The Association of Weight Categories in Adolescence with Cardiovascular Morbidity in Young Adult Israeli Arabs—A Nationwide Study

Objectives. The health consequences of adolescent obesity are understudied in young adult Israeli Arabs. We aimed to evaluate the association of weight categories during adolescence with hypertension (HTN), diabetes mellitus type 2 (DM2), and the composite endpoint of ischemic stroke (IS), myocardial infarction (MI), and heart failure (HF) in young adult Israeli Arabs on a nationwide level. Methods. A retrospective cohort study of 53,726 Arab adolescents born from 1988–1992 was conducted. The cohort was followed, beginning with BMI measurements at ages 17–19 years, until whichever came first among the diagnosis of outcome disease, death, discontinuation of health insurance, or age of 30 years. Results. The incidence (95% CI) of HTN, DM2, and the composite endpoint of IS, MI, and HF was 138.2 (129.1–147.9), 136.7 (127.6–146.3), and 27.3 (23.3–31.7) cases per 10⁵ person-years, respectively. The risk for DM and HTN increased gradually, starting from the ‘overweight’ category, and reaching fully adjusted HRs (95% CI) of 2.80 (1.82–4.30), and 1.97 (1.31–2.96), respectively, in the ‘class 3 obesity’ category. The Hazard ratio (HR) for the composite endpoint, its incidence and components, was highest in the ‘overweight’ category (aHR of 1.64 (1.08–2.50)). Conclusions. The findings emphasize the long-term health consequences of adolescent obesity in early adulthood and, hence, the need for interventions aimed at reducing the rate of adolescent overweight and obesity. The finding of a very high rate of DM2 incidence in early adulthood, even among adolescents without obesity, necessitates an integrated public health approach to all risk factors to prevent DM2 in this population.