. 2025 May 1;8(5):e2511835.

doi: 10.1001/jamanetworkopen.2025.11835.

Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort

Chang Liu¹, Sy-Miin Chow², Izzuddin M Aris³, Dana Dabelea^{4

5

6}, Jenae M Neiderhiser⁷, Leslie D Leve⁸, Clancy Blair⁹, Diane J Catellier¹⁰, Lance Couzens¹⁰, Joseph M Braun¹¹, Assiamira Ferrara^{12

13}, Judy L Aschner^{14

15}, Sean C L Deoni¹⁶, Anne L Dunlop¹⁷, James E Gern¹⁸, Katherine Rivera-Spoljaric¹⁹, Tina V Hartert²⁰, Gurjit K Khurana Hershey²¹, Margaret R Karagas²², Elizabeth M Kennedy¹⁷, Catherine J Karr^{23

24}, Emily S Barrett^{25

26}, Qi Zhao²⁷, Barry M Lester²⁸, Jennifer F Check²⁹, Jennifer B Helderman²⁹, Thomas G O'Connor^{30

31

32}, Jerod M Rasmussen³³, Joseph B Stanford³⁴, Nicole L Mihalopoulos³⁵, Rosalind J Wright^{36

37}, Robert O Wright³⁷, Kecia N Carroll^{37

38}, Cindy T McEvoy³⁹, Carrie V Breton⁴⁰, Leonardo Trasande^{41

42

43}, Scott T Weiss⁴⁴, Amy J Elliott^{45

46}, Christine W Hockett^{45

46}, Jody M Ganiban⁴⁷; Environmental influences on Child Health Outcomes (ECHO)

Collaborators, Affiliations

Collaborators

Environmental influences on Child Health Outcomes (ECHO):
P Brian Smith, L Kristin Newby, Lisa P Jacobson, Richard Gershon, David Cella, Stephanie L Merhar, Andrea L Lampland, Ann Marie Reynolds Lyndaker, Mark Hudak, Gloria S Pryhuber, Paul E Moore, Lisa K Washburn, Lisa Gatzke-Kopp, Margaret M Swingler, Viren D'Sa, Lisa A Croen, Daniel J Jackson, Leonard B Bacharier, George T O'Connor, Meyer Kattan, Robert A Wood, Frances Tylavsky, A Mason, Sheela Sathyanarayana, Nicole R Bush, Kaja Z LeWinn, Brian S Carter, Steven L Pastyrnak, Charles R Neal, Lynne M Smith, Augusto A Litonjua, Robert Zeiger, Robert S Tepper, Christina A Porucznik, Angelo P Giardino, Michelle Bosquet-Enlow, Daphne Koinis Mitchell, Rosalind J Wright

