Association Between Waist Circumference and the Prevalence of (Pre) Hypertension Among 27,894 US Adults

A prospective study of comparing waist circumference and BMI as predictors for the kidney damage progression

OBJECTIVE

Chronic kidney disease (CKD) is irreversible and linked with various adverse health outcomes and diminished quality of life. Although obesity is recognized as a risk factor for the progression of kidney damage, reliance solely on body mass index (BMI) to measure obesity has been increasingly questioned. The use of other indicators that reflect more on abdominal adiposity like waist circumference (WC) have been proposed. This study aims to determine whether WC can serve as an alternative predictor of kidney damage progression.

METHODS

This prospective study enrolled individuals with normal kidney function during their annual health checkups from April 2016 to March 2019. Data on BMI, WC, WC-related devices, health-related lifestyle, and comorbidities were collected at baseline. WC was categorized using various definitions and analyzed for its association with the risk of kidney damage progression, taking into account BMI categories. The participants were monitored until March 2023 to observe kidney damage progression.

RESULTS

Out of the 4,129 participants, WC showed a higher risk of kidney damage progression in males (HR=1.01-1.39, p-value<0.05). These associations were not observed in females. After adjusting for BMI categories, the associations disappeared. Males in the overweight BMI category, defined as a BMI ≥ 25 kg/m2, showed a significantly increased risk of kidney damage progression (HR = 1.69, p-value < 0.0001).

CONCLUSIONS

The findings indicate that waist circumference significantly affects the progression of kidney damage in males. However, the study also reaffirms BMI as a dependable predictor of kidney damage. It underscores the importance of maintaining normal ranges for both BMI and waist circumference to reduce the risk of progressing kidney damage.

Retrospective and longitudinal study of blood pressure in school-aged children

BACKGROUND

Pediatric hypertension (HTN) is increasing over time. Worldwide, the blood pressure (BP) trend has been poorly studied. The aim of our study is to evaluate the recent trend in BP in a school-aged children sample, and to search for factors that might influence BP variability.

MATERIALS AND METHODS

This is a retrospective longitudinal analysis studying the BP of school-aged children covering the classes of 2013-2021. From medical records of the children, sex, date of birth, date of medical visit which takes place every two years (in the 6th, 8th, and 10th grade), height (in cm), weight (in kg), systolic blood pressure (SBP), and diastolic blood pressure (DBP), were collected for each child.

RESULTS

The sample consisted of 2164 children. SBP and DBP were significantly lower in girls than in boys and were significantly correlated with body mass index (BMI) (p-value <0.001 for all comparisons). A significant increase in SBP and DBP was observed from the 6th to the 10th grade, as well as a significant decrease of BP during a nine-year follow-up (p-values <0.001 for all comparisons).

CONCLUSION

Our results confirmed a sex difference in BP, an increase in BP with age and a positive association between BMI and BP. Finally, a negative secular trend for BP was found. Further studies are needed to determine if this decrease in BP with time will persist after the coronavirus disease 19 pandemic.

The association between ten anthropometric measures and osteoporosis and osteopenia among postmenopausal women

Osteoporosis and osteopenia pose substantial public health challenges, particularly among postmenopausal women. Although various anthropometric measures have been proposed for risk assessment, their predictive performance and nonlinear relationships with bone outcomes remain unclear. We analyzed data from six consecutive cycles (2007-2018) of the National Health and Nutrition Examination Survey (NHANES). A total of 4473 postmenopausal women aged ≥ 50 years were included, each classified as having normal bone density, osteopenia, or osteoporosis based on dual-energy X-ray absorptiometry measurements. Ten anthropometric indices-waist-to-height ratio (WTHR), conicity index (CI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product, visceral adiposity index, cardiometabolic index, atherogenic index of plasma, weight-adjusted-waist index (WWI), and triglyceride-glucose (TyG) index-were examined using multiple logistic regression, restricted cubic spline curves, threshold-effect analyses, and SHAP (SHapley Additive exPlanations) analysis to assess their associations with osteoporosis and osteopenia. In fully adjusted models, individuals with higher WTHR, CI, BRI, WWI, and TyG tended to have a lower likelihood of osteoporosis or osteopenia (p < 0.01), whereas those with elevated ABSI were more likely to be diagnosed with these conditions (p < 0.01). Notably, several indices showed nonlinear effects on bone outcomes. Receiver operating characteristic (ROC) analyses indicated that WTHR and BRI had the highest discriminative capacity for differentiating osteoporosis from osteopenia. SHAP analysis further highlighted WTHR and BRI as the most influential predictors. WTHR and BRI demonstrated strong predictive utility for osteoporosis and osteopenia, suggesting their potential as noninvasive, cost-effective screening metrics for postmenopausal bone health. These findings provide insight into the varying roles of central and general obesity indicators in bone density and underscore the importance of incorporating novel anthropometric indices into early-stage risk assessment.

