Trajectories of body mass index among Canadian seniors and associated mortality risk

Trajectories of body mass index and incident kidney stone disease: a prospective cohort study in Chinese young adults

The present study aims to explore the potential changing trajectory patterns of body mass index (BMI) for Chinese young adults and identify the relationship of BMI trajectory patterns with kidney stone disease (KSD) incidence. Latent class growth analysis was used to identify distinct trajectories of BMI during young adulthood. Cox proportion hazard models were conducted to explore the association between the BMI trajectory group memberships and incident KSD. Subgroup and sensitivity analyses were undertaken to test the robustness of the findings. In total, 2,966 young adults who attended at least three annual check-ups from 2014 to 2021 without KSD at baseline were enrolled in the cohort analysis. Three district BMI trajectories were identified for young adults, labeled as low-stable in normal BMI (28.5%), medium-rising to high BMI (67.4%), and rapid-rising to high BMI (4.1%). Compared with the low-stable in normal BMI group, Hazard ratios (HRs) of the rapid-rising and medium-rising to high BMI groups were 3.19 (95% CI: 1.54-6.63) and 1.78 (95% CI: 1.08-2.92) after adjusting the covariates. The cumulative incidence curves likewise illustrated that young adults in the rapid-rising to high BMI group had the highest risk of developing KSD compared to the other two groups. The rapid BMI growth trajectories during young adulthood were identified to be independently associated with a higher risk of KSD. The findings supplied novel insights that monitoring the BMI changing pattern may be favorable to early intervention of KSD during young adulthood.

BMI trajectory in adulthood in relation to all-cause and cause-specific mortality: A retrospective cohort study in Taiwan

A dynamic change of weight over time has been known as an important factor that impacts mortality risk. The aims of this study were to identify the heterogeneity of BMI trajectory groups and to examine the association of the trajectories of BMI and all-cause and cause-specific mortality. The data for this study were obtained from a large prospective cohort study in Taiwan between 1998 and 2019 that was linked to the National Death Registry for death information. The participants were stratified into four groups by age and gender; self-reported demographics and measured BMI data were used. We used group-based trajectory analysis to identify the distinct trajectories of changes in BMI. A Cox proportional hazards model was used to assess the hazard ratio (HR) of all-cause and cause-specific mortality risk. Data were analyzed in April 2020 and included 89,886 participants. Four trajectory groups were identified by the pattern of BMI change over time. Our study shows that different trajectories were associated with mortality. Our findings suggest that the mortality risk differs in each trajectory group and in each age and gender stratification. It appears that obesity is a protective factor in cancer-related mortality in females but not in males in group of old age participants; low-normal weight is a risk factor in respiratory-related mortality in all participants. Our findings can be used to suggest the appropriate BMI in each age and gender groups and thereby earlier health interventions can be taken to avoid mortality.

Multimorbidity resilience and health behaviors among older adults: A longitudinal study using the Canadian Longitudinal Study on Aging

Objective

There has been a growing interest in examining why some individuals adapt and bounce back from multimorbidity (resilience) better than others. This paper investigates the positive role of protective health behaviors on multimorbidity resilience (MR) among older adults focusing on older persons with two or more concurrent chronic conditions, and separately for three multimorbidity chronic illness clusters.

Methods

Using Baseline and Follow-up One data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 10,628 participants aged 65 years and older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: Cardiovascular/metabolic, Musculoskeletal, and Mental health. Associations between health behaviors and MR were evaluated using Linear Mixed Models, adjusting for socio-demographic, social/environmental, and illness context social determinants of health.

Results

Among older adults with two or more illnesses, smoking, satisfaction with sleep, appetite, and skipping meals were associated with MR in the expected direction. Also, obesity (compared to normal weight) and skipping meals showed longitudinal interaction effects with survey wave. Most of the results were replicated for the physical multimorbidity clusters (Cardiovascular/metabolic and Musculoskeletal) compared to the full 2+ multimorbidity analyses; however, for the Mental health cluster, only satisfaction with sleep was supported as a lifestyle predictor of MR.

