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Chen S, Zhu Y, Jin S, Zhao D, Guo J, Chen L, Huang Y. Association of glycemic control with hypertension in patients with diabetes: a population-based longitudinal study. BMC Cardiovasc Disord 2023; 23:501. [PMID: 37817110 PMCID: PMC10566157 DOI: 10.1186/s12872-023-03478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Diabetes increases the risk of hypertension morbidity, but whether this association is varied with glycemic control remains unknown. We aimed to examine the association of glycemic control with hypertension among individuals with diabetes. METHODS Data was from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Participants were categorized as having adequate glycemic control (HbA1c < 7%) and inadequate glycemic uncontrol (HbA1c ≥ 7%) by combining blood glucose tests and physician's diagnoses in 2011. Incident hypertension was ascertained through self-reported physician diagnoses from 2011 to 2018. Cox proportional hazards regression models were used to examine the effect of glycemic control on hypertension. RESULTS Among 436 participants with diabetes in this study, 102 met the glycemic control standard, and 334 were insufficient glycemic control. During 7 years of follow-up, 141 individuals developed hypertension. Compared with adequate glycemic control, the hazard ratio of inadequate glycemic control on hypertension was 1.54 (95% CI, 1.07-2.21) in the multivariate model. Additionally, the influence of glycemic control on hypertension varied based on educational attainment and the presence of depressive symptoms (P for interaction < 0.05). CONCLUSIONS Insufficient glycemic control was associated with a higher risk of hypertension among individuals with diabetes. Notably, the effect of glycemic control on hypertension was more pronounced among those with lower educational attainment and those exhibiting depressive symptoms. These findings underscore the significance of vigilant glycemic monitoring, educational background considerations, and mental health assessments in managing diabetic individuals.
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Affiliation(s)
- Shengliang Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Yi Zhu
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Sihui Jin
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Dongbao Zhao
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Jianwei Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Lijin Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China
| | - Yixiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou, 510030, Guangdong, P. R. China.
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Tan L, Long LZ, Ma XC, Yang WW, Liao FF, Peng YX, Lu JM, Shen AL, An DQ, Qu H, Fu CG. Association of body mass index trajectory and hypertension risk: A systematic review of cohort studies and network meta-analysis of 89,094 participants. Front Cardiovasc Med 2023; 9:941341. [PMID: 36684600 PMCID: PMC9846820 DOI: 10.3389/fcvm.2022.941341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Body mass index (BMI) trajectories, such as non-linear time trends and nonlinear changes in BMI with age, can provide information on the underlying temporal health patterns. The relationship between BMI trajectories and the risk of hypertension remains controversial. Methods PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched from their inception to January 31, 2022. We categorized BMI trajectories as "Stable high," "table normal," "Stable low," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)." The main outcome was the relative risk for the prevalence of hypertension in the different BMI trajectories. Potential sources of heterogeneity were examined using meta-regression and subgroup analysis. A publication bias test and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were also used. Results The 18 cohort studies included 89,094 participants. Compared with the "Stable normal" trajectory, "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension: [RR (95% CI)]: 1.80 (1.29 2.50), p < 0.001; 1.53 (1.27 1.83), p < 0.001; 1.30 (1.24 1.37), p = 0.001, respectively. The "Stable low" trajectory was associated with a reduced risk of hypertension [0.83 (0.79 0.83), p < 0.001]. The "Stable high" trajectory (surface under the cumulative ranking curve = 88.1%) had the highest probability of developing hypertension in the population. The certainty of the evidence for direct comparisons of the incidence of hypertension between various BMI trajectories was generally very low. Conclusion Our findings suggested that "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension, with the "Stable high" trajectory most likely associated with hypertension. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308575], identifier [CRD42022308575].
