Markus Juonala, M.D., Ph.D., Costan G. Magnussen, Ph.D., Gerald S. Berenson, M.D., Alison Venn, Ph.D., Trudy L. Burns, M.P.H., Ph.D., Matthew A. Sabin, M.D., Ph.D., Sathanur R. Srinivasan, Ph.D., Stephen R. Daniels, M.D., Ph.D., Patricia H. Davis, M.D., Wei Chen, M.D., Ph.D., Cong Sun, M.D., Ph.D., Michael Cheung, M.D., Ph.D., Jorma S.A. Viikari, M.D., Ph.D., Terence Dwyer, M.D., M.P.H., and Olli T. Raitakari, M.D., Ph.D.
N Engl J Med 2011; 365:1876-1885
Background: Obesity in childhood is associated with increased cardiovascular risk. It is uncertain whether this risk is attenuated in persons who are overweight or obese as children but not obese as adults.
Methods: We analyzed data from four prospective cohort studies that measured childhood and adult body-mass index (BMI, the weight in kilograms divided by the square of the height in meters). The mean length of follow-up was 23 years. To define high adiposity status, international age-specific and sex-specific BMI cutoff points for overweight and obesity were used for children, and a BMI cutoff point of 30 was used for adults.
Results: Data were available for 6328 subjects. Subjects with consistently high adiposity status from childhood to adulthood, as compared with persons who had a normal BMI as children and were nonobese as adults, had an increased risk of type 2 diabetes (relative risk, 5.4; 95% confidence interval [CI], 3.4 to 8.5), hypertension (relative risk, 2.7; 95% CI, 2.2 to 3.3), elevated low-density lipoprotein cholesterol levels (relative risk, 1.8; 95% CI, 1.4 to 2.3), reduced high-density lipoprotein cholesterol levels (relative risk, 2.1; 95% CI, 1.8 to 2.5), elevated triglyceride levels (relative risk, 3.0; 95% CI, 2.4 to 3.8), and carotid-artery atherosclerosis (increased intima–media thickness of the carotid artery) (relative risk, 1.7; 95% CI, 1.4 to 2.2) (P≤0.002 for all comparisons). Persons who were overweight or obese during childhood but were nonobese as adults had risks of the outcomes that were similar to those of persons who had a normal BMI consistently from childhood to adulthood (P>0.20 for all comparisons).
Conclusions: Overweight or obese children who were obese as adults had increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis. The risks of these outcomes among overweight or obese children who became nonobese by adulthood were similar to those among persons who were never obese. (Funded by the Academy of Finland and others.)
