Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study.,PLOS Medicine

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Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study.
PLOS Medicine ( IF 10.5 ) Pub Date : 2020-03-18 , DOI: 10.1371/journal.pmed.1003078
Louise Lindberg ₁ , Pernilla Danielsson ₁ , Martina Persson _{2,

3,

4} , Claude Marcus ₁ , Emilia Hagman ₁

Affiliation

Background

Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group.

Methods and findings

In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3–17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of follow-up) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0–24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00–8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group.

Conclusions

Our study shows that the risk of mortality in early adulthood may be higher for individuals who had obesity in childhood compared to a population-based comparison group.

中文翻译：

儿童肥胖与早期全因和因特定原因死亡的风险之间的关联：一项瑞典前瞻性队列研究。

背景

小儿肥胖与中年以后早逝的风险增加有关，但尚不清楚该风险在成年后是否已经增加。目的是调查与基于人群的比较组相比，儿童肥胖的儿童在成年后的死亡风险是否增加。

方法和发现

在这项前瞻性队列研究中，我们将全国各地的登记册联系在一起，并收集了41359个人的数据。纳入年龄在3-17.9岁之间的瑞典儿童肥胖治疗登记册（BORIS）中并在其18岁生日（随访开始）居住在瑞典的个人。对照组按出生年份，性别和居住地区进行匹配。我们使用Cox比例风险模型分析了全因死亡率和特定原因死亡率，并根据群体，性别，北欧血统和父母的社会经济地位（SES）进行了调整。随访超过190,752人年（中位随访时间3.6年），记录了104例死亡。死亡的中位年龄（IQR）为22.0（20.0-24.5）岁。在儿童期肥胖人群中，随访期间死亡的比例为0.55％（n = 39），而同期的死亡率为0.19％（n = 39）。比较组中n = 65）（p <0.001）。在儿童期肥胖人群中，超过四分之一的死亡是由肥胖引起的主要或导致死亡的原因。男性和低父母SES与全因早产有关。意图不明的自杀和自残是两组死亡的主要原因。两组之间最大的差异在于内生性死亡原因，接受肥胖治疗的儿童与对照组相比，调整后的死亡率为4.04（95％CI 2.00–8.17，p <0.001）。主要的研究限制是比较组中缺少人体测量数据。