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Affiliation(s)
- Ling Tan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lin-zi Long
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-chang Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Cardiovascular Clinical Medical Research Center of TCM, Beijing, China
| | - Wen-wen Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fei-fei Liao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Yu-xuan Peng
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Jie-ming Lu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - A-ling Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Dong-qing An
- Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, China
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Cardiovascular Clinical Medical Research Center of TCM, Beijing, China,Hua Qu,
| | - Chang-geng Fu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,National Cardiovascular Clinical Medical Research Center of TCM, Beijing, China,*Correspondence: Chang-geng Fu,
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Wang X, Lu J, Gao Y, Song J, Li Y, Hundei W, Han Y, Li X, Liu J, Zheng X. Dose-response association between long-term weight loss in young adults and later-life metabolic health. Obesity (Silver Spring) 2022; 30:1289-1297. [PMID: 35534791 DOI: 10.1002/oby.23436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Long-term weight loss (LTWL) has been shown to be associated with lower metabolic risk in young adults with overweight/obesity. However, the dose-response association is uncertain. METHODS In a large-scale nationwide screening project in China, the participants aged 35 to 64 years who recalled overweight/obesity at age 25 years and experienced LTWL or maintained stable weight were included. The dose-response association between LTWL from age 25 to screening (35 to 64 years) and the odds of metabolic syndrome at screening were assessed using multivariable adjusted regression models with restricted cubic splines. RESULTS A total of 40,150 participants (66.4% women) were included. The increment of LTWL was associated with continuously decreased odds of metabolic syndrome. The odds of metabolic syndrome were 0.64 (0.60 to 0.67), 0.42 (0.40 to 0.45), 0.27 (0.25 to 0.29), and 0.15 (0.13 to 0.17) for those with LTWL of 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and 20% or greater compared with <5% LTWL, respectively. Moreover, the incremental pattern was observed across all population subgroups. CONCLUSIONS An incremental association between LTWL from young adulthood and odds of later-life metabolic syndrome was observed. Our findings highlight the effective ways to achieve LTWL to improve lifetime metabolic health for young adults with overweight/obesity.
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Affiliation(s)
- Xiuling Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiapeng Lu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiali Song
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yan Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Wuhanbilige Hundei
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yi Han
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Zheng
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Coronary Artery Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
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Liu L, Zhen D, Fu S, Sun W, Li H, Zhao N, Hou L, Tang X. Associations of the baseline level and change in glycosylated hemoglobin A1c with incident hypertension in non-diabetic individuals: a 3-year cohort study. Diabetol Metab Syndr 2022; 14:54. [PMID: 35436969 PMCID: PMC9014640 DOI: 10.1186/s13098-022-00827-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 04/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes mellitus increases the risk of developing hypertension. The relationship between glycosylated hemoglobin A1c (HbA1c) level and incident hypertension remains controversial. This study examined the associations of the baseline level and change in the HbA1c level over 3 years with incident hypertension in non-diabetic individuals. METHODS This community-based cohort study was conducted with 2591 individuals aged 40-75 years without hypertension or diabetes at baseline, who participated in a longitudinal (REACTION) study program. Questionnaires were administered during interviews, and anthropometric and laboratory measurements were performed at baseline (2011) and follow-up (2014-2015). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of incident hypertension. RESULTS Over a median follow-up period of 3.08 years (interquartile range 3.00, 3.25), 384 (14.82%) subjects developed hypertension. In the fully adjusted linear regression models, change in HbA1c remained significantly associated with changes in systolic blood pressure and diastolic blood pressure [β-coefficient (95% CI), 4.421 (2.811-6.032), 1.681 (0.695-2.667)]. Logistic regression analyses showed that baseline HbA1c level was positively associated with incident hypertension in the unadjusted model; however, the association was no longer significant after further adjustment. Change in HbA1c was positively associated with the development of hypertension, both as a categorical variable stratified by tertiles [adjusted OR (95% CI) in the highest tertile was 1.690 (1.240-2.303) versus the lowest tertile)] and as a continuous variable [adjusted OR (95% CI), 1.242 (1.106-1.394)], independent of age, sex, body mass index, systolic blood pressure, fasting plasma glucose level, lipid profile, the HbA1c level at baseline and 3-year change in body mass index. CONCLUSIONS A higher baseline HbA1c level was not an independent risk factor for incident hypertension, whereas the change in HbA1c was independently associated with a greater longitudinal increase in blood pressure and an increased risk of incident hypertension in non-diabetic individuals.
