MON-882 - Metabolic Programming at the Population Level: Birth Weight and Adult Metabolic Health Outcomes Across Brazilian State Capitals

Introduction: The developmental origins of health and disease hypothesis states that environmental intrauterine exposures program long-term cardiometabolic health. Individual-level evidence supports this mechanism; here we examine whether similar patterns emerge at the ecological level across Brazilian state capitals. Using publicly available data, we examined associations between birth weight distributions and adult cardiometabolic outcomes across 27 Brazilian state capitals.

Methods: Aggregate birth weight data from the Brazilian Live Births Information System (SINASC; 1996-2005, N=7,298,712 births) to adult health outcomes from the Brazilian Telephone Survey Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL 2023; N=4,707 individuals aged 18-29). Birth cohorts were matched to adult age groups (18-24 and 25-29 years) across 54 capital-cohort strata. We estimated associations using weighted fixed effects regression models using R (version 4.4.3), with capital fixed effects absorbing time-invariant geographic confounders, cohort indicators, and exposure-cohort interactions. Cluster-robust standard errors accounted for within-capital correlation. Exposures were low birth weight ( < 2500g) and macrosomia (≥4000g) prevalence; outcomes were obesity (BMI≥30), overweight (BMI≥25), diabetes, and hypertension prevalence.

Results: Macrosomia prevalence was positively associated with adult overweight (1.55 percentage points per 1% exposure increase, 95% CI: 0.68-2.43, p=0.001) but inversely associated with hypertension (0.77, 95% CI: -1.39 to -0.15, p=0.017). No associations were observed for diabetes and obesity for macrosomia, and no outcome associations were observed for low birth weight.

Conclusions: Higher macrosomia prevalence in birth cohorts was associated with increased adult overweight prevalence across Brazilian state capitals, suggesting a metabolic programming effect at the population level. More studies are needed to assess this effect at the individual level.

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