Association between rapid weight gain and overweight in children aged 0 to 5 years in Latin America

Maíra Barros Louro Hanrieti Rotelli Temponi Carolina Santiago Vieira Gustavo Velasquez-Melendez About the authors

Abstract

Objectives:

to assess the prevalence of rapid weight gain (RWG) in children born with normal weight and its association with overweight (OW) in four Latin America countries.

Methods:

cross-sectional study in children aged 0 to 5 from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher in Brazil and the Encuesta Nacional de Demografía y Salud in Bolivia, Colombia and Peru,using a birth weight ≥2,500g. The outcome variable was OW, the exposure was RWG and breastfeeding (BF) was the adjustment variable. Prevalence, odds ratio and 95% confidence intervalwere estimated using multivariate logistic regression model.

Results:

there was a greater prevalence of RWG and BF at less than 6 months in Brazil, and a greater prevalence of OW in Brazil and Bolivia. The chances of OW when RWG was present and adjusted for BF were 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7) with a p < 0.001 for all countries.

Conclusions:

RWG in children with normal birth weight was associated with a greater chance of being OW in the four observed Latin America countries.

Key words
Pediatric Obesity; Infant; Preschool; Weight gain; Latin America

Resumo

Objetivos:

avaliar a prevalência do ganho rápido de peso (GRP) em crianças nascidas com peso normal e sua associação com o excesso de peso (EP) em quatro países da América Latina.

Métodos:

estudo transversal de inquéritos populacionais com crianças de 0 a 5 anos da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher no Brasil e da Encuesta Nacional de Demografía y Salud da Bolívia, Colômbia e Peru, selecionadas pelo peso ao nascer ≥2.500 gramas. A variável desfecho foi o EP; de exposição o GRP; e de ajuste a amamentação. Foram estimadas as prevalências, odds ratio e intervalo de confiança de 95% por regressão logística multivariada.

Resultados:

observou-se maior prevalência de GRP e tempo de amamentação menor do que 6 meses no Brasil e maior prevalência de EP no Brasil e Bolívia. As chances de EP quando GRP presente e ajustado por amamentação foram de 6,1 vezes (IC95% = 3,8-9,7) no Brasil; 4,4 vezes (IC95% = 3,6-5,3) na Bolívia; 6,7 vezes (IC95% = 5,5-8,2) na Colômbia; 12,2 vezes no Peru (IC95% = 9,4-15,7) e p<0,001 nos quatro países.

Conclusões:

o GRP em crianças nascidas com peso normal foi associado a maior chance de EP infantil nos quatro países da América Latina.

Palavras-chave
Obesidade infantil; Lactente; Pré-escolar; Ganho de peso; América Latina

Introduction

Overweight (OW) in the adult population is considered a global pandemic, observing that in 2016, 39% of adults aged 18 and over were considered overweight and 13% were obese.11 FAO (Food and Agriculture Organization of the United Nations), IFAD (International Fund for Agricultural Development), UNICEF (United Nations Children’s Fund), WFP (World Food Programme), WHO (World Health Organization). The state of food security and nutrition in the world 2019. Rome: FAO/IFAD/UNICEF/WFP/WHO; 2019. In studies using child populations, the same trend is present, as the worldwide prevalence of overweight and obesity in children, aged 0 and 5 years, increased from 33.3 million (5.4%) to 38.9 million (5.7%) between 2000 and 2020. It is estimated that in Latin America and the Caribbean, 3.9 million (7.5%) children under 5 years of age were overweight or were experiencing obesity in 2020.22 UNICEF (United Nations Children’s Fund), WHO (World Health Organization). The World Bank Group joint child malnutrition estimates: levels and trends in child malnutrition: key findings of the 2021 edition. New York: UNICEF/WHO; 2019.

Overweight has a multifactorial etiology, with some of its determining factors being genetic, environmental and psychosocial.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32. In recent decades, the increase in obesity prevalence reported in children in Latin America can be attributed, in part, to the phenomenon of nutritional and epidemiological transitions experienced in populations on a global scale.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.,44 Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Fam Med Prim Care. 2015 Apr/Jun; 4 (2): 187-92. Obesity has a major negative impact on child health, with consequences that can evolve into adulthood. In adults, it can lead to breathing difficulties, increased risk of fractures, hypertension, the presence of early cardiovascular disease biomarkers, insulin resistance, and negative psychological effects.55 WHO (World Health Organization). Obesity and overweight [Internet]. Geneva: WHO; 2018; [access in 2020 Oct 01]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
https://www.who.int/news-room/fact-sheet...

