Youth BMI trajectories: evidence from the NLSY97

Late-onset or chronic overweight/obesity predicts low self-esteem in early adolescence: a longitudinal cohort study

Background

How weight status changes with time may affect self-esteem was seldom studied. We identified the distinct trajectories of overweight/obesity over age and assessed their associations with different domains of self-esteem in Hong Kong Chinese children.

Methods

Territory-wide longitudinal data of 48,558 children (girls: 50.0%; 6.3 ± 0.51 years) studying Primary 1 in the academic cohorts of 1995/96 and 1996/97 followed till Primary 6 were obtained from the Student Health Service of Hong Kong. Weight was annually measured and categorized as underweight/normal and overweight/obese and self-esteem was measured in Primary 6. Distinct trajectories of weight status were first identified using growth mixture modeling and their associations with low self-esteem were assessed by logistic regression.

Results

Four distinct overweight/obesity trajectories were identified: never (76.8%), late-onset (8.1%), early-onset (4.2%) and chronic (10.9%) overweight/obesity. Compared with children who were never overweight/obese, more of those in the late-onset or chronic overweight/obesity group showed low self-esteem and specific domains including general, social and academic/school-related (adjusted odds ratios: 1.20 - 1.43, all P < 0.001) except parent/home-related self-esteem (P = 0.36), whereas children being in the early-onset overweight/obesity group showed no significant difference (P ≥ 0.53) except a lower risk of low social self-esteem (adjusted odds ratio = 0.82, P = 0.03).

Conclusions

Late-onset or chronic overweight/obesity predicted low general, social and academic/school-related self-esteem. Children who successfully reduced weight may have equal levels of self-esteem or even better social self-esteem than those being always underweight/normal weight. Overweight/obese children had a vulnerability to self-esteem in non-domestic environments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12381-5.

Analysis of Factors Associated With Body Mass Index at Ages 18 and 36 Months Among Infants Born Extremely Preterm

IMPORTANCE

The development of neonatology has been associated with improved survival among infants born extremely preterm, and understanding their long-term outcomes is becoming increasingly important. However, there is little information on body mass index (BMI) among these children.

OBJECTIVE

To determine factors associated with BMI at ages 18 months and 36 months among infants born extremely preterm.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective, multicenter cohort study was conducted using data from the Neonatal Research Network Japan database for 8838 infants born at gestational ages 23 to 28 weeks with data on BMI at 18 months and 36 months. Data were analyzed from April 2018 through June 2021.

EXPOSURES

BMI and BMI z score at ages 18 months and 36 months were regressed with gestational age, intrauterine growth restriction (IUGR) status, and complications during pregnancy and the neonatal period separately by presence of multiple pregnancy and sex.

MAIN OUTCOMES AND MEASURES

BMI and BMI z score at ages 18 months and 36 months.

RESULTS

Among 16 791 eligible infants born extremely preterm, 8838 infants were included in the analysis. There were 7089 infants born from single pregnancies (mean [SD] gestational age, 26.0 [1.6] weeks; 3769 [53.2%] boys; mean [SD] birth weight, 847 [228] g) and 1749 infants born from multiple pregnancies (mean [SD] gestational age, 26.3 [1.5] weeks; 903 [51.6%] boys; mean [SD] birth weight, 860 [217] g). In single pregnancies, every week of increased gestational age was associated with an increase in BMI of 0.21 (95% CI, 0.17-0.25) among boys and 0.20 (95% CI, 0.15-0.25) among girls at age 18 months and 0.21 (95% CI, 0.18-0.24) among boys and 0.21 (95% CI, 0.18-0.24) among girls at age 36 months. There was an interaction association between gestational age and IUGR among boys at age 36 months, with a decrease in the change associated with gestational age of 0.12 (95% CI, 0.05-0.19). Every week of increased gestational age in single pregnancies was associated with an increase in BMI z score of 0.14 (95% CI, 0.17-0.21) among boys and 0.17 (95% CI, 0.13-0.21) among girls at age 18 months and 0.19 (95% CI, 0.16-0.22) among boys and 0.17 (95% CI, 0.15-0.20) among girls at age 36 months. Among single pregnancies, IUGR was associated with a decrease in BMI among boys (0.59 [95% CI, 0.23-0.95]) and girls (0.75 [95% CI, 0.39-1.11]) and BMI z score among boys 0.85 [95% CI, 0.25-0.95)] and girls (0.67 [95% CI, 0.36-0.97] at age 18 months and BMI among boys (0.44 [95% CI, 0.17-0.18]) and girls (0.84 [95% CI, 0.55-1.12]) and BMI z score among boys (0.46 [95% CI, 0.21-0.71]) and girls (0.77 [95% CI, 0.53-1.01]) at age 36 months. In multiple pregnancies, IUGR was associated with a decrease in BMI z score at age 36 months among boys (0.26 [95% CI, 0.42-0.89]) and girls (0.29 [95% CI, 0.22-0.79]). In single pregnancies intraventricular hemorrhage (IVH) was associated with a decrease in BMI of 0.47 (95% CI, 0.21-0.73) among boys and 0.42 (95% CI, 0.13-0.71) among girls at age 18 months and 0.53 (95% CI, 0.32-0.74) among boys and 0.31 (95% CI, 0.07-0.54) among girls at age 36 months. IVH was associated with a decrease in BMI z score in single pregnancies of 0.63 (95% CI, 0.20-0.41) among boys and 0.35 (95% CI, 0.12-0.60) among girls at age 18 months and 0.53 (95% CI, 0.34-0.71) among boys and 0.30 (95% CI, 0.11-0.50) among girls at age 36 months. Similar associations were seen in multiple pregnancies.

CONCLUSIONS AND RELEVANCE

This study found that gestational age, the presence of IUGR and multiple pregnancy, and IVH complications were associated with infant BMI at ages 18 months and 36 months. These findings suggest that these complicating factors should be considered when setting growth targets and nutrition strategies for infants born extremely preterm.

Examining the Bidirectional Association Between Body Esteem and Body Mass Index During Adolescence

OBJECTIVE

Research on body esteem (weight and appearance esteem) and weight suggests that having a positive body esteem may be associated with more stable weight trajectories during adolescence, and adolescents with higher weight report lower levels of body esteem. However, bidirectional relationships between body esteem and weight have not yet been examined. This 3-year longitudinal study examined (1) bidirectional relationships between body esteem and body mass index (BMI) and (2) how BMI and body esteem changed together throughout adolescence.

METHODS

Participants (N = 1163 adolescents, at time 1 [T1] baseline; 60.3% female) from a school-based community sample completed surveys approximately annually for 3 years.

RESULTS

Latent growth modeling revealed that (a) among boys and girls, appearance and weight esteem scores decreased over time, (b) higher initial BMI scores were associated with slower decreases in appearance esteem over time. However, evidence for bidirectionality was not found, in which baseline appearance and weight esteem did not predict changes in BMI over time and vice versa.

CONCLUSION

Results suggest that changes in BMI and body esteem are co-occurring (rather than predictive) throughout adolescence. The decreasing trajectory of body esteem over time suggests the need for prevention efforts to improve body esteem throughout adolescence.

Changing from a highly food secure household to a marginal or food insecure household is associated with decreased weight and body mass index z-scores among Latino children from CHAMACOS

BACKGROUND

Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration.

OBJECTIVES

Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12.

METHODS

We analyzed 204 mother-child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood.

RESULTS

Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z-score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z-score compared to those who persistently lived in highly food secure households.

CONCLUSIONS

Changes in food security status and duration of food insecurity were associated with changes in children's growth.

Life-long body mass index trajectories and mortality in two generations

PURPOSE

To identify life-long body mass index (BMI) trajectories across two related generations and estimate their associated mortality risks and population attributable deaths.

METHODS

We use prospective cohort data from the Framingham Heart Study (1948-2011) original (4576 individuals, 3913 deaths) and offspring (3753 individuals, 967 deaths) cohorts and latent trajectory models to model BMI trajectories from age 31 to 80 years. Survival models are used to estimate trajectory-specific mortality risk.