Affiliations

¹ Department of Psychology, Washington State University, Pullman.
² Department of Human Development and Family Studies, The Pennsylvania State University, University Park.
³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
⁴ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.
⁵ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora.
⁶ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.
⁷ Department of Psychology, The Pennsylvania State University, University Park.
⁸ College of Education, University of Oregon, Eugene.
⁹ Department of Applied Psychology, New York University, New York.
¹⁰ RTI International, Research Triangle Park, North Carolina.
¹¹ Department of Epidemiology, Brown University, Providence, Rhode Island.
¹² Kaiser Permanente Northern California Division of Research, Oakland.
¹³ Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM) Center, Kaiser Permanente Northern California Division of Research, Oakland.
¹⁴ Center for Discovery and Innovation, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey.
¹⁵ Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
¹⁶ Department of Pediatrics, Brown University, Providence, Rhode Island.
¹⁷ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
¹⁸ Department of Pediatrics, University of Wisconsin-Madison, Madison.
¹⁹ Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
²⁰ Department of Medicine, Vanderbilt University, Nashville, Tennessee.
²¹ Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²² Department of Epidemiology, Dartmouth College, Hanover, New Hampshire.
²³ Department of Environmental & Occupational Health Sciences, University of Washington, Seattle.
²⁴ Department of Pediatrics, University of Washington, Seattle.
²⁵ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway.
²⁶ Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway.
²⁷ Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis.
²⁸ Women and Infants Hospital Rhode Island, Providence.
²⁹ Wake Forest University School of Medicine, Winston Salem, North Carolina.
³⁰ Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.
³¹ Department of Neuroscience, University of Rochester Medical Center, Rochester, New York.
³² Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
³³ Department of Pediatrics, University of California, Irvine.
³⁴ Department of Family & Preventive Medicine, The University of Utah, Salt Lake City.
³⁵ Department of Pediatrics, The University of Utah, Salt Lake City.
³⁶ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁷ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁸ Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁹ Department of Pediatrics, Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland.
⁴⁰ Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
⁴¹ Department of Pediatrics, New York University Grossman School of Medicine, New York.
⁴² Department of Population Health, New York University Grossman School of Medicine, New York.
⁴³ New York University Wagner Graduate School of Public Service, New York.
⁴⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
⁴⁵ Avera Research Institute, Sioux Falls, South Dakota.
⁴⁶ Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls.
⁴⁷ Department of Psychological & Brain Sciences, Columbian College of Arts & Sciences, The George Washington University, Washington, DC.

PMID: 40402497
PMCID: PMC12100454
DOI: 10.1001/jamanetworkopen.2025.11835

Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort

Chang Liu et al. JAMA Netw Open. 2025.

. 2025 May 1;8(5):e2511835.

doi: 10.1001/jamanetworkopen.2025.11835.

Authors

Collaborators

Environmental influences on Child Health Outcomes (ECHO):
P Brian Smith, L Kristin Newby, Lisa P Jacobson, Richard Gershon, David Cella, Stephanie L Merhar, Andrea L Lampland, Ann Marie Reynolds Lyndaker, Mark Hudak, Gloria S Pryhuber, Paul E Moore, Lisa K Washburn, Lisa Gatzke-Kopp, Margaret M Swingler, Viren D'Sa, Lisa A Croen, Daniel J Jackson, Leonard B Bacharier, George T O'Connor, Meyer Kattan, Robert A Wood, Frances Tylavsky, A Mason, Sheela Sathyanarayana, Nicole R Bush, Kaja Z LeWinn, Brian S Carter, Steven L Pastyrnak, Charles R Neal, Lynne M Smith, Augusto A Litonjua, Robert Zeiger, Robert S Tepper, Christina A Porucznik, Angelo P Giardino, Michelle Bosquet-Enlow, Daphne Koinis Mitchell, Rosalind J Wright

