Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease

Abstract

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.)

American‐Style Football and Cardiovascular Health

“…In the general pediatric population, epidemiologic data obtained from separate cohorts of obese children and adolescents of various ethnicities and from separate geographic regions have also demonstrated increased cardiovascular disease mortality later in adulthood 36, 37, 38, 39. Similar to the observed data reported from adults, strong associations between increased body mass index (BMI; calculated as kg/m 2 ) and systolic blood pressure (SBP) have been demonstrated in large population‐based pediatric studies such as NHANES III (Third National Health and Nutrition Examination Survey) 40…”

Coronary artery disease risk among obese metabolically healthy young men

“…The outcome definition for CAD in the MELANY study is angiography-proven stenosis of 50% in at least one coronary artery (1,17,18). Follow-up began at participants' first visit to the screening center and ended at the time of CAD diagnosis, death, retirement from military service, or 8th March 2011, whichever came first.…”

“…Screening for CAD was conducted as reported previously (1,17). Referral for a diagnostic procedure was based on clinical suspicion for participants %35 years of age, while participants above 35 years of age were referred for a treadmill exercise test (Bruce protocol) in the presence of a board-certified cardiologist.…”

“…Obesity is considered to be an independent risk factor for coronary artery disease (CAD) (1,2). However, some reports have suggested that not all obese individuals are at an increased risk.…”

Asociación entre condición física y adiposidad en escolares de Montería, Colombia / Associations Between Physical Fitness and Adiposity Among School-Age Children from Monteria, Colombia

“…Por su parte, la adiposidad excesiva se ha asociado a riesgo cardiovascular y metabólico. Por ejemplo, valores elevados de IMC en la adolescencia han sido asociados a mayor riesgo de diabetes y enfermedad coronaria en la adultez (14). Igualmente, niveles críticos de porcentaje de masa adiposa (PMA) de 25% en niños y 35% en niñas, han sido asociados con niveles elevados de lipoproteínas, colesterol y tensión arterial en niños y adolescentes (15).…”