RESULTS

We define seven BMI trajectories among original cohort and six among offspring cohort. Among original cohort, people who are normal weight at age 31 years and gradually move to overweight status in middle or later adulthood have the lowest mortality risk even compared to those who maintain normal weight throughout adulthood, followed by overweight stable, lower level of normal weight, overweight downward, class I obese upward, and class II/III upward trajectories. Mortality risks associated with obesity trajectories have declined across cohorts, while the prevalence of high-risk trajectories has increased.

CONCLUSIONS

The mortality impact of weight gain depends on an individual's BMI trajectory. Population attributable deaths associated with unhealthy weight trajectories have grown over generations because the prevalence has increased, offsetting the decline in trajectory-specific mortality risks.

Body Mass Index Trajectory and Incident Hypertension: Results From a Longitudinal Cohort of Chinese Children and Adolescents, 2006-2016

Objectives. To identify body mass index (BMI) trajectories in Chinese children and to compare the risk of incident high blood pressure (HBP) across trajectory groups.Methods. A total of 9286 children were included. The mean age at baseline was 8.9 years; age at endpoint ranged between 16 and 18 years. At least 8 measurements were obtained from each involved child. We used group-based trajectory modeling to identify BMI trajectory groups in each sex. We used blood pressure from each measurement to define HBP.Results. We identified 4 BMI trajectories for each sex. Compared with the low trajectory group, the hazard ratios of HBP in the higher trajectory groups ranged from 1.17 (95% confidence interval [CI] = 1.11, 1.23) to 2.00 (95% CI = 1.78, 2.27) during follow-up, and HBP risk at late adolescence ranged from 1.36 (95% CI = 1.22, 1.52) to 3.63 (95% CI = 3.12, 4.21). All trend P values across trajectories were less than .001. In terms of population level, overweight started 3 years earlier than HBP.Conclusions. Children of higher BMI trajectories had a higher risk of HBP during adolescence. The transition period from overweight to HBP onset could be critical for HBP prevention.

Group‐based trajectory modeling of body mass index and body size over the life course: A scoping review

Background

Group‐based trajectory modeling has been applied to identify distinct trajectories of growth across the life course. Objectives of this study were to describe the methodological approaches for group‐based modeling of growth across the life course and to summarize outcomes across studies.

Methods

A scoping review with a systematic search of Medline, EMBASE, CINAL, and Web of Science was conducted. Studies that used a group‐based procedure to identify trajectories on any statistical software were included. Data were extracted on trajectory methodology, measures of growth, and association with outcomes.

Results

A total of 59 studies were included, and most were published from 2013 to 2020. Body mass index was the most common measure of growth (n = 43). The median number of identified trajectories was 4 (range: 2–9). PROC TRAJ in SAS was used by 33 studies, other procedures used include TRAJ in STATA, lcmm in R, and Mplus. Most studies evaluated associations between growth trajectories and chronic disease outcomes (n = 22).

Conclusions

Group‐based trajectory modeling of growth in adults is emerging in epidemiologic research, with four distinct trajectories observed somewhat consistently from all studies. Understanding life course growth trajectories may provide further insight for population health interventions.

Weight Gain Trajectory and Pain Interference in Young Adulthood: Evidence from a Longitudinal Birth Cohort Study

OBJECTIVE

Obesity is associated with chronic pain, but the contribution of body mass index (BMI) trajectories over the life course to the onset of pain problems remains unclear. We retrospectively analyzed how BMI trajectories during the transition to adulthood were associated with a measure of pain interference obtained at age 29 in a longitudinal birth cohort study.

METHODS

Data from the National Longitudinal Survey of Youth, 1997 Cohort (follow-up from 1997 to 2015), were used to determine BMI trajectories from age 14 to 29 via group trajectory modeling. At age 29, respondents described whether pain interfered with their work inside and outside the home over the past four weeks (not at all, a little, or a lot). Multivariable ordinal logistic regression was used to evaluate pain interference according to BMI trajectory and study covariates.

RESULTS

Among 7,875 respondents, 11% reported "a little" and 4% reported "a lot" of pain interference at age 29. Four BMI trajectory groups were identified, varying in starting BMI and rate of weight gain. The "obese" group (8% of respondents) had a starting BMI of 30 kg/m2 and gained an average of 0.7 kg/m2/y. On multivariable analysis, this group was the most likely to have greater pain interference, compared with "high normal weight" (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.14-1.88), "low normal weight" (OR = 1.45, 95% CI = 1.13-1.87), and "overweight" trajectories (OR = 1.33, 95% CI = 1.02-1.73).

CONCLUSIONS

Obesity and rapid weight gain during the transition to adulthood were associated with higher risk of pain interference among young adults.

Body mass index trajectories from adolescent to young adult for incident high blood pressure and high plasma glucose

Objectives

To explore the association between sex-specific adiposity trajectories among Adolescents to early adulthood with incident high blood pressure (HBP) and high plasma glucose (HPG).

Methods

We studied body mass index (BMI) trajectories among1159 (male = 517) and 664 (male = 263) Iranian adolescents, aged 12–20 years, for incident HPG and HBP, respectively. Latent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to determine sex-specific and distinct BMI trajectories. Logistic regressions were applied to estimate the relationship between latent class membership with HBP and HPG, considering normal trajectory as the reference.

Results

For both HBP and HPG, LCGMM determined two and three distinct BMI trajectories in males and females, respectively. During a follow-up of 12Years 104 (male = 62) and 111(male = 59) cases of HPG and HBP were found, respectively. Among females, faster BMI increases (i.e. overweight to early obese trajectory) but not overweight (i.e. those with BMI = 27.3 kg/m² at baseline) trajectories increased the risk of HPG by adjusted odds ratios (ORs), 2.74 (1.10–5.80) and 0.79 (0.22–2.82), respectively; regarding HBP, the corresponding value for overweight to late obese trajectory was 3.72 (1.37–11.02). Among males, for HBP, the overweight trajectory increased the risk [2.09 (1.04–4.03)]; however, for incident HPG, none of the trajectories showed significant risk.

Conclusions

Among females, trend of increasing BMI parallel with age can be a better predictor for risk of developing HPG and HBP than those with higher BMI at baseline.

Body mass index across adolescence and substance use problems in early adulthood

Excessive substance use and obesity are underpinned by a number of shared risk factors (e.g., reward dysfunction, impulsivity). Food and drugs of abuse engage similar reward-related neural circuitry and the food-drug competition hypothesis proposes that excess consumption of food may diminish desire for drugs of abuse by competing for neural receptors associated with reward and motivation. Adolescence is a high-risk period for both increased substance use and excessive weight gain. In the present study, the authors tested whether, consistent with the food-drug competition hypothesis, elevated body mass index (BMI) across adolescence predicted fewer substance use problems in young adulthood. In a multiwave prospective study of a community sample of families enriched for high levels of substance use disorders, the authors first identified BMI trajectories across adolescence in 565 participants using latent class growth analysis. They then used maximum likelihood methods to compare the equality of mean alcohol-, drug-, and nicotine-related problems during early adulthood across adolescent BMI trajectories. Participants in the obese relative to the normal weight trajectory in adolescence had fewer drinking and illicit drug problems in early adulthood. Relative to the overweight trajectory, nicotine dependence was significantly higher among both the normal weight and obese trajectories. The current findings provide partial support for the food-drug competition hypothesis, which suggests that highly palatable foods may be rewarding enough to compete with drugs of abuse and that transdiagnostic approaches to reducing problematic substance use and overeating in adolescence may be useful. However, the relationship between nicotine and food requires further study. (PsycINFO Database Record

Sociodemographic associations of longitudinal adiposity in youth with type 1 diabetes

