Black/white differences in relative weight and obesity among girls: the Bogalusa Heart Study

Obesity among Black Adolescent Girls: Genetic, Psychosocial, and Cultural Influences

This article focuses on the causes, consequences, and prevention of obesity among a subgroup of the American population, Black adolescent girls. Using an ecological perspective on obesity among Black adolescent girls, including feminist-womanist perspectives and historical and medical sociological perspectives, the authors discuss genetic, psychosocial, and cultural factors that may influence the propensity of Black adolescent girls’ susceptibility to obesity and to diabetes, one of the major complications of obesity. Prevention strategies, including individual and structural interventions, are illuminated.

Female overweight and obesity in adolescence: developmental trends and ethnic differences in prevalence, incidence, and remission

Despite substantial increases in the prevalence of adolescent overweight and obesity documented in recent decades, few studies have prospectively tracked their development during the entire adolescent period. The aims of this study were to characterize developmental trends in prevalence, incidence, and remission of overweight and obesity using annual data collected from ages 12 to 19 for 496 adolescent females. Ethnic differences between African American (n = 37), Latina (n = 96), and European American (n = 348) adolescents were also compared. The prevalence of overweight decreased slightly across adolescence and remission rates exceeded incidence (onset). Obesity was more chronic, with increasing incidence accompanied by decreasing remission rates. Middle through late adolescence was the period of greatest risk for the transition from overweight to obesity. African American and Latina females had higher overweight and obesity prevalence than European American females throughout adolescence. Differences in prevalence were driven by higher onset rates for African American and Latina females, whereas remission rates were comparable across ethnic groups. Results suggest that adolescence is not a high-risk period for onset of obesity for European American adolescent females, but is for African American and Latina adolescent females.

Independent effects of age-related changes in waist circumference and BMI z scores in predicting cardiovascular disease risk factors in a prospective cohort of adolescent females

BACKGROUND

Cross-sectional data indicate that central adiposity is associated with cardiovascular disease risk, independent of total adiposity. The use of longitudinal data to investigate the relation between changes in fat distribution and the emergence of risk factors is limited.

OBJECTIVE

We tested the hypothesis that age-related change in waist circumference (to reflect central adiposity) during adolescence is a significant predictor of longitudinal change in cardiovascular disease risk, after adjustment for change in body mass index (BMI) z score (to reflect total adiposity) in a cohort of postmenarcheal adolescent females. We also tested whether race modified this relation.

DESIGN

We analyzed publicly available data from the National Heart, Lung, and Blood Institute Growth and Health Study. Longitudinal regression models were fitted to investigate the independent effects of changes in waist circumference on cardiovascular disease risk factors.

RESULTS

Steeper age-related increases in waist circumference over time were associated with a greater increase in LDL-cholesterol concentrations, systolic blood pressure, diastolic blood pressure, and homeostasis model assessment of insulin resistance, after adjustment for BMI z score, in white but not in black females. Change in waist circumference was not a statistically significant predictor of age-related changes in HDL-cholesterol, triglyceride, insulin, and glucose concentrations, after adjustment for changes in BMI z score, in either white or black females.

CONCLUSIONS

Our research suggests that monitoring waist circumference in addition to BMI z score has the potential to identify adolescents at risk of the emergence of cardiovascular disease risk factors, at least in white females. The data also suggest that race may modify the relation between fat distribution pattern and cardiovascular disease risk factors.

Patterns of moderate and vigorous physical activity in obese and overweight compared with non-overweight children

OBJECTIVE

We determined whether overweight and obese children performed less combined moderate and vigorous physical activity (MVPA), less vigorous physical activity (VPA) alone, and had distinct patterns of sustained MVPA or VPA compared with non-overweight children.

METHODS

We monitored 106 children (aged 8 to 10 years) for 7 consecutive days using accelerometers. Differences in mean daily MVPA and VPA were assessed by comparing non-overweight (NOW) with overweight and obese (OW/OB) participants using descriptive statistics and regression analysis. We used an algorithm to identify periods of consecutive minutes where MVPA or VPA was continuous, called bouts. We then compared the bouts performed by NOW versus OW and OB participants with respect to the mean of the counts·minute(-1) for the minutes included in the bout, their mean length in minutes, and the number of MVPA bouts performed in sequence.

