Determinants of Age at Adiposity Rebound in Filipino Pediatric Outpatients of a University Hospital

Emmanuel F. Baraquel, Bernard Emil N. Barrera, Danica Louice S. Basilio, Aleeza Casey S. Batara, Serena Mey M. Bautista, Sean Kenneth N. Banting, Charles Dominic Barriga, Eljon Valen C. Baniqued, Marichu J. De Chavez, Leilani B. Mercado-Asis

Apr 2026 DOI 10.35460/2546-1621.2025-0192     Access   

Abstract

Objectives: Adiposity rebound (AR), the childhood period at which body mass index (BMI) rises from its lowest point, is linked to increased risk of later obesity. The study aims to determine the average age at AR, describe baseline characteristics and analyze the correlation between these characteristics and timing of AR in a population of Filipino pediatric outpatients.

Design: Seven subjects born between 2016 and 2019 from a University Hospital Outpatient Department participated in this cross-sectional analytic study. Childhood anthropometrics were retrospectively collected to determine the age at AR by plot visual inspection. Sex, birth weight and gestational age were obtained from hospital records; breastfeeding duration, maternal BMI, parental obesity, maternal age, maternal smoking, education, parity and family income were gathered through a questionnaire completed by mothers or guardians. Associations were assessed using bootstrap univariate linear regression.

Results: The mean age at AR was 3.2 years (SD = 1.2). Vaginal delivery was significantly associated with later age at AR compared to cesarean section (p = 0.035). Socioeconomic status at ages 2 to 5 showed positive association with delayed AR. Higher monthly family income (≥₱19,000) at ages 2 to 5 years was significantly associated with delayed age at AR. Other baseline childhood and parental factors showed no significant correlation with age at AR.

Conclusion: These results highlight the complex and context-dependent nature of AR, emphasizing the need for further studies to better understand and mitigate early obesity risk in Filipino children.

