Obese Kids at Risk for Early Death:
February 10, 2010 - (MedPage) -- Children with obesity, glucose intolerance, or high blood pressure may be at risk of premature death, according to a longitudinal study of Native Americans.
Youngsters from two Arizona tribes who had the highest body mass index (BMI) were more than twice as likely as those with the lowest BMI to die prematurely from endogenous causes, and those with the worst glucose intolerance had a 73% higher risk of death than those with the best control, reported in the Feb. 11 issue of the New England Journal of Medicine.
While the study may not be applicable to the general population, it may "be applicable to those vulnerable populations -- the poor, African Americans, Hispanics -- who today have a comparably high prevalence of childhood obesity.
For their study, the researchers assessed 4,857 children from the Gila River Indian Community in Arizona, most of whom were Pima or Tohono O'odham Indians. All were born between 1945 and 1984, and none had diabetes.All of the children were assessed with glucose tolerance tests.
During a median follow-up of about 24 years, 559 patients died before they reached age 55, with 166 of those deaths due to endogenous, or internal, causes.
The researchers found that BMI was positively associated with the risk of premature death from endogenous causes, including alcoholic liver disease, cardiovascular disease, infections, cancer, diabetes or diabetic nephropathy, and acute alcohol or drug overdose (RR 1.40, 95% CI 1.20 to 1.63).Rates of death from endogenous causes more than doubled among children with the highest BMI, compared with those with the lowest (RR 2.30, 95% CI 1.46 to 3.62).
The association between BMI and premature death was attenuated after adjusting for baseline glucose levels, cholesterol levels, and blood pressure -- but it remained significant (RR 1.41, 95% CI 1.19 to 1.67).
Rates of premature death from endogenous causes among youngsters with the worst glucose intolerance were 73% higher than those in the lowest quartile (RR 1.73, 95% CI 1.09 to 2.74).
In an accompanying editorial, the CDC's Edward W. Gregg, PhD, cautioned that Pima Indians aren't always considered representative of the U.S. population because they have an especially high risk of diabetes. However, he wrote, "the prevalence of impaired glucose tolerance among persons in the current study (4%) is similar to the current prevalence in the general population of U.S. adolescents (3%) and is far less than the prevalence among obese adolescents in the U.S. (9.5%)."
"Since the trends with respect to obesity and diabetes among the Pima Indians have been a reliable harbinger for trends in the rest of the U.S. population during recent decades," he continued, "the present study should intensify the debate about whether interventions that are initiated during childhood and young adulthood can affect our broader diabetes epidemic." He added that it will be "important to convert these results into effective prevention policies."
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