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Mohseni P, Khalili D, Djalalinia S, Mohseni H, Farzadfar F, Shafiee A, Izadi N. The synergistic effect of obesity and dyslipidemia on hypertension: results from the STEPS survey. Diabetol Metab Syndr 2024; 16:81. [PMID: 38566160 PMCID: PMC10988884 DOI: 10.1186/s13098-024-01315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Obesity and dyslipidemia are important risk factors for hypertension (HTN). When these two conditions coexist, they may interact in a synergistic manner and increase the risk of developing HTN and its associated complications. The aim of this study was to investigate the synergistic effect of general and central obesity with dyslipidemia on the risk of HTN. METHOD Data from 40,387 individuals aged 25 to 64 years were obtained from a repeated cross-sectional study examining risk factors for non-communicable diseases (STEPS) in 2007, 2011 and 2016. Body mass index (BMI) was calculated as a measure of general obesity and waist circumference (WC) as a measure of central obesity. Dyslipidemia was defined as the presence of at least one of the lipid abnormalities. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or current use of antihypertensive medication. To analyze the synergistic effect between obesity and dyslipidemia and HTN, the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated. A weighted logistic regression model was performed to estimate the odds ratios (ORs) for the risk of HTN. RESULTS The results showed an association between obesity, dyslipidemia and hypertension. The interaction between obesity and dyslipidemia significantly influences the risk of hypertension. In hypertensive patients, the presence of general obesity increased from 14.55% without dyslipidemia to 64.36% with dyslipidemia, while central obesity increased from 13.27 to 58.88%. This interaction is quantified by RERI and AP values of 0.15 and 0.06 for general obesity and 0.24 and 0.09 for central obesity, respectively. The corresponding SI of 1.11 and 1.16 indicate a synergistic effect. The OR also show that the risk of hypertension is increased in the presence of obesity and dyslipidemia. CONCLUSION Obesity and dyslipidemia are risk factors for HTN. In addition, dyslipidemia with central obesity increases the risk of HTN and has a synergistic interaction effect on HTN. Therefore, the coexistence of obesity and lipid abnormalities has many clinical implications and should be appropriately monitored and evaluated in the management of HTN.
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Affiliation(s)
- Parisa Mohseni
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hamideh Mohseni
- Islamic Azad University of Larestan, Lar, Islamic Republic of Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arman Shafiee
- School of Medicine, Alborz University of Medical Sciences, Alborz, Islamic Republic of Iran
| | - Neda Izadi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
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Ragavan RS, Ismail J, Evans RG, Srikanth VK, Kaye M, Joshi R, Thankappan KR, Chow CK, Riddell MA, Oldenburg B, Mahal A, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Maulik PK, Arabshahi S, Thrift AG. Combining general and central measures of adiposity to identify risk of hypertension: a cross-sectional survey in rural India. Obes Res Clin Pract 2023; 17:249-256. [PMID: 37142499 DOI: 10.1016/j.orcp.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
AIM In three socioeconomically diverse regions of rural India, we determined the optimal cut-offs for definition of overweight, the prevalence of overweight, and the relationships between measures of overweight and risk of hypertension. SUBJECTS AND METHODS Villages were randomly sampled within rural Trivandrum, West Godavari, and Rishi Valley. Sampling of individuals was stratified by age group and sex. Cut-offs for measures of adiposity were compared using area under the receiver operating characteristic curve. Associations between hypertension and definitions of overweight were assessed by logistic regression. RESULTS Of 11 657 participants (50 % male; median age 45 years), 29.8 % had hypertension. Large proportions were overweight as defined by body mass index (BMI) ≥ 23 kg/m2 (47.7 %), waist circumference (WC) ≥ 90 cm for men or ≥ 80 cm for women (39.6 %), waist-hip ratio (WHR) ≥ 0.9 for men or ≥ 0.8 for women (65.6 %), waist-height ratio (WHtR) ≥ 0.5 (62.5 %), or by BMI plus either WHR, WC or WHtR (45.0 %). All definitions of overweight were associated with hypertension, with optimal cut-offs being at, or close to, the World Health Organization (WHO) Asia-Pacific standards. Having overweight according to both BMI and a measure of central adiposity was associated with approximately twice the risk of hypertension than overweight defined by only one measure. CONCLUSIONS Overweight, as assessed by both general and central measures, is prevalent in rural southern India. WHO standard cut-offs are appropriate in this setting for assessing risk of hypertension. However, combining BMI with a measure of central adiposity identifies risk of hypertension better than any single measure. The risk of hypertension is significantly greater in those centrally and generally overweight than those overweight by a single measure.
