Life-course trajectories of body mass index and subsequent cardiovascular risk among Chinese population

Abstract

BackgroundExamining body mass index (BMI) change over life course is crucial for cardiovascular health promotion and prevention. So far, there is very few evidence on the long-term change of BMI from childhood to late life. This study aimed to examine the life-course trajectory patterns of BMI and then to link the trajectory patterns to cardiovascular risk factors in adulthood.MethodsBased on longitudinal data from the China Health and Nutrition Survey, 5276 participants (aged 6–60) at baseline (in 1989) with up to 7 measurements of BMI during 1989–2009 were selected in this study. Cardiovascular risk factors including high blood pressure, high blood glucose and high blood lipids were assessed in 2411 participants in 2009. Latent growth curve modelling was used to analyse the BMI trajectories, and logistic regression was used to examine the associations between trajectory patterns and cardiovascular risk factors.ResultsFour trajectories patterns of BMI over life course (age 6–80) were identified: Normal-Stable (22.4% of the total participants), Low normal-Normal-Stable (44.1%), Low normal-Normal-Overweight (27.2%), and Overweight-Obese (4.3%). Compared to those with Normal-Stable pattern, those with Low normal-Normal-Stable pattern, Low normal-Normal-Overweight pattern and Overweight-Obese pattern had higher risk of high blood pressure (odds ratio range = 1.6–6.6), high blood glucose (1.7–9.1), dyslipidemia (2.6–5.9) and having at least two of the three cardiovascular risk factors (3.9–30.9).ConclusionsHaving a stable BMI within normal range over life course is associated with the lowest cardiovascular risk, whereas remaining overweight and obese over life course is associated with the highest cardiovascular risk.

Weight change from childhood to adulthood and cardiovascular risk factors and outcomes in adulthood: A systematic review of the literature

“…Five articles showed significant associations between high BMI trajectory from childhood to adulthood and increased homeostatic model assessment of insulin resistance (HOMA‐IR) levels 56 and T2D in adulthood 44,45,72,76 . The article based on the Epidemiological Health Investigation of Teenagers in Porto ( N = 719) showed that HOMA‐IR levels were higher among those assigned to the higher BMI trajectory groups in males (mean 2.41; 95% CI, 2.06–2.82) and females (mean 2.07; 95% CI, 1.84–2.32) compared with average BMI trajectory (males: mean 1.49; 95% CI, 1.36–1.63; females: mean 1.67; 95% CI, 1.55–1.79) 56 .…”

“…As shown in Table S1, 10 articles on the association between weight gain 9,12,24,25,55 or weight trajectory 44,56,60,72,76 from childhood to adulthood and adult blood pressure levels or hypertension were included in the systematic review. Three articles using BMI, 9,24,55 one using BMI Z score 25 and one using weight change 12 from childhood to adulthood as a continuous variable showed significant associations between BMI gain or weight gain and systolic blood pressure, 9,12,25 diastolic blood pressure 9,12 and hypertension 24,55 .…”

“…Five articles using BMI trajectory groups from childhood to adulthood showed that compared with children in the persistent normal weight trajectory, those with higher BMI trajectories had higher systolic and diastolic blood pressure levels 56 and an increased risk of hypertension in adulthood 44,60,72,76 . For example, the most recent data from the Young Finns Study ( N = 2631) 72 showed that compared with the stable normal weight group from childhood (6–18 years) to adulthood (34–49 years), the risk of hypertension in adulthood was 1.24 (95% CI, 1.11–1.99) for the progressively overweight group, 2.12 (95% CI, 1.15–2.89) for the progressively obese group, 2.28 (95% CI, 1.32–3.02) for the rapid overweight/obese group and 2.98 (95% CI, 1.51–5.02) for the persistent increasing overweight/obese group, whereas those in the resolving group (i.e., from overweight/obese status to normal weight) did not have significantly increased risk (RR 0.52; 95% CI, 0.13–1.32).…”

“…However, it remains unclear whether a child with obesity who becomes normal weight in adulthood is able to reverse their risk of adult outcomes. Although several long‐term observational studies have examined the association between weight change or weight trajectory from childhood to adulthood with CVD risk factors and subclinical and hard CVD outcomes in adulthood, 8–79 the findings have been inconsistent. For example, whereas several studies show the risk of T2D in adulthood is reversible if children who were overweight or obese become normal weight in adulthood, 29,34 others showed that the risk of T2D persisted 54,71 …”

Predictive Value of Women’s Weight Trajectories in Determining Familial Cardiovascular Disorders: A Family Based Longitudinal Study

“…Although there is no comparable data, we compared with other studies on BMI patterns in speci c life periods. A study conducted among the Chinese population aged 6-60 years identi ed a continuous increase of BMI in all groups of BMI (48). Some studies indicated less variability in the BMI trajectories in midlife in the total population as well as women (49)(50)(51), whereas another study reported different patterns during middle age (52).…”