Joint trajectories of body mass index and waist circumference in early-life to mid-life adulthood and incident hypertension: the China Health and Nutrition Survey

OBJECTIVE: This longitudinal study aims to identify distinct trajectories of body mass index (BMI) and waist circumference (WC) during 20–60 years old, and explore their joint effect on incident hypertension. DESIGN: A longitudinal cohort study. SETTING: China Health and Nutrition Survey, 1993–2011. PARTICIPANTS: The longitudinal cohort included 6571 participants (3063 men) who had BMI and WC repeatedly measured 3–7 times before incident hypertension or loss to follow-up. OUTCOMES: Hypertension was defined as systolic blood pressure/diastolic blood pressure>140/90 mm Hg or diagnosis by medical records or taking antihypertensive medication. RESULTS: Two distinct trajectories were characterised for both BMI and WC: low-increasing and high-increasing. Jointly, subjects were divided into four groups: normal (n=4963), WC-increasing (n=620), BMI-increasing (n=309) and BMI&WC-increasing (n=679). Compared with the normal group, the adjusted HRs and 95% CIs for hypertension were 1.43 (1.19 to 1.74), 1.51 (1.19 to 1.92) and 1.76 (1.45 to 2.14) for WC-increasing, BMI-increasing and BMI&WC-increasing groups, respectively. The model-estimated levels and slopes of BMI and WC were calculated at each age point in 1-year interval according to the model parameters and their first derivatives, respectively. The associations between model-estimated levels and hypertension increased with age, with adjusted ORs and 95% CIs ranging from 0.92 (0.86 to 0.98) to 1.57 (1.47 to 1.67) for BMI and 0.98 (0.92 to 1.05) to 1.44 (1.35 to 1.53) for WC. Conversely, the ORs (95% CIs) of level-adjusted linear slopes decreased with age, ranging from 1.47 (1.38 to 1.57) to 0.97 (0.92 to 1.03) for BMI and 1.36 (1.28 to 1.45) to 0.99 (0.93 to 1.06) for WC. CONCLUSIONS: Our study demonstrates that the joint trajectories of BMI and WC have significant effect on future hypertension risk, and the changing slopes of BMI and WC during young adulthood are independent risk factors. Both BMI and WC should be paid more attention to prevent hypertension, and young adulthood may be a crucial period for intervention.