Document Detail

Adolescent BMI trajectory and risk of diabetes versus coronary disease.
MedLine Citation:
PMID:  21470009     Owner:  NLM     Status:  MEDLINE    
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 (β=1.115, P=0.003; P=0.89 for interaction). In contrast, elevated BMI in both adolescence (β=1.355, P=0.004) and adulthood (β=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.).
Amir Tirosh; Iris Shai; Arnon Afek; Gal Dubnov-Raz; Nir Ayalon; Barak Gordon; Estela Derazne; Dorit Tzur; Ari Shamis; Shlomo Vinker; Assaf Rudich
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  364     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-07     Completed Date:  2011-04-11     Revised Date:  2012-02-29    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1315-25     Citation Subset:  AIM; IM    
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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MeSH Terms
Blood Glucose / analysis
Body Mass Index*
Coronary Disease / epidemiology*
Diabetes Mellitus, Type 2 / epidemiology*
Linear Models
Multivariate Analysis
Obesity / complications*
Prospective Studies
Reg. No./Substance:
0/Blood Glucose
Comment In:
N Engl J Med. 2011 Jun 30;364(26):2558; author reply 2559   [PMID:  21714667 ]
N Engl J Med. 2011 Jun 30;364(26):2558-9; author reply 2559   [PMID:  21714666 ]
Evid Based Med. 2012 Feb;17(1):35-6   [PMID:  22028369 ]

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