Body Mass Index in 2,298,130 Adolescents and Cardiovascular Mortality in Adulthood
2The Pinhas Borenstein, Talpiot Medical Leadership Program, Sheba Medical Center
3The Medical Corps, Israel Defense Forces
4The Sackler School of Medicine, Tel Aviv University
5., The Israeli Ministry of Health
6School of Public Health and Community Medicine, Hebrew University-Hadassah
Background: To assess sequelae of the worldwide increase in childhood obesity, we examined the association of body mass index (BMI) in late adolescence with cardiovascular disease mortality (CVD) in midlife.
Methods: BMI of 2,298,130 Israeli adolescents (60% men; mean age 17.3±0.3 years), measured from 1967-2010, was grouped by US-CDC age and sex percentiles. Outcomes, obtained by linkage with national records, were mortality by mid-2011 attributed to coronary heart disease (CHD), stroke, sudden death and their summation as CVD. Cox proportional hazards models were applied.
Results: During 42,297,007 person-years of follow-up (median 18.4 years) there were 1497, 528, 893 and 2,918 deaths from CHD, stroke, sudden death and CVD, respectively. A graded increase in all CVD-specific outcomes, non-CVD death and all-cause mortality commenced in the 50th-74th percentile BMI group, and persisted in multivariate analysis adjusted for sex, age, birth year, socio-demographic variables and height. The adjusted risk for CVD mortality among overweight (85th≤BMI<95th) and the 50th-74th BMI percentile was 2.2 (95% confidence interval [CI], 1.9-2.6), and 1.3 (1.2-1.5), respectively (reference, 5th-24th percentile). Adjusted risks for mortality attributed to CHD, stroke, sudden death and CVD among obese (≥95th percentile) were 5.0 (4.0-6.3), 2.7 (1.8-4.2), 2.1 (1.5-2.9) and 3.5 (3.0-4.2), respectively. Multivariable-adjusted spline model revealed a minimum risk BMI of 18.3 kg/m2 for CVD mortality (arrow in figure; grey denotes 95%CI). Findings persisted in sex-specific analysis, restriction to participants with unimpaired health, separate analysis for deaths before and after age 45, analysis of CVD deaths by different periods and accounting for competing risks.
Conclusions: Adolescent BMI, well within the currently accepted `normal` range, predicted CVD and all-cause mortality up to 5 decades later. Overweight and obesity was strongly associated with CHD and CVD mortality in midlife. These sequelae in later adulthood point to an increasing future burden of the ongoing childhood obesity epidemic.
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