high body fat trajectories (RR = 3.01; 95% CI 2.62 to 3.46) before 72 months of age were at a greater risk of experiencing early AR. Low birth weight (LBW) (RR = 1.86; 95% CI 1.28 to 2.51), preterm birth (PTB) (RR = 1.50; 95% CI 1.17 to 1.93), and small for gestational age (SGA) (RR = 1.37; 95% CI 1.14 to 1.64) associated with increased risk of early AR. Moreover, infants experiencing RWG (RR = 1.59; 95% CI 1.40 to 1.83), low BMI trajectories (RR = 1.27; 95% CI 1.06 to 1.53) and rising BMI trajectories (RR = 1.50; 95% CI 1.22 to 1.84) in the first two years were at higher risk of developing early AR subsequently. Compared to the group with non-early AR, the BMI of children with early AR tended to be lower first (from birth to 6 months of age) and then higher (from 18 to 72 months of age).ConclusionsChildren with overall high BMI, high waist circumference, and high body fat before 72 months of age are more likely to experience early AR, but infants with low BMI trajectories, rising BMI trajectories and infants experiencing RWG in the first two years of life similarly increase the risk of early AR. These results can help to understand the early factors and processes that lead to metabolic risks.

Height at three months can indicate overweight at two years in catch-up growth of small for gestational age infants

This study aimed to find an indicator at three months to predict overweight and short stature at two years in small for gestational age (SGA) infants. A total of 468 SGA infants and 4642 appropriate for gestational age (AGA) infants were included. Weight and height were measured at birth, three months and two years. Logistic regression and receiver operating characteristic (ROC) curves were performed for the catch-up growth. As compared to AGA infants, the weight of SGA infants was lower and the length/height was shorter at birth, three months, and two years. The weight of the catch-up group was significantly greater at birth and two years. The length/height of the catch-up group was greater at three months and two years. Trajectories of weight standard deviation score (SDS) and height SDS showed that the overweight group (BMI over the 85th percentile) had a shorter length/height SDS but a higher rate of the change in weight SDS during catch-up growth. The multivariate logistic regression indicated that that height at three months was an independent factor for prediction of catch-up growth at two years. The area under curve (AUC) was 0.801 with the 95% confidence interval (CI) from 0.726 to 0.876. Therefore, height at three months can predict overweight at two years.

Catch-up growth and metabolic outcomes in adolescents born preterm

BackgroundAccelerated infant weight gain in individuals born full term is linked to cardiovascular risk in adulthood, but data in those born preterm are inconsistent.ObjectiveTo investigate the association between weight gain...

Implementing evidence-based practice with normalisation process theory to improve nutritional care in the neonatal intensive care unit

BackgroundPostnatal growth failure is common in preterm infants, and one reason for this growth failure is that nutritional care is often variable and suboptimal. We aimed to improve the nutritional care of extremely preterm infants by implementing evidence-based practice changes and embedding these changes into routine care. Given the challenge that this represents, we used the novel sociological framework of normalisation process theory (NPT), to develop, guide, and assess the implementation process. MethodsWe developed and implemented an evidence-based, complex intervention for the nutritional care of preterm infants, including guidelines, a screening tool, and a multidisciplinary ward round. We compared nutrient intakes and growth in infants born before 30 weeks' gestation or weighing less than 1500 g during 2012 (the intervention period, n=75) with those born in 2009 (pre-intervention period, n=65). The extent to which the new practices were being embedded into routine care was assessed with a bimonthly staff questionnaire based on NPT (n=80), allowing weaknesses to be detected and addressed and making implementation a dynamic process. Serial audits of guideline compliance were also done. Primary infant outcomes were daily energy and protein intake, and mean change in standard deviation scores (SDS) for weight and head circumference between birth and discharge. Linear regression was used to compare cohorts, with adjustment for gestational age and weight at birth. FindingsMean daily energy and protein intakes as a percentage of recommended amounts improved significantly from 2009 to 2012 (energy 89·1% [SD 18·6] and protein 66·9% [20·5] vs 96·7 [18·4] and 78·2 [18·6]; p<0·05 for both). Growth also improved, with the mean change in weight SDS between birth and discharge changing from −0·90 (SD 0·78) to −0·57 (SD 0·75) (p<0·01). Head circumference did not improve significantly. During the intervention period, mean daily protein intake and mean NPT scores improved over time (r=0·88 [p=0·02] and 0·18 [p=0·01], respectively). There was a significant linear association between the mean audit score and the mean NPT score (r=0·22, p<0·01). InterpretationThe intervention succeeded in improving the nutrient intakes and growth of preterm infants. The NPT results show that these practices seem to have become part of routine care over time and suggest that measures of practice change using NPT can be related to measures of guideline compliance in the clinical setting. The findings of this study suggest that NPT offers an effective way of implementing and monitoring complex interventions. FundingNational Institute for Health Research.