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Affiliation(s)
- Lijuan Liu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Donghu Zhen
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Songbo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Weiming Sun
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hongli Li
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Nan Zhao
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Lijie Hou
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
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Dai Y, Li Y, Yang S, Xu W, Jia H, Yang C. Association between weight change and risk of metabolic abnormalities in non-overweight/obese and overweight/obese population: A retrospective cohort study among Chinese adults. Front Endocrinol (Lausanne) 2022; 13:1029941. [PMID: 36605936 PMCID: PMC9808089 DOI: 10.3389/fendo.2022.1029941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To explore the effects of weight change on the risk of metabolic abnormalities in the Chinese population. METHODS A total of 1895 metabolically healthy adults aged 21-78 years completed anthropometric and biological measurements at baseline (2012) and at an eight year follow-up (2020). Based on absolute weight change and relative weight change, the participants were split into five classes. A Cox proportional hazards regression model was used to estimate the relative risk (RR) and 95% confidence intervals (95% CI) for the risk of metabolic abnormalities using stable weight as the reference group. Stratified analysis was used to explore this relationship in participants with different baseline body mass index (BMI) levels. RESULTS During the follow-up period, 35.41% of the participants retained a stable weight, and 10.71% had metabolic abnormalities. After covariate adjustment, for every kilogram gained over eight years, the risk of developing metabolic abnormalities increased by 22% (RR: 1.094; 95% CI: 1.063-1.127). Compared with stable weight participants, weight gain of 2-4 Kg and weight gain ≥ 4 Kg exhibited significantly higher risks of metabolic abnormalities, with RR of 1.700 (95% CI 1.150-2.513) and 1.981 (95% CI 1.372-2.859), respectively. A weight gain of ≥ 4 Kg had an opposite effect on the overweight/obesity and non-overweight/obesity groups, with an increased risk of metabolic abnormalities only in the non-overweight/obesity group (RR, 2.291; 95% CI, 1.331-3.942). Moreover, weight loss ≥ 4 Kg significantly reduced the risk of metabolic abnormalities only among overweight/obese adults (RR 0.373; 95% CI 0.154-0.906). Similar results were observed in relative body weight change analyses. CONCLUSIONS Long-term excessive body weight gain is positively associated with an increased risk of metabolic abnormalities among adults with non-overweight/obesity, whereas long-term body weight loss is a protective factor for metabolic health among adults with overweight/obesity.
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Affiliation(s)
- Yanyan Dai
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Yujuan Li
- Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shu Yang
- School of Intelligent Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Weiwei Xu
- Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hong Jia
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
- *Correspondence: Chao Yang, ; Hong Jia,
| | - Chao Yang
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
- *Correspondence: Chao Yang, ; Hong Jia,
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Feng Y, Yang X, Li Y, Han M, Qie R, Huang S, Wu X, Zhang Y, Wu Y, Liu D, Hu F, Zhang M, Yang Y, Shi X, Lu J, Liang S, Hu D, Zhao Y. Cohort study evaluation of New Chinese Diabetes Risk Score: A new non-invasive indicator for predicting metabolic syndrome. Prim Care Diabetes 2021; 15:825-831. [PMID: 34024742 DOI: 10.1016/j.pcd.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the association of the baseline New Chinese Diabetes Risk Score (NCDRS) with metabolic syndrome (MetS) risk and to evaluate the power of the baseline NCDRS to predict MetS based on the rural Chinese cohort study. METHODS Study participants were classified by baseline quartiles of NCDRS by gender. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of MetS according to different diagnostic criteria. The receiver operating characteristic curve (ROC) and area under the ROC curve (AUC) were used to evaluate the power of the baseline NCDRS for predicting MetS according to different diagnostic criteria. RESULTS We included 7,133 participants, and 1,651 MetS cases were identified after 6 years follow-up. After adjusting for multivariable confounding factors and with NCDRS quartile 1 as the reference, with quartile 4, the risk of MetS was increased for all participants, men and women: ORs (95% CIs) 4.03 (3.23-5.02), 3.59 (2.56-5.05) and 5.71 (4.23-7.70), respectively. Similar results were found on sensitivity analysis. The baseline NCDRS was a good predictor of MetS for all participants, men and women with MetS defined according to the diagnostic criteria of the Chinese Joint Committee on the Development of Guidelines for the Prevention and Treatment of Dyslipidemia in Adults (JCDCG). CONCLUSIONS Our study, based on the cohort study, found that the baseline NCDRS was positively associated with risk of MetS. Furthermore, our study might provide suggestions for developing a useful and inexpensive tool for predicting MetS in the Chinese population.