Discussion

Several modifiable health behaviors identified in the broader health and aging literature are important in affecting levels of multimorbidity resilience in older age. These factors are important strength-based areas to target. Additionally, several social determinants of health are also supported and parallel research on multimorbidity risk. The effects of lifestyle factors for resilience among older adults is dependent on the type of multimorbidity measured. We conclude that the results have significant public health, program intervention, and clinical implications for healthy aging among persons coping with multimorbidity.

A systematic review of evidence on employment transitions and weight change by gender in ageing populations

Background

Becoming unemployed is associated with poorer health, including weight gain. Middle- and older-age adults are a growing segment of workforces globally, but they are also more vulnerable to changes to employment status, especially during economic shocks. Expected workforce exits over the next decade may exacerbate both the obesity epidemic and the economic burden of obesity. This review extends current knowledge on economic correlates of health to assess whether employment transitions impact body weight by sex/gender among middle-aged and older adults.

Methods

Eight bibliometric databases were searched between June and July 2021, supplemented by hand-searches, with no restriction on publication date or country. Longitudinal studies, or reviews, were eligible when examining body weight as a function of employment status change in adults ≥50 years. Data extraction and quality appraisal used predefined criteria; reported findings were analysed by narrative synthesis.

Results

We screened 6,001 unique abstracts and identified 12 articles that met inclusion criteria. All studies examined retirement; of which two also examined job-loss. Overall, studies showed that retirement led to weight gain or no difference in weight change compared to non-retirees; however, reported effects were not consistent for either women or men across studies or for both women and men within a study. Reported effects also differed by occupation: weight gain was more commonly observed among retirees from physical occupations but not among retirees from sedentary occupations. Few studies assessed the role of health behaviours; sleep was the least studied. Most studies were medium quality.

Conclusions

Existing studies do not provide a clear enough picture of how employment transitions affect body weight. Firm conclusions on the impact of employment transitions on weight cannot be made without further high-quality evidence that considers the role of gender, job-type, other health behaviours, and other transitions, like job-loss.

Body-mass index trajectories from childhood to mid-adulthood and their sociodemographic predictors: Evidence from the International Childhood Cardiovascular Cohort (i3C) Consortium

Background

Understanding lifecourse trajectories of body-mass index (BMI) is important for identifying groups at high risk of poor health and potential target points for intervention. This study aimed to describe BMI trajectories from childhood to mid-adulthood in four population-based cohorts established in the 1970s and 1980s and to identify childhood sociodemographic factors related to trajectory membership.

Methods

Between Dec 17, 1970 and Dec 15, 1994, data were collected at the first visit from 9830 participants from the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes participants from Australia (1985), Finland (1980) and the USA (1970-1994). Participants had at least three measures of height and weight, including one in childhood (6-18 years) and one in adulthood (>18 years), and were aged 30-49 years at last measurement. Latent Class Growth Mixture Modelling was used to identify lifecourse BMI trajectory groups and log multinomial regression models were fit to identify their childhood sociodemographic predictors.

Findings

Five consistent BMI trajectory groups were identified amongst the four cohorts: persistently low (35.9-58.6%), improving from high (0.7-4.8%), progressing to moderate (9.3-43.7%), progressing to high (1.1-6.0%), and progressing to very high (0.7-1.3%). An additional three BMI trajectory groups were identified in some, but not all, cohorts: adult onset high (three cohorts; 1.8-20.7%), progressing to moderate-high (two cohorts; 5.2-13.8%), and relapsing yo-yoers (alternating upward and downward; one cohort; 1.3%). In pooled analyses, each predictor variable in childhood, including age, gender, parental education and race, was associated with increased likelihood of belonging to the most (e.g., improving from high) and least (e.g., progressing to very high) favourable BMI trajectory groups, suggesting a U-shaped (or inverse U-shaped) pattern of association.

Interpretation

Five consistent BMI trajectory groups were identified across four cohorts from Australia, Finland, and the USA, mainly across two eras of birth. While most participants remained on a persistently low trajectory (50%), many demonstrated worsening BMI trajectories (47%), with only few demonstrating improving trajectories (<5%). Age, gender, parental education, and race appear to be important predictors of BMI trajectory group membership and need consideration in preventive and management strategies.

Funding

This study was supported by funding from the National Institutes of Health, National Heart, Lung and Blood Institute (grant number R01 HL121230).

