Birth order progressively affects childhood height

Background There is evidence suggesting that first-born children and adults are anthropometrically different to later-borns. Thus, we aimed to assess whether birth order was associated with changes in growth and metabolism in childhood. Methods We studied 312 healthy prepubertal children: 157 first-borns and 155 later-borns. Children were aged 3-10 years, born 37-41 weeks gestation, and of birth weight appropriate-for-gestational-age. Clinical assessments included measurement of children's height, weight, fasting lipid and hormonal profiles and DEXA-derived body composition. Results First-borns were taller than later-borns (P < 0.0001), even when adjusted for parents' heights (0.31 vs 0.03 SDS; P = 0.001). There was an incremental height decrease with increasing birth order, so that first-borns were taller than second-borns (P < 0.001), who were in turn taller than third-borns (P = 0.007). Further, among sibling pairs both height SDS (P = 0.009) and adjusted height SDS (P < 0.0001) were lower in second- vs first-born children. Consistent with differences in stature, first- (P = 0.043) and second-borns (P = 0.003) had higher IGF-I concentrations than third-borns. Both first(P < 0.001) and second-borns (P = 0.004) also had reduced abdominal adiposity (lower android fat to gynoid fat ratio) when compared with third-borns. Other parameters of adiposity and blood lipids were unaffected by birth order. Conclusions First-borns were taller than later-born children, with an incremental height reduction from first to third birth order. These differences were present after correction for genetic height, and associated to some extent with alterations in plasma IGF-I. Our findings strengthen the evidence that birth order is associated with phenotypic changes in childhood.