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Affiliation(s)
- Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Li
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Wu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yanyan Zhang
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yuying Wu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China; Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Fulan Hu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Ming Zhang
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yongli Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xuezhong Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Sun Liang
- Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Zhang M, Zhao Y, Sun L, Xi Y, Zhang W, Lu J, Hu F, Shi X, Hu D. Cohort Profile: The Rural Chinese Cohort Study. Int J Epidemiol 2021; 50:723-724l. [PMID: 33367613 DOI: 10.1093/ije/dyaa204] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Liang Sun
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuanlin Xi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Weidong Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Dongsheng Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
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Zeng Q, Sun L, Zeng Q. Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey. BMJ Open 2021; 11:e047920. [PMID: 34233991 PMCID: PMC8264882 DOI: 10.1136/bmjopen-2020-047920] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/18/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study is designed to identify different body mass index (BMI) trajectories of individuals aged 40-70 years and test the effect of distinct BMI trajectories on incident hypertension. DESIGN The accelerated longitudinal design was used for this study. METHODS The study drew data from the third to ninth China Health and Nutrition Surveys (CHNS), and 4697 participants were included between 1991 and 2015. As analysed, three distinct individual BMI trajectories were identified by the latent class growth mixed model (LCGMM). Then, BMI values and BMI slopes were worked out through calculation with LCGMM trajectory parameters and their primary derivatives, respectively. Later, Cox proportional hazard models were applied to examine BMI values and slopes, and find out the relationship between the said predicted data and incident hypertension for different classes. RESULTS Three different trajectory classes were identified, that is, low-stable class (n=3711), sharp-increasing class (n=282) and high-stable class (n=704). Compared with the low-stable class, the adjusted HRs (95% CI) were 1.321 (1.119 to 1.559) and 1.504 (1.322 to 1.711) for the sharp-increasing class and the high-stable class, respectively. The HR (95% CI) for BMI values rose from 1.081 (1.030 to 1.135) to 1.221 (1.171 to 1.273) while the HR (95% CI) for BMI slopes dropped from 1.154 (1.100 to 1.211) to 0.983 (0.943 to 1.025). That is, the HR for BMI slopes were higher than that for BMI values for the class aged 40-47 years. CONCLUSION These findings suggest that the calibrated BMI trajectories for the period from mid-life to elderly adulthood have a significant effect on the risk of incident hypertension. The period from age 40 to 47 years is critical and has positive implications for the early prevention of hypertension.
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Affiliation(s)
- Qi Zeng
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lin Sun
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Qing Zeng
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Xu J, Zhang R, Guo R, Wang Y, Dai Y, Xie Y, Zheng J, Sun Z, Xing L, Sun Y, Zheng L. Trajectories of body mass index and risk of incident hypertension among a normal body mass index population: A prospective cohort study. J Clin Hypertens (Greenwich) 2021; 23:1212-1220. [PMID: 33743180 PMCID: PMC8678668 DOI: 10.1111/jch.14241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
It is unclear whether there are different body mass index (BMI) trajectories among a population with normal BMI levels, and the association between BMI patterns and incident hypertension is not well characterized. This prospective cohort study includes surveys conducted at baseline and three follow‐ups. 3939 participants who are free of hypertension at baseline or first two follow‐ups were enrolled. At baseline, the age of participants ranged from 35 to 82 years and the mean age was 45.9 years. The BMI trajectories were identified using latent mixture modeling with data from the baseline and first two follow‐ups. The effects of different BMI trajectories on the development of hypertension were analyzed using a Cox proportional hazard model. Four distinct BMI trajectories were identified over the study period (2004‐2010): normal‐stable (n = 1456), normal‐increasing (n = 2159), normal‐fluctuated (n = 166), and normal‐sharp‐increasing (n = 158). Relative to the normal‐stable BMI group, the hazard ratios (HRs) and 95% confidence intervals (CIs) after adjustment for confounding factors of the normal‐increasing, normal‐fluctuated, and normal‐sharp‐increasing groups were 1.244 (1.103‐1.402), 1.331 (1.008‐1.756), and 1.641 (1.257‐2.142), respectively. Additionally, subgroup analysis showed that the normal‐fluctuated BMI trajectory was associated with a significantly higher risk of hypertension only in women (HR = 1.362; 95% CI = 1.151‐1.611). The BMI trajectories were significant predictors of hypertension incidence, and increasing BMI trajectories within the currently designated normal range were associated with an increased hypertension risk, especially in women.
