Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi'an 710061, China.
Xi'an Center for Disease Control and Prevention, No. 599, Xiying Road, Xi'an 710054, China.
Nutrients. 2022 Aug 17;14(16):3373. doi: 10.3390/nu14163373.
Objectives: This study assessed the associations between long-term trajectories of percentage of energy from fat (PEF) and obesity among Chinese adults. Methods: Longitudinal data collected by the China Health and Nutrition Survey from 1991 to 2015 were analyzed. A body mass index ≥28.0 was defined as general obesity. Participants’ baseline PEF levels were categorized as lower than the recommendation of the Chinese Dietary Guideline (<20%), meeting the recommendation (20−30%), and higher than the recommendation (>30%). Patterns of PEF trajectories were identified by latent class trajectory analysis for overall participants and participants in different baseline PEF groups, respectively. Cox proportional hazards regression models with shared frailty were used to estimate associations between PEF and obesity. Results: Data on 13,025 participants with 72,191 visits were analyzed. Four patterns of PEF trajectory were identified for overall participants and participants in three different baseline PEF groups, respectively. Among overall participants, compared with “Baseline Low then Increase Pattern” (from 12% to 20%), participants with “Baseline Normal-Low then Increase-to-High Pattern” (from 20% to 32%) had a higher hazard of obesity (hazard ratio (HR) and 95% confident interval (CI) at 1.18 (1.01−1.37)). Compared with the “Stable Pattern” group (stable at around 18% and 22%, respectively), participants with “Sudden-Increase Pattern” (from 18% to 30%) in the baseline group whose PEF levels were lower than the recommendation and those with “Sudden-Increase then Decrease Pattern” (rapidly increased from 25% to 40%, and then decreased) in the baseline group who met the recommendation had higher hazards of obesity (HRs and 95% CIs being 1.65 (1.13−2.41) and 1.59 (1.03−2.46), respectively). Conclusions: Adults with a trajectory that involved a sudden increase to a high-level PEF had a higher risk of general obesity. People should avoid increasing PEF suddenly.
本研究评估了中国成年人中脂肪能量百分比（PEF）长期变化轨迹与肥胖之间的关联。
分析了中国健康与营养调查（1991-2015 年）收集的纵向数据。将体质指数（BMI）≥28.0 定义为一般肥胖。参与者的基础 PEF 水平分为低于中国膳食指南推荐值（<20%）、符合推荐值（20-30%）和高于推荐值（>30%）。采用潜在类别轨迹分析分别对总体参与者和不同基础 PEF 组的参与者进行 PEF 轨迹模式的识别。使用共享脆弱性的 Cox 比例风险回归模型来估计 PEF 与肥胖之间的关联。
共分析了 13025 名参与者的 72191 次就诊数据。确定了总体参与者和三个不同基础 PEF 组参与者的四个 PEF 轨迹模式。在总体参与者中，与“基础值低然后增加模式”（从 12%增加到 20%）相比，“基础值正常低然后增加到高模式”（从 20%增加到 32%）参与者的肥胖风险更高（危险比（HR）和 95%置信区间（CI）为 1.18（1.01-1.37））。与“稳定模式”组（分别稳定在 18%和 22%左右）相比，基础组中 PEF 水平低于推荐值的“突然增加模式”（从 18%增加到 30%）和基础组中符合推荐值的“突然增加然后减少模式”（迅速增加到 40%，然后减少）参与者肥胖风险更高（HRs 和 95% CIs 分别为 1.65（1.13-2.41）和 1.59（1.03-2.46））。
PEF 轨迹突然升高至高水平的成年人患一般肥胖的风险更高。人们应避免 PEF 突然增加。
