Adolescent BMI and risk of diabetes and coronary disease

January 01, 0001

Adolescent BMI and risk of diabetes and coronary disease

These Israeli authors conducted a prospective study in which they followed a cohort of 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through 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.

They found: "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 was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76) and angiography- proven coronary heart disease (hazard ratio, 5.43). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01) but not the association with coronary heart disease (hazard ratio, 6.85). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes. In contrast, elevated BMI in both adolescence and adulthood were independently associated with angiography- proven coronary heart disease."

The authors concluded: "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."

Prevention of coronary artery disease should start young.

For the full abstract, click here.

N Engl J Med 364:1315-1325, 7 April 2011
© 2011 to the Massachusetts Medical Society
Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease. Amir Tirosh, Iris Shai, Arnon Afek, et al. Correspondence to Dr. Tirosh: [email protected]

Category: T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: body mass index, BMI, coronary artery disease, type 2 diabetes, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.