ORIGINAL ARTICLE
Obesity in Adolescence and Adulthood
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and the Risk of Adult Mortality
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Anders Engeland,* Tone Bjørge,† Aage Tverdal,* and Anne Johanne Søgaard*
Background: There are few long-term follow-up data on the rela-
tion between body mass index (BMI) in adolescence and in adult-
hood, and between adolescent BMI and adult mortality. The present
study explores these relations.
Methods: In Norwegian health surveys during 1963–1999, height
and weight were measured for 128,121 persons in a standardized
way both in adolescence (age 14 –19 years) and 10 or more years
later. Persons were followed for an average of 9.7 years after the
adult measurement. Cox proportional hazard regression models were
used to study the association between adolescent and adult BMI and
mortality.
Results: The odds ratio of obesity (BMI ⱖ30) in adulthood in-
creased steadily with BMI in adolescence, from 0.2 for low BMI up
to 16 for very high BMI. Very high adolescent BMI was associated
with 30 – 40% higher adult mortality compared with medium BMI.
Adjusting for adult BMI explained most of the association of
adolescent obesity and mortality, especially among men. Adjust-
ment for smoking did not change the results.
Conclusions: Obesity in adolescence tends to persist into adulthood.
Adolescent obesity is also connected to excess mortality, but this
excess seems to be explained mostly by obesity in adulthood. High
BMI in adolescence seems to be predictive of both adult obesity and
mortality.
(Epidemiology 2004;15: 79 – 85)
O besity in childhood and adolescence appears to be an
important predictor of adult obesity,1–3 and adult obe-
sity is associated with high mortality. However, more long-
term follow-up data on the relation between body mass index
(BMI) in adolescence and in adulthood, as well as between
adolescent BMI and adult mortality, is needed.4,5
Submitted 29 January 2003; final version accepted 12 September 2003.
From the *Division of Epidemiology, Norwegian Institute of Public Health,
Oslo, Norway; and the †Department of Pathology, The Norwegian
Radium Hospital, Oslo, Norway.
Correspondence to: Anders Engeland, Division of Epidemiology, Norwegian
Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Nor-
way. E-mail: anders.engeland@fhi.no.
Copyright © 2003 by Lippincott Williams & Wilkins
ISSN: 1044-3983/04/1501-0079
DOI: 10.1097/01.ede.0000100148.40711.59
Epidemiology • Volume 15, Number 1, January 2004
Studies on persistence of obesity from adolescence into
adulthood have suffered from several weaknesses; the studies
have generally been small,1,6 with adult measurement in early
adulthood only,7 or have had to rely on self-reported height
and weight.7 Nevertheless, these studies have shown that
obesity, to a large extent, persists from childhood and ado-
lescence into adulthood. A more recent study, which followed
approximately 11,000 individuals from birth to early adult-
hood, concluded that this persistence is largely explained by
maternal weight or BMI.8
Because mortality in young adulthood is low, a large
number of subjects and a long follow-up period are necessary
to study the relation between obesity in adolescence and
mortality. Only a few studies have investigated this rela-
tion.3,6,9 –11 All-cause mortality has been shown to be ele-
vated in overweight adolescents.3,10,11 One small study found
an association of adolescent obesity and adult mortality after
adjusting for adult BMI.6 One explanation that has been
proposed for the effect of adolescent obesity on later mortal-
ity is the locus of fat deposition during adolescence.4
A workshop on childhood obesity convened by the
International Obesity Task Force in 1997 concluded that BMI
offers a reasonable measure of fatness in children and ado-
lescents.12 Height and weight measurements are simple and
inexpensive, and these have often been a routine part of
health examinations. Hence, BMI has been calculated in
many epidemiologic studies both among adolescents and
adults.
Because adolescents are at various stages of matura-
tion, age- and sex-specific growth curves are necessary to
define obesity. Cole et al.13 proposed a set of such age- and
sex-specific cutoff points, which were linked to adult catego-
ries of BMI (weight in kilograms)/(height in meters)2 for
overweight (BMI 25–29) and obesity (BMI ⱖ30). In the
United States, the Centers for Disease Control and Prevention
(CDC) at the National Center for Health Statistics (NCHS)
have created growth charts for children and adolescents up to
the age of 20 years based on data from U.S. health examina-
tions.14 The CDC/NCHS guidelines for adolescents suggest
using age- and sex-specific BMI to identify adolescents at the
upper end of the distribution as being “at risk for overweight”
79
 Engeland et al
(BMI between the 85th and 95th percentile) and overweight
(BMI ⱖ95th percentile).
The relation between BMI in adolescence and mortality
has recently been explored in a large Norwegian cohort.10
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The study included the complete cohort of adolescents mea-
sured during a tuberculosis screening program. The risk of
death increased with increasing adolescent BMI. Some of the
