Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI



To evaluate possible associations between body mass index (BMI) at 4 years of age, current and previous dietary intakes and parental BMI.


A follow-up of dietary intake and anthropometry in 127 4-year-old children corresponding to 54% of children who completed an initial intervention study at 18 months of age.


Fourteen percent of the girls and 13% of the boys were overweight (age-adjusted BMI25) and 2% of the girls and 3% of the boys were obese (age-adjusted BMI30). Thirty-four percent and 9% of the fathers and 19 and 7% of the mothers were overweight and obese, respectively. BMI at 6–18 months was a strong predictor of BMI at 4 years. Univariate regression analyses revealed that intake of protein in particular, and also of total energy and carbohydrates at 17/18 months and at 4 years, was positively associated with BMI at 4 years. Although BMI at 6–18 months was the strongest predictor of BMI at 4 years, in the final multivariate models of the child's BMI, protein intake at 17–18 months and at 4 years, energy intake at 4 years and the father's—but not the mother's—BMI were also independent contributing factors.


Among these healthy children, BMI at 4 years of age tracked from 6 to 18 months of age and were associated with previous and current protein intake as well as parental BMI, particularly that of the father.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2


  • Aeberli I, Kaspar M, Zimmermann MB (2007). Dietary intake and physical activity of normal weight and overweight 6 to 14 year old Swiss children. Swiss Med Wkly 137, 424–430.

    CAS  PubMed  Google Scholar 

  • Aggett PJ, Haschke F, Heine W, Hernell O, Koletzko B, Lafeber H et al. (1994). Committee report: childhood diet and prevention of coronary heart disease. ESPGAN Committee on Nutrition. European Society of Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 19, 261–269.

    CAS  PubMed  Google Scholar 

  • Altman DG, Royston P (2006). The cost of dichotomising continuous variables. Br Med J 332, 1080.

    Article  Google Scholar 

  • Blomquist HK, Bergström E (2007). Obesity in 4-year-old children more prevalent in girls and in municipalities with a low socioeconomic level. Acta Paediatr 96, 113–116.

    CAS  Article  Google Scholar 

  • Burke V, Beilin LJ, Dunbar D (2001). Family lifestyle and parental body mass index as predictors of body mass index in Australian children: a longitudinal study. Int J Obes Relat Metab Disord 25, 147–157.

    CAS  Article  Google Scholar 

  • Burke V, Beilin LJ, Simmer K, Oddy WH, Blake KV, Doherty D et al. (2005). Predictors of body mass index and associations with cardiovascular risk factors in Australian children: a prospective cohort study. Int J Obes (Lond) 29, 15–23.

    CAS  Article  Google Scholar 

  • Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000). Establishing a standard definition for child overweight and obesity worldwide: International survey. Br Med J 320, 1240–1243.

    CAS  Article  Google Scholar 

  • Demol S, Yackobovitch-Gavan M, Shalitin S, NagCelberg N, Phillip M (2009). Low-carbohydrate (low and high-fat) versus high-carbohydrate low-fat diets in the treatment of obesity in adolescents. Acta Paediatr 98, 346–351.

    CAS  Article  Google Scholar 

  • Ekblom O, Oddsson K, Ekblom B (2004). Prevalence and regional differences in overweight in 2001 and trends in BMI distribution in Swedish children from 1987 to 2001. Scand J Public Health 32, 257–263.

    Article  Google Scholar 

  • Elmståhl S, Gullberg B (1997). Bias in diet assessment methods–consequences of collinearity and measurement errors on power and observed relative risks. Int J Epidemiol 26, 1071–1079.

    Article  Google Scholar 

  • Garemo M, Arvidsson Lenner R, Nilsson EK, Borres MP, Strandvik B (2007a). Food choice, socio-economic characteristics and health in 4-year olds in a well-educated urban Swedish community. Clin Nutr 26, 133–140.

    Article  Google Scholar 

  • Garemo M, Lenner RA, Strandvik B (2007b). Swedish pre-school children eat too much junk food and sucrose. Acta Paediatr 96, 266–272.

