Rapid Weight Gain in First Three Months of Life -not good

Rapid Growth in Infancy Linked to Cardiovascular and Metabolic Risk Factors Later in Life

by Michael O’Riordan & Penny Murata
Medscape News

June 12, 2009 — Important determinants of cardiovascular disease and type 2 diabetes mellitus in adulthood are increased in infants who gain weight rapidly early in life, a new study has shown. Increased weight gain relative to height in early infancy is associated with reduced insulin sensitivity and serum high-density lipoprotein (HDL)-cholesterol levels, as well as increased waist circumference and serum triglyceride levels, report investigators.

"Rapid weight gain in the first three months of life," write Dr Ralph Leunissen (Erasmus Medical Center, Rotterdam, the Netherlands) and colleagues in the June 3, 2009 issue of the Journal of the American Medical Association, "is more detrimental than slow weight gain. More studies are required to investigate which factors determine rapid weight gain in early infancy, because those results might lead to interventions that could decrease the risk for development of cardiovascular disease and type 2 diabetes later in life."

The data on birth weight and growth early in life is mixed. Some studies have shown that low birth weight is associated with cardiovascular disease and type 2 diabetes later in life, while others suggested that rapid growth patterns in infancy and childhood were an important determinant of risk later in life. Other data have shown that poor growth early in life, followed by catch-up growth after age two, is related to an increased risk of cardiovascular disease later in life.

In this study, Leunissen and colleagues wanted to determine which period in the first year of life is related to determinants of cardiovascular risk. They collected observational data from 217 participants aged 18 to 24 years participating in the Programming Factors for Growth and Metabolism (PROGRAM) study.

Weight gain in the first three months was inversely associated with insulin sensitivity and HDL-cholesterol levels. There were positive associations between weight gain during these months and waist circumference, acute insulin response, ratio of total cholesterol to HDL cholesterol, and triglyceride levels. Acute insulin response was positively associated with weight gain in months 3 to 6 after birth, but no other association was observed, including in months 6 to 9 and 9 months to one year.

A subgroup analysis was performed in 87 subjects who gained weight rapidly in the first year to assess possible relationships between the "tempo" of weight gain and determinants of cardiovascular disease and type 2 diabetes.

Individuals who gained weight rapidly during the first three months had more body fat, central adiposity, and reduced insulin sensitivity in early adulthood than those with slower growth. Rapid weight gain was defined as >0.67 standard deviation from the mean.

"This indicates that having a low birth weight for gestational age is not directly related with an unfavorable cardiovascular and metabolic profile, but increased weight gain during early childhood is," write Leunissen and colleagues, adding that the tempo of weight gain might even be more important than the timing.

The group said that the reasons for the increased cardiovascular risk are unknown, but that nutrient-enriched diets that contribute to rapid weight gain might have adverse effects of cardiovascular risk factors later in life. Formula-fed infants, for example, grow at a faster rate than breast-fed infants but are more likely to be overweight later in life. Their study, however, is limited, in that there are no nutritional data available. Future studies need to confirm these findings and to determine which factors determine weight gain, as well as to investigate associations with parental factors, such as genetics and maternal health during pregnancy.

Clinical Implications

Weight gain in the first 3 months of life is linked with reduced insulin sensitivity and serum HDL level and greater waist circumference, acute insulin response, ratio of total cholesterol to HDL cholesterol level, and triglyceride level in early adulthood.
Rapid weight gain in the first 3 months of life is linked with greater body fat percentage and central adiposity and reduced insulin sensitivity in early adulthood.

source: http://cme.medscape.com/viewarticle/704321?sssdmh=dm1.486011&src=nldne