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Objectives  We aimed to assess the dose–response association between weight gain from young to middle adulthood and odds of metabolic syndrome, across body mass index (BMI) categories at young adulthood.    Methods  Based on a national population-based screening project, middle-aged (35–64 years) participants who recalled weight at age 25 years and received standardized measurements were included. Multivariable adjusted restricted cubic splines and logistic regression models were applied.    Results  In total, 437,849 participants were included (62.1% women, 52.0 ± 7.6 years). Larger weight gains from young to middle adulthood were associated with higher odds of metabolic syndrome at middle adulthood, with odds of 2.01 (1.98–2.05), 1.93 (1.92–1.94), and 1.67 (1.64–1.7) per 5-kg weight gain across participants who were underweight, normal-weight, and overweight/obese at young adulthood, respectively. After further adjusting for current BMI, larger weight gains still correlated with higher odds of metabolic syndrome among underweight and normal-weight participants, while an inverted U-shaped association was observed in overweight/obese participants.    Conclusions  Weight maintenance from young to middle adulthood could be effective to mitigate metabolic syndrome burden, especially among underweight and normal-weight people. Historical weight gain confers varied information about metabolic syndrome risk independent of attained BMI across BMI categories at young adulthood.

Association Between Weight Gain From Young to Middle Adulthood and Metabolic Syndrome Across Different BMI Categories at Young Adulthood