Key Words: Adiposity rebound, early childhood, obesity, BMI, Filipino children

  1. Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). Philippine Nutrition Facts and Figures: 2018-2019 Expanded National Nutrition Survey (ENNS): Food Consumption Survey. Taguig City (PH): DOST-FNRI; 2022.
  2. Mazidi M, Banach M, Kengne AP. Lipid and Blood Pressure Meta-analysis Collaboration Group. Prevalence of childhood and adolescent overweight and obesity in Asian countries: a systematic review and meta-analysis. Arch Med Sci [Internet]. 2018;14(6):1185–203. Available from: http://dx.doi.org/10.5114/aoms.2018.79001 
  3. Zhang X, Liu J, Ni Y, Yi C, Fang Y, Ning Q, et al. Global prevalence of overweight and obesity in children and adolescents: A systematic review and meta-analysis. JAMA Pediatr [Internet]. 2024;178(8):800–13. Available from: http://dx.doi.org/10.1001/jamapediatrics.2024.1576 
  4. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care [Internet]. 2015;4(2):187–92. Available from: http://dx.doi.org/10.4103/2249-4863.154628
  5. Indrio F, Martini S, Francavilla R, Corvaglia L, Cristofori F, Mastrolia SA, et al. Epigenetic matters: The link between early nutrition, microbiome, and long-term health development. Front Pediatr [Internet]. 2017;5:178. Available from: http://dx.doi.org/10.3389/fped.2017.00178 
  6. Marcovecchio ML, Gorman S, Watson LPE, Dunger DB, Beardsall K. Catch-up growth in children born small for gestational age related to body composition and metabolic risk at six years of age in the UK. Horm Res Paediatr [Internet]. 2020;93(2):119–27. Available from: http://dx.doi.org/10.1159/000508974
  7. Koyama S, Ichikawa G, Kojima M, Shimura N, Sairenchi T, Arisaka O. Adiposity rebound and the development of metabolic syndrome. Pediatrics [Internet]. 2014;133(1):e114-9. Available from: http://dx.doi.org/10.1542/peds.2013-0966 
  8. Rolland-Cachera MF, Deheeger M, Guilloud-Bataille M, Avons P, Patois E, Sempé M. Tracking the development of adiposity from one month of age to adulthood. Ann Hum Biol [Internet]. 1987;14(3):219–29. Available from: http://dx.doi.org/10.1080/03014468700008991 
  9. Williams S, Davie G, Lam F. Predicting BMI in young adults from childhood data using two approaches to modelling adiposity rebound. Int J Obes Relat Metab Disord [Internet]. 1999;23(4):348–54. Available from: http://dx.doi.org/10.1038/sj.ijo.0800824 
  10. Freedman DS, Kettel Khan L, Serdula MK, Srinivasan SR, Berenson GS. BMI rebound, childhood height and obesity among adults: the Bogalusa Heart Study. Int J Obes Relat Metab Disord [Internet]. 2001;25(4):543–9. Available from: http://dx.doi.org/10.1038/sj.ijo.0801581 
  11. Eriksson JG, Forsén T, Tuomilehto J, Osmond C, Barker DJP. Early adiposity rebound in childhood and risk of type 2 diabetes in adult life. Diabetologia [Internet]. 2003;46(2):190–4. Available from: http://dx.doi.org/10.1007/s00125-002-1012-5 
  12. Bhargava SK, Sachdev HS, Fall CHD, Osmond C, Lakshmy R, Barker DJP, et al. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med [Internet]. 2004;350(9):865–75. Available from: http://dx.doi.org/10.1056/NEJMoa035698 
  13. Wadsworth M, Butterworth S, Marmot M, Ecob R, Hardy R. Early growth and type 2 diabetes: evidence from the 1946 British birth cohort. Diabetologia [Internet]. 2005;48(12):2505–10. Available from: http://dx.doi.org/10.1007/s00125-005-0007-4 
  14. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, et al. Early life risk factors for obesity in childhood: cohort study. BMJ [Internet]. 2005;330(7504):1357. Available from: http://dx.doi.org/10.1136/bmj.38470.670903.E0 
  15. Williams SM. Weight and height growth rate and the timing of adiposity rebound. Obes Res [Internet]. 2005;13(6):1123–30. Available from: http://dx.doi.org/10.1038/oby.2005.131
  16. Ohlsson C, Lorentzon M, Norjavaara E, Kindblom JM. Age at adiposity rebound is associated with fat mass in young adult males-the GOOD study. PLoS One [Internet]. 2012;7(11):e49404. Available from: http://dx.doi.org/10.1371/journal.pone.0049404 
  17. Hughes AR, Sherriff A, Ness AR, Reilly JJ. Timing of adiposity rebound and adiposity in adolescence. Pediatrics [Internet]. 2014;134(5):e1354-61. Available from: http://dx.doi.org/10.1542/peds.2014-1908 
  18. Péneau S, González-Carrascosa R, Gusto G, Goxe D, Lantieri O, Fezeu L, et al. Age at adiposity rebound: determinants and association with nutritional status and the metabolic syndrome at adulthood. Int J Obes (Lond) [Internet]. 2016;40(7):1150–6. Available from: http://dx.doi.org/10.1038/ijo.2016.39 
