Body mass index trajectories from adolescent to young adult for incident high blood pressure and high plasma glucose

Determining the interplay of prenatal parental BMI in shaping child BMI trajectories: the CHILD Cohort Study

BACKGROUND

Obesity is a major public health concern affecting millions of people globally. Early identification of individuals susceptible to obesity is crucial for reducing the burden of obesity. Obesity is often defined based on body-mass-index (BMI), and tracking BMI trajectories from early childhood offers a valuable tool for risk stratification. Although the role of mothers in shaping these trajectories is well-recognized, the paternal influence on childhood obesity development remains a knowledge gap. We hypothesize that children of fathers with obesity have higher odds of being in the rapid BMI growth trajectory with stronger estimates when the mother is also with overweight or obesity.

METHODS

We analyzed data from the Canadian CHILD Cohort Study, a pregnancy cohort in which both parents were enrolled in early pregnancy when BMI was assessed. The child's BMI was repeatedly collected from birth to age five. We used group-based trajectory modeling to identify offspring BMI z-score (BMIz) trajectory groups (age-and-sex standardized) and weighted multinomial logistic regression analysis to determine the associations between prenatal paternal BMI and offspring growth trajectories, stratified by maternal weight categories.

RESULTS

Among 2 238 participants, the mean prenatal paternal BMI was 27.44 (SD = 4.77), and 22.83% of fathers were with obesity. The four identified offspring BMIz trajectories were: low stable (n = 220, 9.83%), normative (n = 1 356, 60.59%), high stable (n = 572, 25.56%), and rapid BMIz growth trajectory (n = 90, 4.02%). Children of normal-weight mothers and fathers with obesity had 1.86 higher odds (OR: 1.86; 95%CI: 1.22-2.84) of being classified in the rapid growth BMIz trajectory, compared to children of normal-weight fathers. The odds of being in the rapid growth BMIz trajectory were higher when both mothers and fathers were with obesity (OR: 4.35; 95%CI: 2.65-7.14).

CONCLUSIONS

Children of fathers with obesity had higher odds of being in the rapid BMI growth trajectory, particularly when also the mother was with overweight or obesity. These results support the need for preconception advice and interventions for couples to optimize their offspring's health.

Trajectories of body mass index and incident kidney stone disease: a prospective cohort study in Chinese young adults

The present study aims to explore the potential changing trajectory patterns of body mass index (BMI) for Chinese young adults and identify the relationship of BMI trajectory patterns with kidney stone disease (KSD) incidence. Latent class growth analysis was used to identify distinct trajectories of BMI during young adulthood. Cox proportion hazard models were conducted to explore the association between the BMI trajectory group memberships and incident KSD. Subgroup and sensitivity analyses were undertaken to test the robustness of the findings. In total, 2,966 young adults who attended at least three annual check-ups from 2014 to 2021 without KSD at baseline were enrolled in the cohort analysis. Three district BMI trajectories were identified for young adults, labeled as low-stable in normal BMI (28.5%), medium-rising to high BMI (67.4%), and rapid-rising to high BMI (4.1%). Compared with the low-stable in normal BMI group, Hazard ratios (HRs) of the rapid-rising and medium-rising to high BMI groups were 3.19 (95% CI: 1.54-6.63) and 1.78 (95% CI: 1.08-2.92) after adjusting the covariates. The cumulative incidence curves likewise illustrated that young adults in the rapid-rising to high BMI group had the highest risk of developing KSD compared to the other two groups. The rapid BMI growth trajectories during young adulthood were identified to be independently associated with a higher risk of KSD. The findings supplied novel insights that monitoring the BMI changing pattern may be favorable to early intervention of KSD during young adulthood.

Adiposity trajectories and cardiovascular disease risk in women: a population-based cohort study with a focus on menopausal status

Objectives

A single measurement of adiposity indices could predict the incidence of cardiovascular disease (CVD); nonetheless their long-term pattern and its association with incident CVD are rarely studied. This study aimed to determine distinct trajectories of adiposity indices among participants of Tehran Lipid and Glucose Study (TLGS) and their association with incident CVD. Furthermore, this study aimed to investigate whether this association differed among individuals according to their menopausal status.

