Association of body shape trajectories with hypertension in rural adults: An observational study with mendelian randomization analysis

This study investigated the association between long-term body shape trajectories and hypertension (HTN) risk among rural Chinese adults, while assessing the influence of lifestyle factors and potential causal relationships using Mendelian randomization (MR) analysis. A total of 21,500 adults aged 50–79 years from the Henan Rural Cohort Study were included. Group-based trajectory modeling identified five recalled body shape trajectories from childhood to middle adulthood (ages 5–50 years). Logistic regression models were used to evaluate associations between body shape trajectories and HTN risk after adjustment for demographic, socioeconomic, and lifestyle factors. MR analyses using genome-wide association study (GWAS) data were conducted to provide additional evidence regarding the potential causal relationship between body size and HTN. Compared with the lean-stable trajectory, heavier body shape trajectories were associated with increased HTN risk. The multivariable-adjusted odds ratios (ORs) were 1.82 (95% CI: 1.55–2.12) among women with the lean-moderate increase trajectory and 2.80 (95% CI: 2.27–3.45) among men with the heavy-stable trajectory. Unhealthy lifestyle factors, including lower vegetable and fruit intake and high-fat dietary patterns, further increased HTN risk among individuals with unfavorable body shape trajectories. MR analyses provided supportive evidence for a potential causal relationship between larger body size and HTN, although the use of cross-sectional genetic proxies for longitudinal body shape trajectories should be considered when interpreting the findings. This study demonstrates that long-term body shape trajectories are associated with HTN risk in rural Chinese adults. Maintaining healthy body weight throughout adulthood and implementing early, sex-specific prevention strategies may help reduce the future burden of HTN. GRAPHICAL ABSTRACT