A P R E D I C T I O N M O D E L T O P R E V E N T A B N O R M A L W E I G H T I N C H I L D H O O D Introduction There is a rising concern about the worldwide increase of obesity in children1,2,3. Studies during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becom-‐ ing overweight each year4. Also for the Netherlands this tendency prevails and many local, as well as national health programs are focused on reducing this inci-‐ dence. The concern about obesity in childhood is based on the observation, that overweight in childhood leads to obesity in adulthood and thereby to a risk to the metabolic syndrome characterized by insulin resistance, dyslipidemia, elevated blood pressure and cardiovascular diseases5,6,7,8. The idea that the origin of the metabolic syndrome has to be found in early life is based on Barker’s hypothesis, that malnutrition in utero brings about a permanent change in the metabo-‐ lism9,10,11,12. According to the statement of Barker, it is generally accepted that small for gestational age (SGA) children are prone to develop the metabolic syndrome in adulthood. Also obesity in children is rising among the urban poor in developed nations, possibly due to their exposure to Westernized diets coinciding with a his-‐ tory of undernutrition4. This “fetal origin hypothesis” made the youth health care physician and pediatrician involved in this problem. Health professionals, who provide primary care for children, are in the center of the pediatric obesity epidem-‐ ic and can play a pivotal role in early detection of obesity. Cole et al provided cut off points for Body Mass Index (BMI) in childhood13, where-‐ by overweight and obesity in children can be determined. Those cut off points can tell us, if a child suffers from overweight or obesity at that moment. Once over-‐ weight or obesity is manifested, it is very difficult to solve the problem. Therefore, the question arises whether or not it is possible to detect those children, who are at risk to develop overweight already at an early age, before overweight or obesity has been established, in order to make prevention of abnormal weight increase possi-‐ ble. For that reason we constructed a prediction model, based on the longitudinal data of healthy infants, followed from birth until the age of 4 years. This study is performed in the South of the Netherlands from 1995-‐199914. Such a model can provide the possibility to discover, whether the growth of an individual child still fits within the expected range of the growth velocity and thereby to detect if a child risks an abnormal growth. Obesity prevention might then be possible already dur-‐ ing the first years of life in the regular preventive health care program, coordinated by the youth health care providers. Screening tools for deviated growth and body proportions are essential in a preventive program and can be used in the follow up of children. 77
Proefschrift binnenwerk Manon Ernst_DEF.indd
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