Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
N Engl J Med. 2011 Apr 7;364(14):1315-25. doi: 10.1056/NEJMoa1006992.
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.).
从青少年到成年的体重指数（BMI）与年轻人肥胖相关疾病的关联尚未完全阐明。
我们进行了一项前瞻性研究，在以色列军队医疗团的工作人员定期体检中心，对 37674 名看似健康的年轻男性进行了与冠心病和糖尿病相关的血管造影确诊的冠心病和糖尿病的发病率进行了随访。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 65 万个人年的随访期间（平均随访时间为 17.4 年），我们记录了 1173 例 2 型糖尿病和 327 例冠心病事件。在调整年龄、家族史、血压、生活方式因素和血液生物标志物的多变量模型中，青少年 BMI 升高（体重以千克为单位除以身高的平方米；第一至十分位数的平均范围为 17.3 至 27.6）是糖尿病（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）和血管造影确诊的冠心病（风险比，5.43；95%CI，2.77 至 10.62）的显著预测因子。进一步调整成年期 BMI 后，青少年 BMI 与糖尿病的关联完全消失（风险比，1.01；95%CI，0.75 至 1.37），但与冠心病的关联并未消失（风险比，6.85；95%CI，3.30 至 14.21）。在校正多变量模型中 BMI 值为连续变量后，只有成年 BMI 升高与糖尿病显著相关（β=1.115，P=0.003；P=0.89 交互）。相比之下，青少年期（β=1.355，P=0.004）和成年期（β=1.207，P=0.03）BMI 升高均与血管造影确诊的冠心病独立相关（P=0.048 交互）。
青春期 BMI 升高——远在目前被认为正常的范围内——是中年肥胖相关疾病的一个重要危险因素。尽管糖尿病的风险主要与接近诊断时的 BMI 升高有关，但冠心病的风险与青春期和成年期的 BMI 升高有关，这支持了这样一种假设，即导致冠心病事件的发生的过程，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团资助）。
