Childhood body-mass index and the risk of coronary heart disease in adulthood

Abstract

Background: The worldwide epidemic of childhood obesity is progressing at an alarming rate. Risk factors for coronary heart disease (CHD) are already identifiable in overweight children. The severity of the long-term effects of excess childhood weight on CHD, however, remains unknown.

Methods: We investigated the association between body-mass index (BMI) in childhood (7 through 13 years of age) and CHD in adulthood (25 years of age or older), with and without adjustment for birth weight. The subjects were a cohort of 276,835 Danish schoolchildren for whom measurements of height and weight were available. CHD events were ascertained by linkage to national registers. Cox regression analyses were performed.

Results: In 5,063,622 person-years of follow-up, 10,235 men and 4318 women for whom childhood BMI data were available received a diagnosis of CHD or died of CHD as adults. The risk of any CHD event, a nonfatal event, and a fatal event among adults was positively associated with BMI at 7 to 13 years of age for boys and 10 to 13 years of age for girls. The associations were linear for each age, and the risk increased across the entire BMI distribution. Furthermore, the risk increased as the age of the child increased. Adjustment for birth weight strengthened the results.

Conclusions: Higher BMI during childhood is associated with an increased risk of CHD in adulthood. The associations are stronger in boys than in girls and increase with the age of the child in both sexes. Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood.

Copyright 2007 Massachusetts Medical Society.

Figures

Figure 1. Body-Mass Index (BMI) in Childhood and the Risk of Coronary Heart Disease (CHD) in Adulthood

The graphs depict the association between childhood BMI and the risk of having a CHD event (nonfatal or fatal) in adulthood. Hazard ratios and 95% confidence intervals are given for a 1-unit increase in BMI z score at each age from 7 to 13 years. The data are from 139,857 boys (Panel A) and 136,978 girls (Panel B) in the Copenhagen School Health Records Cohort. The associations were linear within each age, since trend tests resulted in the rejection of the alternative of nonlinearity modeled as a restricted cubic spline with five knots (all P values >0.15).