Childhood obesity and slipped capital femoral epiphysis

Journal article

Background Slipped Capital Femoral Epiphysis (SCFE) is believed to be associated with Childhood Obesity, although the strength of the association is unknown. There is little evidence to suggest if this association is causal.

Methods We performed a cohort study using routine data from a nationwide childhood heath screening examination at primary school entry (5-6 years old) at schools in Scotland, linked to a nationwide admissions database. A subgroup of children also had BMI recorded at exit from primary school (11–12 years old).

Results BMI was available for 597,017 children at 5-6 years old school, and 39,468 at 11-12 years old. There were 4.26 million child-years at risk for SCFE. Amongst children obese at 5-6 years old, 75% remained obese at 11-12 years old. There was a very strong biological-gradient between childhood BMI at 5-6 years old and SCFE, with the risk of disease increasing by 1.7 (95% CI 1.5-1.9) for each integer increase in zscore of BMI. There risk of SCFE was almost negligible amongst children with the lowest BMI. The severely obese at 5-6 years old had 5.9 (95% CI 3.9-9.0) times greater risk of SCFE compared to those with a normal BMI, and the severely obese at 11-12 years had 17.0 (95% CI 5.9-49.0) times the risk of SCFE.

Conclusion High childhood BMI is very strongly associated with SCFE. The magnitude of the association, temporal relationship, dose-response, added to the plausible mechanism, offer the strongest evidence available to support a causal association.

Authors: Perry, DC; Metcalfe, D; Lane, S; Turner, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Academy of Pediatrics
• Journal: Pediatrics
• Volume: 142
• Issue: 5
• Publication date: 2018-11-01
• Acceptance date: 2018-08-06
• DOI: 10.1542/peds.2018-1067
• EISSN: 1098-4275
• ISSN: 0031-4005