Interactive Effects of Physical Fitness and Body Mass Index on the Risk of Hypertension

Aerobic Capacity Beyond Cardiorespiratory Fitness Linking Mitochondrial Function, Disease Resilience and Healthy Aging

Aerobic capacity is conventionally equated with cardiorespiratory fitness (CRF), but its physiological essence extends far beyond cardiopulmonary performance. Aerobic capacity is an integrative physiological indicator reflecting the entire process from oxygen uptake and transport to mitochondrial energy conversion, with mitochondrial function constituting its molecular core. Emerging evidence reveals robust associations between diminished aerobic capacity and increased risks of non-communicable chronic diseases and age-related functional decline. However, its potential as a valuable tool for early disease detection and intervention remains undervalued in clinical practice. By synthesizing recent clinical and experimental studies, we highlight the crucial role of aerobic capacity, particularly its mechanistic links to impaired mitochondrial function, which drives disease progression through impaired energy metabolism and chronic inflammation. Furthermore, exercise interventions designed to enhance aerobic capacity have shown promise in improving mitochondrial efficiency, promoting cardiometabolic adaptation, and boosting overall health, thus offering an effective strategy for chronic disease prevention. We advocate for inclusion of aerobic capacity assessments in routine health evaluations and emphasize the need to integrate aerobic capacity optimization into public health frameworks to advance preventive strategies against chronic diseases and promote healthy aging.

Why are we doing this Boss? Justification and implications of aerobic fitness testing in the military

BACKGROUND

Physical fitness is a key tenet of military organisations worldwide. Specifically, many consider aerobic fitness (AF) an essential physical attribute for ensuring optimal military performance and readiness. However, the intricate relationship between AF and various facets of military job performance necessitates comprehensive review to ascertain the appropriateness and effectiveness of its assessment.

OBJECTIVE

This narrative review aims to describe the relationship between AF and factors influencing individual military performance and readiness, and explores the implications of the enforcement of in-service, generic AF test standards in military populations.

METHODS

Databases (PubMed and Google Scholar) were searched for all relevant published peer-reviewed literature as at August 2023.

RESULTS

Inconsistent associations were found between AF and outcomes influencing individual military performance (physical capabilities, cognitive capabilities, presenteeism and productivity, resilience, and technical/tactical capabilities) and readiness (mental health and wellbeing and physical health). Consequently, the level of AF needed for acceptable or optimal military performance remains uncertain.

CONCLUSIONS

AF is a cornerstone of health and performance, yet linking generic AF test standards to job performance is complex, with multiple factors interacting to influence outcomes. From existing literatures, there does not appear to be a specific level of AF at, and/or above, which acceptable military performance is achieved. As such, the enforcement of and emphasis on in-service, pass/fail, generic AF test standards in military populations is questionable and requires thoughtful re-evaluation. Role/task-specific AF should be assessed through evidence-based PES and the use of generic AF tests limited to the monitoring and benchmarking of health-related fitness.

Circulating fatty acids, genetic susceptibility and hypertension: a prospective cohort study

Background

Combining genetic risk factors and plasma fatty acids (FAs) can be used as an effective method of precision medicine to prevent hypertension risk.

Methods

A total of 195,250 participants in the UK Biobank cohort were included in this study from 2006-2010. Polygenic risk scores (PRSs) were calculated for hypertension using single-nucleotide polymorphisms (SNPs). Concentrations of plasma FAs, including polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs) and saturated fatty acids (SFAs), were tested by nuclear magnetic resonance. The Cox model was used to test for the main effects of PRS, different plasma FAs and their joint effects on hypertension. Relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP) were used to test the additive interaction.

Results

Plasma PUFAs, n-3 PUFAs, MUFAs and SFAs were related to the risk of hypertension (PUFAs: HR, 0.878; 95% CI, 0.868-0.888; MUFAs: HR, 1.13; 95% CI, 1.123-1.150; SFAs: HR, 1.086; 95% CI, 1.074-1.098; n-3 PUFAs: HR, 0.984; 95% CI, 0.973-0.995). Moreover, an additive interaction was found between PRS and plasma FAs, which could contribute to an approximately 10-18% risk of hypertension, and the associations between high plasma MUFAs and a high PRS of hypertension were the strongest positive [RERI: 0.178 (95% CI: 0.062, 0.294), AP: 0.079 (95% CI: 0.027, 0.130)].

Conclusion

Increased plasma MUFAs or SFAs and decreased plasma PUFAs or n-3 PUFAs were associated with hypertension risk, especially among people at high genetic risk.

Independent and joint associations of estimated cardiorespiratory fitness and its dynamic changes and obesity with the risk of hypertension: A prospective cohort

Our aim was to examine the independent and joint associations of estimated cardiorespiratory fitness (CRF) and its changes and obesity with risk of hypertension in a rural Chinese population. A prospective cohort including 9848 adults without hypertension at baseline was enrolled. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated by logistic regression models. Restricted cubic splines were used to model the dose-response relationship. During 6 years follow-up, 2,019 individuals developed hypertension. A negative association between estimated CRF and hypertension incidence was observed, with the risk being 0.87 (0.84-0.90) per MET increment. For estimated CRF change, the risks of hypertension were 1.50 (1.27-1.77) and 0.75 (0.59-0.97) for decreasers and increasers, respectively, compared to maintainers. Joint analyses showed individuals in the overweight/obesity-fourth quartile of estimated CRF had a 2.08 times higher risk of hypertension than those in the normal weight-first quartile (Pinteraction < 0.05). Those overweight/obesity-decreasers had the highest risk (OR: 2.19, 95%CI: 1.71-2.81; Pinteraction < 0.05) compared to the normal-maintainers. Similar results for abdominal obesity were also observed. Estimated CRF and its dynamic changes showed a negative association with hypertension incidence in the rural Chinese population.

The relationship between blood pressure and functional fitness of older adults in Korea

Hypertension, also known as high blood pressure (BP), is a critical health issue that can cause cardiovascular disease. It is observed more frequently in older adults. Thus, this study aimed to identify the functional fitness and body composition factors that significantly influence both systolic and diastolic BPs in older adults. Data from 155,266 older adults (51,751 men [33.3%] and 103,505 women [66.7%]) who underwent functional fitness tests between 2013 and 2018 were analyzed. The following seven functional fitness tests were conducted: (a) aerobic endurance (2-min step), (b) upper body muscle strength (hand grip strength), (c) lower body muscle endurance (chair sit-and-stand), (d) flexibility (sit-and-reach), (e) agility (Timed Up and Go), and (f) body composition (body mass index [BMI] and body fat percentage). Systolic and diastolic BPs were used as outcome variables. In examining the proposed relationships, the regression analysis revealed that BMI, body fat percentage, sit-and-reach, 2-min step, hand grip, chair sit-and-stand, and Timed Up and Go were significantly associated with reduced systolic and diastolic body pressures.

The relationship between cardiorespiratory fitness and blood pressure among airline pilots: a mediation analysis of body composition

OBJECTIVE

Blood pressure (BP), cardiorespiratory fitness (CRF), and body composition are independently associated with health outcomes, yet the relationship between these variables has not been explored among airline pilots. The aim of this study was to evaluate the relationship between CRF and BP, and further examine whether the relationship is mediated by body composition.

METHODS

A cross-sectional study was conducted among 356 airline pilots in New Zealand. We measured height, body mass, BP, waist circumference, skinfolds, and CRF (via a WattBike cycle ergometer submaximal VO 2max test). Partial correlation coefficients were estimated to examine the relationships between all variables while controlling for age and sex. Haye's PROCESS macro and the Sobel test were utilized for the mediation analysis.

RESULTS

All body composition variables (body mass index, waist circumference and body fat percentage) were positively correlated with all BP variables (systolic pressure, diastolic pressure and mean arterial pressure) ( P  < 0.001). CRF was negatively correlated with all body composition and BP variables ( P  < 0.001). The Sobel test and indirect effect were significant ( P  < 0.001), confirming that all body composition variables partially mediate the relationship between CRF and all blood pressure variables.

CONCLUSION

Lower CRF is associated with higher blood pressure, and body composition partially mediates the relationship between these health risk factors. These findings highlight the importance of physical fitness and healthy body composition in the management of blood pressure among this occupational group.

What is resistant arterial hypertension?

PURPOSE

The current review is to describe the definition and prevalence of resistant arterial hypertension (RAH), the difference between refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients.

