Original Article

Life-course and Cohort Trajectories of Chronic Non-communicable Diseases Risk Factors in China

Abstract

Background: NCDs are the leading disease burdens in China and the NCDs risk factors shifts have accelerated at an unprecedented scale over the past 30 years. The aim of this study was to analysis the natural trajectories of NCDs risk factors over the life course.

Methods: The large-scale longitudinal data from the CHNS includes nine rounds of surveys between 1989 and 2011. Overall, 145913 observations (29719 individuals) at multiple exams have been followed up over a 23-year period. The mixed-effects models with random intercepts were used to the characterize shifts in the distribution of these risk factors across the whole life course.

Results: During about 23 years observational period across all age bands, the mean AMC, UAC, TSF, BMI, WC, DBP, SD, DD, and PA trajectory all increased until a certain age. Then decreased in both gender, whereas SBP strictly increased across lifespan; and the secular trend in AMC and WC, SBP, DBP was greater in women than in men; younger generations had higher AMC, UAC, TSF, BMI, WC, WHR, WHtR, SBP, DBP levels across adulthood, whereas younger birth cohorts had lower SD, DD, and PA levels.

Conclusion: We observed in a large and comprehensive longitudinal dataset that provided strong evidence of population-wide secular shifts from childhood onwards, which suggests that promoting healthier lifestyles, body weight, blood pressure and enhancing the primary practitioner’s capability should be required to reduce the burden of NCDs in China.

 

Yang G., Wang Y, Zeng Y et al (2013). Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet, 381:1987–2015.

Yang G, Kong L, Zhao W et al (2008). Emergence of chronic non-communicable diseases in China. Lancet, 372:1697–1705.

Khaw KT, Wareham N, Bingham S et al (2008). Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med, 5: e12.

Knoops KT, de Groot LC, Kromhout D et al (2004). Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA, 292: 1433–1439.

Fang EF, Scheibye-Knudsen M, Jahn HJ et al (2015). A research agenda for aging in China in the 21st century. Ageing Res Rev, 24(Pt B):197-205.

Niu J, Seo DC (2014). Central obesity and hypertension in Chinese adults: A 12-year longitudinal examination. Prev Med, 62:113–118.

Samantha M Attarda, Amy H Herringb,c, Bing Zhangd et al. (2015). Associations between age, cohort, and urbanization with SBP and DBP in China: a population-based study across 18 yr. J Hypertens, 33(5):948-56.

Ahn S, Zhao H, Tai-Seale M, Huber C Jr, Smith ML, Ory MG, Phillips CD (2012). The longitudinal effects of behavioral, health, and socio-demographic factors on body mass index among older Chinese adults. Int J Public Health,57(2):269–277.

Jaacks LM, Gordon-Larsen P, Mayer-Davis EJ, Adair LS, Popkin B (2013). Age, Period and Cohort Effects on Adult Body Mass Index and Overweight from 1991 to 2009 in China: the China Health and Nutrition Survey. Int J Epidemiol, 42(3):828-37.

Kenkel D, Lillard DR, Liu F (2009). An analysis of life-course smoking behavior in China. Health Econ, 18: S147–S156.

China Health and Nutrition Survey (2013). China Health and Nutrition Survey. University of North Carolina at Chapel Hill, the USA. http://www.cpc.unc.edu/projects/china.

Popkin BM, Du S, Zhai F, Zhang B (2010). Cohort Profile: The China Health and Nutrition Survey–monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol,39(6):1435–1440.

Durmin JVGA, Rahaman MM (1967). The assessment of the amount of fat in the human body from measurement of skinfold thickness. Br J Nutr, 21:681-9.

Morris JN, Fries BE, Meher DR et al (1994). MDS cognitive performance scale. J Gerontol, 49:M174–82.

Tuan NT, Adair LS, Stevens J, Popkin BM (2010). Prediction of hypertension by different anthropometric indices in adults: the change in estimate approach. Public Health Nutr,13(5):639–646.

Ren Q, Su C, Wang H et al (2016). Prospective Study of Optimal Obesity Index Cut-Off Values for Predicting Incidence of Hypertension in 18-65-Year-Old Chinese Adults. PLoS One, 11(3):e0148140.

Ng SW, Popkin BM (2012). Time use and physical activity: a shift away from movement across the globe. Obes Rev,13: 659–680.

