An Israeli study published these days in the prestigious New England Journal of Medicine shows that the body mass index (BMI) at the age of 17 already predicts the risk of both diabetes and heart disease at the age of 30-40.
An Israeli study published these days in the prestigious New England Journal of Medicine shows that the body mass index (BMI) at the age of 17 already predicts the risk of both diabetes and heart disease at the age of 30-40.
However, while for heart disease, BMI at age 17 (including values considered normal today), and also at age 30 each contribute separately to predicting risk, the body mass index at age 30, closer to the onset of the disease, is dominant in predicting diabetes. This difference between diabetes and heart disease (verified in all cases by catheterization) suggests different mechanisms in the development of the two diseases, and has far-reaching implications in planning interventional approaches to overcome the increase in the prevalence of both diseases in the population in general and in young adults in particular.
A follow-up study, conducted over 17 years among more than 37,000 healthy men who are permanent members of the IDF, found that while type 2 diabetes is associated with a change in body mass from adolescence to early adulthood (ages 30-40) and in the body mass index close to diagnosis, for the assessment of disease risk Pay attention to the body mass index already in adolescence and within the normal range a unique predictive value.
The joint research team, led by Dr. Amir Tirosh (Tel Hashomer Hospital and Harvard University in the USA), Prof. Iris Shai and Prof. Assaf Rodich from Ben-Gurion University, as well as a group of researchers from Tel Hashomer Hospital and the Medical Corps, examined the relationship Between the body mass index at the age of 17, as measured in the recruiting office, and the onset of type 2 diabetes or heart disease at the ages of 25-47, while taking into account the set of risk factors associated with these two diseases (such as age, fasting blood sugar and lipids, blood pressure values , physical activity, smoking, family history, etc.). The relationship was examined in the entire body mass index range, including that which is considered completely normal (below 25 kg/m2). The medical follow-up system of the permanent personnel in the IDF allows examination of this relationship while continuously updating the various risk factors throughout the follow-up period, obtained from the comprehensive periodic examinations that all permanent personnel in the IDF undergo once every 3-5 years.
The study shows that between the ages of 17 and 30 there is an average increase of about 0.3 BMI units per year, which adds up to an increase of about 15 kg. During seventeen years of follow-up (on average), 1,173 new cases of diabetes (according to blood sugar measurements) and 327 new cases of heart disease (all proven by catheterization) were diagnosed among the young men.
Regarding diabetes, a significant increase in the risk of the disease was found from a body mass index value at age 17 of 23.4 kg'2. About 30% of the population of boys at this age have a body mass index equal to or greater than this value. On average, it was found that for every one-unit increase in body mass index at age 17, the risk of diabetes as a young adult increased by about 10%. However, this relationship was largely mediated by body mass index at age 30 - the possible implication of this finding is that boys in the higher BMI percentiles who grew up to be lean adults were not at an increased risk of developing diabetes. These findings were in striking contrast to the relationship with early onset of heart disease: a significant increase in the risk of heart disease was already demonstrated in a body mass index at the age of 17 over 21 (a value that is now considered completely normal). Each increase of one unit in the body mass index was associated with a 12% increase in the risk of heart disease. Furthermore, boys who as adults had a normal body weight were still at increased risk if their body mass was higher than 21 when they were boys: the body mass index at age 17 and at age 30 were each a separate risk factor from the other in predicting early heart disease.
Dr. Amir Tirosh: "We learn from the research that the problem of obesity before the age of majority, according to the criteria used today, is only the tip of the iceberg of an increase in the risk of morbidity that has recently been observed in the 30s and 40s, since the risk increases already in the body mass index range that is considered normal. This is indeed an observational study, but one that calls for intervention studies based on knowledge that did not exist before: it will be important to examine whether early intervention in childhood and adulthood can reduce morbidity rates in diabetes, but especially in heart disease, whether by reducing rates of obesity in adulthood, and whether, mainly Regarding heart disease, also directly through the reduction of body mass index at the age of 17".
Prof. Iris Shay: "The study reinforces the assumption that heart disease has a longer "memory" than diabetes, so we must take it into account in maintaining a healthy lifestyle even among children and adolescents who are of normal weight. It is correct to ask adults about the "medical history" of weight and fat values as teenagers in assessing the prediction of morbidity risk. The better news from the study is that regarding the risk of diabetes, it seems that even a heavier adolescent can avoid the excess risk associated with diabetes by maintaining a normal body weight as an adult. Regarding heart disease, although the process of atherosclerosis is prolonged, we know today from nutritional intervention studies that a lifestyle change, even without the addition of medication, may not only delay the atherosclerosis process, but even induce a certain degree of withdrawal."
Prof. Assaf Rodich: "The increase in overweight and obesity rates among children and youth, including in Israel, and the concerns about the effect of this trend on the health of young adults, necessitates research into the relationship between the two. This is because, to date, not all follow-up studies have demonstrated a relationship between body mass index in childhood and adolescence and morbidity later in life (although in the extreme weight range, obese children and adolescents have a high risk of also becoming obese adults who develop obesity-related diseases in excess). In addition, it is possible that diseases such as diabetes and heart disease are affected by different factors when they appear in the young adult group compared to older people, therefore it is important to identify predictive factors for morbidity especially in this group, which is hardly studied. The medical service provided by the IDF to the permanent personnel and the meticulous manner in which the information is kept create a database unique in scope and quality in the world, from which we have already learned a lot about risk factors for various diseases in the young adult age group. This is a very significant contribution of the IDF to the entire world of medicine."
The team of researchers included Dr. Amir Tirosh, Prof. Iris Shay, Dr. Arnon Afek, Dr. Gal Dubnov-Raz, Dr. Nir Ilon, Dr. Barak Gordon, Ms. Estella Drezna, Dr. Dorit Tzur, Prof. Ari Shamis, Prof. Shlomo Winker and Prof. Assaf Rodich.
2 תגובות
As far as I understand, the research findings are only relevant to men.
Correct me if I'm wrong.
Does the sample of permanent employees really represent the entire population? Is being in the army not a risk factor in itself, alternatively, an emphasis in the army on a healthy lifestyle means that in the general population the results will be more pronounced.