  19. Aris IM, Rifas-Shiman SL, Li L-J, Kleinman KP, Coull BA, Gold DR, et al. Patterns of body mass index milestones in early life and cardiometabolic risk in early adolescence. Int J Epidemiol [Internet]. 2019;48(1):157–67. Available from: http://dx.doi.org/10.1093/ije/dyy286
  20. Di Gravio C, Krishnaveni GV, Somashekara R, Veena SR, Kumaran K, Krishna M, et al. Comparing BMI with skinfolds to estimate age at adiposity rebound and its associations with cardio-metabolic risk markers in adolescence. Int J Obes (Lond) [Internet]. 2019;43(4):683–90. Available from: http://dx.doi.org/10.1038/s41366-018-0144-8 
  21. Nakayama K, Ichikawa G, Naganuma J, Koyama S, Arisaka O, Sairenchi T, et al. Adiposity rebound in very-low-birth-weight infants. J Pediatr Endocrinol Metab [Internet]. 2022;35(1):105–8. Available from: http://dx.doi.org/10.1515/jpem-2021-0333 
  22. Fonseca MJ, Moreira C, Santos AC. Adiposity rebound and cardiometabolic health in childhood: results from the generation XXI birth cohort. Int J Epidemiol [Internet]. 2021;50(4):1260–71. Available from: http://dx.doi.org/10.1093/ije/dyab002 
  23. Haga C, Yokomichi H, Tsuji K, Yamagata Z. Adiposity rebound may be a predictive index of body size for adolescents-based on retrospective cohort data in a Japanese rural area. Obes Res Clin Pract [Internet]. 2022;16(1):50–5. Available from: http://dx.doi.org/10.1016/j.orcp.2021.12.003 
  24. Rolland-Cachera MF, Deheeger M, Bellisle F, Sempé M, Guilloud-Bataille M, Patois E. Adiposity rebound in children: a simple indicator for predicting obesity. Am J Clin Nutr [Internet]. 1984;39(1):129–35. Available from: http://dx.doi.org/10.1093/ajcn/39.1.129
  25. Cissé AH, Lioret S, de Lauzon-Guillain B, Forhan A, Ong KK, Charles MA, et al. Association between perinatal factors, genetic susceptibility to obesity and age at adiposity rebound in children of the EDEN mother-child cohort. Int J Obes (Lond) [Internet]. 2021;45(8):1802–10. Available from: http://dx.doi.org/10.1038/s41366-021-00847-w 
  26. Dorosty AR, Emmett PM, Cowin IS, Reilly JJ. Factors associated with early adiposity rebound. ALSPAC Study Team. Pediatrics [Internet]. 2000;105(5):1115–8. Available from: http://dx.doi.org/10.1542/peds.105.5.1115 
  27. Estévez-González MD, Santana Del Pino A, Henríquez-Sánchez P, Peña-Quintana L, Saavedra-Santana P. Breastfeeding during the first 6 months of life, adiposity rebound and overweight/obesity at 8 years of age. Int J Obes (Lond) [Internet]. 2016;40(1):10–3. Available from: http://dx.doi.org/10.1038/ijo.2015.228 
  28. Linares J, Corvalán C, Galleguillos B, Kain J, González L, Uauy R, et al. The effects of pre-pregnancy BMI and maternal factors on the timing of adiposity rebound in offspring: maternal factors and adiposity rebound. Obesity (Silver Spring) [Internet]. 2016;24(6):1313–9. Available from: http://dx.doi.org/10.1002/oby.21490 
  29. Besharat Pour M, Bergström A, Bottai M, Magnusson J, Kull I, Moradi T. Age at adiposity rebound and body mass index trajectory from early childhood to adolescence; differences by breastfeeding and maternal immigration background: BMI trajectory, breastfeeding and adiposity rebound. Pediatr Obes [Internet]. 2017;12(1):75–84. Available from: http://dx.doi.org/10.1111/ijpo.12111 
  30. González L, Corvalán C, Pereira A, Kain J, Garmendia ML, Uauy R. Early adiposity rebound is associated with metabolic risk in 7-year-old children. Int J Obes (Lond) [Internet]. 2014;38(10):1299–304. Available from: http://dx.doi.org/10.1038/ijo.2014.97 
  31. Mårild S, Sjöberg A, Albertsson-Wikland K, Chaplin JE, Lissner L, Dahlgren J. Features of childhood growth, lifestyle, and environment associated with a cardiometabolic risk score in young adults. Obes Facts [Internet]. 2022;15(2):170–9. Available from: http://dx.doi.org/10.1159/000520661 
  32. Kim JH, Kim SJ, Chung IH, Lim JS. Adiposity rebound timing in small for gestational age children treated with growth hormone: Results from LG Growth Study data. J Korean Med Sci [Internet]. 2025;40(4):e12. Available from: http://dx.doi.org/10.3346/jkms.2025.40.e12 
  33. Ju HO, Park CG. Estimation for the time of adiposity rebound in Korean children and the effects of breast feeding on BMI before adiposity rebound. Korean J Obes [Internet]. 2011;20(1):8. Available from: http://dx.doi.org/10.7570/kjo.2011.20.1.8 
  34. Goh EK, Kim OY, Yoon SR, Jeon HJ. Timing of adiposity rebound and determinants of early adiposity rebound in Korean infants and children based on data from the national health insurance service. Nutrients [Internet]. 2022;14(5):929. Available from: http://dx.doi.org/10.3390/nu14050929 
