Advertisement

Prevalence of High Weight Status in Children Under 2 Years in NHANES and Statewide Electronic Health Records Data in North Carolina and South Carolina

Published:March 24, 2022DOI:https://doi.org/10.1016/j.acap.2022.03.014

      Abstract

      Objectives

      We evaluated the prevalence of high weight status in children ages 0 to 24 months (m) using data from electronic health records (EHR) and NHANES. We also examined relationships between weight status during infancy and obesity at 24 months of age.

      Methods

      EHR data from 4 institutions in North and South Carolina included patients born January 1, 2013–October 10, 2017 (N = 147,290). NHANES data included study waves from 1999 to 2018 (unweighted N = 5121). We calculated weight-for-length (WFL), weight-for-age (WFA), and body mass index (BMI), excluding implausible values, and categorized weight status (<85th, 85th to <95th, or ≥95th percentile), assessing prevalence at birth, 6, 12, 18, and 24 months. Utilizing individual, longitudinal EHR data, we used separate regression models to assess obesity risk at 24 months based on anthropometrics at birth, 6, 12, and 18 months, adjusting for sex, race/ethnicity, insurance, and health system.

      Results

      Prevalence of BMI ≥95th percentile in EHR data at 6, 12, 18, and 24 months were 9.7%, 15.7%, 19.6%, and 20.5%, respectively. With NHANES the prevalence was 11.6%, 15.0%, 16.0%, and 8.4%. For both, the prevalence of high weight status was higher in Hispanic children. In EHR data, high weight status at 6, 12, and 18 months was associated with obesity at 24 months, with stronger associations as BMI category increased and as age increased.

      Conclusions

      High weight status is common in infants and young children, although lower at 24 months in NHANES than EHR data. In EHR data, high BMI at 6, 12, and 18 months was associated with increased risk of obesity at 24 months.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Daniels SR
        • Hassink SG
        • Abrams SA
        • et al.
        The role of the pediatrician in primary prevention of obesity.
        Pediatrics. 2015; 136: e275-e292
        • Lumeng JC
        • Taveras EM
        • Birch L
        • Yanovski SZ.
        Prevention of obesity in infancy and early childhood: a National Institutes of Health workshop.
        JAMA Pediatr. 2015; 169: 484-490
        • Krebs NF
        • Himes JH
        • Jacobson D
        • Nicklas TA
        • Guilday P
        • Styne D.
        Assessment of child and adolescent overweight and obesity.
        Pediatrics. 2007; 120: S193-S228
        • Ogden CL
        • Fryar CD
        • Martin CB
        • et al.
        Trends in obesity prevalence by race and Hispanic origin—1999-2000 to 2017-2018.
        Jama. 2020; 324: 1208-1210
        • Fryar C
        • Carrol M
        • Ogden C.
        Prevalence of High Weight-for-Recumbent Length Among Infants and Toddlers From Birth to 24 Months of Age: United States, 1971-1974 Through 2015-2016.
        National Center for Health Statistics, Hyattsville, Md2018 (Health E-Stats)
        • Akinbami LJ
        • Kit BK
        • Carroll MD
        • et al.
        Trends in anthropometric measures among US children 6 to 23 months, 1976-2014.
        Pediatrics. 2017; 139: e20163374
        • Demerath EW
        • Fields DA.
        Body composition assessment in the infant.
        Am J Hum Biol. 2014; 26: 291-304
        • Roy SM
        • Fields DA
        • Mitchell JA
        • et al.
        Body mass index is a better indicator of body composition than weight-for-length at age 1 month.
        J Pediatr. 2019; 204 (e71): 77-83
        • Woo JG
        • Daniels SR.
        Assessment of body mass index in infancy: it is time to revise our guidelines.
        J Pediatr. 2019; 204: 10-11
        • Corley DA
        • Feigelson HS
        • Lieu TA
        • McGlynn EA.
        Building data infrastructure to evaluate and improve quality: PCORnet.
        J Oncol Pract. 2015; 11: 204-206
      1. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual. US Department of Health and Human Services, Centers for Disease Control and Prevention.2013.

