Major Finding: Childhood obesity raised the risk of premature death in adulthood by 50%, hypertension did so by 57%, and a high glucose level did so by 73%.
Data Source: A study of 4,857 Native American children through adulthood or death.
Disclosures: The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases' intramural research program. Dr. Franks reported no conflicts of interest.
Obesity, hypertension, and glucose intolerance in childhood are strongly associated with premature death from endogenous causes, according to an analysis of data from a longitudinal study.
Failure to reverse the current population trends in childhood obesity thus could have far-reaching consequences for longevity, said Paul W. Franks, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, and his associates.
The investigators noted that “little is known about the way in which cardiovascular risk factors that are present during childhood affect the life span,” and examined the issue using data from a longitudinal study of diabetes among Native Americans who were born between 1945 and 1984. The 4,857 study subjects were children and adolescents (aged 5-20 years) when first enrolled between 1966 and 2003.
The study subjects had at least 4/8 Pima or Tohono O'odham Indian heritage and lived in the Gila River Indian Community.
This is a population with high rates of obesity and diabetes, and 1,394 (29%) of the children in this study were obese. However, “this prevalence is similar to that observed in contemporary Hispanic and African American children.
“Thus … our findings may reflect the future burden of premature death among contemporary children from other ethnic groups and may be more generalizable than the findings in previous studies,” Dr. Franks and his colleagues noted (N. Engl. J. Med. 2010;362;485-93).
The study subjects were followed until death, their 55th birthday, or the end of 2003, whichever came first. Deaths due to endogenous causes were defined as those with a proximate cause of disease or self-inflicted injury such as acute alcohol intoxication or drug use.
A total of 559 (11.5%) study subjects died before they reached 55 years of age, and 166 of these deaths were due to endogenous causes. Most deaths (59) were attributed to alcoholic liver disease, 22 to cardiovascular disease, 21 to infection, 12 to cancer, 10 to diabetes or diabetic nephropathy, 9 to acute alcohol poisoning or drug overdose, and 33 to miscellaneous causes.
Obesity was strongly related to risk of premature death. Adult mortality was more than twice as high among children in the highest quartile of body mass index than among those in the lowest quartile.
Similarly, hypertension and glucose intolerance in childhood were strongly related to premature death. Hypertension raised the risk by 57%, and children in the highest quartile of glucose level had a 73% higher risk of premature death than did those in the lowest quartile.
In contrast, childhood hypercholesterolemia was not associated with premature death. That may be due in part to the fact that the proportion of deaths from cardiovascular disease was quite low in this young cohort (13%).
In addition, cholesterol levels are lower in most Native Americans than in other ethnic groups, which may have affected this outcome, the investigators said.
Dr. Franks was supported in part by grants from the Swedish Diabetes Association, the Swedish Heart Lung Foundation, the Swedish Research Council, Umeå University, and Västerbotten regional health authority.