Relation between obesity from childhood to adulthood and the metabolic syndrome: population based study

BMJ 1998;317:319-320 ( 1 August )

Papers

Relation between obesity from childhood to adulthood and the metabolic syndrome: population based study

Mauno Vanhala, general practitioner, ^a Pasi Vanhala, general practitioner, ^a Esko Kumpusalo, lecturer, ^b Pirjo Halonen, statistician, ^b Jorma Takala, professor. ^b

^a Pieksämäki District Health Centre, PO Box 65, 76101 Pieksämäki, Finland, ^b Kuopio University, Department of Public Health and General Practice, PO Box 1627, FIN-70211 Kuopio, Finland

Correspondence to: Dr M Vanhala, Community Health Centre of the City of Imatra, Virastokatu 2, 55100 Imatra, Finland Mauno.Vanhala{at}pp.inet.fi

Most researchers agree that obesity is an important modulator of the metabolic syndrome, ¹ ² which is a clustering ofcardiovascular risk factors associated with insulin resistance $---$ suchas hypertension, hypertriglyceridaemia, a low concentration ofhigh density lipoprotein cholesterol, abnormal glucose metabolism,and hyperinsulinaemia.³ Little is known, however, about theassociation between relative weight change from childhood to adulthoodand the development of metabolic syndrome in adulthood.

	Material, methods, and results

Top Material, methods, and results Comment References

We recently published data of a population study for the metabolic syndrome, performed during 1993-4 in Pieksämäki, Finland.All subjects (n=1008) born in the years 1947, 1952, and 1957 wereexamined according to a protocol described elsewhere.⁴ Dataon both weight and height at age 7 years (the start of primaryschool) were also collected.

Altogether, 712/1008 (70.6%) subjects participated in the study. Weights and heights at age 7 were traced for 439/712 (61.7%) participants. Obesity was defined both in childhood and in adulthoodas a sex specific highest third of the body mass index (weight(kg)/(height (m)²)). The metabolic syndrome was defined as a cluster of (a) hypertension(a systolic blood pressure $>=$ 140 mm Hg, a diastolic blood pressure $>=$ 90 mm Hg, or treatment with antihypertensive drugs); (b) dyslipidaemia (hypertriglyceridaemia ( $>=$ 1.70 mmol/l) or a high density lipoprotein cholesterol concentration of <1.00 mmol/l (<1.20 mmol/l in women), or both dyslipidaemia and hypertriglyceridaemia); and (c) insulinresistance (abnormal glucose metabolism according to the WorldHealth Organisation's criteria or hyperinsulinaemia ( $>=$ 78 pmol/l),or both).^2-4

Of the 439 subjects, 75 had been obese and 219 not obese in both childhood and adulthood; 71 had not been obese as childrenbut were obese as adults; and 74 had been obese as children butwere not obese as adults. The metabolic syndrome was present in18/219 (8%) men and in 12/220 (5%) women. Of the 30 subjects havingthis syndrome, 28 were obese as adults; 21 of them had also beenobese as children (table). In exact logistic regression analysis(LogXact), the risk of metabolic syndrome was 2.9 (95% confidenceinterval 1.1 to 7.6) for the subjects who had been obese as childrenand 26.7 (6.4 to 237) for the subjects who were obese as adults,compared with their non-obese controls. None of the 74 subjectswho had been obese as children but who were not obese as adultshad the metabolic syndrome. The increased risk of the metabolicsyndrome was still present when the population was split into thirds for weight but not when it was split into thirds for height.

View this table:
[in this window]
[in a new window]

Prevalence and risk (odds ratio) of metabolic syndrome for 146 obese adults (73 men and 73 women), according to childhood obesity status, compared with 293 non-obese adults (146 men and 147 women). Values are numbers (percentages) of subjects unless stated otherwise

	Comment

Top Material, methods, and results Comment References

Our results show that half of the obese children had become obese adults with an especially high risk of the metabolic syndromeand that childhood obesity overall increases the risk for themetabolic syndrome in adulthood. The risk of the syndrome waslower among the obese adults who had not been obese as childrenthan among the obese adults who had also been obese as children.Independent of childhood obesity, the risk for developing thesyndrome was lowest among the non-obese subjects overall. Thisfinding suggests that obesity in adulthood that became establishedin childhood may be a more harmful than obesity that has appearedin adulthood. The possible mechanism is that continuous obesityfrom childhood to adulthood serves as a "generator" for prolongedinsulin resistance, which results in the clustering of hypertensionand metabolic abnormalities in the same individual.⁵ Our resultsalso show that if an obese child reduces his or her relative weightto become a non-obese adult, this may protect against the metabolicsyndrome. Thus, the identification of obese children could leadto early intervention to prevent adult obesity, the metabolicsyndrome, and cardiovascular risk.