MATERIALS AND METHODS

According to the WHO, approximately 1.28 billion adults aged 30-79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihypertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appropriate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrecognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncontrolled BP.

CONCLUSION

RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardiovascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.

Independent and joint associations of cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults

The aim of this study was to investigate the independent and joint associations of low cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults. A total of 360 community-dwelling older adults aged 60-80 years participated in this cross-sectional study. Cardiometabolic risk was based on the diagnosis of Metabolic Syndrome and poor Ideal Cardiovascular Health according to the American Heart Association guidelines. Cardiorespiratory fitness and lower-limb muscle strength were estimated using the six-minute walk and the 30-second chair stand tests, respectively. Participants in the 20th percentile were defined as having low cardiorespiratory fitness and lower-limb muscle strength. Poisson's regression was used to determine the prevalence ratio (PR) and 95% confidence intervals (CI) of Metabolic Syndrome and poor Ideal Cardiovascular Health. Participants with low cardiorespiratory fitness alone and combined with low lower-limb muscle strength were similarly associated with a higher risk for Metabolic Syndrome (PR 1.27, 95% CI 1.09-1.48, and PR 1.32, 95% CI 1.10-1.58, respectively), and poor Ideal Cardiovascular Health (PR 1.76, 95% CI 1.25-2.47, and PR 1.65, 95% CI 1.19-2.28, respectively). Low lower-limb muscle strength alone was not associated with a higher risk for either Metabolic Syndrome or poor Ideal Cardiovascular Health (PR 1.23, 95% CI 0.81-1.87, and PR 1.11, 95% CI 0.89-1.37, respectively). Low cardiorespiratory fitness alone or combined with low lower-limb muscle strength, but not low lower-limb muscle strength alone, was associated with a higher cardiometabolic risk in older adults. The assessment of physical fitness may be a "window of opportunity" to identify youngest-old adults with a high cardiovascular disease risk.

Establishment of hypertension risk nomograms based on physical fitness parameters for men and women: a cross-sectional study

Objective

This study aims to establish hypertension risk nomograms for Chinese male and female adults, respectively.

Method

A series of questionnaire surveys, physical assessments, and biochemical indicator tests were performed on 18,367 adult participants in China. The optimization of variable selection was conducted by running cyclic coordinate descent with 10-fold cross-validation through the least absolute shrinkage and selection operator (LASSO) regression. The nomograms were built by including the predictors selected through multivariable logistic regression. Calibration plots, receiver operating characteristic curves (ROC), decision curve analysis (DCA), clinical impact curves (CIC), and net reduction curve plots (NRC) were used to validate the models.

Results

Out of a total of 18 variables, 5 predictors-namely age, body mass index, waistline, hipline, and resting heart rate-were identified for the hypertension risk predictive model for men with an area under the ROC of 0.693 in the training set and 0.707 in the validation set. Seven predictors-namely age, body mass index, body weight, cardiovascular disease history, waistline, resting heart rate, and daily activity level-were identified for the hypertension risk predictive model for women with an area under the ROC of 0.720 in the training set and 0.748 in the validation set. The nomograms for both men and women were externally well-validated.

Conclusion

Gender differences may induce heterogeneity in hypertension risk prediction between men and women. Besides basic demographic and anthropometric parameters, information related to the functional status of the cardiovascular system and physical activity appears to be necessary.

Analysis of health-related, skill-related physical strength, and physique by blood pressure levels of Korean seniors

In Korea, the prevalence rate of hypertension among people aged over 30 is on an upward trend, which increased from 26.2% in 2008 to 28.3% in 2018. This hovers above the global morbidity rate of hypertension. As hypertension is the cause of cerebrovascular or cardiovascular diseases, early treatment and management are critical. Also, while there has been numerous research conducted on exercise intervention, the number of studies done on hypertension and physical fitness falls far below. To identify the relationship between health and physical fitness depending on the blood pressure levels of Korean seniors, the physical fitness test results of the National Fitness Award 100 conducted in 2017 were used, and blood pressure level, physique, and physical fitness data of 17,110 elderly population aged above 65 were analyzed. IBM Statistics SPSS 25.0 was used to process the collected data. Due to the gender difference in blood pressure levels, physique, and physical strength, the analysis was conducted by each gender, and the analysis of variance (ANOVA) was performed to identify the differences in physique and physical strength depending on the blood pressure level. Also, Tukey's HDS test was conducted if such differences were found. All analyzes were tested at the significance level (α) of 0.05. As a result of comparing the physique factors by blood pressure level, only males showed a significant difference between groups in terms of height(p = .019), and higher blood pressure implied greater height. Also, for both genders, those with high blood pressure appeared to have greater body weight(p < .001), body fat percentage(p < .001), BMI(p < .001), waist circumference(p < .001), and waist-to-height ratio(p < .001),. In addition, as the result of comparing health-related physical strength and skill-related physical strength by blood pressure level, males showed a significant difference only in muscular strength(p = .026) and flexibility(p < .001), while females showed a significant difference between groups in terms of cardiovascular endurance(p < .001), muscular strength(p = .025), muscular endurance(p < .001), balance, and motor coordination except for flexibility. Holistically, males only showed a significant difference in muscular strength and flexibility while females appeared to have a significant difference between groups in all categories except flexibility, which can be considered that physical fitness factors influence the blood pressure of females more than males.

Night Shift Work, Genetic Risk, and Hypertension

OBJECTIVE

To perform a prospective cohort study to investigate whether night shift work is associated with incident hypertension and whether this association is modified by genetic susceptibility to hypertension because evidence on the association between night shift work and hypertension is insufficient.

METHODS

A total of 232,665 participants of UK Biobank who were recruited from 2006 to 2010 and observed to January 31, 2018, were included in this study. A Cox proportional hazards model with covariate adjustment was performed to assess the association between night shift work exposure and hypertension risk. We constructed a polygenic risk score (PRS) for genetic susceptibility to hypertension, which was used to explore whether genetic susceptibility to hypertension modified the effect of night shift work. The robustness of the results was assessed by sensitivity analysis.

RESULTS

Night shift workers had a higher hypertension risk than day shift workers, which increased with increasing frequency of night shift work (P_trend<.001). The association was attenuated but still remained statistically significant in the fully adjusted model. We explored the joint effect of night shift work and genetic susceptibility on hypertension. Permanent night shift workers with higher hypertension PRSs had higher risk of hypertension than day workers with low PRSs.

CONCLUSION

Night shift work exposure was associated with increased hypertension risk, which was modified by the genetic risk for hypertension, indicating that there is a joint effect of night shift work and genetic risk on hypertension.

The association of cardiorespiratory fitness and the risk of hypertension: a systematic review and dose-response meta-analysis

Established evidence has indicated a negative correlation between cardiorespiratory fitness (CRF) and hypertension risk. In this study, we performed a meta-analysis to investigate the categorical and dose-response relationship between CRF and hypertension risk and the effects of CRF changes on hypertension risk reduction. The PubMed, Web of Science, and Embase databases were searched for relevant studies. The summarized relative risk (RR) and 95% confidence interval (95% CI) were estimated using the DerSimonian and Laird random effect model, and the dose-response relationship between CRF and hypertension risk was characterized using generalized least-squares regression and restricted cubic splines. Nine cohorts describing 110,638 incident hypertension events among 1,618,067 participants were included in this study. Compared with the lowest category of CRF, the RR of hypertension was 0.63 (95% CI: 0.56-0.70) for the highest CRF category and 0.85 (95% CI: 0.80-0.91) for the moderate category of CRF. For a 1-metabolic equivalent increment in CRF, the pooled RR of hypertension was 0.92 (95% CI: 0.90-0.94) in the total population. The RR of hypertension was 0.71 (95% CI: 0.64-0.79) for participants with CRF increased compared with those whose CRF was decreased over time. In conclusion, our meta-analysis supports the widely held notion of a negative dose-dependent relationship between CRF and hypertension risk.

Non-Exercise Estimated Cardiorespiratory Fitness and Incident Hypertension

BACKGROUND

The purpose of the current study is to examine the association between non-exercise estimated cardiorespiratory fitness and incident hypertension by sex.

