Abstract
Background and objectives:
Body mass index (BMI) in adolescence may be of particular importance as a predictor of future risk of coronary heart disease (CHD). Associations measured either in childhood or in middle age have appeared to be weaker or non-existent. We investigated the association between BMI measured in adolescence and CHD, and also stroke, among middle aged Swedish men and controlled for potential confounders not included in previous studies.
Methods:
Data on BMI, smoking and blood pressure (diastolic and systolic) was collected from 49 321 Swedish males, born during 1949–1951, at conscription for military service in 1969/70. Census data on socioeconomic indicators in childhood and adulthood was linked to the cohort. The men were followed from 1991 through 2004 in national registers with regard to mortality and hospitalization from CHD and stroke.
Results:
A graded increase of CHD was seen in over six levels of BMI (BMI<18.5, hazard ratio (HR)=1.0, BMI=18.5–20.99 (reference category), BMI=21–22.99, HR=1.2; BMI=23–24.99, HR=1.5; BMI=25–29.99, HR=2.5; BMI ⩾30, HR=4.3). A graded association between BMI and stroke was also found, although weaker. Adjustments for cardiovascular risk factors (smoking, diastolic and systolic blood pressure, and early cardiovascular mortality in parents) attenuated the relative risks to some extent, whereas adjustments for socioeconomic indicators in childhood and adulthood had minor effects.
Conclusion:
The results strongly suggest that BMI in late adolescence is an important predictor of both CHD and stroke among men before age 55 years, independent of smoking, hypertension and early cardiovascular mortality in parents.
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References
Kark M, Rasmussen F . Growing social inequalities in the occurrence of overweight and obesity among young men in Sweden. Scand J Public Health 2005; 33: 472–477.
Janssen I, Katzmarzyk PT, Boyce WF, Vereccken C, Mulvihill C, Roberts C et al. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005; 6: 123–132.
Hoffmans MD, Kromhout D, Coulander CD . Body mass index at the age of 18 and its effects on 32-year-mortality from coronary heart disease and cancer. A nested case–control study among the entire 1932 Dutch male birth cohort. J Clin Epidemiol 1989; 42: 513–520.
Lawlor DA, Leon DA . Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: findings from the Aberdeen children of the 1950s prospective cohort study. Circulation 2005; 111: 1891–1896.
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH . Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922–1935. N Engl J Med 1992; 327: 1350–1355.
Jeffreys M, McCarron P, Gunnell D, McEwen J, Smith GD . Body mass index in early and mid-adulthood, and subsequent mortality: a historical cohort study. Int J Obes 2003; 27: 1391–1397.
Rabkin SW, Mathewson FA, Hsu PH . Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. Am J Cardiol 1977; 39: 452–458.
Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL . The effect of age on the association between body-mass index and mortality. N Engl J Med 1998; 338: 1–7.
McGill Jr HC, McMahan CA, Herderick EE, Zieske AW, Malcom GT, Tracy RE et al. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 2002; 105: 2712–2718.
Berenson GS, Srinivasan SR, Bao W, Newman III WP, Tracy RE, Wattigney WA . Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338: 1650–1656.
Power C, Manor O, Matthews S . Child to adult socioeconomic conditions and obesity in a national cohort. Int J Obes Relat Metab Disord 2003; 27: 1081–1086.
Hardy R, Wadsworth M, Kuh D . The influence of childhood weight and socioeconomic status on change in adult body mass index in a British national birth cohort. Int J Obes Relat Metab Disord 2000; 24: 725–734.
Galobardes B, Lynch JW, Davey Smith G . Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation. Epidemiol Rev 2004; 26: 7–21.
Hemmingsson T, Lundberg I . How far are socioeconomic differences in coronary heart disease hospitalization, all-cause mortality and cardiovascular mortality among adult Swedish males attributable to negative childhood circumstances and behaviour in adolescence? Int J Epidemiol 2005; 34: 260–267.
Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH . Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329: 1008–1012.
Karnehed N, Rasmussen F, Kark M . Obesity and attained education. Cohort study of more than 700 000 Swedish men. Obesity (Silver Spring) 2006; 14: 1421–1428.
Sonne-Holm S, Sorensen TI . Prospective study of attainment of social class of severely obese subjects in relation to parental social class, intelligence, and education. Br Med J (Clin Res Ed) 1986; 292: 586–589.
Mansson NO, Eriksson KF, Israelsson B, Ranstam J, Melander A, Rastam L . Body mass index and disability pension in middle-aged men – non-linear relations. Int J Epidemiol 1996; 25: 80–85.
