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Adolescent BMI trajectory and risk of diabetes versus coronary disease. | LitMetric

Adolescent BMI trajectory and risk of diabetes versus coronary disease.

N Engl J Med

Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Published: April 2011

AI Article Synopsis

  • A study was conducted following 37,674 healthy young men from age 17 to assess the long-term impact of adolescent body-mass index (BMI) on adult obesity-related diseases, particularly diabetes and coronary heart disease.
  • Over 17.4 years, the research found that higher adolescent BMI significantly predicted the development of type 2 diabetes and coronary heart disease, even after adjusting for various health factors.
  • While the association between adolescent BMI and diabetes disappeared when adult BMI was considered, the link between adolescent BMI and coronary heart disease remained significant, indicating that both adolescent and adult BMI contribute independently to cardiovascular risk.

Article Abstract

Background: The association of body-mass index (BMI) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated.

Methods: We conducted a prospective study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age.

Results: During approximately 650,000 person-years of follow-up (mean follow-up, 17.4 years), we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease. In multivariate models adjusted for age, family history, blood pressure, lifestyle factors, and biomarkers in blood, elevated adolescent BMI (the weight in kilograms divided by the square of the height in meters; mean range for the first through last deciles, 17.3 to 27.6) was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76; 95% confidence interval [CI], 2.11 to 3.58) and angiography-proven coronary heart disease (hazard ratio, 5.43; 95% CI, 2.77 to 10.62). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01; 95% CI, 0.75 to 1.37) but not the association with coronary heart disease (hazard ratio, 6.85; 95% CI, 3.30 to 14.21). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes (β=1.115, P=0.003; P=0.89 for interaction). In contrast, elevated BMI in both adolescence (β=1.355, P=0.004) and adulthood (β=1.207, P=0.03) were independently associated with angiography-proven coronary heart disease (P=0.048 for interaction).

Conclusions: An elevated BMI in adolescence--one that is well within the range currently considered to be normal--constitutes a substantial risk factor for obesity-related disorders in midlife. Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes. (Funded by the Chaim Sheba Medical Center and the Israel Defense Forces Medical Corps.).

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939259PMC
http://dx.doi.org/10.1056/NEJMoa1006992DOI Listing

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