title: High Body Mass Index in Infancy May Predict Severe Obesity in Early Childhood.
abstract: To characterize growth trajectories of children who develop severe obesity by age 6 years and identify clinical thresholds for detection of high-risk children before the onset of obesity.
  
  
  
  Two lean (body mass index [BMI] 5th to ≤75th percentile) and 2 severely obese (BMI ≥99th percentile) groups were selected from populations treated at pediatric referral and primary care clinics. A population-based cohort was used to validate the utility of identified risk thresholds. Repeated-measures mixed modeling and logistic regression were used for analysis.
  
  
  
  A total of 783 participants of normal weight and 480 participants with severe obesity were included in the initial study. BMI differed significantly between the severely obese and normal-weight cohorts by age 4 months (P < .001), at 1 year before the median age at onset of obesity. A cutoff of the World Health Organization (WHO) 85th percentile for BMI at 6, 12, and 18 months was a strong predictor of severe obesity by age 6 years (sensitivity, 51%-95%; specificity, 95%). This BMI threshold was validated in a second independent cohort (n = 2649), with a sensitivity of 33%-77% and a specificity of 74%-87%. A BMI ≥85th percentile in infancy increases the risk of severe obesity by age 6 years by 2.5-fold and the risk of clinical obesity by age 6 years by 3-fold.
  
  
  
  BMI trajectories in children who develop severe obesity by age 6 years differ from those in children who remain at normal weight by age 4-6 months, before the onset of obesity. Infants with a WHO BMI ≥85th percentile are at increased risk for developing severe obesity by age 6 years.
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: Allisonsmego@gmail.com.
authors.forename: Allison
authors.initials: A
authors.lastname: Smego
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jessica G
authors.initials: JG
authors.lastname: Woo
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jillian
authors.initials: J
authors.lastname: Klein
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Research Institute, Children's Hospital Colorado, Aurora, CO.
authors.forename: Christina
authors.initials: C
authors.lastname: Suh
authors.affiliation: Department of Radiology, Northeast Ohio Medical University, Rootstown, OH.
authors.forename: Danesh
authors.initials: D
authors.lastname: Bansal
authors.affiliation: Research Institute, Children's Hospital Colorado, Aurora, CO.
authors.forename: Sherri
authors.initials: S
authors.lastname: Bliss
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Research Institute, Children's Hospital Colorado, Aurora, CO.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.affiliation: Pediatric Associates, Crestview Hills, KY.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bolling
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Crimmins
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012737:Sex Factors; D015430:Weight Gain
keywords: BMI percentile; infant growth; obese; weight for length