A PREDICTOR OF LATER HEALTH?
Marie Françoise Rolland-Cachera
INSERM Unit 557, ISTNA-CNAM, 2 rue Conté, 75003 Paris, France
Abstract: The purpose of this review is to describe the studies which investigate the association between early growth pattern and future metabolic risks.
Childhood obesity is increasing but other growth parameters are also changing. There is a trend of earlier maturation and increasing height.
The increase in height from one generation to the next occurs mainly in the first years of life. Rapid growth in early life (rapid weight and length gain, early adiposity rebound) is associated with various health risks in later life (obesity, cancer, cardiovascular diseases, diabetes). Pattern of growth rather than absolute level of fatness seams to be of most importance.
Key words: Child, growth, obesity, adiposity rebound, cancer, cardiovascular diseases, diabetes
1. INTRODUCTION
Childhood obesity is increasing worldwide, but at the same time, various growth parameters are also changing. Alterations in growth patterns, particularly accelerated growth for a few decades, suggest that environmental factors have acted early in life. For a long time, research focused on the consequences of poor growth. More recently, research focused on childhood obesity and its consequences. But various body characteristics have also changed substantially. Tall stature is often viewed as a favourable process, however, there is now increasing evidence that a rapid growth in infancy or early childhood can predispose to adult onset diseases. The different growth patterns, their determinants and their association with health risks will be described here.
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2. SECULAR TRENDS IN OBESITY AND OTHER GROWTH PARAMETERS
In many countries, childhood obesity is increasing. Children now display more android or central body fat distribution and are taller (Eveleth and Tanner, 1990; Deheeger and Rolland-Cachera, 2004).
Increased stature is mainly the result of increased leg length and, because this accounts for most growth before puberty, this trend reflects rapid growth in early life. Accelerated growth is also associated with an earlier age for adiposity rebound (AR). This is defined as the point of minimal body mass index (BMI) value (the nadir of the BMI curve) (Rolland-Cachera et al., 1984). As a rule, an early AR is associated with greater subsequent fatness. It is also associated with advanced bone age.
Mean age at AR in children born in 1955 occurred at 6.2 years but at 5.6 years in those born in 1985 (Rolland-Cachera, 1999). These different observations are in accordance with the time trend of accelerated growth starting in early life.
3. ACCELERATED GROWTH AND FUTURE RISK OF OBESITY
Various studies have examined the association between early growth and the risk of later obesity. They considered either weight, length or BMI gains (Eid,1970; Ong et al., 2000; Cameron et al., 2003; Monteiro et al., 2003) and report that rapid growth after low birth weight is associated with large subsequent weight gain and a central body fat pattern. However, the prediction potentials differ according to the anthropometric indices. In a cohort of French children, large weight and length gain between birth and two years of age were associated with greater weight, BMI and waist circumference at age 14 (Rolland-Cachera et al., 2001). The association was stronger with weight gain than with length gain, but large length gain was associated with an android body fat distribution at 14 years and with an early AR, while large weight gain was not. The best anthropometric predictor for later overweight was the main focus in a retrospective cohort study of Bavarian children (Toschke et al., 2004). Weight, length, BMI and Ponderal index variations between birth and either 6, 12 or 24 months were compared. Weight gain from
birth to 24 months was the best overall predictor of later weight category, but the authors concluded that the predictability was poor in their population.
4. RISK OF ADULT DISEASES
Cancer: Several studies have found an association between stature and cancer (Albanes et al., 1998), particularly between leg length and sex hormone dependent cancers (Gunnell et al., 1998). Because most growth before puberty is due to increases in leg length, this can be used as a marker for exposures that generate the association between adult height and cancer. As rapid growth is associated with an earlier puberty, it has been suggested that the association between leg length and cancer can be explained by a longer exposure to adult concentrations of sex hormones.
Another proposed hypothesis is that childhood diet may influence concentrations of Igf-1, subsequent growth and later risk of cancer.t
Coronary heart disease: Growth acceleration in childhood increases the propensity to later cardiovascular disease. As rapid weight gain is often associated with low birth weight, some authors suggest an adverse effect of a poor fetal nutrition followed by improved postnatal nutrition (Erikson et al., 1999), while others favour the hypothesis of a direct adverse effect of accelerated postnatal growth (Singhal et al., 2004).
Diabetes: The risk of diabetes has been found to be associated with a rapid weight gain in the first 2 weeks of life (Singhal et al., 2003), and also with an early AR (Eriksson et al, 2003). Subjects with impaired glucose tolerance or diabetes typically had a low BMI up to the age of two years, followed by an early AR and an accelerated increase in BMI until adulthood (Bhargava et al., 2004). However, despite an increase in BMI between the ages of 2 and 12 years, none of these subjects were obese at the age of 12 years. This underlies the importance of growth pattern rather than the absolute BMI level.
While an early AR is known to predict future overweight and obesity, it is also significantly associated with a low fatness level in the first years of life (Rolland-Cachera et al., 1987; Williams and Dickson, 2002). The typical growth pattern associated with an early AR (low BMI followed by high BMI after the AR), similar to the BMI pattern of subjects with diabetes, has beeen reported in various circumstances (Rolland-Cachera,
1999). These include the growth pattern in children from industrialised vs developing countries and the pattern in children consuming high vs low protein diets.
5. CONCLUSION
Rapid growth in early life is associated with later health risks.
Various anthropometric markers can predict future obesity (rapid weight and length gain, early AR). They have different predictive values and correspond to different growth patterns. They are likely to have different origins and may be associated with different health risks.
It is therefore important to continue research focussing on the identification of the early environmental factors which influence growth patterns and adult health.
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