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Cited by 1,003Obesity, Physical Activity, DietDiabetes, Cardiovascular Risks, and LipoproteinsCancer Risks and Factors

Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood

Twig, Gilad, Yaniv, Gal, Levine, Hagai, Leiba, Adi, Goldberger, Nehama, Derazne, Estela, Ben-Ami Shor, Dana, Tzur, Dorit +4 more·2016·New England Journal of Medicine
DOI 10.1056/nejmoa1503840
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Abstract

BACKGROUND: In light of the worldwide increase in childhood obesity, we examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood. METHODS: We grouped data on BMI, as measured from 1967 through 2010 in 2.3 million Israeli adolescents (mean age, 17.3±0.4 years), according to age- and sex-specific percentiles from the U.S. Centers for Disease Control and Prevention. Primary outcomes were the number of deaths attributed to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories (total cardiovascular causes) by mid-2011. Cox proportional-hazards models were used. RESULTS: During 42,297,007 person-years of follow-up, 2918 of 32,127 deaths (9.1%) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. On multivariable analysis, there was a graded increase in the risk of death from cardiovascular causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (i.e., within the accepted normal range). Hazard ratios in the obese group (≥95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 (95% confidence interval [CI], 3.9 to 6.1) for death from coronary heart disease, 2.6 (95% CI, 1.7 to 4.1) for death from stroke, 2.1 (95% CI, 1.5 to 2.9) for sudden death, and 3.5 (95% CI, 2.9 to 4.1) for death from total cardiovascular causes, after adjustment for sex, age, birth year, sociodemographic characteristics, and height. Hazard ratios for death from cardiovascular causes in the same percentile groups increased from 2.0 (95% CI, 1.1 to 3.9) during follow-up for 0 to 10 years to 4.1 (95% CI, 3.1 to 5.4) during follow-up for 30 to 40 years; during both periods, hazard ratios were consistently high for death from coronary heart disease. Findings persisted in extensive sensitivity analyses. CONCLUSIONS: A BMI in the 50th to 74th percentiles, within the accepted normal range, during adolescence was associated with increased cardiovascular and all-cause mortality during 40 years of follow-up. Overweight and obesity were strongly associated with increased cardiovascular mortality in adulthood. (Funded by the Environment and Health Fund.).

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Authors
Twig, G., Yaniv, G., Levine, H., Leiba, A., Goldberger, N., Derazne, E., Ben-Ami Shor, D., Tzur, D., Afek, A., Shamiss, A., Haklai, Z., & Kark, J. D.
Affiliations
  • Tel Aviv University (IL)
  • Mount Auburn Hospital (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2016-06-23
Volume
374
Issue
25
Pages
2430-2440
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1503840
OpenAlex
W2338349399
Cited by
1,003
References
5
Citations by year
2026: 51 · 2025: 76 · 2024: 105 · 2023: 137 · 2022: 97 · 2021: 111 · 2020: 109 · 2019: 89 · 2018: 95 · 2017: 89 · 2016: 43
FWCI
104.46
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
body mass index, adolescent obesity, cardiovascular mortality, coronary artery disease, stroke, sudden death, childhood obesity, body mass index percentiles, Israeli youth, long-term follow-up, sex differences in mortality, height adjustment, sociodemographic factors, smoking and alcohol use, physical activity, socioeconomic status, educational attainment, urban-rural differences
MeSH terms
Adolescent, Adult, Cardiovascular Diseases, Cause of Death, Coronary Disease, Death, Sudden, Female, Follow-Up Studies, Humans, Israel, Male, Middle Aged, Obesity, United States, Body Mass Index, Multivariate Analysis, Proportional Hazards Models, Stroke, Overweight, Young Adult

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