Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.
Centre for Research in Mathematics, School of Computing, Engineering & Mathematics, Western Sydney University, Sydney, Australia.
Eur Heart J. 2018 Jun 21;39(24):2263-2270. doi: 10.1093/eurheartj/ehy161.
The relationship between life-course body mass index (BMI) trajectories and adult risk for cardiovascular disease (CVD) is poorly described. In a longitudinal cohort, we describe BMI trajectories from early childhood to adulthood and investigate their association with CVD risk factors [Type 2 diabetes mellitus (T2DM), high-risk lipid levels, hypertension, and high carotid intima-media thickness (cIMT)] in adulthood (34-49 years).
Six discrete long-term BMI trajectories were identified using latent class growth mixture modelling among 2631 Cardiovascular Risk in Young Finns Study participants (6-49 years): stable normal (55.2%), resolving (1.6%), progressively overweight (33.4%), progressively obese (4.2%), rapidly overweight/obese (4.3%), and persistent increasing overweight/obese (1.2%). Trajectories of worsening or persisting obesity were generally associated with increased risk of CVD outcomes in adulthood (24-49 years) [all risk ratios (RRs) >15, P < 0.05 compared with the stable normal group]. Although residual risk for adult T2DM could not be confirmed [RR = 2.6, 95% confidence interval (CI) = 0.14-8.23], participants who resolved their elevated child BMI had similar risk for dyslipidaemia and hypertension as those never obese or overweight (all RRs close to 1). However, they had significantly higher risk for increased cIMT (RR = 3.37, 95% CI = 1.80-6.39).
The long-term BMI trajectories that reach or persist at high levels associate with CVD risk factors in adulthood. Stabilizing BMI in obese adults and resolving elevated child BMI by adulthood might limit and reduce adverse cardiometabolic profiles. However, efforts to prevent child obesity might be most effective to reduce the risk for adult atherosclerosis.
生命历程体重指数（BMI）轨迹与成人心血管疾病（CVD）风险之间的关系描述得还不够充分。在一项纵向队列研究中，我们描述了从儿童早期到成年的 BMI 轨迹，并研究了它们与成年期 CVD 风险因素（2 型糖尿病（T2DM）、高危血脂水平、高血压和高颈动脉内膜中层厚度（cIMT））的相关性。
在 2631 名心血管风险在芬兰年轻人研究参与者（6-49 岁）中，使用潜在类别增长混合模型确定了 6 种离散的长期 BMI 轨迹：稳定正常（55.2%）、缓解（1.6%）、逐渐超重（33.4%）、逐渐肥胖（4.2%）、快速超重/肥胖（4.3%）和持续超重/肥胖（1.2%）。体重恶化或持续肥胖的轨迹通常与成年期（24-49 岁）CVD 结局的风险增加相关（所有风险比（RR）>15，与稳定正常组相比，P<0.05）。虽然不能确认成人 T2DM 的残余风险[RR=2.6，95%置信区间（CI）=0.14-8.23]，但解决儿童时期 BMI 升高的参与者发生血脂异常和高血压的风险与从未肥胖或超重的参与者相似（所有 RR 接近 1）。然而，他们的 cIMT 增加的风险显著更高（RR=3.37，95%CI=1.80-6.39）。
达到或持续处于高水平的长期 BMI 轨迹与成年期 CVD 风险因素相关。稳定肥胖成年人的 BMI 并在成年期解决儿童时期 BMI 升高，可能会限制和减少不良的心脏代谢特征。然而，预防儿童肥胖的努力可能是降低成人动脉粥样硬化风险最有效的方法。
