Prevalence and Risk Factors of Central Obesity among Adults with Normal BMI in Shaanxi, China: A Cross-Sectional Study

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.

Epidemiological characteristics and management of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis in China: A narrative review

AIM

With industrialization and spread of the westernized lifestyle, the number of people affected by non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) is growing rapidly in China; this has become a major public health concern. To better understand the burden and characteristics of NAFLD/NASH in China, we aim to perform a narrative review of the literature published in this field.

MATERIALS AND METHODS

We carried out a comprehensive electronic search of five English-language and three Chinese-language databases, to identify studies regarding NAFLD or NASH published from inception to November 30, 2022. Epidemiological studies of NAFLD/NASH in China were particularly noticed and summarized. We also searched the www.

CLINICALTRIALS

gov and www.chictr.org.cn websites for the registered trials on the treatment of the disease led by Chinese investigators or located in China.

RESULTS

The increasing rate of NAFLD prevalence in China is strikingly high, reaching more than twice that in western countries. The prevalence of NAFLD is nearly 30% of the general Chinese population, making it the leading cause of chronic liver diseases. The prevalence of NAFLD/NASH varies between provinces/regions, age groups, sexes, and individuals with different metabolic profiles. NAFLD co-exists in many Chinese patients with chronic hepatitis B. Since 2020, more Chinese studies have used the term metabolic-associated fatty liver disease (MAFLD), emphasizing the underlying metabolic disorders that occur concurrently with this disease. Several clinical trials involving lifestyle interventions, antidiabetic drugs, or traditional Chinese medicines, registered by Chinese investigators, have been completed or are ongoing. Moreover, several innovative targeted therapies developed in China are revolutionizing the treatment of NAFLD/NASH.

CONCLUSIONS

NAFLD has cast a heavy burden on the Chinese healthcare system. Chinese scholars are making efforts to achieve the optimal management of this disease.

Waist-to-height ratio and new-onset hypertension in middle-aged and older adult females from 2011 to 2015: A 4-year follow-up retrospective cohort study from the China Health and Retirement Longitudinal Study

Background

Central obesity was closely associated with hypertension. Middle-aged and older adult females, defined as those aged 45 and above, were more likely to suffer from central obesity. For waist-to-height ratio (WHtR) was used as central obesity assessment, the object of this study was to illustrate the relationship between WHtR and the incidence of hypertension in middle-aged and older adult females in China.

Methods

Data used in this prospective cohort study was derived from the China Health and Retirement Longitudinal Study (CHARLS) in a baseline survey from 2011 to 2012 with a follow-up duration of 4 years. The waist-to-height ratio was calculated as waist circumstance divided by height, and the cohort was divided into different groups based on WHtR level. The outcome variable was new-onset hypertension.

Results

Of the 2,438 participants included in the study, 1,821 (74.7%) had high WHtR levels (WHtR ≥ 0.5). As WHtR was closely related to new-onset hypertension in a multivariable logistics regression mode [OR: 7.89 (95% CI: 2.10-29.67)], individuals with high WHtR were also more likely to suffer from hypertension compared with low WHtR levels [OR: 1.34 (95% CI: 1.06-1.69)].

Conclusion

WHtR is positively related to the risk of hypertension incidents among middle-aged and older adult females. Individuals with WHtR ≥ 0.5 were more likely to suffer from hypertension.

Association between central obesity and incident diabetes mellitus among Japanese: a retrospective cohort study using propensity score matching

Previous evidence revealed that central obesity played a vital role in the development of diabetes mellitus (DM). However, because of imbalanced confounding variables, some studies have not wholly established the association between central obesity and diabetes. Propensity score matching (PSM) analysis can minimize the impact of potential confounding variables. Therefore, the aim of the present study was to explore the relationship between central obesity and diabetes in the Japanese population by using PSM analysis. This retrospective cohort study included 15,453 Japanese adults who were free of diabetes at baseline between 2004 and 2015, which provided all medical records for individuals participating in the physical exam. Central obesity at baseline was an independent variable, and incident diabetes during follow-up was an outcome variable. Using a 1:1 PSM analysis, the present retrospective cohort study included 1639 adults with and without central obesity. Additionally, we employed a doubly robust estimation method to identify the association between central obesity and diabetes. Subjects with central obesity were 92% more likely to develop DM (HR = 1.65, 95%CI 1.12, 2.41). After adjusting for covariates, subjects with central obesity had a 72% increased risk of developing DM compared with subjects with non-central obesity in the PSM cohort (HR = 1.72, 95% CI 1.16, 2.56). Central obesity individuals had a 91% higher risk of DM than non-central obesity individuals, after adjustment for propensity score (HR = 1.91, 95% CI 1.29, 2.81). In sensitivity analysis, the central obesity group had a 44% (HR = 1.44, 95% CI 1.09, 1.90) and 59% (HR = 1.59, 95% CI1.35, 1.88) higher risk of DM than the non-central obesity group in the original and weighted cohorts after adjusting for confounding variables, respectively. Central obesity was independently associated with an increased risk of developing diabetes. After adjustment for confounding covariates, central obesity participants had a 72% higher risk of development of diabetes than non-central obesity individuals in the PSM cohort.