Excess adiposity is common in youth with type 1 diabetes, yet little is known about the sociodemographic factors that predict longitudinal trajectories of body fat. We analyzed data from 363 females and 379 males with type 1 diabetes over ~9 years of follow-up (mean baseline age 12.8 ± 2.3 years in females, 13.2 ± 2.4 years in males). Estimated body fat percentage (eBFP) was calculated with validated sex- and race/ethnicity-specific equations. Group-based modeling identified three eBFP trajectories for each sex. All female trajectories showed gradual increases, while male trajectories showed gradual decreases (<5% in eBFP) that plateaued around 7 years of diabetes duration. Female trajectories showed differences in baseline eBFP: Group F1 (38.0%), mean eBFP 27.8 ± 3.0%: Group F2 (47.9%), mean eBFP 33.9 ± 3.0%: and Group F3 (14.1%), mean eBFP 41.7 ± 4.1%. Male trajectories also showed differences in baseline eBFP: Group M1 (57.2%), mean eBFP 22.0 ± 3.0%: Group M2 (30.9%), mean eBFP 33.9 ± 3.0%: and Group M3 (12.9%), mean eBFP 36.1 ± 3.7%. In multinomial models, adjusted for clinical factors (eg, insulin regimen, insulin dose, and hemoglobin A1c), females who reported a single-parent household (adjusted odds ratio [aOR] = 3.34, 95% confidence interval [CI]: 1.49, 7.47), parental education of less than a college degree (aOR = 3.79, 95% CI: 1.60, 9.60), and a lack of private health insurance (aOR = 3.74, 95% CI: 1.45, 9.60), and a household income of less than $75 000 per year (aOR = 3.13, 95% CI: 1.27, 7.70) were approximately three to four times more likely to be in the highest eBFP trajectory group relative to the lowest eBFP trajectory group. Males who reported a household income of <$75 000/year were almost twice as likely to be in the Group M3 than the Group M1 in the unadjusted model only (aOR = 1.79, 95% CI: 0.91, 4.01 vs unadjusted OR: 2.48, 95% CI: 1.22, 5.06). Lower socioeconomic status may be associated with excess body fat throughout adolescence in type 1 diabetes, particularly among females.

Body Mass Index Trajectories From Birth to Midlife and Vertebral Dimensions in Midlife: the Northern Finland Birth Cohort 1966 Study

Vertebral fracture risk is higher among individuals with small vertebral dimensions. Obesity is a global health problem and may also contribute to bone size and fracture risk. In this work we report the association between life course body mass index (BMI) and vertebral cross-sectional area (CSA) in midlife. The Northern Finland Birth Cohort 1966 study with its 46-year follow-up provided the material for this study. A subsample of 780 individuals had attended lumbar magnetic resonance imaging (MRI) at the age of 46 years, and had records of objectively measured BMI from the ages of 0, 7, 15, 31, and 46 years. Of these, MRI-derived data on vertebral size was available for 682 individuals. We identified latent lifelong BMI trajectories by performing latent class growth modeling (LCGM) on the BMI data, and then used sex-stratified linear regression models to compare the identified trajectory groups in terms of midlife vertebral CSA. Gestational age, education years, adult height, lifelong physical activity, lifelong smoking history, and adulthood diet were assessed as potential confounders. Three distinct trajectory groups ("stable slim," "stable average," and "early onset overweight") were identified among both sexes. Comparisons to the stable slim trajectory revealed that vertebral CSA was significantly (p < 0.001) larger among the stable average and early onset overweight trajectories (69.8 and 118.6 mm² larger among men, 57.7 and 106.1 mm² larger among women, respectively). We conclude that lifelong BMI has a positive association with midlife vertebral size among both sexes. Future studies should characterize the mediating factors of this association.

Longitudinal Associations Between Anhedonia and Body Mass Index Trajectory Groups Among Adolescents

PURPOSE

Although evidence suggests that anhedonia-a reduced ability to experience pleasure in response to rewarding stimuli-may predict weight gain during adolescence, it remains unclear whether changes in anhedonia during adolescence are associated with changes in body mass index (BMI). This study examines longitudinal associations between changes in anhedonia and developmental trajectories of BMI during adolescence.

METHODS

Self-report measures of anhedonia and BMI were collected at five semiannual assessments among students from 10 high schools in Los Angeles, CA, area (N = 3,396) followed up from the 9th grade to the 11th grade. Four BMI trajectories were identified using growth mixture modeling: (1) stable normative weight; (2) overweight to normative weight (i.e., decreasing BMI); (3) overweight to chronically obese (increasing BMI); and (4) normative weight to overweight (increasing BMI). Latent growth curve modeling estimated baseline level and changes in anhedonia. A multinomial logistic regression model tested associations of baseline level and slope of anhedonia with the four BMI trajectory groups.

RESULTS

Compared with the stable normative BMI trajectory group, each 1-unit standard deviation increase in anhedonia slope increased the odds of membership in the overweight to chronically obese group (odds ratio [OR] [95% confidence interval {CI}] = 1.29 [1.09-1.49], p < .001) and in the normative weight to overweight group (OR [95% CI] = 1.28 [1.04-1.53], p = .006), and decreased the odds of membership in the overweight to normative weight group (OR [95% CI] = .78 [.57-.95], p = .01).

CONCLUSIONS

Across a 2-year period of high school, the rate of change in anhedonia is associated with certain BMI trajectories linked with poorer metabolic health. Increasing anhedonia may be an important risk factor to consider in adolescent obesity prevention.

BMI Trajectories from Birth to Young Adulthood

OBJECTIVE

This study aimed to compare BMI trajectories from childhood to early adulthood in those with overweight and/or obesity versus severe obesity.

METHODS

Longitudinal BMI values (2,542 measurements) were calculated from measured heights and weights for 103 children, adolescents, or young adults with overweight, obesity, or severe obesity. Segmented regression with splines was used to model BMI trajectories.

RESULTS

Sixty-nine participants were classified as ever having severe obesity versus 34 who never had severe obesity. Trajectories and slopes did not differ by sex or race/ethnicity. Compared with those who never had severe obesity, BMI was higher in the group with severe obesity at all ages, and BMI slope was higher for those with severe obesity at age 14 (P = 0.002), with peak slope occurring later (18 years vs. 16 years) and higher (4.5 ± 0.5 kg/m² /y vs. 2.9 ± 0.5 kg/m² /y; P < 0.02). In the group without severe obesity, BMI fell below zero by the mid-20s (-0.3 ± 0.6 kg/m² /y); in those with severe obesity, BMI slope never reached zero (0.9 ± 0.5 kg/m² /y).

CONCLUSIONS

Youth with severe obesity, compared with their peers without, started with higher BMIs, had more rapid rates of BMI increase beginning at age 14, as well as a higher peak and longer period of increase, and never achieved weight stabilization.

Intersecting Social Inequalities and Body Mass Index Trajectories from Adolescence to Early Adulthood

This study combines multiple-hierarchy stratification and life course perspectives to address two research questions critical to understanding U.S. young adult health. First, to what extent are racial-ethnic inequalities in body mass index (BMI) gendered and/or classed? Second, do racial-ethnic, gender, and socioeconomic inequalities in BMI widen or persist between adolescence and early adulthood? Using data from the National Longitudinal Survey of Youth 1997 cohort and growth curve models, results suggest that among white, black, and Hispanic American men and women ages 13 to 31, racial-ethnic inequality in BMI is greatest among women. Black women experience the highest adolescent BMI and the greatest increases in BMI with age. Furthermore, socioeconomic resources are less protective against weight gain for blacks and Hispanics, with the nature of these relationships varying by gender. Findings present a more nuanced picture of health inequality that renders visible the disproportionate burden of poor health experienced by marginalized groups.

Trajectories of aggressive and depressive symptoms in male and female overweight children: Do they share a common path or do they follow different routes?