Socioeconomic status and weight gain in early infancy

ContextThe association between low socioeconomic status (SES) and childhood obesity foreshadows life-long inequalities in health. Insight into the causal mechanisms linking childhood adversity to long-term health could be provided by discovering when the negative SES gradient in weight emerges, and what early life experiences are associated with it.ObjectiveTo examine SES differences in infant weight gain in the first three months of life, and assess contributions of parental BMI, maternal smoking, and feeding method to this association.DesignObservational study using longitudinal weight data from 2402 families taking part in the Gemini study; a twin birth cohort recruited from all twin births between March and December 2007 in England and Wales.Outcome MeasuresInfant weights at birth and three months converted to standard deviation scores (SDS), change in weight SDS, and rapid growth. SES was indexed by occupation and maternal education.ResultsThere were no SES differences in birth weight, but lower SES was associated with higher three-month weight, greater change in weight, and a higher prevalence of rapid growth (all p<0.01); with graded associations across levels of SES. Including parental overweight or smoking in pregnancy in the regression model did not affect the association between SES and weight gain, but including feeding method attenuated the SES effect on weight gain by at least 62% and rendered it non-significant.ConclusionThe foundations for lifelong socioeconomic inequalities in obesity risk may be laid in early infancy, with infant feeding practices playing a part in the diverging weight trajectories.

Influence of Insulin-Like Growth Factor I and Nutrition During Phases of Postnatal Growth in Very Preterm Infants

Pronounced growth restriction (GR) occurs after very preterm birth. The interaction between IGF-I, nutritional intake, and growth was evaluated prospectively in 64 infants with a mean (SD) GA of 25.7 (1.9) wk. Blood sampling of IGF-I and measurements of weight, length, and head circumference were performed weekly until discharge. Daily calculation of nutritional intake was performed. Standard deviation scores (SDSs) for growth parameters defined two growth phases: GR phase (birth until lowest SDS) and catch-up (CU) phase (lowest SDS until 35 gestational weeks). IGF-I concentrations during the first postnatal weeks were low and increased at 30 wk GA, irrespective of GA at birth, coinciding with initiation of CU growth. Concentrations of IGF-I were positively associated with change in weight SDS during the GR phase, p = 0.001 and CU phase, p = 0.004-0.027. Protein and energy intake were not associated with change in SDS weight during the GR phase as opposed to the CU phase (p < 0.001, respectively). Nutritional intake did not correlate to concentrations of IGF-I before 30 wk GA. IGF-I is associated with growth at an earlier postnatal age than nutrient intake and the effect of nutrition on levels of IGF-I may be restricted to the period of established CU growth.

Prenatal and postnatal programming of body composition in obese children and adolescents: evidence from anthropometry, DXA and the 4-component model

Low-birth weight has been proposed to programme central adiposity in childhood. However, there is little information on associations between fetal weight gain and fat distribution within obese individuals. To investigate associations between birth weight and postnatal weight gain with body composition in a sample of obese children and adolescents. Body composition was measured using anthropometry, dual-emission X-ray absorptiometry and the 4-component model in 45 male and 76 female obese individuals aged 5-22 years. General linear models were used to investigate associations between birth weight standard deviation score (SDS), or change in weight SDS between birth and follow-up, and body composition, adjusting for age, pubertal status, height and gender. Birth weight SDS ranged from -1.86 to 3.46, and was inversely associated with current weight SDS after adjustment for height SDS. Birth weight SDS was weakly associated with waist and hip girths, but not waist-hip ratio or trunk fat, after adjusting for age, height, pubertal status and gender. Change in weight SDS was strongly associated with total and central adiposity. Despite incorporating substantial variability, birth weight SDS was only a weak predictor of tissue masses and their distribution in obese children. Variability in central adiposity was more strongly associated with the magnitude of postnatal growth, which in turn was weakly inversely associated with birth weight SDS. In a population uniformly characterised by excess body weight, postnatal weight gain exerted the dominant impact on adiposity and fat distribution.

