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FMF #14 attempted to quell alarms raised by publications warning about early rapid weight gain. Since that 2006 publication, considerable research has focused attention on the topic. Growing out of her concern about the destructive impact of such research, Inés Anchondo, Dr PH, RD, LD, CSP, wrote this issue of Family Meals Focus based on her presentation at the 2010 American Dietetic Association annual meeting.

A spate of research articles have sounded the alarm that too-fast early weight gain is linked to obesity in childhood and disease in adulthood.  Parents, caregivers, and health care providers need to learn the facts about early weight gain to head off interference with feeding and growth and to support optimal feeding of babies. The consequences of early weight gain are not as dire as researchers would have us believe. In fact, some studies have shown it is good and positive for babies to gain more weight after birth.

Definitions of too-fast weight gain are arbitrary. None of the definitions consider early weight gain in the context of feeding dynamics and the infant’s longitudinal growth pattern. Definitions include: 

• Weight for age above the 90th percentile at 6 weeks, 3 months, and 6 months of age.¹
• A 0.67 z-score² point increase in weight for age in z-score at birth, 2 and 5 years of age.³ This is the most commonly used definition in research studies.
• A 1.00 or more z-score point increase at 4 months, 12 months, and 7 years.⁴
• A change in weight for age z-score between 8 days and 112 days of age.⁵

“Consequences” are slight to non-existence and based on problematic methodology. Such problematic methodology includes:

• Using an arbitrary definition of too-fast early weight gain.
• Drawing conclusions about outcomes that are shifted but are not abnormal.
• Ignoring other factors that can impact the results.
• Using a variety of follow-up ages and characteristics.  

Presumably, too-fast early weight gain increases the risk of adult diseases such as cardiovascular disease (CVD), high blood pressure, and metabolic syndrome.  However, the reality is that studies have shown that:

• Low BMI (not high) associates with higher LDL, and VLDL, used as measures of CVD.⁶
• The correlation between BMI at birth and adult BMI is barely significant.⁶ This association could simply reflect genetic inheritance and normal growth patterns. See FMF #14.
• The association between too-fast weight gain after birth and high blood pressure is lost after taking adult height into consideration.⁷
• The diastolic blood pressure is somewhat higher, but it is not abnormal.  Even breastfed, rapidly gaining infants show this modest blood pressure increase.⁸

Early “too-fast” weight gain has important positive effects. These positive effects include higher birth weight in the second generation and longer and more successful schooling.^9,10

• Children who weigh more at birth have a greater chance of survival, which is especially important in a developing country.  In a 2004-2005 study in Brazil, Hortaet al. interviewed 848 mothers and 525 fathers to compare parents’ childhood weight gain with children’s birth weight. Women who had gained weight faster during the first 2 years of life have children who are heavier at birth. Men show no association.⁹
• Children with a good start can have a better future. Martorell et al. studied a large number of individuals from five developing countries - Brazil, Guatemala, India, Philippines, and South Africa - to look at the relationship between schooling, birth weight, and childhood weight.  Higher birth weight and higher weight gain during the first 2 to 4 years of life is associated with more schooling and less grade failure.¹⁰

Do no harm. While scholarly analysis of the research shows the consequences of early weight gain to be modest to non-existent, the consequences of sounding the alarm about early weight gain are dire and may create the very problem they are intended to avoid. Parents, caregivers, pediatricians, nurses, and others may zealously restrict young infants’ food intake in an attempt to keep them from gaining  ‘too much’ weight. Endangering the child’s nutritional status aside, restricting an infant’s food intake complicates his achieving the developmental tasks of homeostasis and attachment, distorts his eating attitudes and behavior, and undermines his regulating his food intake based on internal cues of hunger and fullness. Growing out of these distortions, some infants’ growth may accelerate, others may falter.

What is a practitioner to do?     

• Obtain accurate measures of weight and length or height, as appropriate.²
• Follow the child’s weight over time and determine the pattern.²
• Identify growth divergence. Consider disruptive influences for each child and correct those disruptions.¹¹
• Recommend parents and caregivers follow Satter’s division of responsibility (sDOR).

References

1. Eid EE. Follow-up study of physical growth of children who had excessive weight gain in first six months of life. Br Med J. Apr 11 1970;2(5701):74-76.
2. Satter EM. Chapter 10, Understand Your Child’s Growth. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005.
3. Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. Apr 8 2000;320(7240):967-971.
4. Stettler N, Kumanyika SK, Katz SH, Zemel BS, Stallings VA. Rapid weight gain during infancy and obesity in young adulthood in a cohort of African Americans. Am J Clin Nutr. Jun 2003;77(6):1374-1378.
5. Stettler N, Stallings VA, Troxel AB, et al. Weight gain in the first week of life and overweight in adulthood: a cohort study of European American subjects fed infant formula. Circulation. Apr 19 2005;111(15):1897-1903.
6. Kajantie E, Barker DJ, Osmond C, Forsen T, Eriksson JG. Growth before 2 years of age and serum lipids 60 years later: the Helsinki Birth Cohort study. Int J Epidemiol. Apr 2008;37(2):280-289.
7. Adair LS, Martorell R, Stein AD, et al. Size at birth, weight gain in infancy and childhood, and adult blood pressure in 5 low- and middle-income-country cohorts: when does weight gain matter? Am J Clin Nutr. May 2009;89(5):1383-1392.
8. Singhal A, Cole TJ, Fewtrell M, et al. Promotion of faster weight gain in infants born small for gestational age: is there an adverse effect on later blood pressure? Circulation. Jan 16 2007;115(2):213-220.
9. Horta BL, Gigante DP, Osmond C, Barros FC, Victora CG. Intergenerational effect of weight gain in childhood on offspring birthweight. Int J Epidemiol. Jun 2009;38(3):724-732.
10. Martorell R, Horta BL, Adair LS, et al. Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries. J Nutr. Feb 2010;140(2):348-354.
11. Satter EM. Appendix E, Assessment of Feeding/Growth Problems. Your Child's Weight: Helping Without Harming. Madison, WI: Kelcy Press; 2005.