Setareh Salehi Omran, MD
Despite a decline in stroke hospitalizations among older adults within the United States, there is an increasing incidence of stroke in young adults. Multiple factors are thought to play a role, including a possible increase in atherosclerotic risk factors such as obesity among young adults. Adolescent obesity is an ongoing epidemic that can lead to several complications, including diabetes, metabolic syndrome, and cardiovascular disease. Several studies have shown an association between adolescent obesity and subsequent risk of stroke in older age. It is unclear whether adolescent obesity is associated with the development of stroke in young adults.
Using data from the Israeli National Stroke Registry, Bardugo et al. examined the incidence and association between adolescent obesity and stroke in the young in Israel. Their study included all adolescents who underwent a medical evaluation prior to their mandatory military service between 1985 and 2013. The medical evaluation included information on demographics, vascular risk factors, and body mass index (BMI). BMI values were grouped according to percentiles for age and sex established by the U.S. CDC: underweight (less than 5th percentile), low-normal BMI (5th to 49th percentile), high-normal BMI (50th to 84th percentile), overweight (85th to 94th percentile), or obese (>95th percentile). The primary outcome was a first stroke event as recorded in the national registry between 2014 and 2018. Importantly, data was unavailable for patients who developed a stroke before 2014. Cox proportional hazard models were used to estimate the hazard ratios (HRs) for incidence stroke using the low-normal BMI as the reference group. In addition to a crude HR, the authors also performed three additional analyses adjusted for: 1) sex and age; 2) sex, age, and socio-demographic values; 3) sex, age, socio-demographic values, and diabetes status at beginning of follow-up. The authors also performed several sensitivity and subgroup analyses, including analyses restricted by diabetes status and optimal blood pressure at adolescence.