Abdominal fat accumulation increases the risk of high blood pressure: evidence of 47,037 participants from Chinese and US national population surveys

AIMS

This study aims to ascertain whether abdominal fat accumulation evaluated by waist circumference increases the risk of hypertension using the nationwide population.

METHODS

We enrolled 47,037 participants from the China Health and Nutrition Survey (CHNS), China Health and Retirement Longitudinal Study (CHARLS), and National Health, and Nutrition Examination Survey (NHANES). The adjusted logistic regression model was used to examine the relationship between waist circumference and prevalent hypertension. 9445 participants without baseline hypertension from the CHNS and CHARLS were followed up to investigate the association between waist circumference and onset hypertension. The association was evaluated using a Cox regression model and restricted cubic spline. Furthermore, Mendelian randomization was employed to explore causal inferences.

RESULTS

In the baseline survey, waist circumference demonstrated a notable correlation with hypertension, presenting an odds ratio (with 95% confidence intervals) of 1.34 (1.28 ~ 1.40). After a mean follow-up of 3.8 years for participants without baseline hypertension, 2,592 (27.5%) developed hypertension. In the pooled analysis, the Cox regression showed that every 10 cm increase in waist circumference was associated with 20% (95% CI: 13% ~ 27%) elevated risk of new-onset hypertension. Restricted cubic splines indicated a pronounced linear dose-response relationship. A subgroup analysis affirmed the persisting association between waist circumference and hypertension onset even in those with normal BMI. The Mendelian randomization method revealed a significant causative association between waist circumference and hypertension.

CONCLUSION

Elevated waist circumference stands as an independent risk factor for hypertension, even in those with normal BMI. Our results provide evidence supporting the routine measure for waist circumference.

Body shape index (ABSI), body roundness index (BRI) and risk factors of metabolic syndrome among overweight and obese adults: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is one of the most significant public health issues worldwide, which increases the risk of various diseases. Epidemiological evidence suggests that newer anthropometric measures, such as a body shape index (ABSI) and body roundness index (BRI) can be used to predict MetS. However, anthropometric measures to predict the risk for MetS should be clarified in each population. Therefore, this study aimed to examine the association between ABSI, BRI, and MetS risk factors among overweight and obese Iranian adults.

METHODS

This cross-sectional study included 347 overweight and obese individuals [body mass index (BMI) > 25 kg/m2] aged 20-50 years in Tabriz, Iran. Anthropometric measures were assessed, including BMI, waist circumference (WC), and waist-to-hip ratio (WHR). Additionally, ABSI and BRI were calculated based on the collected data. Blood pressure was measured using standard protocols. Body composition also was measured using body impedance analysis (BIA). Enzymatic-colorimetric methods were used to assess serum glucose and lipids, and enzyme-linked immunosorbent assay (ELISA) kits were used to measure insulin levels.

