Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease
By A. Tirosh, I. Shai, A. Afek, G. Dubnov-Raz, N. Ayalon, B. Gordon, E. Derazne, D. Tzur, A. Shamis, S. Vinker and 1 more. New England Journal of Medicine, 2011
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BACKGROUND The association of body-mass index (BMI) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated. METHODS We conducted a prospective study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age. RESULTS During approximately 650,000 person-years of follow-up (mean follow-up, 17.4 years), we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease. In multivariate models adjusted for age, family history, blood pressure, lifestyle factors, and biomarkers in blood, elevated adolescent BMI (the weight in kilograms divided by the square of the height in meters; mean range for the first through last deciles, 17.3 to 27.6) was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76; 95% confidence interval [CI], 2.11 to 3.58) and angiography-proven coronary heart disease (hazard ratio, 5.43; 95% CI, 2.77 to 10.62). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01; 95% CI, 0.75 to 1.37) but not the association with coronary heart disease (hazard ratio, 6.85; 95% CI, 3.30 to 14.21). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes (β = 1.115, P = 0.003; P = 0.89 for interaction). In contrast, elevated BMI in both adolescence (β = 1.355, P = 0.004) and adulthood (β = 1.207, P = 0.03) were independently associated with angiography-proven coronary heart disease (P = 0.048 for interaction). CONCLUSIONS An elevated BMI in adolescence — one that is well within the range currently considered to be normal — constitutes a substantial risk factor for obesity-related disorders in midlife. Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes. (Funded by the Chaim Sheba Medical Center and the Israel Defense Forces Medical Corps.)
Subfields: Cardiology and Cardiovascular Medicine, Endocrinology, Diabetes and Metabolism, Public Health, Environmental and Occupational Health
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Citations in the corpus
- Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. (2012, background): “This may have serious long-term implications as elevated BMI during adolescence, even within the normal range, predicted the incidence of diabetes and coronary heart disease in adulthood (Tirosh et al., 2011).”
- Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches A Scientific Statement From the American Heart Association (2013, background): “21) in youth with a BMI ≥91st percentile even after adjustment for adult BMI and other cardiovascular risk factors.(29) In a large study of Danish school children, higher BMI during childhood was associated with an increased risk of coronary heart disease in adulthood, and the strength of the associ”
- The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review (2012, background): “Of 10 studies that analysed the relationship between BMI or BMI status in childhood (ages 0–18 years) and type 2 diabetes in adulthood, 9 reported a positive association (n ranged from 822 [17] to 37,674 [16]).”