Harmful exposures to health during the early life cycle, including rapid weight gain (RWG) in early childhood, can contribute to an increased occurrence of chronic non-communicable diseases in adulthood.66 Lourenço ASN, Neri DA, Konstantyner T, Palma D, Oliveira FLC. Fatores associados ao ganho de peso rápido em pré-escolares frequentadores de creches públicas. Rev Paul Pediatr. 2018; 36 (3): 292-300. Child RWG can be defined when the difference in z-score of weight-for-age between two assessment is greater than 0.67.77 Ong KKL, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000 Apr; 320 (7240): 967-71. Studies have shown an association between RWG in childhood and an increased risk of overweight and obesity in the short, medium and long term.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.,88 Nanri H, Shirasawa T, Ochiai H, Nomoto S, Hoshino H, Kokaze A. Rapid weight gain during infancy and early childhood is related to higher anthropometric measurements in preadolescence: Rapid weight gain and anthropometric measurements. Child Care Health Dev. 2017 May; 43 (3): 435-40.,99 Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016 Jun; 50 (6): 761-79. A systematic review and meta-analysis study concluded that children with RWG had 3.66 times more chance of being overweight or obese in adulthood.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32. In addition, RWG was also associated with greater values not only for body mass index (BMI), but also for the percentage of body fat, waist circumference and waist-to-height ratio during the pre-adolescence period.88 Nanri H, Shirasawa T, Ochiai H, Nomoto S, Hoshino H, Kokaze A. Rapid weight gain during infancy and early childhood is related to higher anthropometric measurements in preadolescence: Rapid weight gain and anthropometric measurements. Child Care Health Dev. 2017 May; 43 (3): 435-40.

Latin American countries present different stages in the demographic and epidemiological transition processes, which is a reflection of their opposite economic, social and cultural realities.1010 Vasconcelos AMN, Gomes MMF, França E. Transição epidemiológica na América Latina: diferentes realidades. In: V Congreso de la Asociación Latinoamericana de Población (ALAP), 2012 Oct 23-26, Montevideo, Uruguay. Montevideo: ALAP; 2012. p. 1-21. Furthermore, there is a lack of studies that explore the relationship between RWG and OW in childhood, and existing studies present a small sample size and lack published samples without national representation,66 Lourenço ASN, Neri DA, Konstantyner T, Palma D, Oliveira FLC. Fatores associados ao ganho de peso rápido em pré-escolares frequentadores de creches públicas. Rev Paul Pediatr. 2018; 36 (3): 292-300.,1111 Sacco MR, Castro NP, Euclydes VLV, Souza JM, Rondó PHC. Birth weight, rapid weight gain in infancy and markers of overweight and obesity in childhood. Eur J Clin Nutr. 2013 Nov; 67 (11): 1147-53. or from developed countries.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.,1010 Vasconcelos AMN, Gomes MMF, França E. Transição epidemiológica na América Latina: diferentes realidades. In: V Congreso de la Asociación Latinoamericana de Población (ALAP), 2012 Oct 23-26, Montevideo, Uruguay. Montevideo: ALAP; 2012. p. 1-21.

Studies carried out in Brazil have reported RWG prevalence ranging from 36.8% (from birth and 24 to 34 months of age)66 Lourenço ASN, Neri DA, Konstantyner T, Palma D, Oliveira FLC. Fatores associados ao ganho de peso rápido em pré-escolares frequentadores de creches públicas. Rev Paul Pediatr. 2018; 36 (3): 292-300. and 61.2% (from birth and 5 years of age)1111 Sacco MR, Castro NP, Euclydes VLV, Souza JM, Rondó PHC. Birth weight, rapid weight gain in infancy and markers of overweight and obesity in childhood. Eur J Clin Nutr. 2013 Nov; 67 (11): 1147-53. and both observed a statistically significant relationship between the RWG and OW in childhood. The inclusion of RWG prevention measures may be one of the potential ways to reduce the prevalence of childhood obesity,1212 Rotevatn TA, Overgaard C, Melendez-Torres GJ, Mortensen RN, Ullits LR, Høstgaard AMB, et al. Infancy weight gain, parental socioeconomic position, and childhood overweight and obesity: a Danish register-based cohort study. BMC Public Health. 2019 Sep; 19 (1): 1209. however, it should be stressed that this is a subject that has not been adequately explored in studies in terms of causality of childhood obesity.