RESULTS

Participants with higher ABSI exhibited significantly higher systolic blood pressure (SBP) (P = 0.001), diastolic blood pressure (DBP) (P = 0.010), and triglyceride (TG) levels (P < 0.001), along with significantly lower high-density lipoprotein cholesterol (HDL-C) levels (P < 0.001). In the crude model, individuals in the highest ABSI tertile (tertile 3) had a higher likelihood of having higher SBP (OR: 1.032; 95% CI: 1.014-1.051) and DBP (OR: 1.33; 95% CI: 1.009-1.058), as well as a significant association with lower HDL-C levels (OR: 0.945; 95% CI: 0.918-0.973). Additionally, both ABSI tertile 2 (OR: 1.005; 95% CI: 1.001-1.008) and tertile 3 (OR: 0.993; 95% CI: 1.003-1.011) were linked to a higher likelihood of having higher TG levels. No significant associations were found between BRI tertiles and MetS risk factors.

CONCLUSION

According to our results, ABSI and BRI are poor predictors of MetS risk variables, in overweight and obese individuals. High ABSI is only slightly linked with high SBP, DBP, and TG and low HDL-C. However, longitudinal and long-term investigations are encouraged to verify the efficacy of these two measures.

Prevalence of obesity and overweight in an adult population of Tehran metropolis

Purpose

Obesity is a chronic low-grade inflammatory condition with increasing global prevalence and is associated with cardiovascular diseases. In this study, we aimed to investigate the prevalence of obesity in the Tehran cohort study (TeCS) population.

Methods

We used the data collected by systematic random sampling during the recruitment phase of TeCS. The data comprised 4215 households from all districts of the Tehran metropolis, from which 8296 adults aged ≥ 35 years participated between May 2016 and February 2019. Sociodemographic data, medical history, laboratory tests, and anthropometric measurements were gathered from the participants. Participants with missing data were excluded from the final analysis. Finally, the data was analyzed using SPSS version 23, and distribution maps were created by Stata 14.2.

Results

A total of 8211 participants (53.9% women) with an average age of 53.7 ± 12.6 years were studied. The age-weighted prevalence of overweight and obese among women was (37.5% [95% confidence interval (CI): 34.5, 40.6] and 35.5% [95% CI: 32.6 -38.6]) compared to men (47% [95% CI: 43.6, 50.3] and 22.9% [95% CI: 20.1 -25.8]). The prevalence of substantially increased risk of metabolic complications (SIRMC) based on waist circumference (WC) and waist-to-hip ratio (WHR) was 49.2% (95% CI: 46.3 -52.2) and 75.5% (95% CI: 72.7 -78.1) respectively.

Conclusions

The prevalence of obesity in Tehran (29.3%) was much higher than in previous reports, particularly among older people, women, and socioeconomically underdeveloped districts. After age 55, more than 80% of women had SIRMC compared to 30% of men.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01365-4.

The potential mechanisms underlying the modulating effect of perirenal adipose tissue on hypertension: Physical compression, paracrine, and neurogenic regulation

Hypertension, a prevalent global cardiovascular disease, affects approximately 45.4 % of adults worldwide. Despite advances in therapy, hypertension continues to pose a significant health risk due to inadequate management. It has been established that excessive adiposity contributes majorly to hypertension, accounting for 65 to 75 % of primary cases. Fat depots can be categorised into subcutaneous and visceral adipose tissue based on anatomical and physiological characteristics. The metabolic impact and the risk of hypertension are determined more significantly by visceral fat. Perirenal adipose tissue (PRAT), a viscera enveloping the kidney, is known for its superior vascularisation and abundant innervation. Although traditionally deemed as a mechanical support tissue, recent studies have indicated its contributing potential to hypertension. Hypertensive patients tend to have increased PRAT thickness compared to those without, and there is a positive correlation between PRAT thickness and elevated systolic blood pressure. This review encapsulates the anatomical characteristics and biogenesis of PRAT. We provide an overview of the potential mechanisms where PRAT may modulate blood pressure, including physical compression, paracrine effects, and neurogenic regulation. PRAT has become a promising target for hypertension management, and continuous effort is required to further explore the underlying mechanisms.

