Background

Morbidities related to obesity are usually associated with its severity and duration. Yet, the onset of serious morbidities in early adulthood among otherwise healthy adolescents with obesity is understudied. We aimed to investigate the association between adolescent BMI and serious morbidities before age 25 years.

Methods

In this nationwide, retrospective cohort study, we included Israeli conscripts aged 17–21 years who underwent pre-recruitment medical evaluation between Jan 1, 1996, and Dec 31, 2017, were deemed medically eligible for military service, and were recruited to the Israeli Defense Forces between 1998 and 2018. Exclusion criteria were missing height or weight or service ineligibility for non-medical or medical reasons. Baseline BMI was converted into age-specific and sex-specific percentiles and classified using the US Centers for Disease Control and Prevention categories. The primary outcome was incidence of serious morbidity disqualifying individuals from completing mandatory service. Participants were followed from enlistment until end of service (3 years for males and 2 years for females), onset of serious morbidity, or Dec 31, 2021. Cox models with adjustment to various socio-economic confounders were applied to calculate the hazard ratio (HR) and 95% CI for serious morbidity for the BMI categories.

Findings

A total of 1 264 355 adolescents aged 16–20 years were assessed for military service. 145 702 were excluded; 144 705 were considered ineligible for service (133 112 for non-medical reasons and 11 593 for medical reasons), and 2867 had missing height or weight data. The study included 1 118 653 individuals (622 989 [55·7%] males and 495 664 [44·3%] females), with 23 347 cases of serious morbidity recorded over 2 534 873 person-years. Incidence of serious morbidity increased across BMI groups in both sexes. Among males, compared with those with normal BMI, the adjusted HRs were 0·89 (95% CI 0·83–0·95) for underweight, 1·21 (1·16–1·27) for overweight, 1·39 (1·32–1·47) for obesity class 1, 2·82 (2·60–3·06) for obesity class 2, and 5·14 (4·37–6·04) for obesity class 3. For females, the respective ratios were HR 0·95 (95% CI 0·84–1·09) for underweight, 1·27 (1·17–1·37) for overweight, 1·63 (1·45–1·82) for obesity class 1, 4·00 (3·46–4·61) for obesity class 2, and 7·30 (5·65–9·43) for obesity class 3. Results persisted in sensitivity analyses restricted to those with unimpaired health at baseline or those in civilian-equivalent office employments.

Interpretation

Obesity in otherwise healthy adolescents was linked with increased risk of serious morbidity before age 25 years. Reducing adolescent obesity will have substantial short-term and long-term health benefits in young adults.

Funding

Sheba Medical Center.

中文翻译：

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以色列青少年超重和肥胖以及成年早期严重发病的风险：一项全国性回顾性队列研究

 背景

与肥胖相关的发病率通常与其严重程度和持续时间有关。然而，在其他方面健康的肥胖青少年中，成年早期严重发病率的发作研究不足。我们旨在调查青少年 BMI 与 25 岁前严重发病率之间的关联。

 方法

在这项全国性的回顾性队列研究中，我们纳入了 17-21 岁的以色列应征入伍者，他们在 1996 年 1 月 1 日至 2017 年 12 月 31 日期间接受了征兵前的医学评估，被认为符合服兵役的医学条件，并在 1998 年至 2018 年间被招募到以色列国防军。排除标准是身高或体重缺失或由于非医疗或医疗原因而不符合服务资格。将基线 BMI 转换为年龄特异性和性别特异性百分位数，并使用美国疾病控制和预防中心类别进行分类。主要结局是使个人无法完成义务兵役的严重发病率。参与者从入伍到服役结束（男性 3 年，女性 2 年）、严重发病发作或 2021 年 12 月 31 日进行随访。采用调整各种社会经济混杂因素的 Cox 模型来计算 BMI 类别严重发病率的风险比 （HR） 和 95% CI。

 发现

共有 1 264 355 名 16-20 岁的青少年接受了兵役评估。145 702 人被排除在外;144 705 人被认为不符合服役资格（133 112 人因非医疗原因，11 593 人因医疗原因），2867 人身高或体重数据缺失。该研究包括 1 118 653 人（622 989 [55·7%] 男性和 495 664 [44·3%] 女性），在 2 534 873 人年中记录了 23 347 例严重发病率。男女 BMI 组的严重发病率均增加。在男性中，与 BMI 正常的人相比，校正后的 HR 为体重不足 0·89 （95% CI 0·83–0·95），超重 1·21 （1·16–1·27），1 级肥胖 1·39 （1·32–1·47），2 级肥胖 2 级 2·82 （2·60–3·06） 和 3 级肥胖 5·14 （4·37–6·04）。对于女性，肥胖等级 2 的 HR 分别为 HR 0·95 （95% CI 0·84–1·09）、超重 1·27 （1·17–1·37）、1·63 （1·45–1·82） 肥胖等级、4·00 （3·46–4·61） 肥胖等级 2 和 7·30 （5·65–9·43）。敏感性分析的结果持续存在，仅限于基线时健康状况未受损的人或从事相当于文职办公室工作的人。

 解释

其他方面健康的青少年肥胖与 25 岁之前发生严重疾病的风险增加有关。减少青少年肥胖将对年轻人产生巨大的短期和长期健康益处。

 资金

 Sheba 医疗中心。