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Affiliation(s)
- Jiahui Xu
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Zhang
- College of Public Health, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Rongrong Guo
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yali Wang
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Dai
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanxia Xie
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia Zheng
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liying Xing
- Institute of Chronic Disease, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Department of Cardiology, Department of Library and Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Han M, Qin P, Li Q, Qie R, Liu L, Zhao Y, Liu D, Zhang D, Guo C, Zhou Q, Tian G, Huang S, Wu X, Li Y, Yang X, Zhao Y, Feng Y, Liu Y, Li H, Sun X, Chen Q, Wang T, Chen X, Hu D, Zhang M. Chinese visceral adiposity index: A reliable indicator of visceral fat function associated with risk of type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3370. [PMID: 32562335 DOI: 10.1002/dmrr.3370] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The evidence of the association between Chinese visceral adiposity index (CVAI) and risk of type 2 diabetes mellitus (T2DM) is limited. We explored the association of CVAI with T2DM and directly compared with the predictive power of CVAI with other visceral obesity indices (visceral adiposity index, waist to height ratio, waist circumference and body mass index) based on a large prospective study. METHODS We conducted a population-based study of 12 237 Chinese participants. Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between CVAI and T2DM. RESULTS During follow-up (median: 6.01 years), the incidence of T2DM was 3.29, 7.34, 12.37 and 23.72 per 1000 person-years for quartiles 1, 2, 3 and 4 of CVAI, respectively. The risk of T2DM was increased with quartiles 2, 3 and 4 vs quartile 1 of CVAI (HR 2.12 [95% CI 1.50-3.00], 2.94 [2.10-4.13] and 5.01 [3.57-7.04], Ptrend < 0.001). Per-SD increase in CVAI was associated with a 72% increased risk of T2DM (HR 1.72 [95% CI 1.56-1.88]). Sensitivity analyses did not alter the association. The area under receiver operating characteristic curve was significantly higher for CVAI than other visceral obesity indices (all P <.001). Similar results were observed in stratified analyses by sex. CONCLUSIONS Our findings show a positive association between CVAI and risk of T2DM. CVAI has the best performance in predicting incident T2DM, so the index might be a reliable and applicable indicator identifying people at high risk of T2DM.
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Affiliation(s)
- Minghui Han
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Pei Qin
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
- Community Health Management Center, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, PR China
| | - Ranran Qie
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Leilei Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yang Zhao
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Dechen Liu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Dongdong Zhang
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Qionggui Zhou
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaoyan Wu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Yang Li
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yu Liu
- Community Health Management Center, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Honghui Li
- Community Health Management Center, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Xizhuo Sun
- Community Health Management Center, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
| | - Qing Chen
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, PR China
| | - Tieqiang Wang
- Key Lab of Epidemiology, Department of Chronic Disease Control and Prevention, Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Xiaoliang Chen
- Key Lab of Epidemiology, Department of Chronic Disease Control and Prevention, Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Dongsheng Hu
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
- Community Health Management Center, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
- Department of Mental Health, Bao'an Chronic Diseases Prevent and Cure Hospital, Shenzhen, Guangdong, PR China
- Key Lab of Epidemiology, Department of Chronic Disease Control and Prevention, Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, PR China
| | - Ming Zhang
- Department of Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China
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11
