{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:55:14Z","timestamp":1792292114052,"version":"4.4.0"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T00:00:00Z","timestamp":1634515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2017YFC0907000"],"award-info":[{"award-number":["2017YFC0907000"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shanghai New Three-year Action Plan for Public Health","award":["GWV-10.1-XK16"],"award-info":[{"award-number":["GWV-10.1-XK16"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>A prospective community-based cohort study was conducted to investigate the effects of obesity on hyperhomocysteinemia (HHcy) in community residents from Shanghai, China, with a median follow-up period of 2.98 years. The exposures were high body mass index (BMI) (BMI \u2265 28.0 kg\/m2) and high waist circumference (WC) (WC \u2265 85.0 cm for female and WC \u2265 90.0 for male) at baseline investigation, and the outcome was the incident of HHcy after the follow-up. A restricted cubic spline (RCS) was performed to assess the possible nonlinear relationship of BMI and WC with HHcy. A Cox proportional hazard regression model was used to evaluate the association between BMI and WC measured obesity and the risk of HHcy (Hcy level &gt; 15 \u00b5mol\/L). No significant non-linearity was found between BMI and WC with HHcy. Cox regression model showed that underweight measured by BMI was negatively associated with the risk of HHcy after controlling for confounder variables (adjusted HR = 0.64, 95% CI = 0.42 to 0.99). While abdominal obesity was positively associated with the risk of HHcy for those without CVD-related comorbidities (adjusted HR = 1.26, 95% CI = 1.05 to 1.51). Our results suggested that individuals could maintain a relatively low BMI and normal WC to lower the risk of HHcy.<\/jats:p>","DOI":"10.3390\/nu13103648","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T03:01:13Z","timestamp":1634698873000},"page":"3648","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Association of Obesity with the Risk of Hyperhomocysteinemia among the Chinese Community Residents: A Prospective Cohort Study in Shanghai, China"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7874-9298","authenticated-orcid":false,"given":"Yu","family":"Xiang","sequence":"first","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0140-3920","authenticated-orcid":false,"given":"Qi","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Wang","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Yu","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiping","family":"Wang","sequence":"additional","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuheng","family":"Cui","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiling","family":"Wu","sequence":"additional","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Liu","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonggen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongfu","family":"Yu","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genming","family":"Zhao","sequence":"additional","affiliation":[{"name":"The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"ref_1","first-page":"745","article-title":"Homocysteine as a risk factor for cardiovascular disease: Should we (still) worry about?","volume":"136","author":"Faeh","year":"2006","journal-title":"Swiss. Med. Wkly."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1001\/jamacardio.2019.0295","article-title":"Burden of Cardiovascular Diseases in China, 1990\u20132016: Findings From the 2016 Global Burden of Disease Study","volume":"4","author":"Liu","year":"2019","journal-title":"JAMA Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s12272-018-1016-4","article-title":"Causes of hyperhomocysteinemia and its pathological significance","volume":"41","author":"Kim","year":"2018","journal-title":"Arch. Pharm. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.archger.2008.03.009","article-title":"Hyperhomocysteinemia and Alzheimer\u2019s disease: A systematic review","volume":"48","year":"2009","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"579","DOI":"10.5604\/17322693.1102340","article-title":"Hyperhomocysteinemia in patients with cardiovascular disease","volume":"68","author":"Baszczuk","year":"2014","journal-title":"Postepy Hig. Med. Dosw. (Online)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s11883-016-0575-4","article-title":"Obesity and Cardiovascular Disease: A Risk Factor or a Risk Marker?","volume":"18","author":"Mandviwala","year":"2016","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e1166","DOI":"10.1016\/S2214-109X(19)30276-1","article-title":"Prevention and control of obesity in China","volume":"7","author":"Wang","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1016\/j.jacc.2008.12.068","article-title":"Obesity and cardiovascular disease: Risk factor, paradox, and impact of weight loss","volume":"53","author":"Lavie","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1161\/CIRCULATIONAHA.106.683243","article-title":"High blood pressure trends in children and adolescents in national surveys, 1963 to 2002","volume":"116","author":"Liu","year":"2007","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s00394-010-0165-0","article-title":"Relation of body mass index to blood folate and total homocysteine concentrations in Japanese adults","volume":"50","author":"Nakazato","year":"2011","journal-title":"Eur. J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1093\/ajcn\/73.3.613","article-title":"Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort","volume":"73","author":"Jacques","year":"2001","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/ajcn\/88.3.738","article-title":"Homocysteine, cysteine, and body composition in the Hordaland Homocysteine Study: Does cysteine link amino acid and lipid metabolism?","volume":"88","author":"Elshorbagy","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.nutres.2017.10.008","article-title":"Total homocysteine is positively correlated with body mass index, waist-to-hip ratio, and fat mass among overweight reproductive women: A cross-sectional study","volume":"48","author":"Hamadneh","year":"2017","journal-title":"Nutr. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wang, Y., Jiang, Y., Wang, N., Zhu, M., Liu, X., Wang, R., Jiang, F., Chen, Y., Zhao, Q., and Zhao, G. (2019). Central But Not General Obesity Is Positively Associated with the Risk of Hyperhomocysteinemia in Middle-Aged Women. Nutrients, 11.","DOI":"10.3390\/nu11071614"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e035430","DOI":"10.1136\/bmjopen-2019-035430","article-title":"Cohort profile: Protocol and baseline survey for the Shanghai Suburban Adult Cohort and Biobank (SSACB) study","volume":"10","author":"Zhao","year":"2020","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1038\/sj.ijo.0803354","article-title":"Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China","volume":"31","author":"Wang","year":"2007","journal-title":"Int. J. Obes."