Childhood factors that increase risk for premature adult death elucidated

12 February 2010

MedWire News: Obesity, glucose intolerance, and hypertension in childhood are significantly associated with increased rates of premature death in adulthood, say researchers.

Childhood hypercholesterolemia, however, was not a major predictor of premature death.

Paul Franks (Umeå University Hospital, Sweden) and colleagues recruited 4857 children, aged 11.3 years on average (born 1945–1984), of American–Indian heritage (Pima or Tohono O’odham).

On enrollment, the team measured factors such as body mass index (BMI), glucose tolerance, blood pressure, and cholesterol levels. The cohort were followed-up for a median period of 23.9 years.

Over the follow-up period there were 559 premature (before the age of 55 years) deaths, 166 of which were from endogenous causes, defined as “those in which the proximate cause was disease or self-inflicted injury, such as acute alcohol intoxication or drug use.”

Writing in the New England Journal of Medicine, Franks and team found that rates of death from endogenous causes in individuals in the highest versus the lowest quartile of childhood BMI were more than double (incidence-rate ratio, 2.30).

In a similar fashion, children in the highest quartile of glucose intolerance and hypertension were 73% and 57% more likely to die prematurely from endogenous causes, respectively, than those in the lowest quartiles.

However, no significant associations between childhood cholesterol levels or systolic or diastolic blood pressure on a continuous scale and premature death were observed.

“Childhood obesity is becoming increasingly prevalent around the globe. Our observations, combined with those of other investigators, suggest that failure to reverse this trend may have wide-reaching consequences for the quality of life and longevity,” conclude Franks et al.

In an accompanying editorial, Edward Gregg (Centers for Disease Control and Prevention, Atlanta) commented: “Since the trends with respect to obesity and diabetes among the Pima Indians have been a reliable harbinger for trends in the rest of the U.S. population during recent decades, the present study should intensify the debate about whether interventions that are initiated during childhood and young adulthood can affect our broader diabetes epidemic.”

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N Engl J Med 2010; 362: 485–493, 548–549