Adolescent BMI and Cardiovascular Death in Adulthood
Is body mass index (BMI) in adolescents associated with cardiovascular disease (CVD) death during adulthood?
Data from 2.3 million Israeli adolescents, between the ages of 16 and 19 years (mean age 17.3 years), collected between 1967 and 2010, were used for the present analysis. Adolescents are required to undergo a medical evaluation, 1 year prior to military service. BMI at the time of this examination was categorized using the US Centers for Disease Control and Prevention age- and gender-specific percentiles. The primary outcomes of interest were the number of deaths attributed to coronary heart disease (CHD), stroke, sudden death (from an unknown cause), or a combination of all three categories.
Over 42,297,007 person-years of follow-up, 9.1% of deaths were attributable to CVD, including 1,497 from heart disease, 528 from stroke, and 893 from sudden death. Risk of both all-cause and CVD-related death increased for those with a BMI in the 50th to 74th percentile of BMI. Compared to a reference group with BMIs between the 5th and 24th percentile, those who were obese during adolescence had an increased risk for CHD death (hazard ratio [HR], 4.9; 95% confidence interval [CI], 3.9-6.1), death from stroke (HR, 2.6; 95% CI, 1.7-4.1), sudden death (HR, 2.1; 95% CI, 1.5-2.9), and total CVD death (HR, 3.5; 95% CI, 2.9-4.1), after adjusting for age, sex, birth year, socioeconomic status factors, and height. Risk for CVD death increased with increasing age within BMI percentile groups, while CHD death was consistently high during follow-up.
The investigators concluded that BMI in adolescence was associated with increased risk for CVD and CAD mortality, starting in the 50th to 74th percentile, which is considered a normal range for this age. Overweight and obesity were strongly associated with CVD mortality during adulthood.
These data strongly support the need for programs that promote healthy weight during childhood and adolescence, and suggest recommendations for a BMI under the 25th percentile.
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