RESULTS

The non-overweight group averaged 143 minutes of MVPA per day versus 120 minutes among the OW/OB (p=0.004). The OW/OB group had fewer MVPA bouts per day compared with the NOW (11.6 versus17.6, p=0.012). Fewer VPA bouts were associated with greater body mass index z-score (p<0.001). The NOW children had more intense body motion during MVPA bouts and performed a greater proportion of MVPA bouts in sequences of five or more consecutive bouts, compared with the OW/OB (p=0.05 and p=0.002, respectively).

CONCLUSIONS

In addition to performing less physical activity, we found that obese and overweight children had distinct patterns of MVPA and VPA bouts compared with non-overweight peers.

Do self- or parent-reported dietary, physical activity, and sedentary behaviors predict worsening obesity in children?

OBJECTIVE

To determine whether information gathered during routine healthcare visits regarding obesity related risk factors and risk behaviors predicts increases in BMI z-score over time among overweight and obese children.

STUDY DESIGN

Medical records from 168 overweight and 441 obese patients seen for repeated visits between September 2003 and April 2006 were examined for reported dietary, physical activity, and sedentary behaviors, family history of obesity and diabetes mellitus, documented Acanthosis nigricans, and BMI values. Random-effects regression analysis was done to determine whether demographic, familial, or behavioral data predicted changes in BMI z-score over time.

RESULTS

The presence of A nigricans and a family history of obesity were associated with an increase in BMI z-score (beta=0.56, SE=0.09, P<.001 and beta=0.31, SE=0.13, P=.021). These risk factors explained 8% and 7% of the variation in BMI z-score respectively. Self- or parent-reported dietary and physical activity behaviors did not predict change in BMI z-score.

CONCLUSIONS

Our findings suggest that the risk factors and self- or parent-reported risk behaviors routinely assessed by pediatric clinicians have limited ability to predict future growth trends, demonstrating the difficulty in determining which patients have the greatest risk of progression of obesity.

Racial differences in central adiposity in a longitudinal cohort of black and white adolescent females

BACKGROUND

Central adiposity is related to chronic disease risk in adolescents. Racial differences in waist circumference have been identified using cross-sectional data from this age group. We tested for racial differences in age-related growth in waist circumference in a longitudinal cohort of black and white adolescent girls.

METHODS

We analyzed 9 years of publicly available data from the National Heart, Lung, and Blood Institute Growth and Health Study, for 2379 girls (1213 black and 1166 white) enrolled at age 9-10 years in 1987-1988 and followed annually. Individual growth trajectories of waist circumference were constructed for girls with >3 annual measures. Mixed models were used to compare changes in waist circumference during adolescence between black and white females. BMI and age at menarche were included in the models.

RESULTS

At each age, black females had significantly higher waist circumference. Mean annual increase in waist circumference was significantly higher for black females compared to white females (1.46 cm/yr vs. 1.36 cm/yr, respectively). After adjusting for BMI, the mean annual increase in waist circumference for white females was significantly higher than for black females (0.08 cm/yr vs. -0.07 cm/yr, respectively). These relationships remained significant after adjusting for age at menarche.

CONCLUSIONS

Black females had significantly steeper increases in waist circumference over adolescence than white females. After adjusting for BMI and age at menarche, however, the annual increase in waist circumference for black females was significantly shallower than for their white peers. These data suggest racial differences in the deposition of fat over the adolescent period.

Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study

OBJECTIVE

To understand tracking of overweight status from childhood to young adulthood in a biracial sample.

DESIGN

A longitudinal sample was created from cross-sectional surveys at two time points, childhood (baseline) and young adulthood (follow-up).

SETTING

Bogalusa Heart Study, Louisiana, United States of America.

SUBJECTS

A total of 841 young adults, 19-35 years (68% Euro-Americans (EA), 32% African-Americans (AA)) were studied. The same subjects had also participated in one of the five cross-sectional surveys at childhood (9-11 years).

