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Clinical Studies and Practice

Childhood body mass index and endothelial dysfunction evaluated by peripheral arterial tonometry in early midlife



Endothelial dysfunction predicts mortality but it is unknown whether childhood obesity predicts adult endothelial dysfunction. The aim of this study was to determine whether anthropometric indices of body fat in childhood, adolescence and early midlife are associated with endothelial dysfunction in early midlife.


Participants belonged to a representative birth cohort of 1037 individuals born in Dunedin, New Zealand in 1972 and 1973 and followed to age 38 years, with 95% retention (the Dunedin Multidisciplinary Health and Development Study). We assessed anthropometric indices of obesity at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32 and 38 years. We tested associations between endothelial function assessed by peripheral arterial tonometry (PAT) at age 38 and; age 38 cardiovascular risk factors; age 3 body mass index (BMI); and four BMI trajectory groups from childhood to early midlife.


Early midlife endothelial dysfunction was associated with BMI, large waist circumference, low high-density lipoprotein cholesterol, low cardiorespiratory fitness and increased high-sensitivity C-reactive protein. After adjustment for sex and childhood socioeconomic status, 3-year-olds with BMI 1 s.d. above the mean had Framingham-reactive hyperemia index (F-RHI) ratios that were 0.10 below those with normal BMI (β=−0.10, 95% confidence interval (CI) −0.17 to −0.03, P=0.007) at age 38. Cohort members in the ‘overweight’, ‘obese’ and ‘morbidly obese’ trajectories had F-RHI ratios that were 0.08 (β=−0.08, 95% CI −0.14 to −0.03, P=0.003), 0.13 (β=−0.13, 95% CI −0.21 to −0.06, P<0.001) and 0.17 (β=−0.17, 95% CI −0.33 to −0.01, P=0.033), respectively, below age-peers in the ‘normal’ trajectory.


Childhood BMI and the trajectories of BMI from childhood to early midlife predict endothelial dysfunction evaluated by PAT in early midlife.

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We thank study founder Phil Silva, PhD, the Dunedin Multidisciplinary Health and Development Study of New Zealand members, and the Dunedin Multidisciplinary Health and Development Research Unit research staff. The Dunedin Multidisciplinary Health and Development Research Unit is supported by the Health Research Council of New Zealand and the New Zealand Ministry of Business, Innovation and Employment (MBIE). This research also received support from the United Kingdom Medical Research Council (grant G0100527) and from the National Institute of Aging (grants R01AG032282 and R01AG048895). RT was supported by a Health Research Council Erihapeti Rehu-Murchie fellowship under grant number 13/579. The funding bodies had no role in the design of the study, collection and analysis of data and the decision to publish.

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Correspondence to M J A Williams.

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Williams, M., Milne, B., Ambler, A. et al. Childhood body mass index and endothelial dysfunction evaluated by peripheral arterial tonometry in early midlife. Int J Obes 41, 1355–1360 (2017).

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