Ultra-Processed Food as Mediator of the Association between Birthweight and Childhood Body Weight Outcomes: A Retrospective Cohort Study

Previous studies have shown conflicting findings regarding the association between birthweight and childhood adiposity. We aimed to explore the interaction between ultra-processed food (UPF) and birthweight and its associations with bodyweight markers. The retrospective analysis of data from a Multicity Cohort Study across eastern China was conducted. UPF was computed as percentage of the energy intake and categorized into quartiles. Birthweight was categorized into low (LBW), normal (NBW) and high (HBW). The BMI z-score was calculated using the lambda-mu-sigma method. The sex- and age-specific BMI cutoff points were used to define weight status. Generalized linear models were used to examine modification effects and were performed after adjustment for covariates. The mean percentage of energy intake from UPF was 27.7% among 1370 children. Of all children, 2.3% and 21.4% were born with LBW and HBW, respectively. HBW was a permanent risk for high BMI measures, while LBW was associated with increased BMI measurements only by the addition of the interaction term. The subgroup analysis revealed that HBW and LBW were positively associated with BMI measurements in the lowest UPF intake (Q1), while HBW was related to high BMI measures in Q4. Our findings support efforts to recommend limiting UPF intake, especially for LBW children.