Method

A total of 6840 women participated in TLGS, aged 20 years and older were included in this study; they were followed for a median of 16 years. Body mass index (BMI), waist circumference (WC), conicity index (CI) and body roundness index (BRI) were included in the analysis as adiposity indices. The cohort outcome panel of medical specialists identified the CVD outcomes. Trajectory analyses were used to identify homogeneous distinct clusters of adiposity indices trajectories. The association between the trajectory group membership and incident CVD were explored by Cox proportional hazard models, with unadjusted and adjusted model for baseline age, physical activity, smoking status, menopause and family history of CVD.

Results

Three BMI trajectory groups of low, medium, and high and two trajectories for WC, BRI and CI were identified. Adjusted cox proportional hazard models revealed significant associations between the hazard of CVD experience and the high trajectory group of the BMI (HR: 2.06, 95% CI: 1.38-3.07), WC (HR: 2.71, 95% CI: 1.98-3.70), CI (HR: 1.87, 95% CI: 1.26-2.77) and BRI (HR: 1.55-95% CI: 1.12-2.15), compared to the low trajectory group. Subgroup analysis based on the menopausal status of participants showed that the HR of CVD incidences for all of trajectories adiposity indices, except BMI, was statistically significant. Adjusted cox proportional hazard models, in those women not reached menopause during study, revealed that the HR (95% CI) of CVD incidences for high trajectory of BMI, WC, CI and BRI were 2.80 (1.86-7.05); 2.09 (1.40-6.16); 1.72 (1.42-5.61), and 3.09 (1.06-9.01), respectively. These values for those were menopause at the initiation of the study were 1.40 (1.11, 2.53); 1.65 (1.04-2.75); 1.69 (1.01-2.87), and 1.61 (0.98-2.65), respectively.

Conclusion

Our findings suggest that adiposity trajectories, particularly central adiposity index of CI, could precisely predict the CVD risk. Consequently, preventive strategies should be tailored accordingly.

Life-course trajectories of body mass index and cardiovascular disease risks and health outcomes in adulthood: Systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to assess the effect of life course body mass index (BMI) trajectories (childhood to adulthood) on cardiovascular disease (CVD) risk factors and outcomes.

METHODS

Prospective or retrospective cohort studies were identified that assessed the association of BMI trajectories with CVD risks and outcomes from databases published in English. The pooled effect sizes were estimated using a random-effects model.

FINDINGS

Seventeen eligible studies were included in this systematic review. The results revealed that a persistently overweight trajectory from childhood to adulthood was associated with a higher risk of hypertension (RR: 2.49; 95% CI: 1.9, 3.28) and type 2 diabetes (RR: 4.62; 95% CI: 2.36, 9.04) compared with a trajectory characterized by a normal BMI throughout both childhood and adulthood. Similarly, the risk of hypertension (RR: 2.38; 95% CI: 1.70, 3.33) and type 2 diabetes (RR: 3.66; 95% CI: 2.57, 5.19) was higher in those with normal-to-overweight trajectory compared with participants with a stable normal weight trajectory.

CONCLUSION

The findings suggest that lifetime BMI trajectories may be influential on health outcomes, and preventive strategies should be designed accordingly. Implementing appropriate preventive strategies at all life stages may reduce CVD risks and adverse outcomes later in life.