Association between waist circumference change after smoking cessation and incidence of hypertension in Korean adults

OBJECTIVES

This study investigates the association between smoking cessation and hypertension incidence, as well as the association between waist circumference change after smoking cessation and hypertension incidence.

STUDY DESIGN

This was a nationwide population-based cohort study.

METHODS

We used the Korean Health Screening Cohort data and included 158,505 participants who had undergone two or more health examinations between 2008 and 2011, with follow-ups throughout 2019. Smoking cessation and waist changes were captured based on difference between first and follow-up screening dates. Hazard ratio (HR) and 95% confidence interval (CI) for hypertension risk were estimated using multivariable Cox proportional hazard regression models.

RESULTS

There were 31,270 cases of hypertension during a median follow-up of 8.50 years. After adjusting for potential confounding factors, HR for hypertension were 1.01 (95% CI: 0.97-1.05), 0.91 (95% CI: 0.87-0.95), and 0.88 (95% CI: 0.85-0.91) for recent quitters, long-term quitters, and non-smokers, respectively, compared with current smokers. HR for hypertension, compared with current smokers, were 0.89 (95% CI: 0.84-0.94), 0.91 (95% CI: 0.85-0.97), and 0.99 (95% CI: 0.91-1.08) for long-term quitters with no waist gain, long-term quitters with waist gain of 0.1-5.0 cm, and long-term quitters with waist gain of ≥5.0 cm, respectively.

CONCLUSIONS

Long-term smoking cessation was significantly associated with decreased risk of hypertension, and long-term smoking cessation with no waist gain or less than 5.0 cm of waist gain was significantly associated with decreased risk of hypertension. However, more than 5.0 cm of waist gain can attenuate the effect of long-term smoking cessation on lowering the risk of hypertension.

Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans

OBJECTIVES

The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.

METHODS

The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.

RESULTS

The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.

CONCLUSIONS

The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.

Severity of abdominal obesity and cardiometabolic diseases in US adults

OBJECTIVES

To determine the prevalence of cardiometabolic diseases (CMDs) among adults with abdominal obesity and to evaluate the necessity of differentiating severity of abdominal obesity.

STUDY DESIGN

Cross-sectional study and prospective cohort study.

METHODS

National Health and Nutrition Examination Survey (NHANES) data between 2011 and 2020 were included for cross-sectional analyses. Class I, II and III abdominal obesity were created by dividing waist circumference within sex-specific abdominal obesity range into tertiles. Age-standardized prevalence of CMDs was estimated and differences by severity of abdominal obesity were compared using Poisson regressions. Prospective analyses were performed using NHANES data between 1988 and 2018 with linked mortality data. Cox proportional hazards models were used to assess the association between severity of abdominal obesity and mortality.

RESULTS

Among 23,168 adults included (mean age: 47.8 years, 49.3% men), 13,307 (57.4%) had abdominal obesity. Among adults with abdominal obesity, the estimated prevalence of diabetes was 17.3% (95% confidence interval: 16.3%, 18.2%), hypertension 39.3% (38.2%, 40.3%), dyslipidemia 59.5% (58.0%, 61.1%), cardiovascular disease 9.0% (8.3%, 9.8%), chronic kidney disease 16.8% (15.9%, 17.7%) and non-alcoholic fatty liver disease 39.9% (38.4%, 41.4%). The estimated prevalence was 55.5% (53.8%, 57.2%) for having ≥2 CMDs. Compared with class I abdominal obesity, class III abdominal obesity was related to a 43%-184% higher prevalence of CMDs and a 44% higher risk of all-cause mortality.

CONCLUSIONS

The prevalence of CMDs was high and multimorbidity of CMDs was common among US adults with abdominal obesity. The prevalence of CMDs and risk of mortality differed significantly by severity of abdominal obesity.