METHODS

A total of 5513 participants (4403 men and 1110 women) free of hypertension from the Aerobics Center Longitudinal Study were followed for incident hypertension, which was determined as resting systolic or diastolic blood pressure at least 130/80 mm Hg or physician diagnosis. Non-exercise estimated cardiorespiratory fitness was estimated in metabolic equivalents (METs) with sex-specific algorithms. Age, body mass index, waist circumference, and resting heart rate were used as continuous variables, whereas being physically active and current smoking were dichotomous variables. Multivariable Cox regression models were used to examine the association between cardiorespiratory fitness and risk of developing hypertension. Hazard ratios and 95% confidence intervals (CIs) were reported as an index of strength of association.

RESULTS

During an average follow-up of 5 years, 61.7% of men and 39.5% of women developed hypertension. In men, the upper and middle tertiles of cardiorespiratory fitness had 22% (95% CI, 0.71-0.86) and 10% (95% CI, 0.82-0.99) lower risk, respectively, of developing hypertension compared with those in the lower tertile. In women, the upper and middle tertiles of cardiorespiratory fitness had 30% (95% CI, 0.55-0.88) and 6% (95% CI, 0.74-1.18) lower risk, respectively, of developing hypertension. Each 1-MET increment was associated with a 10% higher risk of incident hypertension in the overall sample.

CONCLUSION

Cardiorespiratory fitness estimated using a non-exercise algorithm is inversely associated with risk of developing hypertension in men and women.

Bioelectrical Impedance Analysis as a Contemporary Biomarker of Obesity in Adults with Marfan- or Loeys-Dietz-Syndrome

Background

It is clinically widely overlooked that many patients with Marfan- (MFS) or Loeys-Dietz-Syndrome (LDS) are obese. While anthropometric routine parameters are not very suitable, the modern Bioelectrical Impedance Analysis (BIA) seems superior for the acquisition of reliable noninvasive assessment of body composition of patients. The aim of the study was to assess the body composition of patients with MFS/LDS by BIA in order to detect occult obesity, which may be a risk marker for aortic or vascular complications.

Methods

In this exploratory cross-sectional study, 50 patients (66% female; mean age: 37.7 ± 11.7 [range: 17-64] years) with a molecular genetic (n = 45; 90%) or clinical (n = 5; 10%) proven diagnosis of MFS or LDS were enrolled between June 2020 and February 2022. All BIA-measurements were performed with the Multifrequence-Impedance-Analyzer Nutriguard-MS (Data Input, Poecking, Germany).

Results

The MFS/LDS collective was significantly different from an age-, sex-, and BMI-adjusted control in terms of body fat, percent cellularity, body cell mass, extra cellular mass/body cell mass index, and phase angle (all p < 0.05). The mean BIA-measured bodyfat was 31.7 ± 8.7% [range: 9.5-53.5%], while the mean calculated BMI of the included patients was 23.0 ± 4.8 kg/ m 2 [range: 15.2-41.9 kg/ m 2 ]. Therefore, using the obesity cut-off values for the body fat percentage of 25% in men and 35% in women, the BIA classifies as many as 28 patients (56.0%) as obese. In contrast only 12 patients (24.0%) were pre-obese, respectively 3 (6.0%) obese by BMI. The significant difference (p < 0.001) had an accordance of 42.7%. Overall, 15 patients (13 MFS; 2 LDS) had previous aortic surgery (n = 14) and/or interventional treatment (n = 2) for aortic complications (aneurysm, aortic dissection). 11 out of these 15 (73.3%) were currently classified as obese by BIA.

Conclusions

The fact that many patients with MFS or LDS are obese is widely unknown, although obesity may be associated with impaired vascular endothelial function and an increased risk of cardiovascular complications. Also, in patients with MFS/LDS, BIA allows a reliable assessment of the body composition beyond the normal anthropometric parameters, such as BMI. In the future, BIA-data possibly may be of particular importance for the assessment of the vascular risk of MFS/LDS patients, besides the aortic diameters.

Body mass index is superior to other body adiposity indexes in predicting incident hypertension in a highly admixed sample after 10-year follow-up: The Baependi Heart Study

Hypertension is the leading cause of overall mortality in low- and middle-income countries. In Brazil, there is paucity of data on the determinants of incident hypertension and related risk factors. We aimed to determine the incidence of hypertension in a sample from the Brazilian population and investigate possible relationships with body adiposity indexes. We assessed risk factors associated with cardiovascular disease, including adiposity body indexes and biochemical analysis, in a sample from the Baependi Heart Study before and after a 10-year follow-up. Hypertension was defined by the presence of systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or the use of antihypertensive drugs. From an initial sample of 1693 participants, 498 (56% women; mean age 38 ± 13 years) were eligible to be included. The overall hypertension incidence was 24.3% (22.3% in men and 25.6% in women). Persons who developed hypertension had higher prevalence of obesity, higher levels for blood pressure, higher frequency of dyslipidemia, and higher body adiposity indexes at baseline. The best prediction model for incident hypertension includes age, sex, HDL-c, SBP, and Body Mass Index (BMI) [AUC = 0.823, OR = 1.58 (95% CI 1.23-2.04)]. BMI was superior in its predictive capacity when compared to Body Adiposity Index (BAI), Body Roundness Index (BRI), and Visceral Adiposity Index (VAI). Incident hypertension in a sample from the Brazilian population was 24.3% after 10-year follow-up and BMI, albeit the simpler index to be calculated, is the best anthropometric index to predict incident hypertension.

Primitive detection of Alzheimer’s disease using neuroimaging: A progression model for Alzheimer’s disease: Their applications, benefits, and drawbacks

Alzheimer’s disease (A.D.) is the most widespread type of Dementia, and it is not a curable neurodegenerative disease that affects millions of older people. Researchers were able to use their understanding of Alzheimer’s disease risk variables to develop enrichment processes for longitudinal imaging studies. Using this method, they reduced their sample size and study time. This paper describes the primitive detective of Alzheimer’s diseases using Neuroimaging techniques. Several preprocessing methods were used to ensure that the dataset was ready for subsequent feature extraction and categorization. The noise was reduced by converting and averaging many scan frames from real to DCT space. Both sides of the averaged image were filtered and combined into a single shot after being converted to real space. InceptionV3 and DenseNet201 are two pre-trained models used in the suggested model. The PCA approach was used to select the traits, and the resulting explained variance ratio was 0.99The Simons Foundation Autism Research Initiative (SFARI)—Simon’s Simplex Collection (SSC)—and UCI machine learning datasets showed that our method is faster and more successful at identifying complete long-risk patterns when compared to existing methods.

Body composition, physical fitness and cardiovascular risk factors in 9-year-old children

The independent associations of body composition and physical fitness components with cardiovascular disease (CVD) risk factors in childhood are not fully understood. Thus, this cross-sectional study examined the independent associations of body composition and physical fitness with CVD risk factors in Swedish 9-year-old children (n = 411). Unadjusted linear regression analyses showed that body mass index (BMI), % fat mass and fat mass index were all positively associated with systolic and diastolic blood pressure, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Metabolic Syndrome (MetS) score (all β ≥ 0.229, P ≤ 0.001). These associations were virtually unaffected by adjustments for basic covariates (child's age and sex, maternal educational level and maternal BMI), fat-free mass and physical fitness. Fat-free mass index had generally weak associations with CVD risk factors and no associations were statistically significant after adjustments (all P > 0.27). Greater cardiorespiratory fitness and motor fitness were associated with lower HOMA-IR and MetS score in unadjusted models (all β ≤ - 0.158, P ≤ 0.039) but not after adjustments for basic covariates and body composition. These findings indicate that cardiovascular health promotion in childhood may focus on the maintenance of a healthy fat mass.

Maternal Obesity Programming of Perivascular Adipose Tissue and Associated Immune Cells: An Understudied Area With Few Answers and Many Questions

At present, the worldwide prevalence of obesity has become alarmingly high with estimates foreshadowing a continued escalation in the future. Furthermore, there is growing evidence attributing an individual’s predisposition for developing obesity to maternal health during gestation. Currently, 60% of pregnancies in the US are to either overweight or obese mothers which in turn contributes to the persistent rise in obesity rates. While obesity itself is problematic, it conveys an increased risk for several diseases such as diabetes, inflammatory disorders, cancer and cardiovascular disease (CVD). Additionally, as we are learning more about the mechanisms underlying CVD, much attention has been brought to the role of perivascular adipose tissue (PVAT) in maintaining cardiovascular health. PVAT regulates vascular tone and for a significant number of individuals, obesity elicits PVAT disruption and dysregulation of vascular function. Obesity elicits changes in adipocyte and leukocyte populations within PVAT leading to an inflammatory state which promotes vasoconstriction thereby aiding the onset/progression of CVD. Our current understanding of obesity, PVAT and CVD has only been examined at the individual level without consideration for a maternal programming effect. It is unknown if maternal obesity affects the propensity for PVAT remodeling in the offspring, thereby enhancing the obesity/CVD link, and what role PVAT leukocytes play in this process. This perspective will focus on the maternal contribution of the interplay between obesity, PVAT disruption and CVD and will highlight the leukocyte/PVAT interaction as a novel target to stem the tide of the current obesity epidemic and its secondary health consequences.

