Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood


In light of the worldwide increase in childhood obesity, we examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood.


We grouped data on BMI, as measured from 1967 through 2010 in 2.3 million Israeli adolescents (mean age, 17.3±0.4 years), according to age- and sex-specific percentiles from the U.S. Centers for Disease Control and Prevention. Primary outcomes were the number of deaths attributed to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories (total cardiovascular causes) by mid-2011. Cox proportional-hazards models were used.


During 42,297,007 person-years of follow-up, 2918 of 32,127 deaths (9.1%) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. On multivariable analysis, there was a graded increase in the risk of death from cardiovascular causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (i.e., within the accepted normal range). Hazard ratios in the obese group (≥95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 (95% confidence interval [CI], 3.9 to 6.1) for death from coronary heart disease, 2.6 (95% CI, 1.7 to 4.1) for death from stroke, 2.1 (95% CI, 1.5 to 2.9) for sudden death, and 3.5 (95% CI, 2.9 to 4.1) for death from total cardiovascular causes, after adjustment for sex, age, birth year, sociodemographic characteristics, and height. Hazard ratios for death from cardiovascular causes in the same percentile groups increased from 2.0 (95% CI, 1.1 to 3.9) during follow-up for 0 to 10 years to 4.1 (95% CI, 3.1 to 5.4) during follow-up for 30 to 40 years; during both periods, hazard ratios were consistently high for death from coronary heart disease. Findings persisted in extensive sensitivity analyses.


A BMI in the 50th to 74th percentiles, within the accepted normal range, during adolescence was associated with increased cardiovascular and all-cause mortality during 40 years of follow-up. Overweight and obesity were strongly associated with increased cardiovascular mortality in adulthood. (Funded by the Environment and Health Fund.)

Supported by a research grant from the Environment and Health Fund in Jerusalem (RGA 1002, to Dr. Kark).

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No potential conflict of interest relevant to this article was reported.

This article was published on April 13, 2016, at

We thank Drs. Lawrence Freedman and Raanan Raz for their statistical consultation, Drs. Noam Levine and Shmulik Tiosano for their assistance in the preparation of the original figures, and the anonymous reviewers for their thoughtful comments.


From the Department of Medicine (G.T., A.L., D.B.-A.S., A.S.) and the Dr. Pinchas Bornstein Talpiot Medical Leadership Program (G.T., G.Y.), Sheba Medical Center, Tel Hashomer, the Israel Defense Forces Medical Corps (G.T., G.Y., A.L., E.D., D.T.), Sackler School of Medicine, Tel Aviv University, Tel Aviv (G.T., A.L., E.D., D.B.-A.S., A.A., A.S.), and Hebrew University–Hadassah School of Public Health and Community Medicine (H.L., J.D.K.) and the Israel Ministry of Health (N.G., A.A., Z.H.), Jerusalem — all in Israel; and the Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.L.).

Address reprint requests to Dr. Twig at the Department of Medicine B, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel, or at.

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Autor / Fonte:Gilad Twig, M.D., Ph.D., Gal Yaniv, M.D., Ph.D., Hagai Levine, M.D., M.P.H., more. N Engl J Med 2016; 374:2430-2440June 23, 2016DOI: 10.1056/NEJMoa1503840