	Acknowledgments

Contributors: MV had the original idea for the present study, coordinated the formulation of the primary study hypothesis, discussed core ideas, designed the protocol, and participated in the data collection, analysis, and writing of the paper. He will also act as the guarantor for the paper. PV collected the data on weights and heights at age 7, discussed the study hypothesis and core ideas, and participated in the writing of the paper. PH participated in the statistical analysis and in the discussion of the core ideas. EK and JT discussed the study hypothesis and core ideas, participated in the planning of the design and practical implementation of the study, and edited and contributed to the paper.

Funding: None.

Conflict of interest: None.

References

Top
Material, methods, and results
Comment
References

DeFronzo RA, Ferrannini E. Insulin resistance, a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 3: 173-194.
Laakso M. The possible pathophysiology of insulin resistance syndrome. Cardiovasc Risk Factors 1993; 1: 55-66.
Reaven GM. Banting lecture 1988: role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607 [Abstract].
Vanhala MJ, Kumpusalo EA, Pitkäjärvi TK, Takala JK. Metabolic syndrome in a middle-aged Finnish population. J Cardiovasc Risk 1997; 4: 291-295 [Medline].
Björntorp P. "Portal" adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis 1990; 10: 493-496 [Free Full Text].

(Accepted 20 March 1998)

© BMJ 1998

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Articles

Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain: Jane Wardle, Naomi Henning Brodersen, Tim J Cole, Martin J Jarvis, and David R Boniface
BMJ 2006 332: 1130-1135. [Abstract] [Full Text] [PDF]

Implications of childhood obesity for adult health: E Leigh Gibson, Jane Wardle, Carolyn Edwards, Lucy Cooke, Charlotte M Wright, and Louise Parker
BMJ 2002 324: 676. [Extract] [Full Text]

Obesity from childhood to adulthood may lead to the metabolic syndrome
BMJ 1998 317: 0. [Full Text]

This article has been cited by other articles:

Goosse, K, Bouckenooghe, T, Balteau, M, Reusens, B, Remacle, C (2009). Implication of nitric oxide in the increased islet-cells vulnerability of adult progeny from protein-restricted mothers and its prevention by taurine. J Endocrinol 200: 177-187 [Abstract] [Full text]
Li, L., Hardy, R., Kuh, D., Lo Conte, R., Power, C. (2008). Child-to-Adult Body Mass Index and Height Trajectories: A Comparison of 2 British Birth Cohorts. Am J Epidemiol 168: 1008-1015 [Abstract] [Full text]
De Ferranti, S. D, Osganian, S. K (2007). Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus. Diabetes and Vascular Disease Research 4: 285-296 [Abstract]
Garnett, S. P, Baur, L. A, Srinivasan, S., Lee, J. W, Cowell, C. T (2007). Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence. Am. J. Clin. Nutr. 86: 549-555 [Abstract] [Full text]
Sinaiko, A. R., Steinberger, J., Moran, A., Hong, C.-P., Prineas, R. J., Jacobs, D. R. Jr (2006). Influence of Insulin Resistance and Body Mass Index at Age 13 on Systolic Blood Pressure, Triglycerides, and High-Density Lipoprotein Cholesterol at Age 19. Hypertension 48: 730-736 [Abstract] [Full text]
Wardle, J., Brodersen, N. H., Cole, T. J, Jarvis, M. J, Boniface, D. R (2006). Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain. BMJ 332: 1130-1135 [Abstract] [Full text]
Xu, W. H., Xiang, Y. B., Zheng, W., Zhang, X., Ruan, Z. X., Cheng, J. R., Gao, Y.-T., Shu, X.-O. (2006). Weight history and risk of endometrial cancer among Chinese women. Int J Epidemiol 35: 159-166 [Abstract] [Full text]
Sachdev, H. S, Fall, C. H., Osmond, C., Lakshmy, R., Dey Biswas, S. K, Leary, S. D, Reddy, K. S., Barker, D. J., Bhargava, S. K (2005). Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am. J. Clin. Nutr. 82: 456-466 [Abstract] [Full text]
Singhal, A., Jamieson, N., Fewtrell, M., Deanfield, J., Lucas, A., Sattar, N. (2005). Adiponectin Predicts Insulin Resistance But Not Endothelial Function in Young, Healthy Adolescents. J. Clin. Endocrinol. Metab. 90: 4615-4621 [Abstract] [Full text]
Godoy-Matos, A., Carraro, L., Vieira, A., Oliveira, J., Guedes, E. P., Mattos, L., Rangel, C., Moreira, R. O., Coutinho, W., Appolinario, J. C. (2005). Treatment of Obese Adolescents with Sibutramine: A Randomized, Double-Blind, Controlled Study. J. Clin. Endocrinol. Metab. 90: 1460-1465 [Abstract] [Full text]
Duncan, G. E., Li, S. M., Zhou, X.-H. (2004). Prevalence and Trends of a Metabolic Syndrome Phenotype Among U.S. Adolescents, 1999-2000. Diabetes Care 27: 2438-2443 [Abstract] [Full text]
Hardy, R., Wadsworth, M. E., Langenberg, C., Kuh, D. (2004). Birthweight, childhood growth, and blood pressure at 43 years in a British birth cohort. Int J Epidemiol 33: 121-129 [Abstract] [Full text]
Hypponen, E., Power, C., Smith, G. D. (2003). Prenatal Growth, BMI, and Risk of Type 2 Diabetes by Early Midlife. Diabetes Care 26: 2512-2517 [Abstract] [Full text]
Giammattei, J., Blix, G., Marshak, H. H., Wollitzer, A. O., Pettitt, D. J. (2003). Television Watching and Soft Drink Consumption: Associations With Obesity in 11- to 13-Year-Old Schoolchildren. Arch Pediatr Adolesc Med 157: 882-886 [Abstract] [Full text]
Cook, S., Weitzman, M., Auinger, P., Nguyen, M., Dietz, W. H. (2003). Prevalence of a Metabolic Syndrome Phenotype in Adolescents: Findings From the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 157: 821-827 [Abstract] [Full text]
Langnase, K., Mast, M., Danielzik, S., Spethmann, C., Muller, M. J. (2003). Socioeconomic Gradients in Body Weight of German Children Reverse Direction between the Ages of 2 and 6 Years. J. Nutr. 133: 789-796 [Abstract] [Full text]
Invitti, C., Guzzaloni, G., Gilardini, L., Morabito, F., Viberti, G. (2003). Prevalence and Concomitants of Glucose Intolerance in European Obese Children and Adolescents. Diabetes Care 26: 118-124 [Abstract] [Full text]
Singhal, A., Farooqi, I. S., Cole, T. J., O'Rahilly, S., Fewtrell, M., Kattenhorn, M., Lucas, A., Deanfield, J. (2002). Influence of Leptin on Arterial Distensibility: A Novel Link Between Obesity and Cardiovascular Disease?. Circulation 106: 1919-1924 [Abstract] [Full text]
Metcalf, B S, Voss, L D, Wilkin, T J (2002). Accelerometers identify inactive and potentially obese children (EarlyBird 3). Arch. Dis. Child. 87: 166-167 [Abstract] [Full text]
Gibson, E L., Wardle, J., Edwards, C., Cooke, L., Wright, C. M, Parker, L. (2002). Implications of childhood obesity for adult health. BMJ 324: 676-676 [Full text]
Wright, C. M, Parker, L., Lamont, D., Craft, A. W (2001). Implications of childhood obesity for adult health: findings from thousand families cohort study. BMJ 323: 1280-1284 [Abstract] [Full text]
Galloway, P J, Donaldson, M D C, Wallace, A M (2001). Sex hormone binding globulin concentration as a prepubertal marker for hyperinsulinaemia in obesity. Arch. Dis. Child. 85: 489-491 [Abstract] [Full text]
Hales, C N., Barker, D. J P (2001). The thrifty phenotype hypothesis: Type 2 diabetes. Br Med Bull 60: 5-20 [Abstract] [Full text]
Fall, C. H D (2001). Non-industrialised countries and affluence: Relationship with Type 2 diabetes. Br Med Bull 60: 33-50 [Abstract] [Full text]
Drake, A J, Greenhalgh, L, Newbury-Ecob, R, Crowne, E C, Shield, J P H (2001). Short report: Pancreatic dysfunction in severe obesity. Arch. Dis. Child. 84: 261-262 [Abstract] [Full text]
Forsen, T., Eriksson, J., Tuomilehto, J., Reunanen, A., Osmond, C., Barker, D. (2000). The Fetal and Childhood Growth of Persons Who Develop Type 2 Diabetes. ANN INTERN MED 133: 176-182 [Abstract] [Full text]
Ong, K. K L, Ahmed, M. L, Emmett, P. M, Preece, M. A, Dunger, D. B (2000). Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 320: 967-971 [Abstract] [Full text]
Eriksson, J G, Forsén, T, Tuomilehto, J, Winter, P D, Osmond, C, Barker, D J P (1999). Catch-up growth in childhood and death from coronary heart disease: longitudinal study. BMJ 318: 427-431 [Abstract] [Full text]

Rapid Responses:

Read all Rapid Responses

Gradation of obesity and other confounders: Tan Gim-Huat
bmj.com, 4 Aug 1998 [Full text]
Other suggestions for findings: Massimo Cigolini
bmj.com, 21 Aug 1998 [Full text]