Weight Status Change From Adolescence to Young Adulthood and the Risk of Hypertension and Diabetes Mellitus

Exploring the cardiovascular health behaviors of college students and the areas that need increased public health efforts

INTRODUCTION

Cardiovascular disease (CVD) is a leading cause of death worldwide among adults. Traditionally, the disease has been considered as a condition affecting older adults. However, its risk factors (e.g., poor diet, sedentary behavior, inadequate sleep, and obesity) are increasingly being identified in younger populations. There is a need to increase the evidence of CVD risk factors in this population to further support preventive programs in this demographic.

OBJECTIVE(S)

This study investigates the prevalence of CVD risk factors in young adult, college students.

DESIGN

Data was used from the American College Health Association's National College Health Assessment (ACHA-NCHA) II-C.

SAMPLE

The sample included data from 426,259 students, ages 18-25.

MEASUREMENTS

Data was reviewed on race, nutrition, physical activity, tobacco use, sleep, weight, and history of chronic disease. Descriptive statistics were utilized to examine the prevalence of CVD risk factors.

RESULTS

There was a notable prevalence of CVD risk factors, such as insufficient nutrition, obesity, insufficient physical activity, and inadequate sleep, among college students.

CONCLUSIONS

CVD-related risk factors are on the rise within this demographic. There is a pressing need for the expansion of public health initiatives aimed at enhancing CVD awareness and prevention among college students.

Feasibility and acceptability of an online multicomponent very low-carbohydrate intervention in young adult women with obesity: a pilot study

BACKGROUND

Approximately one-third of US young adults (18-25 years) have obesity, and there are calls to help young adults lose weight to prevent weight-related chronic conditions. This pilot trial tested the feasibility and acceptability of a very low-carbohydrate (VLC) eating pattern, with supportive positive affect and mindful eating skills, for weight management among young females with obesity.

METHODS

In a single-arm trial, women (N = 17), aged 19-23, with obesity participated in a 4-month diet and lifestyle intervention. Participants were taught how to follow a VLC eating pattern with the help of a coach and 16 weekly web-based sessions. We assessed feasibility and acceptability through session participation, outcome collection, intervention satisfaction, and adverse events.

RESULTS

Seventeen participants enrolled and 14 (82%) reported body weight at 4 months. Fifteen participants (94% of those beginning the intervention) viewed at least one session, and 8/15 (53%) of these participants were active in the intervention, viewing at least half of the sessions. Among the nine participants who provided 4-month self-report information, intervention satisfaction was high (mean 5.89/7, 95% CI 4.59 to 7.19). Among participants with a 4-month body weight, 7/14 (50%) lost ≥ 5% of their body weight, and of those who were also active in the intervention, 6/7 (86%) lost ≥ 5% of their body weight. There were no serious adverse events.

CONCLUSIONS

The results of this pilot study suggest that a VLC eating pattern may be a feasible and acceptable approach for weight loss in some young women with obesity.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov on August 18, 2021. The trial number is NCT05010083.

New Body Mass Index Cut-Off Point for Obesity Diagnosis in Young Thai Adults

Obesity is a global health threat affecting people of all ages, especially young adults. Early diagnosis of obesity allows for effective treatments and the prevention of its consequences. This study aimed to determine the prevalence of obesity in Thai young adults, evaluate the extent to which BMI values indicate excess adiposity, and identify the most appropriate BMI diagnostic cut-point based on body fat percentage. The study included 186 young adults aged 20 to 35 years. The diagnosis of obesity using body mass index (BMI) was compared with dual-energy X-ray absorptiometry-derived body fat percentage, considered the gold standard. The appropriate BMI cut-point was established using ROC curve analysis and the Youden index. Obesity was more common in women and in urban areas. BMI and body fat were significantly correlated; however, there was a high rate of false-negative obesity diagnosis based on the conventional BMI cut-off, a condition known as normal weight obesity (NWO). The newly proposed BMI cut-off points that best correlated with body fat and corrected false negatives were 22.1 kg/m2 for men and 22.5 kg/m2 for women. These new BMI cut-points should be applied together with clinical evaluations for obesity assessment in this particularly high-risk group.

Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease

AIMS

Weight changes from a young age are known to be associated with poor life outcomes in the general population. However, little is known about the association between weight change from a young age and life expectancy in patients with chronic kidney disease (CKD).

METHODS

Data of 2,806 nondialysis CKD patients who participated in the Fukuoka Kidney Disease Registry (FKR) Study, a multicenter observational study, were analyzed. The primary outcome was all-cause death, whereas the secondary outcome was cardiovascular mortality. The covariate of interest was weight change, defined as the difference between body weight at study enrollment and at 20 years old. Cox proportional-hazards models were used to estimate the risks of mortality for participants with weight changes of ≥ 5 or ＜5 kg compared with those with stable weights.

