| Part Ⅰ Characteristics of cardiometabolic diseases in Chinese adultsBackground:Cardiometabolic diseases have been the public health concern in China.Healthy lifestyle behaviors are effective ways to both prevent and manage cardiometabolic diseases.Evaluating the characteristics of the population of different cardiometabolic disease stages,as well as healthy lifestyle behaviors distribution,managing them by different stages,could improve early,sustainable and individualized intervention.However,national data about the proportion of different cardiometabolic disease stages and healthy lifestyle behavior distribution across cardiometabolic disease stages is limited.Method:This study was based on China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project(China PEACE MPP),which covered 170 rural counties and 116 urban districts of 31 provinces in China from 2015 to 2020.Participants aged 35-75 years who had complete data on the cardiometabolic disease diagnosis were included.Standardised devices and procedures were used to investistigate cardiovascularrelated health status,perform the physical examination and test the rapid blood glucose and rapid blood lipid for all participants.According to the prior published validated cardiometabolic disease staging model,cardiometabolic diseases were classified as:stage 3:diabetes,coronary heart disease or stoke;stage 2:impaired fasting glucose or metabolic syndrome;stage 1:meeting one or two of the metabolic syndrome components(elevated blood pressure,elevated triglycerides,low high-density lipoprotein cholesterol,and central obesity,excluding elevated fasting blood glucose);stage 0:no aforementioned cardiovascular diseases or metabolic disorders.There were 5 healthy lifestyle behaviors including healthy body shape(without general obesity and central obesity),never smoking,non-current alcohol drinking,healthy diet and sufficient physical activity.We assessed rates of cardiometabolic disease stages and distribution of healthy lifestyle behaviors across cardiometabolic disease stages.Multivariable logistic regression models were fitted to assess factors related to cardiometabolic diseases and healthy lifestyle behaviors across cardiometabolic disease stages.Results:A total of 1 037 116 participants were included.After standardizing age and sex,11.1%participants had no cardiometabolic disorders,and the proportions of participants of cardiometabolic disease stage 1,stage 2 and stage 3 were 22.8%,48.7%and 17.4%,respectively.The standerdised prevalence of metab olic syndrome and diabetes was 37.3%and 15.6%,respectively.Multivariable mixed models indicated that participants who were older,female,farmer,unemployed or retired,current smokers or former smokers and current drinkers,with higher BMI and leisure-time physical activity levels,followed unhealthy diet,had lower household incomes,and lived in rural areas or western China were more likely to be with cardiometabolic diseases.With the increase of the cardio metabolic disease stages,the rates of following 3 or more healthy lifestyle behaviors decreased(P for trend:<0.001),which were 75.8%,56.4%,49.6%and 46.5%among participants of cardiometabolic disease stage 0,stage 1,stage 2 and stage 3 respectively,and the corresponding rates of following all 5 healthy lifestyle behaviors were 1.1%,0.9%,0.8%and 0.8%.Participants who were older,female,retired,with higher education attainment or higher household incomes,and lived in urban areas or eastern or central China were more likely to follow healthy lifestyle behaviors of all cardiometabolic disease stages,while participants who were farmer were less likely to follow healthy lifestyle behaviors,and the associations were stonger at higher cardiometabolic disease stages.Conclusions:Of the 1 million participants,only 11.1%had no cardiometabolic disease disorders.Adherence to healthy lifestyle behaviors among participants of all cardiometabolic disease stages was no more than 2%.Our study recognized factors related to the prevalence of cardiometabolic diseases and healthy lifestyle behaviors across cardiometabolic disease stages.Part Ⅱ Association between weight gain from young to middle adulthood and metabolic syndromeBackground:Weight gain from young to middle adulthood has been shown to be associated with higher metabolic risk.However,the dose-response associations between weight gain from young to middle adulthood and odds of metabolic syndrome,across BMI categories at young adulthood are still unclear.Methods:This study was based on China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project(China