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 during childhood modifies the increased risk of death from coronary heart disease that is associated with reduced intrauterine growth.
Design: Follow up study of men whose body size at birth was recorded and who had an average of 10 measurements taken of their height and weight through childhood.
Setting: Helsinki, Finland.
Subjects: 3641 men who were born in Helsinki University Central Hospital during 1924-33 and who went to school in Helsinki.
Main outcome measures: Hazard ratios for death from coronary heart disease.
Results: Death from coronary heart disease was associated with low birth weight and, more strongly, with a low ponderal index at birth. Men who died from coronary heart disease had an above average body mass index at all ages from 7 to 15 years. In a simultaneous regression the hazard ratio for death from the disease 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 index in childhood was strongly related to maternal body mass index, which in turn was related to coronary heart disease. The extent of crowding in the home during childhood, although related to body mass index in childhood, was not related to later coronary heart disease.
Conclusion: The highest death rates from coronary heart disease occurred in boys who were thin at birth but whose weight caught up so that they had an average or above average body mass from the age of 7 years. Death from coronary heart disease may be a consequence of poor prenatal nutrition followed by improved postnatal nutrition.

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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Rapid Responses:

Read all Rapid Responses

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]