},{"key":"ref_17","unstructured":"Health Standard of the People\u2019s Republic of China (2013). No. WS\/T 428-2013: Criteria of Weight for Adults, Health Standard of the People\u2019s Republic of China."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.cca.2008.09.019","article-title":"Analytical performance of an enzymatic cycling method for total homocysteine measurement","volume":"399","author":"Jin","year":"2009","journal-title":"Clin. Chim. Acta"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1111\/j.1651-2227.2007.00563.x","article-title":"Association of blood pressure, obesity and serum homocysteine levels in healthy children","volume":"96","author":"Papandreou","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1203\/01.pdr.0000246099.39469.18","article-title":"Total homocysteine, folate, and cobalamin, and their relation to genetic polymorphisms, lifestyle and body mass index in healthy children and adolescents","volume":"60","author":"Huemer","year":"2006","journal-title":"Pediatr. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3233\/CH-2012-1544","article-title":"Homocysteine levels in morbidly obese patients: Its association with waist circumference and insulin resistance","volume":"52","author":"Rivera","year":"2012","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s10654-004-2253-z","article-title":"Body mass index and serum folate in childbearing age women","volume":"19","author":"Mojtabai","year":"2004","journal-title":"Eur. J. Epidemiol."},{"key":"ref_23","first-page":"719","article-title":"Reference range of total serum homocysteine level and dietary indexes in healthy Greek schoolchildren aged 6-15 years","volume":"96","author":"Papandreou","year":"2006","journal-title":"Br. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1507\/endocrj.K07E-018","article-title":"Relationship between metabolic syndrome categorized by newly recommended by International Diabetes Federation criteria with plasma homocysteine concentration","volume":"54","author":"Rhee","year":"2007","journal-title":"Endocr. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1038\/sj.ejcn.1602771","article-title":"Measures of adiposity and body fat distribution in relation to serum folate levels in postmenopausal women in a feeding study","volume":"62","author":"Mahabir","year":"2008","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.3346\/jkms.2013.28.7.1015","article-title":"Changes in body composition predict homocysteine changes and hyperhomocysteinemia in Korea","volume":"28","author":"Park","year":"2013","journal-title":"J. Korean Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1139\/cjpp-2018-0037","article-title":"Connecting homocysteine and obesity through pyroptosis, gut microbiome, epigenetics, peroxisome proliferator-activated receptor \u03b3, and zinc finger protein 407","volume":"96","author":"Laha","year":"2018","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3735","DOI":"10.1007\/s11695-019-04100-2","article-title":"Nutritional Deficiencies, Bariatric Surgery, and Serum Homocysteine Level: Review of Current Literature","volume":"29","author":"Komorniak","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/MCO.0000000000000352","article-title":"Nutrient deficiencies prior to bariatric surgery","volume":"20","author":"Roust","year":"2017","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1056\/NEJM199804093381507","article-title":"Homocysteine and atherothrombosis","volume":"338","author":"Welch","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_31","first-page":"452","article-title":"Abdominal obesity as important component of insulin-resistance syndrome","volume":"9","year":"1993","journal-title":"Nutrition"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.2337\/dc07-2316","article-title":"Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes","volume":"31","author":"Misra","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"003","DOI":"10.4172\/2165-7904.S5-003","article-title":"Exercise Training and Insulin Resistance: A Current Review","volume":"S5","author":"Keshel","year":"2015","journal-title":"J. Obes. Weight Loss Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1007\/s00125-010-1684-1","article-title":"Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: The missing links. The Claude Bernard Lecture 2009","volume":"53","author":"DeFronzo","year":"2010","journal-title":"Diabetologia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.metabol.2006.03.010","article-title":"Associations between serum insulin and homocysteine in a Swedish population-a potential link between the metabolic syndrome and hyperhomocysteinemia: The Skaraborg project","volume":"55","author":"Hellgren","year":"2006","journal-title":"Metabolism"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2147\/VHRM.S168946","article-title":"Obesity paradox in cardiovascular disease: Where do we stand?","volume":"15","author":"Carbone","year":"2019","journal-title":"Vasc Health Risk Manag."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.pcad.2018.07.003","article-title":"An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases","volume":"61","author":"Elagizi","year":"2018","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/bcpt.12424","article-title":"Hyperhomocysteinemia: Impact on Neurodegenerative Diseases","volume":"117","author":"Sharma","year":"2015","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e17970","DOI":"10.1097\/MD.0000000000017970","article-title":"The relationship between cognitive impairment and homocysteine in a B12 and folate deficient population in China: A cross-sectional study","volume":"98","author":"Meng","year":"2019","journal-title":"Medicine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e021103","DOI":"10.1136\/bmjopen-2017-021103","article-title":"Association of total homocysteine with blood pressure in a general population of Chinese adults: A cross-sectional study in Jiangsu province, China","volume":"8","author":"Wu","year":"2018","journal-title":"BMJ Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/09637486.2019.1648387","article-title":"Relationship between folate, vitamin B(12), homocysteine, transaminase and mild cognitive impairment in China: A case-control study","volume":"71","author":"Zhou","year":"2020","journal-title":"Int. J. Food Sci. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/10\/3648\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:17:34Z","timestamp":1760167054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/10\/3648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,18]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["nu13103648"],"URL":"https:\/\/doi.org\/10.3390\/nu13103648","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,18]]}}}