Obese Preschoolers Are More Likely to Sustain Fractures During Childhood

Children who are obese in preschool are more likely to suffer fractures during childhood, according to a report.

“The increasing prevalence of childhood obesity is a major public health concern worldwide. Childhood obesity has previously been associated with cardiorespiratory disease, diabetes, and mental health disorders in later life, in addition to premature mortality,” the study authors stated. “Research to date has largely focused upon the impact of obesity in later childhood and the impact on adult health, with less known about the effect of preschool obesity upon health in childhood and adolescence.”

The researchers collected data from anonymized primary care electronic health records obtained from the Information System for Research in Primary Care (SIDIAP). Data from SIDIAP encompasses nearly three quarters of the population of Catalonia, Spain; 296 primary care centers with 853 primary care pediatricians in the region contribute.

Between 2006 and 2013, 466,997 children (48.6% were female) had a validated weight and height measurement (taken at a routine healthcare screening) at age four; children were followed through age 15, migration out of region, death, or Dec. 31, 2016. Body mass index (BMI) at age four was calculated and classified per World Health Organization growth tables; electronic primary care records were used to identify fracture.

Overweight, Obese Risk Factors for Fracture

Children were followed for a median 4.90 years (interquartile range, 2.50 to 7.61). Cumulative childhood fracture risk for underweight children was 9.20% (95% confidence interval [CI], 3.79% to 14.61%); overweight children, 11.28% (95% CI, 10.22% to 12.35%); and obese children, 13.05% (95% CI, 10.69% to 15.41%). Children who were overweight, compared to children in a normal weight range, had an increased risk of lower limb fracture (adjusted hazard ratio [aHR]=1.42; 95% CI, 1.26 to 1.59) and upper limb fracture [aHR=1.10; 95% CI, 1.03 to 1.17), as did children whose BMI was in the obese range (aHR=1.74; 95% CI, 1.46 to 2.06; and aHR=1.19; 95% CI, 1.07 to 1.31, respectively).

The study was published in the Journal of Bone and Mineral Research.

In looking ahead, the researchers wrote, “Future work could also follow the weight trajectory of this population to determine if there is a change in adiposity during childhood that is associated with fracture risk. Similarly, future research could also collect data surrounding lifestyle confounders such as activity levels and enrich with further details of past medical history that could impact upon bone health to further investigate the potential associations found in this study.”