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Dong Y, Zou Z, Wang H, Dong B, Hu P, Ma Y, Song Y, Ma J. National School-Based Health Lifestyles Intervention in Chinese Children and Adolescents on Obesity and Hypertension. Front Pediatr 2021; 9:615283. [PMID: 34123956 PMCID: PMC8192970 DOI: 10.3389/fped.2021.615283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/15/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: This study aimed to examine the effectiveness of the national school-based intervention on both obesity and high blood pressure in Chinese children and adolescents aged 6-18 years. Methods: The national school-based cluster non-randomized controlled trial was done in seven provinces from September 2013 to February 2014. A total of 23,175 children and adolescents in the control group and 25,702 in the intervention group were included in this trial with a mean follow-up of 6.7 ± 0.9 months. Mixed-effects regression models were used to evaluate the effect of the interventions on body weight and blood pressure (BP). Results: A significant upward in the body mass index (BMI) levels but downward in systolic BP (SBP), diastolic BP (DBP), BMI Z-scores, SBP Z-scores, and DBP Z-scores were witnessed in the intervention group compared to those in the control group (<0.001). Subgroup analyses presented significant intervention effects in children aged 6-12 years for BMI, SBP, DBP, and their standardized values Z-scores, but no effective results were found in adolescents aged 13-18 years. Stratification analyses based on the dynamic weight changes presented non-differential HBP, SHBP, and DHBP prevalence gaps between the control and intervention groups. Children aged 6-12 years with higher BMI percentiles at baseline presented obvious declines in SBP and DBP standardized values Z-scores. Conclusion: A mean 6-month multi-centered school-based comprehensive obesity intervention in China yields a small to null effect on obesity and hypertension with increasing age; the early age before 12 years may be the key period for interventions, and the younger, the better. Precise and high-intensity interventions targeting the population at different stages of childhood and adolescence are urgently needed to be developed. Clinical Trial Registration: https://www.clinicaltrials.gov/, identifier: NCT02343588.
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Affiliation(s)
- Yanhui Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Zhiyong Zou
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Peijin Hu
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yinghua Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Yi Song
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Jun Ma
- School of Public Health, Institute of Child and Adolescent Health, Peking University, Beijing, China
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12
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Chinese visceral adiposity index, a novel indicator of visceral obesity for assessing the risk of incident hypertension in a prospective cohort study. Br J Nutr 2020; 126:612-620. [PMID: 33143773 DOI: 10.1017/s0007114520004298] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present study aimed to investigate the association of the Chinese visceral adiposity index (CVAI) and its 6-year change with hypertension risk and compare the ability of CVAI and other obesity indices to predict hypertension based on the Rural Chinese Cohort Study. Study participants were randomly recruited by a cluster sampling procedure, and 10 304 participants ≥18 years were included. Modified Poisson regression was used to derive adjusted relative risks (RR) and 95 % CI. We identified 2072 hypertension cases during a median of 6·03 years of follow-up. The RR for the highest v. lowest CVAI quartile were 1·29 (95 % CI 1·05, 1·59) for men and 1·53 (95 % CI 1·22, 1·91) for women. Per-sd increase in CVAI was associated with hypertension for both men (RR 1·09, 95 % CI 1·02, 1·16) and women (RR 1·14, 95 % CI 1·06, 1·22). Also, the area under the receiver operating characteristic curve value for hypertension was higher for CVAI than the four other obesity indices for both sexes (all P < 0·05). Finally, per-sd increase in CVAI change was associated with hypertension for both men (RR 1·26, 95 % CI 1·16, 1·36) and women (RR 1·23, 95 % CI 1·15, 1·30). Similar results were observed in sensitivity analyses. CVAI and its 6-year change are positively associated with hypertension risk. CVAI has better performance in predicting hypertension than other visceral obesity indices for both sexes. The current findings suggest CVAI as a reliable and applicable predictor of hypertension in rural Chinese adults.
