Cardiometabolic Risk in Urbanizing China

Heterogeneity in Cardiometabolic Risk with Obesity: Who Is at Risk? (R21-DK089306). National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Principal Investigator: Penny Gordon-Larsen. 7/15/10 – 4/30/13.

Emergence of Cardiometabolic Risk across the Lifecycle in China (R01-HL108427). National Institutes of Health, National Heart, Lung, and Blood Institute. Principal Investigator: Penny Gordon-Larsen. 3/1/12-2/28/16.

The objective of this research project is to investigate the constellation of cardiometabolic risk factors in the context of rapid environmental change seen in China. In this work, we address the recent increases in cardiometabolic risk in the world’s largest population and the resulting millions of affected individuals at enormous societal and economic cost. Findings extend past China to inform efforts to reduce weight gain and cardiometabolic risk across the globe. We take advantage of extraordinary data from The China Health and Nutrition Survey (CHNS) led by Dr. Barry Popkin.

In the Heterogeneity in Cardiometabolic Risk project, we are focused on understanding  how  individuals of similar body mass index can exhibit variability in cardiometabolic risk (i.e., elevated blood pressure, elevated triglycerides, decreased HDL-C, elevated glucose, insulin resistance, and systemic inflammation), resulting in individuals who are metabolically healthy despite being overweight, whereas individuals of normal weight may be at high metabolic risk. While in the US, approximately 16.3 million adults are of normal weight but have two or more metabolic abnormalities, we know very little of these phenotypes in the context of rapidly modernizing countries such as China that have experienced dramatic emergence of obesity, insulin resistance, type 2 diabetes, and cardiovascular disease with urbanization over the past two decades. We are using a Latent Class Trajectory Analysis to characterize the patterns of weight change in the sample. We are particularly interested in contrasts across tempo and timing of weight gain and how this tempo and timing influences cardiometabolic risk.

In the Emergence of Cardiometabolic Risk Project, we will identify the multiple pathways through which such changes influence changes in weight and central adiposity and further, development of cardiometabolic risk across the lifecycle. We are using complex statistical methodology to develop a full, longitudinal structural model to address complex relationships between diet and activity, weight and waist circumference with blood pressure over 20 years. There is little understanding of the multiple and complex pathways to cardiometabolic risk. Using innovative strategies and taking advantage of rapid social, economic and environmental changes with urbanization in China, this project will inform current understanding of the development of cardiometabolic risk. We are excited to understand how the timing and rapidity of weight gain predict the development of hypertension and high risk of diabetes, dyslipidemia, and inflammation.

Our team is comprised of a well-established team of researchers who have worked together for the past 15 years: Dr. Barry Popkin, the Carla Smith Chamblee Distinguished Professor of Global Nutrition and Dr. Linda Adair, Professor of Nutrition. We are very excited about our new collaborative relationships with Dr. Amy Herring, Professor of Biostatistics, Dr. Beth Mayer-Davis, Professor of Nutrition, Dr. Amanda Thompson, Assistant Professor of Anthropology, Dr. Annie Greene Howard, Samantha Attard, all at UNC, as well as Dr. Shengkai Yan of the China-Japan Friendship Hospital, Dr. Bing Zhang of the National Institute of Nutrition and Food Safety, China Center for Disease Control, Beijing China, and Dr. James Meigs of Massachusetts General Hospital and Harvard Medical School.