Association of flavonoid intake with coronary artery disease risk in the older population based on the National Health and Nutrition Examination Survey

We investigated the association between flavonoid intake and coronary artery disease (CAD) risk in older adults. Data were extracted from the National Health and Nutrition Examination Survey (age ≥ 70 years; 2007-2010 and 2017-2018; n = 2 417). The total flavonoid and flavonoid subclass intake was calculated using validated food frequency questionnaires. The association between flavonoid intake and CAD risk was examined using generalized linear models with restricted cubic spline models. After multivariate adjustment, anthocyanin intake was positively associated with CAD risk; no significant associations were observed between other flavonoid subcategories and endpoint outcomes. Anthocyanins exhibited a non-linear association with CAD risk, and threshold effect analysis showed an inflection point of 15.8 mg/day for anthocyanins. Per unit increase in anthocyanins, the odds of CAD on the left of the inflection point decreased by 2%, while the odds on the right increased by 35.8%. Excessive flavonoid intake may increase CAD risk in the older population.

Revisiting Waist Circumference: A Hypertension Risk Factor that Requires a More In-depth Understanding

As a major cause of various cardiovascular diseases, the prevalence of hypertension has been increasing in the past 30 years, leading to significant socioeconomic and health burdens. Obesity is one of the major risk factors for hypertension. Body mass index (BMI) is the most used anthropometric index to measure obesity in clinical practice and to assess the risk of obesity-related diseases. However, obesity is a heterogeneous disease, and the accumulation of fat in different body regions leads to differences in cardiovascular and metabolic risks. BMI only reflects the overall obesity but does not consider the distribution of fat and muscle mass. The limitation of BMI makes it insufficient to assess the risk of hypertension attributed to obesity. In addition, waist circumference is an easily obtainable anthropometric index to evaluate abdominal fat distribution. High waist circumference is an independent risk factor for various cardiovascular diseases and all-cause mortality regardless of BMI. Preliminary data indicate that waist circumference is significantly associated with the risk of hypertension at different BMI levels. However, routine measurement of waist circumference is currently not required in current clinical guidelines or is only recommended for obese populations, indicating an insufficient understanding of waist circumference. In this review, we summarize the measurement methods and diagnostic thresholds of waist circumference for abdominal obesity, the trend of central obesity prevalence, the superiority of waist circumference over other anthropometric indices, and recent cross-sectional and longitudinal studies on the association between obesity and hypertension.

Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey

BACKGROUND

Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India.

METHODS

This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant.

RESULTS

We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82).

CONCLUSIONS

Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.

Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study

Background

Reducing excess body weight is important for control and management of high blood pressure (BP) in adults. Previous studies showed high prevalence of hypertension in River Nile State-north of Sudan, hence this study to establish whether obesity can be among the main risk factors and to study the prevalence of obesity related hypertension among Sudanese adults in River Nile State.

Methods

This was a cross sectional community-based study conducted in River Nile State, Northern Sudan from January to June 2021. Obese and overweight, aged 18 years and above and accepted to participate in the study were included in the study. Convenience sampling method was used to select the participants. Data was collected through structured questionnaire filled by the patients after taking informed consent. Anthropometric measurements were taken. Two measurements of BP were obtained. Data was analyzed using SPSS version 23.0 (IBM, Chicago, USA). Chi-square test was used to determine the associations between categorical variables while logistic regression test was used to predict the presence of hypertension among studied population.

Results

A total of 1,295 participants were enrolled in this study. Obesity was reported in 1,118 (86.3%) of the participants. The prevalence of hypertension among the participants was 1,027 (79.3%). Central obesity was reported in 951 (92.6%) among hypertensive patients (P<0.001). Moreover, among hypertensive patients 470 (45.8%) were obese class I, 334 (32.5%) overweight, 139 (13.5%) obese class II and 84 (8.2%) obese class III (P<0.001). Obesity, BMI are risk factor of hypertension (P<0.001). Other risk factors were age above 40 years (P<0.001), unemployment (P<0.001), low education level (P<0.001) and being married (P<0.001). Logistic regression analysis showed that increasing age [P<0.001; odds ratio (OR) =1.055; 95% confidence interval (CI): 1.041-1.068], central obesity (P<0.001; OR =5.16; 95% CI: 3.4-7.8) and high body mass index (BMI) (P<0.001; OR =3.7; 95% CI: 1.7-7.9) were associated with uncontrolled hypertension.

