title: Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood.
abstract: BACKGROUND
  In light of the worldwide increase in childhood obesity, we examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood.
  
  
  METHODS
  We grouped data on BMI, as measured from 1967 through 2010 in 2.3 million Israeli adolescents (mean age, 17.3±0.4 years), according to age- and sex-specific percentiles from the U.S. Centers for Disease Control and Prevention. Primary outcomes were the number of deaths attributed to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories (total cardiovascular causes) by mid-2011. Cox proportional-hazards models were used.
  
  
  RESULTS
  During 42,297,007 person-years of follow-up, 2918 of 32,127 deaths (9.1%) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. On multivariable analysis, there was a graded increase in the risk of death from cardiovascular causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (i.e., within the accepted normal range). Hazard ratios in the obese group (≥95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 (95% confidence interval [CI], 3.9 to 6.1) for death from coronary heart disease, 2.6 (95% CI, 1.7 to 4.1) for death from stroke, 2.1 (95% CI, 1.5 to 2.9) for sudden death, and 3.5 (95% CI, 2.9 to 4.1) for death from total cardiovascular causes, after adjustment for sex, age, birth year, sociodemographic characteristics, and height. Hazard ratios for death from cardiovascular causes in the same percentile groups increased from 2.0 (95% CI, 1.1 to 3.9) during follow-up for 0 to 10 years to 4.1 (95% CI, 3.1 to 5.4) during follow-up for 30 to 40 years; during both periods, hazard ratios were consistently high for death from coronary heart disease. Findings persisted in extensive sensitivity analyses.
  
  
  CONCLUSIONS
  A BMI in the 50th to 74th percentiles, within the accepted normal range, during adolescence was associated with increased cardiovascular and all-cause mortality during 40 years of follow-up. Overweight and obesity were strongly associated with increased cardiovascular mortality in adulthood. (Funded by the Environment and Health Fund.).
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Gilad
authors.initials: G
authors.lastname: Twig
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Gal
authors.initials: G
authors.lastname: Yaniv
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Hagai
authors.initials: H
authors.lastname: Levine
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Adi
authors.initials: A
authors.lastname: Leiba
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Nehama
authors.initials: N
authors.lastname: Goldberger
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Dana
authors.initials: D
authors.lastname: Ben-Ami Shor
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Ari
authors.initials: A
authors.lastname: Shamiss
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Ziona
authors.initials: Z
authors.lastname: Haklai
authors.affiliation: From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University-Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem - all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality; D003645:Death, Sudden / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D016016:Proportional Hazards Models; D020521:Stroke / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult