(08-05-11) Adolescent BMI trajectory and risk of diabetes versus coronary disease.

Tirosh A, Shai I, Afek A, Dubnov-Raz G, Ayalon N, Gordon B, Derazne E, Tzur D,
Shamis A, Vinker S, Rudich A.
Source
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA 02115, USA. [email protected]
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 (?=1.115, P=0.003; P=0.89 for
interaction). In contrast, elevated BMI in both adolescence (?=1.355, P=0.004)
and adulthood (?=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.).

PMID: 21470009 [PubMed - indexed for MEDLINE]

Source: N Engl J Med. 2011 Apr 7;364(14):1315-25.

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