Abstract
We sought to determine whether change in weight status between adolescence and young adulthood was associated with the risk of developing hypertension among adolescents and whether gender and racial/ethnic group differences existed in the National Longitudinal Study of Adolescent Health. The sample was restricted to participants who self-identified as African-American, Hispanic or White Non-Hispanic (N=8543). Height and weight were measured in adolescence (mean 16yrs), and again in adulthood (mean 29yrs). We categorized the participants weight into four groups: stayed normal weight; gained weight (normal weight in adolescence and obese in adulthood); lost weight (overweight/obese in adolescence non-obese in adulthood); chronically overweight/obese. Hypertension was defined as measured systolic blood pressure of at least 140mmHg or diastolic blood pressure of at least 90mmHG measured in adulthood, or use of antihypertensive medications. A higher risk of hypertension was noted for all gender and racial/ethnic groups who became obese in adulthood. Furthermore, those who were chronically overweight/obese were at higher risk of hypertension for all groups with odds ratios ranging from 2.7 in Hispanic men to 6.5 in Hispanic women. Except for African-American men, those who lost weight during follow up had no significant increased risk compared to those who maintained normal weight. Overall, there was an increased risk of hypertension for those who gained weight in adulthood and among those who remained obese from adolescence to young adulthood. These data give further evidence for prevention strategies that begin earlier in life to reduce or delay the onset of chronic disease in young adults.
Generated Summary
This research, utilizing data from the National Longitudinal Study of Adolescent Health (Add Health), examined the association between changes in weight status from adolescence to adulthood and the risk of developing hypertension. The study’s focus was to explore racial/ethnic and gender differences in this association. The study design involved a nationally representative sample of adolescents, with height and weight measured in adolescence and again in adulthood. Participants were categorized into four weight status groups: stayed normal weight, gained weight, lost weight, and chronically overweight/obese. Hypertension was defined by measured systolic blood pressure, diastolic blood pressure, or use of antihypertensive medications. The Add Health study followed participants over time with in-home interviews, providing data on weight, blood pressure, and other health-related behaviors, as well as socio-demographic factors. The primary aim was to determine if changes in weight status during the transition from adolescence to adulthood correlated with the risk of hypertension, and to understand the variations across different racial/ethnic and gender groups.
Key Findings & Statistics
- In adolescence, 30% of participants were overweight or obese, and this prevalence rose to 36% at follow-up.
- African-American women and Hispanic women were more likely to be chronically overweight/obese (35% and 27% respectively) compared to White women (19%).
- Among men, Hispanic men were more likely to be chronically overweight/obese (24%) compared to White men (22%).
- Hypertension prevalence differed by gender, with 28% of men and 13% of women being hypertensive.
- The study found a higher prevalence of hypertension among African-American women compared to White women (16% vs. 12%).
- Hispanic men had the highest prevalence of hypertension among men (29%), but it was not statistically different from White men (25%).
- In adjusted analyses examining pre-hypertension, significant associations were noted among African-American, Hispanic and white women who became obese in adulthood or who were chronically overweight/obese in adolescence and remained obese in adulthood compared to women of normal weight at both time points.
- Hispanic men and White men who became obese in adulthood as well as White men who were chronically overweight/obese in adolescence and remained obese in adulthood were more likely to be pre-hypertensive compared to men of normal weight at both time points.
- The study found significant associations across all racial/ethnic and gender groups among those who were overweight/obese in adolescence and remained obese in adulthood or who were of normal weight during adolescence but became obese in adulthood.
- Individuals who were formerly overweight but were not obese in adulthood had no increased risk of prehypertension or hypertension compared to those who were of normal weight during both time periods.
- African-American, Hispanic, and White men with normal weight in adolescence but became obese in adulthood had significantly higher SBP (4.4, 4.0 and 5.3 mmHg respectively).
- African-American, Hispanic, and White men who were chronically overweight/obese had significantly higher SBP (11.0, 5.3 and 5.9 mmHg respectively).
- African-American (8.3 mmHg), Hispanic (7.9 mmHg) and White women (6.5 mmHg) who became obese in adulthood or who were chronically overweight/obese had a significantly higher SBP.
Other Important Findings
- A higher risk of hypertension was noted for all gender and racial/ethnic groups who became obese in adulthood.
- Those who were chronically overweight/obese were at higher risk of hypertension for all groups, with odds ratios ranging from 2.7 in Hispanic men to 6.5 in Hispanic women.
- Those who lost weight during follow up had no significant increased risk compared to those who maintained normal weight.
- There was an increased risk of hypertension for those who gained weight in adulthood and among those who remained obese from adolescence to young adulthood.
- Losing weight in adulthood was associated with a similar risk of hypertension as those who remained normal weight from adolescence to adulthood for all racial/ethnic groups except for African-American males.
- A greater change in SBP was noted among chronically obese White and Hispanic women compared to normal weight women than effects noted among White and Hispanic men.
Limitations Noted in the Document
- The definition of hypertension was based on a single time point measurement in adulthood.
- The study’s definition of obesity used standard BMI cut points, which might not fully capture weight gain or loss impacts on hypertension.
- The study did not have information on earlier childhood obesity.
Conclusion
The study provides further evidence supporting the importance of preventing risk factors early in life to reduce chronic diseases like cardiovascular disease and diabetes. The research showed that losing weight is beneficial for clinical parameters such as HbA1C and blood pressure, as well as the overall prevalence of disease. The study’s findings emphasize the impact of weight status changes from adolescence to adulthood on hypertension risk, and that the effects are reversible if normal weight is achieved in adulthood. The findings suggest that the duration of being in an obese state has a negative impact on blood pressure. The racial and ethnic variations also highlight the need for future research. Future studies should explore trajectories of weight status from earlier time points, and look into what factors contribute to the differences across groups. The observed gender differences in the relationship between weight status and blood pressure, where women who were chronically overweight/obese had an increased risk of pre-hypertension, underscore the complexity of this health issue. The study’s strengths include the use of a nationally representative sample and the ability to adjust for socio-demographic factors, which enhances the validity of the findings. The research suggests that addressing adolescent obesity can have long-term benefits for the prevention of hypertension, particularly when normal weight is achieved. This aligns with the concept of preventative healthcare and the mitigation of risk factors early in life to improve health outcomes. This research is an addition to existing knowledge about the long-term effects of childhood obesity, and its implications for cardiovascular health later in life.