Pattern of long-term weight and metabolic changes after a first episode of psychosis: Results from a 10-year prospective follow-up of the PAFIP program for early intervention in psychosis cohort

Background

People with psychosis are at higher risk of cardiovascular events, partly explained by a higher predisposition to gain weight. This has been observed in studies on individuals with a first-episode psychosis (FEP) at short and long term (mainly up to 1 year) and transversally at longer term in people with chronic schizophrenia. However, there is scarcity of data regarding longer-term (above 3-year follow-up) weight progression in FEP from longitudinal studies. The aim of this study is to evaluate the longer-term (10 years) progression of weight changes and related metabolic disturbances in people with FEP.

Methods

Two hundred and nine people with FEP and 57 healthy participants (controls) were evaluated at study entry and prospectively at 10-year follow-up. Anthropometric, clinical, and sociodemographic data were collected.

Results

People with FEP presented a significant and rapid increase in mean body weight during the first year of treatment, followed by less pronounced but sustained weight gain over the study period (Δ15.2 kg; SD 12.3 kg). This early increment in weight predicted longer-term changes, which were significantly greater than in healthy controls (Δ2.9 kg; SD 7.3 kg). Weight gain correlated with alterations in lipid and glycemic variables, leading to clinical repercussion such as increments in the rates of obesity and metabolic disturbances. Sex differences were observed, with women presenting higher increments in body mass index than men.

Conclusions

This study confirms that the first year after initiating antipsychotic treatment is the critical one for weight gain in psychosis. Besides, it provides evidence that weight gain keep progressing even in the longer term (10 years), causing relevant metabolic disturbances.

Effect of Secular Trend, Age, and Length of Follow-up on Optimum Body Mass Index From 1985 Through 2015 in a Large Austrian Cohort

Background

Obesity and its health consequences will dominate health care systems in many countries during the next decades. However, the body mass index (BMI) optimum in relation to all-cause mortality is still a matter of debate.

Material and Methods

Data of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP, 1985–2005) and data provided by the Main Association of Austrian Social Security Institutions (MAASSI, 2005–2015) were analyzed. Information was available on age, sex, smoking status, measured height and weight, and mortality. Generalized additive models were used to model mortality as a function of BMI, calendar time, age, and follow-up.

Results

In MAASSI (N = 282,216, 46.0% men), men and women were on average 2.7 years older than in VHM&PP (N = 185,361, 46.1% men). Average BMI was slightly higher in men (26.1 vs 25.7 kg/m²) but not in women (24.6 vs 24.7 kg/m²). We found an interactive effect of age and follow-up on the BMI optimum. Over age 35 years in men and 55 years in women, the BMI optimum decreased with length of follow-up. While keeping covariates fixed, BMI optimum increased slightly between 1985 and 2015 in men and women, 24.9 (95% CI, 23.9–25.9) to 26.4 (95% CI, 25.3–27.3), and 22.4 (95% CI, 21.7–23.1) to 23.3 (95% CI, 22.6–24.5) kg/m², respectively.

Conclusion

Age and length of follow-up have a pronounced effect on the BMI associated with the lowest all-cause mortality. After controlling for age and length of follow-up, the BMI optimum increased slightly over 30 years in this large study sample.

Adiposity and the role of diverse social supports: an observational, gender-sensitive study using the baseline Canadian Longitudinal Study on Aging

OBJECTIVE

To quantify associations between four types of social support and measured adiposity among women and men.

DESIGN

The cross-sectional sample from the Canadian Longitudinal Study on Aging (CLSA, 2012-2015). Height, weight and waist circumference (WC) were clinically measured, and perceived availability of informational, tangible, emotional and belonging social supports was self-reported.

SETTING

Canada.

PARTICIPANTS

28 779 adults aged 45-85 years from the CLSA.

