Clinical Research Article | Published:

Catch-up growth, metabolic, and cardiovascular risk in post-institutionalized Romanian adolescents

Pediatric Researchvolume 84pages842848 (2018) | Download Citation




Reduced prenatal growth followed by rapid postnatal weight gain are risk factors for developing metabolic and cardiovascular disease. Children reared in institutions experience a similar pattern of growth restriction followed by catch-up growth after removal. We explored whether patterns of catch-up growth affect metabolic and cardiovascular outcomes in previously institutionalized adolescents.


A longitudinal study of institutionalized infants randomized to care as usual (n = 68) or foster care intervention (n = 68), and never institutionalized controls (n = 127). Body mass index (BMI) was measured at baseline (20 months), 30, 42 months, and ages 8, 12, 16. At age 16, metabolic and pro-inflammatory markers were derived from blood samples.


Four BMI trajectories were derived (i.e., average-stable, low-stable, elevated, and accelerated). The accelerated trajectory was comprised predominately of children randomized to foster care, who also exhibited higher levels of glycosylated hemoglobin and C-reactive protein than the other three trajectories. Also, children placed in foster care at younger ages were more likely to be on the accelerated rather than the average-stable trajectory.


Although catch-up growth is viewed as a positive improvement among post-institutionalized children, rapid/continuous increases in body size pose a health concern. Attention should be given to monitoring weight gain, diet, and physical activity.

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Funding Source

The John D. and Catherine T. MacArthur Foundation, the Binder Family Foundation, the Palix Foundation, the Jacobs Foundation, and the National Institute of Mental Health (R01MH091363) to C.A.N. and the Palix Foundation to C.H.Z..

Author information


  1. Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA

    • Alva Tang
    •  & Nathan A. Fox
  2. Shool of Public Health, University of Maryland, College Park, MD, USA

    • Natalie Slopen
  3. Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    • Charles A. Nelson
  4. Tulane University School of Medicine, New Orleans, LA, USA

    • Charles H. Zeanah
  5. Department of Pediatrics, Institute of Child Development, and Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN, USA

    • Michael K. Georgieff


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The authors declare no competing interests.

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Correspondence to Nathan A. Fox.

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