Size at birth, weight gain in infancy and childhood, and adult blood pressure in 5 low- and middle-income-country cohorts: when does weight gain matter?

Abstract

Background: Promoting catch-up growth in malnourished children has health benefits, but recent evidence suggests that accelerated child weight gain increases adult chronic disease risk.

Objective: We aimed to determine how birth weight (BW) and weight gain to midchildhood relate to blood pressure (BP) in young adults.

Design: We pooled data from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa. We used conditional weight (CW), a residual of current weight regressed on prior weights, to represent deviations from expected weight gain from 0 to 12, 12 to 24, 24 to 48 mo, and 48 mo to adulthood. Adult BP and risk of prehypertension or hypertension (P/HTN) were modeled before and after adjustment for adult body mass index (BMI) and height. Interactions of CWs with small size-for-gestational age (SGA) at birth were tested.

Results: Higher CWs were associated with increased BP and odds of P/HTN, with coefficients proportional to the contribution of each CW to adult BMI. Adjusted for adult height and BMI, no child CW was associated with adult BP, but 1 SD of BW was related to a 0.5-mm Hg lower systolic BP and a 9% lower odds of P/HTN. BW and CW associations with systolic BP and P/HTN were not different between adults born SGA and those with normal BW, but higher CW at 48 mo was associated with higher diastolic BP in those born SGA.

Conclusions: Greater weight gain at any age relates to elevated adult BP, but faster weight gains in infancy and young childhood do not pose a higher risk than do gains at other ages.

FIGURE 1

Mean weight-for-age z scores in males (A) and females (B). The solid lines represent those without prehypertension or hypertension (P/HTN), and the dashed lines represent those with P/HTN, defined as a systolic blood pressure ≥130 mm Hg or a diastolic blood pressure ≥80 mm Hg, except for Birth-to-Twenty (Bt20) adolescents (defined as a systolic or diastolic blood pressure ≥90th percentile of age-, sex-, and height-specific cutoffs; 25). Sample sizes were as follows for those with or without P/HTN, respectively: Pelotas (n = 1208 and 279 for males and n = 107 and 375 for females), Guatemala (n = 27 and 88 for males and n = 14 and 86 for females), New Delhi (n = 246 and 345 for males and n = 103 and 320 for females), Cebu (n = 431 and 542 for males and n = 99 and 746 for females), and Bt20 (n = 68 and 100 for males and n = 33 and 118 for females).

FIGURE 2

Mean adult weight of males (A) and females (B) without (first bar for each site) or with prehypertension or hypertension (P/HTN; second bar for each site), stratified by lean and fat mass. The upper error bar represents the SD of the mean fat mass, and the lower error bar represents the SD of the mean lean mass. Numbers in the upper block of each column represent percentage body fat (fat mass/total body weight × 100 ± SD). Pelotas females were excluded because they had missing body-composition data. Sample sizes were as follows for those with or without P/HTN, respectively: Pelotas (n = 196 and 259 for males), Guatemala (n = 26 and 87 for males and n = 14 and 85 for females), New Delhi (n = 245 and 344 for males and n = 100 and 318 for females), Cebu (n = 411 and 485 for males and n = 92 and 638 for females), and Birth-to-Twenty (Bt20; n = 65 and 97 for males and n = 31 and 113 for females).

FIGURE 3

Coefficients estimated from regressing adult systolic blood pressure (BP; solid line) or BMI (dotted line) on birth weight and conditional weight at 12, 24, and 48 mo by using data pooled from the 5 birth cohort studies (n = 4335).