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A study recently published in the journal stroke investigates the possible association between cerebrovascular diseases (CrVDs) and obesity and overweight in men and women.

Study: Obesity in adolescence and young adulthood in association with cerebrovascular disease in adults: the NFBC1966 study. Image credit: crystal light / Shutterstock.com Study: Obesity in adolescence and young adulthood and the association with adult cerebrovascular disease: the NFBC1966 studyPhoto credit: crystal light / Shutterstock.com

Young stroke

CrVDs are the third leading cause of disability and death worldwide. Although older adults are more commonly affected, the incidence of stroke in younger people has increased significantly.

When young adults suffer a stroke, the lifelong disability is significant and has a significant impact on their social and economic status. The inability to effectively treat strokes highlights the need for primary prevention, including the identification of preventable risk factors for CrVDs.

Childhood obesity, for example, increases the risk of chronic cardiovascular disease later in life. However, the effects of changes in body mass index (BMI) over time are not fully understood.

Childhood obesity is an indicator of obesity in adulthood. For example, Finnish statistics show that about 20% of girls and 30% of boys up to 16 years of age are obese, compared to 35% and 47% of young women and men between 18 and 29 years of age, respectively.

Previous studies of the Northern Finland Birth Cohort 1966 (NFBC66) showed that very young girls with growth retardation and low body weight are more likely to suffer an ischemic stroke than adults. The time during which body weight increases during childhood is also important in determining stroke risk in women.

In the present study, NFBC66 data were used to examine the associations between BMI in adolescents and young adults and the risk of stroke before age 55.

What did the study show?

The current study included 10,491 individuals from the NFBC566, all categorized based on their BMI measured between ages 14 and 31. These measurements were then compared with data on the occurrence of ischemic and hemorrhagic stroke between ages 14 and 54. The average follow-up period for each individual was 39 years from age 14 and 23 years from age 31.

CrVD occurred in 4.7% of the study cohort during the follow-up period. Among affected individuals, 31%, 18%, and 40% experienced ischemic stroke, hemorrhagic stroke, and transient ischemic attacks (TIAs), respectively.

The average age for ischemic stroke was 47 years, compared with 44, 45 and 49 years for intracerebral hemorrhagic stroke, subarachnoid hemorrhagic stroke and TIA, respectively. The average BMI in persons aged 14 years was approximately 19.3 kg/m2 for boys and girls. At 31 years, the mean BMI was 24 kg/m2 and 25.3 kg/m2 for women and men respectively.

Ischemic stroke

In women who were overweight at age 14, the risk of CrVD and ischemic stroke was 2.5 times higher compared to normal weight women. In women who were obese at age 14, this risk was almost twice as high compared to normal weight women.

Women with obesity at age 31 have a three-fold higher risk of developing CrVD later in life. The risk of ischemic stroke is more than twice as high in women who are overweight at age 31 and almost three times as high in women with obesity compared to normal weight women.

Interestingly, these associations were not reflected in men, as their BMI at earlier or later time points did not alter these results.

Hemorrhagic stroke

At age 31, the risk of hemorrhagic stroke increases with increasing body weight in both men and women. In overweight women, this risk is 3.5 times higher than in normal weight women. In comparison, the risk of hemorrhagic stroke in overweight men is almost six times higher than in normal weight men.

Gender inequality

The differences in CrVD risk between the sexes were observed at both time points. Girls who were overweight at age 14 had twice the risk of any type of CrVD or ischemic stroke compared to boys. At age 31, the risk of ischemic stroke was six times higher in overweight women than in men.

Only women with a large waist circumference had a three-fold higher risk of stroke at age 31. In addition, the risk of ischemic stroke was seven times higher in overweight women than in men.

Conclusions

In women, obesity during adolescence or young adulthood increases the risk of cerebrovascular disease, particularly ischemic disease, regardless of their earlier or later BMI..”

Regardless of BMI at age 14, women who were overweight or obese at age 31 had a higher risk of CrVD, particularly ischemic stroke. Therefore, weight gain in girls during adolescence should be limited to prevent future stroke risk, even if they lose weight as young adults.

Even girls who were neither overweight nor obese at age 14 may be at risk of stroke if they have a high BMI at age 31. This highlights the importance of weight control during childhood and early adulthood. These findings confirm previous studies that reported that weight gain during adolescence and early adulthood increases the risk of stroke in adulthood.

Possible causes of this association include chronic inflammation due to obesity, which can cause vascular blockages. Obesity is also associated with high blood pressure and diabetes, both of which are risk factors for stroke.

The gender and body weight difference in stroke risk might be due to differences in sex hormone levels in women at different stages of life. Therefore, further research is crucial to identify the mechanisms contributing to this association between age at menarche, body weight and stroke risk.

Journal reference:

  • Mikkola, U., Rissanen, I., Kivela, M., et al. (2024). Obesity in adolescence and young adulthood and the association with adult cerebrovascular disease: the NFBC1966 study. stroke. doi:10.1161/STROKEAHA.123.045444.

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