METHODS

Body mass index (BMI) was used to determine overweight status as per the Centers for Disease Control and Prevention standards. Change in the BMI status from childhood to young adulthood was used to group the participants into the following categories: normal weight to normal weight (NW-NW); normal weight to overweight (NW-OW); overweight to normal weight (OW-NW); and overweight to overweight (OW-OW). Tracking of overweight was defined by (1) correlations between baseline and follow-up BMI, (2) Cohen's kappa concordance test to determine the strength of tracking in BMI quartiles and (3) the percentage of individuals who remained in the same overweight status group from baseline to follow-up.

RESULTS

From baseline to follow-up, the percentage of participants who were overweight increased from 24.7 to 57.7%. A total of 35.2% of the children shifted from normal weight in childhood to overweight in young adulthood (P < 0.0005). Baseline BMI was positively correlated with follow-up BMI (r = 0.66, P < 0.0005). A total of 61.9% of the participants in the highest BMI quartile in childhood remained in the highest BMI quartile in young adulthood. The strength of tracking in BMI quartiles was 27% for EA men (P < 0.0005), 23% for EA women (P < 0.0005), 27% for AA men (P<0.0005) and 35% for AA women (P < 0.0005). A total of 53.7% of the EA women remained in the NW-NW category and 31.2% of the AA women remained in the OW-OW category. The percentage tracking (NW-NW and OW-OW) was 72.8% in EA women, 59.6% in AA men, 59.5% in AA women and 48.8% in EA men (P < 0.0001).

CONCLUSION

Childhood overweight tracked into young adulthood in this sample and the tracking of NW-NW and OW-OW was the most prominent among the EA women.

Ethnic differences in upper lip response to incisor retraction

INTRODUCTION

The purpose of this retrospective longitudinal study was to investigate the response of the upper lip to incisor retraction and to ascertain the effect of ethnicity on this response.

METHODS

Pretreatment and posttreatment lateral cephalograms of 88 postpubertal female patients (44 black and 44 white; mean age, 18.45 years) were evaluated. The groups were matched by age and the amount of incisor retraction at incisor superius.

RESULTS

Although significant pretreatment differences existed between the groups in some cephalometric measurements, analysis of the treatment changes demonstrated significant differences only in incisor inclination. Hard and soft tissue changes of the black group were more downward, whereas changes in the white group were more backward. Multivariate regression analysis showed that the horizontal response of the upper lip to hard tissue changes at subnasale and superior labial sulcus was different in whites than in blacks. At subnasale, stepwise multivariate regression analysis showed that ethnicity contributed to the upper lip response to incisor retraction and was significantly greater in the white group.

CONCLUSIONS

The hard and soft tissue treatment changes of the black group were more downward, and those of the white group were more backward. Ethnic differences exist in the soft tissue response to hard tissue changes in the upper lip, and at subnasale and the superior labial sulcus; however, these response differences at superior labial sulcus can be explained by the ethnic differences in initial lip thickness and incisor inclination; they are not due in and of themselves to ethnicity. The change at prosthion was significantly correlated with the response of the upper lip at labrale superius to incisor retraction. Ethnicity added no increase to the predictability of the response. When incisor retraction was performed, the final horizontal upper lip position could be accurately and reliably predicted.

The influence of lifestyle on cardiovascular risk factors. Analysis using a neural network

The cardiovascular pathologies are the most common causes of death in the elderly patient. To single out the main risk factors in order to effectively prevent the onset of the disease, the authors experimented a special computerized tool, the neural network, that works out a mathematical relation that can obtain certain data (defined as output) as a function of other data (defined as input). Data were processed from a sample of 276 subjects of both sexes aged 26-69 years old. The output data were: high/low cholesterolemia, HDL cholesterol, triglyceridemia with respect to an established cut-off; the input data were: sex, age, build, weight, married/single, number of children, number of cigarettes smoked/day, amount of wine and number of cups of coffee. We conclude that: (i) a relationship exists, deduced from a neural network, between a set of input variables and a dichotomous output variable; (ii) this relationship can be expressed as a mathematical function; (iii) a neural network, having learned the data on a sufficiently large population, can provide valid predictive data for a single individual with a high probability (up to 93.33%) that the response it gives is correct. In this study, such a result is found for two of the three cardiovascular risk indicators considered (cholesterol and triglycerides); (iv) the repetition of the neural network analysis of the cases in question after a "pruning" operation provided a somewhat less good performance; (v) a statistical analysis conducted on those same cases has confirmed the existence of a strong relationship between the input and the output variables. Therefore the neural network is a valid instrument for providing predictive in a single subject on cardiovascular pathology risks.