RESULTS

All social support types were associated with WC and BMI among women but not among men. Women reporting the lowest informational support had significantly higher mean BMI (28·84 kg/m2 (95 % CI 28·63, 29·05)) and WC (90·81 cm (95 % CI 90·31, 91·30)) compared with women reporting maximum support (respectively, 28·09 kg/m2 (95 % CI 27·88, 28·30) and 88·92 cm (95 % CI 88·43, 89·4)). Women's abdominal obesity was associated with low levels of informational, emotional and belonging support, and women's general obesity with informational and emotional support. Notably, informational and emotional support were associated with both obesity outcomes independent of other supports among women. Only a low level of informational support was significantly independently associated with higher odds of obesity among men.

CONCLUSIONS

Our study provides novel insights into gender-specific associations between different types of social support and adiposity. Prospective studies are needed to further investigate potential causality of these associations between the specific social supports and future weight status, especially among women.

Specific body mass index trajectories were related to musculoskeletal pain and mortality: 19-year follow-up cohort

OBJECTIVE

We aimed to study 19-year body mass index (BMI) patterns and their (1) bidirectional relationship with musculoskeletal pain and (2) mortality risk.

STUDY DESIGN AND SETTING

We used data from the Chingford study and group-based trajectory modelling to define 19-year BMI patterns. We investigated whether baseline back, hand, hip, and knee pain (as single- and multi-site) predicted 19-year BMI trajectory, and whether 19-year BMI patterns predicted pain in year 20. We explored BMI trajectories and mortality risk over 25 years (life expectancy).

RESULTS

We included 938 women (mean age: year-1=54, year-20=72) and found seven distinct 19-year BMI trajectories: two normal-weighted (reference), slightly overweight, lower and upper overweight-to-obese, lower and upper obese. BMI patterns capturing the increase overweight-to-obese (BMI 27-34 overtime) were bidirectionally related to knee and multi-site pain. The lower obese pattern (BMI 33-38) was unidirectionally associated with lower limb pain. Women with BMI above 40 had an increased all-cause and cardiovascular mortality risk.

CONCLUSION

For most postmenopausal women, the overweight WHO category was a transition. Two patterns capturing increase overweight-to-obese were mutually related to musculoskeletal pain, i.e., knee and multi-site pain contributed to becoming obese, and trajectories of becoming obese increased the odds of experiencing pain later.

Three-year trajectories of metabolic risk factors predict subsequent long-term mortality in patients with type 2 diabetes

AIM

This study aims to evaluate the associations between 3-year trajectories of metabolic risk factors and subsequent mortality in patients with type 2 diabetes.

METHODS

A total of 6400 persons aged ≥ 30 years with type 2 diabetes and ≥ 3 years of follow-up period were included. The cluster analysis determined the patterns of 3-year trajectories, and Cox proportional hazards models evaluated the associations between patterns and mortality.

RESULTS

Three trajectory subgroups of metabolic risk factors, namely, cluster 1, normal; cluster 2, high-stable or reducing with high level at baseline; and cluster 3, fluctuation: elevated and decreasing, were generated. The clusters 2 and 3 of body mass index (BMI), fasting plasma glucose (FPG), HbA1c, and triglyceride (TG) trajectories were associated with increased risks of all-cause mortality compared with cluster 1 (hazard ratio = 1.27, 95% confidence interval = 1.06-1.51 and 1.45, 1.19-1.78 for BMI; 1.41, 1.22-1.62 and 1.81, 1.38-2.38 for FPG; 1.42, 1.23-1.64 and 1.47, 1.23-1.75 for HbA1c; 1.34, 1.10-1.63 and 2.40, 1.30-4.37 for TG, respectively). For the systolic blood pressure trajectory, only cluster 3 was associated with an increased mortality risk relative to cluster 1 (1.76, 1.13-2.77).

CONCLUSIONS

Long-term metabolic risk factor trajectories may be associated with subsequent mortality.