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Affiliation(s)
- Rathina Srinivasa Ragavan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Jordan Ismail
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Matthew Kaye
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Rohina Joshi
- School of Population Health, UNSW, Sydney, Australia
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; Central University of Kerala, Kasaragod, India
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney and Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Ajay Mahal
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gomathyamma K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
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Wang Q, Song X, Du S, Du W, Su C, Zhang J, Zhang X, Jia X, Ouyang Y, Li L, Zhang B, Wang H. Multiple Trajectories of Body Mass Index and Waist Circumference and Their Associations with Hypertension and Blood Pressure in Chinese Adults from 1991 to 2018: A Prospective Study. Nutrients 2023; 15:751. [PMID: 36771457 PMCID: PMC9919034 DOI: 10.3390/nu15030751] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Body mass index (BMI) and waist circumference (WC) have been suggested to be involved in the etiology of hypertension. The present study aimed to determine multiple trajectories of BMI and WC, then examined their associations with the risks of hypertension and high blood pressure in Chinese adults. The study used China Health and Nutrition Survey data from 1991 to 2018. The sample included 9651 adults aged 18 years or older. We used group-based multi-trajectory modeling to identify trajectories. We estimated the relationships between the trajectories and the risks of hypertension with a Cox proportional hazards regression model and the trajectories' relationships with blood pressure levels with a generalized linear model. We identified four trajectories for each gender: low stable BMI, low increasing WC (group 1); medium increasing BMI, medium increasing WC (group 2); increasing BMI to overweight, increasing WC to central obesity (group 3), increasing BMI to obesity, increasing central obesity WC (group 4). Group 1 was the reference group. Among males in groups 2, 3, and 4, the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) of hypertension were 1.30 (1.15-1.48), 1.86 (1.58-2.18), and 2.60 (2.02-3.34), respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of males in group 4 increased by 11.90 mm of mercury (mmHg) and 7.75 mmHg, respectively. Among females in groups 2, 3, and 4, the HR and 95% CI of hypertension were 1.35 (1.18-1.54), 1.92 (1.62-2.26), and 2.37 (1.85-3.03), respectively. The SBP and DBP of females in group 4 increased by 8.84 mmHg and 5.79 mmHg, respectively. These data indicated that increases in BMI and WC were associated with unfavorable hypertension risks. Attention to both BMI and WC trajectories has the potential to prevent hypertension.
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Affiliation(s)
- Qi Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoyun Song
- Department of Food, School Hygiene, Dalian Centre for Disease Control and Prevention, Dalian 116035, China
| | - Shufa Du
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Wenwen Du
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chang Su
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiguo Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaofan Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaofang Jia
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yifei Ouyang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Li Li
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Bing Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Huijun Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Yang J, Wang X, Jiang S. Development and validation of a nomogram model for individualized prediction of hypertension risk in patients with type 2 diabetes mellitus. Sci Rep 2023; 13:1298. [PMID: 36690699 PMCID: PMC9870905 DOI: 10.1038/s41598-023-28059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) with hypertension (DH) is the most common diabetic comorbidity. Patients with DH have significantly higher rates of cardiovascular disease morbidity and mortality. The objective of this study was to develop and validate a nomogram model for the prediction of an individual's risk of developing DH. A total of 706 T2DM patients who met the criteria were selected and divided into a training set (n = 521) and a validation set (n = 185) according to the discharge time of patients. By using multivariate logistic regression analysis and stepwise regression, the DH nomogram prediction model was created. Calibration curves were used to evaluate the model's accuracy, while decision curve analysis (DCA) and receiver operating characteristic (ROC) curves were used to evaluate the model's clinical applicability and discriminatory power. Age, body mass index (BMI), diabetic nephropathy (DN), and diabetic retinopathy (DR) were all independent risk factors for DH (P < 0.05). Based on independent risk factors identified by multivariate logistic regression, the nomogram model was created. The model produces accurate predictions. If the total nomogram score is greater than 120, there is a 90% or higher chance of developing DH. In the training and validation sets, the model's ROC curves are 0.762 (95% CI 0.720-0.803) and 0.700 (95% CI 0.623-0.777), respectively. The calibration curve demonstrates that there is good agreement between the model's predictions and the actual outcomes. The decision curve analysis findings demonstrated that the nomogram model was clinically helpful throughout a broad threshold probability range. The DH risk prediction nomogram model constructed in this study can help clinicians identify individuals at high risk for DH at an early stage, which is a guideline for personalized prevention and treatments.
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Affiliation(s)
- Jing Yang
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, China
| | - Xuan Wang
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, China
| | - Sheng Jiang
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830017, China.
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Are the different cut-off points for sitting time associated with excess weight in adults? A population based study in Latin America. BMC Public Health 2023; 23:110. [PMID: 36647028 PMCID: PMC9841640 DOI: 10.1186/s12889-023-15029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Excess weight is increasing worldwide, and in Latin America more than half of the population is excess weight. One of the reasons for this increase has been excessive sitting time. Still, it remains to be seen whether there is an excessive amount of that time in Latin American adults. This study aimed to associate different sitting time cut-off points with the excess weight. METHODS Data from the Latin American Study of Nutrition and Health (ELANS), a cross-sectional population-based survey conducted in eight Latin American countries, were used. The excess weight indicators used were body mass index, and waist and neck circumferences. Sitting time was obtained using questionnaires and categorized at different cut-off points. Differences between sitting time categories (< 4 or ≥ 4; < 6 or ≥ 6; and < 8 or ≥ 8 hours/day) and excess weight were obtained by Student's t test for independent samples and the association between sitting time categories and different indicators of excess weight were obtained by logistic regression. RESULTS The median of the sitting time was 420 min/day (IQR: 240-600). There were no significant differences between body mass index (kg/m2) and waist circumference (cm) with categories of sitting time. The mean values of neck circumference (cm) were significantly higher in ≥4, ≥6 and ≥ 8 hours/day than < 4, < 6, and < 8 hours/day of sitting time in the pooled sample. Some distinct differences by country were observed. There were significant differences among excess weight by body mass index (63.2% versus 60.8) with < 8 vs ≥8 hours/day of sitting time. The proportion of excess weight by neck circumference was higher in participants who reported ≥4, ≥6, and ≥ 8 hours/day compared to < 4, < 6, and < 8 hours/day of sitting time. Considering ≥8 hours/day of sitting time, higher odds of excess weight were found evaluated by body mass index (OR: 1.10; 95% CI: 1.01, 1.20) and neck circumference (OR: 1.13; CI 95%: 1.03, 1.24) overall. CONCLUSIONS Sitting time above 8 hours/day was associated with higher odds of excess weight, even though there were no differences in waist circumference between sitting time categories. TRIAL REGISTRATION Clinical Trials NCT02226627. (27/08/2014).