Chinese Visceral Adiposity Index Is More Closely Associated With Hypertension and Prehypertension Than Traditional Adiposity Indices in Chinese Population: Results From the REACTION Study

PURPOSE

The optimal adiposity index that is strongly associated with hypertension or prehypertension remains inconclusive in Chinese population. This study aimed to investigate the relationship between Chinese visceral adiposity index (CVAI) and hypertension and prehypertension, as well as to compare the discriminative power of CVAI, visceral adiposity index (VAI), body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), low-density lipoprotein cholesterol (LDL-C), and waist-to-hip ratio (WHR) with hypertension and prehypertension in Chinese general population.

PATIENTS AND METHODS

A total of 34732 participants from REACTION study were recruited. Multiple logistic regression analyses were performed to detect the association between adiposity indices (CVAI, VAI, BMI, WC, WHtR, WHR, LDL-C) and hypertension and prehypertension.

RESULTS

Multivariate logistic regression analysis showed that compared with other obesity indices, CVAI remained significantly associated with hypertension and prehypertension (Hypertension: odds ratio (OR) 3.475, 95% confidence interval (CI) 3.158-3.824, p<0.001 in total subjects; OR 2.762, 95% CI 2.369-3.221, p<0.001 in men; OR 3.935, 95% CI 3.465-4.469, p<0.001 in women, Prehypertension: OR 2.747, 95% CI 2.460-3.068, p<0.001 in total subjects; OR 2.605, 95% CI 2.176-3.119, p<0.001 in men; OR 2.854, 95% CI 2.465-3.304, p<0.001 in women).In a stratified analysis, CVAI was significantly associated with hypertension and prehypertension at any level of blood glucose, age or estimated glomerular filtration rate(eGFR).

CONCLUSION

CVAI is significantly associated with hypertension and prehypertension. CVAI shows the superior discriminative ability for hypertension and prehypertension compared with VAI, BMI, WC, WHtR, WHR and LDL-C in Chinese general population.

Sex differences in the association between green tea consumption and hypertension in elderly Chinese adults

BACKGROUND

Green tea has been one of the most popular beverages in China since ancient times. Mixed results concerning the effect of green tea consumption on the incidence of hypertension have been published over the past decades. However, no previous studies have focused on longevous individuals in China and the sex differences in the association between habitual green tea intake and hypertension.

METHODS

The data extracted from the database of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018 were used for a secondary analysis. Logistic regression models were employed to examine the odds ratio (OR) of daily green tea consumption on the incidence of hypertension by sex.

RESULTS

A total of 9277 individuals were included in the analysis (39.8% were men). The included individuals had a mean age of 80.9 and 84.8 years for those who drank green tea daily and those who had never, respectively (p <  0.001). The incidence of hypertension varied at baseline according to green tea drinking habit and sex. For women who had a habitual green tea intake or had never drunk green tea, the incidence of hypertension was 47.3 and 43.9%, respectively (p = 0.241), whereas it was 51.6 and 39.7% for men (p <  0.001). After adjusting for potential confounders, a 38% increase in the risk of hypertension was observed in men who consumed green tea daily (OR, 1.38; 95% CI, 1.15-1.67; p <  0.001).

CONCLUSIONS

Chinese longevous men had a 38% higher risk of developing hypertension when drinking green tea daily. However, no effect of green tea consumption on the incidence of hypertension in women was found. More attention should be paid to the lifestyle of longevous individuals for health promotion, and a sex-specific approach to deliver care for very elderly people is warranted.

Effects of Tai Chi or Conventional Exercise on Central Obesity in Middle-Aged and Older Adults : A Three-Group Randomized Controlled Trial

BACKGROUND

Central obesity is a major manifestation of metabolic syndrome, which is a common health problem in middle-aged and older adults.

OBJECTIVE

To examine the therapeutic efficacy of tai chi for management of central obesity.

DESIGN

Randomized, controlled, assessor-blinded trial. (ClinicalTrials.gov: NCT03107741).

SETTING

A single research site in Hong Kong between 27 February 2016 and 28 February 2019.

PARTICIPANTS

Adults aged 50 years or older with central obesity.

INTERVENTION

543 participants were randomly assigned in a 1:1:1 ratio to a control group with no exercise intervention (n = 181), conventional exercise consisting of aerobic exercise and strength training (EX group) (n = 181), and a tai chi group (TC group) (n = 181). Interventions lasted 12 weeks.

MEASUREMENTS

Outcomes were assessed at baseline, week 12, and week 38. The primary outcome was waist circumference (WC). Secondary outcomes were body weight; body mass index; high-density lipoprotein cholesterol (HDL-C), triglyceride, and fasting plasma glucose levels; blood pressure; and incidence of remission of central obesity.

RESULTS

The adjusted mean difference in WC from baseline to week 12 in the control group was 0.8 cm (95% CI, -4.1 to 5.7 cm). Both intervention groups showed reductions in WC relative to control (adjusted mean differences: TC group vs. control, -1.8 cm [CI, -2.3 to -1.4 cm]; P < 0.001; EX group vs. control: -1.3 cm [CI, -1.8 to -0.9 cm]; P < 0.001); both intervention groups also showed reductions in body weight (P < 0.05) and attenuation of the decrease in HDL-C level relative to the control group. The favorable changes in WC and body weight were maintained in both the TC and EX groups, whereas the beneficial effect on HDL-C was only maintained in the TC group at week 38.

LIMITATIONS

High attrition and no dietary intervention.

CONCLUSION

Tai chi is an effective approach to reduce WC in adults with central obesity aged 50 years or older.

PRIMARY FUNDING SOURCE

Health and Medical Research Fund.

Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts

OBJECTIVE

To investigate the possible connection between cardiorespiratory fitness (CRF) and muscle strength in early adulthood and severity of COVID-19 later in life.

DESIGN

Prospective registry-based cohort study.

PARTICIPANTS

1 559 187 Swedish men, undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years.

MAIN OUTCOME MEASURES

Hospitalisation, intensive care or death due to COVID-19 from March to September 2020, in relation to CRF and muscle strength.

RESULTS

High CRF in late adolescence and early adulthood had a protective association with severe COVID-19 later in life with OR (95% CI) 0.76 (0.67 to 0.85) for hospitalisation (n=2 006), 0.61 (0.48 to 0.78) for intensive care (n=445) and 0.56 (0.37 to 0.85) for mortality (n=149), compared with the lowest category of CRF. The association remains unchanged when controlled for body mass index (BMI), blood pressure, chronic diseases and parental education level at baseline, and incident cardiovascular disease before 2020. Moreover, lower muscle strength in late adolescence showed a linear association with a higher risk of all three outcomes when controlled for BMI and height.

CONCLUSIONS

Physical fitness at a young age is associated with severity of COVID-19 many years later. This underscores the necessity to increase the general physical fitness of the population to offer protection against future viral pandemics.

Do assessments of cardiorespiratory and muscular fitness influence subsequent reported physical activity? A randomized controlled trial

BACKGROUND

Regular physical activity and exercise provide many health benefits. These health benefits are mediated in large part through cardiorespiratory fitness and muscular strength. As most individuals have not had an assessment of their personal cardiorespiratory fitness or muscular strength we investigated if measurements of cardiorespiratory fitness and muscular strength would influence an individual's subsequent self-reported exercise and physical activity.

METHODS

Volunteer subjects at a State Fair were randomized in 1:1 parallel fashion to control and intervention groups. The baseline Exercise Vital Sign (EVS) and type of physical activity were obtained from all subjects. The intervention group received estimated maximum oxygen uptake (VO2max) using a step test and muscular strength using a hand grip dynamometer along with age-specific norms for both measurements. All subjects were provided exercise recommendations. Follow up surveys were conducted at 3, 6 and 12 months regarding their EVS and physical activity.

