Editor—Barker and Osmond say that the association between birth weight and adult disease relates to growth retardation in early life.1 Alternatively, babies with a low birth weight might consume a diet that is associated with greater risk of disease.2,3 Firstly, low birth weight might affect appetite and preference for certain foods. Secondly, parents might feed their babies foods with a higher energy or fat content in order to compensate for their low birth weight. Patterns of nutrient intake may be established from 3 years of age,4 so if birth weight were associated with childhood diet the cumulative effect through a lifetime might be considerable.
We used data from the national diet and nutrition survey,5 a representative sample of children aged 1½ to 4½ years in Great Britain, and tested the hypothesis that energy and fat intake varied by birth weight. A total of 1664 subjects (89.5% survey respondents) had complete data on diet (measured using a four day weighed intake record including both weekend days), birth weight (obtained by maternal recall), social class, and current weight. Males had higher birth weight (mean (SE) 3405 (18.9) g v 3279 (18.0) g), energy intake (4895 (38) kJ v 4631 (38) kJ), and fat intake (1757 (19) kJ v 1678 (19) kJ). There were no differences in percentage energy from fat (35.7 (0.2)% v 36.1 (0.2)%).
Among males only, fat intake adjusted for energy intake increased with decreasing birth weight, after adjustment for age, social class, and current weight (table). Mean fat intake in the lowest fifth of birth weight was 5%, or 2.3 g, higher than that in the highest fifth. We could not confirm a further hypothesis that fat intake would be higher for subjects of low birth weight who remained small and had a continuing incentive for parents to feed them more or a sustained alteration of appetite than it would be for those who experienced catch up growth.
Evidence that the relation between birth weight and cardiovascular disease later in life could be mediated, at least in part, by the influence of birth weight on subsequent diet was confined to males. Whether this small difference, were it to be sustained, could have a significant cumulative effect on risk of cardiovascular disease is not clear. Our study, however, was limited to the preschool years. The association at 1½–4½ years may be the tail end of a stronger relation in infancy, or, alternatively, differences in fat intake by birth weight may remain, or even be amplified, in later life. It may be of interest to investigate this relation at other ages.
Table.
Mean (95% confidence interval) daily energy and fat intake by fifth of birth weight adjusted for age, social class, and current weight
| Males (n=805)
|
Females (n=778)
|
||||||
|---|---|---|---|---|---|---|---|
| Fifth of birth weight | Range of birth weight (g) | Mean difference in daily energy intake from baseline (kJ) | Mean difference in daily fat intake from baseline (kJ) | Range of birth | Mean difference in daily energy intake from | Mean difference in daily fat intake from baseline (kJ) | |
| weight (g) | baseline (kJ) | ||||||
| 5 | >3860 | 0.0 | 0.0 | >3700 | 0.0 | 0.0 | |
| 4 | 3550-3860 | 245 (28 to 462)* | 41.4 (−15.0 to 97.8) | 3450-3700 | 27 (−201 to 255) | 30.1 (−26.3 to 86.5) | |
| 3 | 3300-3549 | 151 (−66 to 368) | 45.1 (−11.3 to 101.6) | 3200-3449 | 105 (−121 to 331) | −3.8 (−56.4 to 52.7) | |
| 2 | 2980-3299 | 162 (−59 to 383) | 75.2 (18.8 to 131.7)† | 2900-3199 | 20 (−215 to 256) | −11.3 (−71.5 to 45.1) | |
| 1 | <2980 | 128 (−98 to 354) | 86.5 (30.1 to 146.7)‡ | <2900 | −103 (−337 to 132) | 0.0 (−56.4 to 56.4) | |
P=0.03,
P=0.009,
P=0.004.
Acknowledgments
The national diet and nutrition survey of children aged 1½–4½ years was funded jointly by the Department of Health and the Ministry of Agriculture, Fisheries and Food, and was conducted by the Office for National Statistics and the Medical Research Council, Dunn Nutrition Unit.
References
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