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Wang Q, Song X, Du S, Du W, Su C, Zhang J, Zhang X, Zhang B, Wang H. Waist Circumference Trajectories in Relation to Blood Pressure and the Risk of Hypertension in Chinese Adults. Nutrients 2022; 14:5260. [PMID: 36558419 PMCID: PMC9782435 DOI: 10.3390/nu14245260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Central obesity is associated with a higher risk of hypertension. This study aimed to analyze waist circumference (WC) trajectories and discover their association with blood pressure and the risk of hypertension. The data were obtained from the China Health and Nutrition Survey (CHNS), with a sample of 11,885 adults aged 18 or older. Trajectory groups of WC were identified by group-based trajectory modeling. Three trajectory groups were identified in males: "normal-stable group" (group 1), "normal-increase to central obesity group" (group 2), and "central obesity-slight decrease group" (group 3). There were also three identified in females: "normal-increase to central obesity group" (group 1), "normal-stable group" (group 2), and "central obesity-increase group" (group 3). For males, compared with group 1, systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased by 2.47 mmHg and 2.13 mmHg, respectively, in group 2, and by 3.07 mmHg and 2.54 mmHg, respectively, in group 3. The adjusted hazard ratios (HR) and 95% confidence interval (95% CI) of hypertension in groups 2 and 3 were 1.16 (1.06-1.28) and 1.29 (1.10-1.50), respectively. For females, compared with group 2, SBP and DBP increased by 1.69 mmHg and 1.68 mmHg, respectively, in group 1, and by 4.96 mmHg and 2.77 mmHg, respectively, in group 3. The HR and 95% CI of hypertension in groups 2 and 3 were 1.21 (1.07-1.36) and 1.52(1.17-1.99), respectively. We found that the WC trajectory was a risk factor for hypertension and elevated blood pressure independent of basal WC. Increased risk of hypertension was nonlinearly associated with annual WC increase.
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Affiliation(s)
- Qi Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoyun Song
- Department of Food and School Hygiene, Dalian Centre for Disease Control and Prevention, Dalian 116035, China
| | - Shufa Du
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Wenwen Du
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chang Su
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiguo Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaofan Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Bing Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Huijun Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission of China, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Hu J, Jiang Y, Shen H, Ding L, Xu X, Wu W. What is the best anthropometry index to evaluate the risk of metabolic abnormalities in Chinese adults? Diabetes Metab Res Rev 2022; 38:e3580. [PMID: 36210641 DOI: 10.1002/dmrr.3580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
AIMS Obesity, defined by body mass index (BMI), is a heterogeneous condition with varying metabolic manifestations, and the best index for predicting metabolic abnormalities remains unclear. This study aimed to explore the most suitable anthropometry index for predicting metabolic abnormalities in Chinese adults. METHODS A cross-sectional study was conducted using the data obtained from 9517 Chinese adults who underwent physical examination, bioelectrical impedance analysis, and laboratory examinations between March 2018 and March 2022. Participants were further divided into eight subgroups according to age, BMI, and sex. Descriptive statistics were calculated, and the area under the receiver operating characteristic curve and Youden index values were calculated to identify the best predictor of metabolic abnormalities in Chinese adults. RESULTS The waist-to-height ratio (WHtR) had the largest area under the curve for predicting metabolic abnormalities in men of any age and women aged 18-49 years. However, BMI showed the highest accuracy in predicting metabolic abnormalities in women aged 50 years and older. Based on the highest Youden index, the optimal WHtR threshold was 0.51 in women and 0.53 in men. CONCLUSIONS The WHtR was the most effective index for predicting metabolic abnormalities in most Chinese adults, whereas BMI showed a higher accuracy only in elderly women. This observation supports WHtR as a novel adiposity marker for screening metabolic abnormalities and shows value for public health practice.
