High BMI At Puberty Increases Risk Of Death Due To Cardiovascular Disease Later In Life

It has been previously studied and noted that boys with a largely increased body mass index (BMI of ≥17.9 kg/m2) during puberty and adolescence have an increased mortality risk as a result of cardiovascular disease (CVD) development later on in life.

What was unknown was whether an increased pre-pubertal childhood BMI and a BMI change during puberty to adulthood caused an increase in mortality risk due to the development of cardiovascular diseases. This warranted a clinical study to be performed where researchers wanted to evaluate what contribution BMI values during the two very important and specific developmental periods; childhood and puberty, had on the mortality risk in adult men due to cardiovascular diseases.

The study

Researchers from the University of Gothenburg’s Sahlgrenska Academy analyzed data from these two mentioned BMI parameters for cardiovascular mortality in adult men. The test subjects included nearly 38,000 men born between 1945 and 1961, whose weight and height values were collected from both paediatric healthcare records and military assessments. The parameter of pubertal change in the BMI values of these test subjects was calculated by making use of the measurements at 8 and 20 years of age, and those who emigrated or who had passed away before the age of 20 were excluded from the study.

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Findings

The following discoveries were made when all the information from the test subjects was assessed:

• Boys with a large increase in BMI during puberty had an increased cardiovascular mortality risk. BMI values will normally increase at puberty, but this group of boys was high risk since their BMIs increased by more than 7 BMI units during puberty. The risk of death due to cardiovascular disease later in life, in this group, increases by 22% for every extra BMI unit increase.
• There was no increased mortality risk due to cardiovascular diseases in those who were overweight during childhood (prior to puberty) and whose BMI had become normal during puberty.
• A significant finding would then be that an excessive increase in BMI during puberty would be unhealthy for the child.

Clinical significance

The findings of this study suggest that healthcare professionals should be monitoring the BMI values in schoolchildren especially during the years of puberty. This should be done so that children who are at high risk of developing cardiovascular diseases in the future are identified early and managed appropriately.

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These children would then be assessed by looking at issues such as the child's diet, physical exertion and whether psycho-social and socio-economic issues are present that could be contributing to the child's increased weight. The affected child would then be managed appropriately by addressing these issues and by being referred to the correct specialists and allied healthcare professionals.

An Overview Of Cardiovascular Diseases

Cardiovascular diseases include conditions that affect the heart and its anatomy; such as the coronary arteries, valves, conducting system and muscles and other blood vessels such as the aorta, vena cava and peripheral arteries and veins.

Affected anatomy and symptoms 

Different symptoms are experienced when different parts of the cardiovascular anatomy are affected. These anatomical areas will be discussed together with the associated symptoms that are experienced by the patient.

Atherosclerotic disease - diseased heart vessels that restrict blood flow to the end organ such as the heart and brain therefore causing problems such as a heart attack or stroke, respectively.

• Men usually experience symptoms such as chest pain, also called angina.
• Women tend to experience issues such as shortness of breath, fatigue and nausea.
• Other symptoms include numbness or a cold feeling in the limbs and pain in the neck, throat, jaw area, back or upper abdomen.
• If the brain is affected then symptoms can include difficulty with speech and one-sided facial and/or body paralysis.

Abnormal heartbeats - irregular arrhythmias caused by conduction issues of the heart.

• Chest pain or discomfort.
• Shortness of breath.
• Fluttering in the chest.
• Bradycardia (slow heartbeat).
• Tachycardia (fast heartbeat).
• Dizziness.
• Lightheadedness.
• Fainting (syncope) or near fainting.

Heart defects - include issues such as tetralogy of Fallot and septal defects between the heart chambers.

Serious heart defects can result in the following evident symptoms after the baby is born:

• Pale gray or blue skin colour (cyanosis).
• In an infant, shortness of breath during feedings. This results in poor weight gain.
• Peri-orbital, abdominal and lower limb swelling.

Less serious heart defects are usually diagnosed later in childhood or during adulthood. Non life-threatening signs and symptoms include:

• Experiencing shortness of breath easily during physical activities or exercise.
• Getting easily tired and fatigued during exercise or physical activities.
• Swelling experienced in the feet, ankles or hands.

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Cardiomyopathy - stiffening or thickening of the heart muscle causing difficulty in the heart to effectively pump blood throughout the body.

• Fatigue.
• Lightheadedness, dizziness or fainting.
• Breathlessness at rest or after physical exertion.
• Rapid or fluttering irregular heartbeats.
• Swelling of the peripheral limbs.

Heart infections - the areas that are affected here are the pericardial tissue that covers the heart (pericarditis), the muscular middle area of the heart called the myocardium (myocarditis) and the inner layer of the heart that separates the valves and the chambers called the endocardium (endocarditis).

• Fever.
• Dry or persistent cough.
• Fatigue or generalized weakness.
• Unusual skin rashes.
• Shortness of breath.
• Changes in heart rhythm.
• Swelling of the abdomen or lower limbs.

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Valvular heart diseases - the heart contains four valves (mitral, aortic, pulmonary and tricuspid) and these structures can become diseased which can result in them becoming hardened and narrowed (stenotic) or flaccid and dysfunctional (incompetent).

• Chest pain.
• Shortness of breath.
• Fatigue.
• Fainting/syncope.
• Swollen lower limbs.
• Irregular heartbeat.