Article Text

Download PDFPDF
Growth trajectory during the first 1000 days and later overweight in very preterm infants
  1. Laure Simon1,2,
  2. Alice Hadchouel3,4,
  3. Catherine Arnaud5,
  4. Anne Frondas-Chauty1,2,
  5. Stéphane Marret6,7,
  6. Cyril Flamant1,2,
  7. Dominique Darmaun2,
  8. Christophe Delacourt3,4,
  9. Laetitia Marchand-Martin8,
  10. Pierre Yves Ancel8,
  11. Jean-Christophe Roze1,2
  1. 1 Department of Neonatology, CHU Nantes, Nantes, France
  2. 2 INRAE, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
  3. 3 Pediatric Pulmonology, APHP, Hopital Necker-Enfants malades, Université de Paris Cité, Paris, France
  4. 4 INSERM, U1151, Institut Necker-Enfants Malades, Paris, France
  5. 5 INSERM, UMR 1027, Universite Toulouse III Paul Sabatier, Toulouse, France
  6. 6 Department of Neonatology, CHU Rouen, Rouen, France
  7. 7 INSERM U1245, Equipe 4, Rouen University, Rouen, France
  8. 8 Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM U1153, University of Paris, Paris, France
  1. Correspondence to Dr Laure Simon, Department of Neonatology, CHU Nantes, Nantes, France; laure.simon{at}


Objective To identify the characteristics of early life growth associated with later overweight or obesity (OWO) in very preterm population.

Design Length, weight and body mass index (BMI) were prospectively recorded from three prospective, population-based cohorts with 5 years (Loire Infant Follow-up Team (LIFT), EPIPAGE2 (Etude EPIdémiologique sur les Petits Ages GEstationnels 2)) and 15 years (EPIPAGEADO, Etude EPIdémiologique sur les Petits Ages GEstationnels-Adolescents) of follow-up. Missing data were imputed.

Setting Regional (LIFT), national (EPIPAGE2) and multiregional (EPIPAGEADO) cohorts in France.

Patients Eligible infants born before 33 weeks of gestation in 1997 (EPIPAGEADO), between 2003 and 2014 (LIFT), and in 2011 (EPIPAGE2).

Main outcome measures OWO was determined as BMI Z-score >85th percentile of the WHO reference curves at 5 years (LIFT, EPIPAGE2) and 15 years (EPIPAGEADO).

Results In EPIPAGEADO, LIFT and EPIPAGE2, BMI Z-scores were known for 302 adolescents, 1016 children and 2022 children, respectively. In EPIPAGEADO, OWO was observed in 42 (13.9%, 95% CI 10.5 to 18.3) adolescents. In multivariable models, birthweight Z-score, increase in weight Z-score during neonatal hospital stay and increase in BMI between discharge and at 2 years of corrected age were positively associated with OWO at 15 years (adjusted OR (aOR)=3.65, 95% CI 1.36 to 9.76; aOR=3.82, 95% CI 1.42 to 10.3; and aOR=2.55, 95% CI 1.72 to 3.78, respectively, by Z-score), but change in length Z-score during neonatal hospital stay was negatively associated (aOR=0.41, 95% CI 0.21 to 0.78, p=0.007). These four associations with OWO assessed at 5 years were confirmed in the LIFT and EPIPAGE2 cohorts.

Conclusions Change in length Z-score during hospitalisation, a putative proxy of quality of neonatal growth, was negatively associated with risk of later OWO when change in BMI between discharge and at 2 years was included in the multivariable model.

  • obesity
  • growth
  • neonatology

Data availability statement

Data are available upon reasonable request. Data are uploaded as supplementary document.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Data are uploaded as supplementary document.

View Full Text


  • Contributors J-CR conceptualised and designed the study, collected the data, carried out the initial analyses and act as guarantor for this study. J-CR and LS analysed and interpreted the data. LS drafted the work. AH, CA, AF-C, SM, CF, DD CD, LM-M and PYA revised the manuscript critically for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work.

  • Funding The EPIPAGE2 cohort was funded with support from the National Research Agency through the French EQUIPEX programme of investments in the future (reference ANR-11-EQPX-0038). The EPIPAGEADO study was funded by a grant from the Programme Hospitalier de Recherche Clinique (PHRC) 2010 (Ministère de la Santé, N°AOM P100117).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.