Abstract：
Neonatal care of preterm infants may include dietary approaches such as high calorie formulas to promote physical growth. However, continuing growth-promoting strategies beyond the point of necessity, coupled with poverty and food insecurity which are more common among families of children born preterm, may increase the risk of obesity. Because children born preterm tend to have more pressing health conditions that require ongoing care, obesity may go undiagnosed by providers.
This retrospective cohort study included 38,849 children (31,548 term, 7301 preterm) born from 2010 to 2015, who received clinical care at a large pediatric medical center (Ohio, USA). Electronic medical record data, linked to Ohio birth certificates, were used to identify children with measured obesity (≥2 weight-for-length values ≥95th percentile before 24 months of age or BMI values ≥95th percentile at or after 24 months of age). Children were considered to have diagnosed obesity if their medical record had an obesity-related phrase or billing code recorded. Modified Poisson regression was used to compare risk of obesity undiagnosis among obese children born preterm versus at term.
In total, 13,697 children had measured obesity, 10,273 (75%) of which were undiagnosed. Children born preterm with measured obesity were 8% more likely to be undiagnosed compared to children born at term (adjusted relative risk = 1.08 95% CI 1.05, 1.11). The risk was slightly higher for preterm children born to white women or born to women with higher educational attainment. For both groups, Primary Care and subspecialist clinics were the most common settings for undiagnosed obesity (74.9% and 16.8% of undiagnosed cases, respectively).
Preterm birth was associated with increased risk of undiagnosed obesity in early childhood. This highlights the need to enhance obesity screening in the preterm population and to further explore reasons for this disparity.
This retrospective cohort study included 38,849 children (31,548 term, 7301 preterm) born from 2010 to 2015, who received clinical care at a large pediatric medical center (Ohio, USA). Electronic medical record data, linked to Ohio birth certificates, were used to identify children with measured obesity (≥2 weight-for-length values ≥95th percentile before 24 months of age or BMI values ≥95th percentile at or after 24 months of age). Children were considered to have diagnosed obesity if their medical record had an obesity-related phrase or billing code recorded. Modified Poisson regression was used to compare risk of obesity undiagnosis among obese children born preterm versus at term.
In total, 13,697 children had measured obesity, 10,273 (75%) of which were undiagnosed. Children born preterm with measured obesity were 8% more likely to be undiagnosed compared to children born at term (adjusted relative risk = 1.08 95% CI 1.05, 1.11). The risk was slightly higher for preterm children born to white women or born to women with higher educational attainment. For both groups, Primary Care and subspecialist clinics were the most common settings for undiagnosed obesity (74.9% and 16.8% of undiagnosed cases, respectively).
Preterm birth was associated with increased risk of undiagnosed obesity in early childhood. This highlights the need to enhance obesity screening in the preterm population and to further explore reasons for this disparity.
摘要：
早产儿的新生儿护理可能包括饮食方法，例如高热量配方食品，以促进身体生长。然而,超越必要性的持续促进增长战略，再加上贫困和粮食不安全，这在早产儿童的家庭中更为常见，可能会增加肥胖的风险。因为早产儿往往有更紧迫的健康状况，需要持续护理，肥胖可能无法被提供者诊断。
这项回顾性队列研究包括38,849名儿童（31,548名，7301早产儿）出生于2010年至2015年，在大型儿科医疗中心接受临床护理（俄亥俄州，美国）。电子病历数据，和俄亥俄州的出生证明有关,用于识别已测量的肥胖儿童(24月龄前≥2个体重/身长值≥95百分位数,或24月龄时或之后的BMI值≥95百分位数).如果儿童的医疗记录记录了与肥胖相关的短语或账单代码，则认为他们被诊断为肥胖。改良泊松回归用于比较早产与足月肥胖儿童未诊断肥胖的风险。
总共，13697名儿童测量了肥胖，其中10,273（75％）未被诊断。与足月出生的儿童相比，患有肥胖的早产儿童未被诊断的可能性高8％（调整后的相对风险=1.0895％CI1.05，1.11）。白人妇女或受教育程度较高的妇女所生的早产儿的风险略高。对于这两个群体来说，初级保健和亚专科诊所是未诊断肥胖的最常见设置（74.9%和16.8%的未诊断病例，分别)。
早产与儿童早期未诊断肥胖的风险增加有关。这凸显了在早产人群中加强肥胖筛查的必要性，并进一步探索这种差异的原因。
这项回顾性队列研究包括38,849名儿童（31,548名，7301早产儿）出生于2010年至2015年，在大型儿科医疗中心接受临床护理（俄亥俄州，美国）。电子病历数据，和俄亥俄州的出生证明有关,用于识别已测量的肥胖儿童(24月龄前≥2个体重/身长值≥95百分位数,或24月龄时或之后的BMI值≥95百分位数).如果儿童的医疗记录记录了与肥胖相关的短语或账单代码，则认为他们被诊断为肥胖。改良泊松回归用于比较早产与足月肥胖儿童未诊断肥胖的风险。
总共，13697名儿童测量了肥胖，其中10,273（75％）未被诊断。与足月出生的儿童相比，患有肥胖的早产儿童未被诊断的可能性高8％（调整后的相对风险=1.0895％CI1.05，1.11）。白人妇女或受教育程度较高的妇女所生的早产儿的风险略高。对于这两个群体来说，初级保健和亚专科诊所是未诊断肥胖的最常见设置（74.9%和16.8%的未诊断病例，分别)。
早产与儿童早期未诊断肥胖的风险增加有关。这凸显了在早产人群中加强肥胖筛查的必要性，并进一步探索这种差异的原因。
