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Abstract
CONTEXT: It is thought that slippery femoral epiphysis (SCFE) is associated with childhood obesity, although the strength of the association is unknown.
METHODS: We performed a cohort study using routine data from health screening tests at the entrance of primary school (ages 5 to 6) in Scotland, in conjunction with with a national database on admissions to the hospital. One subgroup took another screening test at the end of primary school (ages 11 to 12).
RESULTS: The BMI was available for 597,017 children aged 5 to 6 years attending school and 39,468 at the age of 11 to 12 years. There were 4.26 million children-years at risk of SCFE. Among obese children aged 5 to 6, 75% remained obese between 11 and 12 years of age. There was a strong biological gradient between BMI in children aged 5-6 years and SCFE, with the risk of disease increasing by a factor of 1.7 (95% confidence interval). [CI] 1.5 to 1.9) for every full increase in BMI z Goal. The risk of SCFE was almost negligible in children with the lowest BMI. Individuals with severe obesity aged 5 to 6 years were 5.9 times more likely to have CPFE (95% CI 3.9 to 9.0) than people with normal BMI; people with severe obesity aged 11 to 12 years were 17.0 times more likely to undergo SCFE (95% CI 5.9 to 49.0).
CONCLUSIONS: A high BMI in children is strongly associated with SCFE. The magnitude of the association, the temporal relationship and the dose-response relationship added to the plausible mechanism constitute the strongest evidence available to corroborate a causal association.
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