The Relationship between Overweight in Adolescence and Premature Death in Women

BACKGROUND: The impact of adiposity in adolescence on death during adulthood is uncertain. OBJECTIVE: To examine the relation between adiposity in adolescence and premature death in women. DESIGN: Prospective cohort study. SETTING: United States. PARTICIPANTS: 102,400 women from the Nurses' Health Study II who were 24 to 44 years of age and free of cancer at baseline. Ninety percent were of non-Hispanic white ethnicity. MEASUREMENTS: In 1989, current weight and height and recalled weight at age 18 years were assessed by using validated questionnaires, and body mass index (BMI) was calculated. Hazard ratios for death and 95% CIs were adjusted for potential confounders, including cigarette smoking, alcohol use, and physical activity during adolescence. RESULTS: During 12 years of follow-up, 710 participants died. Compared with a BMI of 18.5 to 21.9 kg/m2 at age 18 years, the hazard ratio for premature death was 0.98 (95% CI, 0.78 to 1.23) for a BMI less than 18.5 kg/m2, 1.18 (CI, 0.97 to 1.43) for a BMI of 22.0 to 24.9 kg/m2, 1.66 (CI, 1.31 to 2.10) for a BMI of 25.0 to 29.9 kg/m2, and 2.79 (CI, 2.04 to 3.81) for a BMI of 30 kg/m2 or greater. Among participants who never smoked, a BMI of 22.0 to 24.9 kg/m2 at age 18 years was also associated with increased premature death (hazard ratio, 1.50 CI, 1.16 to 1.94). Associations between BMI at age 18 years and death could only partly be explained by adult BMI measured in 1989. LIMITATIONS: Because of the observational study design, residual confounding by imperfectly measured or unknown confounders may still be present. CONCLUSION: Moderately higher adiposity at age 18 years is associated with increased premature death in younger and middle-aged U.S. women.