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Association between postnatal catch-up growth and obesity in childhood: prospective cohort study

BMJ 2000; 320 doi: (Published 08 April 2000) Cite this as: BMJ 2000;320:967
  1. Ken K L Ong, Medical Research Council clinical research fellowa,
  2. Marion L Ahmed, research assistanta,
  3. Pauline M Emmett, senior research nutritionistb,
  4. Michael A Preece, professor of child health and growthc,
  5. David B Dunger, professor in paediatric endocrinology **the Avon Longitudinal Study of Pregnancy and Childhood Study Team. (dbd25{at}
  1. a Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU
  2. b Unit of Paediatric and Perinatal Epidemiology, University of Bristol, Bristol BS8 1TQ
  3. c Endocrinology, and Metabolism Unit, Institute of Child Health, London WC1N 1AH
  1. Correspondence to: D B Dunger
  • Accepted 20 November 1999


Objective: To identify predictors of postnatal catch-up growth from birth to two years and its relation to size and obesity at five years.

Design: Regional prospective cohort study.

Setting: Avon longitudinal study of pregnancy and childhood, United Kingdom.

Subjects: 848 full term singletons from a 10% random sample of the Avon longitudinal study of pregnancy and childhood.

Main outcome measures: Maternal birth weight, prepregnancy weight, pregnancy weight gain, height, smoking, and parity, and paternal height. Weight and length of infants at birth, two years, and five years expressed as standard deviation (SD) scores from the UK reference scores for 1990. Percentage fat mass and total fat mass (estimated from skinfolds) and waist circumference at five years.

Results: Size at birth was representative of the national reference. Overall, 30.7% (260 of 848) of infants showed a gain in SD score for weight greater than 0.67 SD scores between zero and two years, indicating clinically significant catch-up growth. These children had lower weight, length, and ponderal index at birth than other children, and were more often from primiparous pregnancies. They also had taller fathers than other children, and their mothers had lower birth weights and were more likely to smoke during pregnancy. Children who showed catch-up growth between zero and two years were heavier, taller, and fatter (body mass index, percentage body fat, and waist circumference) at five years than other children.

Conclusions: In this contemporary well nourished cohort, catch-up growth was predicted by factors relating to intrauterine restraint of fetal growth. Children who showed catch-up growth between zero and two years were fatter and had more central fat distribution at five years than other children. Mechanisms that signal and regulate early catch-up growth in the postnatal period may influence associations between small size at birth and risks for disease in adulthood.


  • Funding ALSPAC is supported by the Medical Research Council, the Wellcome Trust, the Department of Health, the Department of the Environment, and many others. DBD was also supported by the Wellcome Trust.

  • Competing interests None declared.

  • Accepted 20 November 1999
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