Increased Risk of Cardiometabolic Disease in Ideal Weight Adults With History of Overweight/Obesity in China: A Prospective Cohort Study.

BACKGROUND: Overweight and obesity represent critical modifiable determinants in the prevention of cardiometabolic disease (CMD). However, the long-term impact of prior overweight/obesity on the risk of CMD in later life remains unclear. We aimed to investigate the association between longitudinal transition of body mass index (BMI) status and incident CMD. METHODS AND RESULTS: This prospective cohort study included 57 493 CMD-free Chinese adults from the Kailuan Study. BMI change patterns were categorized according to the BMI measurements obtained during the 2006 and 2012 surveys. The primary end point was a composite of myocardial infarction, stroke, and type 2 diabetes. Cox regression models were used to evaluate the associations of transitions in BMI with overall CMD events and subtypes, with covariates selected on the basis of the directed acyclic graph. During a median follow-up of 7.62 years, 8412 participants developed CMD. After considering potential confounders, weight gain pattern (hazard ratio [HR], 1.34 [95% CI, 1.23-1.46]), stable overweight/obesity (HR, 2.12 [95% CI, 2.00-2.24]), and past overweight/obesity (HR, 1.73 [95% CI, 1.59-1.89]) were associated with the incidence of CMD. Similar results were observed in cardiometabolic multimorbidity, cardiovascular disease, and type 2 diabetes. Additionally, triglyceride and systolic blood pressure explained 8.05% (95% CI, 5.87-10.22) and 12.10% (95% CI, 9.19-15.02) of the association between past overweight/obesity and incident CMD, respectively. CONCLUSIONS: A history of overweight/obesity was associated with an increased risk of CMD, even in the absence of current BMI abnormalities. These findings emphasize the necessity for future public health guidelines to include preventive interventions for CMD in individuals with past overweight/obesity.

Mean arterial pressure trajectory with premature cardiovascular disease and all-cause mortality in young adults: the Kailuan prospective cohort study.

Background: The association between mean arterial pressure (MAP) trajectory in young adults and risk of cardiovascular diseases (CVD) and all-cause mortality is not well-characterized. The objective of this study was to investigate the effects of different MAP trajectory on the risk of CVD and all-cause mortality among the young. Methods: In the Kailuan cohort study, 19,171 participants aged 18-40 years were enrolled without CVD (including myocardial infarction, stroke, atrial fibrillation and heart failure). The potential hybrid model was used to fit different trajectory patterns according to longitudinal changes of MAP. Hazard ratios and 95% confidence intervals for risk of CVD and all-cause mortality were analyzed using Cox proportional hazard regression models for participants with different trajectories. Results: Five distinct MAP trajectories were identified during 2006-2013. Each of the trajectories was labelled as low-stable, middle-stable, decreasing, increasing, or high-stable. With the low-stable trajectory group as the reference, the multivariate adjusted HR (95%CI) of CVD for the middle-stable, decreasing, increasing and high-stable groups were 2.49 (1.41-4.40), 5.18 (2.66-10.06), 5.91 (2.96-11.80) and 12.68 (6.30-25.51), respectively. The HR (95%CI) for all-cause deaths were 1.27 (0.84-1.94), 2.01 (1.14-3.55), 1.96 (1.04-4.3.72), and 3.28 (1.69-6.37), respectively. Conclusion: In young adults, MAP trajectories were associated with the risk of CVD or all-cause mortality and increasing MAP trajectories within the currently designated "normal" range may still increase the risk for CVD.

Metabolic Dysfunction-associated fatty liver disease and incident heart failure risk: the Kailuan cohort study.

BACKGROUND: Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace non-alcoholic fatty liver disease (NAFLD) to emphasize the pathogenic association between fatty liver disease and metabolic dysfunction. Studies have found that MAFLD independently increases the risk of myocardial infarction and stroke. But the relationship between MAFLD and heart failure (HF) is not fully understood. OBJECTIVES: This study aimed to explore the association between MAFLD and the risk of HF. METHODS: The study included 98,685 participants without HF selected from the Kailuan cohort in 2006. All participants were divided into non-MAFLD group and MAFLD group according to MAFLD diagnostic criteria. After follow-up until December 31, 2020, the Cox regression analysis model was used to calculate the effect of MAFLD on the risk of HF. RESULTS: During the median follow-up of 14.01 years,3260 cases of HF were defined, the HF incidence density of non-MAFLD group and MAFLD group was 2.19/1000pys and 3.29/1000pys, respectively. Compared with the non-MAFLD group, participants with MAFLD had an increased risk of HF (HR: 1.40, 95% CI: 1.30-1.50); in addition, an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. We also observed a higher risk of HF among the different metabolic dysfunction of MAFLD in people with both fatty liver disease and type 2 diabetes (HR, 1.95; 95% CI, 1.73-2.20). CONCLUSIONS: Our findings suggest that the risk of HF was significantly increased in participants with MAFLD, and an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. In addition, we should pay more attention to people with MAFLD with type 2 diabetes.

Age-dependent changes in the risk of weight gain in Chinese adults: results from the Kailuan cohort study.

OBJECTIVES: Over the past decades, China has seen a dramatic epidemic of overweight and obesity. However, the optimal period for interventions to prevent overweight/obesity in adulthood remains unclear, and little is known regarding the joint effect of sociodemographic factors on weight gain. We aimed to investigate the associations of weight gain with sociodemographic factors, including age, sex, educational level, and income. STUDY DESIGN: This was a longitudinal cohort study. METHODS: This study included 121,865 participants aged 18-74 years from the Kailuan study who attended health examinations over the period 2006-2019. Multivariate logistic regression and restricted cubic spline were used to evaluate the associations of sociodemographic factors with body mass index (BMI) category transitions over two, six, and 10 years. RESULTS: In the analysis of 10-year BMI changes, the youngest age group had the highest risks of shifting to higher BMI categories, with odds ratio of 2.42 (95% confidence interval 2.12-2.77) for a transition from underweight or normal weight to overweight or obesity and 2.85 (95% confidence interval 2.17-3.75) for a transition from overweight to obesity. Compared with baseline age, education level was less related to these changes, whereas gender and income were not significantly associated with these transitions. Restricted cubic spline analyses suggested reverse J-shaped associations of age with these transitions. CONCLUSIONS: The risk of weight gain in Chinese adults is age dependent, and clear public healthcare messaging is needed for young adults who are at the highest risk of weight gain.