Catch-up growth in childhood and death from coronary heart disease: longitudinal study

BMJ 1999;318:427-431 ( 13 February )

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Catch-up growth in childhood and death from coronary heart disease: longitudinal study

J G Eriksson, senior researcher, ^a T Forsén, research fellow, ^a J Tuomilehto, professor, ^a P D Winter, computing manager, ^b C Osmond, statistician, ^b D J P Barker, director. ^b

^a National Public Health Institute, Department of Epidemiology and Health Promotion, Diabetes and Genetic Epidemiology Unit, Mannerheimintie 166, FIN-00300 Helsinki, Finland, ^b Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton S016 6YD

Correspondence to: Professor Barker david.barker{at}mrc.soton.ac.uk

Objective: To examine whether catch-up growth duringchildhood modifies the increased risk of death from coronary heartdisease that is associated with reduced intrauterinegrowth.
Design: Follow up study of men whose body size atbirth was recorded and who had an average of 10 measurements takenof their height and weight throughchildhood.
Setting: Helsinki,Finland.
Subjects: 3641 men who were born in Helsinki UniversityCentral Hospital during 1924-33 and who went to school inHelsinki.
Main outcome measures: Hazard ratios for death from coronary heartdisease.
Results: Death from coronary heart disease was associatedwith low birth weight and, more strongly, with a low ponderalindex at birth. Men who died from coronary heart disease had anabove average body mass index at all ages from 7 to 15 years.In a simultaneous regression the hazard ratio for death from thedisease increased by 14% (95% confidence interval 8% to 19%; P<0.0001)for each unit (kg/m³) decrease in ponderal index at birth and by 22% (10% to 36%;P=0.0001) for each unit (kg/m²) increase in body mass index at 11 years of age. Body mass indexin childhood was strongly related to maternal body mass index,which in turn was related to coronary heart disease. The extentof crowding in the home during childhood, although related tobody mass index in childhood, was not related to later coronaryheartdisease.
Conclusion: The highest death rates from coronary heartdisease occurred in boys who were thin at birth but whose weightcaught up so that they had an average or above average body massfrom the age of 7 years. Death from coronary heart disease maybe a consequence of poor prenatal nutrition followed by improvedpostnatalnutrition.

Key messages

Men who had low birth weight or were thin at birth have high death rates from coronary heart disease
Death rates are even higher if weight "catches up" in early childhood
Death from coronary heart disease may be a consequence of prenatal undernutrition followed by improved postnatal nutrition
Programmes to reduce obesity among boys may need to focus on those who had low birth weight or who were thin at birth

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Bloomfield, F. H., Oliver, M. H., Giannoulias, C. D., Gluckman, P. D., Harding, J. E., Challis, J. R. G. (2003). Brief Undernutrition in Late-Gestation Sheep Programs the Hypothalamic-Pituitary-Adrenal Axis in Adult Offspring. Endocrinology 144: 2933-2940 [Abstract] [Full text]
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Rapid Responses:

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Improved nutrition, better catch-up growth, higher IQ and coronary heart disease?: Sanjeev Deshpande
bmj.com, 17 Feb 1999 [Full text]
What about placental insufficiency?: Brian S Alper
bmj.com, 1 Mar 1999 [Full text]
Smoking may be a confounder in the relationship between catch-up growth in childhood and death from: Sanjay Kinra
bmj.com, 2 Mar 1999 [Full text]
INCREASED FAT INTAKE BY THIN CHILDREN IN COLD CLIMATES MAY INCREASE THE RISK OF CHD: Patrick J Bradley
bmj.com, 2 Apr 1999 [Full text]