Child-to-Adult BMI and Cardiometabolic Risk

Study Questions:

Are body mass index (BMI) trajectories from childhood to adulthood associated with risk for cardiovascular disease (CVD) risk factors?

Methods:

Data from a subset of patients from the Cardiovascular Risk in Young Finns Study whose height and weight were measured on ≥3 occasions between 1980 and 2011 were used for the present analysis. Information on BMI over time among participants was used to identify discrete long-term BMI trajectories. On average, participants had 5.4 individual BMI records (71% had ≥5). The trajectories included stable normal, resolving, progressively overweight, progressively obese, rapidly overweight/obese, and persistent increasing overweight/obese. Cardiometabolic risk outcomes including type 2 diabetes mellitus, hypertension, and dyslipidemia were assessed in 2001, 2007, and 2011. Carotid intima-media thickness (cIMT) was assessed in 2001 and 2007.

Results:

Among 2,631 participants (1,208 males, 1,423 females), the distribution in the six discrete BMI trajectories included stable normal (55.2%), resolving (1.6%), progressively overweight (33.4%), progressively obese (4.2%), rapidly overweight/obese (4.3%), and persistent increasing overweight/obese (1.2%). Trajectories of worsening or persisting obesity were generally associated with increased risk of CVD outcomes in adulthood (24–49 years) (all risk ratios [RRs] >15, p < 0.05 compared with the stable normal group), although residual risk for adult type 2 diabetes could not be confirmed (RR, 2.6; 95% CI, 0.14–8.23). Participants who resolved their elevated childhood BMI had similar risk for dyslipidemia and hypertension as those who were never obese or overweight (all RRs close to 1). However, they had a significantly higher risk for increased cIMT (RR, 3.37; 95% CI, 1.80–6.39).

Conclusions:

The authors concluded that the long-term BMI trajectories that reach or persist at high levels were associated with CVD risk factors in adulthood. Stabilizing BMI in obese adults and resolving elevated childhood BMI by adulthood might limit and reduce adverse cardiometabolic profiles.

Perspective:

These results support the need to prevent overweight and obesity during early childhood. Such public health measures will likely translate into reductions in CVD risk factors among adults.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Echocardiography/Ultrasound, Hypertension

Keywords: Body Mass Index, Body Weight, Cardiovascular Diseases, Carotid Intima-Media Thickness, Diabetes Mellitus, Type 2, Dyslipidemias, Hypertension, Metabolic Syndrome X, Obesity, Overweight, Pediatrics, Primary Prevention, Public Health, Risk Factors


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