persons included in that study were also measured as adults in
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later population-based health surveys. The present study
explored the relation between BMI in adolescence and in
adulthood in a subcohort measured both at age 14 –19 years
and in adulthood. These persons were followed up with
regard to death. Hence, it was possible to study independent
effects of adolescent and adult BMI on the risk of death.
METHODS
Study Population
Height and weight were measured during 1963–1975 as
part of a tuberculosis screening program in the general
Norwegian population.15–17 This mass examination was com-
pulsory for persons age 15 years and older, but height and
weight were also measured in some persons less than age 15
years. The attendance was approximately 85% in persons
above the age of 15 years.15 Previous reports have described
the impact of adult height and weight on morbidity and
mortality in this cohort.15,16,18 The relation between BMI in
adolescence and mortality has also been explored using the
complete cohort of adolescents (n ⫽ 227,003) measured
during the screening program.10 Since 1973, height and
weight have been measured in several other population-based
health surveys in different parts of Norway.17,19 The atten-
dance in the mid-1970s was 85–90%, but decreased to ap-
proximately 75% in the mid-1990s.17 Because of a unique
11-digit identification number assigned to all residents of
Norway, it was possible to link separate measurements for
each person.
Body weight (in kilograms) was measured using scales
that were calibrated regularly and recorded to the nearest
half-kilogram. Height was measured to the nearest centime-
ter. Measurements were excluded if they were not performed
according to protocol (for example, the persons were wearing
shoes) or if the woman stated that she was pregnant. We
included all persons who were measured at least once in a
screening for tuberculosis at age 14 –19 years and again at
least 10 years later. The lower limit of 10 years was chosen
to ascertain that the persons were adults at the second mea-
surement and to allow sufficient elapsed time between the
measurements.
We excluded 281 persons registered with adolescent
height more than 3 cm above adult height. This left 128,121
persons eligible for analysis.
80
Epidemiology • Volume 15, Number 1, January 2004
In the population-based health surveys, the participants
were asked to complete self-administered questionnaires. The
questionnaires differed across surveys, and so although ques-
tions on smoking habits were included in all, the questions
differed slightly. Thus, we classified the subjects only as
“never-smoker” or “present or former smoker.”
It was possible to follow all persons except one from
date of measurement until emigration, death or until June 30,
2002, using the unique personal identification number and the
Death Registry at Statistics Norway.
Analytic Methods
We extracted the earliest BMI measurement at age
14 –19 and the earliest measurement taken at least 10 years
later for each person. We used multiple logistic regression
models20 to explore the pattern of the relation between BMI
in adolescence and adult obesity (BMI ⱖ30). BMI in adoles-
cence was categorized following the guidelines from CDC/
NCHS by using growth percentile curves from a U.S. refer-
ence population:14,21 low (⬍25th), medium (25th–74th), high
(75th– 84th), and very high (ⱖ85th). From the web site of
CDC/NCHS,21 we extracted percentiles for every 6 months
from the age of 14 –20 years. Complete percentile curves
were then constructed by linear interpolation between these
points. Growth curves from CDC/NCHS were chosen rather
than constructing percentile curves from the study population
to permit comparisons with other studies. Age at measure-
ment in both adolescence (14 –15, 16 –17, and 18 –19 years)
and adulthood (24 –29, 30 –34, 35–39, and 40 –54 years) were
included in the model.
Multiple Cox proportional hazards regression models,
with time since adult measurement as the time variable, were
fitted to estimate relative risk of dying in different groups.22
BMI in adolescence was categorized as previously men-
tioned. The categorization of BMI in adulthood was ⬍18.50,
18.50 –22.49, 22.50 –24.99, 25.00 –27.49, 27.50 –29.99, and
ⱖ30.00. This categorization is more detailed than the recom-
mendations from a WHO Consultation on Obesity in 1997,23
but is consistent with these recommendations.
The proportionality assumption in the Cox model was
assessed by inspecting log-minus-log plots and the results
from stratified analyses.
In addition to the variables included in the main mod-
els, we had information on area of residence at the time of
each measurement (southeast, southwest, mid, and northern
Norway), year of measurement, and smoking habits at the
adulthood measurement (never-smoker and present or former
smoker). The impact of these variables was explored both by
inclusions in the models and by stratified analyses.
Analyses were performed separately for each sex. The
results were presented as odds ratios (OR) of obesity in
adulthood and relative risks (RR) of dying with 95% confi-
dence intervals (CI).
© 2003 Lippincott Williams & Wilkins
 Epidemiology • Volume 15, Number 1, January 2004 Adolescence and Adulthood Obesity in Relation to Mortality

