Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study

Abstract

Background Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group. Methods and findings In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3-17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of followup) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0-24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00-8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group.

A novel interactive mobile health support system for pediatric obesity treatment: a randomized controlled feasibility trial

“…Childhood obesity is a disease associated with severe long-term consequences [ 41 , 42 ] . Reduction of the degree of obesity is stressful for most people and, like all medical treatments, the negative effects of the treatment need to be balanced against the benefits.…”

The Impact of Diabetes Mellitus on Cardiovascular Risk Onset in Children and Adolescents

“…Diabetes mellitus is associated with a two-fold increase in the risk for cardiovascular disease, with a premature CV mortality and a four-fold increase in mortality for all-cause in young [ 17 , 18 , 19 ]. Moreover, the coexistence of obesity further increases the risk for specific- and all-cause mortality [ 20 ]. Previous studies in T1D and T2D, although not conclusive, suggested an increased risk for ischemic heart, macrovascular diseases and death, particularly in patients with T2D diagnosed between 15 and 30 years of age [ 21 ].…”

The effectiveness of pediatric obesity prevention policies: a comprehensive systematic review and dose–response meta-analysis of controlled clinical trials

“…Overweight and obese children persist as a serious health problem and a public challenge of the twenty-first century. Obesity among children and adolescents is a leading cause of health and contributes to cardiovascular disease, cerebrovascular disease, and metabolic diseases [ 1 ]. Nearly one in five children and adolescents are overweight or obese [ 2 ], and the growing prevalence of obesity in youth has led to an alarming increase of 18.5% in children and adolescents between the ages of 2–19 years [ 3 ].…”