Catch-up growth, metabolic, and cardiovascular risk in post-institutionalized Romanian adolescents
Open accessAbstract
Background Reduced prenatal growth followed by rapid postnatal weight gain are risk factors for developing metabolic and cardiovascular disease. Children reared in institutions experience a similar pattern of growth restriction followed by catch-up growth after removal. We explored whether patterns of catch-up growth affect metabolic and cardiovascular outcomes in previously institutionalized adolescents.Method A longitudinal study of institutionalized infants randomized to care as usual (n = 68) or foster care intervention (n = 68), and never institutionalized controls (n = 127). Body mass index (BMI) was measured at baseline (20 months), 30, 42 months, and ages 8, 12, 16. At age 16, metabolic and pro-inflammatory markers were derived from blood samples.Results Four BMI trajectories were derived (i.e., average-stable, low-stable, elevated, and accelerated). The accelerated trajectory was comprised predominately of children randomized to foster care, who also exhibited higher levels of glycosylated hemoglobin and C-reactive protein than the other three trajectories. Also, children placed in foster care at younger ages were more likely to be on the accelerated rather than the average-stable trajectory.Conclusions Although catch-up growth is viewed as a positive improvement among post-institutionalized children, rapid/continuous increases in body size pose a health concern. Attention should be given to monitoring weight gain, diet, and physical activity.
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Rapid catch-up growth in adopted children exposed to institutionalized care is associated with an increased risk for cardiometabolic diseases.
“adopted children who were exposed to institutionalized care often exhibit rapid catch-up growth, which is associated with an increased risk for cardiometabolic diseases”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
The introduction says children adopted after institutional care often show catch-up growth, and the Results report that an accelerated-growth group had higher cardiometabolic risk markers. But the Discussion concludes that catch-up growth was not directly related to an unfavorable cardiovascular and metabolic profile at age 16; the association was specific to an accelerated-growth subgroup, and the study measured risk markers rather than cardiometabolic disease. (LLM, conf=0.87)
Experimental — accuracy not yet measuredFoster care intervention was associated with moderate to strong improvements in physical growth (height, weight, BMI).
“Moderate to strong improvements in physical growth; moderate improvements in stress responses”
From Resilience following severe early life neglect: A review of longitudinal evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
The Results (Variable-centered Trajectories; page unavailable) report a more rapid increase in BMI in the foster-care group than in the care-as-usual group. The paper measured height and weight to calculate BMI, but the cited passages do not establish moderate-to-strong intervention-related improvements in all three measures; the Discussion also cautions that accelerated BMI growth can pose health risks. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdopted children who were exposed to institutionalized care often exhibit rapid catch-up growth.
“adopted children who were exposed to institutionalized care often exhibit rapid catch-up growth”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
Experimental — accuracy not yet measuredRapid catch-up growth following improved care environments may further influence cardiometabolic risk.
“rapid catch-up growth following improved care environments may further influence this risk”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
Previous BEIP studies focused on physical health trajectories from infancy to adolescence found that participants randomized to the foster care group experienced greater increases in BMI.
“previous BEIP studies focused on physical health trajectories from infancy to adolescence found that participants randomized to the foster care group (FCG) experienced greater increases in BMI”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
Distinct BMI trajectories were correlated with higher levels of glycosylated hemoglobin (HbA1c) in previous BEIP studies.
“with distinct trajectories correlated with higher levels of glycosylated hemoglobin (HbA1c)”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
In contrast to Tang et al.'s 16-year follow-up, our accelerated BMI trajectory was not marked by elevated HbA1c.
“In contrast to Tang et al’s 16-year follow-up, our accelerated BMI trajectory was not marked by elevated HbA1c, an indicator of average blood glucose over the past 2–3 months (Tang et al., 2018).”
From Long-term cardiometabolic effects of early institutionalization and foster care: Evidence from the Bucharest Early Intervention Project (2026) · cites this paper as Tang et al., 2018
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References 40 · Cited by 38
Research works printed but not linked: 2
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- Authors
- Tang, A., Slopen, N., Nelson, C. A., Zeanah, C. H., Georgieff, M. K., & Fox, N. A.
- Affiliations
- University of Maryland, College Park (US)
- Boston Children's Hospital (US)
- Tulane University (US)
- University of Minnesota (US)
- Corresponding author
- Fox, Nathan A.
- ORCID
- Venue
- Pediatric Research
- Published
- 2018-10-01
- Volume
- 84
- Issue
- 6
- Pages
- 842-848
- ISSN
- 0031-3998 (ISSN-L)
- 1530-0447
- PMC
- PMC6330119
- OpenAlex
- W2893217610
- Cited by
- 38
- References
- 40
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 7 · 2019: 1
- FWCI
- 3.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Pediatric Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH091363)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD041041)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- catch-up growth, institutionalized children, foster care, body mass index trajectories, metabolic risk, cardiovascular risk, HbA1c, C-reactive protein, inflammation, postnatal weight gain
- MeSH terms
- Adolescent, Adolescent, Institutionalized, Cardiovascular Diseases, Child, Child, Institutionalized, Child, Preschool, Female, Foster Home Care, Growth Disorders, Humans, Infant, Inflammation, Longitudinal Studies, Male, Risk Factors, Romania, Weight Gain, Exercise, Body Mass Index, Body Size
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