TABLE 1. Number of Persons, Number of Deaths, Observed Person-Years After Adult Measurement, and Overall Sex-Specific
Death Rates

Men Women
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No. of No. of Person- Death No. of No. of Person- Death

Persons Deaths Years Rate* Persons Deaths Years Rate*

Birth year
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1943–49 10,456 275 138,625 198 11,547 208 153,404 136

1950–59 51,066 715 458,033 156 55,052 484 489,463 99
Adolescent measurement
Age (years)
14–15 18,390 238 166,951 143 20,159 176 182,071 97
16–17 23,734 344 221,678 155 25,617 243 235,571 103
18–19 19,398 408 208,028 196 20,823 273 225,225 121
Period
1963–70 45,941 869 498,550 174 49,423 606 534,413 113
1971–75 15,581 121 98,107 123 17,176 86 108,454 79
BMI†
Low 14,266 227 137,872 165 10,801 98 102,297 96
Medium 39,474 613 383,785 160 43,511 439 417,805 105
High 4776 89 46,577 191 7405 85 73,627 115
Very high 3006 61 28,423 215 4882 70 49,138 142
Adult measurement
Age (years)
24–29 1811 61 40,216 152 1929 35 42,809 82
30–34 4234 116 75,131 154 4240 66 75,885 87
35–39 5662 96 65,081 148 5984 91 68,119 134
40–54 49,815 717 416,229 172 54,446 500 456,054 110
Period
1973–80 1992 74 45,502 163 2177 44 50,011 88
1981–85 3919 103 69,272 149 3782 65 66,824 97
1986–90 8488 209 109,189 191 9272 162 120,175 135
1991–95 35,434 551 317,575 174 38,327 368 344,608 107
1996–99 11,689 53 55,120 96 13,041 53 61,249 87
BMI‡
⬍18.50 194 7 2249 311 1240 13 14,157 92
18.50–22.49 9032 192 97,660 197 23,796 275 245,731 112
22.50–24.99 19,382 284 195,341 145 19,644 181 185,774 97
25.00–27.49 18,576 254 174,391 146 11,140 99 101,513 98
27.50–29.99 9005 140 81,235 172 5511 55 49,417 111
ⱖ30.00 5333 113 45,782 247 5268 69 46,275 149
Time between measurements (years)
10–14 2930 98 63,160 155 3162 57 68,176 84
15–19 4321 112 71,513 157 4273 73 70,592 103
20–24 35,491 603 335,769 180 38,092 417 362,153 115
25–29 18,780 177 126,215 140 21,072 145 141,946 102
Total 61,522 990 596,657 166 66,599 692 642,867 108
*Number of deaths per 100,000 person-years.
†
Defined by percentiles in a U.S. reference population21: low (⬍25th), medium (25th–74th), high (75th– 84th), and very high (ⱖ85th).
‡
BMI ⫽ (weight in kg)/(height in meter)2.

