title: Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study.
abstract: OBJECTIVE
  Adiposity in middle age is an established risk factor for cardiovascular disease and type 2 diabetes; less is known about the impact of adiposity from early adult life. We examined the effects of high body mass index (BMI) in early and middle adulthood on myocardial infarction (MI), stroke and diabetes risks.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  7735 men with BMI measured in middle age (40-59 years) and BMI ascertained at 21 years from military records or participant recall.
  
  
  METHODS
  30-year follow-up data for type 2 diabetes, MI and stroke incidence; Cox proportional hazards models were used to examine the effect of BMI at both ages on these outcomes, adjusted for age and smoking status.
  
  
  RESULTS
  Among 4846 (63%) men (with complete data), a 1 kg/m(2) higher BMI at 21 years was associated with a 6% (95% CI 4% to 9%) higher type 2 diabetes risk, compared with a 21% (95% CI 18% to 24%) higher diabetes risk for a 1 kg/m(2) higher BMI in middle age (hazard ratio (HR) 1.21, 95% CI 1.18 to 1.24). Higher BMI in middle age was associated with a 6% (95% CI 4% to 8%) increase in MI and a 4% (95% CI 1% to 7%) increase in stroke; BMI at 21 years showed no associations with MI or stroke risk.
  
  
  CONCLUSIONS
  Higher BMI at 21 years of age is associated with later diabetes incidence but not MI or stroke, while higher BMI in middle age is strongly associated with all outcomes. Early obesity prevention may reduce later type 2 diabetes risk, more than MI and stroke.
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Owen
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Venediktos V
authors.initials: VV
authors.lastname: Kapetanakis
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Alicja R
authors.initials: AR
authors.lastname: Rudnicka
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Wathern
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School, London, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Lennon
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School, London, UK.
authors.forename: Olia
authors.initials: O
authors.lastname: Papacosta
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School, London, UK.
authors.forename: S Goya
authors.initials: SG
authors.lastname: Wannamethee
authors.affiliation: Population Health Research Institute, St George's, University of London, London, UK.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Whincup
mesh_terms: D050154:Adiposity; D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D009765:Obesity / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology; D044465:White People
keywords: EPIDEMIOLOGY; STROKE MEDICINE