Trajectories and Transitions in Childhood and Adolescent Obesity

Developmental trajectories of body mass index since childhood and health-related quality of life in young adulthood: Tehran Lipid and Glucose Study

PURPOSE

The association between long-term BMI changes since childhood and health-related quality of life (HRQoL) in adulthood is still unclear. This study aimed to examine the association between identified BMI trajectories and HRQoL.

METHODS

A population-based cohort of 1938 eligible children (3-18 years) and their parents have been repeatedly followed up for 18 years. Offspring BMI trajectories were identified using group-based trajectory models. HRQoL was evaluated in offspring aged 21-36 years using SF-12V2. Using quantile regression analysis, the associations of the identified BMI trajectories and HRQoL in young adulthood were examined.

RESULTS

In males, persistent increasing overweight/obese group was negatively associated with 30th, 40th, 50th, and 60th percentiles of physical component summary (PCS) score distribution (β = - 2.60, p = 0.006; β = - 2.01, p = 0.005; β = - 1.86, p = 0.001; β = - 1.98, p = 0.009, respectively). A similar result was observed only in the 40th percentile of PCS distribution for the progressive overweight group (β = - 1.03, p = 0.022). In addition, the progressive overweight group in males showed a positive association with the upper tail of mental component summary (MCS) score distribution specifically for the 90th percentile (β = 1.15, p = 0.036). Regarding females, the current results indicated that the 90th percentile of MCS distributions was decreased in the persistent increasing overweight/obese group for females (β = - 1.83, p = 0.024). In addition, the progressive overweight group in females had a positive association with lower (30th and 40th) percentiles of PCS distribution (β = 1.29, p = 0.034, and β = 1.15, p = 0.030, respectively).

CONCLUSION

A sex-specific conditional association between developmental BMI trajectories from childhood and HRQoL in young adulthood was observed in physical and mental HRQoL.

Developmental trajectories of body mass index from childhood into late adolescence and subsequent late adolescence-young adulthood cardiometabolic risk markers

Background

Reports on body mass index (BMI) trajectories from childhood into late adolescence, their determinants, and subsequent cardiometabolic risk markers, particularly among European populations have been few. Moreover, sex-specific investigation is necessary considering the sex difference in BMI, and the sex-specific association between BMI and some cardiometabolic risk markers.

Methods

Using a sample from the DOrtmund Nutritional and Anthropometric Longitudinally Designed study, we explored sex-specific trajectories of the BMI standard deviation score (SDS) from 4 to 18 years of age in 354 males and 335 females by latent (class) growth models. The determinants of trajectory were assessed by logistic regression. We identified cardiometabolic risk markers that were highly associated with BMI SDS trajectory by random forest regression, and finally we used generalized linear models to investigate differences in the identified cardiometabolic risk markers between pairs of trajectories.

Results

We observed four: ‘low-normal weight’, ‘mid-normal weight’, ‘high-normal weight’, and ‘overweight’, and three: ‘‘low-normal weight’, ‘mid-normal weight’, and ‘high-normal weight’ trajectories in males and females, respectively. Higher maternal prepregnancy BMI was associated with the ‘overweight’ trajectory, and with ‘high-normal weight’ trajectory in both sexes. In addition, employed mothers and first-born status were associated with ‘high-normal weight’ trajectory in females. BMI SDS trajectory was associated with high-density lipoprotein-cholesterol and interleukin-18 (IL-18) in males, and diastolic blood pressure and interleukin-6 (IL-6) in females. However, only males following the ‘overweight’ trajectory had significantly higher IL-18 when compared to their ‘low-normal weight’ counterpart.

Conclusions

We identified sex-specific distinct trajectories of BMI SDS from childhood into late adolescence, higher maternal prepregnancy BMI as a common determinant of the ‘high-normal weight’ and ‘overweight’ trajectories, and ‘overweight’ trajectory being associated with elevated IL-18 in late adolescence–young adulthood. This study emphasizes the role of maternal prepregnancy BMI in overweight, and highlights IL-18 as a cardiometabolic signature of overweight across life.

Electronic supplementary material

The online version of this article (10.1186/s12933-019-0813-5) contains supplementary material, which is available to authorized users.

Sex-Specific Association between Childhood BMI Trajectories and Asthma Phenotypes

BACKGROUND

Asthma and obesity are two common health problems in the pediatric population. Obesity is associated with several comorbidities which are of great consequence. Excess adipose tissue has been linked to asthma in a number of studies. However, little is known about childhood body mass index (BMI) trajectories and the development of asthma phenotypes.