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Affiliation(s)
- Jun Hu
- Department of Health Management Center, Huadong Sanatorium, Jiangsu, China
| | - Yongbin Jiang
- Department of Health Management Center, Huadong Sanatorium, Jiangsu, China
| | - Hui Shen
- Department of Health Management Center, Huadong Sanatorium, Jiangsu, China
| | - Limin Ding
- Department of Health Management Center, Huadong Sanatorium, Jiangsu, China
| | - Xiaopao Xu
- Department of Health Management Center, Huadong Sanatorium, Jiangsu, China
| | - Wenjun Wu
- Department of Endocrinology, Wuxi People's Hospital, Jiangsu, China
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Al-Mohaissen M, Alkhedeiri A, Al-Madani O, Lee T, Hamdoun A, Al-Harbi M. Association of mammographic density and benign breast calcifications individually or combined with hypertension, diabetes, and hypercholesterolemia in women ≥40 years of age: a retrospective study. J Investig Med 2022; 70:1308-1315. [PMID: 35190487 PMCID: PMC9240332 DOI: 10.1136/jim-2021-002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/08/2022]
Abstract
Recent evidence has linked certain mammographic characteristics, including breast calcifications (Bcs) and mammographic density (MD), with atherosclerotic cardiovascular disease risk factors in women, but data are limited and inconsistent. We aimed to evaluate the association of MD and/or Bcs with hypertension, diabetes, and hypercholesterolemia in women ≥40 years of age. Through hospital electronic records, we retrospectively identified mammograms of non-pregnant women aged ≥40 years and without breast cancer and retrieved reports and relevant data. MD and Bcs were recorded; risk factor status was diagnosed based on treatment profile and clinical and laboratory data. In total, 1406 women were included. MD was inversely related to hypertension, diabetes, hypercholesterolemia, triglyceride levels, age, and body mass index (BMI) (p value for trend <0.001). Bcs were positively associated with hypertension, diabetes, hypercholesterolemia, age, BMI, and elevated creatinine (p<0.05). Controlling for age and BMI, MD category A (MD-A) was independently associated with hypercholesterolemia; Bcs were independently associated with diabetes. Combining MD-A with Bcs did not increase the odds significantly. Analysis for additive interactions revealed a significant interaction between MD-A and BMI, increasing the odds of hypertension, and a trend for increased odds of diabetes by adding MD-A and/or Bcs to BMI. Decreased MD and presence of Bcs are associated with hypertension, diabetes, and hypercholesterolemia in women ≥40 years of age. MD-A may represent a new obesity index independently associated with hypercholesterolemia and additive to hypertension risk. Bcs are independently associated with diabetes. Combining MD and Bcs did not improve the odds significantly, which may reflect mechanistic differences.
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Affiliation(s)
- Maha Al-Mohaissen
- Department of Clinical Sciences (Cardiology), College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Arwa Alkhedeiri
- Department of Radiology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ohoud Al-Madani
- Department of Research Informatics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Anas Hamdoun
- Department of Radiology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Mohammad Al-Harbi
- Department of Radiology, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
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9
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Tang N, Ma J, Tao R, Chen Z, Yang Y, He Q, Lv Y, Lan Z, Zhou J. The effects of the interaction between BMI and dyslipidemia on hypertension in adults. Sci Rep 2022; 12:927. [PMID: 35042940 PMCID: PMC8766602 DOI: 10.1038/s41598-022-04968-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022] Open
Abstract
Body mass index (BMI) and dyslipidemia are indicators of human health and are often associated with high blood pressure. In this study,we explored the relationship between BMI or dyslipidemia and the risk of hypertension and further verified the possible interacting influences of BMI with dyslipidemia on the risk of hypertension. The aim is to explore the possible risk factors of hypertension and to provide scientific basis for the prevention and treatment of hypertension. Eligible subjects were selected from a cross-sectional survey in Changsha City, and we collected relevant data and clinical indicators for each participant. Body mass index (BMI) was calculated as weight (kg)/height2 (m2), and divided into four categories according to the Chinese standard. Dyslipidemia is defined according to Chinese guideline. Unconditional logistic regression models were used for dichotomous variables to determine the risk or protective factors of dependent variables. Multivariate Logistic model was used to study the influence of BMI and dyslipidemia on hypertension. The following indicators were used to assess the interaction effects: (1) Relative excess risk due to interaction (RERI); (2) Attributable proportion due to interaction(AP); (3) Synergy index (SI). SPSS software was used for statistical analysis. A total of 2740 eligible participants were enrolled in the cross-sectional study, of which 765 subjects (27.9%) were diagnosed with hypertension. Multivariate Logistic model showed that overweight (OR: 1.70, 95%CI: 1.39–2.09) or obese (OR: 2.60, 95%CI: 1.84–3.66) subjects had a significantly higher risk of hypertension than normal weight people, and underweight was a protective factor for hypertension(OR: 0.52, 95%CI: 0.29–0.93). People with dyslipidemia have a higher risk of hypertension than those with normal lipids (OR: 3.05, 95%CI: 2.36–3.90). In addition,there was a significant potentiating interaction effect between overweight or obesity and dyslipidemia(overweight: RERI (1.91, 95%CI: 0.17–3.66), AP (0.40, 95%CI:0.14–0.66), SI (2.03, 95%CI:1.11–3.74) and obesity: RERI (2.20, 95%CI:1.01–3.40), AP (0.38, 95%CI:0.18–0.58), SI (1.84, 95%CI:1.18–2.89), while no interaction was found between underweight and dyslipidemia. Low body weight is an independent protective factor for hypertension, but overweight, obesity and dyslipidemia are risk factors for hypertension, and dyslipidemia significantly shared interactions with overweight and obesity that influenced the risk of hypertension.
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Affiliation(s)
- Na Tang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Jian Ma
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Rongqin Tao
- Tianxin District Center for Disease Control and Prevention, Changsha, 410009, Hunan, China
| | - Zhijun Chen
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Quanyuan He
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Yuan Lv
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Zelong Lan
- Tianxin District Center for Disease Control and Prevention, Changsha, 410009, Hunan, China.
| | - Junhua Zhou
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China.