© 2003 Lippincott Williams & Wilkins 81

 Engeland et al Epidemiology • Volume 15, Number 1, January 2004

TABLE 2. Overall Mean Values* of Study Characteristics by Adolescent Body Mass Index (BMI)

Adolescent Measurement Adulthood Measurement

Adolescent Percentage Weight Height BMI Weight Height BMI
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BMI† of Subjects (kg) (cm) (kg/m2) (kg) (cm) (kg/m2)

Men
Low 23.2 56.8 173.9 18.7 75.9 179.7 23.5
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Medium 64.2 64.9 174.6 21.2 82.2 178.9 25.7

High 7.8 73.0 174.7 23.9 89.8 178.3 28.2
Very high 4.9 81.7 174.8 26.7 96.8 178.6 30.3
All 100.0 64.5 174.4 21.1 82.1 179.0 25.6
Women
Low 16.2 49.2 164.5 18.2 60.7 166.3 21.9
Medium 65.3 56.8 164.3 21.0 65.7 165.9 23.9
High 11.1 64.6 163.8 24.0 71.9 165.3 26.3
Very high 7.3 72.2 163.4 27.0 79.0 164.8 29.0
All 100.0 57.5 164.2 21.3 66.6 165.8 24.2
*Additional mean values (both sexes): year of birth ⫽ 1952; age at adolescent measurement ⫽ 17; year of adolescent measurement ⫽ 1969; age at adult
measurement ⫽ 40; year of adult measurement ⫽ 1992.
†
Defined by percentiles in a U.S. reference population21: low (⬍25th), medium (25th–74th), high (75th– 84th), and very high (ⱖ85th).

RESULTS steadily with increasing BMI in adolescence. Adjusting for

The mean age of the 128,121 study subjects (61,522
men and 66,599 women; Table 1) was 17.0 years at the
adolescent measurement (Table 2). Among adolescents, 64%
of the boys and 65% of the girls had medium BMI, whereas
5% of the boys and 7% of the girls had very high BMI (Table
2).
Among men, the most common BMI categories at the
adult measurement were 22.50 –24.99 (32%) and 25.00 –
27.49 (30%) (Table 1). Among women, the most common
adult categories were 18.50 –22.49 (36%) and 22.50 –25.00
(29%). Approximately 9% of men and 8% of women had a
BMI of at least 30. The mean BMI was 25.6 among men and
24.2 among women. The mean time between adolescent and
adult measurement was 23 years among both men and women
(range, 10 –34 years).
Persistence of Obesity
Table 3 shows the BMI at adolescent and adult mea-
surement. Half the men with very high BMI in adolescence
had BMI above 30 as adults, whereas only 5% of men with
low or medium BMI had BMI above 30 as adults. Similar
figures for women were 37% and 4%, respectively. Among
obese (BMI ⱖ30) adults, 28% of men and 35% of women
had very high BMI in adolescence.
The degree of persistence of obesity from adolescence
into adulthood is illustrated in Table 4. The Hosmer-Leme-
show goodness-of-fit statistic was 12.2 in men and 10.1 in
women on 6 degrees of freedom, giving P values of 0.06 and
0.12, respectively. The OR of obesity in adulthood increased
other variables changed the estimates only slightly. The
relative association between BMI in adolescence and adult
obesity was roughly the same among men and women.
Mortality
The persons in this study were followed for an
average of 9.7 years (range 0 –29 years) after the measure-
ment in adulthood, comprising 1,239,523 person-years
(Table 1). Among these, a total of 1682 deaths were
observed. Mean age at death was 46.2 years in men and
46.5 years in women. By June 30, 2002, 126,013 persons
(98.4%) were still alive and living in Norway, and 426
persons had emigrated.
Adolescents with high or very high BMI had a higher
mortality than those with medium BMI (Table 5) after ad-
justing only for age at start of follow up (age at adult
measurement). After adjusting for adult BMI, there was no
excess mortality in men (relative risk [RR] ⫽ 1.1, 0.8 –1.5),
whereas the excess in women persisted (RR ⫽ 1.3, 1.0 –1.7).
Further adjustments for other variables did not change the
results. Low adult BMI seems to be associated with an
increased mortality in men but not in women.
Because BMI in adolescence and in adulthood are
strongly correlated, we performed stratified analyses in which
persons with high adult BMI were excluded from analysis of
the association of adolescent BMI with mortality, or persons
with high adolescent BMI were excluded from analysis of
adult BMI and mortality. Hence, we looked at the indepen-
dent impact of adolescent or adult BMI within a subgroup of