      2. De Onis M, World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. 2006.

        • Daymont C
        • Ross ME
        • Russell Localio A
        • et al.
        Automated identification of implausible values in growth data from pediatric electronic health records.
        J Am Med Inform Assoc. 2017; 24: 1080-1087
        • Freedman DS
        • Goodman AB
        • King RJ
        • Blanck HM.
        Tracking of obesity among 2-to 9-year-olds in an electronic heath record database from 2006 to 2018.
        Obes Sci Pract. 2020; 6: 300-306
        • Casey JA
        • Schwartz BS
        • Stewart WF
        • et al.
        Using electronic health records for population health research: a review of methods and applications.
        Annu Rev Public Health. 2016; 37: 61-81
        • Boone-Heinonen J
        • Tillotson CJ
        • O'Malley JP
        • et al.
        Not so implausible: impact of longitudinal assessment of implausible anthropometric measures on obesity prevalence and weight change in children and adolescents.
        Ann Epidemiol. 2019; 31 (e65): 69-74
        • Boone-Heinonen J
        • Tillotson C
        • O'Malley J
        • et al.
        Characterizing a “big data” cohort of over 200,000 low-income US infants and children for obesity research: The ADVANCE Early Life Cohort.
        Matern Child Health J. 2017; 21: 421-431
      3. Center for Chronic Disease Prevention and Health Promotion. Obesity among WIC-enrolled young children. Available at:https://www.cdc.gov/obesity/data/obesity-among-WIC-enrolled-young-children.html. Updated November 22, 2019. Accessed January 22, 2021.

      4. State of Childhood Obesity. Obesity rates for youth ages 10 to 17. Available at: https://stateofchildhoodobesity.org/children1017/. Updated October 2020. Accessed January 25, 2021.

      5. Georgetown University Center for Children and Families American Academy of Pediatrics. Snapshot of children's coverage: how Medicaid, CHIP, and the ACA cover children. Available at:https://ccf.georgetown.edu/wp-content/uploads/2017/02/North-Carolina-Medicaid-CHIP-new-v1.pdf. Published 2016. Accessed January 28, 2021.

      6. Kaiser Family Foundation. Health insurance coverage of children 0-18. Available at:https://www.kff.org/other/state-indicator/children-0-18/?currentTimeframe=11&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed January 28, 2021.

        • Chaparro MP
        • Anderson CE
        • Crespi CM
        • et al.
        The effect of the 2009 WIC food package change on childhood obesity varies by gender and initial weight status in Los Angeles County.
        Pediatr Obes. 2019; 14: e12526
        • Aris IM
        • Rifas-Shiman SL
        • Li L-J
        • et al.
        Association of weight for length vs body mass index during the first 2 years of life with cardiometabolic risk in early adolescence.
        JAMA Network Open. 2018; 1e182460
        • Perng W
        • Ringham BM
        • Glueck DH
        • et al.
        An observational cohort study of weight-and length-derived anthropometric indicators with body composition at birth and 5 mo: the Healthy Start study.
        Am J Clin Nutr. 2017; 106: 559-567
        • Roy SM
        • Spivack JG
        • Faith MS
        • et al.
        Infant BMI or weight-for-length and obesity risk in early childhood.
        Pediatrics. 2016; 137: e20153492
        • Jabakhanji SB
        • Boland F
        • Ward M
        • et al.
        Body mass index changes in early childhood.
        J Pediatr. 2018; 202: 106-114
        • Taveras EM
        • Rifas-Shiman SL
        • Belfort MB
        • et al.
        Weight status in the first 6 months of life and obesity at 3 years of age.
        Pediatrics. 2009; 123: 1177-1183
        • Tatem KS
        • Romo ML
        • McVeigh KH
        • et al.
        Comparing prevalence estimates from population-based surveys to inform surveillance using electronic health records.
        Prev Chronic Dis. 2017; 14: E44