Predictive value of women's weight trajectories in determining familial cardiovascular disorders: a family-based longitudinal study

Considering the dynamic nature of body mass index (BMI) and its importance in determining cardiovascular risks, this study aimed to investigate the life-course trajectory pattern of women’s BMI and its association with cardiovascular risk factors. A total of 1356 couples with 2976 children were recruited and followed up for an average period of 20 years. Latent growth curve modeling was applied to determine women's BMI trajectories; logistic regression was used to investigate the associations between trajectory patterns and cardiovascular risk factors, including hypertension (HTN), dyslipidemia, diabetes mellitus (DM), and obesity. Women were classified into three trajectories, including normal, stage 1 obesity, and stage 2 obesity. Compared to women’s in the normal trajectory group, those in obesity trajectories had higher odds ratios for HTN, DM, and dyslipidemia. Men with obese spouses showed a higher rate of HTN 1.54 (95% CI 1.05–2.25) and DM 1.55; (95% CI 1.00–2.44). The odds of men’s obesity were higher in obese spouses (OR 1.70; 95% CI 1.10–2.62). Offspring of stage 2 obese (OR 2.39; 95% CI 1.67–3.44) and stage 1 obese (OR 4.81; 95% CI 3.16–7.34) mothers were more likely to be obese. Our findings emphasized paying more attention to women with excessive weight to promote familial cardiovascular health in the communities.

Body mass index trajectories during mid to late life and risks of mortality and cardiovascular outcomes: Results from four prospective cohorts

BACKGROUND

Our understanding of the weight-outcome association mainly comes from single-time body mass index (BMI) measurement. However, data on long-term trajectories of within-person changes in BMI on diverse study outcomes are sparse. Therefore, this study is to determine the associations of individual BMI trajectories and cardiovascular outcomes.

METHODS

The present analysis was based on data from 4 large prospective cohorts and restricted to participants aged ≥45 years with at least two BMI measurements. Hazard ratios (HR) and 95% confidence intervals(95%CI) for each outcome according to different BMI trajectories were calculated in Cox regression models.

FINDINGS

The final sample comprised 29,311 individuals (mean age 58.31 years, and 77.31% were white), with a median 4 BMI measurements used in this study. During a median follow-up of 21.16 years, there were a total of 10,192 major adverse cardiovascular events (MACE) and 11,589 deaths. A U-shaped relation was seen with all study outcomes. Compared with maintaining stable weight, the multivariate adjusted HR for MACE were 1.53 (95%CI 1.40-1.66), 1.26 (95%CI 1.16-1.37) and 1.08 (95%CI 1.02-1.15) respectively for rapid, moderate and slow weight loss; 1.01 (95%CI 0.95-1.07), 1.13 (95%CI 1.05-1.21) and 1.29 (95%CI 1.20-1.40) respectively for slow, moderate and rapid weight gain. Identical patterns of association were observed for all other outcomes. The development of BMI differed markedly between the outcome-free individuals and those who went on to experience adverse events, generally beginning to diverge 10 years before the occurrence of the events.

INTERPRETATION

Our findings may signal an underlying high-risk population and inspire future studies on weight management.

FUNDING

National Natural Science Foundation of China, Guangdong Natural Science Foundation.

Body mass index trajectories among people with obesity and association with mortality: Evidence from a large Israeli database

Objective

Previous studies using longitudinal weight data to characterize obesity are based on populations of limited size and mostly include individuals of all body mass index (BMI) levels, without focusing on weight changes among people with obesity. This study aimed to identify BMI trajectories over 5 years in a large population with obesity, and to determine the trajectories' association with mortality.

Methods

For inclusion, individuals aged 30–74 years at index date (1 January 2013) with continuous membership in Clalit Health Services from 2008 to 2012 were required to have ≥1 BMI measurement per year in ≥3 calendar years during this period, of which at least one was ≥30 kg/m². Latent class analysis was used to generate BMI trajectories over 5 years (2008–2012). Cox proportional hazards models were used to assess the association between BMI trajectories and all‐cause mortality during follow‐up (2013–2017).

Results

In total, 367,141 individuals met all inclusion criteria. Mean age was 57.2 years; 41% were men. The optimal model was a quadratic model with four classes of BMI clusters. Most individuals (90.0%) had stable high BMI over time. Individuals in this cluster had significantly lower mortality than individuals in the other trajectory clusters (p < 0.01), including clusters of people with dynamic weight trajectories.

Conclusions

The results of the current study show that people with stable high weight had the lowest mortality of all four BMI trajectories identified. These findings help to expand the scientific understanding of the impact that weight trajectories have on health outcomes, while demonstrating the challenges of discerning the cumulative effects of obesity and weight change, and suggest that dynamic historical measures of BMI should be considered when assessing patients' future risk of obesity‐related morbidity and mortality, and when choosing a treatment strategy.