Jeannette Brodbeck, Monica S. Bachmann, Tim J et al (2013). Comparing Growth Trajectories of Risk Behaviors From Late Adolescence Through Young Adulthood: An Accelerated Design. Dev Psychol, 49(9):1732–1738.

Wiium N, Breivik K2, Wold B (2015). Growth Trajectories of Health Behaviors from Adolescence through Young Adulthood. Int J Environ Res Public Health, 12(11):13711-13729.

Tsai YW, Tsai TI, Yang CL, Kuo KN (2008). Gender Differences in Smoking Behaviors in an Asian Population. J Womens Health (Larchmt),17(6):971-8.

Dongfeng Gu, Tanika N. Kelly, Xigui Wu et al (2009). Mortality Attributable to Smoking in China. N Engl J Med,360:150-9.

Berg N, Kiviruusu O, Karvonen S, Kestilä L, Lintonen T, Rahkonen O, Huurre T (2013). A 26-Year Follow-Up Study of Heavy Drinking Trajectories from Adolescence to Mid-Adulthood and Adult Disadvantage. Alcohol Alcohol, 48(4):452-457.

Yang L, Zhou M, Sherliker P et al (2012). Alcohol drinking and overall and cause-specific mortality in China: nationally representative prospective study of 220 000 men with 15 yr of follow-up. Int J Epidemiol,41(4):1101-13.

Patrik Midlöv, Matti Leijon, Jan Sundquist et al.(2014). The longitudinal exercise trend among older Swedes aged 53–84 yr – a 16-year follow-up study. BMC Public Health, 14:1327.

Pan LY, Hsu HC, Chang WC, Luh DL (2015). Trajectories of Physical Activity and Risk Factors Among Taiwanese Older Adults. Int J Behav Med, 22(1):62–69.

WHO Guidelines Approved by the Guidelines Review Committee (2010). Global recommendations on physical activity for health. Geneva: World Health Organization; pp.:10-58.

Katzmarzyk PT (2002). The Canadian obesity epidemic: an historical perspective. Obes Res, 10(7):666–74.

Adam Hulman, Adam G Taba, Tibor A Nyari et al (2014). Effect of secular trends on age-related trajectories of cardiovascular risk factors: the Whitehall II longitudinal study 1985–2009. Int J Epidemiol, 43(3):866-77.

Popkin BM (2010). Recent dynamics suggest selected countries catching up to US obesity. Am J Clin Nutr, 91(1):284S–288S.

Stern D, Smith LP, Zhang B, Gordon-Larsen P, Popkin BM (2014). Changes in waist circumference relative to body mass index in Chinese adults, 1993–2009. Int J Obes (Lond), 38(12): 1503–1510.

Liu Y, Tong G, Tong W, Lu L, Qin X (2011). Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese subjects? BMC Public Health, 11:35.

Landi F, Russo A, Liperoti R et al (2010). Midarm muscle circumference, physical performance and mortality: Results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study). Clin Nutr, 29(4):441-7.

Manuela A, Maria M, Luís G et al (2013). Anthropometric Changes in the Brazilian Cohort of Older Adults: SABE Survey (Health, Well-Being, and Aging). J Obes, 2013:695496.

Ho SY, Lam TH, Janus ED (2003). Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol, 13(10):683-691.

Ulmer H, Kelleher CC, Fitz-Simon N et al (2007). Secular trends in cardiovascular risk factors: an age-period cohort analysis of 6 98 954 health examinations in 1 81 350 Austrian men and women. J Intern Med, 261: 566–576.

Assmann G, Cullen P, Evers T, Petzinna D, Schulte H (2005). Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM. Eur Heart J, 26:2120–26.

Nikolaos Lionakis, Dimitrios Mendrinos, Elias Sanidas et al (2012). Hypertension in the Elderly. World J Cardiol, 4(5): 135–147.

Franklin SS, LarsonMG, Khan SA et al (2001). Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation,103(9):1245–49.

Xing Lin Feng, Mingfan Pang, John Beard (2014). Health system strengthening and hypertension awareness, treatment and control: data from the China Health and Retirement Longitudinal Study (J). Bull World Health Organ,92:29–41.

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IssueVol 46 No 5 (2017) QRcode
SectionOriginal Article(s)
Keywords
Chronic non-communicable diseases Risk factors China Life course

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How to Cite
1.
YANG F, QIAN D, HU D. Life-course and Cohort Trajectories of Chronic Non-communicable Diseases Risk Factors in China. Iran J Public Health. 2017;46(5):591-601.