Gender difference on the mediation effects of filial piety on the association between chronic obstructive pulmonary disease and depressive symptoms in older adults: A community-based study

Filial piety is viewed as strong family support for older Chinese people, and strongly associated with depressive symptoms. It is unknown if there exists gender difference in the mediation effects of filial piety on the relationship between chronic obstructive pulmonary disease (manifested as lung function) and depression. We investigated whether filial piety mediates the association between lung function and depression in community-dwelling older men and women using the Healthy Aging Longitudinal Study in Taiwan (HALST). Community dwelling adults aged 65 and above were analyzed. Pulmonary function, depressive symptoms, and filial piety expectation (FPE) and receipt of filial piety (RFP) were collected. The interaction and mediation of filial piety between lung function and depression was analyzed. We found that in older men, forced expiratory volume in the first second (FEV1) was inversely correlated with depression (β = -0.1281, p = 0.004) with no mediation effect of FPE. In older women, FEV1 was negatively associated with FPE, but FPE did not increase the risk of depression (β = 0.0605, p = 0.12). In both older men and women, FEV1 was negatively associated with RFP, while RFP reduced the risk of depression (p< 0.001). In older women, the correlation between FEV1 was complete mediation of RFP. Results indicate that feelings of insufficient filial piety may increase the likelihood of depression, especially in elderly women with worse lung function. Although modest, the main mediation effect of filial piety was improvement of lung function in older subjects, which might decrease depression.

Association between BMI trajectories from childhood to early adulthood and the carotid intima-media thickness in early adulthood: Tehran lipid and glucose study

BACKGROUND AND AIMS

Childhood and adolescence overweight/obesity is an important predictor of obesity and increased long-term cardiometabolic abnormalities in adulthood. In this study, we aimed to investigate the association of body mass index (BMI) and waist circumference (WC) trajectories among children and adolescents with adulthood carotid intima-media thickness (cIMT) as a determinant of subclinical atherosclerosis.

METHODS

In this prospective cohort study, 1265 participants aged 3 to 18 were followed up for 18 years. By using Latent Class Growth Analysis, three groups of BMI and WC trajectory were defined; low stable, moderate-increasing, and high-increasing. Linear and logistic regression analysis were used to investigate the association of each lifetime BMI and WC trajectory group with cIMT.

RESULTS

Although the high-increasing BMI trajectory group was significantly associated with higher cIMT (ß=0.0464, P < 0.001), moderate-increase was not (ß=0.0096, P = 0.102); in reference to the low-stable BMI trajectory group. Among WC trajectory groups, both moderate- (ß=0.0177, P = 0.006) and high-increasing (ß=0.0533, P < 0.001), in reference to the low-stable group, were significantly associated with higher cIMT. The results did not change after adjustment for baseline BMI. The ORs of high-increasing BMI, moderate-increasing WC, and high-increasing WC trajectories were 3.24, 1.92, and 3.29, respectively for high cIMT.

CONCLUSION

Our study resulted that a high-increasing trajectory of childhood BMI and moderate- and high-increasing trajectories of childhood WC are associated with higher cIMT and higher risk of high-cIMT. Regular monitoring and screening of BMI and WC trajectory from childhood may improve identifying individuals with high risks of cardiovascular disease, more accurately.

Association of body mass index trajectory and hypertension risk: A systematic review of cohort studies and network meta-analysis of 89,094 participants

Introduction

Body mass index (BMI) trajectories, such as non-linear time trends and nonlinear changes in BMI with age, can provide information on the underlying temporal health patterns. The relationship between BMI trajectories and the risk of hypertension remains controversial.

Methods

PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched from their inception to January 31, 2022. We categorized BMI trajectories as "Stable high," "table normal," "Stable low," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)." The main outcome was the relative risk for the prevalence of hypertension in the different BMI trajectories. Potential sources of heterogeneity were examined using meta-regression and subgroup analysis. A publication bias test and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were also used.

Results

The 18 cohort studies included 89,094 participants. Compared with the "Stable normal" trajectory, "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension: [RR (95% CI)]: 1.80 (1.29 2.50), p < 0.001; 1.53 (1.27 1.83), p < 0.001; 1.30 (1.24 1.37), p = 0.001, respectively. The "Stable low" trajectory was associated with a reduced risk of hypertension [0.83 (0.79 0.83), p < 0.001]. The "Stable high" trajectory (surface under the cumulative ranking curve = 88.1%) had the highest probability of developing hypertension in the population. The certainty of the evidence for direct comparisons of the incidence of hypertension between various BMI trajectories was generally very low.

