The emerging pandemic of obesity is threatening to reverse the gains in cardiovascular mortality and morbidity that have occurred during the latter half of the 20th century. While adult obesity is clearly related to cardiovascular risk the association of body-mass index (BMI) in adolescence to future adult cardiovascular disease has not been completely delineated.
Using data from the Staff Periodic Examination Center of the Israeli Army Medical Corps the authors were able to assess height and weight from 37,674 apparently healthy young men, starting at age 17 and then being repeated every 3 to 5 years for a median period of 16.9 years. During this time participants were followed for incident angiography-proven coronary heart disease and type II diabetes. During approximately 650,000 person-years of follow-up, 1173 incident cases of type II diabetes and 327 of coronary heart disease were documented. Dividing the cohort into deciles, in multivariate analysis, elevated adolescent BMI was a significant predictor of both diabetes (HR for the highest vs. the lowest decile, 2.76; 95% CI, 2.11 to 3.58) and angiography-proven coronary heart disease (HR, 5.43; 95% CI, 2.77 to 10.62). However, 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) while BMI in both adolescence and adulthood continued to be associated with coronary disease (P=0.048 for interaction).
An elevated BMI in adolescence constitutes a substantial risk factor for obesity-related disorders in later life. Coronary artery disease in particular is strongly associated with an elevated BMI both in adolescence and in adulthood, while diabetes is more strongly associated with BMI closer to the time of diagnosis. Targeted treatment of obesity in early life may be an important strategy to mitigate future cardiovascular risk.
- Tirosh A, Shai I, Afek A et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med. 2011 Apr 7;364(14):1315-25.