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Associations of Changes in Weight and Waist Circumference with Cardiovascular Disease and Mortality in Chinese Adults

24 Pages Posted: 27 Apr 2019

See all articles by Yu Yuan

Yu Yuan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Jun Lv

Peking University - Department of Epidemiology and Biostatistics

Kang Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Canqing Yu

Peking University - Department of Epidemiology and Biostatistics

Gaokun Qiu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Kuai Yu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Yang Xiao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Lue Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Hao Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Xuezhen Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Yanqiu Yu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Jiachen Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Handong Yang

Hubei University of Medicine

Xiulou Li

Hubei University of Medicine

Xinwen Min

Hubei University of Medicine

Ce Zhang

Hubei University of Medicine

Xiaomin Zhang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Meian He

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health; Ministry of Education & Ministry of Environmental Protection, Key Laboratory of Environmental and Health; Huazhong University of Science and Technology (Formerly Tongi Medical University) - State Key Laboratory of Environmental Health (Incubating)

Yan Zheng

Fudan University - School of Life Sciences

Yu Guo

Chinese Academy of Medical Sciences

Zheng Bian

Chinese Academy of Medical Sciences

Huaidong Du

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Ling Yang

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Yiping Chen

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Tao Zhou

Tulane University - Department of Epidemiology

Dianjianyi Sun

Tulane University - Department of Epidemiology

Lu Qi

Tulane University - Department of Epidemiology; Harvard University - Department of Nutrition

Elena C. Hemler

Harvard University - Department of Nutrition

Liming Liang

Harvard University - Department of Nutrition

Zhengming Chen

University of Oxford - Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)

An Pan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

Frank B. Hu

Harvard University - Department of Nutrition

Liming Li

Peking University - Department of Epidemiology and Biostatistics

Tangchun Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

More...

Abstract

Background: The associations of age-related changes in body weight and waist circumferences with cardiovascular disease (CVD) and mortality remain unclear.  

Methods: We assessed changes in weight and waist circumference from baseline survey and resurvey among 27 964 participants in the China Kadoorie Biobank (CKB, 2004-2008) and Dongfeng-Tongji Cohort (DF-TJ, 2008-2013). We used Cox proportional hazards models to evaluate the associations between adiposity changes and the subsequent risks of incident CVD, CVD mortality and all-cause mortality.  

Findings: On average, during a median of 3·4 years from baseline to resurvey, participants experienced a weight loss of 0·6 kg, accompanied by a 2·1 cm increase in waist circumference. We identified 3589 incident CVD cases, 485 CVD deaths, and 1283 all-cause deaths during the follow-up in the CKB (2008-2016) and DF-TJ (2013-2016). Weight loss and waist gain were associated with increased risks of those outcomes in the two cohorts. In particular, compared with participants who had stable waist (waist change -2·0 to 7·0 cm) and weight (weight change -2·5 to 2·5 kg), those who gained waist but lost weight (waist circumference change >7·0 cm, weight change ≤ -2·5 kg) had the highest risk of incident CVD, CVD mortality and all-cause mortality, with the pooled multivariate hazard ratios (HRs) of 1·41 (95% CI, 1·13 to 1·75), 2·48 (1·40 to 4·37), and 1·71 (1·16 to 2·51), respectively. Among the weight-stable participants, waist circumference was linearly associated with CVD risk, with 17% higher risk (HR 1·17, 1·04 to 1·32) for those gained waist while 13% lower risk (HR 0·87, 0·77 to 0·99) for those lost waist compared to waist-stable participants.

Interpretation: Increased waist circumference with concurrent weight loss is significantly associated with increased risks of CVD morbidity, CVD mortality, and all-cause mortality among Chinese middle-aged and elderly adults.    

Funding Statement: This work was partly supported by grants from the Foundation of National Key Programs of Research and Development of China (2016YFC0900800, 2016YFC0900500, 2017YFC0907501 and 2017YFC0907504), the National Natural Science Foundation of China (91643202 and 81390540), the 111 Project and the Program for Changjiang Scholars and Innovative Research Team in University. The China Kadoorie Biobank baseline survey and the first resurvey were supported by the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up has been supported by the UK Wellcome Trust (grants 088158/Z/09/Z, 104085/Z/14/Z), and the Chinese Ministry of Science and Technology (2011BAI09B01). The British Heart Foundation, UK Medical Research Council, and Cancer Research provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The CKB study was approved by the ethics committees or institutional review boards at the University of Oxford, the Chinese Center for Disease Control and Prevention (China CDC), the Chinese Academy of Medical Sciences. The DF-TJ cohort was approved by the ethics committees of Tongji Medical College and the Sinopharm Dongfeng General Hospital. All participants provided written informed consents.