82 © 2003 Lippincott Williams & Wilkins

 Epidemiology • Volume 15, Number 1, January 2004 Adolescence and Adulthood Obesity in Relation to Mortality

TABLE 3. Number of Persons by Body Mass Index (BMI) in Adolescence (14 –19 years) and Adulthood (at least 10 years
later)

Adolescent BMI*
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Adult BMI Low Medium High Very High Total

Men
⬍18.50 178 15 1 194
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18.50–22.49 4945 3997 72 18 9032

22.50–24.99 5573 13061 576 172 19382
25.00–27.49 2758 13813 1486 519 18576
27.50–29.99 663 6099 1446 797 9005
ⱖ30.00 149 2489 1195 1500 5333
Total 14266 39474 4776 3006 61522
Women
⬍18.50 718 502 17 3 1240
18.50–22.49 6226 16097 1148 325 23796
22.50–24.99 2642 14083 2062 857 19644
25.00–27.49 858 7468 1825 989 11140
27.50–29.99 268 3241 1124 878 5511
ⱖ30.00 89 2120 1229 1830 5268
Total 10801 43511 7405 4882 66599
*Defined by percentiles in a U.S. reference population21: low (⬍25th), medium (25th–74th), high (75th– 84th), and very high (ⱖ85th).

adult BMI. When including only persons with adult BMI

TABLE 4. Odds ratios (OR) of Being Obese as an Adult
(body mass index ⱖ30) by Adolescent BMI*
below 27.5, there was little effect of adolescent BMI in either
men or women (Table 6B).
Adolescent BMI† OR (CI)

Men DISCUSSION
Low 0.2 (0.1–0.2) This study included persons whose height and weight
Medium‡ 1.0 were measured both in adolescence and in adulthood. The
High 5.1 (4.7–5.5) odds of being obese in adulthood increased consistently and
Very high 15 (14–17) rapidly with increasing BMI in adolescence. Adults who had
Women been overweight adolescents had increased mortality com-
Low 0.2 (0.1–0.2) pared with those of medium adolescent BMI (ie, BMI be-
Medium‡ 1.0 tween the 25th and the 75th percentile in the U.S. reference
High 4.0 (3.7–4.3) population). After adjusting for adult BMI, there was no
Very high 12 (11–13) excess mortality in men, although the excess mortality per-
*Logistic regression analysis, adjusted for age at adolescent and adult sisted in women. On the other hand, the association between
measurement. adult BMI and mortality was not influenced by adjustment for
†
Defined by percentiles in a U.S. reference population21: low (⬍25th),
medium (25th–74th), high (75th– 84th), and very high (ⱖ85th). adolescence BMI.
‡
Reference category. One of the major strengths of this study was the large
sample size, recruited from the general population. Adoles-
cent weight and height measurements were obtained from the
compulsory national tuberculosis screening program. Both in
the other. When including only persons with low or medium this program and in the later health surveys, measurements
BMI in adolescence, the relation between adult BMI and were performed in a standardized way. The follow up of the
mortality (Table 6A) was similar to that observed in the study subjects was almost complete until the end of follow
whole cohort (Table 5): among men, both low and high adult up; of the 128,121 persons eligible for the study, 99.7% were
BMI was associated with an increased risk of death, whereas registered as either being alive by the end of follow up or
among women, increased risk of death was seen only for high having died during follow up; 0.3% had emigrated.

