Timing of Adiposity Rebound and Determinants of Early Adiposity Rebound in Korean Infants and Children Based on Data from the National Health Insurance Service

Abstract

Adiposity rebound (AR) is defined as the second rise in the body mass index (BMI) usually occurring in early childhood. This study aimed to investigate the timing of AR and the factors determining early AR (EAR) by tracking BMI patterns using large-scale longitudinal nationwide data (n = 142,668; 73,389 boys and 69,279 girls) over seven time periods (4-6, 9-12, 18-24, 30-36, 42-48, 54-60, and 66-71 months). The average BMI rebound indicating AR was found before the age of 5 years (6th time period, 54-60 months). Interestingly, children experiencing BMI rebound during the 4th to 6th time periods showed a small increase in the proportion of underweight in the 2nd time period, but a dramatically higher proportion of underweight during the corresponding time period, similar to M-shaped patterns. In contrast, overweight or obese children in the above group showed opposite W-shaped patterns. The parameters predicting the risk of EAR are diverse for each time period by sex. Adequate breastfeeding before the age of 1 year, adequate diet, and reduced sugar-sweetened beverage consumption after the age of 1 year were important for reducing EAR. This study presents for the first time, the timing of AR and the major determinants of EAR among Korean infants and children based on large-scale nationwide data.

Keywords: adiposity rebound; determinant; nationwide; obesity.

Figure 1

Changes in average body mass index (BMI) for the seven time periods by (a) boys and (b) girls. H_BMI: higher BMI group whose BMI at the 7th time period was higher than the average BMI at the 7th time period; L_BMI: lower BMI group whose BMI at the 7th time period was lower than the average BMI at the 7th time period; M: average BMI group based on the 7th time period.

Figure 2

Distribution of body mass index (BMI) percentile for the seven-time periods according to each time period and onset of adiposity rebound (AR) by (a) boys and (b) girls. The determination of the BMI percentile by age and sex was based on the child growth standards of the World Health Organization. Specifically, BMI-for-age less than 5th percentile is categorized as severely underweight, 5th to less than 15th percentile into underweight, 15th to less than 85th percentile into healthy weight, 85th to less than 95th percentile into overweight, and 95th to 100th percentile into obese based on the age at the time of measurement.