OBJECTIVE

The current study aims to investigate the significance of BMI trajectories over childhood and the risk of asthma phenotypes.

METHODS

The current study is a prospective cohort of children aged 0-2 years who were followed every two years for eight years through cycles one to five in the National Longitudinal Survey of Children and Youths (NLSCY). Statistical analysis: a latent class growth modelling (LCGM) method was used to identify BMI trajectory patterns from cycles one to five. Multiple imputation (number of imputations=5) was carried out to impute children with missing values on height or weight information. Sampling weights and 1,000 bootstrap weights were used in SAS PROC SURVEYLOGISTIC to examine the association between BMI trajectory and asthma phenotypes (persistent or transient asthma) in a multivariate analysis.

RESULTS

The study consisted of 571,790 males and 549,230 females. Among them, 46% of children showed an increasing trajectory in terms of change in BMI percentile during childhood, followed by the stable-trajectory group (41%) and decreasing-trajectory group (13%). After controlling for confounding factors, females in the increasing BMI trajectory group were four times more likely to be associated with persistent asthma (OR = 4.09; 95% CI:1.04-16.15; p = 0.0442) than females in the stable BMI trajectory group. No such relationship was found in males. The BMI trajectory was not significantly associated with risk of transient asthma for either sex.

CONCLUSION

We report a female-specific association between increasing adiposity, measured by BMI, and persistent asthma.

Comparing objective measures of the built environment in their associations with youth physical activity and sedentary behavior across heterogeneous geographies

We compared two strategies for measuring built environment features in their associations with youth physical activity and sedentary behavior across heterogeneous geographies of Pennsylvania. Physical activity environments of communities representing a rural-to-urban gradient were characterized through direct observation and spatially referenced archival data subjected to confirmatory factor analysis. Stratified regression analyses assessed associations between environmental measures and behavioral outcomes by community type. Neither strategy was consistently associated with behavior across communities. Findings highlight the importance of differentiating community type in evaluating associations of the built environment, and the challenge of measuring meaningful differences that influence youth behavior across heterogeneous geographies.

Early Life Growth Predictors of Childhood Adiposity Trajectories and Future Risk for Obesity: Birth to Twenty Cohort

BACKGROUND

There is growing evidence of variations in adiposity trajectories among individuals, but the influence of early life growth patterns on these trajectories is underresearched in low- and middle-income countries. Therefore, our aim was to examine the association between early life conditional weight gain and childhood adiposity trajectories.

METHODS

We previously identified distinct adiposity trajectories (four for girls and three for boys) in black South African children (boys = 877; girls = 947). The association between the trajectories and early life growth patterns, and future obesity risk was assessed by multivariate linear and multinomial logistic and logistic regressions. Conditional weight gain independent of height was computed for infancy (0-2 years) and early childhood (2-4 years).

RESULTS

Conditional weight gain before 5 years of age was significantly associated with early onset of obesity or overweight (excess weight) BMI trajectories in both boys and girls. In girls, greater conditional weight gain in infancy was associated with increased relative risk of being in the early-onset obese to morbid obese trajectory, with relative risk ratios of 2.03 (95% confidence interval: 1.17-3.52) compared to belonging to a BMI trajectory in the normal range. Boys and girls in the early-onset obesity or overweight BMI trajectories were more likely to be overweight or obese in early adulthood.

CONCLUSIONS

Excessive weight gain in infancy and early childhood, independent of linear growth, predicts childhood and adolescent BMI trajectories toward obesity. These results underscore the importance of early life factors in the development of obesity and other NCDs in later life.

Association of a history of childhood-onset obesity and dieting with eating disorders

This was a retrospective, observational chart review conducted on a convenience sample of 537 outpatients, aged 16-60 years, referred to an Italian Dietetic and Nutrition University Center. The study aimed to look at the association between a history of childhood obesity and dieting behaviors with development of eating disorders (EDs) at a later age. Subjects with a history of EDs (n = 118), assessed using both self-report and health records, were compared with those with no EDs (n = 419), who were attending the clinic mainly for primary prevention of metabolic and cardiovascular risk. Logistic regression analysis was performed to assess the association of childhood-onset obesity with development of an ED at a later age. Childhood-onset obesity, gender, maternal history of eating disorders, and dieting were associated with a positive history of EDs at a later age (p < .05). It is important to raise professional awareness of early symptoms of EDs in children with a history of obesity and treat them accordingly.