[pronut-hiv] Elevated BMI in Younger Women Associated With Premature Death

["ProNut-HIV" <pronut-hiv@healthnet.org>]

July 18, 2006 * Elevated body mass index (BMI) in 18-year-old women is associated with premature death, according to the results of a prospective cohort study reported in the July 18 issue of the Annals of Internal Medicine.

"The impact of adiposity in adolescence on death during adulthood is uncertain," write Rob M. van Dam, PhD, from Harvard Medical School in Boston, Mass, and colleagues. "Data on the association between adolescent adiposity and premature death can provide insight into the importance of preventing excessive weight gain during childhood and adolescence."

This study analyzed data from 102,400 women enrolled in the Nurses' Health Study II who were 24 to 44 years of age and free of cancer at baseline. Of these, 90% were non-Hispanic whites. In 1989, the investigators determined current weight and height and recalled weight at age 18 years using validated questionnaires, and they calculated BMI. Hazard ratios (HR) for death were adjusted for cigarette smoking, alcohol use, physical activity during adolescence, and other potential confounders.

During 12 years of follow-up, 710 participants died. Compared with a BMI of 18.5 to 21.9 kg/m2 at age 18 years, the HR for death was 0.98 (95% confidence interval [CI], 0.78 - 1.23) for a BMI less than 18.5 kg/m2, 1.18 (95% CI, 0.97 - 1.43) for a BMI of 22.0 to 24.9 kg/m2, 1.66 (95% CI, 1.31 - 2.10) for a BMI of 25.0 to 29.9 kg/m2, and 2.79 (95% CI, 2.04 - 3.81) for a BMI of 30 kg/m2 or greater.

For participants who never smoked, a BMI of 22.0 to 24.9 kg/m2 at age 18 years was also associated with increased premature death (HR, 1.50; CI, 1.16 - 1.94). Associations between BMI at age 18 years and death could be only partially attributed to adult BMI measured in 1989.

Study limitations include observational study design, possible residual confounding by imperfectly measured or unknown confounders, assessment of adiposity based on self-reported weight and height, failure to include women who died between 18 years of age and the time of study recruitment, and study sample consisting of registered nurses born between 1945 and 1965 who were predominantly white.

"Moderately higher adiposity at age 18 years is associated with increased premature death in younger and middle-aged U.S. women," the authors write. "Our findings support preventive action in children aimed at reducing their risk for becoming overweight."

The National Institutes of Health supported this study. The authors have disclosed no relevant financial relationships.

In an accompanying editorial, William H. Dietz, MD, PhD, from the Centers for Disease Control and Prevention in Atlanta, Ga, notes that preventing overweight should be an even higher public health priority than treatment.

"Prevention of excessive weight gain in those who are not yet overweight may be a more cost-effective approach to weight control in the pediatric population," Dr. Dietz writes. "Similar to tobacco control, prevention of childhood overweight will probably require a comprehensive, multidimensional approach."

Dr. Dietz has disclosed no relevant financial relationships.

Ann Intern Med. 2006;145:91-97, 145-146