Conclusion

Our findings suggested that "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension, with the "Stable high" trajectory most likely associated with hypertension.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308575], identifier [CRD42022308575].

Pediatric body mass index trajectories and the risk of hypertension among adolescents in China: a retrospective cohort study

BACKGROUND

The impact of pediatric body mass index (BMI) trajectories on the risk of adolescent hypertension (HTN) determined by three separate visits remains unclear. This longitudinal study aims to identify potential pediatric sex-specific BMI trajectories and to assess their associations with HTN and HTN subtypes.

METHODS

Based on the Health Promotion Program for Children and Adolescents (HPPCA) in Suzhou, China, a total of 24,426 participants who had initial normal blood pressure (BP) and had at least four BMI measurements during 2012-2020 were included. HTN was defined as simultaneously having three separate visits of elevated BP in 2020. Latent class growth models were used to explore sex-specific BMI trajectories, whose associations with HTN and HTN subtypes were further examined by logistic regression.

RESULTS

The incidence of HTN determined through three separate visits was 3.34%. Four trajectories were identified for both sexes: low BMI increasing, medium BMI increasing, high BMI increasing, and highest BMI increasing. Compared to the medium BMI increasing group, the odds ratio (95% confidential interval) for developing adolescent HTN of the low, high, and highest BMI increasing groups among boys were 0.54 (0.39, 0.75), 1.90 (1.44, 2.51), and 2.89 (1.90, 4.39), respectively; and the corresponding values for girls were 0.66 (0.48, 0.90), 2.30 (1.72, 3.09), and 4.71 (3.06, 7.26). Similar gradually elevated associations between different trajectories with isolated systolic hypertension, systolic and diastolic hypertension were observed.

CONCLUSION

Current results emphasized the adverse effects of stable high BMI on HTN and the benefits of maintaining normal weight throughout childhood.

Joint trajectories of body mass index and waist circumference in early-life to mid-life adulthood and incident hypertension: the China Health and Nutrition Survey

OBJECTIVE

This longitudinal study aims to identify distinct trajectories of body mass index (BMI) and waist circumference (WC) during 20-60 years old, and explore their joint effect on incident hypertension.

DESIGN

A longitudinal cohort study.

SETTING

China Health and Nutrition Survey, 1993-2011.

PARTICIPANTS

The longitudinal cohort included 6571 participants (3063 men) who had BMI and WC repeatedly measured 3-7 times before incident hypertension or loss to follow-up.

OUTCOMES

Hypertension was defined as systolic blood pressure/diastolic blood pressure>140/90 mm Hg or diagnosis by medical records or taking antihypertensive medication.

RESULTS

Two distinct trajectories were characterised for both BMI and WC: low-increasing and high-increasing. Jointly, subjects were divided into four groups: normal (n=4963), WC-increasing (n=620), BMI-increasing (n=309) and BMI&WC-increasing (n=679). Compared with the normal group, the adjusted HRs and 95% CIs for hypertension were 1.43 (1.19 to 1.74), 1.51 (1.19 to 1.92) and 1.76 (1.45 to 2.14) for WC-increasing, BMI-increasing and BMI&WC-increasing groups, respectively. The model-estimated levels and slopes of BMI and WC were calculated at each age point in 1-year interval according to the model parameters and their first derivatives, respectively. The associations between model-estimated levels and hypertension increased with age, with adjusted ORs and 95% CIs ranging from 0.92 (0.86 to 0.98) to 1.57 (1.47 to 1.67) for BMI and 0.98 (0.92 to 1.05) to 1.44 (1.35 to 1.53) for WC. Conversely, the ORs (95% CIs) of level-adjusted linear slopes decreased with age, ranging from 1.47 (1.38 to 1.57) to 0.97 (0.92 to 1.03) for BMI and 1.36 (1.28 to 1.45) to 0.99 (0.93 to 1.06) for WC.

CONCLUSIONS

Our study demonstrates that the joint trajectories of BMI and WC have significant effect on future hypertension risk, and the changing slopes of BMI and WC during young adulthood are independent risk factors. Both BMI and WC should be paid more attention to prevent hypertension, and young adulthood may be a crucial period for intervention.

Maternal body mass index, offspring body mass index, and blood pressure at 18 years: a causal mediation analysis

OBJECTIVE

Understanding the natural history of hypertension is key to identifying prevention strategies. Previous work suggests that in utero exposures and offspring anthropometrics may play a role. This study examined the relationship between maternal pre-pregnancy body mass index (BMI) and the mediating role of childhood and adolescent BMI on offspring blood pressure at 18 years.

METHODS

We performed multivariable regression and causal mediation analyses within 3217 mother - offspring pairs from the Avon Longitudinal Study of Parents and Children prospective birth cohort. The main exposure was maternal pre-pregnancy BMI, and the outcome was offspring blood pressure at 18 years of age categorized as normal or elevated. Latent trajectory analysis was used to quantify the mediator, offspring BMI trajectories, derived from multiple measurements throughout childhood and adolescence. Mediation analyses were repeated using current offspring BMI at 18 years as a continuous variable.

RESULTS

Multivariable logistic regression revealed that for every 1 unit increase in maternal BMI, the risk of elevated blood pressure at 18 years of age increased by 5% (aOR: 1.05, 95% CI: 1.03-1.07; p < 0.001). The strength of this association was reduced after adjusting for offspring BMI trajectory (aOR: 1.03, 95% CI: 1.00-1.05; p = 0.017) and eliminated after adjusting for offspring BMI at 18 years (aOR: 1.00; 95% CI: 0.98-1.03; p = 0.70). Causal mediation analysis confirmed offspring BMI at 18 years as a mediator, where BMI trajectory accounted for 46% of the total effect of maternal BMI on elevated offspring blood pressure and current BMI account for nearly the entire effect.

CONCLUSIONS

Maternal pre-pregnancy BMI is associated with an increased risk of elevated blood pressure in offspring at 18 years of age although it appears to be entirely mediated by offspring BMI.

Revisiting trajectories of BMI in youth: An in-depth analysis of differences between BMI and other adiposity measures

OBJECTIVE

Body mass index (BMI) is used to identify trajectories of adiposity in youth, but it does not distinguish fat- from fat-free-mass. There are other inexpensive measures of adiposity which might better capture fat-mass in youth The objective of this study is to examine differences between sex-specific trajectories of BMI and other adiposity indicators (subscapular and triceps skinfold thickness, waist circumference, waist-to-height ratio) which may better capture fat-mass in youth.

METHODS

Data come from four cycles of a longitudinal cohort of 1293 students in Montréal, Canada at ages 12, 15, 17 and 24. Group-based trajectory models identified sex-specific adiposity trajectories among participants with data in ≥3 cycles (n = 417 males; n = 445 females).

RESULTS

There were six trajectory groups in males and females for all five indicators, except for waist circumference (seven) in both sexes and triceps skinfold thickness (four) and waist-to-height ratio (five) in females. Most trajectories indicated linear increases; only the skinfold thickness indicators identified a decreasing trajectory. While all indicators identified a trajectory with high levels of adiposity, they differed in the number and relative size of trajectories pertaining to individuals in lower half of the adiposity distribution.

CONCLUSION

BMI is a satisfactory indicator of adiposity in youth if the aim of the trajectory analysis is to identify youth with excess adiposity, a known risk factor for cardiometabolic outcomes in adulthood.

Body mass index trajectory from childhood to puberty and high blood pressure: the China Health and Nutrition Survey

OBJECTIVES

The prevalence of childhood hypertension is rising in parallel with the increasing prevalence of overweight and obesity in children. How growth trajectories from childhood to puberty relate to high blood pressure (HBP) is not well defined. We aimed to characterise potential body mass index (BMI) dynamic changing trajectories from childhood to puberty and investigate their association with HBP.

DESIGN

A dynamic prospective cohort.

SETTING

China Health and Nutrition Survey 1991-2015.

PARTICIPANTS

There were 1907 participants (1027 men and 880 women) in this study.

OUTCOMES

The primary outcome was HBP defined as systolic blood pressure (SBP)/diastolic blood pressure (DBP) exceeding the standards or diagnosis by medical records or taking antihypertensive medication.

RESULTS

A model of cubic parameters with three groups was chosen, labelled as normal increasing group (85.16%, n=1624), high increasing group (9.81%, n=187) and resolving group (5.03%, n=96). Compared with the normal increasing group, the unadjusted HRs (95% CIs) for the resolving and high increasing groups were 0.91 (0.45 to 1.86) and 1.88 (1.26 to 2.81), respectively. After adjusting for baseline age, region, sex, baseline BMI z-score, baseline SBP and baseline DBP in model 3, the HRs (95% CIs) for the resolving and high increasing groups were 0.66 (0.30 to 1.45) and 1.56 (1.02 to 2.38).

CONCLUSIONS

These results indicate that the BMI trajectories from childhood to puberty have significant impact on HBP risk. Puberty is a crucial period for the development of HBP.

Predictive value of women's weight trajectories in determining familial cardiovascular disorders: a family-based longitudinal study

Considering the dynamic nature of body mass index (BMI) and its importance in determining cardiovascular risks, this study aimed to investigate the life-course trajectory pattern of women’s BMI and its association with cardiovascular risk factors. A total of 1356 couples with 2976 children were recruited and followed up for an average period of 20 years. Latent growth curve modeling was applied to determine women's BMI trajectories; logistic regression was used to investigate the associations between trajectory patterns and cardiovascular risk factors, including hypertension (HTN), dyslipidemia, diabetes mellitus (DM), and obesity. Women were classified into three trajectories, including normal, stage 1 obesity, and stage 2 obesity. Compared to women’s in the normal trajectory group, those in obesity trajectories had higher odds ratios for HTN, DM, and dyslipidemia. Men with obese spouses showed a higher rate of HTN 1.54 (95% CI 1.05–2.25) and DM 1.55; (95% CI 1.00–2.44). The odds of men’s obesity were higher in obese spouses (OR 1.70; 95% CI 1.10–2.62). Offspring of stage 2 obese (OR 2.39; 95% CI 1.67–3.44) and stage 1 obese (OR 4.81; 95% CI 3.16–7.34) mothers were more likely to be obese. Our findings emphasized paying more attention to women with excessive weight to promote familial cardiovascular health in the communities.

Sex specific trajectories of central adiposity, lipid indices, and glucose level with incident hypertension: 12 years Follow-up in Tehran lipid and glucose study

Aims

To identify sex specific trajectories of waist circumference (WC),triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) during adulthood and examine their associations with incident hypertension.

Methods

The cohort consisted of 5030 participants (2051 males) with at least 2 repeated measurement during a median of 12 years follow up. We identified trajectory groups using latent class growth mixture model, their association with hypertension was examined using multivariate Cox-regression analysis.

Results

We found 997 cases of hypertension (483 male). For both exposures, three distinct trajectory groups were identified in both genders. For WC, in women: low-increasing, 82.4%; high-stable, 13.4%; high-increasing, 4.2% and in men: stable, 94.6%; low-increasing, 3.6% and for high- increasing, 1.7%. For TG, in women: stable, 91.3%; decreasing, 5.9%; inverse U-shape, 2.8%; in men: stable, 89.7%; inverse U- shape, 6.2% and for decreasing, 4.1%.

Regarding WC, high stable and high-increasing trajectories were associated with hypertension in the multivariate model [(hazard ratio (HR) = 1.66 (95% CI 1.26–2.20) and 2.78(1.79–3.60), respectively]. Among men, this association was shown only for the low-increasing trajectory [2.76: 1.49–5.10]. For TG, among women decreasing and inverse U-shape trajectories were significantly associated with hypertension in the multivariate model [1.32:1.01–1.76] and [2.23:1.58–3.23, respectively].

We did not find any impact of increasing trajectories of FPG and HDL-C on incident hypertension. Considering TC, all individuals followed a stable trajectory.

Conclusion

WC dynamic changes in both gender and TG trajectory among women were significantly associated with incident hypertension.

Associations between body mass index trajectories in childhood and cardiovascular risk factors in adulthood

BACKGROUND AND AIMS

Children with a growth trajectory of overweight have higher levels of cardiovascular disease (CVD) risk factors than children with a normal-weight trajectory. However, less is known about how trajectories of body mass index (BMI) across the rest of the BMI spectrum relate to CVD risk factors and whether adult BMI affects these associations. Our aim was to examine associations between childhood BMI trajectories and adult CVD risk factors.

METHODS

We included 2466 individuals with childhood weights and heights (ages 6-14) from the Copenhagen School Health Records Register and adult CVD risk factors (ages 20-81) from the Copenhagen City Heart Study. Associations between childhood BMI trajectories identified by latent class modelling and CVD risk factors were examined using generalized linear regression analyses with and without adjustment for adult BMI. Normal-weight and overweight were defined by growth references from the Centers for Disease Control and Prevention.

RESULTS

We identified four childhood trajectories within the normal-weight spectrum and one trajectory of overweight. Compared to the trajectory with the lowest BMI level, several higher BMI trajectories were associated with worse circumference, HDL and glucose homeostasis in adulthood. The highest trajectory was additionally associated with higher total cholesterol and triglycerides. When adjusting for adult BMI, the higher BMI trajectories had lower waist circumference, blood pressure and triglycerides.

CONCLUSIONS

Trajectories of BMI within the normal-weight range and in the overweight range are associated with a worse CVD risk profile than in the lowest BMI trajectory, and these associations are modifiable by growth after childhood.

Group‐based trajectory modeling of body mass index and body size over the life course: A scoping review

Background

Group‐based trajectory modeling has been applied to identify distinct trajectories of growth across the life course. Objectives of this study were to describe the methodological approaches for group‐based modeling of growth across the life course and to summarize outcomes across studies.

Methods

A scoping review with a systematic search of Medline, EMBASE, CINAL, and Web of Science was conducted. Studies that used a group‐based procedure to identify trajectories on any statistical software were included. Data were extracted on trajectory methodology, measures of growth, and association with outcomes.

Results

A total of 59 studies were included, and most were published from 2013 to 2020. Body mass index was the most common measure of growth (n = 43). The median number of identified trajectories was 4 (range: 2–9). PROC TRAJ in SAS was used by 33 studies, other procedures used include TRAJ in STATA, lcmm in R, and Mplus. Most studies evaluated associations between growth trajectories and chronic disease outcomes (n = 22).

Conclusions

Group‐based trajectory modeling of growth in adults is emerging in epidemiologic research, with four distinct trajectories observed somewhat consistently from all studies. Understanding life course growth trajectories may provide further insight for population health interventions.

Body mass index trajectory across childhood and subsequent risk of elevated blood pressure

We investigated the relationship between the body mass index (BMI) trajectory across childhood and the subsequent occurrence of elevated blood pressure (BP) in the Chinese pediatric population. The study cohort from the China Health and Nutrition Survey comprised 1484 children, each of whom underwent three BP and BMI assessments during childhood and had a non-elevated BP during the first childhood assessment. A group-based trajectory model was used to identify four distinct BMI trajectories across childhood: lean-stable increase, medium-marked increase, heavy marked decrease, and heavy marked increase. Elevated BP in childhood was as defined in the China's national BP reference for children. Covariate-adjusted logistic regression models were used to assess the associations of BMI trajectories with elevated BP. Overall, 27.6% of all participants between 3 and 13 years of age during the first childhood assessment developed elevated BP during a mean 6.5-year follow-up. Compared with participants in the lean-stable increase group, those in the medium-marked increase and heavy marked increase groups were more likely to have elevated BP (odds ratio [95% confidence interval], OR [95% CI]: 1.46 [1.08, 1.96] and 5.29 [2.44, 11.48], respectively; P_s < .05). The OR for the heavy marked decrease group was not statistically significant (OR [95% CI]: 1.58 [0.80, 3.13]; P = .192). In summary, distinct BMI trajectories conferred significantly different odds of elevated BP upon children, thus underscoring the importance of weight management in early life.

