Promotion of Weight Gain in Early Childhood Does Not Increase Metabolic Risk in Adolescents: A 15-Year Follow-Up of a Cluster-Randomized Controlled Trial.
BACKGROUND
A rapid gain in weight for length may put children at a higher risk of noncommunicable diseases later in life.


OBJECTIVE
The objective of this study was to assess the long-term effects of nutrition counseling delivered in the first 2 y of life in Pelotas, a city in Southern Brazil.


METHODS
The original cluster-randomized controlled trial was conducted in 1998. Nutrition counseling (breastfeeding promotion and increased intake of micronutrient-rich and energy-dense foods) was delivered to mothers of children aged 0-17.9 mo attending primary care. Six months later, weight gain was higher in the intervention group than in the control group for children ≥12 mo of age at enrollment. In 2013 (mean age 15 y), assessments included anthropometric measurements, body composition (air-displacement plethysmography), body shape (3-dimensional photonic scan), and plasma total, LDL, and HDL cholesterol, triglycerides, C-reactive protein, and glucose.


RESULTS
A total of 363 of the 424 original participants were assessed. An a priori decision was made to prioritize analyses of subjects aged 12-17.9 mo at enrollment (51 from the intervention group and 45 from the control group). In this subgroup, boys in the intervention group were [mean (95% CI)] 3.4 (0.8, 6.0) cm taller than those in the control group. Systolic blood pressure tended to be 5.2 (-0.8, 11.1) mm Hg higher in male subjects from the intervention group than in those in the control group. Lipid profiles tended to be healthier in the intervention group. The plasma total cholesterol concentration was -17.8 (-29.8, -5.7) mg/dL lower in boys in the intervention group than in those in the control group. The total-to-HDL cholesterol ratio and triglyceride concentration in the girls in the intervention group were -0.4 (-0.6, -0.1) and -26.3 (-46.3, -6.3) mg/dL, respectively, lower than in the control group. There was no difference between the groups in terms of body composition.


CONCLUSIONS
Promotion of weight gain in children between 12.0-17.9 mo of age was not associated with higher metabolic risk 15 y later. On the contrary, there was some evidence of reduced metabolic risk in the intervention group.
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil; inasantos@uol.com.br.
Iná S
IS
Santos
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Preventive Medicine, University of São Paulo, São Paulo, Brazil;
Alicia
A
Matijasevich
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Maria Cecília F
MC
Assunção
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Neiva Cj
NC
Valle
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Bernardo L
BL
Horta
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Helen D
HD
Gonçalves
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Denise P
DP
Gigante
Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway; and.
José C
JC
Martines
Division of Nutritional Sciences, Cornell University, Ithaca, NY.
Gretel
G
Pelto
Postgraduate Program in Epidemiology, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil;
Cesar G
CG
Victora
D000293:Adolescent; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001823:Body Composition; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003376:Counseling; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008055:Lipids / Q000097:blood; D008297:Male; D008659:Metabolic Diseases / Q000517:prevention & control; D018977:Micronutrients / Q000008:administration & dosage; D018673:Nutrition Policy; D012306:Risk; D012737:Sex Factors; D015430:Weight Gain
D001786:Blood Glucose; D008055:Lipids; D018977:Micronutrients; D002097:C-Reactive Protein
adolescence; child growth; metabolic risk; nutrition counseling; randomized controlled trial