Affiliations

¹ Department of Psychology, Washington State University, Pullman.
² Department of Human Development and Family Studies, The Pennsylvania State University, University Park.
³ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
⁴ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.
⁵ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora.
⁶ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.
⁷ Department of Psychology, The Pennsylvania State University, University Park.
⁸ College of Education, University of Oregon, Eugene.
⁹ Department of Applied Psychology, New York University, New York.
¹⁰ RTI International, Research Triangle Park, North Carolina.
¹¹ Department of Epidemiology, Brown University, Providence, Rhode Island.
¹² Kaiser Permanente Northern California Division of Research, Oakland.
¹³ Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM) Center, Kaiser Permanente Northern California Division of Research, Oakland.
¹⁴ Center for Discovery and Innovation, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey.
¹⁵ Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
¹⁶ Department of Pediatrics, Brown University, Providence, Rhode Island.
¹⁷ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
¹⁸ Department of Pediatrics, University of Wisconsin-Madison, Madison.
¹⁹ Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
²⁰ Department of Medicine, Vanderbilt University, Nashville, Tennessee.
²¹ Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
²² Department of Epidemiology, Dartmouth College, Hanover, New Hampshire.
²³ Department of Environmental & Occupational Health Sciences, University of Washington, Seattle.
²⁴ Department of Pediatrics, University of Washington, Seattle.
²⁵ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscataway.
²⁶ Environmental and Occupational Health Sciences Institute, Rutgers, The State University of New Jersey, Piscataway.
²⁷ Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis.
²⁸ Women and Infants Hospital Rhode Island, Providence.
²⁹ Wake Forest University School of Medicine, Winston Salem, North Carolina.
³⁰ Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.
³¹ Department of Neuroscience, University of Rochester Medical Center, Rochester, New York.
³² Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
³³ Department of Pediatrics, University of California, Irvine.
³⁴ Department of Family & Preventive Medicine, The University of Utah, Salt Lake City.
³⁵ Department of Pediatrics, The University of Utah, Salt Lake City.
³⁶ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁷ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁸ Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁹ Department of Pediatrics, Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland.
⁴⁰ Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
⁴¹ Department of Pediatrics, New York University Grossman School of Medicine, New York.
⁴² Department of Population Health, New York University Grossman School of Medicine, New York.
⁴³ New York University Wagner Graduate School of Public Service, New York.
⁴⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
⁴⁵ Avera Research Institute, Sioux Falls, South Dakota.
⁴⁶ Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls.
⁴⁷ Department of Psychological & Brain Sciences, Columbian College of Arts & Sciences, The George Washington University, Washington, DC.

PMID: 40402497
PMCID: PMC12100454
DOI: 10.1001/jamanetworkopen.2025.11835

Abstract

Importance: Identifying atypical body mass index (BMI) trajectories in children and understanding associated, modifiable early-life factors may help prevent childhood obesity.

Objective: To characterize multiphase BMI trajectories in children and identify associated modifiable early-life factors.

Design, setting, and participants: This cohort study included longitudinal data obtained from January 1997 to June 2024, from the Environmental influences on Child Health Outcomes (ECHO) cohort, which included children aged 1 to 9 years with 4 or more weight and height assessments. Analyses were conducted from January to June 2024.

Exposures: Prenatal exposure to substances and stress (smoking, alcohol, depression, anxiety), maternal characteristics (prepregnancy BMI, gestational weight gain), child characteristics (preterm birth, birth weight, breastfeeding), and demographic covariates.

Main outcomes and measures: BMI (calculated as weight in kilograms divided by length in meters squared for children aged 1 and 2 years and as weight in kilograms divided by height in meters squared for children older than 2 years) obtained using medical records, staff measurements, caregiver reports, or remote study measures. The analysis was conducted using a multiphase latent growth mixture model.

Results: This study included 9483 children (4925 boys [51.9%]). Two distinct 2-phase BMI patterns were identified: typical and atypical. The typical group (n = 8477 [89.4%]) showed linear decreases in BMI (b2, -0.23 [95% CI, -0.24 to -0.22]), with the lowest BMI at age 6 years (95% CI, 5.94-6.11), followed by linear increases from 6 to 9 years (slope difference [b4 - b2], 0.81 [95% CI, 0.76-0.86]; mean BMI at 9 years: 17.33). The atypical group (n = 1006 [10.6%]) showed a stable BMI from ages 1 to 3.5 years (b6, 0.06 [95% CI, -0.04 to 0.15]), followed by rapid linear increases from ages 3.5 to 9 years (slope difference [b8 - b6], 1.44 [95% CI, 1.34-1.55]). At age 9 years, this group reached a mean BMI (26.2) that exceeded the 99th percentile. Prenatal smoking, high prepregnancy BMI, high gestational weight gain, and high birth weight were key risk factors for the atypical trajectory.

Conclusions and relevance: In this cohort study of children in the ECHO cohort, analyses identified children on the path to obesity as early as age 3.5 years. Modifiable factors could be targeted for early prevention and intervention programs aimed at reducing childhood obesity.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

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References

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Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort

Collaborators

Affiliations

Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical