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Associations of anthropometry since birth with sagittal posture at age 7 in a prospective birth cohort: the Generation XXI Study
  1. Fábio A Araújo1,2,
  2. Raquel Lucas1,2,
  3. Andrew J Simpkin3,4,
  4. Jon Heron3,4,
  5. Nuno Alegrete5,6,
  6. Kate Tilling3,4,
  7. Laura D Howe3,4,
  8. Henrique Barros1,2
  1. 1 ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
  2. 2 Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
  3. 3 MRC Integrative Epidemiology Unit, Bristol, UK
  4. 4 School of Social and Community Medicine, University of Bristol, Bristol, UK
  5. 5 Centro Hospitalar São João, Porto, Portugal
  6. 6 Departamento de Cirurgia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
  1. Correspondence to Dr Fábio A Araújo; fabio.araujo{at}


Objectives Adult sagittal posture is established during childhood and adolescence. A flattened or hypercurved spine is associated with poorer musculoskeletal health in adulthood. Although anthropometry from birth onwards is expected to be a key influence on sagittal posture design, this has never been assessed during childhood. Our aim was to estimate the association between body size throughout childhood with sagittal postural patterns at age 7.

Design Prospective cohort study.

Setting and participants A subsample of 1029 girls and 1101 boys taking part in the 7-year-old follow-up of the birth cohort Generation XXI (Porto, Portugal) was included. We assessed the associations between anthropometric measurements (weight, height and body mass index) at birth, 4 and 7 years of age and postural patterns at age 7. Postural patterns were defined using latent profile analysis, a probabilistic model-based technique which allows for simultaneously including anthropometrics as predictors of latent profiles by means of logistic regression.

Results Postural patterns identified were sway, flat and "neutral to hyperlordotic"in girls, and "sway to neutral", flat and hyperlordotic in boys; with flat and hyperlordotic postures representing a straightened and a rounded spine, respectively. In both girls and boys, higher weight was associated with lower odds of a flat pattern compared with a sway/"sway to neutral"pattern, with stronger associations at older ages: for example, ORs were 0.68 (95% CI 0.53 to 0.88) per SD increase in birth weight and 0.36 (95% CI 0.19 to 0.68) per SD increase in weight at age 7 in girls, with similar findings in boys. Boys with higher ponderal index at birth were more frequently assigned to the hyperlordotic pattern (OR=1.44 per SD; p=0.043).

Conclusions Our findings support a prospective sculpting role of body size and therefore of load on musculoskeletal spinopelvic structures, with stronger associations as children get older.

  • Body size
  • sagittal standing posture
  • latent profile analysis
  • musculoskeletal epidemiology
  • child

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  • Contributors FAA, RL, NA and HB collaborated in the conceptualisation, design and acquisition of data. FAA, RL, AJS, JH, NA, KT, LDH and HB collaborated in the analysis and interpretation of data. FAA drafted the initial manuscript. RL, AJS, JH, NA, KT, LDH and HB critically reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding Generation XXI was funded by FEDER through the Operational Programme Competitiveness and Internationalization and by national funds through the FCT - Fundação para a Ciência e a Tecnologia via grants POCI-01-0145-FEDER-016838 and POCI-01-0145-FEDER-016837, under the projects PTDC/DTP-EPI/1687/2014 and PTDC/DTP-EPI/3306/2014. Support by Administração Regional de Saúde Norte (Ministry of Health), Fundação Calouste Gulbenkian and Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; UID/DTP/04750/2013) is also acknowledged. Araújo FA and Lucas R were supported by grants SFRH/BD/85398/2012 and SFRH/BPD/88729/2012, co-funded by FCT and the POPH/FSE.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee of São João Hospital/University of Porto Medical School.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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