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Pediatrics

Underdiagnosis of obesity in pediatric clinical care settings among children born preterm: a retrospective cohort study

International Journal of Obesity volume 45, pages 1717–1727 (2021)Cite this article

Subjects

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions and relevance

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.

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Fig. 1: Participant STROBE Flow Diagram, 2010–2016, Ohio, USA.

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Acknowledgements

We thank the Nationwide Children’s Hospital Electronic Data Warehouse, Research Information Solutions and Innovation (RISI), and the Ohio Department of Health for its support services. SAK, MAK, ROF, KB study concept and design; TTI, SAK, and KB acquisition of data; TTI, RL, SAK, MAK, ROF, JR analysis and interpretation of data; TTI and RR wrote the paper; TTI, RL, RR, MAK, ROF JR, KMB, SAK revised the manuscript for important intellectual content; SAK had primary responsibility for the final content. The authors have no conflicts to disclose. The study sponsors did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; and decision to submit the manuscript for publication. This study includes data provided by the Ohio Department of Health which should not be considered an endorsement of this study or its conclusions. All authors have read and approved the final version of the manuscript.

Funding

This study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/ National Institutes of Health (1R03HD084927-01A1).

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Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Taniqua T. Ingol

  2. Department of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA

    Rui Li

  3. Department of Pediatrics, Westchester Medical Center, Valhalla, NY, USA

    Rachel Ronau

  4. Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA

    Mark A. Klebanoff, Joseph Rausch & Sarah A. Keim

  5. Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA

    Mark A. Klebanoff & Reena Oza-Frank

  6. Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Mark A. Klebanoff

  7. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA

    Mark A. Klebanoff & Sarah A. Keim

  8. Ohio Department of Health, Columbus, OH, USA

    Reena Oza-Frank

  9. Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Joseph Rausch, Kelly M. Boone & Sarah A. Keim

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Correspondence to Taniqua T. Ingol.

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Ingol, T.T., Li, R., Ronau, R. et al. Underdiagnosis of obesity in pediatric clinical care settings among children born preterm: a retrospective cohort study. Int J Obes 45, 1717–1727 (2021). https://doi.org/10.1038/s41366-021-00834-1

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