Overweight in children: definitions, measurements, confounding factors, and health consequences

The epidemic of childhood overweight continues to grow at staggering rates, increasing nearly four-fold between 1963 and 2000. Children that are overweight are more apt to be overweight adults and are more likely to suffer adverse health consequences associated with excess weight. Nurses have a unique presence in the healthcare environment to assess children for overweight, provide parent/child nutritional education, and conduct obesity-related research. This article provides an overview of the current body of literature surrounding the definition and measurement of overweight and the morbidity association with childhood overweight.

Health issues of aboriginal female adolescents in Taiwan

BACKGROUND

The mortality rate and prevalence for some chronic diseases are higher for aborigines compared with the rest of the Taiwanese population. Health professionals in many countries have been concerned with the health of aborigines, but specific health policies for native adolescents have been neglected.

AIMS

This paper reports a study comparing the general health status of aborigines and non-aborigine female adolescents, based on school enrollment health examinations.

METHODS

A cross-sectional prevalence study with between group comparison was conducted. School enrollment health files were accessed between September 2000 and June 2001. A total of 320 selected female aboriginal students were compared with 237 non-aborigines.

RESULTS

With the exception of eye problems, general health status was inferior for the aboriginal female adolescent students. They had lower mean red blood cell volumes, lower haemoglobin concentrations, more oral decay, a greater prevalence of hepatitis B virus carriers and were more likely to be overweight.

CONCLUSIONS

It seems reasonable to suggest that health intervention strategies specific for indigenous adolescents should be provided. The design of these strategies should target lifestyle modification and provision of more accessible health information. Health professionals, and particularly nurses, are in a prime position to offer advice and support to this group.

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS)

BACKGROUND

This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents.

METHODS

BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each student's area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances.

RESULTS

Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship.

CONCLUSIONS

This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.

Delayed onset of pubertal development in children and adolescents with perinatally acquired HIV infection

OBJECTIVE

To examine whether greater severity of HIV infection is associated with delayed initiation of pubertal development among perinatally HIV-infected children, and to compare sexual maturation of perinatally HIV-infected children with children in the general US population using the National Health and Nutrition Examination Survey III.

METHODS

In a prospective cohort study, the authors studied 983 HIV-infected children aged 6 to 18 years, who had Tanner stage assessed on at least two occasions between 1995 and 2000. Analyses were conducted separately for girls and boys to identify factors associated with onset of puberty or adrenarche (progression beyond Tanner stage 1).

RESULTS

Among children who were in Tanner stage 1 at their first assessment, 185 of 413 (45%) girls and 144 of 434 (33%) boys entered puberty during the observation period. In multivariate longitudinal regression analyses adjusted for age, race/ethnicity, time interval between study visits, and other clinical factors, girls with severe immunosuppression (CD4% <15) were significantly less likely to enter adrenarche (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.29-0.83) and puberty (OR, 0.57; 95% CI, 0.33-0.96) compared with girls who were not immunosuppressed (CD4% > or =25). For boys, those with severe immunosuppression were significantly less likely to enter adrenarche (OR, 0.52; 95% CI, 0.28-0.96) and tended to be less likely to begin puberty (OR, 0.69; 95% CI, 0.39-1.22) compared with boys who were not immunosuppressed. Qualitative comparisons suggested that HIV-infected children may experience delayed puberty and adrenarche compared with similarly aged children in the general US population.

CONCLUSIONS

Immunosuppression was associated with delayed pubertal onset in perinatally HIV-infected children. Further studies of perinatally HIV-infected and uninfected children are needed to better quantify the delay in pubertal onset and to compare the pace of pubertal maturation.