Suggested Citation

Yuan, Yu and Lv, Jun and Liu, Kang and Yu, Canqing and Qiu, Gaokun and Yu, Kuai and Xiao, Yang and Zhou, Lue and Wang, Hao and Liu, Xuezhen and Yu, Yanqiu and Wu, Jiachen and Yang, Handong and Li, Xiulou and Min, Xinwen and Zhang, Ce and Zhang, Xiaomin and He, Meian and Zheng, Yan and Guo, Yu and Bian, Zheng and Du, Huaidong and Yang, Ling and Chen, Yiping and Zhou, Tao and Sun, Dianjianyi and Qi, Lu and Hemler, Elena C. and Liang, Liming and Chen, Zhengming and Pan, An and Hu, Frank B. and Li, Liming and Wu, Tangchun, Associations of Changes in Weight and Waist Circumference with Cardiovascular Disease and Mortality in Chinese Adults (April 24, 2019). Available at SSRN: https://ssrn.com/abstract=3377533

Yu Yuan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Jun Lv

Peking University - Department of Epidemiology and Biostatistics

No. 38 Xueyuan Road
Haidian District
Beijing, Beijing 100871
China

Kang Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Canqing Yu

Peking University - Department of Epidemiology and Biostatistics ( email )

No. 38 Xueyuan Road
Haidian District
Beijing, Beijing 100871
China

Gaokun Qiu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Kuai Yu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Yang Xiao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Lue Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Hao Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Xuezhen Liu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Yanqiu Yu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Jiachen Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Handong Yang

Hubei University of Medicine

Shiyan, Hubei
China

Xiulou Li

Hubei University of Medicine

Shiyan, Hubei
China

Xinwen Min

Hubei University of Medicine

Shiyan, Hubei
China

Ce Zhang

Hubei University of Medicine

Shiyan, Hubei
China

Xiaomin Zhang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Meian He

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health ( email )

13 Hangkong Rd
Wuhan, 430030
China

Ministry of Education & Ministry of Environmental Protection, Key Laboratory of Environmental and Health ( email )

Wuhan
China

Huazhong University of Science and Technology (Formerly Tongi Medical University) - State Key Laboratory of Environmental Health (Incubating) ( email )

Wuhan, 430030
China

Yan Zheng

Fudan University - School of Life Sciences

China

Yu Guo

Chinese Academy of Medical Sciences

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Zheng Bian

Chinese Academy of Medical Sciences

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Huaidong Du

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Oxford
United Kingdom

Ling Yang

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Oxford
United Kingdom

Yiping Chen

University of Oxford - Medical Research Council Population Health Research Unit (MRC PHRU)

Tao Zhou

Tulane University - Department of Epidemiology

New Orleans, LA 70112
United States

Dianjianyi Sun

Tulane University - Department of Epidemiology

New Orleans, LA 70112
United States

Lu Qi

Tulane University - Department of Epidemiology

New Orleans, LA 70112
United States

Harvard University - Department of Nutrition

Boston, MA 02115
United States

Elena C. Hemler

Harvard University - Department of Nutrition

Boston, MA 02115
United States

Liming Liang

Harvard University - Department of Nutrition

Boston, MA 02115
United States

Zhengming Chen

University of Oxford - Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)

Richard Doll Building
Old Road Campus
Oxford, OX3 7LF
United Kingdom

An Pan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health

1037 Luoyu Rd
Wuhan
China

Frank B. Hu

Harvard University - Department of Nutrition

Boston, MA 02115
United States

Liming Li

Peking University - Department of Epidemiology and Biostatistics

No. 38 Xueyuan Road
Haidian District
Beijing, Beijing 100871
China

Tangchun Wu (Contact Author)

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Occupational and Environmental Health ( email )

1037 Luoyu Rd
Wuhan
China

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