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Body mass index, but not sex, influences exertional heat stroke risk in young healthy men and women.

Exertional heat stroke (EHS) remains a persistent threat for individuals working or playing in the heat, including athletes, the military and emergency service personnel. However, influence of biological sex and/or body mass index (BMI) on the risk of EHS remain poorly understood. The purpose of this study was to retrospectively assess the influence of sex and BMI on risk of EHS in the active duty U.S. Army. We analyzed data from 2016-2021, using a matched case-control approach, where each individual with a diagnosis of EHS was matched to 5 controls based on calendar time, unit ID, and job category, in order to capture control individuals who were matched to EHS events by location, time, and activity. We used a multivariate logistic regression model mutually adjusted for sex, BMI and age to compare 745 (n=61 F) individuals (26 ± 7 yr) with a diagnosed EHS to 4290 (n=384 F) case controls (25 ± 5 yr). Group average BMI were similar: 26.6 ± 3.1 (EHS) and 26.5 ± 3.6 kg/m2 (CON). BMI was significantly (p < 0.0001) associated with higher risk of EHS, with a 3% increase in risk of EHS for every unit increase in BMI. Notably, sex was not associated with any difference in risk for EHI (p = 0.54). These data suggest that young healthy people with higher BMI have significantly higher risk of EHS, but, contrary to what some have proposed, this risk was not higher in young women.