{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:06:38Z","timestamp":1790139998292,"version":"4.0.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Objective<\/jats:title>\n The aim of this study was to explore the impact of birth weight on overweight and obesity in children aged 3\u20136\u202fyears across 13 cities in China, as well as the potential interactions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study was designed as a retrospective analysis adhering to the STROBE guidelines. Data were derived from three waves of the Physical Fitness Survey in Jiangsu targeting children aged 3\u20136\u202fyears, which employed a multi-stage, stratified, cluster probability sampling design to obtain a representative sample from thirteen cities. Overweight and obesity were defined according to the Chinese National Health Industry Standard WS\/T 423\u20142022 (issued in 2022) based on BMI standard deviation scores. Eight covariates, including age, sex, survey year, geographic region, urban\u2013rural status, gestational age, childbearing age, and mother\u2019s education, were included. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risks of overweight, obesity and overweight\/obesity associated with low birth weight and macrosomia after adjusting for covariates. Subgroup analysis results were visualized using forest plots; restricted cubic spline (RCS) analysis was performed to examine nonlinear and dose\u2013response relationships; and sensitivity analysis included mixed-effects logistic regression models to adjust for clustering effects, changing birth weight classification cut-points, and excluding gestational age (a key potential covariate).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 23,362 participants were included. The prevalence of overweight, obesity, and overweight\/obesity was 19.2, 9, and 28.2%, respectively. (1) Birth weight exhibited a nonlinear association with weight and BMI at 3\u20136\u202fyears, with a gentle slope in the early segment and a steeper slope in the later segment (P for nonlinearity &lt; 0.001). (2) After covariate adjustment, low birth weight was not associated with overweight risk (\n p<\/jats:italic>\n =\u202f0.165), although it was associated with obesity and combined overweight\/obesity risks (OR\u202f=\u202f0.628 and 0.736,\n p<\/jats:italic>\n =\u202f0.027 and 0.010). However, after stratification by gender, age, geography, and urban\u2013rural status, all subgroups showed no statistical significance; gestational age had a significant interaction with low birth weight, with low birth weight (term birth) having lower overweight\/obesity risk (\n p<\/jats:italic>\n =\u202f0.001), while preterm infants showed no overweight\/obesity risk (\n p<\/jats:italic>\n &gt;\u202f0.05). (3)Macrosomia was significantly associated with increased risks of overweight (OR\u202f=\u202f1.464, 95%CI: 1.326\u20131.616), obesity (OR\u202f=\u202f2.346, 95%CI: 2.087\u20132.648), and overweight\/obesity (OR\u202f=\u202f2.006, 95%CI: 1.839\u20132.188) compared with normal birth weight (all\n p<\/jats:italic>\n \u202f&lt;\u202f0.001); the subgroup analysis indicated a more pronounced trend in younger age groups (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). (4) After covariate adjustment, the relationship between birth weight and risks of obesity\/overweight\/obesity was flat in the lower range and increased sharply in the higher range, demonstrating a nonlinear dose\u2013response relationship (P for nonlinearity &lt; 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Birth weight shows nonlinear associations with weight, BMI, and risks of obesity\/overweight\/obesity in children aged 3\u20136\u202fyears, characterized by a gentle slope in the lower birth weight range and a steeper slope in the higher range. Low birth weight has limited impact on the development of overweight and obesity, but gestational age shows significant heterogeneity; whereas macrosomia confers significantly higher risks of overweight, obesity, and overweight\/obesity compared with normal birth weight, with this effect diminishing with increasing age.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1883738","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:44:50Z","timestamp":1790138690000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nonlinear association between birth weight and overweight\/obesity in children aged 3\u20136\u202fyears: a retrospective analysis of 13 cities in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Su","family":"Liu","sequence":"first","affiliation":[{"name":"College of Physical Education and Health, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen","family":"Li","sequence":"additional","affiliation":[{"name":"Jiangsu Provincial Center of National Physical Fitness Monitoring","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanhua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Jing Hengyi School of Education, Hangzhou Normal University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Song","sequence":"additional","affiliation":[{"name":"College of Physical Education and Health, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunjing","family":"Tu","sequence":"additional","affiliation":[{"name":"School of Teacher (Physical) Education, Taizhou University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiming","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Physical Education and Health, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/j.jsams.2016.09.014","article-title":"Secular trends in the prevalence of childhood overweight and obesity across Australian states: a meta-analysis","volume":"20","author":"Olds","year":"2017","journal-title":"J Sci Med Sport"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"634","DOI":"10.5604\/12321966.1120616","article-title":"Ten-year secular trend of overweight and obesity in school children in South-Eastern Poland","volume":"21","author":"Mazur","year":"2014","journal-title":"Ann Agric Environ 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