Early Life BMI Plays Role in Future Diabetes and CVD Risk, Regardless of Adult BMI

Using 24 years of follow-up data from more than 12k adolescents provides insight into the impact of childhood BMI z-scores on risk of adverse health outcomes, including development of diabetes and premature myocardial infarction, in adulthood.

A letter published in the Journal of the American College of Cardiology is calling attention to the need for new strategies to address the rising obesity epidemic in younger populations.

Using 24 years of follow-up data from more than 12,000 adolescents, investigators from the University of California San Francisco (UCSF) detail the increased risk of diabetes, hypertension, heart attack, and poorer health associated with each incremental increase in BMI z-score among adolescent patients.

“Our study suggests that adolescence is an important time period to optimize health and prevent early heart attacks. Pediatricians should encourage teens to develop healthy behaviors including physical activity and balanced meals," said lead investigator Jason M. Nagata, MD, MSc, Assistant Professor of Pediatrics in the Division of Adolescent and Young Adult Medicine at UCSF, in a statement.

With an interest in adding to the current knowledge base surrounding adolescent BMI and future health outcomes, Nagata and team of UCSF colleagues sought to assess prospective associations between adolescent BMI and adverse health outcomes later in life using nationally representative data from the US. To do so, the team designed their study as an analysis of data from within the National Longitudinal Study of Adolescent to Adult Health (Add Health), which recorded data from more than 20,000 adolescents from 1994-1995 to 2016-2018.

After exclusion of those with missing information or who did not have follow-up data in adulthood, investigators identified a cohort of 12,300 patients for inclusion in their analyses. This cohort was 51.4% women and 34.2% identified as a racial/ethnic minority. The mean baseline BMI of the study cohort was 22.5 kg/m2 and the standard deviation was 4.5.

When assessing data from the 24-year follow-up, results indicated each 1-unit higher BMI z-score in adolescence was associated with a 4.17 kg/m2 greater BMI in adulthood. Adjusted analyses suggested BMI z-score was prospectively associated with overall poor self-reported general health (aOR, 1.49; 95% CI, 1.31-1.70; P <.001), development of diabetes (aOR, 2.35; 95% CI, 2.11-2.63; P <.001), hypertension (aOR, 1.55; 95% CI, 1.45-1.64; P <.001), hyperlipidemia (aOR, 1.24; 95% CI, 1.15-1.34; P <.001), premature myocardial infarction (aOR, 1.77; 95% CI, 1.41-2.24; P <.001), premature heart failure (aOR, 1.81; 95% CI, 1.37-2.40; P <.001), asthma (aOR, 1.12; 95% CI, 1.07-1.18; P <.001), cancer (aOR, 1.18; 95% CI, 1.05-1.34; P=.008) and obstructive sleep apnea (aOR, 1.64; 95% CI, 1.53-1.77; P <.001).

Investigators also pointed out analyses adjusting for adult BMI indicated adolescent BMI z-score was independently associated with poor general health (aOR, 1.23; 95% CI, 1.05-1.445; P=.010), development of diabetes (aOR, 1.56; 95% CI, 1.36-1.79; P <.001), and premature myocardial infarction (aOR, 1.66; 95% CI, 1.25-2.22; P <.001) in adulthood.

"The finding that adolescent BMI is a risk factor for poor health outcomes in adulthood, regardless of adult BMI, has significant implications for our understanding of cardiovascular disease onset," added Nagata. "Considering these findings, health care providers should consider BMI history when assessing for cardiovascular and chronic disease risk."

This study, “Adolescent Body Mass Index and Health Outcomes at 24-Year Follow-Up: A Prospective Cohort Study,” was published in the Journal of the American College of Cardiology.