Changes in Body Size Phenotypes From Childhood to Adulthood and the Associated Cardiometabolic Outcomes, a Prospective Cohort Study

Abstract Background: Cardiometabolic outcomes associated with changes between body size phenotypes (defined by body mass index [BMI] together with metabolic status) over time have attracted attention recently. It remains unclear how metabolic health change from childhood to adulthood across different BMI categories and how such dynamic changes from childhood to adulthood might affect risk of cardiometabolic outcomes in adulthood. Therefore, we aimed to examine the effects of changes in body size phenotypes between childhood and adulthood on risks of diabetes and left ventricular hypertrophy (LVH) in adulthood.Methods: We included 3,351 individuals who participated as both children and adults in the Bogalusa Heart Study. The mean follow-up period was 36 years. Body size phenotypes for both children and adults were defined by harmonized criteria.Results: Compared with participants with persistently metabolically healthy normal weight (MHNW) from childhood to adulthood, MHNW children who became metabolically unhealthy in adulthood had increased diabetes burden and LVH risk in adulthood; Metabolically unhealthy normal weight (MUNW) children who became MHNW or metabolically healthy obese (MHO) as adults and individuals with persistent MHO from childhood to adulthood were not at increased risks of diabetes or LVH. The risks were increased if MHO during childhood transitioned to metabolically unhealthy obesity (MUO) by adulthood or MUO stayed from childhood to adulthood. MUO children who became MHO or MHNW as adults had decreased diabetes burden and LVH risk in adulthood.Conclusions: Individuals maintained MHO from childhood to adulthood and MUNW children who became MHO as adults had a diabetes burden and LVH risk similar to individuals with persistent MHNW. Progression to metabolically unhealthy status and maintenance of metabolically unhealthy status, regardless of childhood BMI status, were associated with increased cardiometabolic outcomes.