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Dereje R, Hassen K, Gizaw G. Evaluation of Anthropometric Indices for Screening Hypertension Among Employees of Mizan Tepi University, Southwestern Ethiopia. Integr Blood Press Control 2021; 14:99-111. [PMID: 34295187 PMCID: PMC8291801 DOI: 10.2147/ibpc.s317018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally, hypertension is becoming a serious problem affecting the health and wellbeing of the adult population. Anthropometric indices like body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) have long been utilized to screen hypertension; in contrast, other evidence indicates the superior utility of waist-to-height ratio (WHtR) to screen hypertension. There are inconclusive results from different studies done in different settings regarding the best screening index for hypertension. In addition, there is a paucity of information on the evaluation of anthropometric indices for screening hypertension in the study area. Therefore, this study evaluates the utility of anthropometric indices for screening hypertension among Mizan Tepi University employees, southwestern Ethiopia. METHODS An institution-based cross-sectional study was conducted among Mizan Tepi University employees. A gender-based stratified simple random sampling technique was used to select 585 employees. Logistic regression analysis was conducted to assess the association between anthropometric indices and hypertension. Receiver operating characteristic curve (ROC) was employed to evaluate anthropometric indices for screening hypertension, and optimal cutoff points were also developed based on Youden index (sensitivity + specificity - 1) and presented with sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV). RESULTS The overall prevalence of hypertension was 20.9%, which was 22.5% in males and 18.7% in females. Among males, WHtR, WHR, and BMI were significantly associated with hypertension, while, in females, only BMI was associated with hypertension. WHtR had a higher screening ability for hypertension followed by WC in both sexes. For males, the cutoff point for WHR, WC, BMI, and WHtR for screening hypertension was 0.897, 85.17cm, 24.6kg/m2, and 0.51, respectively. In females, the cutoff point developed for screening hypertension for WHR, WC, BMI, and WHtR were 0.92, 85.67cm, 24.8kg/m2, and 0.52, respectively. CONCLUSION The waist-to-height ratio was found to be the best obesity index to screen hypertension than BMI, WC, and WHR. The finding supports the use of WHtR for screening hypertension in resource-limited settings.
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Affiliation(s)
- Rahel Dereje
- Department of Nutrition and Dietetics, Institute of Health Science, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- School of Public Health, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Kalkidan Hassen
- Department of Nutrition and Dietetics, Institute of Health Science, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Getu Gizaw
- Department of Nutrition and Dietetics, Institute of Health Science, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Zhang B, Fan Y, Wang Y, Zhang L, Li C, He J, Guo P, Zhang M, Zhang M. Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults. BMC Cardiovasc Disord 2021; 21:291. [PMID: 34116640 PMCID: PMC8196495 DOI: 10.1186/s12872-021-02100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Few studies have compared bioelectrical body and visceral fat indices with anthropometric measures, or evaluated their optimal cutoffs in relation to hypertension among Asians. We compared the efficiencies of bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for hypertension and re-evaluated the optimal cutoffs of each index by age and gender. Methods We conducted a cross-sectional survey among 8234 adults for health examination. PBF, VFA, BMI, WHR, and data on hypertension and behaviors were collected. Receiver operating characteristic (ROC) curve and areas under curves (AUCs) were used to analyze the efficiencies of the indices for hypertension, optimal cutoffs were estimated using the Youden index. Results A total of 8234 individuals aged 21–91 with median age 44 (interquartile range [IQR] 33–56) years were included and 40.56% were men. The overall prevalence of hypertension was 27.47%. The studied indices were all associated with hypertension in all age-specific groups both among men and women except for WHR in 21–29 years old men and PBF in in 21–29 years old women. Among males, there were no statistical differences in powers of four indices for hypertension in all age-specific groups, except for 40–49 years, in which WHR was better than VFA. Among females, no differences were found among the indices in 30–39 and 70–79 years groups, while WHR was the best in 21–29 years group, VFA was better than PBF in 30–39 and 50–59 years groups, BMI was better than PBF and WHR in 60–69 years group. The optimal cutoffs of PBF, VFA, BMI and WHR ranged from 23.9 to 28.7%, 86.4 to 106.9cm2, 23.5 to 27.1 kg/m2, 0.92 to 0.96 across the age categories in males, and 32.8 to 36.3%, 75.9 to 130.9cm2, 21.9 to 26.4 kg/m2, 0.84 to 0.95 across the age categories in females, respectively. Conclusions The obesity indices’ efficiencies for hypertension varied by age and gender, and their cutoff values varied across the age categories and gender. Specific indices and cutoffs based on person’s age and gender should be used to identify individuals with hypertension.
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Affiliation(s)
- Binbin Zhang
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Yaqi Fan
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Yuxue Wang
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Li Zhang
- Tianjin First Central Hospital, Tianjin, China
| | - Chunjun Li
- Tianjin Union Medical Center, Tianjin, China
| | - Jiangshan He
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Pei Guo
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China
| | - Mianzhi Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Minying Zhang
- School of Medicine, Nankai University, 94, Weijin Road, Tianjin, 300071, China.
