title: Adolescent BMI trajectory and risk of diabetes versus coronary disease.
abstract: BACKGROUND
  The association of body-mass index (BMI) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated.
  
  
  METHODS
  We conducted a prospective study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age.
  
  
  RESULTS
  During approximately 650,000 person-years of follow-up (mean follow-up, 17.4 years), we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease. In multivariate models adjusted for age, family history, blood pressure, lifestyle factors, and biomarkers in blood, elevated adolescent BMI (the weight in kilograms divided by the square of the height in meters; mean range for the first through last deciles, 17.3 to 27.6) was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76; 95% confidence interval [CI], 2.11 to 3.58) and angiography-proven coronary heart disease (hazard ratio, 5.43; 95% CI, 2.77 to 10.62). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01; 95% CI, 0.75 to 1.37) but not the association with coronary heart disease (hazard ratio, 6.85; 95% CI, 3.30 to 14.21). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes (β=1.115, P=0.003; P=0.89 for interaction). In contrast, elevated BMI in both adolescence (β=1.355, P=0.004) and adulthood (β=1.207, P=0.03) were independently associated with angiography-proven coronary heart disease (P=0.048 for interaction).
  
  
  CONCLUSIONS
  An elevated BMI in adolescence--one that is well within the range currently considered to be normal--constitutes a substantial risk factor for obesity-related disorders in midlife. Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes. (Funded by the Chaim Sheba Medical Center and the Israel Defense Forces Medical Corps.).
authors.affiliation: Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. atirosh@partners.org
authors.forename: Amir
authors.initials: A
authors.lastname: Tirosh
authors.forename: Iris
authors.initials: I
authors.lastname: Shai
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
authors.forename: Gal
authors.initials: G
authors.lastname: Dubnov-Raz
authors.forename: Nir
authors.initials: N
authors.lastname: Ayalon
authors.forename: Barak
authors.initials: B
authors.lastname: Gordon
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.forename: Ari
authors.initials: A
authors.lastname: Shamis
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
authors.forename: Assaf
authors.initials: A
authors.lastname: Rudich
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003327:Coronary Disease / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D012306:Risk
chemical_list: D001786:Blood Glucose