The Impact of Lifestyle Changes on Cardiometabolic Health in Modernizing China: A Tale of Three Gorges in the Yangtze River.

Background: Modernization of Chinese adults is associated with increased atherosclerotic diseases. Over 1 million farmers have been resettled upland since 1996 in the Three Gorges dam project of the Yangtze River, with job and other lifestyle changes. We aimed to evaluate the impact of such rapid lifestyle changes on indices of cardiometabolic health. Methods: Ninety-five ex-farmers in Wu Shan (WS) (aged 49.7 ± 9 years) resettled uphill for 3-5 years and 87 age and gender-matched farmers in Da Chang (DC) (aged 48.8 ± 10 years) studied before resettlement were compared. Carotid intima-media thickness (IMT) was measured by ultrasound. Results: Ninety-nine percent WS residents adopted nonfarming jobs or were retired. WS ex-farmers had higher waist-hip ratio (P < 0.0001), low density lipoprotein-cholesterol (P = 0.001), triglycerides (P = 0.001), and prevalence of metabolic syndrome (MS) (43.2% vs. 17.2%, P = 0.01) compared with DC farmers. Smoking status, body mass index, systolic and diastolic blood pressures, high density lipoprotein-cholesterol, and fasting glucose were similar. Carotid IMT was significantly higher in WS residents (0.71 ± 0.16 mm) than in DC farmers (0.64 ± 0.11 mm) (P < 0.001). MS correlated with job changes to more sedentary nature (ß = 0.453, P < 0.0001), but not to leisure exercise activities, nor any specific dietary habits. On multivariate regression, carotid IMT was associated with WS location (ß = 0.196, P = 0.021) and presence of MS (ß = 0.208, P = 0.021), independent of other traditional vascular risk factors (model R2 value = 0.444, F-value 12.0, P < 0.0001). Conclusion: Rapid lifestyle and job changes in ex-farmers in the Three Gorges region are associated with significantly worse cardiometabolic profiles and subclinical atherosclerosis, with potentially important implications for atherosclerosis prevention in modernizing China.

A Tale of Three Gorges in the Yangtze River: Comparing the Prevalence of Metabolic Syndrome According to ATPIII, WHO, and IDF Criteria and the Association with Vascular Health in Modernizing China.

BACKGROUND: Metabolic syndrome (MS) is associated with atherosclerotic diseases. The prevalence of MS according to the Adult Treatment Panel III (ATPIII), World Health Organization (WHO), and International Diabetes Federation (IDF) criteria are variable but increasing in western countries and modernizing China. This study aimed to evaluate the prevalence of MS according to these three criteria, in farmers or ex-farming residents in three-gorges territories undergoing rapid lifestyle changes. METHODS: We compared 95 residents (ex-farmers) in Wu Shan (WS) (28.4% men, aged 49.7 ± 9 years) resettled uphill for 3-5 years, and 87 age- and gender-matched farmers in Da Chang (DC) (27.6% men, aged 48.8 ± 10 years) before migration. MS and other traditional risk factors were assessed and carotid intima-media thickness (IMT) measured. RESULTS: Ninety-nine percent of WS residents were retired or adopted nonfarming jobs. Compared with DC farmers, WS ex-farmers had higher waist circumference, low density lipoprotein-cholesterol, and triglycerides (P < 0.0001), but their blood pressures, HDL-cholesterol, and fasting glucose were similar. MS were identified in 43.2% (IDF), 36.8% (WHO), and 29.5% (ATPIII) respectively in WS ex-farmers, compared with 17.2%, 13.8%, and 11.5% respectively in DC farmers. Carotid IMT was significantly higher in WS ex-farmers (0.74 ± 0.16 mm) than in DC farmers (0.64 ± 0.11 mm) (P < 0.0001). On multivariate regression analysis, prevalence of MS was correlated with job nature (beta = 0.425, P < 0.0001). Carotid IMT was better correlated with IDF MS criteria (beta = 0.208, P = 0.021), independent of age and WS location (regression adjusted R2 = 0.444, F-value 12.0, P < 0.0001), but not with the ATPIII or WHO criteria. CONCLUSIONS: IDF MS criteria is more sensitive, better correlates with atherosclerosis surrogate, and accordingly is more readily applicable to modernizing China.