Neurocognitive and Health Correlates of Overweight and Obesity among Ten-Year-Old Children Born Extremely Preterm

Abstract

Objective: To assess the relationship between overweight (body mass index [BMI] percentile ≥85 and <95) and obesity (BMI ≥95 percentile) and developmental and health outcomes at 10 years of age in a cohort of individuals born extremely preterm.

Study design: This was an observational cohort study of children born extremely preterm and then assessed at age 10 years for neurocognitive function and parent-reported behavior and health outcomes. Participants included 871 children aged 10 years. To describe the strength of association between overweight or obesity and outcomes, we used logistic regression models adjusting for confounders. Neurocognitive function, academic achievement, parent-reported health outcome surveys, and height and weight were measured.

Results: BMI category at 10 years of age was not associated with differences in intelligence, language, or academic achievement. Parents of children with obesity were more likely to report their child had asthma (OR 2.2; 95% CI 1.4-3.5), fair/poor general health (OR 3.2; 95% CI 1.4-7.5), and decreased physical function (OR 1.7; 95% CI 1.1-2.9) but less likely to have physician diagnosed attention-deficit/hyperactivity disorder (OR 0.5; 95% CI 0.3-0.97) or an individualized education plan (OR 0.6; 95% CI 0.4-0.99).

Conclusion: Among children born extremely preterm, an elevated BMI, compared with normal or low BMI, is not associated with a difference in neurocognitive function. However, asthma, fair/poor general health, and decreased physical function were more prevalent among study participants with obesity, and attention-deficit/hyperactivity disorder and individualized education plan were less prevalent.

Keywords: asthma; extremely preterm; neurocognitive outcomes; obesity; overweight.

Figure 1

Forest plots of odds ratios (ORs) and 95% confidence intervals of a Z-score ≤ −1 on each DAS-II and NEPSY-II neurocognitive assessment at age 10 associated with BMI centile at 10 years 85 to < 95 (left panel) and ≥ 95 (right panel). The reference group is children from the same cohort with BMI centile at 10 years <85. Odds ratios are adjusted for maternal Hispanic ethnicity, education ≤ 12 years, single marital status, and pre-pregnancy BMI < 25 and 25 to < 30; and child’s sex and birth weight Z-score < −1. Statistically significant items are bolded.

Figure 2

Forest plots of odds ratios (ORs) and 95% confidence intervals of several educational and health characteristics associated with BMI centile at 10 years 85 to < 95 (left panel) and ≥ 95 (right panel). The reference group is children from the same cohort with BMI centile at 10 years <85. Odds ratios are adjusted for maternal Hispanic ethnicity, education ≤ 12 years, single marital status, and pre-pregnancy BMI < 25 and 25 to < 30; and child’s sex and birth weight Z-score < −1. Statistically significant items are bolded.