    CAS  Article  Google Scholar 

  • Garemo M, Strandvik B (2006). Metabolic markers in relation to nutrition and growth in healthy 4-y-old children in Sweden. Am J Clin Nutr 84, 1021–1026.

    CAS  Article  Google Scholar 

  • Gunther AL, Remer T, Kroke A, Buyken AE (2007). Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nutr 86, 1765–1772.

    Article  Google Scholar 

  • Hermanussen M, Tresguerres JAF (2007). Overweight, appetite control, and the role of glutamate and excess nutritional protein during child development. Hum Ontogenet 1, 23–35.

    Article  Google Scholar 

  • Hoppe C, Molgaard C, Juul A, Michaelsen KF (2004a). High intakes of skimmed milk, but not meat, increase serum IGF-I and IGFBP-3 in eight-year-old boys. Eur J Clin Nutr 58, 1211–1216.

    CAS  Article  Google Scholar 

  • Hoppe C, Molgaard C, Thomsen B, Juul A, Michaelsen KF (2004b). Protein intake at 9 mo of age is associated with body size but not with body fat in 10-y-old Danish children. Am J Clin Nutr 79, 494–501.

    CAS  Article  Google Scholar 

  • Hoppe C, Udam TR, Lauritzen L, Molgaard C, Juul A, Michaelsen KF (2004c). Animal protein intake, serum insulin-like growth factor I, and growth in healthy 2.5-y-old Danish children. Am J Clin Nutr 80, 447–452.

    CAS  Article  Google Scholar 

  • Huus K, Ludvigsson JF, Enskar K, Ludvigsson J (2007). Risk factors in childhood obesity-findings from the all babies in Southeast Sweden (ABIS) cohort. Acta Paediatr 96, 1321–1325.

    Article  Google Scholar 

  • Karlberg J, Luo ZC, Albertsson-Wikland K (2001). Body mass index reference values (mean and s.d.) for Swedish children. Acta Paediatr 90, 1427–1434.

    CAS  Article  Google Scholar 

  • Kivimaki M, Lawlor DA, Smith GD, Elovainio M, Jokela M, Keltikangas-Jarvinen L et al. (2007). Substantial intergenerational increases in body mass index are not explained by the fetal overnutrition hypothesis: the cardiovascular risk in young Finns study. Am J Clin Nutr 86, 1509–1514.

    CAS  Article  Google Scholar 

  • Koletzko B, von Kries R, Monasterolo RC, Subias JE, Scaglioni S, Giovannini M et al. (2009). Can infant feeding choices modulate later obesity risk? Am J Clin Nutr 89, 1502S–1508S.

    CAS  Article  Google Scholar 

  • Lind T, Lönnerdal B, Persson LÅ, Stenlund H, Tennefors C, Hernell O (2003). Effects of weaning cereals with different phytate contents on hemoglobin, iron stores, and serum zinc: a randomized intervention in infants from 6 to 12 mo of age. Am J Clin Nutr 78, 168–175.

    CAS  Article  Google Scholar 

  • Lind T, Persson L, Lönnerdal B, Stenlund H, Hernell O (2004). Effects of weaning cereals with different phytate content on growth, development and morbidity: a randomized intervention trial in infants from 6 to 12 months of age. Acta Paediatr 93, 1575–1582.

    CAS  Article  Google Scholar 

  • Livingstone MB, Black AE (2003). Markers of the validity of reported energy intake. J Nutr 133, 895S–920S.

    CAS  Article  Google Scholar 

  • Mårild S, Bondestam M, Bergström R, Ehnberg S, Hollsing A, Albertsson-Wikland K (2004). Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index. Acta Paediatr 93, 1588–1595.

    Article  Google Scholar 

  • NNR (2004). Nordic Nutrition recommendations 2004. Nordic council of ministers: Copenhagen.

  • Öhlund I, Lind T, Hörnell A, Hernell O (2008). Predictors of iron status in well-nourished 4-y-old children. Am J Clin Nutr 87, 839–845.

    Article  Google Scholar 

  • Petersen S, Brulin C, Bergström E (2003). Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden, from 1986 to 2001. Acta Paediatr 92, 848–853.