Maternal glucose levels influence birthweight and ‘catch‐up’ and ‘catch‐down’ growth in a large contemporary cohort

To explore the effects of maternal glucose on birthweight, infant and childhood growth in non-diabetic pregnant women using routinely collected data. Routinely collected data were extracted retrospectively from two clinical databases. These data comprised measurements of maternal random plasma glucose, infant birthweight, infant and child weight and height at 6-8 weeks, 24-36 weeks and 96-120 weeks in 6263 cases. After data cleaning, 4681 were analysed. When the data were analysed in thirds, a positive association between birthweight standard deviation scores (SDS), weight SDS and height SDS with maternal random plasma glucose (RPG) was observed. Regression analysis of birthweight SDS and RPG was significant (P < 0.001). Babies were approximately 48 g heavier at birth for each 1 mmol/l increase of mother's RPG. Infants who showed 'catch-up' growth (as shown by change in weight SDS) at 2 years were born to mothers with lower glucose levels than infants who showed 'catch-down' growth (P < 0.001). Random maternal glucose concentrations (taken at 28 weeks' gestation) in the normal range are positively related to birthweight. Glucose concentrations also predict greater weight and length in infancy. Despite this, babies born to mothers with higher glucose concentrations within the normal range show significant 'catch-down' growth in infancy as shown by a fall in weight SDS.

Medical assessment of adolescent girls with eating disorders: An evaluation of symptoms and signs of starvation

To investigate the prevalence of symptoms and signs related to starvation at the initial examination of adolescent girls with eating disorders (ED). Two hundred and eleven girls with eating disorders recruited for a multicentre research and evaluation programme of six specialist eating disorder services in Sweden have been studied. The presence or absence of 12 symptoms, reported by the patients, and 16 signs, observed by the examiners, were registered and related to body weight. Eleven observed signs--loss of subcutaneous fat, loss of muscle mass, loss of muscular force, dry and scaly skin, brittle nails, dry and brittle hair, lanugo hair, resting pulse <60, systolic blood pressure <110, peripheral hypothermia, and peripheral cyanosis--were related to body weight expressed in standard deviation scores (SDS). When the number of observed signs for each patient was calculated, there was a strong relationship with weight. The odds ratio for having more than two signs was 4.35 (95% CI 2.67-7.04; p = 2.8 x 10(-9) for every one-unit change in weight SDS. Of the symptoms reported by the patients, only three were related to weight. When the number of reported symptoms for each patient was calculated, a relationship with weight was not observed. In adolescent girls with ED, physical signs observed at medical examination can be related to weight. However, reported symptoms are poorly related to weight and may be influenced by other factors. The finding emphasizes the importance of medical assessment at presentation of patients with ED.

Slowing of growth in height and weight on stimulants: A characteristic pattern

The aims of the present study were to describe the growth pattern of children starting stimulant medication and to analyse the changes over time in height, weight and height velocity in a cohort of treated patients. Retrospective review of growth data from files of all newly treated patients with attention-deficit/hyperactivity disorder in one paediatric practice. Forty-four boys and seven girls were treated for 6-42 months with either dexam-phetamine (n = 32) or methylphenidate (n = 19). During the first 6 months on stimulant medication 44 children (86%) had a height velocity below the age-corrected mean and there was weight loss in 39 (76%). The height and weight standard deviation score (SDS) showed a progressive decline that was statistically significant after 6 and 18 months (P < 0.001, paired t-test). The height velocity was significantly attenuated for the first 30 months (P < 0.01), being lowest during the first 6 months. The mean height deficit during the first 2 years was approximately 1 cm/year. The change in weight SDS was 2.4 times the change in height SDS after 30 months on treatment with a significant correlation (Pearson's correlation coefficient r = 0.88, P < 0.001). Stimulant medication is associated with a decrease in height and weight SDS during the first 6-30 months with a characteristic pattern on the growth chart.