Conclusions

The study showed that the prevalence of obesity related hypertension was high. Common risk factors were age above 40 years, unemployment, and marriage. Importantly, central obesity, gross obesity and increasing age can be associated with uncontrolled BP management.

The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults

OBJECTIVES

This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese.

METHODS

Using the 2011-2015 waves of the China Health and Retirement Longitudinal Study, we conducted a cross-sectional analysis included 9,015 subjects and a longitudinal analysis included 4,961 subjects, with 4,872 having full data on the hypertension stage and 4,784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex.

RESULTS

NWCO was associated with normal→stage 2 (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.11 to 3.42), maintained stage 1 (OR, 1.62; 95% CI, 1.14 to 2.29), and normal→ISH (OR, 1.39; 95% CI, 1.05 to 1.85). AWCO was associated with normal→stage 1 (OR, 1.75; 95% CI, 1.40 to 2.19), maintained stage 1 (OR, 2.77; 95% CI, 2.06 to 3.72), maintained stage 2 (OR, 2.80; 95% CI, 1.50 to 5.25), normal→ISH (OR, 1.56; 95% CI, 1.20 to 2.02), and normal→SDH (OR, 2.54; 95% CI, 1.72 to 3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages.

CONCLUSIONS

This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.

Obesity-and lipid-related indices as a predictor of hypertension in Mid-aged and Elderly Chinese: A Cross-sectional Study

Objective

Middle-aged and elderly people in China probably suffer from hypertension. There is a close relationship between obesity-and lipid-related index and hypertension, which is recognized by recent studies. However, these studies have not systematically compared the relationship between the two. We aim to find the most effective obesity-and lipid-related index for predicting hypertension.

Method

A total of 9488 middle-aged and elderly people in China participated in this study. In this study, the subjects were divided into male and female groups by the definition of the 2018 Chinese Guidelines for Prevention and Treatment of Hypertension. Searching for the best predictors among 13 obesity-and lipid-related indicators through binary logistic regression analyses and receiver operator curve (ROC). These 13 indicators are body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), conicity index (CI), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), triglyceride glucose index (TyG-index) and its correlation index (TyG-BMI, TyG-WC, TyG-WHtR).

Results

After adjusting bias, all 13 indexes are risk factors for hypertension. In ROC curve analysis, thirteen obesity-and lipid-related factors can predict the occurrence of hypertension. Among them, CVAI has the best prediction effect (male: AUC = 0.660, female: AUC = 0.699). AUC for WHtR was equal to that for BRI and TyG - WHtR in identifying hypertension in male. Similarly, AUC of TyG-BMI and BMI were the same. In females, AUC for WHtR and BRI were the same when predicting hypertension. AUC of ABSI was much lower than other test indexes.

Conclusion

In predicting hypertension, thirteen obesity-and lipid-related factors are effective. In addition, in males and females, CVAI is the best indicator to indicate hypertension. TyG-WHtR, WHtR, and BRI performed well in predicting metabolic syndrome in both males and females. ABSI has a poor ability to predict hypertension.

A risk prediction model based on machine learning for early cognitive impairment in hypertension: Development and validation study

Background

Clinical practice guidelines recommend early identification of cognitive impairment in individuals with hypertension with the help of risk prediction tools based on risk factors.

Objective

The aim of this study was to develop a superior machine learning model based on easily collected variables to predict the risk of early cognitive impairment in hypertensive individuals, which could be used to optimize early cognitive impairment risk assessment strategies.

Methods

For this cross-sectional study, 733 patients with hypertension (aged 30-85, 48.98% male) enrolled in multi-center hospitals in China were divided into a training group (70%) and a validation group (30%). After least absolute shrinkage and selection operator (LASSO) regression analysis with 5-fold cross-validation determined the modeling variables, three machine learning classifiers, logistic regression (LR), XGBoost (XGB), and gaussian naive bayes (GNB), were developed. The area under the ROC curve (AUC), accuracy, sensitivity, specificity, and F1 score were used to evaluate the model performance. Shape Additive explanation (SHAP) analysis was performed to rank feature importance. Further decision curve analysis (DCA) assessed the clinical performance of the established model and visualized it by nomogram.