RESULTS

One thousand three hundred fifteen individuals (656 intervention, 659 control) were randomized with 1 year follow up data obtained from 823 subjects (62.5%). Baseline mean EVS was 213 min/week. No change in EVS was found in either group at follow-up (p = 0.99). Subjects who were less active at baseline (EVS < 150) did show an increase in EVS (86 to 146) at 6 months (p < 0.05). At 3 months the intervention group increased resistance training (29.1 to 42.8%) compared to controls (26.3 to 31.4%) (p < 0.05). Lifestyle physical activity increased in the intervention group at 3 months (27.7 to 29.1%) and 6 months (25%) whereas it declined in the control group at 3 months (24.4 to 20.1%) and 6 months (18.7%) (p < 0.05).

CONCLUSION

Providing VO2max estimates and grip strength did not produce an increase in overall physical activity. The EVS and exercise recommendations did however produce an increase in physical activity in less active individuals. In a very active population the VO2max estimate and measured grip strength did increase lifestyle activity and resistance training. Wider adoption of these measures could be effective in promoting physical activity and resistance training.

TRIAL REGISTRATION

clinicaltrials.gov NCT03518931 Registered 05/08/2018 -retrospectively registered.

Risk of hypertension into adulthood in persons born prematurely: a national cohort study

AIMS

Preterm birth has been associated with elevated blood pressure early in life; however, hypertension risks from childhood into adulthood remain unclear. We conducted a large population-based study to examine gestational age at birth in relation to hypertension risks from childhood into adulthood.

METHODS AND RESULTS

A national cohort study was conducted of all 4 193 069 singleton live births in Sweden during 1973-2014, who were followed up for hypertension identified from nationwide inpatient and outpatient (specialty and primary care) diagnoses from any health care encounters through 2015 (maximum age 43 years; median 22.5). Cox regression was used to examine gestational age at birth in relation to hypertension risk while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. In 86.8 million person-years of follow-up, 62 424 (1.5%) persons were identified with hypertension (median age 29.8 years at diagnosis). Adjusted hazard ratios for new-onset hypertension at ages 18-29 years associated with preterm (<37 weeks) and extremely preterm (22-27 weeks) birth were 1.28 [95% confidence interval (CI), 1.21-1.36] and 2.45 (1.82-3.31), respectively, and at ages 30-43 years were 1.25 (1.18-1.31) and 1.68 (1.12-2.53), respectively, compared with full-term birth (39-41 weeks). These associations affected males and females similarly and appeared substantially related to shared genetic or environmental factors in families.

CONCLUSIONS

In this large national cohort, preterm birth was associated with increased risk of hypertension into early adulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for the development of hypertension.

Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men

Aims

Cardiorespiratory fitness, muscular strength, and obesity in adulthood are risk factors for cardiovascular disease (CVD). However, little is known regarding the associations of these risk factors, already in adolescence, with later disability due to chronic CVD. Hence, we investigated associations of cardiorespiratory fitness, muscular strength, and body mass index (BMI) in adolescence with later chronic disability due to specific causes of CVD disability (i.e. cerebrovascular disease, ischaemic heart disease and heart failure).

Methods and results

This population-based cohort study included 1 078 685 male adolescents (16–19 years) from the Swedish military conscription register from 1972 to 1994. Cardiorespiratory fitness (bicycle ergometer test), muscular strength (knee extension strength), and BMI were measured during the conscription examination. Information about disability pension due to CVD was retrieved from the Social Insurance Agency during a mean follow-up of 28.4 years. Cardiorespiratory fitness was strongly and inversely associated with later risk of chronic CVD disability for all investigated causes. The association was particularly strong for ischaemic heart diseases (hazard ratio 0.11, 95% confidence interval 0.05–0.29 for highest vs. lowest fitness-quintiles). Furthermore, overweight/obesity were associated with CVD disability for all investigated causes. Conversely, associations of muscular strength with CVD disability were generally weak.

Conclusions

This study provides evidence for associations between low levels of cardiorespiratory fitness and obesity with later risk of chronic disability due to CVD. Preventive actions may begin at young ages and include promotion of cardiorespiratory fitness and healthy body weight.

Association Between Body Composition and Pulmonary Function Tests Among Health Care Workers in Iran

Background:

Why is bodyweight not a predictor of lung function, while height, sex, race, and age are predictors of lung capacity and function? In this study, we want to investigate the association between body composition and pulmonary function. And, as much as possible, answer the question of why bodyweight is not predictive of lung function.

Methods:

This cross-sectional study was performed among 2967 employees of Tehran University of Medical Sciences (TUMS) who participated in the TUMS Employees Cohort (TEC) study. The body composition of the participants was measured using the Bioelectrical Impedance Analysis (BIA) method. Anthropometric variables were also measured as a confounder. The pulmonary function of participants was assessed by a forced spirometry test.

Results:

The correlation of BIA values including fat-free mass and total body water with a pulmonary function such as FEV1, FVC, and FEF25-75is higher than most anthropometric values such as weight, wrist circumference, and the waist to hip ratio. Also, in regression analysis, age and sex had an association with pulmonary function, but the weight did not show a significant relationship. On the other hand, fat-free mass and visceral fat were significantly associated with pulmonary function. One is direct and the other is inverse.

Conclusion:

We observed a negative association between visceral fat and pulmonary function tests and a direct association between Fat-free mass pulmonary function tests (FEV1 and FVC) adjusted for age, sex, and anthropometric indices.

Age and aging effects on blood pressure: 15 years follow-up of Tehran lipid and glucose study

Age is a known predictor of blood pressure (BP); however, the literature mostly includes cross‐sectional investigations. This prospective cohort study aimed to decompose the cross‐sectional and longitudinal age effects on BP. The secondary data were obtained from the Tehran lipid and glucose study, which comprised six repeated measurements of participants, with median follow‐up of 15.8 (interquartile range of 14.2‐16.9) years. The sample is representative of the metropolitan area of Tehran, Iran, containing 7,460 participants aged 20‐70. The cross‐sectional and longitudinal effects of age (age at baseline and aging, respectively) were fitted in the mixed effects models, taking systolic, diastolic, and pulse BPs as response, adjusting for adiposity, smoking, diabetes, and antihypertensive medication, and stratifying for sex and 10‐year age‐groups. The mean age at baseline was 41.3 (SD = 12.9) years, and 41.7% of the participants were male. Age at baseline and aging were directly associated with BP, aging owned the weaker effect, and the largest distinction were for systolic blood pressure of men aged 40‐49 years (0.75 vs 0.10, p‐value < .001). Moreover, the aging effects on systolic and diastolic BPs were higher in men than women, in the age groups 40‐49 and 30‐39 years (0.35 vs 0.10 and 0.30 vs 0.07, p‐values < .001), respectively. Adjusting for adiposity remarkably declined the impact of aging on BP, among the < 50 years old.

The effect of pretreatment BMI on the prognosis and serum immune cells in advanced LSCC patients who received ICI therapy

This study aims to evaluate the prognosis and serum immune cells of patients with different pretreatment body mass index (BMI) values. The data of 61 newly diagnosed patients with advanced lung squamous cell carcinoma (LSCC) who received immune checkpoint inhibitors (ICIs) combined with chemotherapy were obtained from the database of Rizhao People's Hospital (Rizhao, Shandong). According to the cutoff value of BMI (23.2 kg/m2), 32 patients had a high BMI and the remaining 29 patients had a low BMI. The effects of different BMIs on the prognosis and serum immune cells of patients were analyzed. The median progression-free survival (PFS) times were 7.72 months in the high BMI group and 4.83 months in the low BMI group [adjusted hazard ratio (HR), 0.23; 95% confidence interval (CI), 0.11-0.48; P < .001]. In terms of the overall survival (OS), the median times of the high BMI group and low BMI group were 18.10 and 13.90 months, respectively (adjusted HR, 0.15; 95% CI, 0.07-0.32; P < .001). After 4 cycles of ICI therapy combined with chemotherapy, the objective response rate was 59.4% for the high BMI group and 20.7% for the low BMI group (P = .002). In addition, the number of serum immune cells in patients with high BMI was significantly higher than that in patients with low BMI (all P < .001). There was a linear relationship between BMI value and the number of serum immune cells (all R2 > 0.7). The current results showed that high BMI is associated with better prognosis in LSCC patients who received ICIs, which may be related to higher levels of serum immune cells.

