Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors

Study Questions:

Are cardiovascular risk factors modified when overweight or obese children are no longer obese as adults?

Methods:

Data from four prospective cohort studies that measured childhood and adult body mass index (BMI) were used for the present study. The studies used for this analysis included two from the United States: the Bogalusa Heart Study and the Muscatine Study. One study was from Australia: the Childhood Determinants of Adult Health (CDAH) study. The other one was from Finland: Cardiovascular Risk in Young Finns Study. The mean length of follow-up was 23 years. International age- and sex-specific BMI cutoff points for overweight and obesity were used for children, and a BMI cutoff point of 30 kg/m2 was used for adults. The primary outcomes of interest were type 2 diabetes (DM), hypertension (HTN), dyslipidemia, and carotid intima-media thickness (IMT). Subjects were classified as having DM, if they had a fasting plasma glucose level of 7 mmol/L (126 mg/L) or higher, reported the use of oral glucose-lowering medication or insulin, but had not reported having type 1 diabetes, or had received a diagnosis of type 2 diabetes from a physician. Dyslipidemia was defined, according to National Cholesterol Education Program guidelines, as low-density lipoprotein (LDL) cholesterol levels of 160 mg/dl (4.14 mmol/L) or higher, high-density lipoprotein (HDL) cholesterol levels of <40 mg/dl (1.03 mmol/L), and triglyceride levels of 200 mg/dl (2.26 mmol/L) or higher. Subjects who were taking lipid-lowering medication were also classified as having dyslipidemia. High-risk IMT in adulthood was defined as an IMT ≥ the 90th percentile for age, sex, race, study year, and cohort-specific values.

Results:

A total of 6,328 subjects (2,961 males and 3,367 females) were included in this study. Mean age at baseline was 11.4 ± 4.0 years. Among 5,554 subjects who had had normal weight as children, 812 (14.6%) were obese as adults. Among 774 subjects who had been overweight or obese as children, 500 (64.6%) were obese as adults, and among 147 subjects who had been obese as children, 121 (82.3%) were obese as adults. Risk of DM was increased among subjects who were overweight or obese as children and were obese as adults (relative risk [RR], 5.4; 95% confidence interval [CI], 3.4-8.5). A similar increased risk was observed for HTN (RR, 2.7; 95% CI, 2.2-3.3), elevated LDL cholesterol (RR, 1.8; 95% CI, 1.4-2.3), reduced HDL cholesterol (RR, 2.1; 95% CI, 1.8-2.5), and elevated triglycerides (RR, 3.0; 95% CI, 2.4-3.8). Carotid IMT was also increased (RR, 1.7; 95% CI, 1.4-2.2). Subjects who were overweight or obese during childhood, but were nonobese as adults had risks of the outcomes that were similar to those of persons who had a normal BMI consistently from childhood to adulthood (p > 0.20 for all comparisons).

Conclusions:

The investigators concluded that overweight or obese children who were obese as adults had increased risks of DM, HTN, dyslipidemia, and carotid-artery atherosclerosis. Among overweight or obese children who were not obese as adults, the rates of these CVD risk factors were similar to the rates observed in adults who were never obese.

Perspective:

These data provide powerful evidence that prevention and treatment of overweight and obesity among children reduced the rates of CVD risk factors in adulthood.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, CHD & Pediatrics and Imaging, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Echocardiography/Ultrasound, Hypertension

Keywords: Atherosclerosis, Carotid Intima-Media Thickness, Overweight, Hypertriglyceridemia, Diabetes Mellitus, Type 2, Finland, Risk Factors, Child, Cholesterol, Dyslipidemias, Carotid Artery, Common, Body Mass Index, Australia, Cardiovascular Diseases, Adiposity, Triglycerides, Hypertension, United States


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