The Influence of Adolescent Body Mass Index, Physical Activity, and Tobacco Use on Blood Pressure and Cholesterol in Young Adulthood

doi:10.1016/j.jadohealth.2008.06.010

Journal of Adolescent Health

Volume 43, Issue 6, December 2008, Pages 576-583

https://doi.org/10.1016/j.jadohealth.2008.06.010 Get rights and content

Abstract

Purpose

To test the independent influences of adolescent tobacco use, physical activity/inactivity, and body mass index (BMI) on young adult cardiovascular risk factors.

Methods

This is a prospective cohort study using data from Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health) (N = 14,322). We tested whether Wave I tobacco use, physical activity/inactivity, and BMI predicted self-report of being diagnosed with high blood pressure (BP) or high cholesterol by Wave III, while controlling for gender, age, race/ethnicity, use of healthcare, and Wave III tobacco use, physical activity/inactivity, BMI.

Results

Among young adults aged 18–26, 5.37% report high BP and 4.28% high cholesterol. Obese adolescents are more likely to report high BP by young adulthood than normal-weight adolescents, independent of all control variables including BMI in young adulthood (adjusted odds ratio [aOR] = 1.96; 95% confidence interval = [1.50–2.57]). Overweight and obese adolescents are more likely to report high cholesterol by young adulthood than normal-weight adolescents, independent of all control variables including BMI in young adulthood (aOR = 1.47 [1.14–1.90] and 2.05 [1.44–2.91], respectively). Adolescent tobacco use and physical activity/inactivity do not independently predict reported high BP or cholesterol.

Conclusions

The odds of overweight and obese adolescents reporting a diagnosis for two cardiovascular risk factors by young adulthood are 1.5 to two times higher than normal-weight adolescents, regardless of BMI in young adulthood. The impact of transient and sustained increases in adolescent BMI on the evolution of cardiovascular risk warrants further investigation.

Section snippets

Study design and sample

This prospective cohort study uses data from Add Health. The University of North Carolina institutional review board approved all Add Health study procedures, and the Research Triangle Institute institutional review board approved this project.

The sampling design for Add Health has been described in detail elsewhere [13], [14]. In brief, the original sample was drawn from school enrollment rosters for students in grades 7 to 12 early in the 1994 to 1995 school year. A sample of 80 high schools

Sample description

Of the 18,924 Add Health participants in the nationally representative weighted Wave I sample, 14,322 (75.7%) were relocated and reinterviewed at Wave III. Essentially all Wave III respondents gave responses to the two items we used as outcome variables and were included in our final sample (N = 14,318). Using weighted data, our sample reflects a nationally representative sample of adolescents, now in young adulthood, that is approximately one-half female (48.6%) and racially and ethnically

Discussion

We found that the odds of obese adolescents reporting a diagnosis of high blood pressure or high cholesterol by young adulthood are 1.5 to two times higher than the odds of adolescents who are not obese, regardless of their weight in young adulthood. Although our results rely on reported measures, and blood pressure or cholesterol were not measured in this study during adolescence or adulthood, our results suggest that BMI during adolescence may make a unique contribution to the evolution of

Acknowledgments

We would like to thank Eliana Miller Perrin, MD, MPH, for her helpful review of earlier versions of this manuscript.

References (36)

L.T. Mahoney et al.
Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study
J Am Coll Cardiol
(1996)
G.C. Patton et al.
Pubertal transitions in health
Lancet
(2007)
P. Gordon-Larsen et al.
Adolescent physical activity and inactivity vary by ethnicity: The National Longitudinal Study of Adolescent Health
J Pediatr
(1999)
P. Gordon-Larsen et al.
Longitudinal physical activity and sedentary behavior trends: adolescence to adulthood
Am J Prev Med
(2004)
P. Gordon-Larsen et al.
Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health
Am J Clin Nutr
(2004)
J.C. LaRosa et al.
Cardiovascular risk factors in minorities
Am J Med
(2005)
E. Goodman et al.
Self-reported height and weight and the definition of obesity in epidemiological studies
J Adolesc Health
(2003)
A.M. Minino et al.
Deaths: Preliminary Data for 2004— National Vital Statistics Reports
(2006)
A. Must et al.
Long-term morbidity and mortality of overweight adolescentsA follow-up of the Harvard Growth Study of 1922 to 1935
N Engl J Med
(1992)
G.S. Berenson et al.
Association between multiple cardiovascular risk factors and atherosclerosis in children and young adultsThe Bogalusa Heart Study
N Engl J Med
(1998)

J.M. Gaziano

When should heart disease prevention begin?

N Engl J Med

(1998)

S. Li et al.

Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study

JAMA

(2003)

D.S. Freedman et al.

The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study

Int J Obes Relat Metab Disord

(2004)

The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents....

B.W. McCrindle et al.

Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing

Circulation

(2007)

G. Jimenez-Sanchez et al.

Human disease genes

Nature

(2001)

E. Goodman et al.

Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth

Circulation

(2005)

P.S. Bearman et al.

The National Longitudinal Study of Adolescent Health: Research Design. 1997

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Engagement in physical activity. Physical activity was measured by a modified version of a previously described scale (Ford, Nonnemaker, & Wirth, 2008), containing a range of self-report questions similar to those validated in other studies examining physical activity (Anderson, Crespo, Bartlett, Cheskin, & Pratt, 1998; Heath, Pratt, Warren, & Kann, 1994). In Wave 1 and 2, three items that assessed frequency of participation in the following activities during the past 7 days: (1) rollerblading, roller-skating, skateboarding, and bicycling; (2) playing an active sport, such as baseball, softball, basketball, soccer, swimming, or football; and (3) doing exercise, such as jogging, walking, karate, jumping rope, gymnastics, or dancing.
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Physical activity. Physical activity was measured using a previously developed scale in the literature (Ford, Nonnemaker, & Wirth, 2008). In Wave 1 and Wave 2, three items assessed the frequency of participation in the following activities during the past 7 days: (1) rollerblading, roller-skating, skateboarding, and bicycling; (2) playing an active sport, such as baseball, softball, basketball, soccer, swimming, or football; and (3) doing exercise, such as jogging, walking, karate, jumping rope, gymnastics, or dancing.
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View all citing articles on Scopus

: Support for this project was provided by the RTI-UNC Center for Excellence in Health Promotion Economics.

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Original articleThe Influence of Adolescent Body Mass Index, Physical Activity, and Tobacco Use on Blood Pressure and Cholesterol in Young Adulthood

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Study design and sample

Sample description

Discussion

Acknowledgments

J Am Coll Cardiol

Lancet

J Pediatr

Am J Prev Med

Am J Clin Nutr

Am J Med

J Adolesc Health

Deaths: Preliminary Data for 2004— National Vital Statistics Reports

Long-term morbidity and mortality of overweight adolescentsA follow-up of the Harvard Growth Study of 1922 to 1935

N Engl J Med

Association between multiple cardiovascular risk factors and atherosclerosis in children and young adultsThe Bogalusa Heart Study

N Engl J Med

When should heart disease prevention begin?

N Engl J Med

Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study

JAMA

The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study

Int J Obes Relat Metab Disord

Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing

Circulation

Human disease genes

Nature

Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth

Circulation

The National Longitudinal Study of Adolescent Health: Research Design. 1997

Original article
The Influence of Adolescent Body Mass Index, Physical Activity, and Tobacco Use on Blood Pressure and Cholesterol in Young Adulthood