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 Engeland et al Epidemiology • Volume 15, Number 1, January 2004

TABLE 5. Relative Risk (RR) of Dying Body Mass Index
(BMI) in Adolescence or in Adulthood
Model A* RR
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TABLE 6. Relative Risk of Dying by BMI.* Analysis Restricted
to (A) Persons with Low or Medium BMI in Adolescence or
(B) Persons with BMI Below 27.5 in Adulthood
Model B* RR

Variable (95% CI) (95% CI) Men Women

Men No. of RR No. of RR
Adolescent BMI† (A) Deaths (95% CI) deaths (95% CI)
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Low 1.0 (0.9–1.2) 0.9 (0.8–1.1) Adult BMI

Medium‡ 1.0 1.0 ⬍18.50 7 2.2 (1.0–4.7) 13 1.0 (0.6–1.8)
High 1.2 (1.0–1.5) 1.1 (0.9–1.4) 18.50–22.49 191 1.4 (1.1–1.7) 253 1.2 (1.0–1.5)
Very high 1.4 (1.0–1.8) 1.1 (0.8–1.5) 22.50–24.99§ 270 1.0 143 1.0
Adult BMI (kg/m2) 25.00–27.49 214 1.0 (0.8–1.1) 70 1.0 (0.8–1.4)
⬍18.50 2.2 (1.0–4.6) 2.3 (1.1–4.8) 27.50–29.99 109 1.3 (1.0–1.6) 32 1.1 (0.8–1.7)
18.50–22.49 1.4 (1.1–1.6) 1.4 (1.1–1.7) ⱖ30.00 49 1.6 (1.1–2.1) 26 1.5 (1.0–2.3)
22.50–24.99‡ 1.0 1.0
25.00–27.49 1.0 (0.8–1.2) 1.0 (0.8–1.2) Men Women
27.50–29.99 1.2 (1.0–1.5) 1.1 (0.9–1.4) No. of RR No. of RR
ⱖ30.00 1.7 (1.4–2.1) 1.6 (1.2–2.0) (B) deaths (95% CI) deaths (95% CI)

