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fa ilure risk increased 16 percent for ever y unit of BMI, begin- ning with a BMI of 20. Individua ls with a BMI of 20 to 22.5 at a ge 18 were 22 percent more likely to develop hea r t fa i lure tha n individua ls with a BMI bet ween 18.5 a nd 20. Those in the nex t highest BMI ra nge, 22.5 to 25, were nea rly twice as v ulnerable to hear t failure. Men with a BMI of 35 or more were 10 times more likely to have hea r t fa i lure later in life tha n their non-obese peers. "Obesit y is a well-known risk factor for hea r t fa ilure, a nd our ow n [ prev ious] work ha s show n a n increa se in risk in middle-aged men sta r ting in the high-norma l ra nge of 22.5 to 25 BMI," Dr. Roseng ren says. "However, [that] was a much sma ller study, and ver y few of those men who were investigated in the ea rly 1970s had a BMI of 35 or higher. So the [current study 's] f inding of an increase in men in the norma l BMI range did not surprise me; that has been found in other middle-aged populations, as well. W hat did [surprise me] was the ver y high risk among the young men with obesity, where the risk increase was much steeper tha n in our study of middle-aged men." W hat could account for the f inding that young men on the middle or high ra nge of norma l BMI have a g reater risk for hea r t fa ilure? "Probably a slightly increased ea rly adult BMI is a ma rker that predicts dieta r y habits later in life as a potentia l link to midlife ca rdiometabolic risk prof ile," Dr. Åberg says. "[E]ven slight obesity has hea lth risks, and the risk of disease is present a lready in compa ratively young ages." TROUBLING VISION OF THE FUTURE Solving the obesity crisis and reducing or avoiding its potentia l consequences, including ea rly hea r t failure, will ta ke massive effor t on a societa l sca le. Understa nding the seriousness of those implications, Dr. Rosengren believes, is a f irst step. Still, much must be done to a lter t he present trajector y of obe- sit y rates. "If current trends continue, the probabilit y of ha lting the epidemic is virtua lly zero," Dr. Rosengren says. "As the popula- tion of obese a nd ver y obese young people grows older, we may be looking at a tota lly new scenario and disease pattern within the nex t few decades." For Dr. Åberg, the study 's f indings a re a ca ll to action. " We have a huge cha llenge in the coming yea rs to prevent obesit y in children a nd young people through the education of hea lthca re professiona ls, students, pa rents a nd teachers," she says. " We need ea rly identif ication of young people at risk. We need to f ind methods a nd inter ventions to reduce obesit y a mong ch i ld ren a nd adolescent s t hat a re more rapid a nd longer-lasting tha n today 's. We a lso have to f ind better com- binations of changing diet and physica l activity, probably with different prog ra ms for different t y pes of persona lities." ■ Later Consequences of Early Obesity RECENT STUDIE S BY researchers in the United States and Japan underscore the potential damage obesity in early adulthood can have on future hear t structure and function. The studies used data from the Coronar y Ar ter y Risk Development in Young Adults (CARDIA) study, an ongoing, four-center project in the U.S. Since 1985, CARDIA has collected clinical and physical data, as well as lifestyle information, from more than 5,000 African-American and Caucasian men and women. The par ticipants ranged from 18 to 30 years old when CARDIA began. They have received seven follow-up examinations, most recently in 2010–2011. In a 2014 study, the American and Japanese team found an association between obesity that persists from young adulthood to middle age and diminished pumping function in the left ventricle of the heart. In 2016, the group published a study that found that diabetes and high levels of insulin resistance in young adulthood harm the size, shape and function of the left ventricle in middle age. "High body weight, as well as insulin resistance in youth — even if the person has a normal BMI — effect worse myocardial function later in life," says the lead author of the studies, Satoru Kishi, MD, of the Division of Diabetes at Tokyo's Mitsui Memorial Hospital. "Our study fi ndings indicate that obesity in early adulthood or developed during the fi rst 25 years of early adulthood is related to early measures of systolic and diastolic dysfunction in middle-aged individuals, emphasizing the importance of prevention of obesity development early in life. These fi ndings suggest that, if left unchecked, the ongoing obesity epidemic may increase the lifetime risk of incident heart failure in the general population." SPECIAL CLINICAL SECTION: CARDIOLOGY 2 1 M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 017 fa ilure risk increased 16 percent for ever y unit of BMI, begin- fa ilure risk increased 16 percent for ever y unit of BMI, begin- ning with a BMI of 20. Individua ls with a BMI of 20 to 22.5 at ning with a BMI of 20. Individua ls with a BMI of 20 to 22.5 at a ge 18 were 22 percent more likely to develop hea r t fa i lure a ge 18 were 22 percent more likely to develop hea r t fa i lure tha n individua ls with a BMI bet ween 18.5 a nd 20. Those in tha n individua ls with a BMI bet ween 18.5 a nd 20. Those in the nex t highest BMI ra nge, 22.5 to 25, were nea rly twice as the nex t highest BMI ra nge, 22.5 to 25, were nea rly twice as v ulnerable to hear t failure. Men with a BMI of 35 or more were v ulnerable to hear t failure. Men with a BMI of 35 or more were 10 times more likely to have hea r t fa i lure later in life tha n 10 times more likely to have hea r t fa i lure later in life tha n "Obesit y is a well-known risk factor for hea r t fa ilure, a nd "Obesit y is a well-known risk factor for hea r t fa ilure, a nd our ow n [ prev ious] work ha s show n a n increa se in risk in our ow n [ prev ious] work ha s show n a n increa se in risk in middle-aged men sta r ting in the high-norma l ra nge of 22.5 middle-aged men sta r ting in the high-norma l ra nge of 22.5 to 25 BMI," Dr. Roseng ren says. "However, [that] was a much to 25 BMI," Dr. Roseng ren says. "However, [that] was a much sma ller study, and ver y few of those men who were investigated sma ller study, and ver y few of those men who were investigated Later Consequences 2 1

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