Obesity is a common, pervasive, chronic disease often beginning in early childhood, and infant growth characteristics are key signals of lifelong chronic disease risk. Frequent primary care visits in the first two years of life provide many opportunities for growth surveillance and early intervention, but there are no current clinical practice guidelines for identifying infant growth patterns associated with future risk. The overall goal of this proposal is to fill this knowledge gap by evaluating and comparing standard and novel metrics for infant growth assessment in relation to early childhood outcomes, using large-scale real-world data. We will particularly be evaluating the infrequently-studied WHO weight velocity (WtVel) z-scores (standard and modified methods), peak weight velocity (PWV) in infancy, peak BMI (pBMI) in infancy and change in WHO weight-for-age (WFA) z-scores.
Aims:
Aim 1. Evaluate the potential for practical clinical use of WHO WtVel z-scores, WHO WtVel z-score modifications (WtVel-M), and other research-based growth metrics. We will calculate WHO WtVel and WtVel-M z-scores as well as PWV and infant pBMI to address these hypotheses. Hypothesis 1: Applying the WHO WtVel-M z-score methods will improve the inclusivity and generalizability of weight velocity assessment compared with the standard WHO WtVel z-score calculations. Hypothesis 2: The WtVel-M z-scores will be calculable for more patients than PWV or pBMI.
Aim 2. Test the ability of WtVel z-score, WtVel-M z-scores, pBMI, PWV and change in WFA z-score to predict obesity by 5 years of age. The metrics in Aim 1 plus change in WFA z-score will be compared in their ability to predict early childhood obesity between ages 2 and 5.