Association of Childhood Obesity with Risk of Early All-cause and Cause-specific Mortality: A Swedish Prospective Cohort Study

Overview

Journal PLoS Med

Specialty General Medicine

Date 2020 Mar 19

PMID 32187177

Citations 70

Authors

Louise Lindberg

Pernilla Danielsson

Martina Persson

Claude Marcus

Emilia Hagman

Affiliations

Soon will be listed here.

Abstract

Background: Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group.

Methods And Findings: In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3-17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of follow-up) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0-24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00-8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group.

Conclusions: Our study shows that the risk of mortality in early adulthood may be higher for individuals who had obesity in childhood compared to a population-based comparison group.

Citing Articles

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References

Gortmaker S, Must A, Perrin J, Sobol A, Dietz W . Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med. 1993; 329(14):1008-12. DOI: 10.1056/NEJM199309303291406. View

Fontaine K, Redden D, Wang C, Westfall A, Allison D . Years of life lost due to obesity. JAMA. 2003; 289(2):187-93. DOI: 10.1001/jama.289.2.187. View

Calle E, Kaaks R . Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004; 4(8):579-91. DOI: 10.1038/nrc1408. View

Cohen S, Janicki-Deverts D, Chen E, Matthews K . Childhood socioeconomic status and adult health. Ann N Y Acad Sci. 2010; 1186:37-55. DOI: 10.1111/j.1749-6632.2009.05334.x. View

Hedvall Kallerman P, Hagman E, Edstedt Bonamy A, Zemack H, Marcus C, Norman M . Obese children without comorbidities have impaired microvascular endothelial function. Acta Paediatr. 2013; 103(4):411-7. DOI: 10.1111/apa.12549. View

Zabarsky G, Beek C, Hagman E, Pierpont B, Caprio S, Weiss R . Impact of Severe Obesity on Cardiovascular Risk Factors in Youth. J Pediatr. 2017; 192:105-114. PMC: 9338402. DOI: 10.1016/j.jpeds.2017.09.066. View

Adler N, Ostrove J . Socioeconomic status and health: what we know and what we don't. Ann N Y Acad Sci. 2000; 896:3-15. DOI: 10.1111/j.1749-6632.1999.tb08101.x. View

Franks P, Hanson R, Knowler W, Sievers M, Bennett P, Looker H . Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010; 362(6):485-93. PMC: 2958822. DOI: 10.1056/NEJMoa0904130. View

Hoffmans M, Kromhout D, de Lezenne Coulander C . The impact of body mass index of 78,612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol. 1988; 41(8):749-56. DOI: 10.1016/0895-4356(88)90161-8. View

10.

Reinehr T, Kiess W, de Sousa G, Stoffel-Wagner B, Wunsch R . Intima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure. Metabolism. 2005; 55(1):113-8. DOI: 10.1016/j.metabol.2005.07.016. View

11.

Ward Z, Long M, Resch S, Giles C, Cradock A, Gortmaker S . Simulation of Growth Trajectories of Childhood Obesity into Adulthood. N Engl J Med. 2017; 377(22):2145-2153. PMC: 9036858. DOI: 10.1056/NEJMoa1703860. View

12.

Hagman E, Ek A, Marcus C . Insulin function in obese children within the low and high ranges of impaired fasting glycemia. Pediatr Diabetes. 2018; 20(2):160-165. DOI: 10.1111/pedi.12804. View

13.

Galobardes B, Lynch J, Davey Smith G . Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation. Epidemiol Rev. 2004; 26:7-21. DOI: 10.1093/epirev/mxh008. View

14.

Daniels S . Complications of obesity in children and adolescents. Int J Obes (Lond). 2009; 33 Suppl 1:S60-5. DOI: 10.1038/ijo.2009.20. View

15.

Reilly J, Kelly J . Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2010; 35(7):891-8. DOI: 10.1038/ijo.2010.222. View

16.

Must A, Jacques P, Dallal G, BAJEMA C, Dietz W . Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992; 327(19):1350-5. DOI: 10.1056/NEJM199211053271904. View

17.

Emilsson L, Lindahl B, Koster M, Lambe M, Ludvigsson J . Review of 103 Swedish Healthcare Quality Registries. J Intern Med. 2014; 277(1):94-136. DOI: 10.1111/joim.12303. View

18.

Reilly J, Methven E, McDowell Z, Hacking B, Alexander D, Stewart L . Health consequences of obesity. Arch Dis Child. 2003; 88(9):748-52. PMC: 1719633. DOI: 10.1136/adc.88.9.748. View

19.

Lobstein T, Jackson-Leach R . Planning for the worst: estimates of obesity and comorbidities in school-age children in 2025. Pediatr Obes. 2016; 11(5):321-5. DOI: 10.1111/ijpo.12185. View

20.

Puhl R, King K . Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab. 2013; 27(2):117-27. DOI: 10.1016/j.beem.2012.12.002. View