Change in Weight Status From Childhood to Young Adulthood and Risk of Adult Coronary Heart Disease

Childhood overweight is associated with adult coronary heart disease (CHD); the extent to which this risk can be mitigated by remission of childhood overweight before young adulthood is not clear.

To evaluate if remission of elevated childhood weight before young adulthood mitigates the risk of adult CHD.

This population-based cohort study was conducted among individuals born between 1945 and 1968 in Gothenburg, Sweden, as a part of the BMI Epidemiology Study (BEST). Archived child and school health records were linked to national high-quality registers in November 2022. Data analysis was performed from 2024 to 2025.

Childhood (women at age 7 years and men at age 8 years) and young adult (women age 18 years and men age 20 years) overweight derived from weight and height measurements in school health records and at conscription.

The primary outcome was register-derived CHD diagnosis (fatal or nonfatal) in adult age.

This study included 103 232 individuals (45 965 women [44.5%]; mean [SD] childhood body mass index, calculated as weight in kilograms divided by height in meters squared, of 15.6 [1.5]) born 1945-1968 in Gothenburg, Sweden. Childhood and young adult overweight were associated with increased risk of CHD in both men and women. No significant sex interaction was observed for these associations. Remission of childhood overweight before young adulthood resulted in a similar risk of CHD as in individuals who had persistent normal weight (reference category; hazard ratio [HR], 0.98; 95% CI, 0.84-1.14). Both pubertal onset overweight (ie, normal weight in childhood and overweight in young adulthood; HR, 1.83; 95% CI, 1.66-2.03) and persistent overweight (ie, overweight in both childhood and young adulthood; HR, 1.53; 95% CI, 1.30-1.78) were associated with increased risk of adult CHD events. However, individuals with pubertal onset overweight had higher risk of CHD than individuals with persistent overweight (HR, 1.23; 95% CI, 1.03-1.49; P = .03).

In this population-based cohort study, increased risk of CHD in Swedish individuals with childhood overweight was reversed with remission of overweight before young adulthood; furthermore, overweight in young adulthood with pubertal onset was associated with higher risk of adult CHD compared to overweight persistent throughout childhood and puberty. These findings have implications for public health planning, emphasizing the importance of early detection and treatment of overweight during childhood and adolescence.