It isn't just the fat kids who are in danger of becoming diabetics as adults. Children who are skinny as babies but start bulking up early are at risk even if they aren't overweight, a study found.
That is true of all children whose weight gain outstrips their growth rate early on, but "it seems to be more pronounced in those who were initially slim or skinny,'' said Dr. Harshpal Singh Sachdev, a pediatrics professor at Maulana Azad Medical College in New Delhi.
He said it may be possible to stem diabetes by making sure that children who bulk up sooner and faster than most get additional exercise and a sound diet.
Sachdev was a lead researcher in the 30-year study published in Thursday's New England Journal of Medicine. He and his colleagues measured 1,492 children in India and tracked them until adulthood.
Toddlers grow up faster than they grow out, so they usually slim down. They tend to "rebound'' around age 6, starting to bulk up again. But 21 percent of those who began their rebound between ages 2 and 5 developed diabetes or impaired glucose tolerance as adults, compared with 12 percent to 14.5 percent of those whose rebounds began later.
The diabetes and glucose-intolerance rate was as high as 27 percent among children who were skinny as babies but rebounded quickly. None of the children in the study were actually overweight.
Doctors should reconsider the idea that small babies should get extra calories to encourage rapid growth, said Dr. Francine Kaufman, a pediatric endocrinologist at Children's Hospital-Los Angeles and past president of the American Diabetes Association.
"We need to look at not overfeeding some of these children,'' she said.
Dr. William H. Dietz of the Centers for Disease Control and Prevention's division of nutrition and physical activity, said the study may have little effect on medical practice, since rebound often goes unnoticed until it has occurred, and "it's not clear to me that anyone knows how to prevent early rebound.''
He agreed that additional exercise and good nutrition might help children who rebound early avoid diabetes later. And pediatricians should look more carefully at how children's body mass index - a ratio of weight to height - is changing, he said. But, he said, it is more important to focus on children who already are overweight.
The study also may be more applicable to developing countries than to the United States and Europe, he said, since many of the children in this study were undernourished during early childhood.