The prevalence of childhood overweight is a major social and public health issue, and primary assessment should focus on early and middle childhood, because weight gain in these phases constitutes a strong predictor of subsequent negative outcomes. Studies on community samples have shown that growth curves may follow linear or non-linear trajectories from early to middle childhood, and can differ based on sex. Overweight children may exhibit a combination of physiological and psychosocial issues, and several studies have demonstrated an association between overweight and internalizing/externalizing behavior. Nevertheless, there is a dearth of longitudinal studies on depressive and aggressive symptoms in children with high BMI. This study adopted a growth curve modeling over three phases to: (1) describe BMI trajectories in two groups of children aged 2–8 (overweight and normal weight) from a community sample; (2) describe the developmental trajectories of children’s aggressive and depressive symptoms from 2 to 8 years of age. Results indicate higher BMI in 2-year-old girls, with males catching up with them by age 8. While overweight females’ BMIs were consistently high, males’ increased at 5 and 8 years. The mean scores for aggressive symptoms at T1 (2 years of age) were the same in all subjects, but a significant deviation occurred from T1 to T2 in both samples, in divergent directions. With regards to children’s depressive symptoms, the two groups had different starting points, with normal weight children scoring lower than overweight youths. Overweight females showed lower depressive scores than overweight males at T1, but they surpassed boys before T2, and showed more maladaptive symptoms at T3. This study solicits professionals working in pediatric settings to consider overweight children’s psychopathological risk, and to be aware that even when children’s BMI does not increase from 2 to 8 years, their psychopathological symptoms may grow in intensity.

Behavioural patterns only predict concurrent BMI status and not BMI trajectories in a sample of youth in Ontario, Canada

Background

Youth are engaging in multiple risky behaviours, increasing their risk of overweight, obesity, and related chronic diseases. The objective of this study was to examine the effect of engaging in unique clusters of unhealthy behaviours on youths’ body mass index (BMI) trajectories.

Methods

This study used a linked-longitudinal sample of Grades 9 and 10 students (13 to 17 years of age) participating in the COMPASS host study. Students reported obesity-related and other risky behaviours at baseline and height and weight (to derive BMI) at baseline (2012/2013) and annually for 2 years post-baseline (2013/14 and 2014/15). Students were grouped into behavioural clusters based on response probabilities. Linear mixed effects models, using BMI as a continuous outcome measure, were used to examine the effect of engaging in clusters of risky behaviours on BMI trajectories.

Results

There were significant differences in BMI of the four behavioural clusters at baseline that remained consistent over time. Higher BMI values were found among youth classified at baseline to be Typical High School Athletes (β = 0.232 kg/m², [confidence interval (CI): 0.03–0.50]), Inactive High Screen-User (β = 0.348 kg/m², CI: 0.11–0.59) and Moderately Active Substance Users (β = 0.759 kg/m², CI: 0.36–1.15) compared to students classified as Health Conscious. Despite these baseline differences, BMI appeared to increase across all behavioural clusters annually by the same amount (β = 0.6097 kg/m², (CI) = 0.57–0.64).

Conclusions

Although annual increases in BMI did not differ by behavioural clusters, membership in a particular behavioural cluster was associated with baseline BMI, and these differences remained consistent over time. Results indicate that intervening and modifying unhealthy behaviours earlier might have a greater impact than during adolescence. Health promotion strategies targeting the highest risk youth as they enter secondary school might be promising means to prevent or delay the onset of obesity.

Body Mass Index Trajectories from Adolescence to Early Young Adulthood: Do Adverse Life Events Play a Role?

OBJECTIVE

The aim of this study was to investigate whether there are different classes of body mass index (BMI) development from early adolescence to young adulthood and whether these classes are related to the number of adverse life events children experienced.

METHODS

Data were from the TRAILS (TRacking Adolescents' Individual Lives Survey) cohort (n = 2,218). Height and weight were objectively measured five times between participants' ages 10 to 12 years and 21 to 23 years. Parents reported on the occurrence of adverse life events in their child's life in an interview when children were 10 to 12 years old. Unconditional and conditional growth mixture modeling was used for statistical analysis.

RESULTS

"Normal weight" (75.1%), "late onset overweight" (20.1%), and "early onset overweight" classes (4.8%) were identified. In analyses unadjusted for additional covariates, children who experienced a higher number of adverse events had higher odds to be in the late onset overweight (OR [95% CI] = 1.08 [1.00-1.17]) than the normal weight class, but the association was attenuated in analyses adjusted for additional covariates (OR [95% CI] = 1.07 [0.98-1.16]).

CONCLUSIONS

Three BMI trajectory classes can be distinguished from early adolescence to young adulthood. The accumulation of adverse life events is not related to BMI trajectory class.

Trajectories of maternal weight from before pregnancy through postpartum and associations with childhood obesity

Background: Prepregnancy body mass index [BMI (in kg/m²)], gestational weight gain, and postpartum weight retention may have distinct effects on the development of child obesity, but their combined effect is currently unknown.Objective: We described longitudinal trajectories of maternal weight from before pregnancy through the postpartum period and assessed the relations between maternal weight trajectories and offspring obesity in childhood.Design: We analyzed data from 4436 pairs of mothers and their children in the National Longitudinal Survey of Youth 1979 (1981-2014). We used latent-class growth modeling in addition to national recommendations for prepregnancy BMI, gestational weight gain, and postpartum weight retention to create maternal weight trajectory groups. We used modified Poisson regression models to assess the associations between maternal weight trajectory group and offspring obesity at 3 age periods (2-5, 6-11, and 12-19 y).Results: Our analysis using maternal weight trajectories based on either latent-class results or recommendations showed that the risk of child obesity was lowest in the lowest maternal weight trajectory group. The differences in obesity risk were largest after 5 y of age and persisted into adolescence. In the latent-class analysis, the highest-order maternal weight trajectory group consisted almost entirely of women who were obese before pregnancy and was associated with a >2-fold increase in the risk of offspring obesity at ages 6-11 y (adjusted RR: 2.39; 95% CI: 1.97, 2.89) and 12-19 y (adjusted RR: 2.74; 95% CI: 2.13, 3.52). In the analysis with maternal weight trajectory groups based on recommendations, the risk of child obesity was consistently highest for women who were overweight or obese at the beginning of pregnancy.Conclusion: These findings suggest that high maternal weight across the childbearing period increases the risk of obesity in offspring during childhood, but high prepregnancy BMI has a stronger influence than either gestational weight gain or postpartum weight retention.

Post-term growth and cognitive development at 5 years of age in preterm children: Evidence from a prospective population-based cohort

While the effects of growth from birth to expected term on the subsequent development of preterm children has attracted plentiful attention, less is known about the effects of post-term growth. We aimed to delineate distinct patterns of post-term growth and to determine their association with the cognitive development of preterm children. Data from a prospective population-based cohort of 3,850 surviving infants born at less than 35 weeks of gestational age were used. Growth was assessed as the Body Mass Index (BMI) Z-scores at 3, 9, 18, 24, 36, 48, and 60 months. Cognitive development at five years of age was evaluated by the Global School Adaptation score (GSA). Latent class analysis was implemented to identify distinct growth patterns and logistic regressions based on propensity matching were used to evaluate the relationship between identified growth trajectories and cognitive development. Four patterns of post-term growth were identified: a normal group with a Z-score consistently around zero during childhood (n = 2,469; 64%); a group with an early rapid rise in the BMI Z-score, but only up to 2 years of age (n = 195; 5%); a group with a slow yet steady rise in the BMI Z-score during childhood (n = 510; 13%); and a group with a negative Z-score growth until 3 years of age (n = 676; 18%). The group with a slow yet steady rise in the BMI Z-score was significantly associated with low GSA scores. Our findings indicate heterogeneous post-term growth of preterm children, with potential for association with their cognitive development.

Paediatric obesity and cardiovascular risk factors - A life course approach

Childhood obesity is increasingly prevalent worldwide, and Portugal presents one of the highest prevalence of obesity and overweight among the European countries. Since childhood obesity is a risk factor for obesity in adulthood, the high prevalence of overweight and obesity in paediatric age currently experienced is expected to lead to even higher prevalence of obesity in adulthood in future decades. It is well known that the prenatal period and infancy are critical or sensitive periods for obesity development, but a growing body of evidence also suggests a relevant role of childhood and adolescence. The exposure to some factors during these periods or specific time frames within these periods may confer additional risk for obesity development. Paediatric obesity is associated with cardiovascular risk factors both in the short or medium-term, but also in the long term, conferring additional risk for future adult health. However, it is not clear whether the relation between paediatric obesity and adult health is independent of adult adiposity. There is a moderate to high tracking of obesity from paediatric age into adulthood, which may partially explain the association with adult outcomes. Therefore, there has been increasing interest on life course frameworks to study the effect of the dynamics of adiposity across paediatric age on adult outcomes, namely on the cardiovascular disease risk. The use of this approach to study determinants and consequences of obesity raises methodological challenges to summarize the exposure to adiposity/obesity across the life span, being the identification of growth trajectories and the quantification of the duration of obesity among the most used methods. However, further investigation is still needed to explore the best methods to summarize exposure to adiposity and its variation across time.

