Departments of Nutrition, Carolina Population Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27516-3997, USA.
JAMA. 2010 Nov 10;304(18):2042-7. doi: 10.1001/jama.2010.1635.
Although the prevalence of obesity has increased in recent years, individuals who are obese early in life have not been studied over time to determine whether they develop severe obesity in adulthood, thus limiting effective interventions to reduce severe obesity incidence and its potentially life-threatening associated conditions.
To determine incidence and risk of severe obesity in adulthood by adolescent weight status.
DESIGN, SETTING, AND PARTICIPANTS: A cohort of 8834 individuals aged 12 to 21 years enrolled in 1996 in wave II of the US National Longitudinal Study of Adolescent Health, followed up into adulthood (ages 18-27 years during wave III [2001-2002] and ages 24-33 years during wave IV [2007-2009]). Height and weight were obtained via anthropometry and surveys administered in study participants' homes using standardized procedures.
New cases of adult-onset severe obesity were calculated by sex, race/ethnicity, and adolescent weight status. Sex-stratified, discrete time hazard models estimated the net effect of adolescent obesity (aged <20 years; body mass index [BMI] ≥95th percentile of the sex-specific BMI-for-age growth chart or BMI ≥30.0) on risk of severe obesity incidence in adulthood (aged ≥20 years; BMI ≥40.0), adjusting for race/ethnicity and age and weighted for national representation.
In 1996, 79 (1.0%; 95% confidence interval [CI], 0.7%-1.4%) adolescents were severely obese; 60 (70.5%; 95% CI, 57.2%-83.9%) remained severely obese in adulthood. By 2009, 703 (7.9%; 95% CI, 7.4%-8.5%) non-severely obese adolescents had become severely obese in adulthood, with the highest rates for non-Hispanic black women. Obese adolescents were significantly more likely to develop severe obesity in young adulthood than normal-weight or overweight adolescents (hazard ratio, 16.0; 95% CI, 12.4-20.5).
In this cohort, obesity in adolescence was significantly associated with increased risk of incident severe obesity in adulthood, with variations by sex and race/ethnicity.
近年来，肥胖症的患病率有所上升，但对于早年肥胖的个体，尚未进行长期研究以确定他们是否会在成年后发展为重度肥胖，从而限制了有效干预措施的实施，以降低重度肥胖的发病率及其潜在的危及生命的相关疾病。
根据青少年时期的体重状况，确定成年后重度肥胖的发生率和风险。
设计、地点和参与者：这项队列研究纳入了 1996 年参加美国国家青少年健康纵向研究第二期（NHS II）的 8834 名年龄在 12 至 21 岁的个体，随访至成年期（第三期[2001-2002 年]为 18-27 岁，第四期[2007-2009 年]为 24-33 岁）。身高和体重通过人体测量学和在家中使用标准化程序进行的调查获得。
按性别、种族/民族和青少年体重状况计算新出现的成年起病的重度肥胖病例。采用性别分层离散时间风险模型，根据青少年肥胖（年龄<20 岁；体重指数[BMI]≥性别特异性 BMI 年龄生长图表的第 95 百分位数或 BMI≥30.0），调整种族/民族和年龄后，估计青少年肥胖对成年后重度肥胖发生率（年龄≥20 岁；BMI≥40.0）的净效应，并进行全国代表性加权。
1996 年，79 例（1.0%；95%置信区间[CI]，0.7%-1.4%）青少年为重度肥胖；60 例（70.5%；95%CI，57.2%-83.9%）在成年期仍为重度肥胖。到 2009 年，703 例（7.9%；95%CI，7.4%-8.5%）非重度肥胖的青少年在成年后已成为重度肥胖，其中非西班牙裔黑人女性的发生率最高。与体重正常或超重的青少年相比，肥胖青少年在成年早期发生重度肥胖的风险显著更高（风险比，16.0；95%CI，12.4-20.5）。
在该队列中，青春期肥胖与成年后发生重度肥胖的风险显著增加相关，且存在性别和种族/民族差异。
