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How pre- and postnatal risk factors modify the effect of rapid weight gain in infancy and early childhood on subsequent fat mass development: results from the Multicenter Allergy Study 90^1,2,3

¹ From the Research Institute of Child Nutrition, Rheinische Friedrich-Wilhelms-Universität Bonn, Dortmund, Germany (NK-D, AEB, and AK); the Institute for Social Medicine, Epidemiology and Health Economics, Charité, Berlin, Germany (MK and TK); the Department of Nutrition, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany (AK); University Children's Hospital, University of Freiburg, Freiburg, Germany (JF); Pediatric Pneumology and Allergology, Children's Hospital, Mainz University, Mainz, Germany (WK); the Department of Pediatric Cardiology and Pneumology, University of Düsseldorf, Düsseldorf, Germany (AS); the Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany (CH); the Department of Obstetrics, Charité University Medical Centre, Campus Virchow Klinikum, Berlin, Germany (RLB); and the Department of Pediatric Pneumology and Immunology, Allergy Center Charité, Charité University Medical Center, Berlin, Germany (UW and SL)

Background: It is unclear which exposures may cause or modify the adverse effect of rapid weight gain on fat mass development in term children whose birth weight is appropriate-for-gestational age (AGA).

Objective: To determine which intrauterine or postnatal exposures increase the risk of or modify the effect of rapid weight gain on body fat percentage (BF%) and body mass index (BMI) trajectories between 2 and 6 y of age.

Design: Term AGA singletons (n = 370) from the German Multicenter Allergy Study (MAS-90), a longitudinal birth cohort study, with repeated anthropometric measurements until 6 y, and data on breastfeeding status, exposure to smoking during pregnancy, and maternal anthropometric and socioeconomic characteristics were included in this analysis.

Results: A shorter gestation [multivariate-adjusted odds ratio (OR): 5.12; 95% CI: 2.22, 11.82; P = 0.0001], being firstborn (OR: 2.01; 95% CI: 1.10, 3.69; P = 0.02), and having been bottle-fed (OR: 3.02; 95% CI: 1.68, 5.43; P = 0.0002) all significantly increased a child's risk of gaining weight rapidly, whereas a larger BMI at birth was protective (OR: 0.54; 95% CI: 0.38, 0.77; P = 0.0006). Multilevel model analyses showed that rapid growers exposed to tobacco in utero subsequently gained more BF% between 2 and 6 y than did rapid growers who had not been exposed (β ± SE: 0.78 ± 0.28%/y; P = 0.005). Similarly, change in BF% was greater in rapid growers with an overweight mother than in those with a normal-weight mother (1.01 ± 0.30%/y; P = 0.0007).

Conclusions: The occurrence of rapid weight gain between birth and 2 y and the magnitude of its effect on BF% development in AGA children is influenced by both intrauterine and postnatal exposures.