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Naghipour M, Joukar F, Salari A, Asgharnezhad M, Hassanipour S, Mansour-Ghanaei F. Epidemiologic Profile of Hypertension in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS). Ann Glob Health 2021; 87:14. [PMID: 33614420 PMCID: PMC7879995 DOI: 10.5334/aogh.3027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Estimates region-related prevalence of hypertension and attempts to identify its related factors at the district levels are required for prevention and management of hypertension. Objective The aim of this study was to investigate the epidemic features and related factors of hypertension and its awareness, treatment, and control rates among the northern Iranian population. Methods It was a community based cross-sectional study based on data from PERSIAN Guilan Cohort Study (PGCS). In total, 10,520 participants (aged 35-70 years) from the Guilan Province in northern Iran included in this study, between October 8, 2014, and January 20, 2017. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or a prior diagnosis of hypertension or being on antihypertensive medication. Potential correlates of hypertension and its awareness, treatment and control were analyzed by multivariate logistic regression adjusted for demographic factors, anthropometric characteristics, lifestyle variables, past medical history, and laboratory data. Results The prevalence of hypertension was 43.2% and the hypertension awareness, treatment, and control rate were 53.4%, 49.8%, and 73.7%, respectively. The multivariate logistic regression analyses revealed that older age, urbanization, lower education, overweight and obesity, lower physical activity, prediabetes and diabetes, cardiovascular disease, psychiatric disorder, positive family history of hypertension and raised serum creatinine were independently associated with presence of hypertension. Awareness of hypertension was greater in the female sex, older age, rural residency, higher education and patient with comorbidities. Older age, rural residency and comorbidities were associated with treatment of hypertension. Control of hypertension was better among younger age, higher education, normal weight and higher physical activity. Conclusion Hypertension is highly prevalent in the northern Iranian population. About half of affected persons are unaware of their disease and untreated. Modifying risk factors (such as weight lose and increase physical activity) and increasing hypertension awareness (by screening) is essential for primary and secondary prevention of high blood pressure in this population, especially in urban areas and among males, younger ages, and less educated.
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Affiliation(s)
- Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Asgharnezhad
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Guo X, Ding Q, Liang M. Evaluation of Eight Anthropometric Indices for Identification of Metabolic Syndrome in Adults with Diabetes. Diabetes Metab Syndr Obes 2021; 14:1431-1443. [PMID: 33833536 PMCID: PMC8019619 DOI: 10.2147/dmso.s294244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Several previous reports have highlighted the association between adiposity and risk of metabolic syndrome (MetS). Although it is necessary to identify which adiposity indices are best suited to identify MetS, no such study has been completed in diabetic patients. The aim of this study was to evaluate the ability of eight anthropometric indices to identify MetS in diabetic, middle-aged and elderly Chinese patients. PATIENTS AND METHODS A cross-sectional study was conducted in 906 type 2 diabetic patients in Guangxi. RESULTS The highest odds ratios for the identification of MetS were identified with CUN-BAE (OR = 28.306). The largest areas under the curve (AUCs) were observed for WHtR and BRI in men aged 40-59; CUN-BAE in men aged 60 and over; WHtR, BRI, and TyG in women aged 40-59; and BMI for women aged 60 and over. The weakest indicator for the screening of MetS in type 2 diabetes was the ABSI. CONCLUSION The most effective anthropometric indicator for the identification of MetS varied across sex and age subgroups.
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Affiliation(s)
- Xintong Guo
- Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
| | - Qinpei Ding
- Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
| | - Min Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, People’s Republic of China
- Correspondence: Min Liang Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of ChinaTel +138-7883-8907 Email
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Głuszek S, Ciesla E, Głuszek-Osuch M, Kozieł D, Kiebzak W, Wypchło Ł, Suliga E. Anthropometric indices and cut-off points in the diagnosis of metabolic disorders. PLoS One 2020; 15:e0235121. [PMID: 32569336 PMCID: PMC7307766 DOI: 10.1371/journal.pone.0235121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/09/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Identifying metabolic disorders at the earliest phase of their development allows for an early intervention and the prevention of serious consequences of diseases. However, it is difficult to determine which of the anthropometric indices of obesity is the best tool for diagnosing metabolic disorders. The aims of this study were to evaluate the usefulness of selected anthropometric indices and to determine optimal cut-off points for the identification of single metabolic disorders that are components of metabolic syndrome (MetS). DESIGN Cross-sectional study. PARTICIPANTS We analyzed the data of 12,328 participants aged 55.7±5.4 years. All participants were of European descent. PRIMARY OUTCOME MEASURE Four MetS components were included: high glucose concentration, high blood triglyceride concentration, low high-density lipoprotein cholesterol concentration, and elevated blood pressure. The following obesity indices were considered: waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), body fat percentage (%BF), Clínica Universidad de Navarra-body adiposity estimator (CUN-BAE), body roundness index (BRI), and a body shape index (ABSI). RESULTS The following indices had the highest discriminatory power for the identification of at least one MetS component: CUN-BAE, BMI, and WC in men (AUC = 0.734, 0.728, and 0.728, respectively) and WHtR, CUN-BAE, and WC in women (AUC = 0.715, 0.714, and 0.712, respectively) (p<0.001 for all). The other indices were similarly useful, except for the ABSI. CONCLUSIONS For the BMI, the optimal cut-off point for the identification of metabolic abnormalities was 27.2 kg/m2 for both sexes. For the WC, the optimal cut-off point was of 94 cm for men and 87 cm for women. Prospective studies are needed to identify those indices in which changes in value predict the occurrence of metabolic disorders best.
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Affiliation(s)
- Stanisław Głuszek
- Institute of Medical Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
| | - Elzbieta Ciesla
- Institute of Health Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
| | - Martyna Głuszek-Osuch
- Institute of Health Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
| | - Dorota Kozieł
- Institute of Health Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Kiebzak
- Institute of Health Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
| | - Łukasz Wypchło
- Institute of Medical Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
| | - Edyta Suliga
- Institute of Health Sciences, Medical College, Jan Kochanowski University, Kielce, Poland
- * E-mail:
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Tumwesigye NM, Mutungi G, Bahendeka S, Wesonga R, Katureebe A, Biribawa C, Guwatudde D. Alcohol consumption, hypertension and obesity: Relationship patterns along different age groups in Uganda. Prev Med Rep 2020; 19:101141. [PMID: 32685360 PMCID: PMC7358719 DOI: 10.1016/j.pmedr.2020.101141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022] Open
Abstract
Hypertension prevalence ratios don’t rise with age groups among frequent drinkers. Alcohol consumption pattern partly modifies the age-hypertension relationship. Alcohol consumption pattern does not modify obesity-age relationship.
