Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Cardiovascular Diabetology
Published in: Cardiovascular Diabetology 1/2018

Open Access 01-12-2018 | Original investigation

Sex-specific associations between adolescent categories of BMI with cardiovascular and non-cardiovascular mortality in midlife

Authors: Ariel Furer, Arnon Afek, Omri Orr, Liron Gershovitz, Moran Landau Rabbi, Estela Derazne, Orit Pinhas-Hamiel, Noam Fink, Adi Leiba, Amir Tirosh, Jeremy D. Kark, Gilad Twig

Published in: Cardiovascular Diabetology | Issue 1/2018

Login to get access

Abstract

Context

Most studies linking long-term consequences of adolescent underweight and obesity are limited to men.

Objective

To assess the sex-specific association of adolescent BMI with cardiovascular- and non-cardiovascular-related mortality in young adulthood and midlife.

Setting

A nationwide cohort.

Participants

927,868 women, 1,366,271 men.

Interventions

Medical examination data at age 17, including BMI, were linked to the national death registry.

Main outcomes

Death attributed to cardiovascular (CVD) and non-CVD causes.

Results

During 17,346,230 women-years and 28,367,431 men-years of follow-up, there were 451 and 3208 CVD deaths, respectively, and 6235 and 22,223 non-CVD deaths, respectively. Compared to low-normal BMI (18.5–22.0 kg/m2), underweight women had a lower adjusted risk for CVD mortality (Cox hazard ratio (HR) = 0.68; 95% CI 0.46–0.98) in contrast to underweight men (HR = 0.99; 0.88–1.13). The latter were at higher risk for non-CVD mortality (HR = 1.04; 1.00–1.09), unlike underweight women (HR = 1.01; 0.93–1.10). Findings, which persisted when the study sample was limited to those with unimpaired health, were accentuated for the obese with ≥ 30 years follow-up. Both sexes exhibited similarly higher risk estimates already in the high-normal BMI range (22.0 ≤ BMI < 25.0 kg/m2) with overall no interaction between sex and BMI (p = 0.62). Adjusted spline models suggested lower BMI values for minimal mortality risk among women (16.8 and 18.2 kg/m2) than men (18.8 and 20.0 kg/m2), for CVD and non-CVD death, respectively.

