JOURNAL PRESENTATION

BMI Increase Through Puberty and Adolescence is

Associated with Risk of Adult Stroke

Amanda P Kirana
00000003983
Pembimbing : dr. Retno Jayantri Ketaren
Sp.S
Penguji : dr. Retno Jayantri Ketaren Sp.S
 Writer :

Claes Ohlsson, Maria

Bygdell, Arvid Sonden,
Christina Jern, Annika
Rosengren, and Jenny M.
Kindblom
 Key Points

Background

Methods

Results

Discussion
 STROKE
is a medical condition that occurs when the
blood supply to part of the brain is cut off
 Background
Stroke incidence has decreased among older
individuals but increasing among young adults

The cause is not known It coincides with the

obesity epidemic
A high adult BMI is a risk factor for stroke

For prepubertal childhood BMI, there is no

clear evidence of an association with adult risk
of stroke
 BMI increase during puberty might be a risk
marker of adult stroke

To evaluate the relative contribution of childhood

BMI and BMI increase through puberty and
adolescence as risk markers for adult stroke
 Methods

Study population

Subject : All men born in 1945-1961 in

Gothenburg, Sweden (with SHC record
and PIN)

Place : Gothenburg, Sweden

 Standard protocol
approvals,
registrations, and
patient consents

BMI (6,5-9 yo)

BMI (17,5-22 yo)

followed from 20 years of

age until censoring due to
Association stroke, death, migration, or
between exposures until December 31, 2013
and events
RESULTS
Total stroke : 918
Ischemic : 672
ICH : 207
N : 39
 BMI increase through BMI increase through
puberty and puberty and adolescence
adolescence, but not was moderately
childhood BMI, was associated with IS and
directly associated with strongly associated with
risk of stroke ICH
 Childhood
overweight
(17.9 kg/m2)

Young adult
overweight (25
kg/m2)
EARLY AND LATE STROKE
EVENTS
 BMI increase through puberty and
Risk of
adolescence adjusted for childhood early ICH is
BMI predicted early stroke and IS substantial

BMI increase during puberty was a

moderate risk marker of both early
and late adult stroke and IS while it
was a substantial risk marker
specifically of early adult ICH
 Exclusion of participants
Sensitivity with censoring during the Similar
analysis first 10 years of follow-up results
Evaluated a subpopulation

Additional
Adjusment for Similar
adjustment for
birthweight results
birthweight

Whether or not BMI

increase through puberty
Association with Strong
and adolescence was
hypertension associated with an adult association
diagnosis of hypertension
DISCUSSION
 BMI increase through puberty and
adolescence is an independent predictor
of adult CVD mortality

BMI increase through puberty and

adolescence is associated with risk of
adult stroke (IS and ICH)

The correlations between childhood BMI

and BMI increase through puberty and
adolescence were only marginal
 The present finding that young adult BMI
predicts risk of adult stroke confirms the
results from several previous studies

Only BMI increase through puberty and

adolescence independently associated
with risk of adult stroke

BMI increase through puberty and

adolescence is an independent risk
marker for adult stroke
 A large BMI increase during puberty was a
moderate risk marker of both early (<55 years of
age) and late (55 years of age) adult IS while it
was a substantial risk marker specifically of early
adult ICH

Although IS and ICH to some extent have

separate risk factors, high blood pressure is a
major risk factor for both diseases

High blood pressure might be a mediating factor

for the association between BMI increase
through puberty and adolescence and risk of
adult stroke
 HYPOTHESIS
Avoiding excessive BMI increase during puberty might
reduce the risk of adult stroke

One should consider monitoring adult blood pressure

in men with excessive BMI increase during puberty
 + -
No information on
childhood socioeconomic
factors or education
Large size of cohort
cannot control for several
Extended adult follow up
important risk factors or for
Population based
BMI at middle age
the Swedish national
The present cohort
disease registers are of
includes primarily
recognized high quality
Caucasian men
well-powered and therefore
Age interval was 5268
possible to identify relatively
years at the end of follow-
small effects
up (December 31, 2013) and
thus stroke risk later in life
could not be studied
 CONCLUSSION
BMI increase through puberty and adolescence
is associated with risk of adult IS

BMI increase through puberty and adolescence

is associated with risk of early adult ICH in men

High BMI increase during puberty might cause

increased risk of adult stroke at least partly via
increased blood pressure