Being heavy in childhood doesn’t guarantee an increased risk of heart disease in the long run, provided children lose weight as adults.…
In a meta-analysis of four studies, Markus Juonala, MD, PhD, of the University of Turku, in Finland, and colleagues found that there was no difference in terms of risk for several parameters of cardiovascular disease — including diabetes, dyslipidemia, and hypertension — between patients who had been normal weight all their lives and those who were obese or overweight as kids but not as adults,
They wrote, “A decrease in adiposity between childhood and adulthood was associated with marked reductions in the risks of type 2 diabetes, hypertension, and dyslipidemia.” Some studies have suggested that cardiovascular disease risk is attenuated in patients who are heavy as kids but lose weight as adults, although consensus is unclear.
The researchers looked at data from four prospective studies that assessed childhood and adult body mass index (BMI): the Bogalusa Heart Study, the Muscatine Study, the Childhood Determinants of Adult Health Study, and the Cardiovascular Risk in Young Finns Study. A total of 6,328 patients were followed for a mean of 23 years. Among the 774 patients who were overweight or obese as children, 64.6% were obese as adults.
The researchers found that compared with those who had a normal BMI as children and weren’t obese as adults, patients who were consistently heavy from childhood to adulthood had a greater risk of several markers of cardiovascular disease (P≤0.002 for all):
- Type 2 diabetes (RR 5.4, 95% CI 3.4 to 8.5)
- Hypertension (RR 2.7, 95% CI 2.2 to 3.3)
- Elevated LDL (RR 1.8, 95% CI 1.4 to 2.3)
- Reduced HDL (RR 2.1, 95% CI 1.8 to 2.5)
- Elevated triglycerides (RR 3.0, 95% CI 2.4 to 3.8)
- Carotid artery atherosclerosis (RR 1.7, 95% CI 1.4 to 2.2)
Yet they found no difference in risk in any of those parameters between those who were heavy as kids but shed the pounds as adults, and those who had a normal BMI all along. They added that those who were obese as adults, regardless of childhood adiposity, had significantly increased risks of all outcomes.
The findings were supported by multivariable models, which showed that the effects of childhood adiposity on the risk of type 2 diabetes, dyslipidemia, and carotid atherosclerosis became nonsignificant when adult obesity was taken into account, the investigators noted.
Only the association between childhood obesity and the risk of hypertension remained significant in those models, they wrote. “This suggests that childhood adiposity has a residual effect on the risk of hypertension.”
The researchers concluded that reducing BMI in children and adolescents likely will help reduce their cardiovascular risk. “If this hypothesis is correct, primary care physicians should not take the pessimistic view that once childhood obesity is established, cardiovascular risk is also determined,” they wrote, “but should recognize that cardiovascular risk may be substantially reduced if childhood obesity is successfully treated.”
The study was limited because the data didn’t allow for complete comparisons to be made across cohorts with respect to some variables such as socioeconomic status. Also, the study’s observational nature precluded the researchers from establishing causality, and the findings may lack generalizability since they mainly pertained to white children.
Albert Rocchini, MD, of the University of Michigan in Ann Arbor, in an accompanying editorial, noted that more evidence has shown that obesity in childhood doesn’t guarantee an increased heart disease risk in adulthood, and the present study “adds considerably to our observations” regarding that. In order to reduce the incidence of adult heart disease and to control healthcare spending in the U.S., “now is the time to do whatever it takes to develop more effective methods for both the prevention and the treatment of childhood obesity,” he wrote.
- Note that the effects of childhood adiposity on the risk of type 2 diabetes, dyslipidemia, and carotid atherosclerosis became nonsignificant when adult obesity was taken into account.
- Explain that being heavy in childhood doesn’t guarantee an increased risk of heart disease in the long run, provided children lose weight as adults.
Juonala M, et al “Childhood adiposity, adult adiposity, and cardiovascular risk factors” N Engl J Med 2011; 365(20): 1876-1885.