title: Adolescence BMI and trends in adulthood mortality: a study of 2.16 million adolescents.
abstract: BACKGROUND
  The consequence of elevated body mass index (BMI) at adolescence on early adulthood mortality rate and on predicted life expectancy is unclear.
  
  
  OBJECTIVE
  The objective of the investigation was to study the relationship between BMI at adolescence and mortality rate as well as the mortality trend over the past 4 decades across the entire BMI range.
  
  
  METHODS
  The study included a nationwide longitudinal cohort.
  
  
  METHODS
  A total of 2 159 327 adolescents (59.1% males) born between 1950 and 1993, who were medically evaluated for compulsory military service in Israel, participated in the study.
  
  
  METHODS
  Height and weight were measured at age 17 years, and BMI was stratified based on the Centers for Disease Control and Prevention-established percentiles for age and sex.
  
  
  METHODS
  Incident cases of all-cause mortality before age 50 years were recorded. Cox-proportional hazard models were used to assess mortality rates and its trend overtime.
  
  
  RESULTS
  During 43 126 211 person-years of follow-up, 18 530 deaths were recorded. As compared with rates observed in the 25th to 50th BMI percentiles, all-cause mortality continuously increased across BMI range, reaching rates of 8.90/10(4) and 2.90/10(4) person-years for men and women with BMI greater than the 97th percentile, respectively. A multivariate analysis adjusted for age, socioeconomic status, education, and ethnicity demonstrated a significant increase in mortality at BMI greater than the 50th percentile (BMI > 20.55 kg/m(2)) for men and the 85th percentile or greater in women (BMI > 24.78 kg/m(2)). During the last 4 decades, a significant decrease in mortality rates was documented in normal-weight participants born between 1970 and 1980 vs those born between 1950 and 1960 (3.60/104 vs 4.99/10(4) person-years, P < .001). However, no improvement in the survival rate was observed among overweight and obese adolescents during the same time interval. Significant interaction between BMI and birth year was observed (P = .007).
  
  
  CONCLUSIONS
  BMI at adolescence, within the normal range, is associated with all-cause mortality in adulthood. Mortality rates among overweight and obese adolescents did not improve in the last 40 years, suggesting that preadulthood obesity may attenuate the progressive increase in life expectancy.
authors.affiliation: Department of Medicine (G.T.), The Dr Pinchas Bornstein Talpiot Medical Leadership Program (G.T., A.T.), The Chaim Sheba Medical Center Management (A.A., A.S.), Tel-Hashomer 52621, Israel; The Israel Defense Forces Medical Corps (G.T., E.D., M.L.R., D.T., B.G.), Israel. The Sackler School of Medicine (A.A., A.S., E.D., M.L.R., B.G.), Tel-Aviv University, Tel-Aviv 69978, Israel; The Division of Endocrinology, Diabetes, and Hypertension (A.T.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.
authors.forename: Gilad
authors.initials: G
authors.lastname: Twig
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
authors.forename: Ari
authors.initials: A
authors.lastname: Shamiss
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.forename: Moran
authors.initials: M
authors.lastname: Landau Rabbi
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.forename: Barak
authors.initials: B
authors.lastname: Gordon
authors.forename: Amir
authors.initials: A
authors.lastname: Tirosh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D002423:Cause of Death; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D009026:Mortality / Q000639:trends*