LETTER TO THE EDITOR
Implications of late adiposity reboundTo the Editor:
The increased risk of obesity with early adiposity reboundis well documented, but the clinical significance of lateadiposity rebound is not fully understood.1-3 Moon
concluded that late adiposity rebound (³7 years of age) was
significantly associated with a decreased risk of obesity andan increased probability of reversing obesity among kindergarteners.4 Thus, in considering the transition of the risk ofobesity during early childhood, the progress of late adiposity
rebound is important.4
We would like to add our observations on comparison oflate and early adiposity rebound based on body mass index(BMI) and plasma lipoproteins at 12 years of age. The subjects were 217 children in a birth cohort who underwent
annual measurements of BMI at 1-16 years of age.2,3 Relationships were evaluated among the timing of adiposity
rebound (early vs late: <3 vs ³7 years old), timing of entering
puberty, and BMI and plasma lipid profiles at 12 years of age.
Growth velocities of >7.0 cm per year in girls and >8.0 cm peryear in boys were used as an estimation of the time of entering
puberty.5
The age of onset of puberty was significantly lower in children with adiposity rebound at <3 years compared with thosewith adiposity rebound at ³7 years in girls (8.5  1.51 years[n = 8] vs 9.8  0.63 years [n = 10]; P < .05) and in boys
(11.3  0.95 years [n = 7] vs 12.4  0.96 [n = 16];
P < .05). Early adiposity rebound is known to be associatedwith maturation.6 In a combined examination of boys andgirls, the mean BMI at 12 years of age was lower in children
with late adiposity rebound than in those with early adiposity
rebound (17.4 [n = 26] vs 22.5 [n = 15]; P < .001) and themean plasma lipid profiles at 12 years of age in children
with late adiposity rebound (n = 26) showed a less atherogenic pattern compared with those with early adiposity
rebound (n = 15): high-density lipoprotein cholesterol,
62.2 mg/dL vs 70.0 mg/dL (P < .01); triglycerides, 69.3 mg/
dL vs 59.3 mg/dL (P < .05); apolipoprotein B, 86.8 vs 70.3(P < .05); and atherogenic index 1.81 vs 1.51 (P < .05).7
It is possible that the increased energy demand for thedeveloping brain in early childhood is related to lateadiposity rebound (reduced insulin resistance).8,9 Therefore,
it is important to clarify the importance of late adiposity

rebound not only from the viewpoint of the path to obesity,
but also from the perspective of development of brain healthin children.
Osamu Arisaka, MD, PhD
Go Ichikawa, MD, PhD
Department of Pediatrics
Nasu Red Cross Hospital
Ohtawara, Tochigi-ken, JapanGeorge Imataka, MD, PhD
Satomi Koyama, MD, PhD
Department of Pediatrics
Dokkyo Medical University School of Medicine
Mibu, Tocjigi-ken, JapanToshimi Sairenchi, PhD
Department of Public Health
Dokkyo Medical University School of Medicine
Mibu, Tochigi-ken, Japan
https://doi.org/10.1016/j.jpeds.2019.12.024

References
1. Rolland-Cachera MF, Cole TJ. Does the age at adiposity rebound reflect acritical period? Pediatr Obes 2019;14, in press.
2. Koyama S, Ichikawa G, Kojima M, Shimura N, Sairenchi T, Arisaka O.
Adiposity rebound and the development of metabolic syndrome. Pediatrics 2014;133:e114-9.
3. Arisaka O, Ichikawa G, Koyama S, Sairenchi T. Early increase in bodymass index and cardiometabolic risk in adolescence. J Pediatr 2019;243:214.
4. Moon RC. Late adiposity rebound and the probability of developing andreversing childhood obesity. J Pediatr 2019;216:128-35.
5. Gasser T, Sheehy A, Largo RH. Statistical characterization of the pubertal
growth. Ann Hum Biol 2001;28:395-402.
6. Williams S, Dickson N. Early growth, menarche, and adiposity rebound.
Lancet 2002;359:580-1.
7. Watabe Y, Arisaka O, Miyake N, Ichikawa G, Koyama S, Shimura N.
Estimation of LDL particle size using lipid indices: A population–based
study of 1578 school children. Metab Syndr Relat Disord 2015;13:465-9.
8. Kuzawa CW, Blair C. A hypothesis linking the energy demand of the brain
to obesity risk. Proc Natl Acad Sci U S A 2019;116:13266-75.
9. Schapiro ALB, Wilkening G, Aalrborg J, Ringham BM, Glueck DH,Tregellas JR, et al. Childhood metabolic biomarkers are associated withperformance on cognitive tasks in young children. J Pediatr 2019;211:
92-7.

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