Thus, the aim of the present study was to analyze the prevalence of RWG in children born with adequate weight and its association with OW in children between zero and five years in four Latin American countries.

Methods

This was a cross-sectional epidemiological study, which used data from four population surveys conducted in four Latin American countries: Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), carried out in Brazil between 2006 and 2007,1313 Ministry of Health (BR). Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher - PNDS 2006: dimensões do processo reprodutivo e da saúde da criança [Internet]. Brasília (DF): Ministry of Health; 2009; [access in 2020 Dec 01]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
Encuesta Nacional de Demografía y Salud, conducted in Bolivia (ENDSA), in 2008,1414 Coa R, Ochoa LH. Encuesta Nacional de Demografía y Salud (ENDSA 2008). La Paz: Ministerio de Salud y Deportes; 2009. Encuesta Nacional de Demografía y Salud (ENDS), conducted in Colombia between 2009 and 2010,1515 Ojeda G, Ordóñez M, Ochoa LH. Encuesta Nacional de Demografía y Salud (ENDS 2010). Bogotá: Asociación Probienestar de la Familia Colombiana Profamilia; 2010. and in Peru, Encuesta Demográfica y de Salud Familiar (ENDES), conducted in 2012.1616 Instituto Nacional de Estadística e Informática (INEI). Encuesta Demográfica y de Salud (ENDS 2012). Lima: Instituto Nacional de Estadística e Informática; 2012. The four country sample data are part of the DHS Measure (Demographic and Health Survey) project, which are conducted on a global scale with the support of the United States Agency for International Development (USAID) in partnership with other international institutions.1717 ICF. Demographic and health survey interviewer’s manual. Rockville: ICF; 2017.

The DHS are national representative household surveys, carried out using complex probability sampling models.1717 ICF. Demographic and health survey interviewer’s manual. Rockville: ICF; 2017. The sampling units are selected in at least two stages: in the initial stage, the Primary Sampling Units (PSU) are selected, composed of conglomerates such as a sector census, provinces, municipalities and a set of households according to the definition of each country. Subsequently, the secondary units, formed by household units, are selected.1717 ICF. Demographic and health survey interviewer’s manual. Rockville: ICF; 2017.

For the Brazilian data analysis, which relies on the PNDS, the databases referring to households, women, pregnancies and children were grouped as previously described.1818 Mendes MSF. Antropometria em mulheres e desfechos reprodutivos [tese]. Belo Horizonte (MG): Escola de Enfermagem da Universidade Federal de Minas Gerais (UFMG); 2013. For the data analysis of Bolivia, Colombia and Peru, the referred databases were used according to the women population, aged 15 to 49 years, which also contains data on children under five years of age. Some variables available in the database for households were included, each one properly coded.

Brazilian population was sampled during November 2006 and May 2007. From a total of 14,617 selected households, 15,575 women were interviewed.1313 Ministry of Health (BR). Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher - PNDS 2006: dimensões do processo reprodutivo e da saúde da criança [Internet]. Brasília (DF): Ministry of Health; 2009; [access in 2020 Dec 01]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
Data from Bolivia were taken from February to June 2008, with 20,003 selected households and 16,939 women included in the study.1414 Coa R, Ochoa LH. Encuesta Nacional de Demografía y Salud (ENDSA 2008). La Paz: Ministerio de Salud y Deportes; 2009. Data from Colombia were collected from November 2009 to November 2010, in a total of 51,447 selected households, with a total of 49,818 women interviewed.1515 Ojeda G, Ordóñez M, Ochoa LH. Encuesta Nacional de Demografía y Salud (ENDS 2010). Bogotá: Asociación Probienestar de la Familia Colombiana Profamilia; 2010. Finally, data from Peru were collected from March to December 2012, with 27,488 selected households and 23,888 women interviewed.1616 Instituto Nacional de Estadística e Informática (INEI). Encuesta Demográfica y de Salud (ENDS 2012). Lima: Instituto Nacional de Estadística e Informática; 2012.Figure 1 presents the sample flowchart.

