Impact of growth markers and patterns of growth on children's cardiometabolic health: a life course perspective.
Luo Ling L, Tong Juan J, Wang Xing X, Huang Qi-Zheng QZ et al.
Growth and development in children are known to be closely associated with cardiometabolic health. However, there is a lack of systematic assessments of associations between growth markers and growth patterns across different developmental stages and pediatric cardiometabolic health in prospective birth cohorts. This study aimed to identify critical developmental windows and growth characteristics that may be relevant to cardiometabolic health that could inform future prevention strategies. We utilized the Ma'anshan birth cohort and obtained repeated measurements of body length/height and weight from birth through school age at each follow-up visit to examine childhood body mass index (BMI) growth curves. During school age, additional measurements were taken for cardiometabolic risk factors (CMRFs) including waist circumference, blood pressure, blood glucose, and blood lipids. Linear mixed modeling was used to fit childhood BMI growth curves and calculate 11 growth markers: adiposity peak (AP)-age, AP-BMI, adiposity rebound (AR)-age, AR-BMI, infancy slope, toddlerhood slope, preschool/school-age slope, infancy area under the curve (AUC), toddlerhood AUC, preschool age AUC, and school-age AUC. Different growth patterns were classified using k-means clustering. Among the 1786 children included, significant differences existed between boys and girls in growth markers (t-tests) and patterns (chi-square tests) (P < 0.05). With the exception of AP-age, the remaining 10 growth markers showed significant associations with clustered CMRFs in both boys and girls (P < 0.05). Compared to low-risk patterns, children with high-risk patterns had significantly increased risks of clustered CMRFs in both boys [relative risk (RR) = 6.75, 95% confidence interval (CI) = 3.81-12.92, P < 0.05] and girls (RR = 8.34, 95% CI = 4.15-18.69, P < 0.05). In stratified analyses by obesity status, these associations remained significant. Childhood growth patterns and markers during different parts of the life course were closely associated with cardiometabolic health; AP-age association was sex-specific. These findings support the importance of monitoring childhood growth trajectories from infancy onward for early identification of cardiometabolic risk.