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Predicting adult metabolic syndrome from childhood body mass index: follow-up of the New Delhi birth cohort
  1. H P S Sachdev1,
  2. C Osmond2,
  3. C H D Fall2,
  4. R Lakshmy3,
  5. S Ramji4,
  6. S K Dey Biswas5,
  7. D Prabhakaran6,
  8. N Tandon3,
  9. K S Reddy7,
  10. D J P Barker2,
  11. S K Bhargava8
  1. 1
    Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
  2. 2
    Medical Research Council Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK
  3. 3
    All India Institute of Medical Sciences, New Delhi, India
  4. 4
    Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
  5. 5
    Indian Council of Medical Research, New Delhi, India
  6. 6
    Centre for Chronic Disease Control, New Delhi, India
  7. 7
    Public Health Foundation of India, New Delhi, India
  8. 8
    Department of Paediatrics, Sunder Lal Jain Hospital, Delhi, India
  1. Correspondence to Professor H P S Sachdev, E-6/12 Vasant Vihar, New Delhi 110057, India; hpssachdev{at}


Objectives: To assess whether serial measurements of childhood body mass index (BMI) give clinically useful predictions of the risk of developing adult metabolic syndrome and impaired glucose tolerance or type 2 diabetes.

Design/setting: Follow-up of a community-based birth cohort in Delhi, India.

Participants: 1492 men and women aged 26–32 years whose BMI was recorded 6-monthly throughout childhood.

Main outcome measures: The predictive value of childhood BMI for adult metabolic syndrome and impaired glucose tolerance (IGT) and diabetes mellitus.

Results: 25% of subjects had metabolic syndrome and 15% had IGT/diabetes mellitus. Both outcomes were associated with greater childhood BMI gain (metabolic syndrome: OR 1.63 (95% CI 1.44 to 1.85); IGT/diabetes mellitus: 1.39 (1.20 to 1.60) per unit increase in within-cohort BMI SD score between 5 and 14 years). The best predictions of adult disease were obtained using a combined test comprising (i) any increase in BMI SD score between 5 and 14 years and (ii) a BMI SD score >0 at 14 years (metabolic syndrome: sensitivity 45%, specificity 78%; IGT/diabetes mellitus: 37%, 73%). Likelihood ratios were low (metabolic syndrome: 1.4–2.0; IGT/diabetes mellitus: 1.2–1.4). A single high BMI measurement at 14 years (overweight or obese, according to International Obesity Task Force criteria) was highly specific but insensitive (metabolic syndrome: sensitivity 7%, specificity 97%; IGT/diabetes mellitus: 8%, 97%). Charts for plotting BMI SD scores through childhood were produced.

Conclusions: Serial measurements of childhood BMI give useful predictions of adult risk and could guide advice to children and parents on preventing later disease.

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  • Funding The original cohort study was funded by the National Centre for Health Statistics, USA and the Indian Council of Medical Research, and this study was funded by the British Heart Foundation. All the researchers are independent of the funder, and the funder played no part in the study design, collection, analysis and interpretation of data, the writing of the report, or the decision to submit the article for publication.

  • Competing interests None.

  • Ethics approval The study was approved by the All India Institute of Medical Sciences research ethics committee.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.