Change in body mass index from childhood onwards and risk of adult cardiovascular disease^,

Abstract

Childhood obesity adversely affects the structure and function of the cardiovascular system, but the relationship between excessive weight gain during childhood and adult cardiovascular disease (CVD) is not fully understood. This review summarizes evidence for associations of change in body mass index (BMI) from childhood onwards with CVD outcomes. We found that excessive gain in BMI from childhood onwards was consistently associated with the presence of CVD risk factors, with increased risks of coronary heart disease, and there were suggestions of associations with stroke, atrial fibrillation and heart failure, but a lack of evidence precludes firm conclusions. These results indicate that the risk of CVD can be traced back to child ages and highlights the importance of primordial prevention of CVD by preventing excessive weight gain in childhood.

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.