Results

Hip circumference, age, education levels, and physical activity were considered significant predictors of early cognitive impairment in hypertension. The AUC (0.88), F1 score (0.59), accuracy (0.81), sensitivity (0.84), and specificity (0.80) of the XGB model were superior to LR and GNB classifiers.

Conclusion

The XGB model based on hip circumference, age, educational level, and physical activity has superior predictive performance and it shows promise in predicting the risk of cognitive impairment in hypertensive clinical settings.

A novel index, Chinese visceral adiposity index is closely associated with urinary albumin-creatinine ratio in Chinese community adults, especially in hypertensive or hyperglycemic population: Results from the REACTION study

BACKGROUND

The association between the Chinese Visceral Adiposity Index (CVAI) and urinary albumin to creatinine ratio (UACR) has not been illustrated. The current study aimed to investigate the association between CVAI and UACR and to compare the discriminative power of CVAI, triglyceride, body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with UACR in the Chinese community population.

METHODS

This study included 34 732 participants from the REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals) study. Binary logistic regression analyses were performed to detect the association between CVAI, triglyceride, BMI, WC, WHR and UACR.

RESULTS

Binary logistic regression analysis showed that, after adjusting for potential confounders, in women, CVAI (odds ratio [OR]:1.16, 95% confidence interval [CI]: 1.01-1.34) and triglyceride (OR: 1.18, 95% CI: 1.04-1.33) were associated with UACR, whereas BMI, WC, and WHR were not associated with UACR; in men, CVAI (OR: 1.24, 95% CI: 1.02-1.50), WC (OR: 1.21, 95% CI 1.00-1.48), and triglycerides (OR: 1.18, 95% CI 0.97-1.44) were associated with UACR, whereas BMI and WHR were not associated with UACR. Stratified analysis showed that the correlation between CVAI and UACR was stronger in the population with 5.6 ≤ fasting blood glucose (FBG) <7.0 or 7.8 ≤ post-load blood glucose (PBG) <11.1 mmol/L, FBG ≥7.0 or PBG ≥11.1, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg.

CONCLUSIONS

In the Chinese general population, CVAI and UACR were significantly associated in both genders. At higher CVAI levels, the population with prediabetes, diabetes, and hypertension has a more significant association between CVAI and UACR.

Associations between novel anthropometric measures and the prevalence of hypertension among 45,853 adults: A cross-sectional study

AIMS

Traditional anthropometric measures, including body mass index (BMI), are insufficient for evaluating the risk of hypertension. We aimed to investigate the association between novel anthropometric indices and hypertension risk in a large population in the United States.

METHODS

Forty-five thousand eight hundred fifty-three participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were enrolled. Social demographic information, lifestyle factors, blood biochemical measurements and anthropometric indices, including body weight, body mass index (BMI), waist circumference, waist-to-height ratio (WtHR), conicity index (CI), a body shape index (ABSI), body roundness index (BRI) and lipid accumulation product (LAP) were collected. Multivariable logistic regression and restricted cubic spline were adopted to investigate the associations between hypertension risk and anthropometric indices. We also performed receiver operating characteristic (ROC) curve analyses to further evaluate the discriminatory powers of anthropometric measurements for screening hypertension risk. Moreover, participants were randomly assigned to the training group and the validation group in a ratio of 3 to 1. A nomogram model based on anthropometric measures was established and validated in the training group and validation group, respectively.