PEACE MPP).Middle-aged(35-64 years)participants at screeing from 2015 to 2020 who recalled weight at age 25 years,kept stable weight or gained weight from age 25 years to the screening were included.Standardised devices and procedures were used to investistigate cardiovascular-related health status,perform the physical examination and test the rapid blood glucose and rapid blood lipid for all participants.BMI at age 25 years was classified into underweight(BMI<10.5 kg/m2),normal weight(18.5 kg/m2≤BMI<24 kg/m2)and overweight/obesity(BMI≥24 kg/m2).Multivariable adjusted restricted cubic splines and logistic regression models were applied to assess the dose-response association between weight gain from young to middle adulthood and prevalence of metabolic syndrome at middle adulthood across different BMI categories.Results:In total,437 849 participants were included.The median age of the participants was 52 years(IQR:46,58),and 62.1%were women.In multivariable logistic regression model adjusting for age,sex,geographical region,urbanity,socioeconomic characteristics,lifestyle behaviors and comorbidities,larger weight gain from young to middle adulthood was associated with higher odds of metabolic syndrome at middle adulthood,with odds of 1.6(95%confidence interval:1.57-1.64),3.85(3.77-3.94),and 11.05(10.73-11.38)across moderate(weight gain≥2.5 kg and<10 kg),marked(weight gain≥10 kg and<20 kg),and extreme amount of weight gain(weight gain≥20 kg)compared with stable weight(weight gain<2.5 kg),respectively.The ORs of metabolic syndrome were 2.01(1.982.05),1.93(1.92-1.94),1.67(1.64-1.7)per 5-kg weight gain across participants who were underweight,normal-weight and overweight/obese at young adulthood,respectively.After further adjusting for current body mass index(BMI),although the associations were attenuated,larger weight gains still correlated with higher odds of metabolic syndrome among underweight and normal-weight participants.An inverted U-shaped association was observed in overweight/obese participants:odds of metabolic syndrome increased with increasing weight gain until around 12 kg and then decreased(P for nonlinearity:<0.001).Conclusions:Weight maintenance from young to middle adulthood could be effective to mitigate metabolic syndrome burden,especially among underweight and normal-weight people.Historical weight gain confers information about metabolic syndrome prevalende risk independent of attained BMI.Part Ⅲ Dose-response association between long-term weight loss in overweight/obese young adults and metabolic healthBackground:Long-term weight loss has been shown to be associated with lower metabolic risk in young adults with overweight/obesity.However,the dose-response association is uncertain.Methods:This study was based on China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project(China PEACE MPP).The participants aged 3564 years at screeing from 2015 to 2020 who recalled overweight/obesity at age 25 years and experienced long-term weight loss or maintained stable weight were included.Standardised devices and procedures were used to investistigate cardiovascular-related health status,perform the physical examination and test the rapid blood glucose and rapid blood lipid for all participants.The dose-response association between long-term weight loss from age 25 to screening and the odds of metabolic syndrome at screening was assessed using multivariable adjusted regression models with restricted cubic splines.Results:A total of 40 150 participants(66.4%women)were included.In multivariable logistic regression model adjusting for BMI at age 25 years,age,sex,geographical region,urbanity,socioeconomic characteristics,and lifestyle behaviors,the increment of longterm weight loss was associated with continuously decreased odds of metabolic syndrome.The odds of metabolic syndrome were 0.64(0.60-0.67),0.42(0.40-0.45),0.27(0.250.29),and 0.15(0.13-0.17)for those with long-term weight loss of 5-9.9%,10-14.9%,15-19.9%,and over 20%compared with<5%long-term weight loss,respectively.Moreover,the incremental pattern was observed across all population subgroups defined by age,sex,BMI categories,smoking status,urbanity and education level.Conclusions:An incremental association between long-term weight loss from young adulthood and odds of later-life metabolic syndrome was observed.Our findings highlight the effective ways to achieve long-term weight loss to improve lifetime metabolic health for young adults with overweight/obesity. |
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