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Published on: November 24, 2020
Chinese Population-Wide Lipid Trajectories From Age 20 to 85: Sex- and Adiposity-Specific Patterns
Yanyan Zhang1, Yijin Pei1, Yanzhi Yan1
1Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China.
Background:
Existing studies focused on the association of lipid trajectory classifications with cardiovascular outcomes, whereas the natural life-course pattern and sex-specific modulation by obesity are poorly characterized.
Objectives:
This study sought to characterize the sex-specific lipid trajectories and examine the role of obesity indicators in shaping them.
Methods:
In a longitudinal cohort of 83,487 Chinese adults (median follow-up: 11.00 years; Q1-Q3:6.80-11.72) with 2-4 repeated lipid measurements, we applied generalized additive mixed model to characterize age-related lipid trajectories and assess modifications by obesity indicators (body mass index and waist circumference).
Results:
Total cholesterol (TC), low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol (non-HDL-C) exhibited 3-phase trajectory (increase, plateau, slight decrease), whereas triglyceride and remnant cholesterol showed 2-phase (increase, decrease). Female subjects showed delayed trajectory transitions (13-17 years) and more adverse late-adulthood lipid profiles than male subjects did. Obesity indicators were positively associated with elevated lipid levels (all P < 0.001), with stronger association in male subjects than in female subjects (eg, per 1-SD body mass index increase, β-coefficient for TC: 3.43 [95% CI: 3.15-3.71] vs 2.71 [95% CI: 2.48-2.94] mg/dL, respectively; Pinteraction < 0.001). Notably, the lipid-lowering associations of adiposity reduction attenuated with age in male subjects, whereas in female subjects they remained stable for triglyceride and remnant cholesterol (eg, the mean differences between obese and non-obese groups defined by waist circumference 28.96 [95% CI: 23.13-32.14] and 3.19 [95% CI: 2.72-3.66] mg/dL) or showed "L-shape" pattern with inflection around age 40 for TC, low-density lipoprotein cholesterol, and non-HDL-C.
Conclusions:
Our findings highlight sex-specific impact of obesity on lifelong lipid trajectories, suggesting sex- and age-specific strategies for early lipid management and obesity intervention.
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