Early childhood weight gain: latent patterns and body composition outcomes

Background: Despite early childhood weight gain being a key indicator of obesity risk, we do not have a good understanding of the different patterns that exist. Objectives: To identify and characterise distinct groups of children displaying similar early life weight trajectories. Methods: A growth mixture model captured heterogeneity in weight trajectories between 0-60 months in 1,390 children in the Avon Longitudinal Study of Parents and Children. Differences between the classes in characteristics and body size/composition at 9 years were investigated. Results: The best model had five classes. The “Normal” (45%) and “Normal after initial catch-down” (24%) classes were close to the 50th centile of a growth standard between 24-60 months. The “High-decreasing” (21%) and “Stable-high” (7%) classes peaked at the ~91st centile at 12-18 months, but while the former declined to the ~75th centile and comprised constitutionally big children, the latter did not. The “Rapidlyincreasing” (3%) class gained weight from below the 50th centile at 4 months to above the 91st centile at 60 months. By 9 years, their mean body mass index (BMI) placed them at the 98th centile. This class was characterised by the highest maternal BMI; highest parity; highest levels of gestational hypertension and diabetes; and the lowest socio-economic position. At 9 years, the “Rapidly-increasing” class was estimated to have 68.2% (48.3,88.1) more fat mass than the “Normal” class, but only 14.0% (9.1,18.9) more lean mass. Conclusions: Criteria used in growth monitoring practice are unlikely to consistently distinguish between the different patterns of weight gain reported here.