Childhood Growth Pattern Linked to Heart Disease Risk

Children who start out skinny and small, but gain weight relatively rapidly after the age of two are at increased risk for Coronary heart disease later in life, researchers here reported.

Conversely, rapid weight gain between birth and two years is good, said David Barker, M.D., Ph.D., of the Oregon Health and Science University's heart research center here.

The increased risk for those who gain weight rapidly after age two is present even if the child is not obviously fatter than his or her peers, Dr. Barker and colleagues reported in the Oct. 27 issue of the New England Journal of Medicine.

What's important for low-birth-weight children, he said in an interview, is the "trajectory" of weight gain in childhood, not whether they appear overweight in the schoolyard.

Dr. Barker is known for his research showing that poor prenatal nutrition - resulting in low birth weight - predisposes people to Coronary heart disease as adults. But, he said, it was never likely that the biological process would stop at birth, he said. "The obvious next question was how does growth after birth add to or subtract from the risks acquired before birth."

The answer to the question, he and colleagues reported, came from a data set in Helsinki, Finland - highly detailed records of weight and height from birth to age 11 for 8,760 people born between 1934 and 1944, coupled with medical histories that included deaths and hospitalizations for Coronary heart disease.

"The Helsinki data are just fantastic, because each person was measured on average 11 times between birth and two years," Dr. Barker said. From ages two to 11, they were measured six times on average.

The data contained a "very, very clear answer" to the question, Dr. Barker said. Rapid weight gain between birth and age two is good, but the same sort of gain after two years is bad.

Specifically, the study found:

• Of the total cohort, 357 men and 87 women had either been admitted to hospital for or had died from Coronary heart disease.
  
• The mean birth weight of boys who would later have a coronary event was 0.2 standard deviations below the average for the cohort and weight and body mass index (BMI) and remained low until age two, when the boys began to gain weight rapidly, approaching average BMI by age 11.
  
• The same pattern was seen for the girls who would later have a coronary event, although they would slightly exceed the average BMI.
  
• A pattern of low BMI at age two and a relatively high BMI at age 11 was associated with increased coronary risk.