Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey

Abstract

Objectives: This study is designed to identify different body mass index (BMI) trajectories of individuals aged 40-70 years and test the effect of distinct BMI trajectories on incident hypertension.

Design: The accelerated longitudinal design was used for this study.

Methods: The study drew data from the third to ninth China Health and Nutrition Surveys (CHNS), and 4697 participants were included between 1991 and 2015. As analysed, three distinct individual BMI trajectories were identified by the latent class growth mixed model (LCGMM). Then, BMI values and BMI slopes were worked out through calculation with LCGMM trajectory parameters and their primary derivatives, respectively. Later, Cox proportional hazard models were applied to examine BMI values and slopes, and find out the relationship between the said predicted data and incident hypertension for different classes.

Results: Three different trajectory classes were identified, that is, low-stable class (n=3711), sharp-increasing class (n=282) and high-stable class (n=704). Compared with the low-stable class, the adjusted HRs (95% CI) were 1.321 (1.119 to 1.559) and 1.504 (1.322 to 1.711) for the sharp-increasing class and the high-stable class, respectively. The HR (95% CI) for BMI values rose from 1.081 (1.030 to 1.135) to 1.221 (1.171 to 1.273) while the HR (95% CI) for BMI slopes dropped from 1.154 (1.100 to 1.211) to 0.983 (0.943 to 1.025). That is, the HR for BMI slopes were higher than that for BMI values for the class aged 40-47 years.

Conclusion: These findings suggest that the calibrated BMI trajectories for the period from mid-life to elderly adulthood have a significant effect on the risk of incident hypertension. The period from age 40 to 47 years is critical and has positive implications for the early prevention of hypertension.

Keywords: epidemiology; hypertension; public health.

Figure 1

BMI trajectories of Chinese classes aged 40–70 years (the 95% CI is shown in shadow). BMI, body mass index.

Figure 2

HRs (95% CI) of model-predicted BMI values and BMI slopes for incident hypertension by age, with adjustment for gender, smoking, alcohol drinking, working status, urban–rural residence, marital status and education level. The 95% CIs are shown in shadow. BMI, body mass index.