  35. Liu J-M, Ye R, Li S, Ren A, Li Z, Liu Y, et al. Prevalence of overweight/obesity in Chinese children. Arch Med Res [Internet]. 2007;38(8):882–6. Available from: http://dx.doi.org/10.1016/j.arcmed.2007.05.006 
  36. Franchetti Y, Ide H. Socio-demographic and lifestyle factors for child’s physical growth and adiposity rebound of Japanese children: a longitudinal study of the 21st century longitudinal survey in newborns. BMC Public Health [Internet]. 2014;14(1):334. Available from: http://dx.doi.org/10.1186/1471-2458-14-334 
  37. Ip EH, Marshall SA, Saldana S, Skelton JA, Suerken CK, Arcury TA, et al. Determinants of adiposity rebound timing in children. J Pediatr [Internet]. 2017;184:151-156.e2. Available from: http://dx.doi.org/10.1016/j.jpeds.2017.01.051 
  38. Doi L, Williams AJ, Frank J. How has child growth around adiposity rebound altered in Scotland since 1990 and what are the risk factors for weight gain using the growing up in Scotland birth cohort 1? BMC Public Health [Internet]. 2016;16(1):1081. Available from: http://dx.doi.org/10.1186/s12889-016-3752-z 
  39. Baldassarre ME, Di Mauro A, Caroli M, Schettini F, Rizzo V, Panza R, et al. Premature birth is an independent risk factor for early adiposity rebound: Longitudinal analysis of BMI data from birth to 7 years. Nutrients [Internet]. 2020;12(12):3654. Available from: http://dx.doi.org/10.3390/nu12123654
  40. Lin D, Chen D, Huang J, Li Y, Wen X, Wang L, et al. Pre-birth and early-life factors associated with the timing of adiposity peak and rebound: A large population-based longitudinal study. Front Pediatr [Internet]. 2021;9:742551. Available from: http://dx.doi.org/10.3389/fped.2021.742551 
  41. Oddy WH, Mori TA, Huang R-C, Marsh JA, Pennell CE, Chivers PT, et al. Early infant feeding and adiposity risk: from infancy to adulthood. Ann Nutr Metab [Internet]. 2014;64(3–4):262–70. Available from: http://dx.doi.org/10.1159/000365031 
  42. Fujiwara T, Oguni T, Unishi G, Tanabe T, Ohbayashi K, Kaneko K. Factors related to patterns of body mass index in early infancy: 18 month longitudinal study: BMI patterns in early infancy. Pediatr Int [Internet]. 2014;56(3):406–10. Available from: http://dx.doi.org/10.1111/ped.12272 
  43. Giles LC, Whitrow MJ, Davies MJ, Davies CE, Rumbold AR, Moore VM. Growth trajectories in early childhood, their relationship with antenatal and postnatal factors, and development of obesity by age 9 years: results from an Australian birth cohort study. Int J Obes (Lond) [Internet]. 2015;39(7):1049–56. Available from: http://dx.doi.org/10.1038/ijo.2015.42 
  44. Williams SM, Goulding A. Patterns of growth associated with the timing of adiposity rebound. Obesity (Silver Spring) [Internet]. 2009;17(2):335–41. Available from: http://dx.doi.org/10.1038/oby.2008.547 
  45. Lachin JM. Introduction to sample size determination and power analysis for clinical trials. Control Clin Trials [Internet]. 1981;2(2):93–113. Available from: http://dx.doi.org/10.1016/0197-2456(81)90001-5 
  46. World Health Organization. Obesity and overweight [Internet]. World Health Organization. 2021 [cited 2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight 
  47. Kroke A, Hahn S, Buyken AE, Liese AD. A comparative evaluation of two different approaches to estimating age at adiposity rebound. Int J Obes (Lond) [Internet]. 2006;30(2):261–6. Available from: http://dx.doi.org/10.1038/sj.ijo.0803143 
  48. Korpela K. Impact of delivery mode on infant gut microbiota. Ann Nutr Metab [Internet]. 2021;77(Suppl. 3):1–9. Available from: http://dx.doi.org/10.1159/000518498 
  49. Nuriel-Ohayon M, Neuman H, Koren O. Microbial changes during pregnancy, birth, and infancy. Front Microbiol [Internet]. 2016;7:1031. Available from: http://dx.doi.org/10.3389/fmicb.2016.01031 
  50. Abu Y, Roy S. Intestinal dysbiosis during pregnancy and microbiota-associated impairments in offspring. Front Microbiomes [Internet]. 2025;4:1548650. Available from: http://dx.doi.org/10.3389/frmbi.2025.1548650 
  51. Geng J, Ni Q, Sun W, Li L, Feng X. The links between gut microbiota and obesity and obesity related diseases. Biomed Pharmacother [Internet]. 2022;147(112678):112678. Available from: http://dx.doi.org/10.1016/j.biopha.2022.112678 
  52. Angeles-Agdeppa I, Sun Y, Denney L, Tanda KV, Octavio RAD, Carriquiry A, et al. Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey. Nutr J [Internet]. 2019;18(1):59. Available from: http://dx.doi.org/10.1186/s12937-019-0481-z 

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