Conclusions

Underweight adolescent females have favorable cardiovascular outcomes in adulthood. Otherwise the risk patterns were similar between the sexes. The optimal BMI value for women and men with respect to future CVD outcomes is within or below the currently accepted low-normal BMI range.
Appendix
Available only for authorised users
Literature
1.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.CrossRefPubMed
2.
3.
Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. J Am Med Assoc. 2016;315(21):2292–9.CrossRef
4.
Bender R, Jockel KH, Trautner C, Spraul M, Berger M. Effect of age on excess mortality in obesity. J Am Med Assoc. 1999;281(16):1498–504.CrossRef
5.
6.
Tirosh A, Shai I, Afek A, Dubnov-Raz G, Ayalon N, Gordon B, Derazne E, Tzur D, Shamis A, Vinker S, et al. Adolescent BMI trajectory and risk of diabetes versus coronary disease. N Engl J Med. 2011;364(14):1315–25.CrossRefPubMedPubMedCentral
7.
Falkstedt D, Hemmingsson T, Rasmussen F, Lundberg I. Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men. Int J Obes (Lond). 2007;31(5):777–83.CrossRef
8.
Ohlsson C, Bygdell M, Sonden A, Rosengren A, Kindblom JM. Association between excessive BMI increase during puberty and risk of cardiovascular mortality in adult men: a population-based cohort study. Lancet Diab Endocrinol. 2016;4(12):1017–24.CrossRef
9.
Must A, Jacques P, Dallal G, Bajema C, Dietz W. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard growth study of 1922 to 1935. N Engl J Med. 1992;327(19):1350–5.CrossRef
10.
Strand BH, Kuh D, Shah I, Guralnik J, Hardy R. Childhood, adolescent and early adult body mass index in relation to adult mortality: results from the British 1946 birth cohort. J Epidemiol Community Health. 2012;66(3):225–32.CrossRefPubMed
11.
Wandell PE, Carlsson AC, Theobald H. The association between BMI value and long-term mortality. Int J Obes (Lond). 2009;33(5):577–82.CrossRef
12.
Roh L, Braun J, Chiolero A, Bopp M, Rohrmann S, Faeh D. Mortality risk associated with underweight: a census-linked cohort of 31,578 individuals with up to 32 years of follow-up. BMC Public Health. 2014;14(1):371.CrossRefPubMedPubMedCentral
13.
Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, Ben-Ami Shor D, Tzur D, Afek A, Shamiss A, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016;374(25):2430–40.  CrossRefPubMed
14.
Twig G, Tirosh A, Leiba A, Levine H, Ben-Ami Shor D, Derazne E, Haklai Z, Goldberger N, Kasher-Meron M, Yifrach D, et al. BMI at age 17 years and diabetes mortality in midlife: a nationwide cohort of 2.3 million adolescents. Diab Care. 2016;39(11):1996–2003.CrossRef
15.
Collaboration ERF. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;2011(364):829–41.CrossRef
16.
Kaati G, Bygren LO, Edvinsson S. Cardiovascular and diabetes mortality determined by nutrition during parents’ and grandparents’ slow growth period. Eur J Hum Genet. 2002;10:682.CrossRefPubMed
17.
Afshin A, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, Singh G, Yakoob MY, Abdollahi M, Al-Hooti S, et al. The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis. BMJ Open. 2015;5(5):e006385.CrossRefPubMedPubMedCentral
18.
Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes–causes, effects and coping strategies. Diab Obes Metab. 2007;9(6):799–812.CrossRef
19.
Tzibel N. Characterization and classification of local authorities by the socio-economic level of the population 2006. Hebrew: Central Bureau of Statistics; 2009.
20.
Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Stanford: Stanford University Press; 1959.
21.
Twig G, Ben-Ami Shor D, Furer A, Levine H, Derazne E, Goldberger N, Haklai Z, Levy M, Afek A, Leiba A, et al. Adolescent body mass index and cardiovascular disease–specific mortality by midlife. J Clin Endocrinol Metab. 2017;102(8):3011–20.CrossRefPubMed
22.
Twig G, Afek A, Shamiss A, Derazne E, Landau Rabbi M, Tzur D, Gordon B, Tirosh A. Adolescence BMI and trends in adulthood mortality: a study of 2.16 million adolescents. J Clin Endocrinol Metab. 2014;99(6):2095–103.CrossRefPubMed
23.
Sidney S, Quesenberry CP Jr, Jaffe MG, et al. Recent trends in cardiovascular mortality in the united states and public health goals. JAMA Cardiol. 2016;1:594–9.CrossRefPubMed
24.
Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, et al. Decline in cardiovascular mortality. Possible Causes Implic. 2017;120(2):366–80.
25.
Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, D'Onofrio G, Lichtman JH, Krumholz HM. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337–45.CrossRefPubMedPubMedCentral
26.
Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007;2007(50):2128–32.CrossRef
27.
Bairey Merz CN, Andersen H, Sprague E, Burns A, Keida M, Walsh MN, Greenberger P, Campbell S, Pollin I, McCullough C, et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the women’s heart alliance. J Am Coll Cardiol. 2017;70(2):123–32.CrossRefPubMed
28.
Mongraw-Chaffin ML, Peters SAE, Huxley RR, Woodward M. The sex-specific association between BMI and coronary heart disease: a systematic review and meta-analysis of 95 cohorts with 1.2 million participants. Lancet Diab Endocrinol. 2015;3(6):437–49.CrossRef
29.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body-mass index and mortality in a prospective cohort of US adults. New Engl J Med. 1999;341:1097–105.CrossRefPubMed
30.
Katzmarzyk PT, Craig CL, Bouchard C. Original article underweight, overweight and obesity: relationships with mortality in the 13-year follow-up of the Canada Fitness Survey. J Clin Epidemiol. 2001;54(9):916–20.CrossRefPubMed
31.
Seidell JC, Verschuren WM, van Leer EM, Kromhout D. Overweight, underweight, and mortality: a prospective study of 48,287 men and women. Arch Intern Med. 1996;156:958–63.CrossRefPubMed
