Adolescent BMI trajectory and risk of diabetes versus coronary disease.
Adolescent BMI trajectory and risk of diabetes versus coronary disease.
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DOI：
10.1056/nejmoa1006992
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发表时间：
2011-04-07
期刊：
影响因子：
--
通讯作者：
Rudich A
中科院分区：
文献类型：
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作者：
Tirosh A;Shai I;Afek A;Dubnov-Raz G;Ayalon N;Gordon B;Derazne E;Tzur D;Shamis A;Vinker S;Rudich A
从青春期到成年期的体重指数（BMI）与年轻人肥胖相关疾病的关系尚未完全阐明。我们进行了一项前瞻性研究，在这项研究中，我们通过以色列陆军医疗队的工作人员定期检查中心跟踪了37，674名表面上健康的年轻男性，这些男性患有血管造影证实的冠心病和糖尿病。参与者的身高和体重定期测量，第一次测量是在他们17岁时进行的。在大约650，000人-年的随访期间（平均随访时间为17.4年），我们记录了1173例2型糖尿病和327例冠心病。在根据年龄、家族史、血压、生活方式因素和血液生物标志物调整的多变量模型中，青少年BMI升高（体重（千克）除以身高（米）的平方;第一个到最后一个十分位数的平均范围为17.3到27.6）是糖尿病和糖尿病的重要预测因子。（最高与最低十分位数的风险比，2.76; 95%置信区间[CI]，2.11至3.58）和血管造影证实的冠心病（风险比，5.43; 95% CI，2.77至10.62）。成年后进一步调整BMI完全消除了青少年BMI与糖尿病的相关性（风险比，1.01; 95%CI，0.75 - 1.37），但与冠心病的相关性没有消除（风险比，6.85; 95%CI，3.30 - 14.21）。在多变量模型中调整BMI值作为连续变量后，只有成年期BMI升高与糖尿病显著相关（β = 1.115，P = 0.003;交互作用P = 0.89）。相反，青春期（β = 1.355，P = 0.004）和成年期（β = 1.207，P = 0.03）BMI升高与血管造影证实的冠心病独立相关（相互作用P = 0.048）。青春期BMI的升高--在目前认为正常的范围内--是中年肥胖相关疾病的一个重要风险因素。虽然糖尿病的风险主要与接近诊断时的BMI增加有关，但冠心病的风险与青春期和成年期的BMI升高有关，这支持了以下假设：导致冠心病事件的过程，特别是动脉粥样硬化，比导致糖尿病事件的过程更为渐进。（由Chaim Sheba医疗中心和以色列国防军医疗队资助。
The association of body-mass index (BMI) from adolescence to adulthood with obesity-related diseases in young adults has not been completely delineated. We conducted a prospective study in which we followed 37,674 apparently healthy young men for incident angiography-proven coronary heart disease and diabetes through the Staff Periodic Examination Center of the Israeli Army Medical Corps. The height and weight of participants were measured at regular intervals, with the first measurements taken when they were 17 years of age. During approximately 650,000 person-years of follow-up (mean follow-up, 17.4 years), we documented 1173 incident cases of type 2 diabetes and 327 of coronary heart disease. In multivariate models adjusted for age, family history, blood pressure, lifestyle factors, and biomarkers in blood, elevated adolescent BMI (the weight in kilograms divided by the square of the height in meters; mean range for the first through last deciles, 17.3 to 27.6) was a significant predictor of both diabetes (hazard ratio for the highest vs. the lowest decile, 2.76; 95% confidence interval [CI], 2.11 to 3.58) and angiography-proven coronary heart disease (hazard ratio, 5.43; 95% CI, 2.77 to 10.62). Further adjustment for BMI at adulthood completely ablated the association of adolescent BMI with diabetes (hazard ratio, 1.01; 95% CI, 0.75 to 1.37) but not the association with coronary heart disease (hazard ratio, 6.85; 95% CI, 3.30 to 14.21). After adjustment of the BMI values as continuous variables in multivariate models, only elevated BMI in adulthood was significantly associated with diabetes (β = 1.115, P = 0.003; P = 0.89 for interaction). In contrast, elevated BMI in both adolescence (β = 1.355, P = 0.004) and adulthood (β = 1.207, P = 0.03) were independently associated with angiography-proven coronary heart disease (P = 0.048 for interaction). An elevated BMI in adolescence — one that is well within the range currently considered to be normal — constitutes a substantial risk factor for obesity-related disorders in midlife. Although the risk of diabetes is mainly associated with increased BMI close to the time of diagnosis, the risk of coronary heart disease is associated with an elevated BMI both in adolescence and in adulthood, supporting the hypothesis that the processes causing incident coronary heart disease, particularly atherosclerosis, are more gradual than those resulting in incident diabetes. (Funded by the Chaim Sheba Medical Center and the Israel Defense Forces Medical Corps.)