Growth Mixture Modeling of Adolescent Body Mass Index Development: Longitudinal Patterns of Internalizing Symptoms and Physical Activity

Growth mixture modeling was used to identify different trajectories of body mass index (BMI) among adolescents ages 10-15 from a national sample. Three distinct classes were found for both boys and girls: "normative" (90.9% and 89.7%), "high increasing" (6.3% and 7.4%), and "decreasing" (2.8% and 2.9%). Multinomial logistic regression identified family income as predictive of class membership for boys and pubertal status and being rural as predictive for girls. Parent-reported health was a common predictor across gender. Growth curves of internalizing symptoms and physical activity were modeled to explore trends across classes. Findings highlight complexities in the relations between BMI, internalizing symptoms, and physical activity in this developmental period.

Socio-economic and demographic factors influencing nutritional status among early childbearing young mothers in Bangladesh

Background

Early childbearing influences women’s health. This study aims to examine the effects of socio-demographic factors on nutritional status of early childbearing mothers in Bangladesh based on Body Mass Index (BMI) as the indicator.

Methods

Data was extracted from Bangladesh Demographic and Health Survey (BDHS)-2011. The survey was performed on 17,842 married women aged 15–49. We focused on early childbearing mothers (age ≤ 24, and who had delivered their first child ≤ 20). Mothers who were underweight (BMI ≤ 18.5 kg/m²) would be further classified into various grades of chronic energy deficiency (CED): mild (17.0 ≤ BMI < 18.5 kg/m²), moderate (16.0 ≤ BMI <17.0 kg/m²), and severe (BMI < 16.0 kg/m²). Multiple logistic regression model was used to examine the effect of socio-demographic factors on nutritional status.

Results

Mean age of the mothers was 20.49 ± 2.37 years (ranged 15–24 years). The prevalence of underweight among early childbearing mothers was 32.1 % (urban 25 % and rural 35.1 %). Most of the underweight mothers had mild (62.2 %) CED, while the remaining had either moderate (25.9 %) or severe (11.9 %) CED. Multiple logistic regression analysis demonstrated that young mothers from rural areas, poor families, and those who were illiterate or with low level of education, working, and married to unemployed husband were at higher risk for being underweight. Young mothers who had non-caesarean delivered, delivered at home, or married at early age and had more than two children were also at higher risk for being underweight.

Conclusions

The prevalence of underweight among early childbearing mothers in Bangladesh is very high (32.1 %), associated with the still common practice of teenage marriage. Education level, wealth index, occupation, place of residence, age at first marriage and parity were important predictors for their nutritional status. The government and non-government organizations should take initiatives to reduce the prevalence of underweight mothers in Bangladesh.

Childhood adiposity trajectories are associated with late adolescent blood pressure: birth to twenty cohort

BACKGROUND

Elevated blood pressure in childhood is a risk factor for adult hypertension which is a global health problem. Excess adiposity in childhood creates a predisposition to develop adult hypertension. Our aim was to explore distinct sex-specific adiposity trajectories from childhood to late adolescence and examined their association with blood pressure.

METHODS

Latent Class Growth Mixture Modeling (LCGMM) on longitudinal data was used to derive sex-specific and distinct body mass index (BMI: kg/m(2)) trajectories. We studied 1824 black children (boys = 877, girls = 947) from the Birth to Twenty (Bt20) cohort from Soweto, South Africa, and obtained BMI measures at ages 5 through 18 years. Participants with at least two age-point BMI measures, were included in the analysis. Analysis of variance (ANOVA), chi-square test, multivariate linear and standard logistic regressions were used to test study characteristics and different associations.

RESULTS

We identified three (3) and four (4) distinct BMI trajectories in boys and girls, respectively. The overall prevalence of elevated blood pressure (BP) was 34.9 % (39.4 % in boys and 30.38 % in girls). Boys and girls in the early onset obesity or overweight BMI trajectories were more likely to have higher BP values in late adolescence. Compared to those in the normal weight BMI trajectory, girls in early onset obesity trajectories had an increased risk of elevated BP with odds ratio (OR) of 2.18 (95 % confidence interval 1.31 to 4.20) and 1.95 (1.01 to 3.77). We also observed the weak association for boys in early onset overweight trajectory, (p-value = 0.18 and odds ratio of 2.39 (0.67 to 8.57)) CONCLUSIONS: Distinct weight trajectories are observed in black South African children from as early as 5 years. Early onset adiposity trajectories are associated with elevated BP in both boys and girls. It is important to consider individual patterns of early-life BMI development, so that intervention strategies can be targeted to at-risk individuals.

Exploring Categorical Body Mass Index Trajectories in Elementary School Children

BACKGROUND

Studies of body mass index (BMI) change have focused on understanding growth trajectories from childhood to adolescence and adolescence to adulthood, but few have explored BMI trajectories solely in elementary (grades K-5) school children. This report complements these studies by exploring changes in obesity status using analytic methods developed to investigate categorical changes in life-course events.

METHODS

Sequences of a 4-state BMI variable (underweight, normal, overweight, and obese) were calculated using height and weight data collected annually (2008-2013) from 414 kindergarten and first-grade students participating in the Community and Schools Together (CAST) project. These sequences were explored using the TraMineR software package to investigate the distribution of sequences and states, calculate transition rates among states, and examine clustering of sequences.

RESULTS

Aggregated cluster solutions were identified consisting of either 4 clusters (normal, stepped, mixed, and obese) or 3 clusters (aggregation of obese cluster cases into stepped cluster) with membership in the former predicted by ethnicity and socioeconomic status (SES) and the latter by SES alone. Transition rate patterns among states varied markedly by cluster and state.

CONCLUSION

The finding of early emergence of stable obesity states, especially in Hispanic children confirms the need for early childhood interventions to influence BMI.

The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis

BACKGROUND

It is uncertain which simple measures of childhood obesity are best for predicting future obesity-related health problems and the persistence of obesity into adolescence and adulthood.

OBJECTIVES

To investigate the ability of simple measures, such as body mass index (BMI), to predict the persistence of obesity from childhood into adulthood and to predict obesity-related adult morbidities. To investigate how accurately simple measures diagnose obesity in children, and how acceptable these measures are to children, carers and health professionals.

DATA SOURCES

Multiple sources including MEDLINE, EMBASE and The Cochrane Library were searched from 2008 to 2013.

METHODS

Systematic reviews and a meta-analysis were carried out of large cohort studies on the association between childhood obesity and adult obesity; the association between childhood obesity and obesity-related morbidities in adulthood; and the diagnostic accuracy of simple childhood obesity measures. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and a modified version of the Quality in Prognosis Studies (QUIPS) tool. A systematic review and an elicitation exercise were conducted on the acceptability of the simple measures.

RESULTS

Thirty-seven studies (22 cohorts) were included in the review of prediction of adult morbidities. Twenty-three studies (16 cohorts) were included in the tracking review. All studies included BMI. There were very few studies of other measures. There was a strong positive association between high childhood BMI and adult obesity [odds ratio 5.21, 95% confidence interval (CI) 4.50 to 6.02]. A positive association was found between high childhood BMI and adult coronary heart disease, diabetes and a range of cancers, but not stroke or breast cancer. The predictive accuracy of childhood BMI to predict any adult morbidity was very low, with most morbidities occurring in adults who were of healthy weight in childhood. Predictive accuracy of childhood obesity was moderate for predicting adult obesity, with a sensitivity of 30% and a specificity of 98%. Persistence of obesity from adolescence to adulthood was high. Thirty-four studies were included in the diagnostic accuracy review. Most of the studies used the least reliable reference standard (dual-energy X-ray absorptiometry); only 24% of studies were of high quality. The sensitivity of BMI for diagnosing obesity and overweight varied considerably; specificity was less variable. Pooled sensitivity of BMI was 74% (95% CI 64.2% to 81.8%) and pooled specificity was 95% (95% CI 92.2% to 96.4%). The acceptability to children and their carers of BMI or other common simple measures was generally good.