The prevalence of non-communicable diseases including hypertension and obesity is rising and alcohol consumption is a predisposing factor. This study explored the effect of alcohol consumption patterns on the hypertension-age group and obesity-age group relationships. The data were extracted from the 2014 National NCD Survey of adults aged 18–69 years. Hypertension was defined as a condition of having systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg while obesity was defined as having a body mass index ≥30 kg/m2. Frequent alcohol consumption was measured as alcohol use ≥3 times a week. Multivariable log binomial regression analysis was used to assess independent relationship between the outcomes and alcohol consumption. The prevalences of hypertension, frequent alcohol consumption and obesity increased across age groups but were divergent towards last age group. Hypertension prevalence ratios were higher with higher age groups among moderate and nondrinkers but not among frequent drinkers. Alcohol drinking pattern modified the age hypertension relationship in a model with ungrouped age. The drinking pattern did not modify obesity-age relationship. Alcohol consumption pattern appeared to modify the hypertension-age group relationship. However, more research is needed to explain why prevalence ratios are higher with higher age groups among moderate drinkers and abstainers while they stagnate among the frequent drinkers. There was no evidence to show the effect of alcohol consumption on obesity-age group relationship.
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Affiliation(s)
| | - Gerald Mutungi
- Control of Non-communicable Diseases Desk, Ministry of Health, Kampala, Uganda
| | - Silver Bahendeka
- Department of Internal Medicine St. Francis Hospital Nsambya, Kampala, Uganda
| | - Ronald Wesonga
- School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Agaba Katureebe
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Uganda
| | - Claire Biribawa
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Uganda
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Buawangpong N, Pinyopornpanish K, Jiraporncharoen W, Dejkriengkraikul N, Sagulkoo P, Pateekhum C, Angkurawaranon C. Incorporating the patient-centered approach into clinical practice helps improve quality of care in cases of hypertension: a retrospective cohort study. BMC FAMILY PRACTICE 2020; 21:108. [PMID: 32532206 PMCID: PMC7293111 DOI: 10.1186/s12875-020-01183-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treating hypertensive patients by integrating the patient-centered approach would influence the practice and outcome of treatment. Our purpose was to determine whether the implementation of a patient-centered approach in health care delivery can improve adhering to guidelines and the quality-of-care. METHODS A retrospective study was conducted using secondary data from the electronic medical records of the patients treated in the two primary care outpatient settings at the Family Medicine (FM) and Social Security (SS) clinics. A key feature of the FM clinic is the incorporation of a patient-centered approach in its service delivery. Individual information regarding initial assessment and treatment at the follow-up visits was reviewed for 1 year. Comparison of adherence to treatment guidelines between the two primary care clinics was performed by using chi-square, Fisher's exact test or a t-test. To explore the difference in blood pressure and BP control between the two clinics, linear and logistic regression analysis respectively were performed with an adjustment for CV risk score in 2016 as a key confounder. RESULTS The evidence included 100 records from each clinic, showed variation between the two primary care sites. The FM clinic had more complete records regarding family history of hypertension, assessment for secondary causes, prescription for lifestyle modification and appropriate adjustment of medication. Higher levels of blood pressure control were recorded in the FM clinic, specifically systolic pressure 2.92 mmHg (p = 0.073) and diastolic pressure 5.38 mmHg (p < 0.001) lower than those recorded in the SS clinic. There was a 2.96 times higher chance for BP goals to be achieved in patients in receipt of hypertensive care at the FM clinic (p = 0.004). CONCLUSIONS Adopting a patient-centered approach in service delivery could improve the quality of care for hypertension patients in primary care in Thailand.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Pakorn Sagulkoo
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Chanapat Pateekhum
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200 Thailand
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Kawamoto R, Kikuchi A, Akase T, Ninomiya D, Kumagi T. Usefulness of waist-to-height ratio in screening incident hypertension among Japanese community-dwelling middle-aged and elderly individuals. Clin Hypertens 2020; 26:9. [PMID: 32467773 PMCID: PMC7227084 DOI: 10.1186/s40885-020-00142-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/13/2020] [Indexed: 02/08/2023] Open
Abstract
Background The incidence of hypertension is increasing worldwide and obesity is one of the most significant risk factors. Obesity can be defined by various anthropometric indices such as body mass index (BMI), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR). This study examined a range of anthropometric indices and their relationships with hypertension. Methods This study included 768 men aged 70 ± 10 years and 959 women aged 70 ± 8 years from a rural village. The relationship between anthropometric indices (BMI, WHpR, and WHtR) and hypertension was examined using cross-sectional (baseline, N = 1727) and cohort data (follow-up, N = 419). Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in both genders. Logistic regression models were used to evaluate WHtR as a significant predictor of hypertension. Results In the cross-sectional study, WHtR, BMI, and WHpR showed significant predictive abilities for hypertension in both genders, with WHtR showing the strongest predictive ability. Also, in the cohort study, WHtR showed a significant predictive ability for incident hypertension in both genders, and, for women, BMI as well as WHtR had also predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.53 (sensitivity, 44.3%; specificity, 80.2%) for men and 0.54 (sensitivity, 60.9%; specificity, 68.6%) for women. In the cohort study, the optimal WHtR values were 0.47 (sensitivity, 85.4%; specificity, 39.8%) for men and 0.51 (sensitivity, 66.7%; specificity, 58.2%) for women. Conclusions The results suggest that WHtR is a useful screening tool for hypertension among Japanese middle-aged and elderly community-dwelling individuals.