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

INTRODUCTION

This longitudinal study aims to characterize distinct body mass index (BMI) trajectories during early to mid-life adulthood and to explore the association between BMI change from young adulthood to midlife and incident diabetes.

RESEARCH DESIGN AND METHODS

This study included 7289 adults who had repeatedly measured BMI 3-9 times during 1989-2011 and information on incident diabetes. Latent class growth mixed model (LCGMM) was used to identify different BMI trajectories. Cox proportional hazard models were used to investigate the association between the trajectory group membership and incident hyperglycemia, adjusting for covariates. The hyperglycemia group included individuals with prediabetes or diabetes. The model-estimated BMI levels and slopes were calculated at each age point in 1-year intervals according to the model parameters and their first derivatives, respectively. Logistic regression analyses were used to examine the association of model-estimated levels and slopes of BMI at each age point with incident hyperglycemia. The area under the curve (AUC) was computed from longitudinal growth curve models during the follow-up for each individual. Prior to the logistic regression analyses, quartiles of total, baseline, and incremental AUC values were calculated.

RESULTS

Three distinct trajectories were characterized by LCGMM, comprising of low-increasing group (n=5136), medium-increasing group (n=1914), and high-increasing group (n=239). Compared with the low-increasing group, adjusted HRs and 95% CIs were 1.21 (0.99 to 1.48) and 1.56 (1.06 to 2.30) for the medium-increasing and the high-increasing group, respectively. The adjusted standardized ORs of model-estimated BMI levels increased among 20-50 years, ranging from 0.98 (0.87 to 1.10) to 1.19 (1.08 to 1.32). The standardized ORs of level-adjusted linear slopes increased gradually from 1.30 (1.16 to 1.45) to 1.42 (1.21 to 1.67) during 20-29 years, then decreased from 1.41 (1.20 to 1.66) to 1.20 (1.08 to 1.33) during 30-43 years, and finally increased to 1.20 (1.04 to 1.38) until 50 years. The fourth quartile of incremental AUC (OR=1.31, 95% CI 1.03 to 1.66) was significant compared with the first quartile, after adjustment for covariates.

CONCLUSIONS

These findings indicate that the BMI trajectories during early adulthood were significantly associated with later-life diabetes. Young adulthood is a crucial period for the development of diabetes, which has implications for early prevention.

Are genes destiny? Exploring the role of intrauterine environment in moderating genetic influences on body mass

OBJECTIVES

Genes influence every aspect of human behavior, physiology, and health. Obesity, a major global public health concern, is no exception. However, relatively little is known about whether environmental factors moderate the effects of genetic influences on body mass. By incorporating molecular genetics and the fetal origins of obesity hypothesis into a gene-environment interaction framework, this study investigates how the effect of the obesity-associated gene (FTO) interacts with the effect of intrauterine environment to influence body mass during adulthood.

METHODS

This study uses data from the Wisconsin Longitudinal Study, and uses sibling comparisons that allow for quasi-experimental variation in both genetic and environmental factors.

RESULTS

This study found positive, but noisy, within-family estimates of the FTO-body mass index (BMI) association. The association between birth weight and adult BMI was robust to controlling for unobserved family background factors. More importantly, this study revealed that the association between having a risk allele of the FTO gene and BMI (and obesity status) is largely concentrated among individuals who were heavier at birth. This provides evidence of a gene-environment interaction on BMI (and the development of obesity).

CONCLUSIONS

Genes are not destiny and environmental factors may offset the effects of obesity-promoting genes. Public health efforts to counteract genetic effects on body mass may begin as early as in utero. Efforts to prevent higher birth weight may thus help reduce the risk of obesity later in life, by directly addressing the programming effects of the in utero environment and also indirectly moderating obesity-promoting genetic effects.