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Birth order is associated with an increased risk of obesity in young adults in Thailand
  1. Linda Aurpibul1,
  2. Éadaoin M Butler2,3,
  3. Antika Wongthanee4,
  4. Amaraporn Rerkasem1,
  5. Sakda Pruenglampoo1,
  6. Ampica Mangklabruks4,
  7. Kittipan Rerkasem1,5,
  8. José G B Derraik1,2,3,6,7
  1. 1 NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  2. 2 A Better Start - National Science Challenge, The University of Auckland, Auckland, New Zealand
  3. 3 Liggins Institute, The University of Auckland, Auckland, New Zealand
  4. 4 Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  5. 5 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  6. 6 Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
  7. 7 Endocrinology Department, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
  1. Correspondence to Kittipan Rerkasem, Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand; rerkase{at} and José Derraik, Liggins Institute, University of Auckland, Auckland, New Zealand; j.derraik{at}


Background There is a growing body of evidence showing that early life events are associated with increased risk of cardiovascular and metabolic diseases later in adult life. However, there is a paucity of data in this field from Asian populations. In this study, we examined the association of birth order with obesity risk and cardiometabolic outcomes in young adults in Thailand.

Methods Participants were the offspring from a birth cohort study in Chiang Mai (northern Thailand), who were followed up at ~20.5 years of age. Clinical assessments included anthropometry, blood pressure, fasting blood samples and carotid intima-media thickness. Insulin sensitivity was estimated using homeostatic model assessment of insulin resistance (HOMA-IR). Participants were stratified into two groups: first-borns and later-borns. Health outcomes between groups were compared using multivariable models adjusting for important confounders, in particular maternal body mass index (BMI).

Results A total of 559 participants were studied: 316 first-borns (46% males) and 243 later-borns (47% males). Adjusted models showed anthropometric differences, with first-borns being 2.3 kg heavier (p=0.023) with a BMI 0.86 kg/m2 greater (p=0.019) than later-borns. Thus, rates of obesity were higher in first-borns than in later-borns (6.6% vs 2.9%), so that first-borns had an adjusted relative risk of obesity 3.3 times greater than later-borns [95% CI 1.42 to 7.88; p=0.006]. There were no observed differences in cardiovascular or metabolic parameters assessed, including HOMA-IR.

Conclusion As observed in other populations, first-borns in Thailand had greater BMI and an increased risk of obesity in young adulthood. However, we observed no other cardiometabolic differences between first- and later-borns.

  • Obesity
  • Cardiovascular disease
  • Epidemiology of chronic non communicable diseases
  • Maternal & child CG

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  • KR and JGBD contributed equally to this work.

  • Contributors KR, AW and AM conceived and performed the original follow-up study; SP, JGBD, KR, and LA conceived this study; AW and JGBD compiled the data, which were analysed by JGBD; LA, EMB and JGBD wrote the manuscript, which was critically revised by KR, AW and AR; all authors have approved this version of the manuscript and agree with its submission. LA is the guarantor.

  • Funding This work was jointly supported by Chiang Mai University (Chiang Mai, Thailand), and the Health System Research Institute.

  • Competing interests The authors have no financial or non-financial conflicts of interest to declare in association with this work. The funders had no role in the research design; data collection, analyses, and interpretation of the data; preparation and approval of the manuscript; or decision to submit the manuscript for publication.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (approval #177/2009). Written informed consent was obtained from all participants prior to study recruitment.

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