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Is body mass index before middle age related to coronary heart disease risk in later life? Evidence from observational studies

Abstract

Objective:

Although obesity beginning early in life is becoming more common, its implications for coronary heart disease (CHD) risk in later life remain uncertain. We examined the relationship of body mass index (BMI) before 30 years of age to CHD risk in later life.

Design:

Systematic review of published studies relating BMI between age 2 and 30 years to later CHD risk. Studies were identified using Medline (1950 onwards), Embase (1980 onwards) and Web of Science (1970 onwards) databases (to November 2007).

Measurements:

Relative risks (RR) of CHD associated with a 1 standard deviation (s.d.) higher BMI (most based on a narrow age range at measurement) were extracted by two authors independently, and combined using random-effect models.

Results:

A total of 15 studies provided 17 estimates (731 337 participants, 23 894 CHD events) of the association of early BMI to later CHD outcome. BMI in early childhood (2–6 years, 3 estimates) showed a weak inverse association with CHD risk (RR 0.94, 95% CI 0.82–1.07). BMI in later childhood (7 to <18 years, 7 estimates) and BMI in early adult life (18–30 years, 7 estimates) were both positively related to later CHD risk (RR 1.09, 95% CI 1.00–1.20; RR 1.19, 95% CI 1.11–1.29 respectively). However, there was considerable statistical heterogeneity between study estimates. Results were unaffected by adjustment for social class and/or cigarette smoking, blood pressure and/or total cholesterol, in studies with available data. Gender and year of birth (1900–1976) had little effect on the association.

Conclusions:

BMI is positively related to CHD risk from childhood onwards; the associations in young adults are consistent with those observed in middle age. Long-term control of BMI from childhood may be important to reduce the risk of CHD.

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Acknowledgements

We thank David Gunnell and Elise Whitley (Department of Social Medicine, University of Bristol, UK) for kindly providing unpublished data for inclusion in the review. We thank Gary Whitlock (Clinical Trial Service Unit, University of Oxford, UK) for useful comments made on an earlier draft of the paper. This work was supported by the British Heart Foundation (grant PG/04/072).

Contributors: CGO, PHW, DGC, CO, JRE contributed substantially to the conception and design of this paper. QC, AKW, SJK carried out the literature search, CGO and LO extracted data and carried out the statistical analyses. The paper was critically appraised by all authors for intellectual content; CGO drafted the paper and will act as guarantor. The guarantor accepts full responsibility for the integrity of the work as a whole. All authors had access to the data, and approved the final version to be published.

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Correspondence to C G Owen.

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Supplementary Information accompanies the paper on International Journal of Obesity website (http://www.nature.com/ijo)

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Appendix: Search strategies used

Appendix: Search strategies used

Medline

(((Coronary Heart Disease) OR (Ischaemic heart disease) OR (Ischemic heart disease) OR (Cardiovascular Disease) OR (Cardiovascular mortality) OR (Myocardial infarction)).tw) AND (((Child) OR (Childhood) OR (Children) OR (Adolescent) OR (Adolescence) OR (Teenage$) OR (Early adulthood) OR (Young adults)).tw)

AND ((Body Mass Index).tw) OR (((Coronary Disease/) OR (Cardiovascular Diseases/) OR (Myocardial Infarction/) OR (Myocardial Ischemia/))

AND ((CHILD/) OR (ADOLESCENT/)) AND (Body Mass Index/))

Embase

(((Coronary Heart Disease) OR (Ischaemic heart disease) OR (Ischemic heart disease) OR (Cardiovascular Disease) OR (Cardiovascular mortality) OR (Myocardial infarction)).tw) AND (((Child) OR (Childhood) OR (Children) OR (Adolescent) OR (Adolescence) OR (Teenage$) OR (Early adulthood) OR (Young adults)).tw)

AND ((Body Mass Index).tw) OR (((Coronary Artery Disease/) OR (Cardiovascular Disease/) OR (Heart Infarction/) OR (Heart Muscle Ischemia/))

AND ((CHILD/) OR (ADOLESCENT/)) AND (Body Mass/)))

Web of Science

((Coronary Heart Disease) OR (Ischaemic heart disease) OR (Ischemic heart disease) OR (Cardiovascular Disease) OR (Cardiovascular mortality) OR (Myocardial infarction))

AND ((Child) OR (Childhood) OR (Children) OR (Adolescent) OR (Adolescence) OR (Teenage) OR (Early adulthood) OR (Young adults))

AND ((Body Mass Index)))

Key: $=wildcards, tw=text words, upper case words and / denote MESH (for Medline) and subject (for Embase) headings. Note: Web of Science searches are text word only.

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Owen, C., Whincup, P., Orfei, L. et al. Is body mass index before middle age related to coronary heart disease risk in later life? Evidence from observational studies. Int J Obes 33, 866–877 (2009). https://doi.org/10.1038/ijo.2009.102

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