The relation of menarcheal age to obesity in childhood and adulthood: the Bogalusa heart study

BACKGROUND

Several studies have shown that girls who undergo menarche at a relatively young age tend to be more obese as adults. However, because childhood (pre-menarcheal) levels of weight and height are associated with an earlier menarche, the increased prevalence of adult obesity among early maturers may largely reflect the persistence of childhood obesity into adulthood.

METHODS

We examined these interrelationships among 1179 girls (65% white, 35% black) who were examined as children (mean age, 9 y), adolescents, and adults (mean age, 26 y) in the Bogalusa Heart Study.

RESULTS

Both white and black women who reported that they underwent menarche before age 12 y had, on average, higher adult levels of weight (+10 kg), body mass index (BMI, +4 kg/m2) and skinfold thicknesses (+6 mm) than did women who underwent menarche after age 13.5 y. However, relatively fat children tended to undergo menarche earlier than did thinner children, with each standard deviation increase in pre-menarcheal BMI increasing the odds of early menarche (<12 y) by approximately 2-fold. Stratified and regression analyses indicated that (1) adult obesity was more strongly associated with childhood obesity than with menarcheal age, and (2) about 60% to 75% of the apparent effect of menarcheal age was due to the influence of childhood obesity on both menarcheal age and adult obesity.

CONCLUSIONS

Although additional longitudinal studies are needed, it is likely that the importance of early menarche in adult obesity has been overestimated. Most of apparent influence of menarcheal age on adult obesity is attributable to the association of childhood obesity with both menarcheal age and adult obesity.

Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region

BACKGROUND

Few European studies have investigated how cardiovascular risk factors (CRF) in adults relate to those observed in younger generations.

OBJECTIVE

To explore this issue in a Swiss region using two population health surveys of 3636 adolescents ages 9-19 years and 3299 adults ages 25-74 years.

METHODS

Age patterns of continuous CRF were estimated by robust locally weighted regression and those of high-risk groups were calculated using adult criteria with appropriate adjustment for children.

RESULTS

Gender differences in height, weight, blood pressure, and HDL cholesterol observed in adults were found to emerge in adolescents. Overweight, affecting 10-12% of adolescents, was increasing steeply in young adults (three times among males and twice among females) in parallel with inactivity. Median age at smoking initiation was decreasing rapidly from 18 to 20 years in young adults to 15 in adolescents. A statistically significant social gradient in disfavor of the lower education level was observed for overweight in all age groups of women above 16 (odds ratios (ORs) 2.4 to 3.3, P < 0.01), for inactivity in adult males (ORs 1.6 to 2.0, P < 0.05), and for regular smoking in older adolescents (OR 1.9 for males, 2.7 for females, P < 0.005), but not for elevated blood pressure.

CONCLUSION

Discontinuities in the cross-sectional age patterns of CRF indicated the emergence of a social gradient and the need for preventive actions against the early adoption of persistent unhealthy behaviors, to which low-educated girls and women are particularly exposed.

Preventing pediatric obesity: assessment and management in the primary care setting

PURPOSE

To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese.

DATA SOURCES

Selected research, national guidelines and recommendations, and the professional experience of the authors.

CONCLUSIONS

The focus of primary care involves early detection and family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems.

IMPLICATIONS FOR PRACTICE

Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender.