Longitudinal association between physical activity and blood pressure, risk of hypertension among Chinese adults: China Health and Nutrition Survey 1991-2015

OBJECTIVES

To examine the effects of physical activity (PA) in adults with or without prehypertension at baseline on systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension risk by gender.

METHODS

A total of 5986 men and 6525 women (≥18 years old) without hypertension-related disease at baseline who attended surveys from China Health and Nutrition Survey (1991-2015) at least twice were selected. In terms of the nested data structure, three-level random intercept growth model and three-level logistic regression were used to estimate the relationship between the PA and SBP/DBP or hypertension risk.

RESULTS

The incidence of hypertension increased from 10.86% in 1991 to 20.34% in 2015, and the median of PA dropped from 408 MET·h/week in 1991 to 104 MET·h/week in 2015. After adjusting confounders, PA in the third and fourth quartiles decreased SBP (by 0.98 and 0.96 mm Hg, p < 0.05) and DBP (by 0.30 and 0.38 mm Hg, p < 0.05), and it reduced the odds of hypertension by 12 and 15% (p < 0.05), compared with PA in the lowest quartile. For normotensive women in the third quartile of PA and prehypertensive women in the fourth quartile of PA, the risk of hypertension was reduced 15 and 22%, compared with women in the lowest quartile of PA.

CONCLUSIONS

Physical activity should be improved to the relatively high level to be effective in controlling blood pressure. Normotensive women had an association between physical activity and SBP, DBP, and the risk of hypertension.

Increased nitro-oxidative stress toxicity as a major determinant of increased blood pressure in mood disorders

BACKGROUND

Hypertension, atherogenicity and insulin resistance are major risk factors of cardiovascular disorder (CVD), which shows a strong comorbidity with major depression (MDD) and bipolar disorder (BD). Activated oxidative and nitrosative stress (O&NS), inflammatory pathways, and increased atherogenicity are shared pathways underpinning CVD and mood disorders.

METHODS

The current study examined the effects of lipid hydroperoxides (LOOH), superoxide dismutase (SOD), nitric oxide metabolites (NOx), advanced oxidation protein products (AOPP), and malondialdehyde (MDA) on systolic (SBP) and diastolic (DBP) blood pressure in 96 mood disordered patients and 60 healthy controls.

RESULTS

A large part of the variance in SBP (31.6%) was explained by the regression on a z unit-weighted composite score (based on LOOH, AOPP, SOD, NOx) reflecting nitro-oxidative stress toxicity (NOSTOX), coupled with highly sensitive C-reactive protein, body weight and use of antihypertensives. Increased DBP was best predicted (23.8%) by body mass index and NOSTOX. The most important O&NS biomarkers predicting an increased SBP were in descending order of significance: LOOH, AOPP and SOD. Higher levels of the atherogenic index of plasma, HOMA2 insulin resistance index and basal thyroid-stimulating hormone also contributed to increased SBP independently from NOSTOX. Although there were no significant changes in SBP/DBP in mood disorders, the associations between NOSTOX and blood pressure were significant in patients with mood disorders but not in healthy controls.

CONCLUSIONS

Activated O&NS pathways including increased lipid peroxidation and protein oxidation, which indicates hypochlorous stress, are the most important predictors of an increased BP, especially in patients with mood disorders.

Associations Between Physical Activity and Incident Hypertension Across Strata of Body Mass Index: A Prospective Investigation in a Large Cohort of French Women

Background

High body mass index (BMI) and low physical activity are associated with increased risk of hypertension. Few studies have assessed their joint impact or the relation of physical activity and hypertension among individuals within a healthy BMI range. The objective of this study was to investigate the associations between physical activity and hypertension across strata of BMI.

Methods and Results

We used data from the E3N (Etude Epidémiologique de femmes de la Mutuelle Générale de l´Education) cohort, a French prospective study of women aged 40 to 65 years. We included participants who completed a diet history questionnaire and who did not have prevalent hypertension at baseline, resulting in a total of 41 607 women. Questionnaires assessed time spent undertaking various types of physical activity. Hypertension cases were self‐reported. Cox models were used to calculate hazard ratios (HRs) for physical activity. Associations were assessed over strata of BMI. Among the 41 607 included women, 10 182 cases of hypertension were identified in an average follow‐up time of 14.5 years. Total physical activity was associated with a lower hypertension risk in women within the high‐normal BMI range (BMI, 22.5–24.9) (HR_{Quartile 1–Quartile4}, 0.89; 95% CI, 0.79–0.99). An inverse relationship was observed between sports (HR_{sports >2 hours}, 0.87; 95% CI, 0.83–0.93), walking (HR_{walk >6.5 hours}, 0.94; 95% CI, 0.90–1.00), and gardening (HR_{gardening >2.5 hours}, 0.94; 95% CI, 0.89–0.99). Sports were associated with a reduced risk of hypertension in women with a healthy weight, but evidence was weaker in overweight/obese or underweight women.

Conclusions

Women with a healthy weight were those who could benefit most from practicing sports, and sports provided the largest risk reduction compared with other types of activity.

Early-Life Cardiorespiratory Fitness and Long-term Risk of Prostate Cancer

BACKGROUND

Adolescence is a period of rapid prostatic growth, yet is understudied for susceptibility for future risk of prostate cancer. We examined cardiorespiratory fitness (CRF) in late adolescence in relation to long-term prostate cancer risk.

METHODS

A population-based cohort study was conducted of all 699,125 Swedish military conscripts during 1972-1985 (97%-98% of 18-year-old men) in relation to risk of prostate cancer overall, aggressive prostate cancer, and prostate cancer mortality during 1998-2017 (ages 50-65 years). CRF was measured by maximal aerobic workload, and prostate cancer was ascertained using the National Prostate Cancer Register. Muscle strength was examined as a secondary predictor.

RESULTS

In 38.8 million person-years of follow-up, 10,782 (1.5%) men were diagnosed with prostate cancer. Adjusting for sociodemographic factors, height, weight, and family history of prostate cancer, high CRF was associated with a slightly increased risk of any prostate cancer [highest vs. lowest quintile: incidence rate ratio (IRR), 1.10; 95% CI, 1.03-1.19; P = 0.008], but was neither significantly associated with aggressive prostate cancer (1.01; 0.85-1.21; P = 0.90) nor prostate cancer mortality (1.24; 0.73-2.13; P = 0.42). High muscle strength also was associated with a modestly increased risk of any prostate cancer (highest vs. lowest quintile: IRR, 1.14; 95% CI, 1.07-1.23; P < 0.001), but neither with aggressive prostate cancer (0.88; 0.74-1.04; P = 0.14) nor prostate cancer mortality (0.81; 0.48-1.37; P = 0.43).

CONCLUSIONS

High CRF or muscle strength in late adolescence was associated with slightly increased future risk of prostate cancer, possibly related to increased screening, but neither with risk of aggressive prostate cancer nor prostate cancer mortality.

IMPACT

These findings illustrate the importance of distinguishing aggressive from indolent prostate cancer and assessing for potential detection bias.

Body Composition, Metabolic Health, and Functional Impairment among Adults Treated for Abdominal and Pelvic Tumors during Childhood

BACKGROUND

We aimed to characterize body composition, metabolic impairments, and physical performance among survivors of pediatric abdominal and pelvic solid tumors.

METHODS

Participants included 431 survivors of abdominal or pelvic tumors [median attained age = 29.9 (range: 18.7-55.1) years]. Relative lean mass and fat mass were assessed with dual X-ray absorptiometry. Metabolic outcomes [insulin resistance (IR), high-density lipoprotein (HDL), low-density lipoprotein, and triglycerides] were based on laboratory values and medication usage. General linear regression evaluated associations between treatment and lifestyle with body composition; binomial regression evaluated associations between body composition and metabolic outcomes and physical performance.