LIMITATIONS

Little evidence was available regarding childhood measures other than BMI. No individual-level analysis could be performed.

CONCLUSIONS

Childhood BMI is not a good predictor of adult obesity or adult disease; the majority of obese adults were not obese as children and most obesity-related adult morbidity occurs in adults who had a healthy childhood weight. However, obesity (as measured using BMI) was found to persist from childhood to adulthood, with most obese adolescents also being obese in adulthood. BMI was found to be reasonably good for diagnosing obesity during childhood. There is no convincing evidence suggesting that any simple measure is better than BMI for diagnosing obesity in childhood or predicting adult obesity and morbidity. Further research on obesity measures other than BMI is needed to determine which is the best tool for diagnosing childhood obesity, and new cohort studies are needed to investigate the impact of contemporary childhood obesity on adult obesity and obesity-related morbidities.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42013005711.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Body Mass Index Trajectories among Middle-Aged and Elderly Canadians and Associated Health Outcomes

BACKGROUND

Whether there is heterogeneity in the development of BMI from middle-age onward is still unknown. The primary aim of this study is to analyze long-term obesity and how BMI trajectories are associated with health outcomes in midlife.

METHODS

Latent Class Growth Modelling was used to capture the changes in BMI over time. In this study, 3070 individuals from the National Population Health Survey (NPHS), aged 40-55 years at baseline, were included.

RESULTS

Four BMI trajectory groups, "Normal-Stable" (N-S), "Overweight-Stable" (OV-S), "Obese I-Stable" (OB I-S), and "Obese II-Stable" (OB II-S), were identified. Men, persons of White ancestry, and individuals who had no postsecondary education had higher odds of being in the latter three groups. Moreover, members of the OV-S, OB I-S, and OB II-S groups experienced more asthma, arthritis, hypertension, diabetes, heart disease, cognitive impairment, and reduced self-rated overall health. Individuals in the OB II-S group were at greater risk for back problems, chronic bronchitis or emphysema, and emotional issues when compared to the N-S group.

CONCLUSION

Understanding different BMI trajectories is important in order to identify people who are at the highest risk of developing comorbidities due to obesity and to establish programs to intervene appropriately.

Body Mass Index Trajectories and Healthcare Utilization in Young and Middle-aged Adults

The obesity epidemic is a significant public health issue with adverse impact on health and costs. Applying a life-course perspective to obesity may advance our understanding of the influence of obesity over time on patterns of healthcare utilization in young and middle-aged United States (US) adults.We identified baseline body mass index (BMI) and BMI trajectories, and assessed their association with outpatient visits, emergency department (ED) visits, and hospitalizations in a well-defined population of young and middle-aged US adults.Using the Rochester Epidemiology Project resources, we conducted a retrospective cohort study of adults (N = 23,254) aged 18 to 44 years, with at least 3 BMI measurements, residing in Olmsted County, MN from January 1, 2005 through December 31, 2012.We observed that 27.5% of the population was obese. Four BMI trajectories were identified. Compared to under/normal weight, obese class III adults had higher risk of outpatient visits (adjusted rate ratio [RR], 1.86; 95% confidence intervals [CIs], 1.67-2,08), ED visits (adjusted RR, 3.02; 95% CI, 2.74-3.34), and hospitalizations (adjusted RR, 1.67; 95% CI, 1.59-1.75). BMI trajectory was positively associated with ED visits after adjustment for age, sex, race, and Charlson Comorbidity Index (P < 0.001 for trend).Among young and middle-aged US adults, baseline BMI is positively associated with outpatient visits, ED visits, and hospitalizations, while BMI trajectory is positively associated with ED visits. These findings extend our understanding of the longitudinal influence of obesity on healthcare utilization in early to mid-adulthood.

Trajectories of Body Mass Index from Young Adulthood to Middle Age among Canadian Men and Women

Knowledge regarding the heterogeneity of BMI trajectories is limited for the Canadian population. Using latent class growth modelling, four distinct BMI trajectories of individuals from young adulthood to middle age were identified for both women and men from the longitudinal data of the National Population Health Survey. The associations between BMI trajectories and the individuals’ sociodemographic characteristics and behavioural factors were also examined. Aboriginal women were found more likely to be in the long-term overweight or obese groups. It reveals that increased years of smoking, drinking, and being physically active were associated with lowering the BMI trajectory in all groups for both women and men, with some exceptions in the long-term normal weight group for men. Increased years of rural living, being employed, and living with low income were associated with raising the BMI trajectory in all groups for women and in some groups for men. Food insecurity was associated with raising the BMI trajectory in each group for both women and men.

The associations of BMI trajectory and excessive weight gain with demographic and socio-economic factors: the Adolescent Nutritional Assessment Longitudinal Study cohort

Assessing changes in adolescents’ BMI over brief periods could contribute to detection of acute changes in weight status and prevention of overweight. The objective of this study was to analyse the BMI trajectory and the excessive weight gain of Brazilian adolescents over 3 years and the association with demographic and socio-economic factors. Data regarding the BMI of 1026 students aged between 13 and 19 years were analysed over 3 consecutive years (2010, 2011 and 2012) from the Adolescent Nutritional Assessment Longitudinal Study. Linear mixed effects models were used to assess the BMI trajectory according to the type of school attended (public or private), skin colour, socio-economic status and level of maternal schooling by sex. Associations between excessive weight gain and socio-economic variables were identified by calculation of OR. Boys attending private schools (β coefficient: 0·008; P=0·01), those with white skin (β coefficient: 0·007; P=0·04) and those whose mothers had >8 years of schooling (β coefficient: 0·009; P=0·02) experienced greater BMI increase than boys and girls in other groups. Boys in private schools also presented higher excessive weight gain compared with boys attending public schools (P=0·03). Boys attending private schools experienced greater BMI increase and excessive weight gain, indicating the need to develop specific policies for the prevention and reduction of overweight in this population.

The effect of differing patterns of childhood body mass index gain on adult physiology in American Indians

OBJECTIVE

Identifying groups of individuals with similar patterns of body mass index (BMI) change during childhood may increase understanding of the relationship between childhood BMI and adult health.

METHODS

Discrete classes of BMI z-score change were determined in 1,920 American Indian children with at least four non diabetic health examinations between the ages of 2 and 18 years using latent class trajectory analysis. In subsets of subjects, data were available for melanocortin-4 receptor (MC4R) sequencing; in utero exposure to type 2 diabetes (T2D); or, as adults, oral glucose tolerance tests, onset of T2D, or body composition.

RESULTS

Six separate groups were identified. Individuals with a more modern birth year, an MC4R mutation, or in utero exposure to T2D were clustered in the two groups with high increasing and chronic overweight z-scores (P < 0.0001). The z-score classes predicted adult percent fat (P < 0.0001, partial r(2)  = 0.18 adjusted for covariates). There was a greater risk for T2D, independent from adult BMI, in three classes (lean increasing to overweight, high increasing, and chronic overweight z-scores) compared to the two leanest groups (respectively: HRR= 3.2, P = 0.01; 6.0, P = 0.0003; 11.6, P < 0.0001).

CONCLUSIONS

Distinct patterns of childhood BMI z-score change associate with adult adiposity and may impact risk of T2D.

Two Worlds of Obesity: Ethnic Differences in Child Overweight/Obesity Prevalence and Trajectories

OBJECTIVES

Research on childhood obesity has examined the prevalence of overweight and obesity during childhood and developmental trajectories. This study focuses on the extent to which Hispanic and non-Hispanic white elementary students differ in prevalence of overweight and obesity by grade level, time, gender, and school setting. It also focuses on comparison of the trajectories in weight status for the Hispanic and non-Hispanic white students.

METHODS

BMI values were examined both using standard scores (z-scores) and as categorical variables. Cross-sectional data from 4 years were used to examine prevalence, and panel data across 2-year periods examined trajectories. Descriptive statistics and mixed models, controlling for school setting, were used.