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13
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Association of Weight Loss from Early to Middle Adulthood and Incident Hypertension Risk Later in Life. Nutrients 2020; 12:nu12092622. [PMID: 32872103 PMCID: PMC7551896 DOI: 10.3390/nu12092622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The effect of obesity in early adulthood and weight loss on incident hypertension in older age has not been well characterized. This study aimed to examine the association of weight loss from young adulthood to midlife with risk of incident hypertension later in life. Methods: We performed a retrospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES). Five weight change groups were categorized: stable normal, weight loss, weight gain, maximum overweight and stable obese. The hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between weight change and risk of hypertension in later life were estimated using Cox regression models. Results: Compared with participants who maintained normal weight, the stable obese, weight gain, maximum overweight and weight loss groups exhibited significantly higher risks of incident hypertension, with HR of 3.28 (95% CI = 2.71 to 3.96), 2.93 (95% CI = 2.62 to 3.28), 1.76 (95% CI = 1.55 to 2.00) and 1.97 (95% CI = 1.17 to 3.31), respectively. We also observed a lower risk among those in the weight loss group (HR = 0.60, 95% CI = 0.35 to 1.02) compared with those who were stable obese. Conclusions: Weight loss from early to middle adulthood was associated with lower risk of incident hypertension as compared to those who stayed obese and higher risk of incident hypertension as compared to those who maintained normal weight. Thus, maintaining normal weight throughout adulthood may be important for the primary prevention of hypertension.
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14
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Effects of long- and short-term body mass index changes on incident hypertension are different. Nutrition 2020; 74:110755. [PMID: 32240929 DOI: 10.1016/j.nut.2020.110755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate hypertension risk associated with long- and short-term body mass index (BMI) changes. METHODS This prospective cohort study included four examinations: 2004 to 2006, 2008, 2010, and 2017. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of BMI changes on incident hypertension. The difference of β coefficients between long- and short-term BMI changes were examined using Fisher Z-test. RESULTS Relative to stable, normal BMI, both long- and short-term elevated BMI conferred an increased risk for hypertension, with HRs of 1.507 (95% CI, 1.286-1.767) and 1.197(95% CI, 1.019-1.405), respectively. In contrast, relative to stable overweight, both long- and short-term decreased BMI conferred a reduced risk for hypertension, with HRs of 0.651(95% CI, 0.536-0.789) and 0.775 (0.625-0.962), respectively. Additionally, for BMI changing from normal to overweight, long-term changes were relatively more strongly associated with increased risk for incident hypertension than short-term based on regression coefficients (β = 0.410 versus β = 0.179, P < 0.001). For BMI changing from overweight to normal, long-term changes were relatively more strongly associated with lower risk than short-term based on regression coefficients (β = -0.430 versus β = -0.254, P = 0.007). Additionally, there was no correlation between absolute changes in BMI and systolic blood pressure for long- (P = 0.744) and short-term (P = 0.097). CONCLUSION For participants with normal BMI, risk tended to be higher in adults whose elevated BMI occurred during the long-term. For those who are overweight, long-term decreased BMI can reduce the risk for incident hypertension to a greater extent. No correlation was found between absolute changes in BMI and systolic blood pressure.
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15
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Baghbani-Oskouei A, Tohidi M, Hasheminia M, Azizi F, Hadaegh F. Impact of 3-year changes in fasting insulin and insulin resistance indices on incident hypertension: Tehran lipid and glucose study. Nutr Metab (Lond) 2019; 16:76. [PMID: 31728151 PMCID: PMC6842481 DOI: 10.1186/s12986-019-0402-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background To examine the association between changes in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin-glucose ratio (IGR) levels, over approximately 3 years with incident hypertension. Methods A total of 2814 Iranian participants (1123 men) without hypertension and known diabetes at baseline and the first examination were followed for a median of 6.32 years. The associations between quartiles of changes in fasting insulin and IR indices with incident hypertension were assessed using multivariate Cox proportional hazard regression analyses with first quartile as reference. The models were adjusted for baseline values of insulin or each IR index, and age, sex, smoking, physical activity, educational levels, marital status, history of cardiovascular diseases, baseline levels of systolic and diastolic blood pressures, estimated glomerular filtration rate, triglycerides, total cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose (only for insulin change) and both body mass index (BMI) per se, and its change. Akaike's information criteria (AIC) was applied as indicator for goodness of fit of each predictive model. The discrimination ability of models was calculated using the Harrell's C statistic. Results During the study, 594 incident cases of hypertension (253 men) were identified. The 4th quartile of changes in insulin, HOMA-IR, and IGR showed hazard ratios (95% confidence interval) of 1.31 (1.01-1.69), 1.18 (0.92-1.52), and 1.53 (1.18-1.98) for hypertension, respectively, in fully-adjusted models. Changes in fasting insulin levels and IR indices showed significant increasing trends for incident hypertension, moving from 1st to 4th quartiles (all P-values < 0.05). Focusing on model fitness, no superiority was found between changes in fasting insulin, HOMA-IR, and IGR to predict incident hypertension. The discriminatory powers of changes in fasting insulin and IR indices as assessed by C index were similar (i.e. about 80%). Conclusion Changes in fasting insulin and IR indices were significantly associated with developing hypertension among normotensive population even after considering BMI changes.