Karnehed N, Rasmussen F, Kark M . Obesity in young adulthood and later disability pension: a population-based cohort study of 366,929 Swedish men. Scan J Public Health, in press.
Hemingway H, Marmot M . Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ 1999; 318: 1460–1467.
Nilsson PM, Nilsson JA, Berglund G . Family burden of cardiovascular mortality: risk implications for offspring in a national register linkage study based upon the Malmo Preventive Project. J Intern Med 2004; 255: 229–235.
Larsson D, Hemmingsson T, Allebeck P, Lundberg I . Self-rated health and mortality among young men: what is the relation and how may it be explained? Scand J Public Health 2002; 30: 259–266.
Andreasson S, Allebeck P, Romelsjo A . Alcohol and mortality among young men: longitudinal study of Swedish conscripts. Br Med J (Clin Res Ed) 1988; 296: 1021–1025.
WHO Expert Committee on Physical Status: the Uses and Interpretation of Anthropometry. Physical Status: The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee. Geneva, Switzerland: World Health Organization, 1995. World Health Organization Technical Report Series 854.
Batty GD, Lawlor DA, Macintyre S, Clark H, Leon DA . Accuracy of adults' recall of childhood social class: findings from the Aberdeen children of the 1950s study. J Epidemiol Commun Health 2005; 59: 898–903.
Whincup P, Cook D, Geleijnse J . A life course approach to blood pressure. In: Kuh D, Ben-Shlomo Y (eds) A Life Course Approach to Chronic Disease Epidemiology. Oxford University Press: New York, 2004; 218–239.
Rasmussen F, Tynelius P, Kark M . Importance of smoking habits for longitudinal and age-matched changes in body mass index: a cohort study of Swedish men and women. Prev Med 2003; 37: 1–9.
Oren A, Vos LE, Uiterwaal CS, Gorissen WH, Grobbee DE, Bots ML . Change in body mass index from adolescence to young adulthood and increased carotid intima-media thickness at 28 years of age: the Atherosclerosis Risk in Young Adults study. Int J Obes Relat Metab Disord 2003; 27: 1383–1390.
Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G . Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort. Am J Clin Nutr 1998; 67: 1111–1118.
Freedman DS, Dietz WH, Tang R, Mensah GA, Bond MG, Urbina EM et al. The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study. Int J Obes Relat Metab Disord 2004; 28: 159–166.
Raitakari OT, Juonala M, Viikari JS . Obesity in childhood and vascular changes in adulthood: insights into the Cardiovascular Risk in Young Finns Study. Int J Obes (Lond) 2005; 29 (Suppl 2): S101–S104.
Bender R, Jockel KH, Trautner C, Spraul M, Berger M . Effect of age on excess mortality in obesity. JAMA 1999; 281: 1498–1504.
Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T . Do obese children become obese adults? A review of the literature. Prev Med 1993; 22: 167–177.
Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS . The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics 2005; 115: 22–27.
Rosengren A, Wedel H, Wilhelmsen L . Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality. A prospective population study. Eur Heart J 1999; 20: 269–277.
Hubert HB, Feinleib M, McNamara PM, Castelli WP . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968–977.
Srinivasan SR, Bao W, Wattigney WA, Berenson GS . Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism 1996; 45: 235–240.
Smoak CG, Burke GL, Webber LS, Harsha DW, Srinivasan SR, Berenson GS . Relation of obesity to clustering of cardiovascular disease risk factors in children and young adults. The Bogalusa Heart Study. Am J Epidemiol 1987; 125: 364–372.
McCarron P, Davey Smith G . Commentary: incubation of coronary heart disease – recent developments. Int J Epidemiol 2005; 34: 248–250.
Viner RM, Cole TJ . Adult socioeconomic, educational, social, and psychological outcomes of childhood obesity: a national birth cohort study. BMJ 2005; 330: 1354.
Sarlio-Lahteenkorva S, Lahelma E . The association of body mass index with social and economic disadvantage in women and men. Int J Epidemiol 1999; 28: 445–449.
Acknowledgements
The ethics committee at the Karolinska Institute, Stockholm, approved this study. The study was financed by the Swedish Council for Working Life and Social Research (Project No 2003–0382).
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Falkstedt, D., Hemmingsson, T., Rasmussen, F. et al. Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men. Int J Obes 31, 777–783 (2007). https://doi.org/10.1038/sj.ijo.0803480
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DOI: https://doi.org/10.1038/sj.ijo.0803480
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