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Childhood, adolescent and early adult body mass index in relation to adult mortality: results from the British 1946 birth cohort
  1. Bjørn Heine Strand1,2,
  2. Diana Kuh1,
  3. Imran Shah1,
  4. Jack Guralnik2,
  5. Rebecca Hardy1
  1. 1MRC National Survey of Health and Development, MRC Unit for Lifelong Health and Ageing, London, UK
  2. 2Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Bjørn Heine Strand, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Avenue, Gateway Building, Suite 3C309, Bethesda, Maryland 20892-9205, USA; heine{at}


Background Adult body mass index (BMI) has been consistently related to mortality, but little is known about the impact of earlier life BMI on adult mortality. The aim is to investigate the impact of childhood, adolescent and early adult BMI on premature adult all-cause mortality.

Methods The British 1946 cohort study was used to assess the association of BMI in childhood, adolescence and adulthood with mortality 26–60 years (332 deaths). 4462 (83%) respondents were available for analysis at age 26 years. Splines were used in Cox regression to model the associations between BMI and mortality.

Results In both genders, adult BMI from 20 years onwards showed a consistent U-shaped relationship with adult mortality (overall p value <0.05 for BMI at ages 20, 26 and 36 years). In women, a similar relationship was observed for adolescent BMI at 15 years (p=0.02); the HR comparing women with low BMI (2 SDs below mean) versus mean BMI was 2.96 (95% CI 1.26 to 6.97). The corresponding HR for women with BMI 2 SDs above the mean was 1.97 (0.95 to 4.10). BMI in childhood was generally not associated with adult mortality except female BMI at 4 years where a U-shaped relationship was observed (p=0.02); HR for BMI 2 SDs below mean versus mean was 2.13 (0.97 to 4.70) and the corresponding HR for 2 SDs above the mean was 1.67 (0.85 to 3.28). This association was not attenuated by subsequent BMI change or mediators.

Conclusions High and low BMI from early adulthood were related to adult premature mortality suggesting that promoting a normal weight in early adulthood could prevent premature mortality.

  • Body mass index
  • BMI
  • growth trajectories
  • life-course
  • underweight
  • overweight
  • obesity
  • childhood
  • adolescent
  • mortality
  • longitudinal studies
  • mortality SI

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  • Funding The study is funded by the MRC Unit for Lifelong Health and Ageing, UK, and supported in part by the Intramural Research Program, National Institute on Aging, NIH, USA. The funders of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report.

  • Competing interests None.

  • Ethics approval Obtained from the Multicentre Research Ethics Committee (MREC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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