Abstract
BACKGROUND: The sensitive period during which the adult cardiovascular system is particularly vulnerable to body mass index (BMI) changes remains unclear. This study aimed to examine how rates of BMI change from childhood to adulthood influence the risk of subclinical cardiovascular outcomes in mid-adulthood. METHODS: This cohort study included 2446 participants from the Hanzhong Adolescent Hypertension Study who had at least two BMI measurements in childhood/adolescence (6-18 years) and at least two in adulthood (≥ 19 years). The BMI growth curve from ages 6 to 52 years was modeled using random-effects mixed models with restricted cubic splines. These models yielded age-specific estimates of BMI levels and rates of change, the latter of which were subsequently residual-adjusted for concurrent BMI levels. Multivariable logistic regression models were used to examine the associations of BMI levels and level-adjusted rates of change from 6 to 52 years with left ventricular hypertrophy (LVH) and arterial stiffness in mid-adulthood. RESULTS: BMI at each age from 10 to 52 years was associated with mid-adult LVH and arterial stiffness, and these associations became stronger with increasing age at BMI measurement. Additionally, age-level-adjusted rates of BMI change at most ages from childhood to adulthood were positively associated with a higher risk of both subclinical cardiovascular outcomes. However, the odds ratios (ORs) for both LVH and arterial stiffness per 1-SD increase in BMI change rate declined with increasing age. For LVH, the ORs decreased from 2.49 (95% confidence interval (CI): 2.01-3.08) at 6 years to 1.23 (1.01-1.50) at 34 years. Similarly, for arterial stiffness, the ORs decreased from 1.60 (95% CI: 1.41-1.81) at 6 years to 1.13 (1.01-1.27) at 42 years. Of note, from childhood to adolescence, age-level-adjusted rates of BMI change showed stronger associations with LVH and arterial stiffness than contemporaneously measured BMI levels. CONCLUSIONS: Rapid rates of BMI increase, particularly during childhood/adolescence, are strongly associated with a higher risk of mid-adulthood subclinical cardiovascular outcomes. These findings highlight childhood/adolescence as sensitive periods for the influence of BMI on cardiovascular disease development, emphasizing the need for early prevention and intervention.