Elevated BMI in Adolescence Increases Risk for Diabetes, Stroke in Young Adulthood, Regardless of Adult BMI

Adults in their 30s and 40s who had high BMI in adolescence were at highest risk for type 2 diabetes and early MI, regardless of adult BMI, after 24 years of follow-up, a new study finds.

Higher body mass index (BMI) in late childhood through adolescence may lead to increased risk of cardiometabolic disease in adulthood, regardless of adult BMI, according to investigators from the University of California San Francisco (UCSF).

In a research letter published in the Journal of the American College of Cardiology, researchers point to an increased risk of diabetes, hypertension, heart attack, and poorer health in adults in the third and fourth decade for each incremental increase in BMI z-score among adolescents. The study, led by Jason M. Nagata, MD, MSc, assistant professor of pediatrics in the Division of Adolescent and Young Adult Medicine at UCSF, is the first to demonstrate the adverse relationship in younger adults, according to an American College of Cardiology statement.

"The finding that adolescent BMI is a risk factor for poor health outcomes in adulthood, regardless of adult BMI, has significant implications for our understanding of cardiovascular disease onset," said lead author Nagata in the statement. "Considering these findings, health care providers should consider BMI history when assessing for cardiovascular and chronic disease risk."

To learn more about the impact of elevated adolescent BMI on the risk for poorer health in adulthood, Nagata et al analyzed data spanning 24 years from the National Longitudinal Study of Adolescent to Adult Health, which recorded data from more than 20 000 adolescents from 1994-1995 to 2016-2018. In the final cohort of 12 300 participants, age was between 11 and 18 years; 51.4% were women and 34.2% identified as a racial/ethnic minority. Average baseline BMI was 22.4 kg/m2.


Authors report that at the 24-year follow-up each 1-unit higher BMI z-score in adolescence was associated with a 4.17 kg/m2 higher BMI in adulthood.

In adjusted analyses, investigators found a prospective association of BMI z-score with overall poor self-reported general health (adjusted odds ratio [aOR], 1.49; 95% confidence interval [CI], 1.31-1.70; P<.001) and development of:

Diabetes (aOR, 2.35; 95% CI, 2.11-2.63; P<.001)

Hypertension (aOR, 1.55; 95% CI, 1.45-1.64; P<.001)

Hyperlipidemia (aOR, 1.24; 95% CI, 1.15-1.34; P<.001)

Premature MI (aOR, 1.77; 95% CI, 1.41-2.24; P<.001)

Premature HF (aOR, 1.81; 95% CI, 1.37-2.40; P<.001)

Asthma (aOR, 1.12; 95% CI, 1.07-1.18; P<.001)

Cancer (aOR, 1.18; 95% CI, 1.05-1.34; P=.008)

OSA (aOR, 1.64; 95% CI, 1.53-1.77; P<.001)

After adjustment for adult BMI, adolescent BMI z-score was independently associated with poor general health (aOR, 1.23; 95% CI, 1.05-1.445; P=.010), development of diabetes (aOR, 1.56; 95% CI, 1.36-1.79; P <.001), and premature myocardial infarction (aOR, 1.66; 95% CI, 1.25-2.22; P <.001) in adulthood.

Their findings, the researchers said, support the hypothesis not only the age of onset of obesity but also the cumulative obesity exposure contribute to insulin resistance and atherosclerosis. Greater focus on guidance to and support for young patients from pediatricians will be needed to combat poor health outcomes, they said.

In addition to suggesting that health care providers consider BMI history in adult patients as part of an assessment for risk of CV and other chronic disease, Nagat and colleagues emphasize that "adolescence is an important time period to optimize health and prevent early heart attacks." They call on pediatricians to "encourage teens to develop healthy behaviors including physical activity and balanced meals."

REFERENCE: Jason M. Nagata, Kyle T. Ganson, Jingyi Liu, et al. Adolescent body mass index and health outcomes at 24-year follow-up: a prospective cohort study. J Am Coll Cardiol. 2021;77:3229–3231.