As an epidemiologist, my research is related to childhood obesity and nutrition and their long-term impact on cardiometabolic health into adulthood. I am also interested in early-life exposures occurring during pregnancy and breastfeeding that may help establish developmental trajectories into childhood and beyond. I have significant expertise in how children develop relative to growth charting. My goal is to understand whether there are critical periods in early life or key aspects of developmental exposures that may prevent future obesity and cardiometabolic diseases.
My early research focused on infancy and the role of breastfeeding and human milk composition in modulating obesity risk. This work used a set of parallel international cohorts recruited in Cincinnati, Mexico City and Shanghai. I evaluated the role of human milk adiponectin in infant growth while considering complementary feeding timing and diversity of foods in this relationship.
My groundbreaking work has centered on the use of growth charts to evaluate infant obesity and identify critical time periods for the development of early-onset severe obesity. In 2009, I identified that the Centers for Disease Control and Prevention (CDC) body mass index (BMI) z-scores, used widely in clinical and research applications, have a critical flaw. In particular, because of how they were developed, CDC BMI z-scores do not effectively differentiate the weight status of children and adolescents with severe obesity. This topic was the focus of a National Center for Health Statistics (NCHS) workshop that aimed to propose alternative metrics for effectively assessing adiposity status at the high end of the distribution. This work has resulted in several manuscript publications and altered recommendations for the use of CDC growth charts.
Traditionally, there has not been a definition of obesity for children under the age of two and a hesitancy to identify infants as obese. My studies have identified that children who develop severe early-onset (prior to age 6) obesity have a significantly different BMI trajectory in infancy that is identifiable as early as six months of age. Infants at or above the 85th percentile on the World Health Organization (WHO) BMI growth charts have a 50 percent risk of being overweight or obese by age six, compared with just 11 percent of those below this threshold.
My ongoing research focuses on the follow-up of several large-scale epidemiologic cohorts, which recruited children in the 1970s and 1980s, following them into mid-adulthood. Study assessments include cardiometabolic risk factors, adiposity, diet, cardiovascular disease and death. This life-course view of the impact of childhood risk factors on adult disease has demonstrated that the risk of adult disease arises from even modest elevations in childhood risk factors that can help direct early prevention efforts. This work is conducted in collaboration with the International Childhood Cardiovascular Cohorts (i3C) Consortium.
I’ve been honored to receive the following awards and honors:
BA: Cornell University, Ithaca, NY, 1993.
MHSA: University of Michigan, Ann Arbor, MI, 1995.
PhD: University of Cincinnati, Cincinnati, OH, 2004.
Early life influences on the development of pediatric obesity; severe obesity in childhood; breastfeeding and complementary food; life-course epidemiology of obesity and cardiometabolic disease; dyslipidemia and insulin resistance; nutritional epidemiology
Biostatistics and Epidemiology, Heart
Timing and Magnitude of Peak Body Mass Index and Peak Weight Velocity in Infancy Predict Body Mass Index at 2 Years in a Retrospective Cohort of Electronic Health Record Data. The Journal of Pediatrics. 2023; 257:113356.
Lipoprotein(a) in Youth and Prediction of Major Cardiovascular Outcomes in Adulthood. Circulation. 2023; 147:23-31.
Longitudinal Changes in Various BMI Metrics and Adiposity in 3- to 7-Year-Olds. Pediatrics. 2022; 150:e2022058302.
The Longitudinal Relation between Infant Feeding Styles and Growth Trajectories among Families from Low-Income Households. The Journal of nutrition. 2022; 152:2015-2022.
Childhood obesity and adverse cardiometabolic risk in large for gestational age infants and potential early preventive strategies: a narrative review. Pediatric Research. 2022; 92:653-661.
Childhood Risk Factors and Adult Cardiovascular Events. Reply. The New England journal of medicine. 2022; 387:473-474.
Body-mass index trajectories from childhood to mid-adulthood and their sociodemographic predictors: Evidence from the International Childhood Cardiovascular Cohort (i3C) Consortium. EClinicalMedicine. 2022; 48:101440.
Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events. The New England journal of medicine. 2022; 386:1877-1888.
Prevalence Implications of the 2017 American Academy of Pediatrics Hypertension Guideline and Associations with Adult Hypertension. The Journal of Pediatrics. 2022; 241:22-28.e4.
Jessica Graus Woo, MHSA, PhD, Elaine M. Urbina, MD, MS2/8/2023
Jessica Graus Woo, MHSA, PhD4/6/2022
Jessica Graus Woo, MHSA, PhD11/18/2020
Jessica Graus Woo, MHSA, PhD10/30/2020
Jessica Graus Woo, MHSA, PhD10/9/2019