Teen Obesity and Heart Disease

Written by Dr. Steve Chaney on . Posted in Uncategorized

Author: Dr. Stephen Chaney

teen obesity and heart diseaseI don’t need to tell you that we are in the midst of an obesity epidemic. Sadly, that obesity epidemic has even affected our children. Currently, one third of the adolescent population of the United States and other developed countries is overweight or obese, and those numbers are rapidly increasing.  Teen obesity and heart disease are not uncommon.

You probably also knew already that overweight and obesity in the early years increases the risk of death from cardiovascular disease and other causes among young adults, but a new study suggests that the consequences of overweight during the teen years may be much worse than we thought.

How Was This Study Done?

This study (Twig et al, The New England Journal of Medicine, DOI:10.1056/NEJMoa1503840, Published April 13, 2016) was based on a national database of 2.3 million Israeli adolescents ages 16-19 (average 17.1) for whom height and weight were measure between 1967 and 2010. Israel has such an extraordinarily large database because one year before military service all Israeli adolescents are required to undergo a medical evaluation. This is predominantly a male population because Orthodox women are excluded from service.

military studyIsrael also has a national health service that keeps a comprehensive database of deaths. Therefore, the investigators were able to record all deaths in this group that were attributable to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories, which they classified as total cardiovascular deaths through June 30, 2011. That means that the median age at the end of the study was around 40.

The investigators divided the subjects into groups based on their BMI (weight (kg)/ height (m)2), a measure of the leanness or obesity of each individual and compared BMI with deaths due to various kinds of heart disease.

What sets this study apart from all previous studies was the size of the database (2.3 million). Because of the very large number of subjects in the study the investigators:

  1.  Were able to accurately measure the effect of BMI on cardiovascular deaths in people aged 30-40, an age at which the incidence of cardiovascular deaths is relatively low.
  2. Were able to divide the subjects into seven BMI groupings, rather than the two or three used in most previous studies.

For example, most previous studies have simply compared individuals who were obese (BMI > 95th percentile) or overweight (BMI in 85th to 94th percentile) with everyone in the normal range (BMI in the 5th to 84th percentile).

This study further separated individuals within the normal BMI range to high-normal (BMI in the 75th to 84th percentile), mid-normal (BMI in the 50th to 74thpercentile), and low normal (BMI in the 25th to 49th percentile) and compared each group to individuals with BMIs in the 5th to 24th percentile.

Teen Obesity and Heart Disease:  Will Your Teen Die Prematurely?

The results of the study were pretty sobering.

teen deaths from heart disease1)     For teens who are obese (210 pounds for a 6’ boy and 175 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increases 4.9 fold
  • Stroke increases 2.6 fold
  • All cardiovascular causes increases 3.5 fold
  • The increased risk of dying from all kinds of cardiovascular disease was 2-fold greater by age 27 and 4-fold greater by the time the subjects had reached age 37-47.

2)     For teens who are overweight (185-209 pounds for a 6’ boy and 155-174 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increases 3.0 fold
  • Stroke increases 1.8 fold
  • All cardiovascular causes increases 2.2 fold

3)     For teens who are at high-normal weight (175-184 pounds for a 6’ boy and 145-154 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increases 2.0 fold
  • Stroke increases 1.4 fold
  • All cardiovascular causes increases 1.8 fold

4)     Perhaps the most surprising finding was that even for teens who are at mid-normal weight (155-174 pounds for a 6’ boy and 130-144 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increase 1.5 fold
  • All cardiovascular causes increases 1.3 fold

5)     The number of teen girls in the study was much less, but they appeared to have similar increased risk of cardiovascular deaths with increased BMI compared to the boys in the study.

The message is clear on teen obesity and heart disease.

  • Obesity and overweight during the teen years are killers. They can lead to a significant increase in deaths due to heart attacks, strokes and all cause cardiovascular mortality long before those teens reach the age of 50.
  • Even teens who are in the higher end of what is considered a normal weight range are at increased risk of cardiovascular mortality long before they reach their golden years.

The Bottom Line

A recent study compared the BMI of 2.3 million Israeli teens (average age 17) with cardiovascular deaths over the next few decades

1)     Teens who were overweight or obese had a 2-fold greater risk of dying from cardiovascular disease by age 27 and 4-fold greater risk by the time they reached age 37-47.

2)     Even teens who were at the upper end of the normal weight range had a 1.8-fold increased risk of dying from cardiovascular disease.

The message is clear.

  • Obesity and overweight during the teen years are killers. They can lead to a significant increase in deaths due to heart attacks, strokes and all cause cardiovascular mortality long before those teens reach the age of 50.
  • Even teens who are in the higher end of what is considered a normal weight range are at increased risk of cardiovascular mortality before they reach their golden years.

     These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

Can Plant-based Diets Be Unhealthy?

Posted September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

 

plant-based diets vegetablesPlant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

 

How Was The Study Done?

plant-based diets studyThis study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

  • The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
  • The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
  • The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

 

Do Plant-Based Diets Reduce Heart Disease Deaths?

plant-based diets reduce heart deathsThe participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

  • The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
  • Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
  • Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

 

Can Plant-Based Diets Be Unhealthy?

plant-based diets unhealthy cookiesNow, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

  • The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
  • The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

 

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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