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Affiliation(s)
- Ryuichi Kawamoto
- 1Department of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Japan.,Department of Internal Medicine, Seiyo Municipal Nomura Hospital, 9-53 Nomura, Nomura-cho, Seiyo-City, Japan
| | - Asuka Kikuchi
- 1Department of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Japan.,Department of Internal Medicine, Seiyo Municipal Nomura Hospital, 9-53 Nomura, Nomura-cho, Seiyo-City, Japan
| | - Taichi Akase
- 1Department of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Japan.,Department of Internal Medicine, Seiyo Municipal Nomura Hospital, 9-53 Nomura, Nomura-cho, Seiyo-City, Japan
| | - Daisuke Ninomiya
- 1Department of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Japan.,Department of Internal Medicine, Seiyo Municipal Nomura Hospital, 9-53 Nomura, Nomura-cho, Seiyo-City, Japan
| | - Teru Kumagi
- 1Department of Community Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Japan
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Associated Factors of Hypertension in Women and Men in Vietnam: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234714. [PMID: 31779236 PMCID: PMC6926662 DOI: 10.3390/ijerph16234714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 12/27/2022]
Abstract
Background: Hypertension is a direct cardiovascular disease risk. It causes a heavy burden on the healthcare system globally. We aim to assess hypertension occurrence and its associated factors among women and men in Vietnam. Methods: A cross-sectional study was conducted from January to February 2019 on 2203 community-dwelling women and men aged 18 years or above. Participants’ characteristics, comorbidity, behaviors, and physical measures were evaluated. Hypertension was classified as systolic/diastolic blood pressure ≥140/90 mmHg or using antihypertensive medication. We analyzed data using logistic regression models. Results: The prevalence of hypertension was 24.3% (20.9% in women, 29.1% in men). For women, older age (odds ratio, OR, 6.80–12.41; p < 0.001), income above the poverty line (OR, 0.64; p = 0.008), diabetes comorbid (OR, 2.98; p < 0.001), added salts consumption (OR, 1.80; p < 0.001), overweight/obesity (OR, 1.64; p = 0.005), abdominal obesity (OR, 2.07; p < 0.001) were associated with hypertension. For men, older age (OR, 2.67–5.92; p < 0.001), diabetes comorbid (OR, 2.25; p = 0.010), smoking (OR, 1.38; p = 0.046), and overweight/obesity (OR, 2.18; p < 0.001) were associated with hypertension. Conclusions: Hypertension is prevalent in Vietnamese people. The associated factors of hypertension are varied by gender.
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Nguyen Ngoc H, Kriengsinyos W, Rojroongwasinkul N, Aekplakorn W. Association of Adiposity Indices with Hypertension in Middle-Aged and Elderly Thai Population: National Health Examination Survey 2009 (NHES-IV). J Cardiovasc Dev Dis 2019; 6:E13. [PMID: 30871270 PMCID: PMC6463150 DOI: 10.3390/jcdd6010013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/19/2019] [Accepted: 03/08/2019] [Indexed: 12/11/2022] Open
Abstract
Obesity in terms of excess fat mass is associated with increased morbidity, disability and mortality due to obesity-related disorders, including hypertension. Many hypertensive individuals are overweight and often receive their advice to lose weight related to body-fat, in order to lower their blood pressure. However, it is still unclear whether there is a strong association of adipose tissue measured by adiposity indicators with hypertension in the Thai population. Various adiposity indices have been published to distinguish the distribution of body fat with disparate properties. This study examined nine adiposity markers and their association with hypertension in 15,842 Thai adults ≥35 years old. Data were obtained from the nationwide Thai National Health Examination Survey 2009. Accuracy performance and associations of indexes with hypertension were analyzed by Area Under Curve (AUC) and logistic regression analyses. Regardless of gender, the best methods to distinguish performance were waist-to-height ratio (WHtR) [AUC: 0.640 (0.631⁻0.649)], followed by lipid accumulation product (LAP) [AUC: 0.636 (0.627⁻0.645)], waist circumference (WC) [AUC: 0.633 (0.624⁻0.641)], and Conicity index (C-Index) [AUC: 0.630 (0.621⁻0.639)]. Linear regression analysis exhibited the independent association of the top four indices, WC, WHtR, C-Index, and LAP with higher systolic and diastolic blood pressure. Those indices' quartiles were graded in a dose-response manner which significantly increased at the higher quartiles. The indicator's cutoff point carried the odds ratio of presence hypertension in the range of 1.7 to 2.5 (p < 0.001). Among the nine obesity indices, WHtR (cutoff >0.52) in both genders was the simplest and most practical measurement for adiposity in association with hypertension in middle-aged and elderly Thais.
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Affiliation(s)
- Hung Nguyen Ngoc
- Institute of Nutrition, Mahidol University, Nakhon Pathom 73170, Thailand.
| | | | | | - Wichai Aekplakorn
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
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