OR07-5 BMI Trajectory of Severely Obese Children Diverges from Normal-Weight Children during Infancy

Program: Abstracts - Orals, Poster Previews, and Posters
Session: OR07-Predictors of Weight Gain and Disease
Friday, April 1, 2016: 11:45 AM-1:15 PM
Presentation Start Time: 12:45 PM
Room 160 (BCEC)

Outstanding Abstract Award
Allison R. Smego*1, Jessica G Woo1, Jillian Klein2, Danesh Bansal3, Christopher F. Bolling4, Stephen R. Daniels5 and Nancy Crimmins1
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 2Cincinnati Children's Hospital Medical Cener, Cincinnati, OH, 3Northeast Ohio Medical University, 4Pediatric Associates, Crestview Hills, KY, 5Children’s Hospital of Colorado, Denver, CO
Background: Young children with severe obesity have high lifetime risk for persistent obesity and metabolic disease. It is unknown when young children with severe obesity develop abnormal weight gain patterns thus limiting early identification and intervention. Our objective was to characterize growth patterns of children who become severely obese (BMI>99%ile) by age 6 to identify whether these children experience a critical period of deviation from normal growth, and to characterize that growth relative to normally-developing children.  

 Methods: Two lean cohorts (BMI 5th to ≤75%ile; one from low-income primary care clinic, one from longitudinal epidemiologic study) and two severely obese cohorts (BMI≥99%ile; one from low-income primary care clinic, one from obesity referral clinic) were selected based on BMI between ages 2-6.  Growth data were abstracted from birth through age 6 for each. In addition, sex, race, and health insurance type were collected. Repeated measures mixed modeling and logistic regression were used to distinguish growth characteristics of the lean and obese cohorts.

 Results: 783 lean (647 low-income, 136 population-based) and 480 severely obese (365 low income, 115 referral clinic) participants were included. Sex distribution of patients was similar among all groups. Both the low-income populations were predominantly African-American at 79% and 62%, respectively, while the population-based and referral clinic had a significantly lower proportion of African-Americans, at 24% and 23%, respectively. Clinical obesity onset occurred at median 2.00 [IQR: 1.24, 3.11] years of age in the low income obese, and at 1.36 [0.61, 3.02] years in the referral obese group. However, BMI differed significantly between severely obese and lean cohorts by 4 months of age (p<0.0001) while WHO weight-for-age percentile differed by 2 months (p<0.0001), prior to obesity onset. BMI high-specificity (95%) thresholds accurately differentiated severely obese from lean groups at 6, 12, and 18 months of age (51%, 52% and 95% sensitivity, respectively).

 Conclusions:  BMI trajectories in children who become severely obese by age 6 differ from children who remain normal weight as early as 4-6 months of age, approximately 12-18 months prior to the median onset of clinical obesity. Infant BMI at 6, 12, or 18 months above 85th percentile on WHO growth chart is highly specific for identifying children at risk for early onset severe obesity and should prompt close monitoring.

Nothing to Disclose: ARS, JGW, JK, DB, CFB, SRD, NC

*Please take note of The Endocrine Society's News Embargo Policy at https://www.endocrine.org/news-room/endo-annual-meeting/pr-resources-for-endo