Int J Obes (Lond). 2026 Apr 30. doi: 10.1038/s41366-026-02091-6. Online ahead of print.
ABSTRACT
BACKGROUND: The relationship between body size across the life course and risks of cardiovascular disease (CVD) and mortality remains incompletely understood, particularly regarding transitions from childhood to adulthood and potential sex-specific differences. We examined the independent and joint associations of childhood body size, adulthood body mass index (BMI), and life-course body size trajectories with incident CVD and mortality.
METHODS: We analyzed data from 456,461 UK Biobank participants free of CVD at baseline. Childhood body size at age 10 was self-reported as thinner, about average, or plumper relative to peers. Adulthood BMI was measured and classified as normal weight (<25 kg/m²), overweight (25-29.9 kg/m²), or obesity (≥30 kg/m²). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD-including stroke, coronary artery disease (CAD), and heart failure (HF)-and all-cause and cause-specific mortality. Sex-stratified analyses were conducted to assess effect modification.
RESULTS: During follow-up, 2703 participants developed stroke, 13,349 HF, and 37,365 CAD. Compared with average childhood body size, plumper childhood was associated with higher risks of HF (HR 1.21, 95% CI 1.14-1.28) and CAD (HR 1.08, 95% CI 1.04-1.11). Adulthood obesity was strongly associated with HF (HR 1.91, 95% CI 1.80-2.02), CAD (HR 1.59, 95% CI 1.53-1.64), and all-cause mortality (HR 1.16, 95% CI 1.12-1.20). Life-course transitions toward obesity showed the highest risks, particularly for thinner-to-obesity trajectories (HF: HR 2.18, 95% CI 2.00-2.39; CAD: HR 1.72, 95% CI 1.62-1.81; all-cause mortality: HR 1.21, 95% CI 1.14-1.28). Associations with stroke were weaker and mainly observed for thinner-to-obesity transitions (HR 1.24, 95% CI 1.02-1.52). Associations were generally stronger in women.
CONCLUSION: Body size across the life course is associated with CVD and mortality, with progression to obesity from childhood to adulthood conferring the greatest risk. These findings support life-course and sex-sensitive obesity prevention strategies.
PMID:42062534 | DOI:10.1038/s41366-026-02091-6