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Affiliation(s)
- Aidin Baghbani-Oskouei
- 1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- 1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Hasheminia
- 1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- 2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- 1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Association between body mass index changes and short- and long-term outcomes of hypertension in a Chinese rural cohort study. J Hum Hypertens 2019; 34:593-601. [PMID: 31666663 DOI: 10.1038/s41371-019-0276-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
This study aimed to investigate the effect of body mass index (BMI) changes on hypertension among rural areas of China. A population-based sample of 13,263 and 5944 rural Chinese people aged ≥35 years and without hypertension at baseline was included in our analysis of BMI changes (from (2004-2006) to 2008) and short- and long-term outcomes of hypertension (from 2008 to 2010 and 2010 to 2017). The participants were divided into four groups by a comprehensive cross-sectional combination according to baseline BMI (18.5-24 vs. ≥24 kg/m2) and follow-up changes (decreased vs. increased). Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). During a median follow-up period of 4.8 (short-term) and 11.7 (long-term) years, 2299 (17.33%) and 2020 (33.98%) participants developed hypertension, respectively. For participants with a baseline BMI ≥ 24 kg/m2, when BMI decreased in follow-ups, the multivariable-adjusted HRs (95% CI) of short-term hypertension were 0.898 (0.857-0.942). For baseline 18.5 kg/m2 ≤ BMI < 24 kg/m2, when BMI increased in follow-ups, the risks of short-term hypertension were 1.103 (1.068-1.139). We detected that BMI changes had a lower impact on the incidence of hypertension in long-term than short-term. Our study indicated that BMI changes were significantly associated with the incidence of hypertension for the short-term, and it had a stronger impact on short-term outcomes than long-term. Managing weight by lifestyle modification was particularly important for the primary prevention of hypertension in rural Chinese population.
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17
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Ahmadi S, Sajjadi H, Nosrati Nejad F, Ahmadi N, Karimi SE, Yoosefi M, Rafiey H. Lifestyle modification strategies for controlling hypertension: How are these strategies recommended by physicians in Iran? Med J Islam Repub Iran 2019; 33:43. [PMID: 31456967 PMCID: PMC6708116 DOI: 10.34171/mjiri.33.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background: This study aimed to evaluate lifestyle changes and their impact on hypertension control and why and how lifestyle modifications are recommended for patients with hypertension. Four non pharmacological strategies have been recommended by physicians for hypertension control for hypertensive patients in Iran: healthier diet, smoking cessation, physical activity, and weight loss.
Methods: Among participants of Iran STEPS Non-communicable Disease Risk Factors Survey (STEPs), 7879 hypertensive patients aged ≥25 years were selected. All statistical analyses were calculated using STATA software version 14. Means, proportions, and multiple binary logistic regression models were used. Two-tailed p values of <0.05 were considered statistically significant.
Results: The results of this study showed that about three quarters of people with high blood pressure had been recommended lifestyle strategies by their physician for blood pressure control. Of the participants, 41% reported that they had been recommended only lifestyle modification for their blood pressure (BP), while 35% reported that they were recommended both lifestyle changes and medications as part of their treatment. Healthier diet, 71.9% (70.8-72.9), and smoking cessation, 23.8% (21.4-25.6), were the most and least frequently recommended strategies, respectively. Also, the rates of recommendations on smoking cessation, weight loss, increased physical activity, and healthier diet were more among women, married, and illiterate individuals, respectively.
Conclusion: Because of the changes and transitions in the lifestyle and dietary habits in the modern world, policies and training programs should be developed to improve the recommendations on lifestyle modification. Also, educational programs should be developed to increase patient’s acceptance of lifestyle modifications and physical activity.
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Affiliation(s)
- Sina Ahmadi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farhad Nosrati Nejad
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Moein Yoosefi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Rafiey
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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