RESULTS

Hispanic students began first grade with higher prevalence of obesity and overweight, and the differences were larger in higher grades and later years. The majority of students had stable weight status over the 2-year periods of the trajectory analysis, but Hispanic students began the panel with higher BMI-Z values and were more likely to increase and less likely to decrease BMI-Z.

CONCLUSIONS

The findings suggest that the degree of childhood overweight/obesity, especially among Hispanics, is substantial and will likely have profound impacts on adult obesity and other associated health issues in the future. Findings confirm the need for early childhood interventions to influence BMI.

Body mass index trajectories from ages 1 to 20: Results from two nationally representative canadian longitudinal cohorts

OBJECTIVE

In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified; each trajectory according to socio demographic and family characteristics was described.

METHODS

Participants came from two national population surveys (n = 7,253; n = 901) and were aged 1-6 years at baseline. Children were surveyed biennially over eight waves up to 14-20 years of age. BMI trajectories by sex and survey cohort were identified by group-based trajectory modeling. After crossvalidating trajectories between survey cohorts, the characteristics of trajectory membership were assessed by multinomial regression.

RESULTS

Four BMI trajectories were found: low, decreasing, medium, and high. The decreasing trajectory was characterized by an overweight or obese childhood followed by a normal-weight adolescence. The low, medium, and high trajectories were characterized by growth curves culminating, by age 20, to BMI 22.6, 29.3, and 34.9 kg/m(2) , respectively, for males and 20.6, 24.5, and 32.0 kg/m(2) , respectively, for females. Factors associated with the high trajectory included ethnicity and paternal education (female only), large for gestational age, rural area residence, and maternal smoking.

CONCLUSIONS

The identification and validation of four major trajectories reflect the heterogeneity in patterns of BMI development from 1 to 20 years.

Developmental trajectories of adiposity from birth until early adulthood and association with cardiometabolic risk factors

OBJECTIVE

To identify developmental trajectories of adiposity from birth until early adulthood, and to investigate how they relate with cardiometabolic risk factors at 21 years of age.

METHODS

Participants' weight and height measurements were obtained using the EPITeen cohort protocol at 13, 17 and 21 years of age, and extracted from child health books as recorded during health routine evaluations since birth. Blood pressure, triglycerides, cholesterol and insulin resistance (HOMA-IR) were assessed at 21 years. Trajectories were defined using 719 participants contributing 11 459 measurements. The individual growth curves were modelled using mixed-effects fractional polynomial, and the trajectories were estimated using normal mixture modelling for model-based clustering. Differences in cardiometabolic risk factors at 21 years according to adiposity trajectories were estimated through analysis of covariance (ANCOVA), and adjusted means are presented.

RESULTS

Two trajectories-'Average body mass index (BMI) growth' (80.7%) and 'Higher BMI growth' (19.3%)-were identified. Compared with those in 'Average BMI growth', 'Higher BMI growth' participants were more frequently delivered by caesarean section, mothers were younger and had higher BMI, and parental education was lower; and at 21 years showed higher adjusted mean systolic (111.6 vs 108.3 mm Hg, P<0.001) and diastolic blood pressure (71.9 vs 68.4 mm Hg, P<0.001), and lower high-density lipoprotein cholesterol (53.3 vs 57.0 mg dl(-1), P=0.001). As there was a significant interaction between trajectories and sex, triglycerides and HOMA-IR were stratified by sex and we found significantly higher triglycerides, in males, and higher HOMA-IR in both sexes in 'Higher BMI growth' trajectory. All the differences were attenuated after adjustment for BMI at 21 years.

CONCLUSIONS

In this long-term follow-up, we were able to identify two adiposity trajectories, statistically related to the BMI and cardiometabolic profile in adulthood. Our results also suggest that the impact of the adiposity trajectory on cardiometabolic profile is mediated by current BMI.

Childhood body mass index trajectories predicting cardiovascular risk in adolescence

PURPOSE

The present study compared growth parameters of girls' and boys' body mass index (BMI) trajectories from infancy to middle childhood and evaluated these parameters as predictors of cardiovascular disease (CVD) risk in adolescence.

METHODS

Using 657 children from the NICHD Study of Early Child Care and Youth Development, quadratic growth curve analyses were conducted to establish growth parameters (intercept, slope, and quadratic term) for girls and boys from age 15 months to 10.5 years. Parameters were compared across gender and evaluated as predictors of a CVD risk index at the age of 15 years, controlling for characteristics of the adiposity rebound (AR) including age at which it occurred and children's BMI at the rebound.

RESULTS

Boys had more extreme trajectories of growth than girls with higher initial BMI at age 15 months (intercept), more rapid declines in BMI before the AR (slope), and sharper rebound growth in BMI after the rebound (quadratic term). For boys and girls, higher intercept, slope, and quadratic term values predicted higher CVD risk at the age of 15 years, controlling for characteristics of the AR.

CONCLUSIONS

Findings suggest that individuals at risk for developing CVD later in life may be identified before the AR by elevated BMI at 15 months and slow BMI declines. Because of the importance of early intervention in altering lifelong health trajectories, consistent BMI monitoring is essential in identifying high-risk children.

Racial and Ethnic Disparities in Early Childhood Obesity: Growth Trajectories in Body Mass Index

OBJECTIVE

The aims of this study are to describe growth trajectories in the body mass index (BMI) among the major racial and ethnic groups of US children and to identify predictors of children's BMI trajectories.

METHODS

The Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) was used to identify predictors of BMI growth trajectories, including child characteristics, maternal attributes, home practices related to diet and social behaviors, and family sociodemographic factors. Growth models, spanning 48 to 72 months of age, were estimated with hierarchical linear modeling via STATA/Xtmixed methods.

RESULTS

Approximately one-third of 4-year-old females and males were overweight and/or obese. African-American and Latino children displayed higher predicted mean BMI scores and differing mean BMI trajectories, compared with White children, adjusting for time-independent and time-dependent predictors. Several factors were significantly associated with lower mean BMI trajectories, including very low birth weight, higher maternal education level, residing in a two-parent household, and breastfeeding during infancy. Greater consumption of soda and fast food was associated with higher mean BMI growth. Soda consumption was a particularly strong predictor of mean BMI growth trajectory for young Black children. Neither the child's inactivity linked to television viewing nor fruit nor vegetable consumption was predictive of BMI growth for any racial/ethnic group.

CONCLUSION

Significant racial and ethnic differences are discernible in BMI trajectories among young children. Raising parents' and health practitioners' awareness of how fast food and sweetened-beverage consumption contributes to early obesity and growth in BMI-especially for Blacks and Latinos-could improve the health status of young children.

Long-Term BMI Trajectories and Health in Older Adults: Hierarchical Clustering of Functional Curves

OBJECTIVE

This project contributes to the emerging research that aims to identify distinct body mass index (BMI) trajectory types in the population. We identify clusters of long-term BMI curves among older adults and determine how the clusters differ with respect to initial health.

METHOD

Health and Retirement Study cohort (N = 9,893) with BMI information collected in up to 10 waves (1992-2010) is analyzed using a powerful cutting-edge approach: hierarchical clustering of BMI functions estimated via the Principal Analysis by Conditional Expectations (PACE) algorithm.

RESULTS

Three BMI trajectory clusters emerged for each gender: stable, gaining, and losing. The initial health of the gaining and stable groups in both genders was comparable; the losing cluster experienced significantly poorer health at baseline.

DISCUSSION

BMI trajectories among older adults cluster into distinct types in both genders, and the clusters vary substantially in initial health. Weight loss but not gain is associated with poor initial health in this age group.

Predictors of favorable growth patterns during the obesity epidemic among US school children

OBJECTIVE

To report the prevalence of favorable growth patterns, including healthy weight maintenance (HWM) and return to healthy weight (RHW) among US school-age children.

METHODS

A longitudinal analysis of childhood growth patterns from the Early Childhood Longitudinal Study-Kindergarten Cohort was completed (n = 9416). The primary outcome included describing the prevalence of HWM/RHW patterns using consecutive child growth data from kindergarten to fifth grades. Multivariate logistic regression was used to explore predictors of HWM/RHW. Incidence of RHW is calculated by grade level.

