Childhood Obesity -- A Looming Disaster

Abrams, Jonathan
March 2008
Travel Medicine Advisor;Mar2008, Vol. 18 Issue 3, p15
This remarkable study is a population analysis of a huge cohort of children in Denmark who were followed, since 1930 or later, for the presence of coronary heart disease (CHD), and had all mandatory annual examinations at schools in Copenhagen. The study analyzed data from 277,000 children, aged 7-13. During a 46-year period, over 10,000 CHD events occurred among men and 4,300 among women; there were 5 million person-years of follow-up! Body Mass Index (BMI) was identified for each child from years 1955-1960; the BMI score was calculated by subtracting the child's BMI from the mean BMI in this fixed-reference population and dividing the result by the standard deviation of the reference population. The investigators employed the National Death Registry in Denmark, as well as the ICD-8 and ICD-10 curves (International Classification of Diseases). Late follow-up of subjects began at age of 28, or in 1977 (when the Hospital Discharge Registry was established). Almost 281,000 subjects were eligible for analysis. Cox proportional-hazards regression data were used to assist in the analysis of data to determine the probability of adult CHD events. Probabilities for children were calculated separately at ages 7 and 13. Results: During the 46 years of surveillance, more than 14,000 CHD events were recorded. When the data were assessed for the effect of childhood BMI on the effect of any CHD event, it was found that the risk for events in adulthood increased significantly for each one unit increase for BMI score. The risk of adult CHD was highest for boys who had the highest BMI values and lowest for boys with the lowest BMI levels. The risk of an adult event increased as the children's age increased for both boys and girls; risk for girls was lower for all events. The risk of non-fatal events was associated with childhood BMI, and these increased with the age of the child; the association between childhood BMI and adult non-fatal events was linear. Fatal events occurred in 32,000 women with risk, and were associated with increasing age in those with a high childhood BMI. Probabilities of CHD events during adulthood was not high in either group of children, but were elevated when compared to non-obese subjects. For instance, an average-sized boy of 13 had a 33% higher risk of a CHD event in adulthood if he was obese in childhood. The authors conclude that "higher childhood BMI values elevated the risk of having a CHD event in adulthood, with risk increasing linearly in boys and girls." Birth weight was not shown to have an interaction with subsequent obesity or with an increase in events. "Childhood BMI, even after the effects of birth weight have been taken into account, is associated with CHD in adulthood."


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