Adiposity and Outcome After Ischemic Stroke: Obesity Paradox for Mortality and Obesity Parabola for Favorable Functional Outcomes

BACKGROUND AND PURPOSE

A survival advantage among individuals with higher body mass index (BMI) has been observed for diverse acute illnesses, including stroke, and termed the obesity paradox. However, prior ischemic stroke studies have generally tested only for linear rather than nonlinear relations between body mass and outcome, and few studies have investigated poststroke functional outcomes in addition to mortality.

METHODS

We analyzed consecutive patients with acute ischemic stroke enrolled in a 60-center acute treatment trial, the NIH FAST-MAG acute stroke trial. Outcomes at 3 months analyzed were (1) death; (2) disability or death (modified Rankin Scale score, 2-6); and (3) low stroke-related quality of life (Stroke Impact Scale<median). Relations with BMI were analyzed univariately and in multivariate models adjusting for 14 additional prognostic variables.

RESULTS

Among 1033 patients with acute ischemic stroke, average age was 71 years (±13), 45.1% female, National Institutes of Health Stroke Scale 10.6 (±8.3), and BMI 27.5 (±5.6). In both unadjusted and adjusted analysis, increasing BMI was linearly associated with improved 3-month survival (P=0.01) odds ratios in adjusted analysis for mortality declined across the BMI categories of underweight (odds ratio, 1.7 [CI, 0.6-4.9]), normal (odds ratio, 1), overweight (0.9 [CI, 0.5-1.4]), obese (0.5, [CI, 0.3-1.0]), and severely obese (0.4 [CI, 0.2-0.9]). In unadjusted analysis, increasing BMI showed a U-shaped relation to poststroke disability or death (modified Rankin Scale score, 2-6), with odds ratios of modified Rankin Scale score, 2 to 6 for underweight, overweight, and obese declined initially when compared with normal weight patients, but then increased again in severely obese patients, suggesting a U-shaped or J-shaped relation. After adjustment, including for baseline National Institutes of Health Stroke Scale, modified Rankin Scale score 2 to 6 was no longer related to adiposity.

CONCLUSIONS

Mortality and functional outcomes after acute ischemic stroke have disparate relations with patients' adiposity. Higher BMI is linearly associated with increased survival; and BMI has a U-shaped or J-shaped relation to disability and stroke-related quality of life. Potential mechanisms including nutritional reserve aiding survival during recovery and greater frequency of atherosclerotic than thromboembolic infarcts in individuals with higher BMI.

Group‐based trajectory modeling of body mass index and body size over the life course: A scoping review

Background

Group‐based trajectory modeling has been applied to identify distinct trajectories of growth across the life course. Objectives of this study were to describe the methodological approaches for group‐based modeling of growth across the life course and to summarize outcomes across studies.

Methods

A scoping review with a systematic search of Medline, EMBASE, CINAL, and Web of Science was conducted. Studies that used a group‐based procedure to identify trajectories on any statistical software were included. Data were extracted on trajectory methodology, measures of growth, and association with outcomes.

Results

A total of 59 studies were included, and most were published from 2013 to 2020. Body mass index was the most common measure of growth (n = 43). The median number of identified trajectories was 4 (range: 2–9). PROC TRAJ in SAS was used by 33 studies, other procedures used include TRAJ in STATA, lcmm in R, and Mplus. Most studies evaluated associations between growth trajectories and chronic disease outcomes (n = 22).

Conclusions

Group‐based trajectory modeling of growth in adults is emerging in epidemiologic research, with four distinct trajectories observed somewhat consistently from all studies. Understanding life course growth trajectories may provide further insight for population health interventions.

