Life-course BMI trajectories and long-term weight gain in relation to hepatic steatosis in a rural community-based cohort in Southwest China
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Background Rural communities in Southwest China are undergoing rapid nutrition and lifestyle transitions, with sustained positive energy balance and long-term weight gain. These settings are often ethnic minority-dominant and characterized by higher habitual alcohol consumption than most other Chinese populations. Evidence on how life-course adiposity relates to metabolic liver fat burden in such a rural community with varying alcohol drinking frequency remains limited. We examined associations of current BMI, life-course BMI trajectories, and long-term BMI change with controlled attenuation parameter (CAP)-defined hepatic steatosis. Methods We conducted a retrospective cohort analysis embedded within a routine health examination program in Ning’er County, Yunnan Province, China. Adults who underwent an index examination including vibration-controlled transient elastography (VCTE) were included. Hepatic steatosis and severe steatosis were defined as CAP ≥238 and ≥292 dB/m, respectively. Body weight and height at ages 18, 30 and 40 years were extracted from prior health examination records, and BMI at each time point was calculated and categorized using Chinese cut-offs to construct life-course trajectory patterns. Multivariable logistic regression estimated odds ratios (ORs) for CAP-defined outcomes adjusting for age, sex, ethnicity, smoking, and past-year alcohol drinking frequency, with further adjustment for waist circumference and metabolic and liver biomarkers. Restricted cubic splines evaluated dose–response associations between long-term BMI change (ΔBMI from age 18 to the index examination) and steatosis. Results Among 956 adults (predominantly ethnic minorities), the prevalence of CAP-defined steatosis and severe steatosis was 52.9 and 18.2%, respectively. Higher current BMI and weight-gain or persistent-obesity trajectory patterns were associated with greater odds of steatosis and severe steatosis. After additional adjustment, BMI ≥ 28.0 kg/m 2 remained independently associated with steatosis (OR 2.08; 95% CI 1.05–4.14), whereas associations with severe steatosis were attenuated. Long-term BMI gain was monotonically associated with steatosis, with the OR becoming statistically significant at ΔBMI 6.64 kg/m 2 . Alcohol drinking frequency showed no strong independent association with CAP-defined outcomes. Conclusion In this ethnic minority-dominant rural population with relatively frequent self-reported alcohol use, sustained weight gain across adulthood and adverse life-course BMI trajectories were associated with a higher burden of CAP-defined hepatic steatosis and severe steatosis. These findings support the importance of life-course weight maintenance for reducing liver fat accumulation in rural community settings
Body mass index · Cohort · Fatty liver · National Health and Nutrition Examination Survey · Odds ratio · Steatosis · Transient elastography · Waist · Alcohol Consumption and Health Effects · Diabetes, Cardiovascular Risks, and Lipoproteins · Liver Disease Diagnosis and Treatment
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