Change in body mass index from childhood onwards and risk of adult cardiovascular disease,☆,✰✰
Introduction
The epidemic of childhood overweight and obesity constitutes a major global health problem. In the Unites States, 13.7% of children aged 2–5 years and 20.5% of adolescents aged 16–19 years had obesity in 2015–16 [1]. Of great concern is that excess weight in childhood has serious health consequences appearing at both child and adult ages [2], [3], [4]. Excess childhood body mass index (BMI; kg/m2) is linked to concomitantly elevated cardiovascular disease (CVD) risk factors [2] and there is evidence for links to adult CVD as well. Two meta-analyses demonstrated that higher BMIs in childhood are associated with significantly increased risks of coronary heart disease (CHD), inclusive of stable angina and acute myocardial infarction [3], [5]. Although earlier reviews and studies reported limited evidence supporting an association between childhood BMI and risks of stroke [3], [4], [6], we recently showed that children with an above-average BMI at ages 7–13 years have increased risks of early (<55 years) but not late ischemic stroke [7]. Additionally, high childhood BMI has been positively associated with heart failure, atrial fibrillation and flutter (AFF), CHD mortality and CVD mortality [8], [9], [10], [11], [12].
Taken together there is strong evidence that obesity at one age in childhood increases the risk of adult CVD. However, from a public health perspective, early adverse BMI trajectories are important to understand as they may reveal potential intervention targets. This raises the questions of whether cardiovascular health is worsened by excessive BMI increases during childhood and if it can be improved or restored by weight loss during childhood and through to adulthood. The aim of this review is to summarize the current evidence for associations of change in BMI during childhood and from childhood to adulthood with CVD outcomes, and to discuss potential biological mechanisms underlying these associations.
Section snippets
Methodology
This narrative review includes topics of excessive gain in BMI (covered by “BMI”, “overweight,” “obesity”, “childhood growth”, “trajectory”, “BMI change”, “BMI increase”) and CVD (defined as “coronary heart disease”, “stroke”, “heart failure” and “atrial fibrillation”). Studies on associations between change in BMI or weight status during childhood, defined as <16 years, or from childhood to adulthood and any CVD outcome were included.
In children, BMI increases with age. To standardize body
Discussion
The main finding of this review is that children who gain excess BMI from childhood onwards have increased risks of CHD, which may be mediated by CVD risk factors. Although some studies support an association with stroke, the evidence is inconsistent, and the association may differ by age at diagnosis. Evidence for an association with heart failure, AFF and composite measures of CVD morbidity and mortality is limited, but generally support an association.
For many CVD outcomes, the risks
Conclusions
Current evidence supports an association between excess gain in BMI during childhood and from child to adult ages and presence of CVD risk factors and increased risks of CHD. Studies also indicate that excess BMI gain from childhood onwards is associated with ischemic stroke, heart failure, and composite measures of CVD morbidity and mortality although there are few studies in these areas. Underlying mechanisms may include clustering of cardiovascular risk factors, structural changes in cardiac
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Conflicts of interest: None.
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Funding: This work was supported by grants from The Danish heart foundation (17-R115-A7640-22055), The European Union's Horizon 2020 research and innovation programme (633595), DynaHEALTH and The Bispebjerg and Frederiksberg Hospital Research Fund.