Ethnic issues in the epidemiology of childhood obesity

Childhood obesity may be seen as a marker for high-risk dietary and physical inactivity practices. Recent increases in the prevalence of overweight and obesity among American children are not limited to one age, gender, or ethnic group, which suggests that unique behaviors of the members of various racial or ethnic subgroups of the population are unlikely to be the major contributing factors. Rather, it seems that environmental changes promoting increased energy intake and decreased energy output are occurring and have widespread impact on children from various backgrounds. Although no ethnic group is immune from the current shift in energy balance, differential rates of overweight seem to exist among ethnic groups. National probability samples of African-American, Hispanic, and white children in the United States provide clear evidence that white children are at lower risk for childhood overweight than are African-American or Hispanic children. Of concern is the lack of national data on the prevalence of overweight and obesity for Native-American and Asian-American groups. Also of concern is the aggregation of racial and ethnic subgroups, which may render prevalence rates meaningless. This possibility is clearly true with some surveys of weight status that combine diverse populations, such as Asians and Pacific Islanders, into one group. The high rates of obesity in African-American, Hispanic, and Native-American children are of concern. Although parental SES is associated inversely with childhood obesity among whites, higher SES does not seem to protect African-American and Hispanic children against obesity. In these groups, childhood obesity does not seem to be associated significantly with parental income and education. Health consequences of childhood obesity include a higher prevalence of type 2 diabetes and an increased risk for adverse levels of lipids, lipoproteins, and blood pressure. The effects of recently reported unprecedented levels of childhood overweight on subsequent risk for obesity in middle age are not known until future longitudinal data can be collected. It seems likely, however, that future health consequences of current early and severe childhood obesity will be staggering. Funding for adult follow-up of longitudinal studies of high-risk African American, Hispanic, and Native-American children is needed urgently to provide information on the long-term effects of childhood obesity. Halting the obesity epidemic is a formidable task, but the success in recent decades of drastically reducing childhood undernutrition offers hope and should spur similar action and leadership efforts. Promotion of efforts to reduce excess caloric intake with efforts to increase energy expenditure should receive paramount attention in the design of health programs. Given the relatively few published obesity-prevention and treatment studies that are designed to address specific cultural issues, it is important to promote the development of culturally appropriate intervention strategies that are shown to be effective among youth of diverse backgrounds. Although the dietary and activity goals will be similar, parental, family, and community messages and techniques grounded in cultural traditions and norms will be different for each ethnic group. This approach is crucial in the United States, a country with an increasingly diverse population.

Obesity intervention among African-American children and adolescents

Often, researchers and clinicians approach the African-American community from a deficit model with African Americans viewed as having less desirable health practices and higher disease risk; however, in developing interventions for African Americans, it is important to keep in mind positive aspects of black culture as they relate to obesity. For example, the cultural acceptance of a larger body type and less negative views toward overweight individuals need not be viewed as problematic or abnormal. In fact, it could be argued that majority culture has a dysfunctional view of body image and obesity. The fact that whites are less likely to be overweight than African Americans may stem from a value system that places undue emphasis on thinness, youth, and external beauty and a culture that imbues women with shame about how they look and what they eat. Thus, rather than holding whites and majority culture as the ideal, it may be important to incorporate the positive elements of black culture regarding body image and food rather than attempting to shift their values toward those of European Americans. How best to achieve a reduction in obesity and its medical consequences, without inducing undesirable shifts in body image and attitudes toward food, is a formidable but important challenge.

BMI rebound, childhood height and obesity among adults: the Bogalusa Heart Study

OBJECTIVE

The beginning of the post-infancy rise in the body mass index (BMI, kg/m2) has been termed the adiposity rebound, and several studies have found that an early rebound increases the risk for overweight in adulthood. We examined whether this relation is independent of childhood BMI levels.

DESIGN

A longitudinal study of 105 subjects who examined at ages 5, 6, 7, 8 and 19-23 y.

RESULTS

Subjects with an age at the BMI rebound (age(min)) of < or =5 y were, on average, 4-5 kg/m2 heavier in early adulthood than were subjects whose age(min) was > or =7 y. Age(min), however, was also correlated with childhood BMI levels (r approximately -0.5), and we found that age(min) provided no additional information on adult overweight if the BMI level at age 7 y (or 8 y) was known. In contrast, childhood height, which was also correlated with age(min) (r=-0.47), was independently related to adult BMI. Among relatively heavy (BMI=16.0 kg/m2) 5-y-olds, a child with a height of 120 cm was estimated to be 1.2 kg/m2 heavier in adulthood than would a 104 cm tall child.

CONCLUSIONS

Although an early BMI rebound was related to higher levels of relative weight in adulthood, this association was not independent of childhood BMI levels. The relation of childhood height to adult BMI needs to confirmed in other cohorts, but it is possible that childhood height may help identify children who are likely to become overweight adults.