FEDME-EPIDEMIEN OG ALMEN PRAKSIS

Thorkild I.A. Sørensen, Professor, Dr.Med.

Figure 2. Histogram of the distribution of Body Mass Index at conscription board examination

for the 5,531 men

0

200

400

600

Num

ber

15 20 25 31 35 40 45Body mass index (kg/m²)

Figure 4. Kaplan Meier plots for the obese cohort (grey line) and the randomly selected

cohort (black line)

0.00

0.25

0.50

0.75

1.00P

ropo

rtio

n su

rviv

ing

20 30 40 50 60 70 80 90

Age

Figure 3. Cumulative hazard plot of the randomly selected cohort versus the obese cohort

0

1

2

Cu

mu

lativ

e h

aza

rd o

bese

co

hort

0 .5 1Cumulative hazard randomly selected cohort

Figure 5. Smoothing spline (5 d.f.) of the association between BMI at conscription board

examination and all-cause mortality

1

2

3

4

HR

for

mor

talit

y

20 25 31 35 40Body mass index (kg/m²)

The grey line illustrates the entire cohort and the black line illustrates the sub-cohort with information on education and intelligence test score (with 95% confidence limits)

CHD events

Association between BMI z-scores at ages 7-13 y and adult CHD

among boys

Age (y)

7 8 9 10 11 12 13

Haz

ard

ratio

0.90

0.95

1.00

1.05

1.10

1.15

1.20

From: Baker et al. NEJM 2007:357;2329-2337

Association between BMI z-scores at ages 7-13 y and adult CHD

among girls

Age (y)

7 8 9 10 11 12 13

Haz

ard

ratio

0.90

0.95

1.00

1.05

1.10

1.15

1.20

From: Baker et al. NEJM 2007:357;2329-2337

Mortality by Weight Change in 1975–1981 among Those Reporting Trying to Lose Weight in 1975

Mortality by Weight Change in 1975–1981 among Those with No Intention to Lose Weight in 1975

Waist circumference

Waist circumference and all-cause mortality

BMI and all-cause mortality

Body composition, waist circumference, and mortality in men and women aged 50-64 Yrs

Differential effects of body mass components

This series of studies – supported by other studies – strongly suggest that the body compartments have different impact on health, even measured crudely as total mortality:

• More abdominal fat mass is harmful• More peripheral fat mass is beneficial • More lean body mass (to some level) is beneficial

It is likely that the net effect on mortality of these body compartments depends on their relative size and effect by size.

Multiple predictors of childhood obesity – But are they also modifiable causes?

• Genetic variation• Maternal prepregnancy weight• Gestational weight gain• Smoking during pregnancy• Birth weight (for given gestational age and length)• Duration of breast feeding• Age at start of complementary feeding• Protein intake• Growth during infancy• Duration of sleep• Mother-child relationships• Sugary soft drink intake• Physical activity• Television viewing• Adiposity rebound

Heritability estimates for relative weight from birth to age 18 of Swedish twin pairs

00,10,20,30,40,50,60,70,80,9

1

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Additive genetic factors Common environmental factorsUnique environmental factors

• The obesity epidemic is affecting the school-boys much earlier than the draftees and obviously before the economic growth began!

• Also, the environmental changes driving the epidemic did not affect individuals at any of these ages equally.

• Note that the changes ocurred about 10 years later in the about 10-year-older young men.

Year of measurement

• The trends coincides by year of birth

• Implies that the environmental changes driving the epidemic operate around the time of birth – the individuals may become susceptible within the first years of life.

• This susceptibility may contribute along with the genes to the well known tracking of obesity over the ages.

Odds ratio for obesity by parental support perceived by the teacher

0

1

2

3

4

5

6

7

8

Overprotective vsharmoniousModest vs harmonious

No support vsharmonious

p=0.2 p=0.3 p<0.0001

Odds ratio for obesity by appearance at school health exa

0

1

2

3

4

5

6

7

8

9

10

Well-groomed vsaverageDirty and neglected vsaverage

p=0.4 p<0.0001

Year of birth, about 20 years before examination

Obesity in Danish young menObesity in Danish conscripts (BMI >= 30)

0246

81012

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

Birth year

Ob

esit

y p

reva

len

ce (

%)

age < 18 age 19 age 20 age 21 - 24

http://www.forsvaretsuddannelser.dk/ForsvaretsDagOgVaernepligt/Pages/bmi.aspx

Er det stilhed fEr det stilhed føør stormen?r stormen?

Det er svDet er svæært at sprt at spåå, is, isæær om fremtiden!r om fremtiden!

How much is a z-score increase in BMI?