Women Adolescent BMI‡

Adolescent BMI† Low 218 1.1 (0.9–1.3) 97 0.9 (0.8–1.2)
Low 0.9 (0.7–1.1) 0.9 (0.7–1.1) Medium§ 464 1.0 382 1.0
Medium‡ 1.0 1.0 High 44 1.3 (1.0–1.8) 60 1.1 (0.8–1.5)
High 1.1 (0.9–1.4) 1.1 (0.9–1.4) Very high 11 1.0 (0.6–1.9) 29 1.2 (0.8–1.8)
Very high 1.4 (1.1–1.8) 1.3 (1.0–1.7) *Cox regression analysis, including age at start of follow up (ie, age at
Adult BMI (kg/m2) adult measurement).
‡
Defined by percentiles in a U.S. reference population21: low (⬍25th),
⬍18.50 1.0 (0.6–1.7) 1.1 (0.6–1.9) medium (25th–74th), high (75th– 84th), and very high (ⱖ85th).
§
18.50–22.49 1.2 (1.0–1.4) 1.2 (1.0–1.5) Reference category.
22.50–24.99‡ 1.0 1.0
25.00–27.49 1.0 (0.8–1.3) 1.0 (0.8–1.2)
27.50–29.99 1.1 (0.8–1.5) 1.1 (0.8–1.5)
ⱖ30.00 1.5 (1.1–2.0) 1.4 (1.0–1.8) adolescence, from good predictability at age 13 years to
excellent at age 18 years.1 We observed a strong association
*Cox regression analysis. Model A: age at start of follow up (ie, age at
adult measurement) and either adolescent or adult measurement; Model B:
between adolescent overweight and adult obesity. The finding
age at start of follow up (ie, age at adult measurement) and both adolescent that 50% of men and 37% of women with very high BMI in
and adult measurement. adolescence had BMI above 30 as adults is roughly consistent
†
Defined by percentiles in a U.S. reference population:21 low (⬍25th),
medium (25th–74th), high (75th– 84th), and very high (ⱖ85th). with findings from other studies.3 Several risk factors for
‡
Reference category. adult obesity have been reported previously; these include
parental fatness, social factors, birth weight, timing of mat-
uration, physical activity, and dietary factors.2,5,8
Because mortality in adolescence and young and mid-
Because of the large size of the dataset, it was possible dle-aged adulthood is low, a large number of persons and a
to analyze many categories of BMI, height, age and year of long follow up are necessary to observe a sufficiently large
birth instead of modeling these variables as continuous vari- number of deaths for precise estimates. In the present study,
ables. The effects of various levels of the variables were persons were followed for up to 29 years after the adolescent
therefore not “forced” into a specific pattern. The effect of measurement, although they were followed for only 10 years
adjusting for continuous confounders by the use of categor- on average after the adult measurement. Hence, even in this
ical variables has been questioned.24 Hence, we performed large cohort, the mortality data are limited.
additional analyses, including age and year of birth, first as Studies including BMI in adolescence have used dif-
continuous variables and then as linear spline functions (data ferent definitions of overweight and obesity.3 In the present
not shown). Similar results were obtained. study, we chose to use age- and sex-specific growth charts
The predictability of overweight at age 35 years from from CDC/NCHS to group adolescents by BMI. Another
adolescent BMI has been shown to increase with age during alternative was to use the growth charts from Cole et al.13

84 © 2003 Lippincott Williams & Wilkins

 Epidemiology • Volume 15, Number 1, January 2004
However, Cole et al. provided growth charts corresponding
only to BMI of 25 and 30 at age 18 years. The CDC/NCHS
growth charts made it possible to categorize in greater detail.
Even so, the choice of growth charts was not important for
Downloaded from http://journals.lww.com/epidem by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1
the results. Similar results were obtained when we used the
growth charts by Cole et al. (data not shown).
In a study from 1992, Must et al.6 followed 508 persons
who were either lean or overweight during adolescence for 55
AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 06/12/2024
years. Leanness in adolescence was defined as BMI between
the 25th and 50th percentiles, and overweight as BMI above
the 75th percentile. An excess mortality was observed in men
(but not women) who were overweight in adolescence com-
pared with those who were lean. Adjusting for adult BMI
decreased the relative risk only slightly. However, the adult
BMI was calculated from self-reported height and weight.
Errors in self-reported height and weight vary systematically
with BMI.25 Hence, systematic misclassification, combined
with a limited study size (n ⫽ 150 men), could have influ-
enced the results. In the present study, excess mortality was
observed in both men and women who were overweight in
adolescence. Adjustment for adult BMI reduced the excess
mortality in men, less so for women. Among persons with
BMI below 27.5 in adulthood, there was no clear evidence of
an effect of high adolescent BMI. Although the present
dataset was large, it was not large enough to explore this issue
more comprehensively, eg, with further stratification.
In the present study, we had information on smoking
habits at the adult measurement. Like in the study of Must et
al.,6 inclusion of smoking status to the regression model did
not change the estimated relative risks.
In summary, this study showed that obesity in adoles-
cence tends to persist into adulthood. Adolescent obesity is
also connected to an excess mortality in adulthood, although
this excess seems to be explained by obesity in adulthood, at
least in men. High BMI in adolescence is predictive of both
subsequent obesity and subsequent mortality.
ACKNOWLEDGMENTS
We are grateful to those who, during almost 40 years,
have collected the data used in the present study. These are
persons connected to the former National Health Screening
Service, The Nord-Trøndelag health survey (HUNT), The
Hordaland health survey (HUSK), and The Tromsø study.
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