RESULTS

Lean mass was lower than values from the National Health and Nutrition Examination Survey (NHANES) in males (Z-score = -0.67 ± 1.27; P < 0.001) and females (Z-score = -0.72 ± 1.28; P < 0.001). Higher cumulative abdominal and pelvic radiation doses were associated with lower lean mass among males [abdominal: β = -0.22 (SE) ± 0.07; P = 0.002 and pelvic: β = -0.23 ± 0.07; P = 0.002] and females (abdominal: β = -0.30 ± 0.09; P = 0.001 and pelvic: β = -0.16 ± 0.08; P = 0.037). Prevalence of IR (40.6% vs. 33.8%; P = 0.006), low HDL (28.9% vs. 33.5%; P = 0.046), and high triglycerides (18.4% vs. 10.0%; P < 0.001) was increased among survivors relative to NHANES. Compared with survivors with normal/high lean mass and normal/low fat mass, survivors with normal/high lean mass and high fat mass had an increased risk of IR (P < 0.001), low HDL (P < 0.001), reduced quadriceps strength at 60°/second (P < 0.001) and 300°/second (P < 0.001), and reduced distance covered in the 6-minute walk (P < 0.01).

CONCLUSIONS

Abdominal/pelvic radiotherapy is associated with body composition changes that can adversely influence metabolic outcomes and performance status among survivors.

IMPACT

Interventions targeting body composition may facilitate management of cardiovascular disease risk in this population.

Reference values and secular trends for cardiorespiratory fitness in children and adolescents with obesity

AIM

To present specific reference values for cardiorespiratory fitness (CRF) in children with obesity and to analyse secular trends of CRF in the studied population.

METHODS

Cardiorespiratory fitness, the maximal oxygen uptake (VO₂ max), was estimated with the Åstrand-Rhyming submaximal bicycle test, in 705 Swedish children (356 girls, 8-20 years) with obesity according to the International Obesity Task Force (IOTF). Data were collected from 1999 to 2013. Secular trends, analysed with multiple linear regression, were adjusted for age, height and body mass index standard deviation score (BMI SDS).

RESULTS

All children had low CRF compared with normal weight standards but there was a marked variability of CRF in children with obesity, which was possible to quantify with the developed obesity specific CRF reference values. The mean value of absolute VO₂ max (L/min) increased with age and relative VO₂ max (mL/kg/min) decreased with age in both boys and girls. There was a negative secular trend in both sexes (P < .001).

CONCLUSION

These are the first obesity specific reference values of CRF in children enabling clinical evaluation in childhood obesity treatment. Cardiorespiratory fitness in children with obesity has declined the last decades, indicating that also within this vulnerable group physical activity has gone down.

Interaction between lipoprotein (a) levels and body mass index in first incident acute myocardial infarction

BACKGROUND

Possible interaction between Lipoprotein (a) (Lp(a)) and body mass index (BMI) was investigated with regard to the risk of first incident acute myocardial infarction (AMI).

METHODS

Cross-sectional study of 1522 cases with initial AMI and 1691 controls without coronary artery disease (CAD) were retrospectively analyzed using logistic regression model. Subjects were categorized based on Lp(a) and BMI and compared with regard to occurrence of AMI by calculating odds ratios (ORs) with 95% confidence intervals (CIs). A potential interaction between Lp(a) and BMI was evaluated by the measures of effect modification on both additive (Relative excess risk due to interaction, RERI) and multiplicative scales.

RESULTS

Compared with reference group (BMI < 24 kg/m² and in the first quintile of Lp(a)), multivariable-adjusted analysis revealed that ORs(95%CI) of AMI were 2.27(1.46-3.52) for higher BMI alone; 1.79(1.11-2.90), 1.65(1.05-2.60), 1.96(1.20-3.20) and 2.34(1.47-3.71) for higher Lp(a) alone across its quintiles; and 2.86(1.85-4.40), 3.30(2.14-5.11), 4.43(2.76-7.09) and 5.98(3.72-9.60) for both higher BMI and higher Lp(a), greater than the sum of the both risks each. Prominent interaction was found between Lp(a) and BMI on additive scale (RERI = 2.45 (0.36-4.54) at the fifth quintile of Lp(a)) but not on multiplicative scale.

CONCLUSIONS

This study demonstrates that BMI and Lp(a) levels are important factors affecting the risk of AMI. Significant interaction is found between Lp(a) and BMI in initial AMI on additive scale, indicating that Lp(a) confers greater risk for initial AMI when BMI is elevated. For those whose BMIs are inadequately controlled, Lp(a) lowering may be an option.

TRIAL REGISTRATION

This clinical study was not registered in a publicly available registry because this study was a retrospective study first started in 2015. Data are available via the correspondent.

Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome

: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.

Secular Trends of the Impact of Overweight and Obesity on Hypertension in Yi People: Yi Migrant Study, 1996-2015

Background

Rising hypertension prevalence, coupled with increasing overweight and obesity rates, has been observed in Yi people. Moreover, the growing blood pressure level among Yi people was mostly attributable to the continuous increase of body mass index (BMI). However, little is known about the trend of association between them.

Methods

Consequently, we investigated the impact of overweight/obesity on hypertension over three periods (1996, 2007-2008, 2015) using data from Yi Migrant Study (n = 8749). The Yi Migrant Study incorporated three successive cross-sectional studies which were implemented by the same team with consistent protocols.

Results

Compared with period 1 (1996), the influence of overweight/obesity on hypertension risk significantly increased in period 2 (2007-2008) and period 3 (2015); relative excess risk due to interaction (RERI) was 1.59 (95% CI: 0.12, 3.05) and 1.41 (95% CI: 0.30, 2.78), respectively. Meanwhile, the overweight/obese population in period 3 did not show hypertension risk higher than that in period 2 (RERI = 0.15; 95% CI: -0.76, 1.07). Additionally, we observed a continuously growing trend of hypertension risk among normal weight Yi people.

Conclusions

During the past two decades, there was a significant increase in the association between overweight/obesity and hypertension in Yi people, whereas the increasing trend has leveled off in more recent years. These findings suggest that overweight/obesity and hypertension are becoming more epidemic comorbidity over time. Interventions to prevent hypertension should focus not only on the overweight/obese population, but also on those with normal weight.

Disruption of Pressure-Induced Ca2+ Spark Vasoregulation of Resistance Arteries, Rather Than Endothelial Dysfunction, Underlies Obesity-Related Hypertension

Supplemental Digital Content is available in the text.

Obesity-related hypertension is one of the world’s leading causes of death and yet little is understood as to how it develops. As a result, effective targeted therapies are lacking and pharmacological treatment is unfocused. To investigate underlying microvascular mechanisms, we studied small artery dysfunction in a high fat–fed mouse model of obesity. Pressure-induced constriction and responses to endothelial and vascular smooth muscle agonists were studied using myography; the corresponding intracellular Ca²⁺ signaling pathways were examined using confocal microscopy. Principally, we observed that the enhanced basal tone of mesenteric resistance arteries was due to failure of intraluminal pressure-induced Ca²⁺ spark activation of the large conductance Ca²⁺ activated K⁺ potassium channel (BK) within vascular smooth muscle cells. Specifically, the uncoupling site of this mechanotransduction pathway was at the sarcoplasmic reticulum, distal to intraluminal pressure-induced oxidation of Protein Kinase G. In contrast, the vasodilatory function of the endothelium and the underlying endothelial IP-3 and TRPV4 (vanilloid 4 transient receptor potential ion channel) Ca²⁺ signaling pathways were not affected by the high-fat diet or the elevated blood pressure. There were no structural alterations of the arterial wall. Our work emphasizes the importance of the intricate cellular pathway by which intraluminal pressure maintains Ca²⁺ spark vasoregulation in the origin of obesity-related hypertension and suggests previously unsuspected avenues for pharmacological intervention.

Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association

Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.

Frequency of achieving a 'fit' cardiorespiratory fitness level and hypertension: a cohort study

OBJECTIVES

Although maintaining cardiorespiratory fitness is encouraged to reduce the risk of hypertension, the level at, and length of time for which, individuals need to maintain fitness remains unclear. We examined the association between the frequency of achieving the recommended fitness levels of the 'Physical Activity Reference for Health Promotion 2013' and the risk of hypertension among Japanese men.

METHODS

This cohort study was conducted in 6653 men without hypertension enrolled in 1986. Whether the participants' fitness level was equal to or exceeded the reference value (fit) or not (unfit) was determined. The frequency of achieving the recommended fitness level was calculated by counting the number of times the fitness level was achieved in 1980 through 1986. Incident hypertension was defined as the first visit with a SBP/DBP of at least 140/90 mmHg or self-reported antihypertensive medication use and was evaluated during annual health examinations from 1986 until 2009.

