Childhood Obesity and Slipped Capital Femoral Epiphysis

Daniel C. Perry (Corresponding Author), David Metcalfe, Steven Lane, Steven Turner

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Abstract

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is believed to be associated with childhood obesity, although the strength of the association is unknown.

METHODS: We performed a cohort study using routine data from health screening examinations at primary school entry (5–6 years old) in Scotland, linked to a nationwide hospital admissions database. A subgroup had a further screening examination at primary school exit (11–12 years old).

RESULTS: BMI was available for 597 017 children at 5 to 6 years old in school and 39 468 at 11 to 12 years old. There were 4.26 million child-years at risk for SCFE. Among children with obesity at 5 to 6 years old, 75% remained obese at 11 to 12 years old. There was a strong biological gradient between childhood BMI at 5 to 6 years old and SCFE, with the risk of disease increasing by a factor of 1.7 (95% confidence interval [CI] 1.5–1.9) for each integer increase in BMI z score. The risk of SCFE was almost negligible among children with the lowest BMI. Those with severe obesity at 5 to 6 years old had 5.9 times greater risk of SCFE (95% CI 3.9–9.0) compared with those with a normal BMI; those with severe obesity at 11 to 12 years had 17.0 times the risk of SCFE (95% CI 5.9–49.0).

CONCLUSIONS: High childhood BMI is strongly associated with SCFE. The magnitude of the association, temporal relationship, and dose response added to the plausible mechanism offer the strongest evidence available to support a causal association.
Original languageEnglish
Article numbere20181067
Pages (from-to)1-10
Number of pages10
JournalPediatrics
Volume142
Issue number5
Early online date22 Oct 2018
DOIs
Publication statusPublished - Nov 2018

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