Birth Weight and Obesity and Fat Distributionin Later Life

Imogen Rogers*Unit of Paediatric and Perinatal Epidemiology, Division of Community-Based Medicine, University of Bristol, Bristol, UK

Received 13 January 2005; Accepted 4 April 2005

Low birth weight, obesity and a central pattern of fatdistribution are all related to a number of chronic diseasesin adult life, including coronary heart disease, hyperten-sion and non–insulin-dependent diabetes mellitus. The re-lationship between birth weight and obesity is therefore ofinterest as a possible mediator of the birth weight–diseaseassociation.

There is consistent evidence from studies in both adultsand children that there is a positive association betweenbirth weight and subsequent body mass index (BMI) andobesity. This association is linear in some studies (Rasmus-sen and Johansson, 1998; Parsons et al., 2001) or U-shapedin others (Curhan et al., 1996), with some excess of obesityin the lowest birth weight groups.

BMI is a measure of relative weight, and as such does notdistinguish between lean and fat mass. The positive asso-ciation between weight at birth and relative weight later oncould be generated by increases in total adiposity, centraladiposity, or lean body mass. Studies that have measuredlean and fat body mass have tended to find a positiveassociation between birth weight and lean body mass andan inverse association with relative adiposity (Phillips,1995; Gale et al., 2001), although the data are more consis-tent for adults than for children. There is a lack of studiesthat have assessed lean and fat mass by accurate methodssuch as dual-energy X-ray absorptiometry (DXA) scans ordeuterium dilution.

Several studies have related birth weight to subsequentfat distribution, but their interpretation is made difficult bythe wide range of indices of fat distribution used, includingwaist circumference, waist:hip ratio (WHR), and skinfoldratios such as the subscapular:triceps ratio. These are all ofdisputed validity, particularly for children, and there is alack of studies with direct measures of intraabdominal orperipheral fat, for example, by computerized tomographyor DXA scan. Most studies of children have tended to useskinfold ratios, whereas those in adults have tended to useWHR. Although there does not appear to be a direct asso-ciation between birth weight and fat distribution on con-trolling for BMI, there is fairly consistent evidence that lowbirth weight is associated with a more central pattern of fatdistribution. This evidence is more consistent for skinfoldratios (Byberg et al., 2000; Okosun et al., 2000) than forWHR (Yarbrough et al., 1998; Bavdekar et al., 1999).

The associations that have been observed between birthweight and subsequent body habitus could be genetic inorigin or could be a result of programming by the intra-uterine environment. Birth weight differences between themembers of monozygotic twin pairs must be environmen-

tally determined, so if these were to be associated withdifferences in adult BMI, this would suggest a long-termprogramming effect on subsequent ponderosity. Data fromthe largest twin study of 1440 twin pairs in Minnesotafound that intrapair birth weight differences were associ-ated with differences in adult height and weight but notBMI (Allison et al., 1995), and a smaller twin study in theUnited Kingdom reported similar findings (Baird et al.,2001). Other twin studies have been less conclusive, find-ing no associations between intrapair birth weight differ-ences and differences in adult body habitus in most cases,but some evidence that large birth weight differences(�15%) are associated with some differences in adult BMIor lean body mass. Studies that control for parental BMIalso go some way toward controlling for genetic predispo-sition to obesity. Among adults the relationship betweenbirth weight and obesity is largely removed on controllingfor BMI; however, in children an independent positiveassociation seems to remain.

Studies of the offspring of women exposed to famineduring pregnancy or of the offspring of diabetic pregnan-cies could be considered to provide proxy measures of theintrauterine environment, the former representing intra-uterine undernutrition and the latter intrauterine overnu-trition. Information on the effects of exposure to famine isavailable from studies of the offspring of women exposedto the Dutch famine and the siege of Leningrad. Among19-year-old men, exposure to famine in utero in the firsttrimester was associated with increased rates of obesity,whereas exposure in the third trimester was associatedwith reduced rates of obesity (Ravelli et al., 1976). A secondstudy of 50-year-old subjects found exposure to famine inearly gestation to be associated with increased BMI amongwomen but not men, whereas exposure in late gestationwas associated with reduced birth weight but no differ-ences in adult BMI. Among subjects born around the timeof the siege of Leningrad (Stanner et al., 1997), exposure tofamine in utero was associated with increased subscapular:triceps ratio, but no difference in BMI, despite large birthweight differences. Studies of the Pima Indians of Arizona,a group with exceptionally high rates of diabetes, have

Grant sponsor: University of Bristol.*Correspondence to: Dr. Imogen Rogers, Unit of Paediatric and PerinatalEpidemiology, Division of Community-Based Medicine, University of Bristol,Bristol, UK. E-mail: Imogen.Rogers@bristol.ac.ukPublished online 15 June 2005 in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/bdra.20168

© 2005 Wiley-Liss, Inc. Birth Defects Research (Part A) 73:485–486 (2005)

Birth Defects Research (Part A): Clinical and Molecular Teratology 73:485–486 (2005)

found that the offspring of diabetic mothers are heavierthan the offspring of nondiabetic mothers, and that thisapplies even among siblings discordant for maternal dia-betes in pregnancy (Pettitt et al., 1983). Maternal diabetesin pregnancy seems to override the correlation betweenmaternal and offspring BMI. Studies of other groups ofdiabetic women are less conclusive. In the “Growing UpToday” study in the United States, the risk of obesityassociated with maternal diabetes was attenuated on con-trolling for BMI and, in a study of women with milddiabetes in pregnancy, there was no association with BMIin their offspring.

Pregnancy weight gain could be viewed as a measure ofnutrient availability in utero, and is positively correlatedwith weight and skinfold thickness at birth. Most of thepublished studies have found no association betweenpregnancy weight gain and later BMI and/or obesity(Maffeis et al., 1994; Stettler et al., 2000), possibly becausepregnancy weight gain is generally self-reported. The onestudy to find a significant association found that BMI andpercentage body fat of 10- to 11-year-old Italian childrenwas inversely associated with pregnancy weight gain (Es-posito-Del Puente et al., 1994).

Catch-up growth, that is, an increase in weight or heightsd score of �0.67, normally occurs in the first 2 years of lifeand may be a sign that fetal growth has been constrained.Catch-up growth appears to be driven by increased foodintake by the infant and may be regulated by program-ming of appetite, possibly via alterations in leptin levels.Catch-up growth has been associated with increased BMI,percentage body fat, and waist circumference in childhood(Ong et al., 2000).

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