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

EDITOR With reference to the paper by Eriksson et al (1) may I
suggest an additional possible reason why some underweight infants have an
increased risk of future Coronary Heart Disease (CHD).

Fatness provides insulation in cold climates. Thus at 30 degrees
Celsius the metabolic heat production of thin adults is 20% higher than
that of fat adults (2). Children because of their greater surface to
volume ratio and less insulation are even more vulnerable to cold stress.
Thin children are presumably at an even greater disadvantage. Thus thin
children in cold climates may have relatively higher average energy
requirements and thus consume relatively more high energy nutrients such
as fats.

Indeed some studies suggest that lighter infants do consume
relatively more energy and more fat than heavier infants (3,4). It may be
that some mothers believing that “heavier is healthier” have consciously
fed their underweight infants high fat diets. Alternatively, underweight
infants in cold climates may have a physiologically heightened taste
preferences for high energy (high fat) foods.

CHD, Non-Insulin Dependent Diabetes (NIDD) and hypertension have all
been linked to low infant weight. However, these same disorders are part
of the Syndrome X group of metabolic abnormalities which also includes
insulin resistance, abdominal obesity and dyslipidaemia.

The incidence of Syndrome X in developing countries increases
dramatically as these countries “westernise” their diet. There is strong
evidence implicating increased fat consumption but the role of the refined
carbohydrates is more controversial. In animals fructose and sucrose have
adverse effects but the limited studies of humans have had conflicting
results. Nevertheless, some groups of subjects may be more sensitive to
the adverse effects of fructose and sucrose than other groups (5).

Thus we have a potential link between underweight infants, to their
proportionally greater energy needs, to their proportionally higher intake
of fats and also possibly sucrose and fructose, to the metabolic
abnormalities of Syndrome X and thereby to an increased risk of CHD and
NIDD.

Patrick J Bradley

P. O. Box 765
Chatswood
NSW 2057
AUSTRALIA

1. Eriksson JG, Forsen T, Tuomilehto J, Winter PD, Osmond C, Barker
DJP. Catch-up growth in childhood and death from coronary heart disease:
longitudinal study. BMJ 1999; 318: 427 - 431.

2. Pittet PG. Direct calorimeter with fast response time using the
gradient-layer principle: some illustrations of its utilization in human
studies. In: Bjorntorp P, Cairella M, Howard AN, eds. Recent Advances in
Obesity Research: III. London: John Libbey &
Company Limited, 1981:146 – 152.

3. Dubois S, Hill DE, Beaton GH. An examination of factors believed
to be associated with infantile obesity. Am J Clin Nutr 1979; 32: 1997 –
2004.

4. Vobecky JS, Vobecky J, Shapcott D, Demers PP. Nutrient intake
patterns and nutritional status with regard to relative weight in early
infancy. Am J Clin Nutr 1983; 38:730-738.

5. Daley ME, Vale C, Walker M, Alberti KG, Mathers JC. Dietary
carbohydrates and insulin sensitivity: a review of the evidence and
clinical implications. Am J Clin Nutr 1997; 66:1072 – 1085.