1. Longer exposure to adiposity in adulthood was associated with a cumulative adverse effect on cardiovascular phenotype later in life.
2. Reduction in Body Mass Index (BMI) category at any age, even if not sustained, was associated with decrease in carotid intima media thickness (cIMT) and improved cardiovascular risk-factor profile later in life.
Evidence Rating Level: 2 (Good)
Study Rundown: Overweight body habitus and obesity are associated with the development of type 2 diabetes and cardiovascular disease. These disease burdens have reached epidemic proportions worldwide. The current study investigated the effect of lifetime exposure to adiposity on cardiovascular health by measuring carotid intima media thickness (cIMT) as a surrogate marker for adverse cardiovascular events in late adulthood. Various other risk factors, such as hypertension and diabetes, were also examined. Longer exposure to adiposity in adulthood was associated with higher cIMT and less favorable cardiovascular risk-factor profiles. Weight loss resulting in a decrease of BMI category at any period in adult life was shown to diminish this adverse effect, even when the weight loss was not sustained. These findings suggested that high adiposity in adulthood had a cumulative adverse effect on cardiovascular phenotype in later life. Additionally, weight loss at any age in adulthood, even if not sustained, could result in long-term cardiovascular benefit. As the longest prospective British cohort study so far, the study provided a longitudinal perspective on the association between adiposity and adult health. Limitations of the study included a small sample size, lack of ethnic diversity, and the low levels of childhood obesity compared with more recent population cohorts.
The study was funded by the Medical Research Council and the British Heart Foundation.
Relevant Reading: Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors
In-Depth [cohort]: This study included 1,273 participants from the National Survey of Health and Development Study cohort, which included births during March, 1946. Participants received carotid intima media thickness (cIMT) measurements at 60-64 years of age as an indicator of vascular phenotype. Body habiti were measured at ages 36, 43, 53 and 60-64 years and were classified as normal weight (BMI <25 kg/m2), overweight (BMI 25-29 kg/m2), or obese (BMI >30 kg/m2).
At age 60-64 years, overweight or obese participants had higher cIMT (mean difference 0.03 mm, 95% confidence interval [CI] 0.015–0.045) and systolic blood pressure (7.95 mm Hg, 95% CI 5.86–10.0) compared to the normal weight participants. Additionally, overweight or obese individuals had higher concentrations of inflammatory markers, leptin, and HbA1c (p<0.0001 for all). Prevalence of type 2 diabetes was also higher for the overweight or obese group (odds ratio 2.48, 95% CI 1.37-4.47; p=0.003).
Among the overweight and obese participants, those whose BMI category dropped (obese to overweight, or overweight to normal) in adulthood had lower cIMT (lower by 0.03 mm, 95% CI-0.01-0.06) compared to participants whose BMI category had never dropped, even if the weight change was not maintained. This favorable association was also observed for other cardiometabolic risk factors including leptin (p<0.001), HbA1c (p=0.04) and adiponectin (p<0.0001).
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