Is infant weight associated with childhood blood pressure? Analysis of the Promotion of Breastfeeding Intervention Trial (PROBIT) cohort

Abstract

Background: Weight gain during infancy may programme later health outcomes, but examination of this hypothesis requires appropriate lifecourse methods and detailed weight gain measures during childhood. We examined associations between weight gain in infancy and early childhood and blood pressure at the age of 6.5 years in healthy children born at term.

Methods: We carried out an observational analysis of data from a cluster-randomized breastfeeding promotion trial in Belarus. Of 17 046 infants enrolled between June 1996 and December 1997, 13 889 (81.5%) had systolic and diastolic blood pressure measured at 6.5 years; 10 495 children with complete data were analysed. A random-effects linear spline model with three knot points was used to estimate each individual's birthweight and weight gain from birth to 3 months, 3 months to 1 year and 1-5 years. Path analysis was used to separate direct effects from those mediated through subsequent weight gain.

Results: In boys, after controlling for confounders and prior weight gain, the change in systolic blood pressure per z-score increase in weight gain was 0.09 mmHg [95% confidence interval (95% CI) -0.14 to 0.31] for birthweight; 0.41 mmHg (95% CI 0.19-0.64) for birth to 3 months; 0.69 mmHg (95% CI 0.47-0.92) for 3 months to 1 year and 0.82 mmHg (95% CI 0.58-1.06) for 1-5 years. Most of the associations between weight gain and blood pressure were mediated through weight at the age of 6.5 years. Findings for girls and diastolic blood pressure were similar.

Conclusions: Children who gained weight faster than their peers, particularly at later ages, had higher blood pressure at the age of 6.5 years, with no association between birthweight and blood pressure.

Figures

Figure 1

Directed acyclic graph showing relationships between birthweight (z-score adjusted for gestational age), weight gain (z-score) and systolic blood pressure (mmHg), adjusted for confounding factors, PROBIT Study 1996–2003. Coefficients (standard errors) shown are in red for girls and blue for boys

Figure 2

Directed acyclic graph showing relationships between birthweight (z-score adjusted for gestational age), weight gain (z-score) and diastolic blood pressure (mmHg), adjusted for confounding factors, PROBIT Study 1996–2003. Coefficients (standard errors) shown are in red for girls and blue for boys