Figure 1
Sample size flowchart.

The inclusion criterion for the present study included children aged 0-5 years old with normal birth weight (equal to or greater than 2,500 grams). Children with low birth weight were excluded in the analyses. In Brazil, the final sample consisted of 2,321 children; in Bolivia, 7,257; in Colombia, 13,918; and in Peru, 8,406 children. Children who had questionable values for their weight-for-age index, assessed by the WHO Anthroprogram1919 WHO (World Health Organization). WHO anthro survey analyser. Geneva: WHO; 2011. (z scores <-6 and >5) and who had incomplete data for target variables, were excluded from the analysis.

The interviews were carried out by trained members of the research team according to standardized protocols1717 ICF. Demographic and health survey interviewer’s manual. Rockville: ICF; 2017.. The anthropometric measurements from the subjects were obtained according to internationally standardized procedures,2020 WHO (World Health Organization). WHO Expert Committee on Physical Status: the Use and Interpretation of Anthropometry (‎1993: Geneva, Switzerland)‎ & World Health Organization. (‎1995)‎. Physical status: the use of and interpretation of anthropometry. Report of a WHO expert committee. WHO Health Organ Tech Rep Ser. 1995;854:1-452. in accordance to the DHS protocols used in the four countries.1717 ICF. Demographic and health survey interviewer’s manual. Rockville: ICF; 2017.

Birth weight was obtained from each child’s birth certificate, and when such information was not available, the mother or responsible guardian was asked to provide the weight at birth. An infantometer was used to assess the length of children under two years of age, and a stadiometer was used to measure the height of children aged two years or over. Both devices were calibrated to a precision of one millimeter. Weight was obtained on an electronic scale calibrated with a precision of 100g. Weight and length/height were measured at the time of the interview.

In order to guarantee the comparability of the results of the present study, the target variables taken from the four countries were used in the data analysis.

The main exposure variable, RWG, was defined when the difference between the weight-for-age (WAZ) z-score value at the time of the interview and the WAZ z-score value at birth was greater than 0.67.77 Ong KKL, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000 Apr; 320 (7240): 967-71. Obesity was the outcome variable, which was defined as a z-score of BMI for age (BMIz) ≥ 2.2121 WHO (World Health Organization). WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age; methods and development. Geneva: WHO; 2006.

The adjustment variable was the duration of breastfeeding, considering the guidelines by the World Health Organization on the minimum ideal time of exclusive breastfeeding during 6 months.2222 WHO (World Health Organization). Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: WHO; 2017. Because the data base did not distinguish between exclusive or non-exclusive breastfeeding, the variable was therefore classified as “breastfeeding duration greater than or equal to 6 months” and “breastfeeding duration less than 6 months”, regardless of being exclusive or non-exclusive. The variable “age” was categorized into five age groups to describe the sample population and defined as 0 to 12 months, 13 to 24 months, 25 to 36 months, 37 to 48 months, and 49 to 60 months.

For descriptive analysis, the prevalence and 95% confidence intervals of RWG, OW and duration of breastfeeding were estimated. In addition, Pearson’s chi-square test was performed to test the differences between the proportions of these variables. Multivariate logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI95%) of the association between RWG and OW. All models were adjusted for duration of breastfeeding as a potential confounding variable.

Data were analyzed using the STATA program, version 13.123 by means of an unconditional analysis of subpopulations. In other words, all participants were included in the analysis, even those who met the exclusion criteria.2424 West BT, Berglund P, Heeringa SG. A closer examination of subpopulation analysis of complex-sample survey data. Stata J. 2008; 8(4): 520-31. Because this was a complex sampling plan, the unconditional analysis included models of the group of excluded subjects and this guaranteed the maintenance of the complex structure of the final sample.2424 West BT, Berglund P, Heeringa SG. A closer examination of subpopulation analysis of complex-sample survey data. Stata J. 2008; 8(4): 520-31.