32.
Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G. Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort. Am J Clin Nutr. 1998;67:1111–8.CrossRefPubMed
33.
Bjorge T, Engeland A, Tverdal A, Smith GD. Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents. Am J Epidemiol. 2008;168:30–7.CrossRefPubMed
34.
Manson JE, Stampfer MJ, Hennekens CH, Willett WC. Body weight and longevity. A reassessment. JAMA, J Am Med Assoc. 1987;257(3):353–8.CrossRef
35.
Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–19.  CrossRefPubMed
36.
Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156.CrossRefPubMedPubMedCentral
37.
Collaboration PS. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.CrossRef
38.
Calle E, Thun M, Petrelli J, Rodriguez C, Heath C Jr. Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med. 1999;341:1097–105.CrossRefPubMed
39.
Song X, Tabák AG, Zethelius B, Yudkin JS, Söderberg S, Laatikainen T, Stehouwer CD, Dankner R, Jousilahti P, Onat A. Obesity attenuates gender differences in cardiovascular mortality. Cardiovasc Diabetol. 2014;13(1):144.CrossRefPubMedPubMedCentral
40.
Collaboration GBM. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776–86.CrossRef
41.
Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics. 2007;120(Suppl 4):S193–228.CrossRefPubMed
42.
Peter RS, Mayer B, Concin H, Nagel G. The effect of age on the shape of the BMI-mortality relation and BMI associated with minimum all-cause mortality in a large Austrian cohort. Int J Obes (Lond). 2015;39:530–4.CrossRef
43.
Lopez-Otin C, Galluzzi L, Freije JMP, Madeo F, Kroemer G. Metabolic control of longevity. Cell. 2016;166:802–21.CrossRefPubMed
44.
45.
46.
Willcox BJ, Willcox DC, Suzuki M. Demographic, phenotypic, and genetic characteristics of centenarians in Okinawa and Japan: part 1-centenarians in Okinawa. Mech Ageing Dev. 2017;165(Pt B):75–9.CrossRefPubMed
47.
Pinhas-Hamiel O, Reichman B, Shina A, Derazne E, Tzur D, Yifrach D, Wiser I, Afek A, Shamis A, Tirosh A, et al. Sex differences in the impact of thinness, overweight, obesity, and parental height on adolescent height. J Adolesc Health. 2017;61(2):233–9.CrossRefPubMed
48.
Ostan R, Monti D, Gueresi P, Bussolotto M, Franceschi C, Baggio G. Gender, aging and longevity in humans: an update of an intriguing/neglected scenario paving the way to a gender-specific medicine. Clin Sci (London, England: 1979). 2016;130(19):1711–25.CrossRef
49.
Pontiroli AE, Zakaria AS, Mantegazza E, et al. Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and nondiabetic obese patients undergoing gastric banding: a controlled study. Cardiovasc Diabetol. 2016;15:39.CrossRefPubMedPubMedCentral
50.
Bjerregaard LG, Jensen BW, Ängquist L, Osler M, Sørensen TIA, Baker JL. Change in overweight from childhood to early adulthood and risk of type 2 diabetes. N Engl J Med. 2018;378(14):1302–a12.CrossRefPubMed
51.
Peter RS, Keller F, Klenk J, Concin H, Nagel G. Body mass trajectories, diabetes mellitus, and mortality in a large cohort of Austrian adults. Medicine. 2016;95:e5608.CrossRefPubMedPubMedCentral
52.
Cohen-Manheim I, Doniger GM, Sinnreich R, Simon ES, Murad H, Pinchas-Mizrachi R, Kark JD. Body mass index, height and socioeconomic position in adolescence, their trajectories into adulthood, and cognitive function in midlife. Alzheimer’s Dis. 2017;55(3):1207–21.CrossRef
53.
Zucker I, Shohat T, Dankner R, Chodick G. New onset diabetes in adulthood is associated with a substantial risk for mortality at all ages: a population based historical cohort study with a decade-long follow-up. Cardiovasc Diabetol. 2017;16:105.CrossRefPubMedPubMedCentral
54.
Kark JD, Laor A. Cigarette smoking and educational level among young Israelis upon release from military service in 1988—a public health challenge. Isr J Med Sci. 1992;28(1):33–7.PubMed
55.
Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, van der Schouw YT, Spencer E, Moons KG, Tjonneland A, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359(20):2105–20.CrossRefPubMed
56.
Force USPST, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW, Jr., Kemper AR, Krist AH, et al. Screening for obesity in children and adolescents: US preventive services task force recommendation statement. J Am Med Assoc. 2017;317(23):2417–26.CrossRef
57.
Hogstrom G, Nordstrom A, Nordstrom P. Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men. Int J Epidemiol. 2015;2015;45:1159–68.PubMed
Metadata
Title
Sex-specific associations between adolescent categories of BMI with cardiovascular and non-cardiovascular mortality in midlife
Authors
Ariel Furer
Arnon Afek
Omri Orr
Liron Gershovitz
Moran Landau Rabbi
Estela Derazne
Orit Pinhas-Hamiel
Noam Fink
Adi Leiba
Amir Tirosh
Jeremy D. Kark
Gilad Twig
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2018
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-018-0727-7

Other articles of this Issue 1/2018

Cardiovascular Diabetology 1/2018 Go to the issue

Review

Potential mechanisms responsible for cardioprotective effects of sodium–glucose co-transporter 2 inhibitors

Original investigation

Donor artery stenosis interactions with diastolic blood pressure on coronary collateral flow in type 2 diabetic patients with chronic total occlusion

Original investigation

Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes

Review

Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017

Original investigation

Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery

Original investigation

Associations between circulating full-length angiopoietin-like protein 8 levels and severity of coronary artery disease in Chinese non-diabetic patients: a case–control study

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits