The Impact of Lifestyle Changes on Cardiometabolic Health in Modernizing China: A Tale of Three Gorges in the Yangtze River

Abstract

Background: Modernization of Chinese adults is associated with increased atherosclerotic diseases. Over 1 million farmers have been resettled upland since 1996 in the Three Gorges dam project of the Yangtze River, with job and other lifestyle changes. We aimed to evaluate the impact of such rapid lifestyle changes on indices of cardiometabolic health. Methods: Ninety-five ex-farmers in Wu Shan (WS) (aged 49.7 ± 9 years) resettled uphill for 3-5 years and 87 age and gender-matched farmers in Da Chang (DC) (aged 48.8 ± 10 years) studied before resettlement were compared. Carotid intima-media thickness (IMT) was measured by ultrasound. Results: Ninety-nine percent WS residents adopted nonfarming jobs or were retired. WS ex-farmers had higher waist-hip ratio (P < 0.0001), low density lipoprotein-cholesterol (P = 0.001), triglycerides (P = 0.001), and prevalence of metabolic syndrome (MS) (43.2% vs. 17.2%, P = 0.01) compared with DC farmers. Smoking status, body mass index, systolic and diastolic blood pressures, high density lipoprotein-cholesterol, and fasting glucose were similar. Carotid IMT was significantly higher in WS residents (0.71 ± 0.16 mm) than in DC farmers (0.64 ± 0.11 mm) (P < 0.001). MS correlated with job changes to more sedentary nature (β = 0.453, P < 0.0001), but not to leisure exercise activities, nor any specific dietary habits. On multivariate regression, carotid IMT was associated with WS location (β = 0.196, P = 0.021) and presence of MS (β = 0.208, P = 0.021), independent of other traditional vascular risk factors (model R2 value = 0.444, F-value 12.0, P < 0.0001). Conclusion: Rapid lifestyle and job changes in ex-farmers in the Three Gorges region are associated with significantly worse cardiometabolic profiles and subclinical atherosclerosis, with potentially important implications for atherosclerosis prevention in modernizing China.