The surveys were approved by the Human Research Ethics Committees of the respective countries and participants were informed about the research objectives. Those wishing to participate gave their Informed Consent. The databases are part of the public domain and can be freely accessed through the respective websites: http://bvsms.saude.gov.br/bvs/pnds/index.php and https://dhsprogram.com/data/availabledatasets.cfm

Results

The children’s characteristics, estimates of breastfeeding prevalence, RWG and OW and the respective 95% confidence intervals for the four studied populations are presented in Table 1. The greatest prevalence of RWG and breastfeeding for less than 6 months was observed in Brazil (35.59% and 41.73%, respectively). The greatest prevalence of OW was reported in Brazil and Bolivia (11.09% and 11.58%, respectively).

Table 1
Prevalence of breastfeeding duration, rapid weight gain and overweight for age in Brazil, Bolivia, Colombia and Peru.

Table 2 presents the prevalence distribution of children with RWG, by age group, according to country. In Brazil there was no observed statistically significant difference between age groups (p = 0.274). However, other countries have a greater proportion of children with RWG from zero and twelve months of age: 21.5% in Bolivia (p < 0.001), 30.2% in Colombia (p < 0.001) and 27.05% in Peru (p < 0.001).

Table 2
Proportion of children with rapid weight gain according to each age group in Brazil, Bolivia, Colombia and Peru.

Figure 2 CI95% values obtained from the logistic regression model for estimating the strength of association between RWG in children born with adequate weight and OW children in each analyzed country.

Figure 2
Odds Ratio and 95% Confidence Interval for obesity in children aged 0-5 years, according to rapid weight gain, adjusted for duration of breastfeeding in Brazil, Bolivia, Colombia and Peru.

We observed that the chance of children being overweight when experienced RWG, compared to those who did not have RWG, was 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7), which was considered the greatest chance. It is noteworthy that the association between RWG and OW was statistically significant (p < 0.001) in the four countries, and all models were adjusted for the variable duration of breastfeeding (Figure 2).

The OR and CI95% values to estimate the strength of association between the RWG in children born with normal weight and OW in children from the respective countries were also evaluated and stratified by age group, in addition to being adjusted for the duration of breastfeeding variable (Figure 3). Peru and Brazil presented the greatest OR during the first 12 months of age (15.2 and 12.7, respectively); Peru and Colombia, between 1 and 2 years of age (16.0 and 9.0, respectively), between 2 and 3 years of age (8.4 and 6.1, respectively), and between 3 and 4 years of age (8.8 and 11.4 respectively); and, finally, Peru and Brazil between 4 and 5 years of age (13.9 and 9.0, respectively).

Figure 3
Odds Ratio and 95% Confidence Interval for obesity in children aged 0-5 years, according to rapid weight gain, adjusted for duration of breastfeeding and stratified by age groups in Brazil, Bolivia, Colombia and Peru.

Discussion

The results of this study confirm the cross-sectional relationship between the presence of RWG and a high chance of a child becoming OW in Brazil, Bolivia, Colombia and Peru. In addition, a prevalence of RWG above 15.0% and a prevalence of OW above 5.6% were estimated in the four evaluated countries.

In general, Latin American nations are classified as low and middle income countries having a predominately agriculture-based economy. However, some nations are industrially and technologically more advanced, such as Brazil.2525 Moya J. Migration and the historical formation of Latin America in a global perspective. Sociologias. 2018; 20 (49): 24-68. There exists a correlation between robust healthy economies and a reduced period of breastfeeding duration, with some high income countries reporting a less than 20.0% breastfeeding prevalence.2626 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan; 387 (10017): 475-90.

When evaluating the Gross Domestic Product (GDP) per capita, considering the year in which the DHS were developed,2727 CIA World Factbook. Historical data graphs per year [Internet]. CIA World Factbook; 2015; [access in 2019 Jan 09]. Available from: https://www.indexmundi.com/g/g.aspx?v=65&c=bl&l=pt
https://www.indexmundi.com/g/g.aspx?v=65...
we failed to observe a relationship between greater economic status and a shorter breastfeeding period for each of the countries under study. Other indicators must be evaluated related to social inequality, such as health service coverage, education, sanitation and drinking water supply, as well as policies to encourage breastfeeding, and not just those related to income.

