Rate of BMI Increase in Childhood Predicts Risk of Adult Heart Disease

Low birth weight and a combination of low BMI at 2 years and high BMI at 11 years, reflecting rapid weight gain between age 2 and 11 years, predicts later CHD.

The rate at which body mass index (BMI) increases in childhood is associated with the risk of coronary heart disease (CHD) as an adult.

“Low birth weight is a risk factor for coronary heart disease,” write David J. P. Barker, MD, Phd, FRS, from the University of Southampton, Southampton General Hospital in the U.K, and colleagues. “It is uncertain how postnatal growth affects disease risk.”

The investigators studied 8,760 people born in Helsinki from 1934 through 1944 and who had records of childhood growth, and they measured coronary risk factors in a subset of 2,003 people. CHD leading to hospitalization or death occurred in 357 men and in 87 women.

The mean body size of children who had coronary events as adults was below average at birth, and at two years of age, these children were thin. Subsequently, their BMI increased compared with that of other children and had reached average values by 11 years of age. Simultaneous regressions revealed that for the boys, the hazard ratios (HRs) associated with a 1 SD increase in BMI were 0.76 at two years and 1.14 at 11 years. For the girls, the corresponding figures were 0.62 and 1.35.

Low BMI at two years of age and increased BMI from 2 to 11 years of age were also associated with increased fasting insulin concentrations.

“On average, adults who had a coronary event had been small at birth and thin at two years of age and thereafter put on weight rapidly,” the authors write. “This pattern of growth during childhood was associated with insulin resistance in later life. The risk of coronary events was more strongly related to the tempo of childhood gain in BMI than to the BMI attained at any particular age.”

“Babies who are thin or short at birth lack muscle, a deficiency that will persist into childhood, since there is little cell replication in muscle after birth,” the authors conclude. “We suggest that rapid weight gain in such children may lead to a disproportionately high fat mass in relation to muscle mass. This may underlie the strong associations between this path of growth and insulin resistance in our study and may offer one explanation of why this pattern of growth leads to later coronary heart disease.”
N Engl J Med. 2005;353:1802-1809, 1848-1850

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