Longitudinal trajectories of BMI and cardiovascular disease risk: the national longitudinal study of adolescent health

Abstract

Objective: In adulthood, excess BMI is associated with cardiovascular disease (CVD); it is unknown whether risk differs by BMI trajectories from adolescence to adulthood.

Design and methods: The National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal adolescent cohort (mean age: 16.9 years) followed into adulthood (mean age: 28.8 years) [n = 13,984 individuals (41,982 observations)] was examined. Separate logistic regression models for diabetes, hypertension, and inflammation were used to examine odds of risk factors at given adult BMI according to varying BMI trajectories from adolescence to adulthood.

Results: CVD risk factor prevalence at follow-up ranged from 5.5% (diabetes) to 26.4% (hypertension) and 31.3% (inflammation); risk differed across BMI trajectories. For example, relative to men aged 27 years (BMI = 23 kg/m(2) maintained over full study period), odds for diabetes were comparatively higher for men of the same age and BMI ≈ 30 kg/m(2) with ≈8 BMI unit gain between 15 and 20 years (OR = 2.35; 95% CI, 1.51, 3.66) or in those who maintained BMI ≈ 30 kg/m(2) across the study period (OR = 2.33; 1.92, 2.83) relative to the same ≈8 BMI unit gain, but between 20 and 27 years (OR = 1.44; 1.10, 1.87).

Conclusions: Specific periods and patterns of weight gain in the transition from adolescence to adulthood might be critical for CVD preventive efforts.

Figure 1

Constructed BMI trajectories used to examine differential odds of diabetes, hypertension, and inflammation in participants aged 15 y at wave II, from the National Longitudinal Study of Adolescent Health^{a a}We derived 10 BMI trajectories (Figure 1) based on: (1) a priori research interests regarding baseline weight, timing of weight gain, and adult weight in association with future cardiometabolic risk; and (2) distributions of BMI and BMI change in our nationally representative sample, ensuring that the 10 selected BMI trajectories were well represented in the sample (and thus in the United States). We chose the following distributions of BMI and BMI change to construct our trajectories: wave II BMI (23, 30, and 36 kg/m² representing the 25^th, 75^th, and 95^th percentiles, respectively), BMI change between waves (≈1, 4, or 8 BMI unit increase between waves II-III or III-IV representing the 20^th, 60^th, or 90^th percentiles of BMI change, respectively), and wave IV BMI (23, 30, and 36 kg/m² representing the 25^th, 60^th, and 85^th percentiles, respectively). With these 10 BMI trajectories, we then tested hypotheses regarding differential associations between BMI trajectories and CVD risk factors. The consistent BMI=23 kg/m² trajectory over the full follow-up period was used as the referent in statistical modeling. ^bSmall (≈20^th percentile), medium (≈60^th percentile), and large (≈90^th percentile) annualized change in BMI between waves II-III or waves III-IV are based upon the distribution in the analytic sample.