Lancet Reg Health West Pac. 2026 Sep 19;74:101986. doi: 10.1016/j.lanwpc.2026.101986. eCollection 2026 Sep.
ABSTRACT
BACKGROUND: Metabolic abnormalities are increasingly prevalent in young adults and commonly cluster in the elderly. We aimed to map the landscape of metabolic burden and quantify the related cardiovascular impact across the adulthood in Chinese population.
METHODS: The prospective cohort included 7,513,828 adults (3,907,602 women and 3,606,226 men) from northwestern China who were free of cardiovascular disease (CVD) at baseline. Participants were grouped by age (18-<40, 40-<60, 60-<80, and ≥80 years). Age-specific distribution and time-series trajectories were depicted for 6 major metabolic risk factors, including obesity, hepatic steatosis, hypertension, hyperlipidemia, diabetes, and renal dysfunction. Their age-specific associations with incident CVD and population attributable fractions (PAFs) were assessed, considering potential sex difference.
FINDINGS: Metabolic states exhibited obvious age-dependent sexual dimorphism, characterized by an initial female advantage in young adults which reversed around age 45. Over a median follow-up of 4.5 years, the metabolic factors exhibited strong associations with incident CVD in younger adults which gradually attenuated with advancing age. In particular, the HR for hypertension declined from 3.60 in the youngest group to 2.12 in the middle-aged group, 1.41 in the older group, and 1.21 in the very old (≥80 years). Regardless of age or sex, obesity demonstrated the highest PAF to CVD. For combined metabolic burden, the PAF was highest in middle-aged group (37.89%), followed by people aged 18-<40 years (29.78%) and 60-<80 years (25.24%), and lowest in the very old (15.85%). The PAF was higher in men than women only in those under 40 and the sex disparity reversed in the older groups. Among metabolically abnormal participants, transitioning to a healthier metabolic state, within an average of 1 year, was associated with a substantially reduced risk of CVD, particularly in the younger groups.
INTERPRETATION: The metabolic burden and its cardiovascular effects are heterogeneous across demographic segments, supporting the rationale of implementing age-specific and gender-sensitive strategies for metabolic management and CVD prevention.
FUNDING: Key Research and Development Project of Xinjiang Uyghur Autonomous Region; Suzhou Applied Basic Research (Medical and Health) Science and Technology Innovation Project; Jiangsu Frontier Technology Research and Development Program.
PMID:42825051 | PMC:PMC13628673 | DOI:10.1016/j.lanwpc.2026.101986