RESULTS

All of the anthropometric measurements investigated were positively and independently associated with the hypertension risk. Among all anthropometric indices, per-SD increment in ABSI had the highest OR (OR: 3.4; 95% CI: 2.73-4.24) after adjusting for age, sex, race/ethnicity, education, smoking, drinking, diabetes, and eGFR. Moreover, results from restricted cubic splines revealed the non-linear association between anthropometric measurements and hypertension risk. In ROC analyses, CI had superior discriminatory power for hypertension (area under the curve: 0.71; 95% CI: 0.706-0.715; optimal cutoff value: 1.3) compared with other indices. Nomogram model based on age, sex, diabetes, CI and LAP showed favorable predicting ability of hypertension risk with an AUC (95% CI) in training group of 80.2% (79.7-80.6%), and the AUC (95% CI) in validation group was 79.5% (78.3-80.1%). Meanwhile, calibration plot showed good consistency.

CONCLUSIONS

Anthropometric measurements including BMI, WtHR, CI, ABSI, BRI and LAP are closely associated with hypertension risk in the present study. For better prevention and treatment of hypertension, more attention should be paid to anthropometric indices, especially novel anthropometric indices.

Trends in general and abdominal obesity in US adults: Evidence from the National Health and Nutrition Examination Survey (2001-2018)

Aim

This study investigates the trend in general obesity and abdominal obesity in US adults from 2001 to 2018.

Methods

We included 44,184 adults from the nine cycles of the continuous NHANES (2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016, and 2017-2018). The age-adjusted mean body mass index and waist circumference were calculated, and the sex-specific annual change was estimated by the survey cycle. We used the weighted sex-specific logistic regression models to analyze the prevalence of general obesity and abdominal obesity from 2001 to 2018. The weighted adjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated.

Results

Our study showed that general obesity and abdominal obesity account for about 35.48 and 53.13% of the US population. From 2001-2002 to 2017-2018, the age-adjusted prevalence of general obesity increased from 33.09 to 41.36% in females and from 26.88 to 42.43% in males. During 2001-2018, the age-adjusted prevalence of abdominal obesity increased from 57.58 to 67.33% in females and from 39.07 to 49.73% in males. A significant time-dependent increase was observed in the prevalence of general obesity (adjusted OR, 1.007; 95% CI 1.005-1.009, P < 0.001) and abdominal obesity (adjusted OR, 1.006; 95% CI, 1.004-1.008; P < 0.001).

Conclusion

General obesity and abdominal obesity are a heavy health burden among US adults, and the increasing trend remains in both males and females from 2001 to 2018.

Prevalence of Prehypertension and Associated Cardiovascular Risk Profiles among Adults in Peru: Findings from a Nationwide Population-Based Study

Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50–59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.

High waist circumference is a risk factor for hypertension in normal-weight or overweight individuals with normal metabolic profiles

This study aims to investigate the relationship between waist circumference and hypertension risk in normal‐weight/overweight individuals with normal cardiometabolic profiles. The authors included 7217 normal‐weight and overweight individuals with normal cardiometabolic profiles from the 2001 to 2014 US National Health and Nutrition Examination Survey. The authors summarized demographic characteristics, cardiometabolic profiles, and behavioral factors across waist circumference quartiles. Then, in the logistic regression analysis, the authors observed a positive and significant association between waist circumference (as a continuous variable) and the prevalence of hypertension in all three models (nonadjusted, minimally adjusted, and fully adjusted), with odds ratios (95% confidence intervals) of 1.76 (1.65–1.86), 1.29 (1.20–1.39), and 1.24 (1.09–1.40), respectively. When analyzed as a categorical variable, individuals in the highest waist circumference group had a 1.48‐fold increased risk of hypertension than the lowest group in the fully adjusted model. Moreover, the Cox regression analysis revealed a positive and significant association between waist circumference and all‐cause mortality in individuals with hypertension in the nonadjusted model (HR, 1.27; 95% CI, 1.10–1.47) and the fully adjusted model (HR, 1.59; 95% CI, 1.22–2.06). In conclusions, our results showed that, even in those with normal metabolic profiles, high waist circumference was significantly associated with the increased prevalence of hypertension. And once hypertension has been established, patients with high waist circumference showed elevated all‐cause mortality. Therefore, waist circumference should be routinely measured and controlled regardless of metabolic profiles.

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.