Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease?

Background: A high birth weight has been suggested to increase the later risk of obesity, as measured by body mass index, but, paradoxically, to decrease the later propensity to cardiovascular disease. Programming of more lean tissue rather than fat mass by a high birth weight might explain this paradox and also explain the association of birth weight with later body mass index. This concept has been inadequately tested. Objective: The objective was to test the hypothesis that a high birth weight programs a greater proportion of lean mass in children and adolescents. Design: Body fat mass and fat-free mass were assessed by both skinfold-thickness measurement and bioelectrical impedance analysis in adolescents aged 13-16 y (n = 78) who were part of a study that investigated the early origins of cardiovascular disease. Body composition was assessed by dual-energy X-ray absorptiometry in a separate group of younger children. Results: An increase in birth weight of 1 SD was significantly associated with a 0.9-1.4-kg (2-3%) increase in fat-free mass in adolescents but not with an increase in fat mass. This association was independent of age, sex, height, pubertal stage, socioeconomic status, and physical activity. Similar observations were made in younger children. Conclusions: Our data support the hypothesis that fetal growth, measured by birth weight, programs lean mass later in life. Our observations may therefore explain the association of birth weight with body mass index and have implications for the early origins of both obesity and cardiovascular disease.