Sex Differences in the Non-linear Association Between BMI and LDL Cholesterol in Middle-aged and Older Adults: Findings from Two Nationally Representative Surveys in China

Overview

Journal Lipids Health Dis

Publisher Biomed Central

Specialties Biochemistry
Endocrinology

Date 2021 Nov 14

PMID 34774059

Citations 6

Authors

Haibin Li

Jiahui Ma

Deqiang Zheng

Xia Li

Xiuhua Guo

Jing Wang

Pixiong Su

Affiliations

Soon will be listed here.

Abstract

Background: The relationship between body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C) has not been clearly elucidated in middle-aged and older adults. This study aimed to evaluate the non-linear dose-response relationship between BMI and LDL-C in males and females.

Methods: Data was obtained from two nationally representative surveys in China-the China Health and Nutrition Survey (CHNS, 2009) and China Health and Retirement Longitudinal Study (CHARLS, 2011-2012). To evaluate the sex differences in the association between BMI and LDL-C, the generalized additive models with a smooth function for continuous BMI and smooth-factor interaction for sexes with BMI were used. Segmented regressions were fitted to calculate the slopes with different estimated breakpoints among females and males.

Results: A total of 12,273 participants (47.1% male) aged 45 to 75 years were included. The generalized additive models revealed that a non-linear relationship between BMI and LDL-C level in both sexes after adjustment for age, residence, education levels, marital status, drinking, smoking status, and cohort (CHNS or CHARLS). Slopes of the association between BMI and LDL-C association changed at BMI 20.3 kg/m (95% CI: 18.8 to 21.8) in females and 27.1 kg/m (95% CI: 25. 8 to 28.4) in males. Below these BMI breakpoints, LDL-C levels increased 1.84 (95% CI: 1.45 to 2.31) in males and 3.49 (95% CI: 1.54 to 5.45) mg/dL per kg/m in females. However, LDL-C levels declined - 1.50 (95% CI: - 2.92 to - 0.09) mg/dL per kg/m above BMI of 27.1 kg/m in males. The non-linear association BMI and LDL-C in males and females was varied by cohort source, age groups, and the number of metabolic syndrome criteria.

Conclusions: In the Chinese middle aged and older adults, the BMI and LDL-C relationship was inverted U-shaped with a high level of LDL-C at a BMI of 27.1 kg/m in males, and an approximately linear association was observed in females.

Citing Articles

Sources of variation in the serum metabolome of female participants of the HUNT2 study.

Debik J, Mrowiec K, Kurczyk A, Widlak P, Jelonek K, Bathen T Commun Biol. 2024; 7(1):1450.

PMID: 39506131 PMC: 11541904. DOI: 10.1038/s42003-024-07137-x.

The association between telomere length and blood lipids: a bidirectional two-sample Mendelian randomization study.

Yang S, Wang X, Li Y, Zhou L, Guo G, Wu M Front Endocrinol (Lausanne). 2024; 15:1338698.

PMID: 38863926 PMC: 11165217. DOI: 10.3389/fendo.2024.1338698.

Sex differences in the non-linear association between BMI and LDL cholesterol in type 2 diabetes.

Li K, Cao B, Wang X, Chai T, Ke J, Zhao D Front Endocrinol (Lausanne). 2023; 14:1180012.

PMID: 37484947 PMC: 10360932. DOI: 10.3389/fendo.2023.1180012.

Young Japanese Underweight Women with "Cinderella Weight" Are Prone to Malnutrition, including Vitamin Deficiencies.

Iizuka K, Sato H, Kobae K, Yanagi K, Yamada Y, Ushiroda C Nutrients. 2023; 15(9).

PMID: 37409654 PMC: 10181057. DOI: 10.3390/nu15092216.

Loss of Anthropometry-Lipids Relationship in Obese Adults: A Cross-Sectional Study in Southern China.

Huang W, Feng R, Xu X, Ma M, Chen J, Wang J Clin Epidemiol. 2023; 15:191-201.

PMID: 36825208 PMC: 9942499. DOI: 10.2147/CLEP.S400150.