    CAS  Article  Google Scholar 

  • Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I et al. (2005). Early life risk factors for obesity in childhood: cohort study. Br Med J 330, 1357.

    Article  Google Scholar 

  • Rolland-Cachera MF, Deheeger M, Akrout M, Bellisle F (1995). Influence of macronutrients on adiposity development: a follow up study of nutrition and growth from 10 months to 8 years of age. Int J Obes Relat Metab Disord 19, 573–578.

    CAS  PubMed  Google Scholar 

  • Rolland-Cachera MF, Deheeger M, Bellisle F (2001). Early adiposity rebound is not associated with energy or fat intake in infancy. Pediatrics 108, 218–219.

    CAS  Article  Google Scholar 

  • Roos G, Prattala R, Koski K (2001). Men, masculinity and food: interviews with Finnish carpenters and engineers. Appetite 37: 47–56.

    CAS  Article  Google Scholar 

  • Saunders KL (2007). Preventing obesity in pre-school children: a literature review. J Public Health (Oxf) 29, 368–375.

    Article  Google Scholar 

  • Silfverdal SA, Hernell O (2008). Who is responsible for dietary advice for our children? Läkartidningen 105, 1863–1864.

    PubMed  Google Scholar 

  • Sjöberg A, Lissner L, Mårild S (2008). Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls. Acta Paediatr 97, 118–123.

    Article  Google Scholar 

  • Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD et al. (1988). Skinfold equations for estimation of body fatness in children and youth. Hum Biol 60, 709–723.

    CAS  Google Scholar 

  • The National Food Administration (2006). Dietary habits and nutrient intake in Swedish children 4 year old and school children in grade 2 and 5 (Riksmaten - barn 2003) Uppsala, National Food Administration (Livsmedelsverket), Uppsala, Sweden.

  • Vogels N, Posthumus DL, Mariman EC, Bouwman F, Kester AD, Rump P et al. (2006). Determinants of overweight in a cohort of Dutch children. Am J Clin Nutr 84, 717–724.

    CAS  Article  Google Scholar 

  • Von Post-Skagegard M, Samuelson G, Karlström B, Mohsen R, Berglund L, Bratteby LE (2002). Changes in food habits in healthy Swedish adolescents during the transition from adolescence to adulthood. Eur J Clin Nutr 56: 532–538.

    CAS  Article  Google Scholar 

  • Wang Y, Lobstein T (2006). Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1, 11–25.

    Article  Google Scholar 

  • Whitaker RC (2004). Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics 114, e29–e36.

    Article  Google Scholar 

  • Williams S (2001). Overweight at age 21: the association with body mass index in childhood and adolescence and parents’ body mass index. A cohort study of New Zealanders born in 1972–1973. Int J Obes Relat Metab Disord 25, 158–163.

    CAS  Article  Google Scholar 

  • WHO (2006). WHO child growth standards: length/height -for-age, weight-for-length, weight-for-height and body mass index-for-age:methods and development. World Health Organization: Geneva.

  • WHO (2007). Protein and amino acid requirements in human nutrition. World Health organization: Geneva.

Download references


We are most grateful to all of the participating children and their parents, and to research nurse Margareta Henriksson for invaluable assistance in collecting the data. We are also grateful to the dieticians Maria Sehlstedt, Anna Karlsson and Agneta Frängsmyr for tabulating the dietary data. This study was supported by grants from the Goljes Memory Foundation, the Oskar Foundation, the Axel Adlers Foundation and the Mayflower Charity Foundation.

Author information

Authors and Affiliations


Corresponding author

Correspondence to I Öhlund.

Additional information

Contributors: IÖ is the main author of this paper; she has also participated in the planning of the study, food data collection and analyses. OH and TL contributed to the planning and data analyses and in writing the manuscript. AH took part in the data analyses and in writing of the manuscript. HS took part in the statistical analyses.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Öhlund, I., Hernell, O., Hörnell, A. et al. BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI. Eur J Clin Nutr 64, 138–145 (2010).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • body mass index
  • protein
  • dietary intake
  • child
  • heredity
  • predictors

Further reading


Quick links