Predicting Adult Body Mass Index–Specific Metabolic Risk From Childhood

Background: Metabolic risk varies within adult body mass index (BMI) categories; however, the development of BMI-specific metabolic risk from childhood is unknown. Methods: The sample included 895 adults (20–38 years of age; 43% male, 34% black) from the Bogalusa Heart Study (1995–2002), who had been measured as children (5–18 years of age) in 1981–1982. Adult metabolic risk was assessed using two definitions: Cardiometabolic risk factor clustering (RFC) included two or more abnormal risk factors [blood pressure, high-density lipoprotein cholesterol (HDL-C), triglycerides, and fasting glucose] and insulin resistance (IR), comprising the top quartile of the homeostasis model of insulin resistance (HOMA-IR) distribution. Logistic regression, within BMI categories, was used to predict adult metabolic risk from childhood mean arterial pressure (MAP), HDL-C, low-density lipoprotein cholesterol (LDL-C), glucose, and triglycerides. Covariates included childhood age, race, sex, adult BMI, and length of follow-up. Results: The prevalence of the adult abnormal metabolic risk profile varied by definitions of metabolic risk (normal weight, 5%–9%; overweight, 15%–23%; and obese, 40%–53%). The adult abnormal profile was associated with higher childhood LDL-C [IR, odds ratio (OR), 1.95; 95% confidence interval (CI), 1.06–3.58) and insulin (IR, OR, 1.69; CI, 1.10–2.58) in normal-weight adults; lower childhood HDL-C in overweight adults (RFC, OR, 0.61; CI, 0.40–0.94); and higher childhood MAP (RFC, OR, 1.75; CI, 1.24–2.47) and glucose (IR, OR,1.38; CI, 1.06–1.81) in obese adults. Conclusions: Some childhood metabolic risk factors are moderately associated with adult BMI-specific metabolic risk profiles. The ability to identify children with high future adult cardiovascular risk may initiate early treatment options.