References

Sarwar N, Sandhu M, Ricketts S, Butterworth A, Di Angelantonio E, Boekholdt S . Triglyceride-mediated pathways and coronary disease: collaborative analysis of 101 studies. Lancet. 2010; 375(9726):1634-9. PMC: 2867029. DOI: 10.1016/S0140-6736(10)60545-4. View

Terry R, Wood P, Haskell W, Stefanick M, Krauss R . Regional adiposity patterns in relation to lipids, lipoprotein cholesterol, and lipoprotein subfraction mass in men. J Clin Endocrinol Metab. 1989; 68(1):191-9. DOI: 10.1210/jcem-68-1-191. View

Grundy S, Barnett J . Metabolic and health complications of obesity. Dis Mon. 1990; 36(12):641-731. View

DeStefano F, Berg R, Griese Jr G . Determinants of serum lipid and lipoprotein concentrations in children. Epidemiology. 1995; 6(4):446-9. DOI: 10.1097/00001648-199507000-00024. View

Hu D, Hannah J, Gray R, Jablonski K, Henderson J, Robbins D . Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study. Obes Res. 2000; 8(6):411-21. DOI: 10.1038/oby.2000.51. View

Kelly T, Yang W, Chen C, Reynolds K, He J . Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008; 32(9):1431-7. DOI: 10.1038/ijo.2008.102. View

Abdullah S, DeFina L, Leonard D, Barlow C, Radford N, Willis B . Long-Term Association of Low-Density Lipoprotein Cholesterol With Cardiovascular Mortality in Individuals at Low 10-Year Risk of Atherosclerotic Cardiovascular Disease. Circulation. 2018; 138(21):2315-2325. DOI: 10.1161/CIRCULATIONAHA.118.034273. View

Maki K, Kritsch K, Foley S, Soneru I, Davidson M . Age-dependence of the relationship between adiposity and serum low density lipoprotein cholesterol in men. J Am Coll Nutr. 1998; 16(6):578-83. View

Perry A, Applegate E, Allison M, Miller P, Signorile J . Relation between anthropometric measures of fat distribution and cardiovascular risk factors in overweight pre- and postmenopausal women. Am J Clin Nutr. 1997; 66(4):829-36. DOI: 10.1093/ajcn/66.4.829. View

10.

Beckles G, Miller G, Alexis S, Price S, Kirkwood B, Carson D . Obesity in women in an urban Trinidadian community. Prevalence and associated characteristics. Int J Obes. 1985; 9(2):127-35. View

11.

Kivimaki M, Kuosma E, Ferrie J, Luukkonen R, Nyberg S, Alfredsson L . Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health. 2017; 2(6):e277-e285. PMC: 5463032. DOI: 10.1016/S2468-2667(17)30074-9. View

12.

Le Lay S, Ferre P, Dugail I . Adipocyte cholesterol balance in obesity. Biochem Soc Trans. 2004; 32(Pt 1):103-6. DOI: 10.1042/bst0320103. View

13.

Liao Y, Chu C, Wang Y, Zheng W, Ma Q, Hu J . Sex differences in impact of long-term burden and trends of body mass index and blood pressure from childhood to adulthood on arterial stiffness in adults: A 30-year cohort study. Atherosclerosis. 2020; 313:118-125. DOI: 10.1016/j.atherosclerosis.2020.10.003. View

14.

Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J . Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373(9669):1083-96. PMC: 2662372. DOI: 10.1016/S0140-6736(09)60318-4. View

15.

Wang Z, Dong B, Hu J, Adegbija O, Arnold L . Exploring the non-linear association between BMI and mortality in adults with and without diabetes: the US National Health Interview Survey. Diabet Med. 2016; 33(12):1691-1699. DOI: 10.1111/dme.13111. View

16.

Gordon T, Kannel W, Hjortland M, MCNAMARA P . Menopause and coronary heart disease. The Framingham Study. Ann Intern Med. 1978; 89(2):157-61. DOI: 10.7326/0003-4819-89-2-157. View

17.

Jeenduang N . Circulating PCSK9 concentrations are increased in postmenopausal women with the metabolic syndrome. Clin Chim Acta. 2019; 494:151-156. DOI: 10.1016/j.cca.2019.04.067. View

18.

Denke M, Sempos C, Grundy S . Excess body weight. An under-recognized contributor to dyslipidemia in white American women. Arch Intern Med. 1994; 154(4):401-10. DOI: 10.1001/archinte.154.4.401. View

19.

Laclaustra M, Corella D, Ordovas J . Metabolic syndrome pathophysiology: the role of adipose tissue. Nutr Metab Cardiovasc Dis. 2007; 17(2):125-39. DOI: 10.1016/j.numecd.2006.10.005. View

20.

Holmes M, Asselbergs F, Palmer T, Drenos F, Lanktree M, Nelson C . Mendelian randomization of blood lipids for coronary heart disease. Eur Heart J. 2014; 36(9):539-50. PMC: 4344957. DOI: 10.1093/eurheartj/eht571. View