The American journal of clinical nutrition · 2025
Association between size at birth, rapid weight gain in infancy, and overweight status among Palestinian refugees under 5 years old: a retrospective cohort study.
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Jamaluddine Zeina, Campbell Oona Mr, Sato Miho, Seita Akihiro, Ohuma Eric O, Frongillo Edward A, Ghattas Hala
Аннотация
BACKGROUND: Evidence on the association of birth size and rapid weight gain with overweight/obesity is inconsistent. Refugees face unique nutritional challenges that influence weight patterns, yet data remain limited.
OBJECTIVES: We examined the association between size at birth, infant feeding, and rapid weight gain in the first year of life, and subsequent overweight/obesity in childhood among Palestinian refugees.
METHODS: This retrospective cohort study used data from 388,347 live births from 1 January, 2010 to 31 December, 2020, linked to child growth monitoring data using United Nations Relief and Works Agency electronic-health records. The cohort included children aged 0 to 60 mo from 5 regions: Gaza, Jordan, Lebanon, Syria, and the West Bank. Size at birth was categorized into 9 phenotypes, and rapid weight gain was defined as an increase of 0.67 in weight-for-age z-score from birth until age 12 mo. Overweight/obesity occurrence was defined as a weight-for-height z-score >+2 at any time point after 24 to 60 mo of age. Multilevel mixed-effects models and structural equation modeling were used to analyze associations.
RESULTS: Small for gestational age children had lower odds of exclusive human milk feeding [adjusted odds ratio (aOR): 0.83; 95% confidence interval (CI): 0.81, 0.85], higher odds of rapid weight gain (aOR: 2.39; 95% CI: 2.32, 2.45), and lower odds of overweight/obesity (aOR: 0.50; 95% CI: 0.46, 0.56) compared with appropriate for gestational age children. Large for gestational age children showed lower odds of rapid weight gain (aOR: 0.35; 95% CI: 0.33, 0.36) but higher odds of overweight/obesity (aOR: 2.76; 95% CI: 2.59, 2.95) compared with appropriate for gestational age. Between 22.2% and 34.4% of children experienced rapid weight gain. Rapid weight gain was strongly associated with overweight/obesity at 24 to 60 mo (aOR: 6.53; 95% CI: 6.15, 6.94). Exclusive human milk feeding was associated with lower odds of rapid weight gain (aOR: 0.66; 95% CI: 0.65, 0.67).
CONCLUSIONS: Rapid weight gain in infancy, regardless of birth size, is a predictor of childhood overweight/obesity. Exclusive human milk feeding mitigates the risk of rapid weight gain and subsequent overweight/obesity.
OBJECTIVES: We examined the association between size at birth, infant feeding, and rapid weight gain in the first year of life, and subsequent overweight/obesity in childhood among Palestinian refugees.
METHODS: This retrospective cohort study used data from 388,347 live births from 1 January, 2010 to 31 December, 2020, linked to child growth monitoring data using United Nations Relief and Works Agency electronic-health records. The cohort included children aged 0 to 60 mo from 5 regions: Gaza, Jordan, Lebanon, Syria, and the West Bank. Size at birth was categorized into 9 phenotypes, and rapid weight gain was defined as an increase of 0.67 in weight-for-age z-score from birth until age 12 mo. Overweight/obesity occurrence was defined as a weight-for-height z-score >+2 at any time point after 24 to 60 mo of age. Multilevel mixed-effects models and structural equation modeling were used to analyze associations.
RESULTS: Small for gestational age children had lower odds of exclusive human milk feeding [adjusted odds ratio (aOR): 0.83; 95% confidence interval (CI): 0.81, 0.85], higher odds of rapid weight gain (aOR: 2.39; 95% CI: 2.32, 2.45), and lower odds of overweight/obesity (aOR: 0.50; 95% CI: 0.46, 0.56) compared with appropriate for gestational age children. Large for gestational age children showed lower odds of rapid weight gain (aOR: 0.35; 95% CI: 0.33, 0.36) but higher odds of overweight/obesity (aOR: 2.76; 95% CI: 2.59, 2.95) compared with appropriate for gestational age. Between 22.2% and 34.4% of children experienced rapid weight gain. Rapid weight gain was strongly associated with overweight/obesity at 24 to 60 mo (aOR: 6.53; 95% CI: 6.15, 6.94). Exclusive human milk feeding was associated with lower odds of rapid weight gain (aOR: 0.66; 95% CI: 0.65, 0.67).
CONCLUSIONS: Rapid weight gain in infancy, regardless of birth size, is a predictor of childhood overweight/obesity. Exclusive human milk feeding mitigates the risk of rapid weight gain and subsequent overweight/obesity.