RESULTS

During the 5-year observation period, 243 participants died from all causes and 62 from cardiovascular disease. The risk of all-cause mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.11; 95% confidence interval [CI], 1.52-2.93). Conversely, the risk of cardiovascular mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.48; 95% CI, 1.32-4.64). However, no significant association was observed between weight gain and the risks of all-cause and cardiovascular mortalities.

CONCLUSION

Weight loss from 20 years of age was found to be associated with higher risks of all-cause and cardiovascular mortalities in patients with CKD.

Longitudinal Analysis of the Relationship Between Social Isolation and Hypertension in Early Middle Adulthood

BACKGROUND

Most studies have used cross-sectional or limited follow-up data to evaluate the relationship between social isolation (SI) and hypertension in older populations. The objective of this analysis was to examine the relationship between longitudinal SI and hypertension in a younger population.

METHODS AND RESULTS

The present analysis used data from waves I to V of the National Longitudinal Study of Adolescent to Adult Health (1994-2018) and logistic regression models to describe the association of timing, duration, and transitional patterns of SI with hypertension in early middle adulthood. Models were adjusted for demographic variables and adolescent socioeconomic and health-related confounders. SI was higher across life stages among individuals with hypertension (adolescence: 38% versus 35%, young adulthood: 52% versus 44%, and early middle adulthood: 61% versus 52%). Individuals who were socially isolated in young adulthood or early middle adulthood had greater odds of hypertension in early middle adulthood than those who were not (odds ratio [OR], 1.30 [95% CI, 1.07-1.56]; OR, 1.42 [95% CI, 1.15-1.76], respectively). Early middle adulthood hypertension was significantly associated with persistent SI across all life stages and for those who moved into persistent SI after adolescence (OR, 1.40 [95% CI, 1.02-1.93]; OR, 1.61 [95% CI, 1.18-2.19], respectively).

CONCLUSIONS

SI in young or early middle adulthood significantly increased the odds of hypertension, as did moving into SI and the accumulation of SI across life stages. Our analysis provides insights regarding timing for effective interventions to reduce hypertension earlier in the life course, which may prevent future adverse cardiovascular-related events.

Weight status change from birth to childhood and the odds of high blood pressure among Chinese children

Background

It is well documented that birth weight and childhood weight are associated with the blood pressure (BP) levels in childhood. However, the impact of weight status change from birth to childhood on BP among children is less well described. We aimed to assess the association between changes in weight status from birth to childhood and high BP in childhood.

Methods and results

Data were obtained from a cross-sectional survey conducted in Jinan, China, and a total of 5,546 children aged 6–17 years were included in this study. Based on the birth weight status [high weight (> 4,000 g) vs. normal weight (2,500–4,000 g)] and childhood weight status during the survey period [high weight (overweight and obesity) vs. normal weight], children were assigned into four groups: persistently normal weight (normal birth weight and normal childhood weight), resolved high weight (high birth weight but normal childhood weight), incident high weight (normal birth weight but high childhood weight), and persistently high weight (high birth weight and high childhood weight). After adjustment for sex and age, BP in childhood was more responsive to current body mass index (BMI) than birth weight. After adjustment for the potential covariates, compared with children who had persistently normal weight from birth to childhood, those with incident high weight (odds ratio [OR] = 3.88, 95% confidence interval [CI] = 3.29–4.57) and persistently high weight (OR = 3.52, 95% CI = 2.71–4.57) were associated with the increased odds of childhood high BP. However, children who had resolved high weight did not have significantly increased odds of high BP in childhood (OR = 0.86, 95% CI = 0.59–1.25).

Conclusion

The association of BP with recent BMI was stronger than with birth weight. Children who had incident or persistently high weight from birth to childhood had increased odds of high BP in childhood, whereas the odds was not significantly increased among those with high birth weight but changed to normal weight in childhood. Our findings highlight the importance of maintaining an appropriate weight in the early lifetime for the prevention of high BP and other related diseases, especially for those with high birth weight.

Keeping obesity status is a risk factor of hypertension onset: evidence from a community-based longitudinal cohort study in North China

Objective

The purpose of our study was to investigate the association of obesity status change with hypertension onset based on a community-based longitudinal cohort study in North China.

Methods

This longitudinal study included 3,581 individuals free of hypertension at baseline in the first survey (2011-2012). All participants were followed up (2018-2019). According to the criteria, a total of 2,618 individuals were collected for analysis. We used adjusted Cox regression models and Kaplan-Meier survival analysis to estimate the association between obesity status change and hypertension onset. Additionally, we applied the forest plot to visualize the subgroup analysis including age, gender, and the differences in some variables between baseline and follow-up. Finally, we conducted a sensitivity analysis to examine the stability of our results.