Effects of Social Development Intervention in Childhood on Adult Life at Ages 30 to 39

Elementary schools can be effective sites for universal preventive interventions. Less is known about how long effects of intervention in elementary grades last. Can they improve outcomes in adulthood? To test effects of a social developmental intervention in the elementary grades on adult life through the 30s, the Seattle Social Development Project, a nonrandomized controlled trial, followed all consenting 5th-grade students (N = 808) from 18 Seattle public elementary schools from age 10 (in 1985) to age 39 (in 2014), with 88% retention. The sample was gender balanced and ethnically and economically diverse. The full intervention, called Raising Healthy Children, continued from Grades 1 through 6 and consisted of teacher in-service training in classroom management and instructional methods; cognitive, social, and refusal skills training for children; and parent workshops in child behavior monitoring and management, academic support, and anticipatory guidance. Using structural equation modeling, we examined intervention effects from age 30 to age 39 across 9 constructs indicating 3 domains of adult life: health behavior, positive functioning, and adult health and success. An omnibus test across all 9 constructs indicated a significant positive overall intervention-control difference. Examined individually, significant intervention effects included better health maintenance behavior, mental health, and overall adult health and success. Significant effects were not found on substance use disorder symptoms, sex-risk behaviors, or healthy close relationships in the 30s. Results indicate that sustained, theory-based, multicomponent intervention in the elementary grades can produce lasting changes in health maintenance, mental health, and adult functioning through the 30s.

Trajectories of body mass index (BMI) and hypertension risk among middle-aged and elderly Chinese people

This study aimed to identify heterogeneity in BMI trajectories and evaluate the impact of BMI trajectories on the risk of hypertension in middle-aged and elderly Chinese people. After data screening, 28, 706 residents' e-health records from 2010 to 2018, including basic personal information, lifestyle and health, were finally included in this population-based longitudinal study. By latent class growth modeling, we identified 12 BMI trajectories: "underweight-increase I (A1)" and "underweight-increase II (A2)"; "normal weight-stable (B1)", "normal weight-decrease (B2)", "normal weight-increase I (B3)" and "normal weight-increase II (B4)"; "overweight-stable (C1)", "overweight-decrease (C2)" and "overweight-increase (C3)"; and "obese-stable I (D1)", "obese-decrease (D2)" and "obese-stable II (D3)". By Cox proportional hazards models, we found that the risk of hypertension in the BMI stable group was lower than that in the BMI increasing trajectory group and higher than that in the BMI decreasing group. For the underweight and normal weight groups, the risk of hypertension was related not only to the magnitude of BMI growth, but also to the rate of growth. For overweight and obesity groups, the risk of hypertension was higher in the high-level stable BMI group than in the low-level stable BMI group. Therefore, for underweight and normal weight people, weight growth and growth rate should be controlled; for overweight and obese people, health education or targeted weight loss exercise should be taken to reduce weight as much as possible to prevent hypertension.

Distinct developmental trajectories of body mass index and diabetes risk: A 5-year longitudinal study of Chinese adults

AIMS/INTRODUCTION

This longitudinal study aimed to explore whether distinct developmental trajectories of body mass index (BMI) would be predictive of diabetes risk in general Chinese adults.

MATERIALS AND METHODS

A total of 4,519 participants aged >18 years who were free of diabetes in 2011 (baseline of the current analysis) were enrolled in this study. All participants completed a medical examination every year during 2011-2016, and BMI levels were measured two to six (average 5.6) times. Group-based trajectory modeling was applied to identify BMI trajectories over time. New-onset diabetes was confirmed in 2016.

RESULTS

During 2011-2016, four distinct BMI trajectories were identified according to BMI range and changing pattern over time: "low" (19.6%), "moderate" (33.4%), "moderate-high" (33.4%) and "high" (13.6%). A total of 168 (3.7%) new-onset diabetes cases were confirmed in 2016. Compared with the "low" BMI trajectory, participants in the "high" BMI trajectory were at significantly higher risk for new-onset diabetes (adjusted relative risk 3.24, 95% confidence interval 1.27-8.24). Notably, BMI trajectories based on the first four or three annual BMI tests yielded similar results. By contrast, no significant correlation was found between categories of baseline BMI and new-onset diabetes in 2016 after multivariate adjustment.

CONCLUSIONS

The present results show that distinct BMI trajectories, even identified using just four or three annual BMI tests, are significantly associated with new-onset diabetes. Monitoring BMI trajectories over time might provide an important approach to identify subpopulations at higher risk for developing diabetes.

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

BACKGROUND

Examining 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.

METHODS

Based 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.

RESULTS

Four 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).

CONCLUSIONS

Having 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.