Early adulthood weight change, midlife “Life’s essential 8” health status and risk of cardiometabolic diseases: a chinese nationwide cohort study

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Abstract

Background

The association between weight change during early adulthood and cardiometabolic diseases remains uncertain in Chinese population. Whether the association varies with comprehensive cardiovascular health (CVH) in midlife assessed by “Life’s Essential 8” has not been characterized. We aim to examine the associations of early adulthood weight change and midlife “Life’s Essential 8” CVH status with cardiometabolic outcomes in a Chinese cohort.

Methods

The study participants were from the China Cardiometabolic Disease and Cancer Cohort (4 C) Study. This analysis included 72,610 middle-aged and older participants followed for a median of 3.6 years. At baseline, the participants recalled body weight at age 20 and 40 years, and we calculated change in weight and BMI between 20 and 40 years of age. Health behaviors information in “Life’s Essential 8” was collected by questionnaire, and health factors were measured in the study center. During follow-up, we ascertained incident cardiovascular events based on medical records, and diagnosed incident diabetes according to the American Diabetes Association 2010 criteria.

Results

72,610 study participants were included with a mean age of 56.0 ± 8.8 years and 29% of them were males. Weight gain of more than 10 kg between 20 and 40 years of age was associated with 22% increased risk of incident cardiovascular events (HR: 1.22; 95%CI: 1.04–1.43) and 38% increased risk of diabetes (HR: 1.38; 95%CI: 1.25–1.53) compared to stable weight. Besides, the association of weight gain more than 10 kg in early adulthood with cardiometabolic risk was even stronger in those with low CVH score in midlife (HR: 2.44; 95%CI: 2.01–2.97 for incident cardiovascular events; HR: 2.20; 95%CI: 1.90–2.55 for incident diabetes) or with few ideal cardiovascular health metrics in midlife.

Conclusions

Our study indicated that weight gain in early adulthood was associated with significantly increased risk of cardiometabolic diseases. And the association could be stronger in those with poor CVH profiles in midlife. These findings confirmed the significance of weight management during early adulthood and suggested that individuals who experienced substantial weight gain in early life should be encouraged to maintain good CVH status in Chinese population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12986-023-00765-w.

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Most cited references 29

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Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants

Emily Sonestedt, Kim Overvad (2016)

Summary Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world’s men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world’s poorest regions, especially in south Asia. Funding Wellcome Trust, Grand Challenges Canada.

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Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Leandra Abarca-Gómez, Ziad A Abdeen, Zargar Abdul Hamid … (2019)

Summary Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Funding Wellcome Trust, AstraZeneca Young Health Programme.

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Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

(2004)

A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> or =25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations; for high risk it varies from 26 kg/m2 to 31 kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23.0, 27.5, 32.5, and 37.5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.

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Author and article information

Contributors

Jieli Lu: jielilu@hotmail.com

Yufang Bi: byf10784@rjh.com.cn

Journal

Journal ID (nlm-ta): Nutr Metab (Lond)

Journal ID (iso-abbrev): Nutr Metab (Lond)

Title: Nutrition & Metabolism

Publisher: BioMed Central (London )

ISSN (Electronic): 1743-7075

Publication date (Electronic): 1 November 2023

Publication date PMC-release: 1 November 2023

Publication date Collection: 2023

Volume: 20

Electronic Location Identifier: 48

Affiliations

[1 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, ; 197 Rui-Jin 2nd Road, Shanghai, 200025 China

[2 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, ; Shanghai, China

[3 ]The First Affiliated Hospital of Zhengzhou University, ( https://ror.org/056swr059) Zhengzhou, China

[4 ]GRID grid.12981.33, ISNI 0000 0001 2360 039X, Sun Yat-sen Memorial Hospital, , Sun Yat-sen University, ; Guangzhou, China

[5 ]GRID grid.265219.b, ISNI 0000 0001 2217 8588, Department of Epidemiology, , Tulane University School of Public Health and Tropical Medicine, ; New Orleans, USA

[6 ]Dalian Municipal Central Hospital, ( https://ror.org/01n6v0a11) Dalian, China

[7 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Union Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; Wuhan, China

[8 ]Zhejiang Provincial Center for Disease Control and Prevention, ( https://ror.org/03f015z81) Hangzhou, China

[9 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Tongji Hospital, Tongji Medical College, , Huazhong University of Science and Technology, ; Wuhan, China

[10 ]Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China

[11 ]GRID grid.16821.3c, ISNI 0000 0004 0368 8293, Xinhua Hospital, , Shanghai Jiao Tong University School of Medicine, ; Shanghai, China

[12 ]GRID grid.414252.4, ISNI 0000 0004 1761 8894, Chinese people’s Liberation Army General Hospital, ; Beijing, China

[13 ]The First Hospital of Lanzhou University, ( https://ror.org/05d2xpa49) Lanzhou, China

[14 ]The Affiliated Hospital of Southwest Medical University, ( https://ror.org/0014a0n68) Luzhou, China

[15 ]The First Hospital of Jilin University, ( https://ror.org/034haf133) Changchun, China

[16 ]The First Affiliated Hospital of Wenzhou Medical University, ( https://ror.org/03cyvdv85) Wenzhou, China

[17 ]The First Affiliated Hospital of Guangxi Medical University, ( https://ror.org/030sc3x20) Nanning, China

[18 ]Qilu Hospital of Shandong University, ( https://ror.org/056ef9489) Jinan, China

[19 ]GRID grid.415002.2, ISNI 0000 0004 1757 8108, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, ; Nanchang, China

[20 ]The Second Affiliated Hospital of Harbin Medical University, ( https://ror.org/03s8txj32) Harbin, China

[21 ]Central Hospital of Shanghai Jiading District, ( https://ror.org/00p0n9a62) Shanghai, China

[22 ]GRID grid.412676.0, ISNI 0000 0004 1799 0784, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, ; Nanjing, China

[23 ]The First Affiliated Hospital of Anhui Medical University, ( https://ror.org/03t1yn780) Hefei, China

[24 ]Karamay Municipal People’s Hospital, Xinjiang, China

[25 ]The First Affiliated Hospital of Nanjing Medical University, ( https://ror.org/04py1g812) Nanjing, China

[26 ]The First Affiliated Hospital of Chongqing Medical University, ( https://ror.org/033vnzz93) Chongqing, China

[27 ]Shandong Provincial Hospital Affiliated to Shandong University, ( https://ror.org/02ar2nf05) Jinan, China

[28 ]Guiqian International General Hospital, Guiyang, China

Article

Publisher ID: 765

DOI: 10.1186/s12986-023-00765-w

PMC ID: 10621175

PubMed ID: 37915057

SO-VID: 9ca4a3ea-a77b-447e-8ac9-da8fbfdeb617

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 May 2023

Date accepted : 4 October 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100013105, Shanghai Rising-Star Program;

Award ID: 21QA1408100

Funded by: FundRef http://dx.doi.org/10.13039/501100012166, National Key Research and Development Program of China;

Award ID: 2022ZD0162102

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81970728, 82022011, 82088102, 91857205, 81930021

Funded by: FundRef http://dx.doi.org/10.13039/501100018630, Shanghai Municipal People’s Government;

Award ID: 22Y31900300

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: weight,cardiovascular health,cardiovascular disease,diabetes

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: weight, cardiovascular health, cardiovascular disease, diabetes

Early adulthood weight change, midlife “Life’s essential 8” health status and risk of cardiometabolic diseases: a chinese nationwide cohort study

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Abstract

Background

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Most cited references 29

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

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