Analysis of 'sensitive' periods of fetal and child growth

Xun Zhang, Kate Tilling, Richard Martin, Emily Oken, Ashley Naimi, Izzuddin Aris, Seungmi Yang , Michael S. Kramer*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

9 Citations (Scopus)
153 Downloads (Pure)


Background: Birth weight and weight gain in infancy and early childhood are commonly studied as risk factors for later cardiometabolic diseases. In this study, we explore methods for quantifying weight gain during different age periods and for comparing the magnitude of the associations with later blood pressure.

Methods: Based on data from a birth cohort study nested within a large cluster-randomized trial with repeated measures of weight from birth to 16 years of age, we compared the results of four analytic approaches to assess sensitive periods of growth on blood pressure at age 16 years.

Results: Approaches based on z-scores of weight or weight gain velocity (both standardized for age and sex), or on regression-based conditional weight standardized residuals, yielded more coherent results than an approach based on absolute weight gain velocity. Weight gain standardized by sex and age was positively associated with blood pressure at 16 years at all postnatal age periods, but the magnitude of association was larger during adolescence (11.5 to 16 years) than during earlier intervals (0-3 months, 3-12 months, 1-6.5 years, or 6.5-11.5 years).

Conclusions: Standardization of weight and weight gain by age and sex, or regression-based standardized residuals based on conditional weight, reflects relative gain and thus accounts for the rapid weight gains normally observed in early infancy and puberty. Adolescence appears to be a more sensitive period for relative weight gain effects on later blood pressure than earlier periods, even those of similar duration.
Original languageEnglish
Article numberdyy045
Pages (from-to)116-123
Number of pages8
JournalInternational Journal of Epidemiology
Issue number1
Early online date2 Apr 2018
Publication statusPublished - 1 Feb 2019


  • Growth
  • Weight Gain
  • Blood Pressure
  • Developmental origins of health and disease


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  • NIHR BRC Nutrition

    Ness, A. R.


    Project: Research, Parent

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