The association between events that occur in early life, such as poor prenatal and postnatal growth, short- and long-term excessive adiposity, and overweight in children, have been described in the literature.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.,77 Ong KKL, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000 Apr; 320 (7240): 967-71. In children who were born with low birth weight, RWG may be protective to regain adequate weight. However, RWG does not occur only in children who were born with a low birth weight or prematurity. RWG occurred in children who were born with normal weight,33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32. as demonstrated in the present study. In this sense, the occurrence of infant RWG can also be explained by other risk factors, which include the prenatal period, such as excessive gestational weight gain, as well as factors that include the postnatal period and the use of infant formula.2828 Yang S, Mei H, Mei H, Yang Y, Li N, Tan Y, et al. Risks of maternal prepregnancy overweight/obesity, excessive gestational weight gain, and bottle-feeding in infancy rapid weight gain: evidence from a cohort study in China. Sci China Life Sci. 2019 Dec; 62 (12): 1580-9.

In the present study, which examined children born with normal body weight, RWG indicates potential non-beneficial effects for the accumulation of body fat in childhood. The plausibility of the association between RWG and overweight remains unclear, despite the existence of several studies on the subject.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32. The potential heterogeneity of the strength of association of values between RWG and OW observed in children from these countries requires further investigation using more sophisticated methodological strategies to rule out alternative explanations. Furthermore, factors such as nutritional transition stages, cultural practices of infant feeding and public policies are potential reasons to explain the heterogeneity of variations of association.

Evidence suggests that the child’s postnatal nutritional pattern,33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32. in addition to maternal factors, such as maternal weight and smoking,99 Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016 Jun; 50 (6): 761-79. may present a relevant impact. Importantly, other studies have confirmed this association using anthropometric measures of adipose tissue distribution, such as waist circumference, skinfolds and visceral adiposity.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.

The prevalence of OW in the world population is increasing11 FAO (Food and Agriculture Organization of the United Nations), IFAD (International Fund for Agricultural Development), UNICEF (United Nations Children’s Fund), WFP (World Food Programme), WHO (World Health Organization). The state of food security and nutrition in the world 2019. Rome: FAO/IFAD/UNICEF/WFP/WHO; 2019.,22 UNICEF (United Nations Children’s Fund), WHO (World Health Organization). The World Bank Group joint child malnutrition estimates: levels and trends in child malnutrition: key findings of the 2021 edition. New York: UNICEF/WHO; 2019. and, in this context, RWG during childhood is also a potential determinant for future overweight or obesity.33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.,88 Nanri H, Shirasawa T, Ochiai H, Nomoto S, Hoshino H, Kokaze A. Rapid weight gain during infancy and early childhood is related to higher anthropometric measurements in preadolescence: Rapid weight gain and anthropometric measurements. Child Care Health Dev. 2017 May; 43 (3): 435-40.,99 Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016 Jun; 50 (6): 761-79.,1212 Rotevatn TA, Overgaard C, Melendez-Torres GJ, Mortensen RN, Ullits LR, Høstgaard AMB, et al. Infancy weight gain, parental socioeconomic position, and childhood overweight and obesity: a Danish register-based cohort study. BMC Public Health. 2019 Sep; 19 (1): 1209. It is important to identify the decisive periods of OW risks and, with this, specify the susceptible events for intervention.99 Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016 Jun; 50 (6): 761-79.,2929 Zhou J, Dang S, Zeng L, Gao W, Wang D, Li Q, et al. Rapid infancy weight gain and 7- to 9-year childhood obesity risk: a prospective cohort study in rural Western China. Medicine (Baltimore). 2016 Apr; 95 (16): e3425. Also in this study, we observed that the greater chances of OW among children who presented RWG were greater during the first two years of life, with the exception of Colombia. According to Zheng et al.,33 Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32. the first two years of life are strongly related to excessive weight gain. However, a Brazilian study reported that children between 2 and 5 years of age, that presented accelerated weight gain, were the same children who also were at a greater risk of becoming OW.3030 Matos SMA, Jesus SR, Saldiva SRDM, Prado MS, D’Innocenzo S, Assis AMO, et al. Velocidade de ganho de peso nos primeiros anos de vida e excesso de peso entre 5-11 anos de idade, Salvador, Bahia, Brasil. Cad Saúde Pública. 2011 Apr; 27 (4): 714-22.

Systematic reviews highlight the importance of the child’s first thousand days of life for the prevention of childhood obesity, such as high pre-pregnancy maternal BMI, high maternal gestational weight gain, prenatal exposure to tobacco, high birth weight and RWG9 in terms of important infant intervention target measures.