RESULTS

Seventy percent (n = 6617) of children enter kindergarten at a healthy weight and approximately 70% maintained a healthy weight through fifth grade. Among overweight/obese kindergartners, only 17.1% outgrew their weight risk (RHW) by fifth grade.

CONCLUSIONS

Fewer than 1 in 5 at-risk children outgrow their weight risk during school-age yet a majority of healthy weight children can maintain healthy weight during a critical growth period. Future work should explore additional socioecologic factors associated with favorable growth.

Heterogeneity of sex-stratified BMI trajectories in children from 8 to 14 years old

OBJECTIVE

Describe and predict sex-stratified trajectories of weight change in youths transitioning from childhood to adolescence.

METHODS

Using an accelerated longitudinal design, 461 children between 8 and 12 years old at baseline were followed over three years. Body mass index was calculated from self-reported height and weight. Latent class growth analysis was used to identify BMI trajectories and multinomial logistic regressions, to predict group membership.

RESULTS

A four-group heterogeneous trajectory model emerged for boys and girls alike. Characteristics of the trajectories differed between sexes and no obesity group was found for boys. Sociocultural factors, such as media influence, body dissatisfaction, weight victimization, awareness of thin-ideal standards and related pressures were important correlates of trajectory membership.

CONCLUSION

BMI trajectories during preadolescence are stable over time for heavier children. Body image concerns and weight stigmatization stand out as important factors in the prediction of developmental weight trajectories and could therefore be integrated in weight gain prevention programs for children of all weights as well as in weight management interventions for overweight and obese children.

The protective role of family meals for youth obesity: 10-year longitudinal associations

OBJECTIVE

To examine whether having family meals as an adolescent protects against becoming overweight or obese 10 years later as a young adult.

STUDY DESIGN

Data from Project Eating and Activity in Teens -III, a longitudinal cohort study with emerging young adults, were used. At baseline (1998-1999), adolescents completed surveys in middle or high schools, and at 10-year follow-up (2008-2009) surveys were completed online or via mailed surveys. Young adult participants (n = 2117) were racially/ethnically and socioeconomically diverse (52% minority; 38% low income) between the ages of 19 and 31 years (mean age = 25.3; 55% female). Logistic regression was used to associate weight status at follow-up with family meal frequency 10 years earlier during adolescence, controlling and testing for interactions with demographic characteristics.

RESULTS

All levels of baseline family meal frequency (ie, 1-2, 3-4, ≥5 family meals/wk) during adolescence were significantly associated with reduced odds of overweight or obesity 10 years later in young adulthood compared with never having family meals as an adolescent. Interactions by race indicated that family meals had a stronger protective effect for obesity in black vs white young adults.

CONCLUSIONS

Family meals during adolescence were protective against the development of overweight and obesity in young adulthood. Professionals who work with adolescents and parents may want to strategize with them how to successfully carry out at least 1 to 2 family meals per week in order to protect adolescents from overweight or obesity in young adulthood.

Growth mixture modeling with non-normal distributions

A limiting feature of previous work on growth mixture modeling is the assumption of normally distributed variables within each latent class. With strongly non-normal outcomes, this means that several latent classes are required to capture the observed variable distributions. Being able to relax the assumption of within-class normality has the advantage that a non-normal observed distribution does not necessitate using more than one class to fit the distribution. It is valuable to add parameters representing the skewness and the thickness of the tails. A new growth mixture model of this kind is proposed drawing on recent work in a series of papers using the skew-t distribution. The new method is illustrated using the longitudinal development of body mass index in two data sets. The first data set is from the National Longitudinal Survey of Youth covering ages 12-23 years. Here, the development is related to an antecedent measuring socioeconomic background. The second data set is from the Framingham Heart Study covering ages 25-65 years. Here, the development is related to the concurrent event of treatment for hypertension using a joint growth mixture-survival model.

Overweight in infancy: which pre- and perinatal factors determine overweight persistence or reduction? A birth cohort followed for 11 years

BACKGROUND

A considerable proportion of children with early-life overweight attain a normal weight. To recognize infants at risk of persistent overweight, we compared early-life factors of children with a longitudinal pattern of persistent overweight to children with a pattern of overweight in early but not in later childhood.

METHODS

In 3,550 children participating in a birth cohort that started in 1996/1997 in the Netherlands, body mass index was repeatedly assessed until age 11 and dichotomized into with/without overweight. Latent class growth modeling was used to distinguish trajectories. Our analysis was focused on the comparison of early-life factors in children in a persistent overweight pattern with those in an overweight reduction pattern using multivariable log-binomial regression analyses.

RESULTS

Children (n = 133) in the persistent overweight pattern were more likely to have overweight parents [relative risk (RR)mother: 1.85, 95% CI: 1.37-2.49: RRfather: 1.75, 95% CI: 1.21-2.55] than children in the overweight reduction pattern (n = 303). Maternal education, child's gender, ethnicity, birth weight, breast-feeding and maternal smoking during pregnancy did not differ between the trajectories.

CONCLUSION

Health care practitioners should focus on high-weight infants with overweight parents, as these children are less likely to resolve their overweight.

Developmental trajectories of Body Mass Index from infancy to 18 years of age: prenatal determinants and health consequences

BACKGROUND

Knowledge on the long-term development of adiposity throughout childhood/adolescence and its prenatal determinants and health sequelae is lacking. We sought to (1) identify trajectories of Body Mass Index (BMI) from 1 to 18 years of age, (2) examine associations of maternal gestational smoking and early pregnancy overweight with offspring BMI trajectories and (3) determine whether BMI trajectories predict health outcomes: asthma, lung function parameters (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio), and blood pressure, at 18 years.

METHODS

The Isle of Wight birth cohort, a population-based sample of 1456 infants born between January 1989 and February 1990, was prospectively assessed at ages 1, 2, 4, 10 and 18 years. Group-based trajectory modelling was applied to test for the presence of latent BMI trajectories. Associations were assessed using log-binomial and linear regression models.

RESULTS

Four trajectories of BMI were identified: 'normal', 'early persistent obesity', 'delayed overweight', and 'early transient overweight'. Risk factors for being in the early persistent obesity trajectory included maternal smoking during pregnancy (RR 2.16, 95% CI 1.02 to 4.68) and early pregnancy overweight (3.16, 1.52 to 6.58). When comparing the early persistent obesity to the normal trajectory, a 2.15-fold (1.33 to 3.49) increased risk of asthma, 3.2% (0.4% to 6.0%) deficit in FEV1/FVC ratio, and elevated systolic 11.3 mm Hg (7.1 to 15.4) and diastolic 12.0 mm Hg (8.9 to 15.1) blood pressure were observed at age 18 years.

CONCLUSIONS

Maternal prenatal exposures show prolonged effects on offspring's propensity towards overweight-obesity. Distinct morbid BMI trajectories are evident during the first 18 years of life that are associated with higher risk of asthma, reduced FEV1/FVC ratio, and elevated blood pressure.

The longitudinal relationship between sleep duration and body mass index in children: a growth mixture modeling approach

OBJECTIVE

A growing number of studies indicate that shorter sleep durations could contribute to obesity in children. The objective of this article was to further examine the longitudinal relationship between sleep duration and body mass index (BMI) in children by using a growth mixture modeling approach.

METHOD

This article used prospective data from the Longitudinal Study of Australian Children. Participants included 1079 children aged 4 to 5 years (2004) followed up until age 10 to 11 years (2010). Growth mixture modeling was performed to examine the longitudinal association between sleep duration and body mass index within distinct body mass index trajectories.

RESULTS

The results indicated 3 distinct body mass index trajectories: healthy weight, early onset obesity, and later onset obesity. Longitudinal inverse associations were evident between sleep duration and body mass index in the Early Onset Trajectory. There were some associations between sleep duration and body mass index in the other trajectories.

CONCLUSIONS

This article provides further insight into the longitudinal relationship between sleep duration and body mass index in children. In particular, the results indicate that shorter sleep durations are primarily associated with body mass index in children with early onset obesity.