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Original Investigation |

Appetite and Growth:  A Longitudinal Sibling Analysis

Cornelia H. M. van Jaarsveld, PhD1,2; David Boniface, MSc1; Clare H. Llewellyn, PhD1; Jane Wardle, PhD1
[+] Author Affiliations
1Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, England
2Division of Health and Social Care Research, King’s College London, London, England
JAMA Pediatr. 2014;168(4):345-350. doi:10.1001/jamapediatrics.2013.4951.
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Importance  Identifying early markers of future obesity risk can help target preventive interventions. Several studies have shown that a heartier appetite in infancy is a risk factor for more rapid weight gain, but to date no investigations have been able to rule out familial confounding.

Objectives  To use a sibling design (data from same-sex, dizygotic twin pairs) to test the hypothesis that sibling differences in infant appetite predicted differential weight gain during childhood.

Design, Setting, and Participants  Gemini is a population-based twin cohort among the general United Kingdom population born between March 1, 2007, and December 15, 2007. Growth trajectories were analyzed from birth to age 15 months. Appetite-discordant pairs were selected from 800 nonidentical, same-sex twin pairs.

Exposures  Appetite during the first 3 months of life was assessed with the food responsiveness (FR) and satiety responsiveness (SR) subscales from the Baby Eating Behaviour Questionnaire. Discordance was defined as a within-pair difference of at least 1 SD.

Main Outcomes and Measures  A mean of 11.5 weight measurements per child were available between birth and age 15 months. Multilevel models, adjusted for sex and birth weight, compared growth curves for the higher-appetite vs lower-appetite twins.

Results  In total, 172 pairs were discordant for SR and 121 pairs for FR. Within-pair analyses showed that those with higher FR and those with lower SR grew faster than their sibling. At age 6 months, those with higher FR were 654 (95% CI, 395-913) g heavier and at age 15 months were 991 (95% CI, 484-1498) g heavier. For sibling pairs discordant for SR, the weight differences between siblings were 637 (95% CI, 438-836) g at age 6 months and 918 (95% CI, 569-1267) g at age 15 months.

Conclusions and Relevance  A heartier appetite (indexed with higher FR or lower SR) in early infancy is prospectively associated with more rapid growth up to age 15 months in a design controlling for potential familial confounding, supporting a causal role for appetite in childhood weight gain. Appetite could be an early marker for risk of weight gain in the current obesogenic environment and might be a potential target for preventive interventions.

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Figure 1.
Growth Trajectories in Siblings With Higher (Top Curve) and Lower (Bottom Curve) Food Responsiveness

The 95% CIs are indicated by the dashed lines.

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Figure 2.
Growth Trajectories in Siblings With Lower (Top Curve) and Higher (Bottom Curve) Satiety Responsiveness

The 95% CIs are indicated by the dashed lines.

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