This study also reinforces the need to explore non-modifiable determinants of biological factors,77 Ong KKL, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000 Apr; 320 (7240): 967-71. including genetic factors that may be involved. Investigations such as the one in the present study, using representative data from children from Latin American countries, and demonstrating consistent results, bear relevance to the results in terms of plausibility and external validity of the presented associations.

The study presented several important limitations intrinsically common to a cross-sectional design, which does not allow for assessing the temporality of the relationships between exposure and outcome. The differences in surveys dates, taken from the studied target populations, was an additional methodological weakness, but the associations proved to be very strong and in the same direction. Without considering the potential heterogeneity of the values of the strength of association between populations, a subject that warrants further studies with more robust outcomes, it was clear that the observed associations would not have alternative explanations due to confusion, selection or measurement biases.

The variability of the odds ratio estimates between the populations and stratification groups (age and country) can be partially explained by the different sample sizes, this according to the amplitude of the 95% confidence intervals. Therefore, we should emphasize that the consistency of this association was observed across countries and age groups. These associations remained significant even after adjusting for duration of breastfeeding, which also acts as an important confounding variable.

Based on the results of the present study, the importance of preventing RWG during early childhood should be considered an important measure for reducing the incidence of OW in childhood. Child growth monitoring, including weight and height measures, is routinely done at primary care facilities using growth curves as a strategy for preventing risks to child health. Additionally, it has been suggested that monitoring the occurrence of RWG can also be considered a possible control measure.

We may conclude that there was an association between the occurrence of RWG in children born with adequate weight and the increased chance of childhood overweight, observed from the studied Latin American countries, namely Brazil, Bolivia, Colombia and Peru. Although the association values vary for each age group and country, the observed data were statistically significant, adding to and reinforcing the findings in the literature of the relationship between RWG and childhood OW. Attention must be given to ages that include early childhood, in order to promote a balanced and healthy child development. Thus, new exploratory studies on risk factors for RWG are crucial, since these are also presented as risk factors for childhood OW.

