Long-term body mass trajectories and hypertension by sex among Chinese adults: a 24-year open cohort study

Abstract

Evidence was limited on trajectory of body mass index (BMI) through adulthood and its association with hypertension. We aimed to evaluate their association by sex in large-scale study. Data were obtained from the China Health and Nutrition Survey (CHNS) from 1991 to 2015. Latent class trajectory analysis (LCTA) was used to capture BMI change trajectories. Hazard risks (HRs) were estimated from Cox proportion hazard regression. Among 14,262 participants (mean age, 38.8; 47.8% men), 5138 hypertension occurred (2687 men and 2451 women) occurred during a mean follow-up 9.6 years. Four body mass trajectory groups were identified as BMI loss, stable, moderate and substantial gain. Appropriately half of participants (48.0%) followed 1 of the 2 BMI gain trajectories, where BMI increased at least 3 kg/m2 overtime. Compared with participants with stable BMI, those gaining BMI substantially had higher risk of hypertension by 65% (HR 1.65, 95% CI 1.45–1.86) in male and 83% (HR 1.83, 95% CI 1.58–2.12) in female. The HRs in BMI loss patterns were 0.74 (0.62–0.89) in men and 0.87 (0.75–1.00) in women. Our findings imply that majority of Chinese adults transited up to a higher BMI level during follow-up. Avoiding excessive weight gain and maintaining stable weight might be important for hypertension prevention.