Long-term BMI burden, its variability from childhood to adulthood and cardiovascular-kidney-metabolic syndrome in midlife: a 36-year cohort study
G Hu, Z Man, T Guo, Y Mei, C Chu, Y Yan, D Wang, C Chen, J Zhang, M Chang, M Du, S Zuo, J MuAbstract
Background
Limited data exist on the longitudinal associations of body mass index (BMI) burden and variability from childhood to adulthood with the development and severity of Cardiovascular-Kidney-Metabolic (CKM) syndrome in midlife.
Purpose
This study assessed the relationship between long-term BMI burden, visit-to-visit BMI variability, and midlife CKM stages and its components.
Methods
Utilizing data from the Hanzhong Adolescent Hypertension Study (initiated 1987; follow-up 2023), we classified 1948 participants into CKM stages 0-4. For analysis, stages were grouped as: Early Stage (0 & 1), Intermediate Stage 2, and Advanced Stage (3 & 4). Mean BMI and cumulative BMI burden (calculated as the area under the BMI-time curve [AUC-BMI] using trapezoidal integration) were derived from BMI measurements collected in 1987, 1989, 1992, 1995, 2005, 2013, 2017, and 2023. BMI variability was quantified using standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of the mean (VIM). Associations with CKM outcomes were evaluated using multivariable logistic regression.
Results
For Intermediate Stage CKM, adjusted odds ratios (95% CI) per 1-SD increase were: mean BMI: 1.24 (1.16-1.33); cumulative BMI burden: 1.68 (1.45-1.95); BMI SD: 1.55 (1.39-1.74); BMI CV: 1.08 (1.06-1.11); BMI ARV: 1.80 (1.48-2.22); BMI VIM: 1.40 (1.26-1.55). For Advanced Stage CKM, corresponding ORs were: mean BMI: 1.42 (1.31-1.55); cumulative BMI burden: 2.18 (1.82-2.63); BMI SD: 1.57 (1.38-1.78); BMI CV: 1.07 (1.05-1.10); BMI ARV: 1.90 (1.52-2.40); BMI VIM: 1.33 (1.18-1.51). Associations for all variability indices (SD, CV, ARV, VIM) with CKM stages remained significant after adjustment for mean BMI and cumulative burden. Higher cumulative burden and variability were also associated with increased risks of left ventricular diastolic dysfunction (LVDD), subclinical renal damage, (SRD) albuminuria, and metabolic abnormalities.
Conclusion
Elevated long-term cumulative BMI burden and greater visit-to-visit BMI variability from childhood to midlife are associated with increased severity of CKM syndrome and its key components by midlife.