References

  • 1
    FAO (Food and Agriculture Organization of the United Nations), IFAD (International Fund for Agricultural Development), UNICEF (United Nations Children’s Fund), WFP (World Food Programme), WHO (World Health Organization). The state of food security and nutrition in the world 2019. Rome: FAO/IFAD/UNICEF/WFP/WHO; 2019.
  • 2
    UNICEF (United Nations Children’s Fund), WHO (World Health Organization). The World Bank Group joint child malnutrition estimates: levels and trends in child malnutrition: key findings of the 2021 edition. New York: UNICEF/WHO; 2019.
  • 3
    Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018; 19 (3): 321-32.
  • 4
    Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Fam Med Prim Care. 2015 Apr/Jun; 4 (2): 187-92.
  • 5
    WHO (World Health Organization). Obesity and overweight [Internet]. Geneva: WHO; 2018; [access in 2020 Oct 01]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
    » https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  • 6
    Lourenço ASN, Neri DA, Konstantyner T, Palma D, Oliveira FLC. Fatores associados ao ganho de peso rápido em pré-escolares frequentadores de creches públicas. Rev Paul Pediatr. 2018; 36 (3): 292-300.
  • 7
    Ong KKL, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000 Apr; 320 (7240): 967-71.
  • 8
    Nanri H, Shirasawa T, Ochiai H, Nomoto S, Hoshino H, Kokaze A. Rapid weight gain during infancy and early childhood is related to higher anthropometric measurements in preadolescence: Rapid weight gain and anthropometric measurements. Child Care Health Dev. 2017 May; 43 (3): 435-40.
  • 9
    Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016 Jun; 50 (6): 761-79.
  • 10
    Vasconcelos AMN, Gomes MMF, França E. Transição epidemiológica na América Latina: diferentes realidades. In: V Congreso de la Asociación Latinoamericana de Población (ALAP), 2012 Oct 23-26, Montevideo, Uruguay. Montevideo: ALAP; 2012. p. 1-21.
  • 11
    Sacco MR, Castro NP, Euclydes VLV, Souza JM, Rondó PHC. Birth weight, rapid weight gain in infancy and markers of overweight and obesity in childhood. Eur J Clin Nutr. 2013 Nov; 67 (11): 1147-53.
  • 12
    Rotevatn TA, Overgaard C, Melendez-Torres GJ, Mortensen RN, Ullits LR, Høstgaard AMB, et al. Infancy weight gain, parental socioeconomic position, and childhood overweight and obesity: a Danish register-based cohort study. BMC Public Health. 2019 Sep; 19 (1): 1209.
  • 13
    Ministry of Health (BR). Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher - PNDS 2006: dimensões do processo reprodutivo e da saúde da criança [Internet]. Brasília (DF): Ministry of Health; 2009; [access in 2020 Dec 01]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdf
    » http://bvsms.saude.gov.br/bvs/publicacoes/pnds_crianca_mulher.pdf
  • 14
    Coa R, Ochoa LH. Encuesta Nacional de Demografía y Salud (ENDSA 2008). La Paz: Ministerio de Salud y Deportes; 2009.
  • 15
    Ojeda G, Ordóñez M, Ochoa LH. Encuesta Nacional de Demografía y Salud (ENDS 2010). Bogotá: Asociación Probienestar de la Familia Colombiana Profamilia; 2010.
  • 16
    Instituto Nacional de Estadística e Informática (INEI). Encuesta Demográfica y de Salud (ENDS 2012). Lima: Instituto Nacional de Estadística e Informática; 2012.
  • 17
    ICF. Demographic and health survey interviewer’s manual. Rockville: ICF; 2017.
  • 18
    Mendes MSF. Antropometria em mulheres e desfechos reprodutivos [tese]. Belo Horizonte (MG): Escola de Enfermagem da Universidade Federal de Minas Gerais (UFMG); 2013.
  • 19
    WHO (World Health Organization). WHO anthro survey analyser. Geneva: WHO; 2011.
  • 20
    WHO (World Health Organization). WHO Expert Committee on Physical Status: the Use and Interpretation of Anthropometry (‎1993: Geneva, Switzerland)‎ & World Health Organization. (‎1995)‎. Physical status: the use of and interpretation of anthropometry. Report of a WHO expert committee. WHO Health Organ Tech Rep Ser. 1995;854:1-452.
  • 21
    WHO (World Health Organization). WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age; methods and development. Geneva: WHO; 2006.
  • 22
    WHO (World Health Organization). Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: WHO; 2017.
  • 23
    StataCorp (US). Stata Statistical Software: Release 13. College station: StataCorp LP.; 2013.
  • 24
    West BT, Berglund P, Heeringa SG. A closer examination of subpopulation analysis of complex-sample survey data. Stata J. 2008; 8(4): 520-31.
  • 25
    Moya J. Migration and the historical formation of Latin America in a global perspective. Sociologias. 2018; 20 (49): 24-68.
  • 26
    Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan; 387 (10017): 475-90.
  • 27
    CIA World Factbook. Historical data graphs per year [Internet]. CIA World Factbook; 2015; [access in 2019 Jan 09]. Available from: https://www.indexmundi.com/g/g.aspx?v=65&c=bl&l=pt
    » https://www.indexmundi.com/g/g.aspx?v=65&c=bl&l=pt
  • 28
    Yang S, Mei H, Mei H, Yang Y, Li N, Tan Y, et al. Risks of maternal prepregnancy overweight/obesity, excessive gestational weight gain, and bottle-feeding in infancy rapid weight gain: evidence from a cohort study in China. Sci China Life Sci. 2019 Dec; 62 (12): 1580-9.
  • 29
    Zhou J, Dang S, Zeng L, Gao W, Wang D, Li Q, et al. Rapid infancy weight gain and 7- to 9-year childhood obesity risk: a prospective cohort study in rural Western China. Medicine (Baltimore). 2016 Apr; 95 (16): e3425.
  • 30
    Matos SMA, Jesus SR, Saldiva SRDM, Prado MS, D’Innocenzo S, Assis AMO, et al. Velocidade de ganho de peso nos primeiros anos de vida e excesso de peso entre 5-11 anos de idade, Salvador, Bahia, Brasil. Cad Saúde Pública. 2011 Apr; 27 (4): 714-22.

Publication Dates

  • Publication in this collection
    09 May 2022
  • Date of issue
    Jan-Mar 2022

History

  • Received
    18 Dec 2020
  • Reviewed
    10 Nov 2021
  • Accepted
    30 Nov 2021
Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br
Accessibility / Report Error