Results

Over nearly 7 years of follow-up, a total of 811 (31%) developed hypertension. The new hypertension incidence was mostly observed in those who were obese all the time (P for trend < 0.01). In the fully adjusted Cox regression model, being obese all the time increased the risk of hypertension by 30.10% [HR 4.01 (95% CI 2.20-7.32)]. The Kaplan-Meier survival analysis revealed the change in obesity status as an important feature to predict the occurrence of hypertension. Sensitivity analysis shows a consistent trend between the change in obesity status and hypertension onset in all populations. Subgroup analysis showed that age above 60 years was an important risk factor for hypertension onset, that men were more likely than women to develop hypertension, and that weight control was beneficial in avoiding future hypertension in women. There were statistically significant differences in ΔBMI, ΔSBP, ΔDBP, and ΔbaPWV between the four groups, and all variables, except baPWV changes, increased the risk of future hypertension.

Conclusion

Our study shows that obese status was notably associated with a significant risk of hypertension onset among the Chinese community-based cohort.

Ideal Cardiovascular Health in adolescents: Findings from Study of Cardiovascular Risks in Adolescents

BACKGROUND AND AIM

We assessed the Ideal Cardiovascular Health (CVH) in Brazilian adolescents according to demographics and socioeconomic characteristics.

METHODS AND RESULTS

This is a cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents (ERICA), with a nationwide representative sample of 36,956 Brazilian adolescents, aged 12-17 years, enrolled in public and private schools. The CVH metrics considered were body mass index (BMI), physical activity, smoking, healthy diet score, blood pressure, fasting plasma glucose, and total cholesterol. The demographics and socioeconomic characteristics analyzed were sex, age, race/skin color, and type of school attended. The study design was considered, and the significant difference determined by the non-overlapping of 95% Confidence Interval. The mean ideal CVH score was 4.0, higher for females, adolescents aged 15-17 years, and students from private schools. The prevalence of ideal fasting plasma glucose was 96%, of non-smoking 95.6%, of ideal blood pressure 75.5%, of ideal BMI 73.2%, of ideal total cholesterol 55.4%, of ideal physical activity 45.2%, and only 0.5% had an ideal diet. The prevalence of ideal CVH metrics varied according to demographics and socioeconomic characteristics.

CONCLUSION

Females, older adolescents, and students who attended private school had a better CVH. Demographics and socioeconomic characteristics were associated with CVH metrics. The low ideal proportions found for diet and physical activity are of concern and reinforce the need for food and nutritional educational actions designed to promote healthy behaviors in adolescence to prevent the development of cardiovascular diseases.

Association between age at onset of overweight and risk of hypertension across adulthood

OBJECTIVE

The aim of this study was to examine the association between age at onset of overweight and incident hypertension.

METHODS

We analysed 4742 participants with new-onset overweight from the Kailuan study between 2006 and 2015 and and 4742 age-matched and sex-matched controls selected randomly from the same cohort but with normal weight. Participants were compared with respect to subsequent risk of hypertension, with sub-HR calculated with the Fine and Gray model, according to age of onset of overweight.

RESULTS

Over a mean follow-up period of 5.17 years, 1642 overweight participants (34.6%) and 1293 normal-weight controls (27.3%) were subsequently diagnosed with hypertension. The median age at onset of overweight was 49.1 years. Compared with normal-weight controls, the multivariable-adjusted sub-HR for hypertension among participants with onset of overweight at 18-39 years of age, 40-49 years of age, 50-59 years of age and ≥60 years of age was 1.38 (95% CI 1.11 to 1.72), 1.27 (95% CI 1.09 to 1.49), 1.23 (95% CI 1.09 to 1.38) and 1.14 (95% CI 0.99 to 1.32), respectively. Onset of overweight in each age range was significantly associated with increased risk of hypertension, except for the group with onset at ≥60 years of age. The risk increased with each decade of attenuation of age at onset, peaking at 18-39 years of age.

CONCLUSIONS

Younger age at onset of overweight across adulthood was associated with significantly increased risk of hypertension, with the highest relative risk among participants with onset of overweight at 18-39 years of age.

Life-Course Implications of Pediatric Risk Factors for Cardiovascular Disease

The concept that origins of cardiovascular disease (CVD) begin in childhood is supported by substantial evidence. Prospective studies beginning in childhood report associations of childhood obesity, abnormal blood pressure (BP), dyslipidemia, diabetes, and tobacco use with intermediate CVD markers, including left ventricular hypertrophy and vascular stiffness in young adulthood. Trajectory analyses from longitudinal studies describe discrete BP pathways from childhood to young adult status of hypertension and prehypertension. Among individuals with familial hypercholesterolemia, abnormal low-density lipoprotein cholesterol levels are present in childhood. Some children are at risk for future CVD owing to hereditary factors, psychosocial stress, race, low birth weight, or other nonmodifiable exposures. Behavioural factors, including suboptimal diet, sedentary activity, and tobacco use, in childhood augment risk and can be modified to reduce risk. Pharmacologic treatments are reserved for those at high levels of the BP and cholesterol distributions and for those with diabetes and additional risk factors.