RESULTS

During the follow-up period, 3630 men developed hypertension. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing men with fit versus unfit at baseline was 0.79 (0.74-0.85). Moreover, the frequency of achieving the recommended fitness level was inversely associated with the incidence of hypertension. The risk of hypertension was lower among those who achieved three or more of the recommended levels (0.72 for three times to 0.62 for seven times).

CONCLUSION

Achieving the fitness level recommended in the Japanese guideline three or more times during a 6-year period can be beneficial for the risk reduction of hypertension.

The effect of body mass index and its interaction with family history on hypertension: a case-control study

Background

BMI is an indicator commonly used in the world to measure the weight and height of the body, it reflects the comprehensive outcome of acquired lifestyle; FH is a sign reflecting the main role of genetic factors. This study aimed to evaluate the effect of BMI and interaction with FH on hypertension risk in Shanghai adult population.

Methods

According to l:l matched pairs design, 342 cases and 342 controls were selected and investigated in this study, this study was performed in Shanghai, China. Participants received face-to-face questionnaire survey, anthropometric tests and laboratory examinations. Relevant indicators that reflect obesity including BMI and waist to hip ratio (WHR) were calculated. Multivariate logistic regression analysis was applied to explore the association between factors and hypertension risk. Interactive effect was evaluated by synergy index (SI), relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and the percentage of the interaction between the pure factors (PAP).

Results

Among 684 study participants aged 28–87 years old, the differences of mean age and height between case group and control group are no significant (p > 0.05), but the differences of mean of weight, WC, HC, BMI and WHR are significant (p < 0.001). The OR of FH on hypertension is 4.986 (95%CI: 2.832~ 8.877); the OR of BMI on hypertension is respectively: low weight is 1.528 (95%CI: 0.551~ 4.239), overweight is 3.333 (95%CI: 1.678~ 6.617) and obesity is 7.312 (95%CI: 3.556~ 15.035). The OR of interaction between FH and BMI to hypertension is 12.993 (95%CI: 7.426~22.734). SI is 1.90 (95% CI: 1.48~3.78), RERI is 5.67 (95% CI: 1.66~11.88), AP is 43.87% (95% CI: 12.84~91.88%), and PAP is 47.55% (95%CI: 13.91~99.58%). FH and BMI have positive interaction on hypertension. 43.87% of hypertension exposed to both FH and BMI was attributable to the interaction of them.

Conclusions

FH and BMI are significant higher risks of hypertension; with the increase of BMI, the risk of hypertension will increase more. FH and BMI have positive interaction with hypertension, the interaction is greater than the sum of two independent actions.

Fitness and Body Mass Index During Adolescence and Disability Later in Life: A Cohort Study

BACKGROUND

Low physical fitness, obesity, and the combination of the two in adolescence may be related to risk for disability in adulthood, but this has rarely been studied.

OBJECTIVE

To examine individual and combined associations of cardiorespiratory fitness and obesity in male adolescents with later receipt of a disability pension due to all and specific causes.

DESIGN

Population-based cohort study.

SETTING

Sweden.

PARTICIPANTS

1 079 128 Swedish adolescents aged 16 to 19 years who were conscripted into the military between 1972 and 1994.

MEASUREMENTS

Cardiorespiratory fitness and body mass index (BMI) were measured at conscription and were related to information on later receipt of a disability pension obtained from the Social Insurance Agency.

RESULTS

Over a median follow-up of 28.3 years, 54 304 men were granted a disability pension. Low cardiorespiratory fitness was strongly associated with later receipt of a disability pension due to all causes (hazard ratio, 3.74 [95% CI, 3.55 to 3.95] for lowest vs. highest fitness decile) and specific causes (psychiatric, musculoskeletal, injuries, nervous system, circulatory, and tumors). Obesity was associated with greater risk for receipt of a disability pension due to all and specific causes, with the greatest risks observed for class II and III obesity. Compared with being unfit, being moderately or highly fit was associated with attenuated risk for receipt of a disability pension across BMI categories.

LIMITATION

The cohort did not include women, had data on smoking and alcohol intake only in a subsample, and lacked repeated measures of exposures and covariates.

CONCLUSION

Low cardiorespiratory fitness, obesity, and the combination of the two were strongly associated with later chronic disability due to a wide range of diseases and causes. Although additional well-designed studies are required, these findings support the importance of high cardiorespiratory fitness and healthy body weight during adolescence to prevent later chronic disease.

PRIMARY FUNDING SOURCE

Karolinska Institutet.

Exercise Is Medicine: Primary Care Counseling on Aerobic Fitness and Muscle Strengthening

Patient counseling on physical fitness remains underutilized in primary care, despite its clinical and cost effectiveness. Most counseling interventions have focused on aerobic activity and neglected another vital component of physical fitness, muscle strengthening, which has recently been shown to be independently protective against cardiometabolic diseases and premature mortality. This article reviews the latest scientific evidence and makes recommendations toward a more comprehensive approach for promoting physical fitness in primary care. Given the high prevalence and wide-ranging health impacts of physical inactivity, counseling on physical fitness should be a standard part of wellness promotion and disease prevention and treatment for all patients. Interventions that include muscle strengthening will have a significantly greater impact on health outcomes than those focused on aerobic fitness alone. Counseling to promote both aerobic fitness and muscle strengthening is indicated for all patients, irrespective of body weight, and should begin early in life and continue across the life course.

Lifetime predictors of stroke in subjects without a diagnosis of hypertension: the aerobics center longitudinal study

BACKGROUND AND PURPOSE

Although several studies have assessed the importance of traditional risk factors in predicting stroke, none have concurrently addressed the stroke-predicting ability of these risk factors across the lifespan of subjects without a hypertension (HTN) diagnosis. Thus, this study aimed to assess the importance of blood-pressure-related risk indicators, cardiorespiratory fitness (CRF), weight status, diabetes mellitus (DM), and lifestyle factors as predictors of stroke in different stages of life among non-hypertensive subjects.

MATERIALS AND METHODS

This study was a long-term follow-up study including 33,254 men and 10,598 women from the Aerobics Center Longitudinal Study (ACLS) who were 18-100 years old and did not have a HTN diagnosis at baseline. Logistic regression models were constructed using forward selection procedures for each age category, with stroke occurrence as the dependent variable, and pulse pressure (PP), mean arterial pressure (MAP), systolic blood pressure (SBP), smoking status, CRF, drinking behavior, DM status, and weight status as potential predictors.

RESULTS

In total, 507 subjects had a stroke during an average follow-up period of 17 years (range=1-34 years). Logistic regression models showed that MAP values (P=0.043) in those aged 19-39 years; SBP (P<0.001), CRF (P=0.001), weight status (P=0.005), and alcohol consumption (P=0.001) in those 40-60 years old; and CRF (P=0.002), weight status (P=0.005), and DM status (P=0.037) in those over 60 years old were predictors of stroke.

CONCLUSION

These findings suggest that, among individuals without a baseline HTN diagnosis, classic modifiable risk factors for stroke change across different stages of life.

Comparison of adiposity indices in relation to prehypertension by age and gender: A community-based survey in Henan, China

BACKGROUND

To compare the efficiency of bioelectrical indices (visceral fat index [VFI], percentage body fat [PBF]) and anthropometric indices (body mass index, waist circumference, waist-to-height ratio, a body shape index ) in the relation to prehypertension (120-139/80-89 mm Hg) among the Chinese population.

METHODS

Using stratified multistage random sampling method, a general population-based sample of 11 175 adults in Henan province were selected from 2013 to 2015. The individuals were divided into three categories by blood pressure levels: normotension (<120 and 80 mm Hg), stage 1 prehypertension (120-129/80-84 mm Hg) and stage 2 prehypertension (130-139/85-89 mm Hg).

RESULTS

VFI and PBF tended to increase with age in men and women. However, for each age-specific group, men tended to have higher VFI than women (all P < 0.01) and women tended to have greater PBF (all P < 0.0001). The odds ratios (OR) and area under the receiver operating characteristic curves for prehypertension associated with adiposity indices declined with age. VFI and PBF showed higher standardized adjusted ORs for prehypertension in young (~40 years) men (VFI: 2.02-3.05; PBF: 1.82-2.80) and young women (VFI: 1.90-2.58; PBF:1.70-2.29). Moreover, based on Youden's index, VFI and PBF exhibited the superiority for identifying prehypertension in men (0.20-0.32) and women (0.31-0.39), respectively.

CONCLUSION

In summary, there was stronger association of VFI and PBF with prehypertension in men than in women, respectively, especially for young adults.